Human cytomegalovirus and Epstein‐Barr virus type 1 in periodontal abscesses

Objectives: Recent studies have linked herpesviruses to severe types of periodontal disease, but no information exists on their relationship to periodontal abscesses. The present study determined the presence of human cytomegalovirus (HCMV) and Epstein‐Barr virus type 1 (EBV‐1) in periodontal abscesses and the effect of treatment on the subgingival occurrence of these viruses. Material and methods: Eighteen adults with periodontal abscesses participated in the study. Subgingival samples were collected from each patient with sterile curettes from an abscess‐affected site and a healthy control site. HCMV and EBV‐1 were identifed by polymerase chain reaction at the time of the abscess and at 4 months after surgical and systemic doxycycline therapy. Results: HCMV was detected in 66.7% of periodontal abscess sites and in 5.6% of healthy sites (P = 0.002). EBV‐1 occurred in 72.2% of abscess sites but not in any healthy site (P < 0.001). HCMV and EBV‐1 co‐infection was identified in 55.6% of the abscess sites. Posttreatment, HCMV and EBV‐1 were not found in any study site. Conclusions: HCMV and EBV‐1 genomes are commonly found in periodontal abscesses. These data favor a model in which a herpesvirus infection of the periodontium impairs the host defense and serves as a platform for the entrance of bacterial pathogens into gingival tissue with subsequent risk of abscess development.     

Herpesviruses: a unifying causative factor in periodontitis?

Human cytomegalovirus and Epstein‐Barr virus type 1 are discussed in this review as they relate to destructive periodontal disease in humans. Genomes of the two herpesviruses occur frequently in severe adult periodontitis, localized and generalized juvenile periodontitis, Papillon‐Lefèvre syndrome periodontitis, Down’s syndrome periodontitis, HIV‐associated periodontitis and acute necrotizing ulcerative gingivitis. Herpesvirus infections generally involve a mild or asymptomatic primary phase followed by an asymptomatic latent phase interrupted sporadically by periods of activation, where viral replication and possibly clinical disease become manifest. Herpesvirus reactivation is triggered by a number of immunosuppressing factors, some of which have also been shown to be risk indicators of periodontal disease. Available evidence argues for the involvement of active cytomegalovirus infection in the initiation and progression of localized juvenile periodontitis and possibly other types of periodontal disease. In periodontal disease, herpesviruses may cause release of tissue‐destructive cytokines, overgrowth of pathogenic periodontal bacteria, and initiation of cytotoxic or immunopathogenic events. Understanding the significance of herpesviruses in the causation and pathogenesis of destructive periodontal diseases may have important implications in future prevention and treatment of the diseases.     

Periodontal diseases in HIV-infected patients

Abstract Periodontal diseases may be the first clinical sign of human immunodeficiency virus (HIV)-infection. Since the immunosuppression and subsequent susceptibility may alter the responses of the oral tissues as well as the microflora, both periodontal treatment and result of therapy may be modified. The periodontal diseases in HIV-seropositive patients include common as well as less conventional forms of gingivitis and periodontitis, and bacteria, mycotic and viral infections are seen. Neoplasias may also involve the periodontium; most common are Kaposi's sarcoma and non-Hodgkin's lymphoma. Recent studies of unselected groups of patients indicate that periodontal health in at least some groups of HIV-seropositive patients is better than previously reported.     

Herpesviruses in human periodontal disease

Recent studies have identified various herpesviruses in human periodontal disease. Epstein–Barr virus type 1 (EBV‐1) infects periodontal B‐lymphocytes and human cytomegalovirus (HCMV) infects periodontal monocytes/macrophages and T‐lymphocytes. EBV‐1, HCMV and other herpesviruses are present more frequently in periodontitis lesions and acute necrotizing ulcerative gingivitis‐lesions than in gingivitis or periodontally healthy sites. Reactivation of HCMV in periodontitis lesions tends to be associated with progressing periodontal disease. Herpesvirus‐associated periodontitis lesions harbor elevated levels of periodontopathic bacteria, including Acrinobacillus actinomycetemcomitans , Porphyromonas gingivalis , Bacteriodes forsythus , Prevotella intermedia , Prevotella nigrescens and Treponema denticola . It may be that active periodontal herpesvirus infection impairs periodontal defenses, thereby permitting subgingival overgrowth of periodontopathic bacteria. Alteration between latent and active herpesvirus infection in the periodontium might lead to transient local immunosuppression and explain in part the episodic progressive nature of human periodontitis. Tissue tropism of herpesvirus infections might help explain the localized pattern of tissue destruction in periodontitis. Absence of herpesvirus infection or viral reactivation might explain why some individuals carry periodontopathic bacteria while still maintaining periodontal health. Further studies are warranted to delineate whether the proposed herpesvirus‐periodontopathic bacteria model might account for some of the pathogenic features of human periodontal disease.     

Human cytomegalovirus and Epstein–Barr virus inhibit oral bacteria‐induced macrophage activation and phagocytosis

Introduction: Periodontal disease is an inflammatory condition caused by periodontal microorganisms. Viruses such as human cytomegalovirus (HCMV) and Epstein–Barr virus (EBV) are associated with certain types of periodontal disease, but their roles in promoting the disease are unclear. Because both viruses infect human macrophages, cells which play key roles in the clearance of pathogenic bacteria, it is likely that the viruses alter the functional capacity of macrophages by inhibiting their defense mechanisms against invading pathogens. Methods: Macrophages preinfected with HCMV or EBV were evaluated following stimulation by selected oral bacteria. Bacteria‐induced macrophage activation was assayed by measuring the levels of tumor necrosis factor‐α (TNF‐α) produced in the media, and phagocytic activity was analysed by a phagocytosis assay with fluorescein isothiocyanate‐labeled bacteria. The virus‐infected macrophages were also subjected to semi‐quantitative polymerase chain reaction to measure the expression of toll‐like receptor 9, which is involved in the activation of phagocytosis‐related pathways. Results: Both HCMV and EBV significantly diminished the TNF‐α production typically induced by oral bacteria, inhibited the phagocytic activity of macrophages, and downregulated the expression of toll‐like receptor 9. Conclusion: Infection by HCMV or EBV inhibits the functional ability of macrophages to respond to bacterial challenge, thereby suggesting their pathogenic role in the development of periodontal disease.     

Detection and quantification of herpesviruses in Kostmann syndrome periodontitis using real‐time polymerase chain reaction: a case report

Background/aims: Kostmann syndrome, or severe congenital neutropenia, is an autosomal recessive disease of neutrophil production and is associated with severe periodontal pathology. The aim of this study was to determine whether human cytomegalovirus (HCMV) and Epstein‐Barr virus (EBV) contribute to the pathogenesis of Kostmann syndrome periodontitis. Methods: Supragingival plaque and saliva samples were taken from a 6‐year‐old boy and his 3‐year‐old sister suffering from Kostmann syndrome, and from two age‐ and gender‐matched healthy children serving as controls. The samples were taken before and 24 months after periodontal treatment. Real‐time polymerase chain reaction (TaqMan Real‐Time PCR) assay was used to quantify HCMV and EBV DNA. Results: EBV was detected in baseline samples from the Kostmann syndrome patients but not in samples from the healthy control subjects. HCMV was only detected in the saliva of the boy with Kostman syndrome at baseline. Herpesviruses numbers decreased dramatically in the post‐treatment samples. Conclusion: EBV and HCMV were detected in the two subjects with Kostmann syndrome periodontitis. The results of the study indicate that nonsurgical treatment of Kostmann syndrome periodontitis can reduce supragingival and salivary herpes viral loads.     

Periodontal health status and treatment needs among the elderly

The numbers of dentate elderly are growing rapidly in all industrialized countries, and epidemiological information about their oral health is urgently needed. Our study is part of the population-based Helsinki Ageing Study (HAS), and this paper describes the periodontal health status as well as the need for periodontal treatment among the dentate elderly born in 1904, 1909, and 1914 and living in January, 1989, in Helsinki, Finland (n = 175). The dental examinations were carried out during 1990 and 1991 at the Institute of Dentistry, University of Helsinki, Finland. The subjects' periodontal health was recorded by the CPITN (Community Periodontal Index of Treatment Needs) method. The mean number of remaining teeth was 15.1 among men and 14.0 among women, with the mean number of remaining sextants 3.7 and 3.5, respectively. Healthy periodontal tissues (CPI = 0) were found in 7% of the subjects. Bleeding on probing (CPI = 1) was recorded in 6%, and calculus and/or overhanging margins of restorations (CPI = 2) in 41% of the subjects, as the worst finding. Altogether, 46% of the subjects had deep periodontal pockets, 35% with at least one 4- to 5-mm pocket (CPI = 3), and 11% with at least one ≥ 6-mm pocket (CPI = 4). Overall, 93% of the subjects required oral hygiene instruction, 87% scaling and root planing, and 11% complex periodontal treatment. The periodontal treatment need was significantly higher in men than in women; however, no significant differences were observed among the three age cohorts. The need for complex periodontal treatment was unexpectedly low, probably explained by the fact that there were many missing teeth, especially molars, perhaps lost due to poor periodontal health.     

PCR检测口腔单纯疱疹损害愈合前后HSV DNA

目的在于了解复发性单纯疱疹损害愈合后病毒是否仍然潜伏在粘膜内。采用聚合酶链反应（PCR）技术检测36例口腔复发性单纯疱疹损害愈合前后HSVNDA。结果:所有愈合前的损害均可检测到23Obp的HSVDNA片段；愈后8周内原损害部位活检组织HSVDNA检出率为80.5%（29／36），原损害外粘膜部位HSVDNA的检出率为5．5％（2／36），对照组为5％。提示复发性单纯疱疹损害愈后HSV仍可潜伏在粘膜内，并倾向在原损害部位存在。     

Periodontal treatment needs of diabetic adults

AIM: The aim of this study was to investigate diabetes-related factors in relation to periodontal treatment needs. MATERIAL AND METHODS: A cross-sectional study was conducted among 299 dentate diabetics attending a diabetic clinic in Tehran, Iran. A self-administered questionnaire was administered during a dental appointment in order to gather information about year of birth, year of onset of diabetes, education and organ complications related to diabetes. Number of teeth, the Community Periodontal Index of Treatment Needs and visible plaque were recorded. RESULTS: None of the subjects had a healthy periodontium. Shallow periodontal pockets were the most prevalent finding. Periodontal pockets exceeding 5 mm and a higher number of missing teeth were associated with a low level of education. The sum of plaque scores [odds ratio (OR)=1.3; 95% confidence interval (CI) 1.1-1.5] was related to the presence of deepened pockets when controlling for other factors. Among diabetes-related factors, the only significant association with CPITN > or =3 was by HbA1c (OR=0.7; 95% CI 0.6-0.9); for CPITN=4, no associations with the diabetes-related factors appeared. CONCLUSIONS: The poor periodontal status of our diabetic patients indicates a need to establish a comprehensive oral health promotion programme for diabetics based on collaboration between dental and general health care professionals involved in diabetic care.     

Viruses in periodontal disease - a review

The purpose of this review was to evaluate the evidence supporting the hypothesis that viral infection plays a role in the development of periodontitis. An involvement in periodontal diseases has been suspected specifically for human immunodeficiency virus (HIV) and herpes viruses. An association has been demonstrated between HIV infection and some distinct forms of periodontal infection, i.e. necrotizing lesions. Furthermore, reports of increased prevalence and severity of chronic periodontitis in HIV-positive subjects suggests that HIV infection predispose to chronic periodontitis. Several studies, most of them from the same research group, have demonstrated an association of herpesviruses with periodontal disease. Viral DNA have been detected in gingival tissue, gingival cervicular fluid (GCF) and subgingival plaque from periodontaly diseased sites. In addition markers of herpesviral activation have been demonstrated in the GCF from periodontal lesions. Active human cytomegalovirus (HCMV) replication in periodontal sites may suggest that HCMV re-activation triggers periodontal disease activity. Concerns regarding sampling, methods and interpretation cast doubts on the role of viruses as causes of periodontal disease.     

Periodontal treatment need in a Finnish industrial population

A periodontal study was conducted in a paper mill in Finland. To adapt the Periodontal Treatment Need System (PTNS) to a Finnish adult population the estimates of Finnish periodontologists were used. The mean estimate of periodontal treatment need was 97 +/- 58 (s.d.) min per person and 32 +/- 18 min per jaw segment. Periodontal treatment need increased with age. No significant differences in periodontal treatment need by sex, education, type of employment, regularity of working hours or frequency of dental visits were observed. Adjusted family income and toothbrushing frequency did not produce significant differences in periodontal treatment need, except in the group having four dentulous jaw segments. The groups using sugar, other sweetening agents or neither of these, mainly in coffee or tea, differed significantly: the non-users of sugar had lowest treatment time and those who used other sweetening agents than sugar had highest treatment time.     

Correlation between different genotypes of human cytomegalovirus and Epstein-Barr virus and peri-implant tissue status

Background: The purpose of this study was to estimate the prevalence of different genotypes of human cytomegalovirus (HCMV) and Epstein‐Barr virus (EBV) in peri‐implantitis and mucositis sites, and to evaluate the correlation between herpesvirus presence and clinical parameters. Methods: A total of 80 dental implants (mean time of loading, 4.16 ± 1.8 years) were evaluated during the course of the study (30 peri‐implantitis, 25 mucositis and 25 healthy peri‐implant sites). The following clinical parameters were assessed: visible plaque index, bleeding on probing, suppuration and probing depth. A polymerase chain reaction (PCR) assay was used to identify the presence of different HCMV and EBV genotypes in peri‐implant tissue plaque samples. Results: HCMV‐2 was detected in 53.3% and EBV‐1 in 46.6% of the 30 peri‐implantitis sites evaluated. By contrast, HCMV‐2 was not detected in healthy periodontal sites and EBV‐1 was detected in one healthy site. A statistically significant correlation was found between the presence of HCMV‐2 and EBV‐1 genotypes and clinical parameters of peri‐implantitis. Conclusions: The results from the present study confirmed the high prevalence of HCMV‐2 and EBV‐1 in the peri‐implant tissue plaque of peri‐implantitis sites and suggests a possible active pathogenic role of the viruses in peri‐implantitis.     

Presence of human papilloma virus,herpes simplex virus and Epstein–Barr virus DNA in oral biopsies from Sudanese patients with regard to toombak use

J Oral Pathol Med (2010) 39 : 599–604 Using PCR/DNA sequencing, we investigated the prevalence of human papillomavirus (HPV), herpes simplex virus (HSV) and Epstein–Barr virus (EBV) DNA in brush biopsies obtained from 150 users of Sudanese snuff (toombak) and 25 non‐users of toombak in formalin‐fixed paraffin‐embedded tissue samples obtained from 31 patients with oral dysplasias (25 toombak users and 6 non‐users), and from 217 patients with oral cancers (145 toombak users and 72 non‐users). In the brush tissue samples from toombak users, HPV was detected in 60 (40%), HSV in 44 (29%) and EBV in 97 (65%) of the samples. The corresponding figures for the 25 samples from non‐users were 17 (68%) positive for HPV, 6 (24%) positive for HSV and 21 (84%) for EBV. The formalin‐fixed samples with oral dysplasias were all negative for HPV. In the 145 oral cancer samples from toombak users, HPV was detected in 39 (27%), HSV in 15 (10%) and EBV in 53 (37%) of the samples. The corresponding figures for the samples from non‐users were 15 (21%) positive for HPV, 5 (7%) for HSV and 16 (22%) for EBV. These findings illustrate that prevalence of HSV, HPV and EBV infections are common and may influence oral health and cancer development. It is not obvious that cancer risk is increased in infected toombak users. These observations warrant further studies involving toombak‐associated oral lesions, to uncover the possible mechanisms of these viral infections in the development of oral cancer, and the influence of toombak on these viruses.     

逆行性牙髓炎中疱疹病毒与牙周致病菌的关系

目的：研究逆行性牙髓炎中疱疹病毒和五种牙周致病菌的关系。方法：采集38例逆行性牙髓炎患牙的龈下菌斑和牙髓组织样本,应用SYBR Green实时荧光定量PCR检测样本中5种牙周致病菌：伴放线放线杆菌（Actinobacillus actinomycetemcomitans,A.a）,牙龈卟啉单胞菌（Porphyromonas gingivalis,P.g）,中间普氏菌（Prevotella intermedia,P.i）,福赛坦氏菌（Tannerella forsythensis,T.f）,齿垢密螺旋体（Treponema denticola,T.d）的检出率.同时应用巢式PCR方法检测人巨细胞病毒（human cytomegalovirus,HCMV）,EB病毒1型（Epstein-Barr virus-1,EBV-1）的检出率.应用SPSS13.0软件包对数据进行卡方检验和相关性检验。结果：龈下菌斑和牙髓组织中EBV-1和HCMV混合感染的检出率具有相关性。牙髓组织中检出3~5种致病菌的样本中EBV-1的阳性率显著高于未检出致病菌的样本（P〈0.05）,且疱疹病毒阳性样本中感染3~5种牙周致病菌的样本所占比例高于感染两种及两种以下致病菌样本的比例。结论：EBV-1和HCMV之间,以及牙周致病菌和疱疹病毒之间可能存在相互协同致病作用。     

Periodontal and prosthetic treatment in patients with oral lichen planus

The problems of periodontal and prosthetic treatment are demonstrated with a typical case of oral erosive lichen planus with gingival involvement. The results attained suggest that oral lichen can be improved by optimum plaque control and periodontal treatment. Prosthetic treatment should be based on bridgework and not on removable partial dentures owing to the isomorphous irritant effect that characterizes lichen planus. Once the plaque situation is firmly under control, even teeth with advanced destruction of the supporting tissues may be used as abutments. In the event of all molars being absent, cantilever bridges should be fitted. In this case it is not essential to replace all the molars provided that the masticatory function is subjectively adequate.