Association between periodontal pathogens and risk of nonfatal myocardial infarction

Andriankaja O, Trevisan M, Falkner K, Dorn J, Hovey K, Sarikonda S, Mendoza T, Genco R. Association between periodontal pathogens and risk of nonfatal myocardial infarction. Community Dent Oral Epidemiol 2011; 39: 177–185. © 2011 John Wiley & Sons A/S Abstract – Background: The direct effect of periodontal pathogens on atherosclerotic plaque development has been suggested as a potential mechanism for the observed association between periodontal disease and coronary heart disease, but few studies have tested this theory. Objectives: (i) To assess the association of periodontal pathogens in periodontal pockets with the risk of myocardial infarction (MI) and (ii) to assess whether an increase in the number of periodontal bacterial species increases the risk of MI. Methods: A total of 313 cases and 747 controls, consisting of Caucasian men and women from Western New York, aged 35 to 69 years, were recruited for this study. The presence of microorganisms was assessed by indirect immunofluorescence microscopy, using species‐specific polyclonal and monoclonal serodiagnostic reagents. The presence of six periodontal pathogens, Porphyromonas gingivalis (Pg), Tannerella forsythensis (Tf), Prevotella intermedia (Pi), Campylobacter recta (Cr), Fusobacterium nucleatum (Fn), and Eubacterium saburreum (Es), and their co‐occurrence (0–6) was compared with the odds of having myocardial infarction. Results: Univariate analyses revealed a higher percentage of the presence of each bacterium in cases compared to controls. In multivariate analyses, only Tf and Pi were statistically associated with an increase in the odds of having MI [Odds ratio OR = 1.62; 95% CI (1.18–2.22); and 1.40; 95% (1.02–1.92), respectively] after adjusting for age, gender, education, cholesterol, high blood pressure, diabetes, and total pack‐years of cigarette smoking. An increase in the number of different periodontal bacteria in pockets was also found to increase the odds of MI [adjusted OR = 1.14; 95% CI (1.03–1.26)]. Participants who had three species or more of periodontal pathogens had about 2‐fold increase in odds of having nonfatal MI than those who did not have any type of bacterial species [OR = 2.01 (1.31–3.08)]. Conclusion: The presence of periodontal pathogens, specifically Tf or Pi, and an increase in total burden of periodontal pathogenic species were both associated with increased odds of having MI. However, further studies are needed to better assess any causal relationship, as well as the biological mechanisms underlying this association.     

Association between betel quid chewing, periodontal status and periodontal pathogens

The present investigation examined whether an association exists between betel quid chewing and signs of periodontal disease and determined the prevalence of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis by polymerase chain reaction. The periodontal status of 34 betel quid chewers and 32 non-betel quid chewers were compared. A significantly higher prevalence of bleeding on probing was found in betel quid chewers than non-chewers among the subjects with higher plaque level, greater gingival inflammation, deeper probing depth or greater attachment loss. Also, the results suggested that betel quid chewers may harbor higher levels of infection with A. actinomycetemcomitans and P. gingivalis than non-betel quid chewers. The association persists after adjusting for severity of the clinical parameters. In conclusion, betel quid chewing was associated with a higher prevalence of bleeding on probing where higher clinical levels of disease existed, and with a likelihood of subgingival infection with A. actinomycetemcomitans and P. gingivalis.     

Prevalence and risk indicators for destructive periodontal diseases in 3 urban American minority populations

BACKGROUND, AIMS: Destructive periodontal diseases have been reported disproportionately more prevalent and severe in African-Americans relative to other American populations. Differences in subgingival microbiota and host immune response have also been reported for African-Americans, implying that risk factors for disease progression may also differ for these populations. Since it is not clear whether these differences are truly genetic or due to confounding variables such as social economic status, we examined a series of clinical, environmental, demographic, and microbiologic features associated with periodontal disease status in a group of 185 urban minority subjects resident within the greater New York metropolitan area. METHODS: The study population consisted of 56 Asian-American, 71 African-American and 58 Hispanic subjects. Clinical data recorded included pocket depth, attachment level, gingival erythema, bleeding upon probing, suppuration, and the presence of supragingival plaque. Environmental and demographic data recorded included smoking history, years resident in the United States, whether the subject reported a private dentist and occupational status. Subgingival plaque was sampled from the mesial aspect of all teeth exclusive of third molars and the levels of 40 subgingival species enumerated using checkerboard DNA-DNA hybridization. RESULTS: The African-American group had more missing teeth, deeper periodontal pocket depth and more attachment loss than the Asian-American or Hispanic groups. However, the African-American group were less likely to report having a private dentist, had a greater proportion of smokers and a greater proportion of unskilled individuals. The profile of subgingival species differed among the three ethnic/racial groups with A. actinomycetemcomitans, N. mucosa, S. noxia and T. socranskii significantly elevated in the Asian-American group and P. micros significantly elevated in the African-American group. When subset by occupational status, numbers of missing teeth, pocket depth, attachment level and prior disease activity were all found increased in the unskilled relative to the professional group. Local factors including the mean % of sites with plaque, marginal gingival erythema, bleeding upon probing and suppuration were also elevated in the unskilled group. The microbial profile differed among the 3 occupational groups with the unskilled group having elevated numbers of species associated with destructive periodontal diseases. CONCLUSIONS: Although greater destructive periodontal disease prevalence and severity were found in the African-American group, these results suggest that environmental and demographic variables, such as occupational status, may have a greater influence on risk indicators associated with disease prevalence and progression in these populations.     

Detection of high-risk groups and individuals for periodontal diseases: laboratory markers based on the microbiological analysis of subgingival plaque

Periodontal microbiology is reviewed with regard to the potential of certain characteristics to serve as markers of high risk groups or individuals for periodontal diseases. The generally accepted associations between particular organisms and the various periodontal diseases are discussed. The usefulness of various clinical study designs is reviewed. The ecology of the subgingival plaque microflora is discussed and a number of suggestions for future research are made. We have concluded that there is no monospecific aetiology to any of the various periodontal conditions. Nevertheless, we give particular attention to the role of the black-pigmented bacteroides based upon our belief that they, and Bacteroides gingivalis in particular, are fundamental to our understanding of the biology of periodontal diseases in humans and other animals. Consequently, the contribution of its various virulence factors and their potential as markers of disease susceptibility and activity is addressed.     

Prevalence of suspected periodontal pathogens identified using ELISA in adolescents of differing ethnic origins

Abstract The aim of this study was to determine the prevalence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia in a group of adolescents and investigate the association of these organisms with various clinical parameters. A total of 527, 11-13-year-old children, of whom 333 (63%) were white Caucasian, 187 (35%) Indo-Pakistani and 7 (1%) Afro-Caribbean, participated in the study. Subgingival plaque samples, collected from the mesio-buccal of both upper first permanent molars using sterile paper points, were stored in phosphate buffered saline with 0.01% thiomersal and analysed for the presence of A. actinomycetemcomitans, P. gingivalis and P. intermedia using ELISA. The mesio-buccal sites of both upper 1st permanent molars were also examined and the presence/absence of supragingival plaque, subgingival calculus, bleeding on probing and pocket depths greater than 3 mm were recorded. The % of white Caucasian children in whom the monoclonal antibody identified at least 1 site with A. actinomycetemcomitans, P. gingivalis and P. intermedia were 4%, 3% and 2%, respectively, and for Indo-Pakistanis were 3%, 17% and 2%. The difference for P. gingivalis was statistically significant (p < 0.001). The associations between the clinical parameters and the 3 organisms were considered separately for both upper first molar sites. The prevalence of P. gingivalis was higher for sites with subgingival calculus, pockets >3 mm and bleeding on probing (p < 0.001).     

Prevalence of periodontitis and suspected periodontal pathogens in families of adult periodontitis patients

Abstract The aim of the present study was to investigate the prevalence of periodontopathic microorganisms and periodontal destruction in the spouses and children of adult periodontitis patients. For this study, 24 families were selected on the basis of one parent with severe periodontal breakdown and the presence of Actinobacillus actinomycetemcomitans and/or Porphyromonas gingivalis and/or more than 30%Prevotella intermedia subgingivally. The clinical examination of both parents and children included pocket depth and clinical attachment loss (CAL) measurements. Samples for bacterial examination were obtained from the mucous membranes, the saliva and pockets. Pocket selection was based on the most advanced periodontitis situation found in a subject. The samples were cultured for the detection of A. actinomycetemcomitans, P. gingivalis and P. intermedia. By phase-contrast microscopy, the % of spirochetes and motile microorganisms was assessed. The number of children within each family varied between 1 and 3. In total 49 children were investigated with a range in age of 3 months to 15 years. Results showed that under the age of 5 years, none of the children had CAL. whereas in the age group of 5–15 years, 26.5% had 1–5 sites in the primary and/or permanent dentition with 1–3 mm CAL. 3 of the spouses had no interproximal CAL. 16 of the 24 spouses had a light to moderate form of periodontitis, with at least one site with 1 to 4 mm CAL and 5 spouses had severe periodontal breakdown with sites showing at least 8 mm CAL. Spirochetes, motile microorganisms and P. intermedia were frequently present in all family members. 18 out of the 24 probands were positive for P. gingivalis. This organism was found once only in a 5-year-old boy and in 11 of the spouses. A. actinomycetemcomitans was detected in 13 probands; 5 children and 5 of the spouses were also positive for this bacterium. If a child harboured one of the periodontopathogens, at least 1 of the parents was also positive for that bacterium. This phenomenon may be due to transmission of microorganisms between family members. Comparison of the clinical data reported in the present study with similar clinical parameters from epidemiological studies of the Dutch population suggest that the spouses and children of adult periodontitis patients might be at relatively high risk of developing periodontal breakdown.     

The effect of SRP on the clinical and microbiological parameters of periodontal diseases

The purpose of the present investigation was to examine the effect of SRP on clinical and microbiological parameters in 57 subjects with adult periodontitis (mean age 47± 11 years). Subjects were monitored clinically and micro-biologically prior to and 3, 6 and 9 months after full-mouth SRP under local anaesthesia. Clinical assessments of plaque, redness, suppuration, BOP, pocket depth and attachment level were made at 6 sites per tooth. The means of duplicate attachment level measurements taken at each visit were used to assess change between visits. Clinical data were averaged within each subject and then averaged across subjects for each visit. Subgingival piaque samples were taken from the mesial aspect of each tooth and the presence and levels of 40 subgingival taxa were determined using whole genomic DNA probes and checkerboard DNA-DNA hybridization. The mean levels and % of sites colonized by each species (prevalence) was computed for each subject at each visit. Differences in clinical and microbiological parameters before and after SRP were sought using the Wilcoxon signed ranks test or the Quade test for more than 2 visits. Overall, there was a mean gain in attachment level of 0.11±0.23 mm (range –0.53 to 0.64 mm) 3 months post-therapy. There was a significant decrease in the % of sites exhibiting gingival redness (68 to 57%) and BOP (58 to 52%) as well as a mean (±SEM) pocket depth (3.3±0.06 to 3.1 ±0.05 mm). Sites with pre-therapy pocket depths of <4 mm showed a non-significant increase in pocket depth and attachment level. 4–6 mm pockets showed a significant decrease in pocket depth and a non-significant gain in attachment post-therapy, while 6 mm pockets showed a significant decrease in pocket depth and attachment level measurements post-therapy. Significant clinical improvements were seen in subjects who had never smoked or were past smokers but not in current smokers. Mean prevalences and levels of P. gangivalis, T. denticola and B. forsythus were significantly reduced after SRP. while A. viscosus showed a significant increase in mean levels. The mean decrease in prevalence of P. gingivalis was similar at all pocket depth categories, while B. forsythus decreased more at shallow and intermediate pockets and A. viscosus increased most at deep sites, P. gingivalis, B. forsythus and T. denticola were equally prevalent among current, past and never smokers pre-therapy, decreased significantly post-SRP in never and past smokers but increased in current smokers. Clinical improvement post-SRP was accompanied by a modest change in the subgingival microbiota, primarily a reduction in P. gingivalis, B. forsythus and T. denticola, suggesting potential targets for therapy and indicating that radical alterations in the subgingival microbiota may not be necessary or desirable in many patients.     

On the interpretation of microbial clusters in periodontal disease

Cluster analysis is sometimes used in periodontal research to describe patterns of microbial identifications observed among cases (subjects or sites). These patterns are assumed to define subsets of cases that are meaningful, in the sense of defining periodontal subgroups that have reliable differences in some aspect of their disease. However, cluster analysis is an exploratory, first-stage technique that does not incorporate the machinery that allows one to evaluate the statistical significance and reliability of the patterns observed. Problems inherent in drawing inferences from cluster analysis are discussed and, as one methodological example of how the statistical significance of clustering might be determined, a randomization-based test for binary scaled microbial identifications is described. The introduction of cluster analysis to the study of periodontal microbiology was important and innovative, but future work needs to incorporate validation by either statistical means or independent replication. The present rarity of such confirmatory methods in the literature suggests caution in accepting specific cluster-based hypotheses about patient-microbial patterns.     

Epidemiologic associations between periodontal disease and chronic obstructive pulmonary disease

The nature of the relationship of periodontal disease to a number of systemic health outcomes, including chronic obstructive pulmonary disease (COPD), remains unclear. Various causal mechanisms have been proposed to explain the observed epidemiologic associations between periodontal diseases and respiratory diseases. We have reviewed the epidemiologic and clinical evidence for this association. The methodologic approach we have taken is based on a structured systematic review of the indexed biomedical literature on these subjects. The primary focus of this review was on the analysis of periodontal health status measures and their association with COPD, which includes chronic bronchitis and emphysema. We found that a paucity of published results exist on this specific relationship and those which do exist typically represent secondary analyses of existing data sets. Nevertheless, the epidemiologic evidence identified in this systematic review indicates that worse periodontal health status is associated with an increased risk of COPD, with odds ratios ranging from 1.45 to 4.50 (significant at the 95% confidence interval). However, it is possible that residual confounding by tobacco smoking may account in part for the observations. A causal association between periodontal health status and risk of COPD, although biologically plausible, remains speculative. Randomized controlled trials will be required in order to address the question of causality and to better understand the biological basis of these epidemiologic associations.     

Crevicular fluid level of β-glucuronidase in relation to clinical periodontal parameters and putative periodontal pathogens in early-onset periodontitis

Abstract. Analysis of β-glucuronidase (βG) in the gingival crevicular fluid (GCF) provides an indication of neutrophil influx into the crevicular environment. The aim of this study was to test the hypotheses that: (1) βG is significantly elevated in individuals with early-onset periodontitis (EOP) and that βG activity correlates with disease severity: and (2) βG level may reflect the local bacterial challenge in the gingival crevice. The study subjects consisted of a sub-sample of individuals examined in the National Survey of Oral Health of United States Children, which was undertaken during the 1986/87 school year. A total of 249 individuals were selected based on presence or absence of clinical attachment loss at baseline. The individuals were examined a second time 6 years later and the clinical attachment loss was assessed, and subgingival plaque and GCF were collected. The subjects were classified into 3 types of EOP and a control group, βG activity in the GCF and the levels of 7 putative micro-organisms in the pocket were assessed. The generalized EOP group had the highest βG activity, followed by the localized and incidental EOP groups, and the controls, respectively. There was a significant increase in βG activity with the increase in probing depth. Also, sites with bleeding on probing had a significantly higher βG activity than sites without bleeding. However, the effect of gingival inflammation on βG activity was more evident in the generalized and localized EOP groups. Sites harboring high levels of one or more of the micro-organisms tended to have high βG activity. There were moderate differences between the organisms with respect to their effect on βG activity, but sites with high numbers of Porphyromonas gingivalis, Prevotella intermedia, or Treponema dentieola also had the highest βG activity. The present findings suggest that βG activity in GCF from patients with EOP can be of value in the early identification of individuals at higher risk of developing EOP, The findings also suggest that host mechanisms leading to higher βG activity in EOP represent systemic responses and are only partly related to the presence of local factors at the site-level.     

Prevalence and severity of periodontal disease in patients with inflammatory bowel disease

Previous reports have demonstrated that oral mucosa and periodontal lesions occur in patients suffering from inflammatory bowel disease (Crohn's disease [CD] and ulcerative colitis [UC]). It is unknown whether periodontal disease is an occasional or regular finding in these patients. The purpose of this study was to assess the prevalence and severity of periodontal disease in patients with inflammatory bowel disease (IBD). The periodontal status of 107 consecutive patients seeking treatment for inflammatory bowel disease was assessed. Examination of the mid- and mesiobuccal aspects of one quadrant on one jaw and the contralateral quadrant of the opposite jaw revealed the 93.5% of the CD patients and 95.1% of UC patients had at least one site with probing attachment loss of 2 mm or greater, and a mean probing attachment loss 1.4 +/- 0.9 mm and 1.5 +/- 1.0 mm, respectively. We found that 28.3% of CD patients and 29.5% of UC patients possessed at least 1 site with a pocket probing depth of 4 mm or greater; the mean pocket probing depth in these patients was 2.4 +/- 0.2 mm and 2.3 +/- 0.2 mm, respectively. Compared with the assessment of Oral Health of United States Adults, IBD patients revealed a 11.9% higher prevalence (P less than or equal to 0.01) but 0.6 mm lower severity (P less than or equal to 0.01) of periodontal disease. The magnitudes of these differences suggest no clinical implications for the management of periodontal disease in IBD subjects.     

Prevalence of periodontal pathogens in localized and generalized forms of early-onset periodontitis

The primary objectives of this study were to investigate the prevalence of 8 putative periodontal pathogens in subjects with early-onset periodontitis (EOP) and to evaluate the microbial differences between localized and generalized forms of this periodontal disease condition. Thirty-one females and 11 males with a mean age of 30.3 (s.d. 4.0) years were examined. Seventeen subjects had generalized (GEOP) and 25 had localized early-onset periodontitis (LEOP). Subgingival plaque samples were assayed using PCR which provided subject prevalence data for the pathogens; Bacteroides forsythus 78.6%, Treponema denticola 88.1%, Actinobacillus actinomycetemcomitans 19.0%, Porphyromonas gingivalis 16.7%, Prevotella intermedia 40.4%, Prevotella nigrescens 61.9%, Eikenella corrodens 42.3% and Campylobacter rectus 92.8%. Only 3 healthy sites harbored one or more of these periodontal pathogens. Seven of the 8 subjects positive for A. actinomycetemcomitans had LEOP. P. intermedia was present in 58.8% of GEOP compared with 28% of LEOP subjects (p=0.046). At 82.4% of GEOP sites P. nigrescens was present while this bacteria was detected at 52% of LEOP (p=0.044). P. gingivalis was isolated from 22.6% of females but no male subjects (p=0.084). C. rectus was recovered from all female subjects compared to 72.7% of males (p=0.014). A. actinomycetemcomitans (37.5%) and C. rectus (86.5%) were more frequently identified in non-smokers compared to 7.6% and 68.8% of smokers, respectively (p <0.05). Microbial associations coincided with the clinical division of the cases into LEOP and GEOP in 83% of the subjects.     

Prevalence of periodontal pathogens in Brazilians with aggressive or chronic periodontitis

OBJECTIVES: Previous studies suggest differences between geographically and racially distinct populations in the prevalence of periodontopathic bacteria as well as greater periodontal destruction associated with infection by highly leucotoxic Actinobacillus actinomycetemcomitans. The present study examined these hypotheses in Brazilians with aggressive or chronic periodontitis. MATERIALS AND METHODS: Clinical, radiographical, and microbiological assessments were performed on 25 aggressive periodontitis and 178 chronic periodontitis patients including 71 males and 132 females, 15-69 years of age. RESULTS: The prevalence of Porphyromonas gingivalis was similar to that of other South American populations. The prevalence of A. actinomycetemcomitans and its highly leucotoxic subgroup was higher in Brazilians. Highly leucotoxic A. actinomycetemcomitans was more prevalent in aggressive periodontitis (chi2=27.83) and positively associated with deep pockets (>6 mm, chi2=18.26) and young age (<29 years, chi2=18.68). Greater mean attachment loss was found in subjects with highly leucotoxic A. actinomycetemcomitans than in subjects with minimally leucotoxic (p=0.0029) or subjects not infected (p=0.0001). CONCLUSION: These data support the hypothesis of differences between populations in the prevalence of periodontopathic bacteria and of greater attachment loss in sites infected with highly leucotoxic A. actinomycetemcomitans. Detection of highly leucotoxic A. actinomycetemcomitans in children and adolescents may be a useful marker for aggressive periodontitis.     

Prevalence of periodontal pathogens with varying metabolic control of diabetes mellitus

Abstract. The purpose of this study was to determine the prevalence of 5 periodontal pathogens in individuals with diabetes mellitus. Subjects ( n = 107) 20–70 years of age with type 1 ( n = 60) or 2 ( n = 47) diabetes mellitus were studied for the occurrence of the periodontal pathogens A. actinomycetemcomitans, F. nude-alum, E. corrodens, P. gingivalis and P. intermedia. Subgingival plaque was sampled in each subject from a single site exhibiting the greatest inflammation. The evaluation of selected periodontal bacterial pathogens was based on an immunoassay utilizing bacterial specific monoclonal antibodies. 35% of the sites harbored P. gingivalis , 28% F. nucleatum and 21% E. corrodens. A. actinomycetemcomitans and P. intermedia were found in less than 10% of the sites. Subjects for whom the probing depth at the sampled site was 4 mm were more often found to have detectable pathogens than those with a probing depth 3 mm. Diabetic factors such as duration, type and metabolic control of the disease had no statistically significant effect on the prevalence of these bacteria.     

Periodontopathic bacterial infection in childhood

BACKGROUND: Little information is available on periodontopathic bacterial infection in childhood. We assessed the prevalence by age of 10 putative periodontopathic microorganisms in periodontally healthy children using a polymerase chain reaction (PCR) assay. METHODS: Plaque samples were collected from the buccal-mesial sulcus of the first molar or second primary molar in the right upper quadrant of 144 children (2 to 13 years old, 12 subjects from each year of age) who showed negligible periodontal inflammation. Using species-specific primers of Porphyromonas gingivalis, Bacteroides forsythus, Prevotella intermedia, Prevotella nigrescens, Campylobacter rectus, Eikenella corrodens, Actinobacillus actinomycetemcomitans, Capnocytophaga ochracea, Capnocytophaga sputigena, and Treponema denticola, PCR amplification was performed with bacterial genomic DNA from plaque samples. RESULTS: The results indicated that C. rectus, E. corrodens, A. actinomycetemcomitans, C. ochracea, and C. sputigena were found in about 50% of the plaque samples from all age groups, while B. forsythus and P. intermedia were detected less frequently, and P. gingivalis and T. denticola were not found. In contrast, the percentage of P. nigrescens-positive subjects increased with age in primary dentition, and reached about 50% at 7 years of age and older. Subject-based analyses suggested that the number of bacterial species in the plaque samples increased gradually with age until 5 years old, and then reached a plateau after the mixed dentition period. CONCLUSIONS: The colonization of many putative periodontopathic microorganisms can occur quite early in childhood without clinical signs of periodontal disease. However, colonization by P. gingivalis and T. denticola was not detected in periodontally healthy children.     

Interaction between periodontal disease and systemic secondary amyloidosis: from inflammation to amyloidosis

Background: It has become increasingly clear in recent years that periodontal disease can cause a dramatic increase in the levels of markers of systemic inflammation, and that periodontal treatment can result in reduction in the levels of these markers. We have previously shown that the prevalence of moderate to severe periodontitis was significantly higher in patients with familial Mediterranean fever (FMF) with amyloidosis than in patients with FMF without amyloidosis. Thus, the aim of this study is to investigate if chronic periodontitis is associated with secondary amyloidosis in the Black Sea region of Turkey. Methods: A total of 112 patients with biopsy‐proven secondary amyloidosis (59 patients with FMF, 40 patients who were either chronically infected or had malignant disease, 13 patients with periodontitis) and 22 healthy subjects, were included in this study. Periodontal health and disease were evaluated using gingival index (GI), papillary bleeding index (PBI), plaque index (PI), and periodontal disease index (PDI). The concentrations of serum acute phase reactants (APRs) were measured at baseline and at 4 to 6 weeks after completion of the non‐surgical periodontal therapy. Results: The prevalence of moderate to severe periodontitis was 47.5% in patients with FMF, 72.5% in patients who were either chronically infected or had malignant disease, and 84.6% in patients with periodontitis. Serum levels of APRs in patients with amyloidosis were reduced significantly after non‐surgical periodontal therapy (P <0.01). Conclusions: Periodontitis can increase the levels of APRs and potentiate the development of amyloidosis either by themselves or association with traditional factors, such as FMF and other chronic inflammatory diseases. Thus, preventing or treating periodontitis might prevent or at least alleviate the progression of amyloidosis. Periodontal evaluation should be performed as part of a medical assessment and considered as an etiologic factor for secondary amyloidosis.     

Plausibility of periodontal disease estimates from NHANES III

OBJECTIVES: This study investigated possible reasons for observed discrepancies in prevalence estimates and measures of association for periodontal disease between phases (1988-91 and 1991-94) of the third National Health and Nutrition Examination Survey (NHANES III). METHODS: NHANES III data on CD-ROM were obtained from the National Center for Health Statistics. Accompanying documentation states that each phase and combined phases constitute national probability samples of the US population. Weighted estimates of prevalence (percent of persons affected) and extent (percent of sites affected) for previously reported thresholds of gingival bleeding (GB), attachment loss (AL), and probing pocket depth (PD) were generated using data from all 15,511 persons aged 13-90 years who received periodontal examinations. Odds ratios for associations between four selected risk indicators and both PD and AL were compared between phases. RESULTS: Phase 2 estimates of GB and PD were as much as 56 percent lower than phase 1 estimates and both were different from combined-phase estimates. However, AL prevalence was consistent between phases. Prevalence differences between phases could be explained in part by examiner variations. Odds ratios for PD differed between phases by as much as one-third, although the direction and precision of associations were not affected, and differences were reduced after controlling for examiner. CONCLUSIONS: Combined-phase estimates of GB and PD prevalence and extent differ from previously published estimates derived from Phase 1, apparently because estimates in at least one phase of the NHANES III study are biased. However, associations with selected risk indicators were fairly consistent between phases.     

Prevalence of six periodontal pathogens detected by DNA probe method in HIV vs non-HIV periodontitis

OBJECTIVE: The aim of the study was to examine the prevalence of selected periodontal pathogens associated with HIV and non-HIV related periodontal lesions. METHODS: Subgingival plaque samples were obtained from both HIV-seropositive and HIV-seronegative patients affected with periodontal disease. DNA probes were used to detect Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Bac-teroides forsythus, Eikenella corrodent and Campylobacter rectus. RESULTS: A. actinomycetemcomitans, P. intermedia and B. forsythus (P < 0.05) were more prevalent in HIV-seronegative patients with rapidly progressive periodontitis. Only G. rectus was slightly more prevalent in HIV-seropositive subjects with periodontal diseases, but this was not significant.