Utility of radiographic crestal lamina dura for predicting periodontitis disease-activity

Abstract. The relationship between radiographic crestal lamina dura and periodontitis disease-activity was studied longitudinally in 51 treated adult patients on a systematic 3-month maintenance program. The presence or absence of crestal lamina dura at 1809 interproximal sites was scored from periapical and bitewing radiographs taken at baseline of a 36-month maintenance care period. Semi-annual clinical evaluations by 2 independent examiners were carried out on each patient, with disease recurrence defined as sites revealing a 3 mm increase in probing depth from baseline, or a 2 mm increase in probing depth together with a 2 mm loss of relative attachment level from an occlusal stent. Over the 36-month study period, 23 (45%) patients exhibited disease recurrence at 55 (3%) interproximal tooth sites scored for baseline crestal lamina dura. Absence of detectable baseline crestal lamina dura yielded high sensitivity (87–100%), but low specificity (17%) and low positive predictive values (0.8–3.2%), for localized periodontitis recurrence. In contrast, no sites exhibiting an intact baseline crestal lamina dura demonstrated periodontitis recurrence up to 24 months from baseline (100% positive predictive values). Presence of radiographic crestal lamina dura was positively associated with clinical periodontal stability (summary odds ratio for sites = 2.6, P = 0.0004), and negatively associated with periodontitis recurrence (summary odds ratio for sites = 0.4, P = 0.0004), for the 36-month study period. Evaluation of radiographic crestal lamina dura status appears valuable for assessing the risk of periodontitis disease-activity at interproximal tooth sites in patients on maintenance care programs.     

Practical antimicrobial periodontal therapy

Specific pathogenic bacteria play a central role in the etiology and pathogenesis of destructive periodontal disease. Under suitable conditions, periodontal pathogens colonize the subgingival environment and are incorporated into a tenacious biofilm. Successful prevention and treatment of periodontitis is contingent on effective control of the periodontopathic bacteria, which is accomplished with professional treatment of diseased periodontal sites and patient performed plaque control. Subgingival mechanical debridement, with or without surgery, constitutes the basic means of disrupting the subgingival biofilm and controlling pathogens. Appropriate antimicrobial agents that can be administered systemically or via local delivery may enhance eradication or suppression of subgingival pathogens. Microbiological testing may aid the clinician in the selection of the most effective antimicrobial agent or combination of agents. Understanding the benefits and limitations of antibiotics and antiseptics will optimize their usefulness in combating periodontal infections.     

General health risk of periodontal disease

The possibility that periodontal disease might influence the morbidity and mortality of systemic diseases constitutes a research topic of great current interest. Human periodontal disease is associated with a complex microbiota containing approximately 500 microbial taxa and various human viruses, many of which possess significant virulence potential. Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and other periodontopathic bacteria that are unique to the oral cavity and may disseminate to other body sites comprise the best‐documented form of dental focal infection. However, systemically healthy individuals seem to be at low risk of acquiring acute non‐oral diseases from direct infections by periodontal pathogens. Research data from various laboratories point to periodontal infections as a risk factor for chronic medical disorders, including cardiovascular disease, cerebrovascular accidents and low‐birth‐weight infants. However, recent epidemiological studies have failed to show a significant relationship between periodontal disease and cardiovascular disease. This review paper evaluates the current status of knowledge on dental focal infection and suggests avenues for further research into the topic of general health risks of periodontal disease.     

Mitsuokella dentalis in human periodontitis

The occurrence of Mitsuokella dentalis in periodontitis was determined by culture and DNA probe detection. Subgingival paper-point samples from 480 periodontitis patients were transported in VMGA III, plated onto brucella agar with 5% sheep blood and incubated anaerobically for 7 days. Presumptive identification was based on a colony morphology resembling a water drop and biochemical characteristics. DNA probe detection was performed on paper-point samples using a digoxigenin-labeled cellular M. dentalis DNA probe in a dot-blot assay. Culture and DNA probe identified M. dentalis in 18.1% and in 80.7% of the study patients, respectively. M. dentalis isolates produced phosphatases, galactosidase, glucosidase and acetylglucosaminidase and showed high in vitro sensitivity to metronidazole. This study revealed that M. dentalis is a constituent of the pathogenic microbiota in human periodontitis. The periodontopathic potential of the organism is unknown.     

Ciprofloxacin treatment of periapical Pseudomonas aeruginosa infection

Abstract Survival of bacteria in periapical tissues may be the reason for endodontic failures. This case report describes the treatment of a patient with periapical lesions refractory to endodontic treatment. Microbiological sampling from fistulae associated with the lesions revealed the presence of Pseudomonas aeruginosa. Phenoxymethyl penicillin, metronidazole and carbenicillin were ineffective in eliminating the periapical infection. However, an investigational antibiotic, Ciprofloxacin, which was administered orally twice daily for 15 weeks, proved to be an effective, safe and convenient medicament in the treatment of periapical Pseudomonas aeruginosa infection. The fistulae closed in less than 2 weeks and a radiograph taken during the fourteenth week of therapy showed healing of the apical periodontitis with osseous regeneration. It is suggested that Ciprofloxacin is a valuable agent in the treatment of apical periodontitis, and probably other odontogenic infections caused by susceptible aerobic gram-negative bacilli.     

Purification and properties of hemagglutinin from culture supernatant of Bacteroides gingivalis.

The hemagglutinating factor (hemagglutinin) of Bacteroides gingivalis was prepared from the supernatant of a 5-day diffusate broth culture by ammonium sulfate precipitation and column chromatography with a hydrophobic column of Phenyl-Sepharose CL-4B, DEAE-Sephadex A-50, and Sephadex G-100 gel filtration. The hemagglutinating activity of the preparation was 53.3 times higher than that of ammonium sulfate precipitate. In electron microphotographs, hemagglutinin appears to have a vesicle or tubelike structure. The hemagglutinating activity of intact cells was completely destroyed by heating at 100 degrees C for 10 min, but the activity of extracted hemagglutinin was heat stable. The activity of hemagglutinin was inhibited by L-arginine and L-lysine and partially inhibited by phospholipase D, but it was not affected by proteolytic enzymes, neuraminidase, hyaluronidase, lipase, phospholipase A and C, or sugars. The B. gingivalis hemagglutinin appeared to be comprised mainly of a 40,000-molecular-weight material. The Fab fragment of immunoglobulin G prepared from rabbit antiserum to whole cells of B. gingivalis and monoclonal antibody against the hemagglutinin bound to the cell surface and inhibited the hemagglutinating activity of both the cells and the purified hemagglutinin.     

Periodontal pathogens on polytetrafluoroethylene membrane for guided tissue regeneration inhibit healing

Abstract This study determined the microbial composition of the apical parts of the expanded polytetrafluoroethylene membrane surfaces facing the gingiva and the tooth in guided tissue regeneration. Microbial and clinical features of 2-to-3 wall periodontal bony defects treated with membranes with and without concomitant use of systemic Augmentin® therapy were also determined. 18 patients with 18 study sites participated. 9 patients received systemic 500 mg Augmentin 1 h prior to surgery, and 500 mg TID for 8 days thereafter. 9 patients received no systemic antimicrobial therapy. Microbiological examination was performed 1 h prior to surgery, at the time of membrane removal at week 6, and at 6 months post-surgery. Microbial morphotypes, total viable counts, and the occurrence of selected microbial species were determined by phase-contrast microscopy, selective and non-selective culture, and DNA probes. Study sites were examined for probing pocket depths and attachment levels. At baseline, no microbial or clinical parameter showed statistical differences between groups. At 6 months, the Augmentin group demonstrated a significantly higher (P=0.032; Student t-test) mean probing attachment gain (36.5% of potential gain to the cemento-enamel junction) than the 9 control patients (22.4% of potential gain). At the time of removal, membranes in the Augmentin group showed significantly fewer organisms than membranes in the control group (52.2×10⁶ versus 488.6×10⁶). Sites free of pathogens on the membrane surface toward the tooth gained the most clinical attachment, even in the presence of various pathogens on the gingiva-facing membrane surface. Sites with little or no attachment gain demonstrated several periodontal pathogens on both sides of the barrier membrane. The present findings underscore the importance of controlling microbial pathogens in guided tissue regeneration procedures. Pathogens on the tooth-facing surface of the membrane, in particular, seemed to be a critical determinant on the outcome of guided tissue regeneration and appear essential to control to obtain optimal results.     

Subgingival occurrence of enteric rods, yeasts and staphylococci after systemic doxycycline therapy

The occurrence of subgingival enteric rods, yeasts and staphylococci (pre-treatment and post-treatment) was examined in 21 adult periodontitis patients receiving mechanical periodontal therapy and systemic doxycycline (200 mg on first day, then 100 mg/day for 20 days). Subgingival samples obtained prior to, and 2 weeks and 4 weeks after completion of the antibiotic therapy were transported in VMGA III and plated onto TSBV (for enteric rods and yeasts) and Staphylococcus 110 media. At baseline, small numbers of enteric rods (3 patients), yeasts (5 patients) and staphylococci (11 patients) were detected subgingivally. After the antibiotic therapy, more than 10-fold increases were seen in subgingival numbers of Enterobacter aerogenes (2 patients), Escherichia coli (1 patient), Candida albicans (2 patients), and staphylococci (11 patients). These findings demonstrating that systemic doxycycline therapy may result in at least temporary subgingival overgrowths of enteric rods, yeasts and staphylococci, may indicate the risk of frequent use of tetracycline in periodontal therapy.