Comparison of the benzoyl-DL-arginine-naphthylamide (BANA) test, DNA probes, and immunological reagents for ability to detect anaerobic periodontal infections due to Porphyromonas gingivalis, Treponema denticola, and Bacteroides forsythus.

Most forms of periodontal disease are associated with the presence or overgrowth of anaerobic species that could include Treponema denticola, Porphyromonas gingivalis, and Bacteroides forsythus among others. These three organisms are among the few cultivable plaque species that can hydrolyze the synthetic trypsin substrate benzoyl-DL-arginine-naphthylamide (BANA). In turn, BANA hydrolysis by the plaque can be associated with periodontal morbidity and with the presence of these three BANA-positive organisms in the plaque. In this investigation, the results of the BANA test, which simultaneously detects one or more of these organisms, were compared with the detection of these organisms by (i) highly specific antibodies to P. gingivalis, T. denticola, and B. forsythus; (ii) whole genomic DNA probes to P. gingivalis and T. denticola; and (iii) culturing or microscopic procedures. The BANA test, the DNA probes, and an enzyme-linked immunosorbent assay or an indirect immunofluorescence assay procedure exhibited high sensitivities, i.e., 90 ot 96%, and high accuracies, i.e., 83 to 92%, in their ability to detect combinations of these organisms in over 200 subgingival plaque samples taken from the most periodontally diseased sites in 67 patients. This indicated that if P. gingivalis, T. denticola, and B. forsythus are appropriate marker organisms for an anaerobic periodontal infection, then the three detection methods are equally accurate in their ability to diagnose this infection. The same statement could not be made for the culturing approach, where accuracies of 50 to 62% were observed.     

Reduced oxidative function in gingival crevicular neutrophils in periodontal disease.

Measurable amounts of viable and functional polymorphonuclear neutrophils (PMNs) are recovered from pooled washings of the gingival crevice of healthy individuals. In the present study, we have assessed the ability of the PMNs removed from single healthy or diseased pocket sites to mount an oxidative burst when challenged with phorbol myristate acetate (PMA) and compared these activities with each other and with those obtained with autologous peripheral-blood PMNs. The oxidative burst after PMA stimulation was evaluated by using methods developed for the flow cytometer. The results showed that the PMNs collected from untreated disease sites were minimally responsive to PMA when compared with peripheral-blood PMNs collected at the same time from the same individual. Thus, whereas the peripheral-blood PMNs exhibited significantly lower resting oxidative product formation and a 500% increase when stimulated with PMA, all gingival-crevicular PMNs exhibited significantly higher resting formation of oxidized products but only a 150% increase after PMA stimulation. PMNs obtained from a consistently healthy site had significantly higher resting production of oxidized products and were able to mount the greatest absolute increase in oxidized products after PMA stimulation when compared with PMNs collected from diseases sites. Mechanical debridement of these diseased sites, which both reduced the bacterial numbers and restored clinical health, resulted in the recovery of gingival-crevicular PMNs that exhibited an oxidative burst more typical of that observed in PMNs obtained from healthy gingival sites and from the peripheral blood. This suggested that the PMNs collected from the diseased sites either had been exhausted by the large numbers of bacteria present in these sites or had been specifically inhibited by these bacteria.     

Effects of estradiol and progesterone on Bacteroides melaninogenicus and Bacteroides gingivalis.

Bacteroides melaninogenicus subsp. intermedius increases in the subgingival microflora during pregnancy. These studies evaluated direct interactions between hormonal steroids and oral Bacteroides species. Resting cell suspensions of pure cultures of plaque organisms were incubated anaerobically with [14C]estradiol and [14C]progesterone. Uptake of labeled compound per microgram of bacterial protein was determined by thin-layer chromatography and liquid scintillation counting. B. melaninogenicus subsp. intermedius and B. melaninogenicus subsp. melaninogenicus took up 2.6 x 10(-4) to 5.4 x 10(-4) mumol of estradiol or progesterone per microgram of cell protein. Minimal steroid uptake was observed with B. gingivalis and five other organisms. Uptake of steroids by B. melaninogenicus subsp. intermedius was temperature dependent and resulted in a labeled product as detected on thin-layer chromatography. Growth curves indicated that intermedius and melaninogenicus subspecies of B. melaninogenicus but not B. gingivalis could substitute progesterone or estradiol for vitamin K, an essential growth factor. Growth of B. melaninogenicus subsp. intermedius in steroids was concentration dependent. Addition of fumarate to resting cells of B. melaninogenicus subspecies as well as B. gingivalis increased steroid uptake by 70 to 500% and resulted in the gas-liquid chromatographic detection of succinate. Cultures given fumarate alone or steroids alone produced no succinate. Steroids appeared to directly interact with the fumarate reductase system and foster the growth of B. melaninogenicus subsp. intermedius. This interaction may be of ecological significance.     

Microbiology and treatment of halitosis

The many thousands of individuals who experience oral malodor that stems from the overgrowth of proteolytic, anaerobic bacteria on their tongue surfaces can be successfully treated by a regimen that includes tongue brushing and tooth brushing, often in combination with a mouthrinse containing an antibacterial agent. Several candidate mouthrinses containing essential oils (Listerine; Warner-Lambert, Morris Plains, NJ), ZnCl₂, chlorine dioxide, or an oil:water-cetylpyridium chloride mouthrinse have reduced the organoleptic scores of individuals with moderate levels of oral malodor in the absence of tongue brushing. Very little long-term data beyond 6 weeks of use are available.     

Current research in diagnostic methods for assessing periodontal disease and its future impact

A diagnostic test should be useful, ideally leading to a choice of treatment(s) that would confer benefits upon the patient. The many uses of diagnostic tests are listed in Table 2, but it should be recognized that no single test can be relied on exclusively. Combinations of various tests, especially those which detect infections and those which detect inflammation, would provide useful information for diagnosing and managing the patient's treatment. Certainly, any test or procedure can be considered useful if it facilitates the successful treatment of a patient's periodontal condition without a disproportionate increase in the cost to the patient or in his or her discomfort. By these criteria, many of the tests described in this paper are useful. The entry of these tests into clinical practice seems to be only a matter of time; their true usefulness is for the clinician to determine.     

Extracts of feverfew may inhibit platelet behaviour via neutralization of sulphydryl groups

It has been suggested that extracts of feverfew may inhibit platelet behaviour via effects on platelet sulphydryl groups. In the present study we have obtained evidence for such a mode of action. Compounds that contain sulphydryl groups such as cysteine and N-(2-mercaptopropionyl)glycine prevented the inhibition of platelet behaviour by feverfew. Feverfew and parthenolide (one of the active components of feverfew) dramatically reduced the number of acid-soluble sulphydryl groups in platelets. This effect occurred at concentrations similar to those that inhibited platelet secretory activity. Feverfew itself did not induce the formation of disulphide-linked protein polymers in platelets but polymer formation occurred when aggregating agents were added to feverfew-treated platelets. Feverfew evoked changes in the metabolism of arachidonic acid that were similar to those observed in glutathione-depleted platelets.     

Estimation of sensitivity and specificity of site-specific diagnostic tests

Clinical trials designed to estimate the sensitivity and specificity of periodontal diagnostic tests often use multiple sites per patient as experimental units of analyses. Since site-specific test results within a patient are dependent observations, a correlated binomial model should be employed to estimate the sensitivity and specificity of these diagnostic tests. Ignoring the within-patient correlation can result in an over- or underestimation of the true standard errors.     

Measuring harmful levels of bacteria in dental aerosols.

The potential spread of the bacteria in aerosols emphasizes the familiar triad--gloves, masks and eyewear--for all operative procedures.