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.     

Contribution of periodontal disease in pregnant women as a risk factor for low birth weight

Abstract – Starting in the 1990s, several authors sought to investigate the hypothesis that periodontitis during pregnancy may contribute towards the birth of low‐weight children. However, this relationship is still not well established. The aim of this study was to evaluate whether this oral infection is associated with this gestational event. Methods: This was a case‐control study among 548 puerperae, of whom 164 were the mothers of low‐weight live births (case group) and 384 were the mothers of live births of normal gestational weight (control group). They were selected at two public hospital units in two municipalities in the State of Bahia. From interviews and data gathered using live birth cards or birth certificates, information was obtained regarding age, height, previous diseases, marital status, socioeconomic situation, smoking and alcohol use. Mothers who presented at least four teeth on which one or more sites had a probing depth of greater than or equal to 4 mm, clinical attachment loss of greater than or equal to 3 mm and bleeding on probing, at the same site, were deemed to present periodontal disease. The data were analysed by stratification from logistic regression. Results: Periodontal disease was diagnosed in 42.7% of the case group and 30% of the control group. A statistically significant association was found between periodontal disease and low birth weight (unadjusted OR = 1.74; 95% CI: 1.19–2.54), particularly among mothers with low schooling levels (adjusted OR = 2.30; 95% CI: 1.14–4.6). Conclusion: The findings suggest an association between periodontal disease and low birth weight among mothers with low education levels.     

Periodontal infections and pre-term low birth weight: a case-control study

OBJECTIVE: Pre-term delivery of low-birth-weight infants [pre-term low birth weight (PLBW)] remains a significant public health issue and a major cause of neonatal death and long-term health problems. There is a growing consensus that infections remote from fetal-placental unit may influence PLBW infants. Recent studies have suggested that maternal periodontal disease may be an independent risk factor for PLBW. The purpose of the present study was to evaluate the possible link between periodontal infections and PLBW by means of clinical and microbiological data in post-partum women with low socioeconomic level. METHODS: Clinical periodontal recordings comprising dental plaque, bleeding on probing, probing pocket depth and gingival recession were performed (six sites/tooth) in a total number of 181 women (53 cases and 128 controls) within 3 days post-partum. Subgingival plaque samples from mesio-or disto-buccal aspect of randomly selected one first molar and one incisor tooth have been obtained by paperpoints and were analysed by checkerboard DNA-DNA hybridization with respect to 12 bacterial species. In all analyses, the individual subject was the computational unit. Thus, mean values for all clinical parameters were calculated and bacterial scores from each individual sample were averaged. Statistical methods included Student's t-test, Fisher's exact test/chi(2) test, and multiple logistic regression analysis. RESULTS: The cases have gained significantly less weight during the pregnancy than did the controls (p<0.05). There were no statistically significant differences between the cases and controls with regard to the dental and periodontal parameters and the values of clinical periodontal recordings were found to be very similar (p>0.05). Mean and median scores (bacterial loads) of Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Actinobacillus actinomycetemcomitans, and Streptococcus intermedius in the subgingival plaque sampling sites were significantly higher in the controls than in the cases (p<0.05). The occurrence rates of P. intermedia, Fusobacterium nucleatum, Peptostreptococcus micros, Campylobacter rectus, Eikenella corrodens, Selenomonas noxia and S. intermedius were higher in the cases compared with the controls, but the differences were not statistically significant (p>0.05). According to the model created by the multiple logistic regression analysis, P. micros and C. rectus were found to significantly increase the risk of PLBW (p<0.01 and p<0.05 respectively), while P. nigrescens and A. actinomycetemcomitans decreased this risk (p<0.01). CONCLUSION: The present findings indicated that when subgingival bacteria were evaluated together, P. micros and C. rectus may have a role in increasing the risk for PLBW, although no single bacteria exhibited any relation with the risk of PLBW. Further studies are required to better clarify the possible relationship between periodontal diseases and PLBW.     

Subgingival microflora and periodontal disease

Abstract This article describes the subgingival microflora of the healthy periodontium, gingivitis, advanced adult periodontitis, and juvenile periodontitis. A total of seven to nine subjects were examined in each of the four periodontal clinical entities listed. The individual bacteriological samples included material from the base of a single periodontal pocket. The sampling, the treatment of the samples, and the bacteriological cultivations were carried out using continuous anaerobic techniques. Briefly, the healthy gingival sulcus harbored a scant microflora dominated by Gram-positive organisms (85%), usually Streptococcus and facultative Actinomyces species. The development of gingivitis was accompanied by a marked increase in the total number of Gram-negative organisms. Fusobacterium nucleatum, Bacteroides melaninogenicus ss. intermedius, Haemophilus species, and other Gram-negative organisms comprised about 45% of the total gingivitis isolates. Streptococcus and facultative and anaerobic Actinomyces species constituted the majority of the Gram-positive gingivitis isolates. The micro-flora of advanced adult periodontitis was comprised mainly of Gram-negative anaerobic rods (about 75%), B. melaninogenicus ss. asaccharolyticus and F. nucleatum being the most predominant isolates. The deep pocket microflora in juvenile periodontitis was also made up mainly of Gram-negative organisms (about 65%), but was of a nature different from that of adult periodontitis, being predominated by isolates of Bacteroides species and other organisms of unknown species. The present article also concerns factors of importance for the colonization of Gram-negative anaerobic rods in the oral cavity and periodontal pockets. In vitro experiments showed that cells of B. melaninogenicus ss. asaccharolyticus and other Gram-negative organisms attached in high numbers to epithelial cells, hydrosyapatite (HA) surface, and Gram-positive bacteria when suspended in phosphate-buffered saline; however, the bacterial attachment to epithelial cells and HA was strongly inhibited in the presence of human saliva and serum. In contrast, saliva and serum had little effect upon the attachment of Gram-negative bacteria to Gram-positive bacterial cells. These findings agreed well with data from an in vivo study, in which streptomycin-labeled cells of B. melaninogenicus ss. asaccharolyticus were introduced into the mouth of two volunteers. A significantly higher number of B. melaninogenicus cells was recovered from dental plaque than from the other oral surfaces studied. The present series of studies has pointed to certain Gram-negative organisms as potential pathogens in rapidly progressing periodontal lesions. The available data on oral microbial ecology suggest that the presence of dental plaque containing Gram-positive organisms may be essential for the attachment and colonization of several Gram-negative species after their initial introduction into the mouth and the periodontal pocket area. The clinical relevance of these findings is discussed.     

牙周疾病与早产儿及低体重儿相关性的研究进展

妇女在妊娠期间身体和情绪的变化会影响其口腔健康。孕期常见的口腔表现是牙龈炎和牙周炎。牙周疾病与分娩出早产儿(PTB)及低体重儿(LBW)的相关性是近年颇具争议的研究热点。本文就这一方面的研究现状作一综述。     

Preterm low birth weights associated with periodontal disease in the Fiji Islands

AIM: To determine any association between pre-term low birth weight (PTLBW) neonates and periodontal disease during the mother's pregnancy. DESIGN: A multi-centered prospective case cohort study. SETTING: Ante-natal clinics at the Colonial War Memorial and Lautoka Hospitals, Fiji from 1st January to 30th June 2004. PARTICIPANTS: 670 multiethnic pregnant women. METHODS: Participants were interviewed to identify confounding variables--medical conditions, smoking, alcohol consumption, maternal age and history of preterm birth. Oral examination was conducted and included the Community Periodontal Index of Treatment Needs (CPITN). Delivery outcome was recorded for each woman. RESULTS: The mean age of participants was 25.80 +/- 5.56 years. 1.9% (n=13) women delivered preterm babies. More than 50% of this group displayed moderate to severe periodontitis compared with 13% of women who had a normal delivery. Preterm birth was also associated with the mother having had a previous preterm birth and who was more likely to be Indo-Fijian (p < 0.01). There was no significant association with where the mother lived; however, rural women with PTLBW babies had more severe periodontal disease (p = 0.0001). CONCLUSION: There is a highly significant association between pre-term birth and moderate to severe periodontal disease (p = 0.0001).     

Microbial etiology of periodontal disease

Abstract Longitudinal studies with humans indicate that gingivitis is associated with an increased dental plaque mass. Also, prior to the onset of gingivitis, changes in the microflora towards a more complex bacterial composition frequently occur. On the other hand, recent cross sectional cultural studies generally do not reveal clear-cut differences between the composition of the subgingival microflora associated with healthy or inflamed gingivae. Also, some studies have demonstrated an enhanced cell-mediated immune response during the course of gingivitis to a variety of subgingival plaque bacteria. It has also been observed that plaques allowed to form on cleaned teeth for 2 or 3 days do not differ substantially in their microbial composition. However, long-term thorough oral hygiene performed at intervals of 48 h permits maintenance of gingival health, whereas that instituted at intervals of 72 h will lead eventually to gingivitis. Collectively, this evidence supports the concept that the etiology of gingivitis is bacteriologically nonspecific. Thus a large increase in the accumulation of bacteria on the tooth surface per se may have a greater pathogenic effect on the periodontal tissues than the relatively minor and inconsistent shifts in the microbial composition. The transition from gingivitis into periodontitis may be induced by changes in the pathogenic potential of subgingival plaque. Gram-negative rods appear to be specifically associated with periodontitis. A growing body of evidence implicates especially Bacteriodes asaccharolyticus as one of the responsible pathogens. Juvenile periodontitis (periodontosis) seems to be a distinct disease entity. Recent findings suggest abnormalities in peripheral blood polymorphonuclear leucocytes (PMNL) of patients with juvenile periodontitis. The subgingival microflora is different from that associated with periodontitis and the findings so far implicate Actinobacillus actinomycetemcomitans as an important pathogen. The bacterial etiology of acute necrotizing ulcerative gingivitis (ANUG) is still unclear. Satisfactory cultural studies have yet to be performed. The presence of spirochetes in the ulcerative lesions of the junctional epithelium does not necessarily imply that they play an important role in this disease entity. Future research on the bacteriology of periodontal disease should concentrate on longitudinal studies; particular attention should be paid to the change of gingivitis into periodontitis whereby animals as well as humans can be used. Improvements of sampling methods as well as precise and simple identification techniques of microorganisms are required.     

On the symmetry of periodontal disease

BACKGROUND, AIM: Symmetry is a common feature of biological systems, and can be observed in multiple aspects of the human body. The purpose of this study was to estimate the impact of symmetry on variance observed in intraoral topographic distribution patterns of chronic periodontitis. METHOD: This analysis was performed on a data set from 56 subjects, including clinical and microbiological variables, recorded at the mesial and distal aspect of every tooth in the entire dentition. The impact of contralateral conditions was determined on the level of the site, the tooth, and the quadrant. RESULTS: Significant correlations were detected between probing depths, recession, attachment levels, total cultivable bacterial counts and the plaque index recorded on the right and left side on all levels of analysis. The odds for bleeding on sampling, as well as for the presence of P. intermedia/nigrescens and A. actinomycetemcomitans increased significantly if the respective contralateral site was positive for the same parameter. In combining ipsilateral and contralateral parameters into the analysis it could be shown in several instances that this contralateral effect was stronger than the impact of other, ipsilateral factors. As an example, the odds for bleeding on sampling increased up to 10 fold if the contralateral site was bleeding, whereas the ipsilateral total cultivable count, determined at the same site, explained less than 30% of the variation in the bleeding tendency. CONCLUSION: These findings support the view that the development of periodontal disease in any site cannot be explained by the influence of local detrimental factors alone.     

The occurrence of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and Bacteroides intermedius in destructive periodontal disease in adults

A total of 235 subgingival sites, including 104 progressive deep lesions from 61 untreated patients, 26 progressive deep lesions from 10 treated patients, 33 nonprogressive deep sites from 20 untreated patients, and 72 nonprogressive sites from 55 treated patients were examined for Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and Bacteroides intermedius. The periodontal disease progression was mainly determined on the basis of radiographic changes in the crestal alveolar bone level. A. actinomycetemcomitans isolation was carried out using the selective TSBV medium and B. gingivalis and B. intermedius isolations were performed using a nonselective blood agar medium. 1 or more of the 3 bacteria studied appeared in 99.2% of progressive periodontal lesions but only in 40.0% of nonprogressive sites. Culture-positive progressive periodontal sites in comparison with culture-positive nonprogressive sites showed higher median recovery rates of A. actinomycetemcomitans (0.5% vs 0.3%), B. gingivalis (30.5% vs 0.3%) and B. intermedius (4.9% vs 0.5%). Of total progressive lesions, 12.3% yielded solely A. actinomycetemcomitans, 21.5% demonstrated solely B. gingivalis, and 20.8% revealed solely B. intermedius. The A. actinomycetemcomitans--B. intermedius combination was found in 24.6% of progressive lesions. A. actinomycetemcomitans appeared in significantly higher prevalence in treated-progressive lesions (80.8%) than in nontreated-progressive lesions (42.3%). 32 of the 42 culture-positive nonprogressive sites yielded B. intermedius as the sole test organism. The main conclusion is that A. actinomycetemcomitans, B. gingivalis and B. intermedius are closely related to disease-active periodontitis, and more closely than to periodontal pocket depth. This finding is important in understanding periodontal disease etiology and pathogenesis and may also aid in a clinical setting to differentiate progressing and nonprogressing periodontal sites.     

Relationship between maternal periodontal disease and low-birth-weight pre-term infants

OBJECTIVES: The purpose of this study was to determine the influence of periodontal status on low-birth-weight pre-term delivery. MATERIAL AND METHODS: Ninety-six pregnant women were examined in their first, second and third trimester to record plaque scores, clinically assessed gingival inflammation and probing depth (mean depth and percentage of sites with depth of >3 mm). Binary logistic regression analyses were performed using SUDAAN 7.5 program. The type 1 (alpha) error established at 0.05 and an (alpha) error of 0.05-0.1 were considered nearly significant. RESULTS: The 96 women delivered 89 newborns: 16 were pre-term and seven of these were of low birth weight. There were seven miscarriages, all in the second trimester. No statistically significant association was found between gestational age and periodontal parameters. No significant relationship was found between low-weight delivery and plaque index measurements, although the association with gingival index was close to significant. A relationship was observed between low-weight birth and probing depth measurements, especially the percentage of sites of >3 mm depth, which was statistically significant (p=0.0038) even when gestational age was controlled for. CONCLUSIONS: According to these results, periodontal disease is a significant risk factor for low birth weight but not for pre-term delivery.     

Preterm low birth weight and periodontal disease among African Americans

African Americans consistently experience higher rates of preterm and low birth weight (LBW) deliveries than do whites. LBW and preterm infants are more likely to die before their first birthday and survivors may suffer from a number of health problems. Therefore, identification of modifiable risk factors for preterm deliveries and LBW has considerable public health significance. Pregnant women's poor periodontal healtlh is emerging as one such factor. Maternal clinical periodontal status and bacteriologic and immunologic profiles related to periodontal disease have been associateted with risk of fetal growth and preterm LBW, and periodontal treatment during pregnancy has reduced the incidence of preterm deliveries. This article reviews the literature on the above association and presents data from a previously published prospective study of predominantly African Americans to show that preterm LBW deliveries are associated with higher midtrimester maternal serum antibody levels against Porphyromonas gingivalis.     

Higher risk of preterm birth and low birth weight in women with periodontal disease

Pregnant women with periodontal disease (PD) may be at increased risk for having preterm low-birth-weight (PLBW) children. We investigated whether the maintenance of the mothers' periodontal health after 28 weeks' gestation reduces the risk of PLBW. Of the 639 women studied, 406 had gingivitis and received treatment before 28 weeks' gestation, and 233 had PD and were treated after delivery. Data about previous and current pregnancies and known risk factors were obtained from patients' medical records. Primary outcomes were delivery before 37 weeks' gestation or an infant with birth weight below 2500 g. The incidence of PLBW was 2.5% in periodontally healthy women, and 8.6% in women with PD (p = 0.0004, relative risk = 3.5, 95% CI, 1.7 to 7.3). Risk factors significantly associated with PLBW were previous PLBW, PD, fewer than 6 pre-natal visits, and low maternal weight gain. PD was associated with both preterm birth and low birth weight, independent of other risk factors.     

母体牙周炎与早产低体重儿关系的研究进展

早产低体重儿(preterm low birth weight,PLBW)是指妊娠时间不足37周,体重不足2500 g的新生儿。据统计,早产约占所有分娩人数的5%-15%,,是当前围产儿死亡的主要原因,约有2/3—3/4围产儿死亡及患病与早产有关,比足月产儿高11-16倍。由于过早分娩,中断了胎儿在宫内的正常生长发育,约有1/4的PLBW留有神经或智力方面的后遗症。因此,防治PLBW是降低围产儿死亡率,提高新生儿质量的主要举措之一。     

Current evidence regarding periodontal disease as a risk factor in preterm birth

Preterm birth, resulting in babies born too little and too soon, is a major cause of morbidity. Evidence indicates that infections can be major risk factors in preterm birth. Case-control studies point to an association between periodontal infection and increased rates of preterm birth. This paper summarizes evidence to date and the strategies that ongoing intervention studies are using to answer the fundamental clinical question: can periodontal therapy reduce the risk of preterm birth? Ann Periodontol 2001;6:183-188.     

Microbiology in the management of destructive periodontal diseasea

This paper summarizes the rationale for the application of microbiology in the management of destructive periodontal diseases. The subgingival microbiota in patients with severe periodontitis is complex and contains high numbers of obligate anaerobic bacteria as well as facultative micro-organisms. It has become clear that major differences exist in the composition of the subgingival microflora. These differences are not only quantitative but also qualitative. Difference in plaque composition is the basis for the application of clinical microbiology in the management of periodontal disease. Several bacterial species have emerged as useful indicators for progressive periodontitis. In this respect, the importance of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and Bacteroides intermedius has been shown in a number of studies. It has become clear that A. actinomycetemcomitans is not specifically associated with the local form of juvenile periodontitis, but this micro-organism is probably also of importance in severe periodontitis in adult patients. Selection of individuals with an A. actinomycetemcomitans associated periodontitis is essential since successful treatment in these patients needs an adjunctive antibiotic therapy. Microbiological testing can be useful in patients showing a poor response to periodontal treatment (refractory periodontitis). Factors which may be responsible include poor oral hygiene, poor subgingival debridement, the patient's susceptibility and a subgingival microflora resistant to therapy. In this patient category, microbiological testing is capable of diverting continuing periodontal treatment. Furthermore, microbiology can be useful in evaluating periodontal treatment. Successful elimination of specific periodontopathic microorganisms can be used to determine recall intervals.