Abstract
Background:Listgarten and Hellden (1978) used darkfield microscopy of wet mounts to differentiate between healthy and periodontally diseased sites in the mouth by expressing the different bacterial morphotypes observed as a percentage of the total number of bacteria counted. This method of periodontal disease assessment gained favour as a diagnostic tool but presented with the limitation of immediate examination to determine the number of motile rods present and an inability to distinguish between gingivitis and periodontitis. Grading of bacterial morphotypes into several distinct categories of health or disease (Ison and Hay, 2002), simplified the scoring system of Gram-stained smears for the diagnosis of bacterial vaginosis (Nugent et al. 1991). The application of a similar grading system using stained smears rather than wet mounts could be advantageous to the diagnosis of periodontal disease.Objectives/aims:This study tested the hypothesis that stained smears of dental plaque collected from the gingival crevice of individuals with varying probing pocket depths (PD) may provide a grading system for periodontal disease assessment.Materials and methods:Subgingival plaque samples were collected from 49 patients, stained with a silver stain and the proportions of each bacterial morphotype graded relative to their respective PD measurements.Results:This technique allowed for a grading system of I–IV, with grade I indicating health and grade IV indicating severe periodontal disease.Discussion:Stained smear examination eliminates the time restriction for motile rod enumeration and allows for storage of smears for future reference.Conclusion:Standardization of the microscopic areas to be evaluated or examined will facilitate the agreement of cut-off values for the diagnosis of periodontal disease.
Highlights
Plaque-induced chronic inflammatory periodontal disease (CIPD) can be classified as gingivitis and periodontitis
Microbiological diagnosis of endogenous infections such as periodontal disease and bacterial vaginosis (BV) employ a system of microscopically counting bacterial morphotypes in wet mount preparations[2] and Gram-stained smears,[3] respectively, using cocci and increased motile rods and spirochaetes to differentiate between healthy and periodontally diseased sites in the mouth,[2] and lactobacilli and mixed microbiota to differentiate between normal, healthy microbiota and BV-associated microbiota, respectively.[3]
Using the silver staining method, bacterial morphotypes stained black against a white background
Summary
Plaque-induced chronic inflammatory periodontal disease (CIPD) can be classified as gingivitis (gingival inflammation without loss of connective tissue attachment and alveolar bone) and periodontitis (with loss of the structures that support the tooth, namely, periodontal ligament, connective tissue attachment and alveolar bone). Listgarten and Hellden (1978) used darkfield microscopy of wet mounts to differentiate between healthy and periodontally diseased sites in the mouth by expressing the different bacterial morphotypes observed as a percentage of the total number of bacteria counted. This method of periodontal disease assessment gained favour as a diagnostic tool but presented with the limitation of immediate examination to determine the number of motile rods present and an inability to distinguish between gingivitis and periodontitis. CONCLUSION: Standardization of the microscopic areas to be evaluated or examined will facilitate the agreement of cut-off values for the diagnosis of periodontal disease
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