Abstract
Our aim was to investigate the value of salivary concentrations of four major periodontal pathogens and their combination in diagnostics of periodontitis. The Parogene study included 462 dentate subjects (mean age 62.9 ± 9.2 years) with coronary artery disease (CAD) diagnosis who underwent an extensive clinical and radiographic oral examination. Salivary levels of four major periodontal bacteria were measured by quantitative real-time PCR (qPCR). Median salivary concentrations of Porphyromonas gingivalis, Tannerella forsythia, and Prevotella intermedia, as well as the sum of the concentrations of the four bacteria, were higher in subjects with moderate to severe periodontitis compared to subjects with no to mild periodontitis. Median salivary Aggregatibacter actinomycetemcomitans concentrations did not differ significantly between the subjects with no to mild periodontitis and subjects with moderate to severe periodontitis. In logistic regression analysis adjusted for age, gender, diabetes, and the number of teeth and implants, high salivary concentrations of P. gingivalis, T. forsythia, and P. intermedia were significantly associated with moderate to severe periodontitis. When looking at different clinical and radiographic parameters of periodontitis, high concentrations of P. gingivalis and T. forsythia were significantly associated with the number of 4–5 mm periodontal pockets, ≥6 mm pockets, and alveolar bone loss (ABL). High level of T. forsythia was associated also with bleeding on probing (BOP). The combination of the four bacteria, i.e., the bacterial burden index, was associated with moderate to severe periodontitis with an odds ratio (OR) of 2.40 (95% CI 1.39–4.13). When A. actinomycetemcomitans was excluded from the combination of the bacteria, the OR was improved to 2.61 (95% CI 1.51–4.52). The highest OR 3.59 (95% CI 1.94–6.63) was achieved when P. intermedia was further excluded from the combination and only the levels of P. gingivalis and T. forsythia were used. Salivary diagnostics of periodontitis has potential especially in large-scale population studies and health promotion. The cumulative strategy appears to be useful in the analysis of salivary bacteria as markers of periodontitis.
Highlights
Periodontitis is a multifactorial and multibacterial disease of the supporting tissues of teeth initiated by disturbances in the subgingival biofilm and host homeostasis
In the whole study population, 55.2, 65.7, 24.1, and 10.8% of the subjects were positive for saliva P. gingivalis, T. forsythia, P. intermedia, and A. actinomycetemcomitans, respectively
Our results show that salivary concentrations of P. gingivalis, T. forsythia, and P. intermedia are associated with periodontitis
Summary
Periodontitis is a multifactorial and multibacterial disease of the supporting tissues of teeth initiated by disturbances in the subgingival biofilm and host homeostasis. The symptoms of the disease involve gingival swelling and bleeding, formation of deepened periodontal pockets, and inflammatory destruction of periodontal ligament and alveolar bone. The progression of periodontitis is characterized by an increase in subgingival bacterial load and by the transformation of the dominance of Grampositive bacteria to a majority of Gram-negative bacteria. The “red complex” periodontopathogens, including Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, have a strong association with periodontitis-related clinical parameters such as pocket probing depth (PPD) and bleeding on probing (BOP) (Socransky et al, 1998). The “orange complex” involves typical periodontopathogens related to PPD, e.g., Prevotella intermedia (Socransky et al, 1998). Aggregatibacter actinomycetemcomitans is among the bacteria involved in the pathology of periodontitis (Genco, 1996; Henderson et al, 2010; Könönen and Müller, 2014)
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