The vaginal microflora in relation to gingivitis.

Rutger Persson,Mario Vaneechoutte,Marianne Weibel,Rita Verhelst,Kathleen Paul,Marilynn Rothen,David Eschenbach,Regula Hirschi,Jane Hitti,Marleen Temmerman,Rigmor Persson

doi:10.1186/1471-2334-9-6

Abstract

BackgroundGingivitis has been linked to adverse pregnancy outcome (APO). Bacterial vaginosis (BV) has been associated with APO. We assessed if bacterial counts in BV is associated with gingivitis suggesting a systemic infectious susceptibilty.MethodsVaginal samples were collected from 180 women (mean age 29.4 years, SD ± 6.8, range: 18 to 46), and at least six months after delivery, and assessed by semi-quantitative DNA-DNA checkerboard hybridization assay (74 bacterial species). BV was defined by Gram stain (Nugent criteria). Gingivitis was defined as bleeding on probing at ≥ 20% of tooth sites.ResultsA Nugent score of 0–3 (normal vaginal microflora) was found in 83 women (46.1%), and a score of > 7 (BV) in 49 women (27.2%). Gingivitis was diagnosed in 114 women (63.3%). Women with a diagnosis of BV were more likely to have gingivitis (p = 0.01). Independent of gingival conditions, vaginal bacterial counts were higher (p < 0.001) for 38/74 species in BV+ in comparison to BV- women. Counts of four lactobacilli species were higher in BV- women (p < 0.001). Independent of BV diagnosis, women with gingivitis had higher counts of Prevotella bivia (p < 0.001), and Prevotella disiens (p < 0.001). P. bivia, P. disiens, M. curtisii and M. mulieris (all at the p < 0.01 level) were found at higher levels in the BV+/G+ group than in the BV+/G- group. The sum of bacterial load (74 species) was higher in the BV+/G+ group than in the BV+/G- group (p < 0.05). The highest odds ratio for the presence of bacteria in vaginal samples (> 1.0 × 104 cells) and a diagnosis of gingivitis was 3.9 for P. bivia (95% CI 1.5–5.7, p < 0.001) and 3.6 for P. disiens (95%CI: 1.8–7.5, p < 0.001), and a diagnosis of BV for P. bivia (odds ratio: 5.3, 95%CI: 2.6 to 10.4, p < 0.001) and P. disiens (odds ratio: 4.4, 95% CI: 2.2 to 8.8, p < 0.001).ConclusionHigher vaginal bacterial counts can be found in women with BV and gingivitis in comparison to women with BV but not gingivitis. P. bivia and P. disiens may be of specific significance in a relationship between vaginal and gingival infections.

Highlights

Gingivitis has been linked to adverse pregnancy outcome (APO)
A Nugent score of 0–3, considered as indicative for normal vaginal microflora without signs of inflammation, was found in 83 women (46.1%), and a score of > 7, i.e. clear Bacterial vaginosis (BV) was present in 49 women (27.2%)
Studies of the bacterial colonization of the oral cavity have shown that Actinomyces sp. [28], Fusobacterium spp. [29], Prevotella sp. [30], Capnocytophaga sp. [31] and T. forsythia [32] are associated with gingivitis

Summary

Introduction

Gingivitis has been linked to adverse pregnancy outcome (APO). Bacterial vaginosis (BV) has been associated with APO. Adverse preterm outcomes occur in approximately 10% of all pregnancies [1]. It remains a major source of neonatal morbidity and mortality. Gingivitis is a reversible inflammatory condition of keratinized and non-keratinized gum tissues surrounding the teeth. Periodontitis is a non-reversible inflammatory condition that includes loss of alveolar bone and other tooth supporting structures. The association between gingivitis or periodontitis and an increased risk of preterm birth remains a matter of dispute. Several recent studies support the hypothesis that periodontal infectious disease is a risk factor for adverse pregnancy outcomes [2,3,4,5,6,7,8]. One hypothesized mechanism is that inflammation may upregulate the inflammatory response in anatomically distinct locations such as the uterus and the amniotic cavity [7,8,9]

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