Use and interpretation of microbiological assays in periodontal diseases.

Abstract

This report summarizes the rationale and illustrates the use of microbiological assays for specific microorganisms such as Actinobacillus (Haemophilus) actinomycetemcomitans in periodontal diseases. Data on the prevalence and monitoring of A. actinomycetemcomitans in patients with localized juvenile periodontitis (LJP) are presented. A. actinomycetemcomitans was found in 57 of 60 LJP patients for a prevalence of 95%. Two of the three patients not demonstrating the organism had serum antibodies to A. actinomycetemcomitans suggesting that they were once infected. Large numbers of A. actinomycetemcomitans were found in two‐thirds or more of the periodontally involved sites in the LJP patients. Microbiologic and clinical data illustrates the critical need for complete eradication of this organism in order to ensure successful therapy. The general use of microbiological tests for specific microorganisms in individual periodontitis patients can be applied to: (a) determine the causative agent, (b) assess disease activity for treatment planning, (c) monitor the effects of treatment, and (d) decide on recall intervals. Bacterial culture of the subgingival flora and determination of antibiotic susceptibility is likely to be useful in patients in whom therapy has not been successful. Rapid assays are also useful in examining subjects in epidemiologic studies to determine the prevalence of pathogens in various populations, in longitudinal studies to assess the importance of various microorganisms in the etiology of periodontal disease, and to identify persons at‐risk for either the initial episode of periodontal disease or for recurrent disease.The data presented here and the review of the relevant literature strongly support the use of microbiological assays for specific microorganisms as adjuncts in the diagnosis and management of periodontal disease. It is clear that meticulous, long‐term supragingival plaque control and root planing to achieve smooth surfaces of the roots is very important for the management of most forms of periodontal disease, however, identification and monitoring of specific microorganisms represents a new approach to the management of periodontal disease and provides a rationale for treatment of the specific infections of the periodontium. Although all of the specific periodontal pathogens have not been defined, a sufficient number of important pathogens are known and testing for these organisms is, therefore, indicated. Furthermore, technologies have developed to the point where rapid microbiological tests are feasible and practical. Future developments will likely provide more efficient and improved tests. In conclusion, the rationale for assessment of several important periodontal pathogens and the present level of technology making such assessment feasible, strongly support the use of microbiologic assays as adjuncts in the clinical management of various forms of periodontal disease.