Gingiva Of Patients Research Articles

Effects of Brazilian Propolis on Dental Plaque and Gingiva in Patients with Oral Cleft Malformation Treated with Multibracket and Removable Appliances: A Comparative Study.

Orthodontic appliances modify the local environment of the oral cavity, increase the accumulation of dental plaque, and affect the condition of the gingiva. The aim of this study is assessment of Brazilian propolis toothpaste's effect on plaque index (PLI) and gingival index (GI) in patients with CL/CLP treated using orthodontic appliances in the 35-day study period. The study population included 96 patients of an Orthodontic Outpatient Clinic, ACSiMS in Bytom. All the patients participated in the active phase of orthodontic treatment using buccal multibracket appliances or removable appliances. During the first examination, each patient was randomly qualified to the propolis group or control group. A statistically significant decrease in GI and PLI in the entire propolis group (P < 0.01) was shown during repeated examination. Insignificant change in GI was in the entire control group during the repeated examination compared to the baseline. Similar result was obtained in patients treated with multibracket and removable appliances. The orthodontic appliance type did not affect the final dental plaque amount and gingival condition in patients using the propolis toothpaste. These results may be clinically useful to improve prevention and control oral infectious diseases during orthodontic treatment patients with oral cleft.

Periodontal Soft Tissue Non-Root Coverage Procedures: Practical Applications From the AAP Regeneration Workshop.

Focused Clinical Question: What are the indications and clinical applications for gingival augmentation procedures, and what factors guide the choice among treatment options in specific situations? Summary: Although there is still controversy regarding whether there needs to be a minimum amount of attached gingiva to maintain the stability of the gingival margin, prospective and retrospective studies have shown that, in the presence of suboptimal plaque control and clinical inflammation, attachment loss and gingival recession (GR) may result unless a minimum amount of keratinized tissue (KT) and attached gingiva are present. Treatment of mucogingival deformities requires gingival augmentation procedures that address both a functional and esthetic component for the patient. Although free gingival grafts (FGGs) are considered the gold standard for treatment of GR defects to obtain root coverage, augmentation of KT and attached gingiva may be accomplished by FGG or other autogenous grafting options, including the free connective tissue graft, the lateral pedicle graft, and the double papilla technique. In addition, the modified apically repositioned flap can be considered in some instances. Alternatives to autogenous graft tissue include acellular dermal matrix, extracellular matrix membrane, bilayer collagen matrix, and living cellular construct. Conclusions: Understanding the clinical importance of the presence of a minimum amount of attached gingiva in patients with suboptimal hygiene is an important first step in addressing the condition. Patient education to address plaque control and counseling to quit smoking in patients who are smokers help enhance the success of these mucogingival surgical procedures. An analysis of patient-specific factors will help with the appropriate choice of surgical procedures aimed at augmenting the dimension of KT/attached gingival tissue. Evidence supporting the treatment decisions described in this practical application is summarized in the companion papers from the American Academy of Periodontology Regeneration Workshop (Kim and Neiva, J Periodontol 2015;86(Suppl.):S56-S72; Scheyer et al., J Periodontol 2015;86(Suppl.):S73-S76).

Comparison of the Proportion of Non‐Classic (CD14+CD16+) Monocytes/Macrophages in Peripheral Blood and Gingiva of Healthy Individuals and Patients With Chronic Periodontitis

Monocyte subsets with low CD14 expression that coexpress CD16 (CD14+CD16+) are called non-classic or hyperinflammatory monocytes. Previous studies have reported an increase in the percentage of CD14+CD16+ monocytes in the peripheral blood of patients with chronic periodontitis (CP). To our knowledge, there are no reports demonstrating the presence of CD14+CD16+ monocyte-derived macrophages (MDMs) in the gingival tissue. The objective of this study is to identify the proportion of non-classic (CD14+CD16+) monocytes/macrophages in peripheral blood and gingiva of healthy individuals and patients with CP. A total of 60 individuals (n = 30 per group) were recruited for the study. Group 1 included 30 individuals with healthy gingiva, and group 2 included 30 patients with CP. Direct immunofluorescent staining was done in 200 μL whole-blood and single-cell suspensions obtained from gingival tissue, with fluorochrome-conjugated monoclonal antibodies against CD14, CD16, and human leukocyte antigen-DR (HLA-DR), and subjected to flow cytometric analysis. The mean percentage of CD14+CD16+ monocytes in the peripheral blood of healthy individuals was 9.10% ± 1.39%, and for patients with CP it was 14.18% ± 2.69% (P <0.05). The mean percentage of CD14+CD16+ MDMs in the gingival tissue of healthy individuals was found to be 0.93% ± 0.33%, whereas in patients with CP, it was 1.92% ± 0.78% (P <0.01). Non-classic monocytes/macrophages showed a high median fluorescent intensity for HLA-DR (DR++). This study demonstrates an increased proportion of CD14+CD16+HLA-DR++ monocytes/macrophages in the peripheral blood and gingiva of patients with CP.

A Stab‐and‐Roll Biopsy Technique to Maintain Gingival Epithelium for Desquamative Gingivitis

Desquamative gingivitis (DG) is a clinical manifestation common to several diseases. It is known that most cases of DG are caused by mucous membrane pemphigoid (MMP), oral lichen planus (OLP), or pemphigus vulgaris (PV). Early recognition and treatment of these diseases can improve the prognosis, but diagnostic delays are common in patients with DG because obtaining a diagnostic biopsy is technically challenging. A biopsy technique designed to maintain the gingival epithelium for patients with DG was developed. The usefulness of this technique is discussed. This study is based on a retrospective review of 27 DG cases. A stab-and-roll technique was used to obtain gingival tissue. This technique is designed to reduce lateral forces on the epithelium during the procedure and to thereby prevent the inadvertent removal of the epithelium from the biopsy specimen. A total of 52 biopsies comprising 27 for hematoxylin and eosin (H&E)-stained samples and 25 for direct immunofluorescence (DIF) testing were reviewed. Fifty-one of the 52 biopsies (98.1%) maintained the epithelium. Only one biopsy (1.9%) showed that the epithelium was totally absent. Therefore, H&E and DIF features of 51 biopsies were analyzed. Definitive diagnoses of the diseases causing DG included MMP (13 cases), PV (eight cases), and OLP (six cases). A diagnostic biopsy was obtained from the gingiva of patients with DG using the stab-and-roll technique. The gingival epithelium was well maintained, and the relationship with the underlying connective tissue was diagnostic. In the future, this stab-and-roll biopsy technique may facilitate early diagnosis and treatment of diseases causing DG.

Immunolocalization of CD34 Positive Progenitor Cells in Diabetic and Non Diabetic Periodontitis Patients - A Comparative Study.

Little research has been documented to determine the CD34 positive cells in healthy periodontium, chronic periodontitis and in chronic periodontitis with diabetes mellitus individuals. The aim of the present study was to evaluate and compare the CD34 positive progenitor cells of the gingiva in patients with healthy periodontium, chronic periodontitis and chronic periodontitis with Diabetes Mellitus. A total number of 75 patients were divided into 3 groups which included Group I (healthy periodontium), Group II (chronic periodontitis) and Group III (chronic periodontitis with diabetes mellitus). Periodontal examination included Plaque index, Gingival index, Gingival bleeding index, Probing pocket depth and Clinical attachment levels. Gingival biopsies were collected from each participant and they were fixed in formalin embedded in paraffin which was later subjected to immunohistochemical procedure with anti-CD34 (a stemness marker). T-Test and Regression analysis (R-square) was used to analyse the data. The mean number of CD34 positive cells were higher in group III (5.71±1.97) compared to Group chronic periodontitis group I (4.98± 2.08) and II (4.48± 1.24). Although CD34 is a non specific stemness marker, results suggest that there is a significant difference in the number of CD34 positive progenitor cells between Group II and Group III but no significant difference was observed between Group I, II and Group I, III.

Periodontal Tissue and Serum Concentration of Clarithromycin After Systemic Administration in Patients Affected by Chronic Periodontitis

During the past two decades, dentists and microbiologists have relied on periodontal antibiotic therapy in the management of periodontitis. This association has accumulated and strengthened exponentially. Macrolides attain high therapeutic concentrations in infected tissue, so they are potentially a good choice for inhibiting invasive periodontal pathogens. Clarithromycin accumulates in phagocytes, monocytes, fibroblasts, polymorphonuclear cells, macrophages, and lymphocytes. These cells are more numerous at inflamed sites, so it is reasonable to expect clarithromycin levels to be higher in periodontally diseased sites. This study determines the distribution profile of clarithromycin in the gingiva of patients with periodontitis compared to serum after systemic administration of clarithromycin. Twenty patients (14 males and six females, aged 25 to 45 years) with chronic periodontitis were enrolled in the study. Gingival index and plaque index were recorded at baseline and 3 days after administration of 500 mg clarithromycin, twice daily, for 3 days. Intravenous blood and biopsy of periodontal tissue samples were taken on the third day. These samples were analyzed for detection of clarithromycin concentration using high-performance liquid chromatography. Approximately 6 hours after the last dose of clarithromycin, mean clarithromycin concentrations in serum and periodontal tissue were 0.465 μg/mL and 2.61 μg/g, respectively, and the difference was statistically significant. Clarithromycin can attain higher levels in gingiva than serum of patients with periodontitis. This distribution profile of clarithromycin can thus be advantageous in the management of periodontal lesions.

Inducible nitric oxide synthase (iNOS) in gingival tissues of chronic periodontitis with and without diabetes: Immunohistochemistry and RT-PCR study

BackgroundThere is few data concerning the pathogenesis and contribution of inducible nitric oxide synthase (iNOS) in the inflammatory reactions of the periodontium in the course of diabetes. This study evaluated the expression of iNOS in the gingival biopsies of periodontitis patients with and without type 2 diabetes. Methods80 subjects were evaluated in four groups: patients with chronic periodontitis and diabetes, patients with chronic periodontitis, periodontally healthy patients with diabetes, and systemically and periodontally healthy control subjects. Gingival biopsies were subjected to immunohistochemistry as well as reverse transcription polymerase chain reaction (RT-PCR) for determination of iNOS. ResultsAll diseased gingival tissues had a significant increase in iNOS expression by immunohistochemistry (P<0.001) compared to controls. There was no significant difference observed between patients with both diabetes and periodontitis and diabetic patients regarding iNOS+ cells. Meanwhile, these two groups had significantly increased iNOS+ cells when compared to periodontitis patients (P<0.001). There are significantly higher levels of iNOS mRNA expression of all patient groups compared to controls (P<0.0001). In addition, samples from patients with diabetes and periodontitis showed significantly higher levels of iNOS mRNA expression compared to samples from periodontitis patients and diabetic patients (P<0.0001) yet, without noting statistically significant differences between the latter two groups. ConclusionsAlthough iNOS expression was prominent in the gingiva of patients with diabetes and periodontitis, periodontitis patients and diabetic patients, the higher mRNA for iNOS observed in diabetes and periodontitis may indicate a possible involvement of this mediator in the periodontal destruction of type 2 diabetes.

Expression of angiogenesis-stimulating factors (VEGF, CD31, CD105) and angiogenetic index in gingivae of patients with chronic periodontitis

The aim of this study was to determine the prognostic value of the angiogenesis rate in chronic periodontitis (CP). A total of 61 human gingival samples were taken from patients with CP (n = 40) obtained during open curettage with gingivectomy, healthy periodontia (n = 15), and reactive lymph nodes (n = 7). Quantitative immunocytochemistry studies of VEGF, CD31 (PECAM-1) and CD105 (endoglin) were performed using the spatial visualization method. CD105/CD31 and VEGF/CD31 angiogenetic ratios (ARs) were established to determine the proliferation fraction of the endothelium. In patients with CP, the proliferation of blood vessels was observed, including the presence of numerous high endothelial venules (HEVs) and ordinary vessels. In gingival HEVs of patients with CP, the higher expression was shown by CD31 and, in turn CD105 and VEGF. The entire vascular expression of CD31 in the gingiva correlates with grading in lamina propria, but our study failed to document correlations between the expression of VEGF and CD105 and clinical data of patients with CP. Higher ARs were seen in gingivae of CP patients compared to controls. We concluded that overexpression of the angiogenesis-associated factors in CP suggests its significance in protracting the inflammatory process or periodic exacerbations of the process and destruction of the periodontium. The increased CD105/CD31 and VEGF/CD31 ratios in gingiva confirms an augmented proliferative fraction of the endothelium in gingiva with CP.

Expression of angiogenesis-stimulating factors (VEGF, CD31, CD105) and angiogenetic index in gingivae of patients with chronic periodontitis

The aim of this study was to determine the prognostic value of the angiogenesis rate in chronic periodontitis (CP). A total of 61 human gingival samples were taken from patients with CP (n = 40) obtained during open curettage with gingivectomy, healthy periodontia (n = 15), and reactive lymph nodes (n = 7). Quantitative immunocytochemistry studies of VEGF, CD31 (PECAM-1) and CD105 (endoglin) were performed using the spatial visualization method. CD105/CD31 and VEGF/CD31 angiogenetic ratios (ARs) were established to determine the proliferation fraction of the endothelium. In patients with CP, the proliferation of blood vessels was observed, including the presence of numerous high endothelial venules (HEVs) and ordinary vessels. In gingival HEVs of patients with CP, the higher expression was shown by CD31 and, in turn CD105 and VEGF. The entire vascular expression of CD31 in the gingiva correlates with grading in lamina propria, but our study failed to document correlations between the expression of VEGF and CD105 and clinical data of patients with CP. Higher ARs were seen in gingivae of CP patients compared to controls. We concluded that overexpression of the angiogenesis-associated factors in CP suggests its significance in protracting the inflammatory process or periodic exacerbations of the process and destruction of the periodontium. The increased CD105/CD31 and VEGF/CD31 ratios in gingiva confirms an augmented proliferative fraction of the endothelium in gingiva with CP.

Role of high endothelial postcapillary venules and selected adhesion molecules in periodontal diseases: a review

Periodontitis is accompanied by the proliferation of small blood vessels in the gingival lamina propria. Specialized postcapillary venules, termed periodontal high endothelial-like venules, are also present, and demonstrate morphological and functional traits similar to those of high endothelial venules (HEVs) in lymphatic organs. The suggested role of HEVs in the pathogenesis of chronic periodontitis involves participation in leukocyte transendothelial migration and therefore proinflammatory effects appear. Recent observations suggest that chronic periodontitis is an independent risk factor for systemic vascular disease and may result in stimulation of the synthesis of acute phase protein by cytokines released by periodontal high endothelial cells (HECs). However, tissue expression of HEV-linked adhesion molecules has not been evaluated in the gingiva of patients with chronic periodontitis. This is significant in relation to potential therapy targeting expression of the adhesion molecules. In this review, current knowledge of HEV structure and the related expression of four surface adhesion molecules of HECs [CD34, platelet endothelial cell adhesion molecule 1, endoglin and intercellular adhesion molecule 1 (ICAM-1)], involved in the key steps of the adhesion cascade in periodontal diseases, are discussed. Most studies on the expression of adhesion molecules in the development and progression of periodontal diseases pertain to ICAM-1 (CD54). Studies by the authors demonstrated quantitatively similar expression of three of four selected surface markers in gingival HEVs of patients with chronic periodontitis and in HEVs of reactive lymph nodes, confirming morphological and functional similarity of HEVs in pathologically altered tissues with those in lymphoid tissues.

Nitric oxide in gingival crevicular fluid and nitric oxide synthase expression in the gingiva of patients with sickle cell disease.

This study aimed to biochemically measure the production of nitric oxide in gingival crevicular fluid and immunohistochemically measure the expression of inducible nitric oxide synthase in the gingiva of patients with sickle cell disease. Additionally, we aimed to obtain insight into the immunopathology of sickle cell disease by comparing inducible nitric oxide synthase levels in patients with sickle cell disease and controls using gingiva and gingival crevicular fluid. The study included 20 sickle cell disease patients and 20 healthy controls. Immunohistochemical analysis was used to measure inducible nitric oxide synthase expression in gingiva and nitric oxide levels in gingival crevicular fluid were spectrophotometrically measured. Nitric oxide levels in the patients and controls did not differ significantly (21.2±4.5 and 23.1±2.3 μM L-1, respectively, p>0.05). There weren't any statistically significant differences in infiltrated inflammatory cells, density of inflammatory cells that stained with inducible nitric oxide synthase, or nitric oxide expression in gingiva between the patient and control groups (p>0.05). To the best of our knowledge this is the first study to examine the expression of inducible nitric oxide synthase in the gingiva and gingival crevicular fluid in patients with sickle cell disease. Using the gingiva and gingival crevicular fluid we were unable to observe sickle cell disease-associated inducible nitric oxide synthase expression and a difference in nitric oxide levels.

Prevalence of TT Virus in patients with chronic periodontitis, patients with aggressive periodontitis and healthy controls: a pilot study

Torque teno virus (TTV), a novel DNA virus resides in peripheral blood mononuclear cells and replicates when these cells get activated. The TTV replication shifts the immunobalance. Aim: To determine the presence of TTV in the gingiva of patients with aggressive periodontitis, patients with chronic periodontitis, and healthy controls, and to correlate the presence of TTV with probing pocket depth and clinical attachment level. Methods: Forty-two subjects (22 males and 20 females) aged 21 to 55 years were recruited for this study. Subjects were stratified into aggressive periodontitis (Group I), chronic periodontitis (Group II) and healthy controls (Group III). Gingival tissue biopsy was taken from all the subjects and the presence of TTV was analyzed using PCR and 2% agarose gel electrophoresis. Results: TTV was identified in half of the subjects and more number of subjects with periodontitis have TT virus compared to controls. There was significant association between presence of TT virus and pocket depth, clinical attachment level. Conclusions: The findings from the present study shows that there was no significant association between TT virus and periodontitis, even though it was isolated from more number of subjects with aggressive periodontitis, and TTV was associated with pocket depth and clinical attachment level. These findings need to be investigated in further studies.

Appearance of Multidrug‐Resistant Opportunistic Bacteria on the Gingiva During Leukemia Treatment

Dentists generally recognize the importance of periodontal treatment in patients with leukemia, with the most attention paid to preventing the development of odontogenic infection. For physicians, the worst type of infection is one caused by multidrug-resistant bacteria. Here, we report a patient with an abnormal increase in multidrug-resistant opportunistic bacteria in the gingiva during hematopoietic cell transplantation (HCT). A 53-year-old woman receiving HCT for leukemia had an insufficient blood cell count for invasive periodontal treatment before HCT. Even brushing caused difficulties with hemostasis. Therefore, frequent pocket irrigation and local minocycline administration were performed. The multidrug-resistant opportunistic bacterium Stenotrophomonas maltophilia was detected first in phlegm 2 days before HCT, and it was detected in a gingival smear and a blood sample 7 and 11 days after HCT, respectively. The patient developed sepsis on day 11 and died 14 days after HCT. Frequent irrigation and local antibiotic application were ineffective against S. maltophilia on the gingiva. Inflammatory gingiva without scaling and root planing showed bleeding tendency, and this interfered with the eradication of this bacterium. The gingiva in patients undergoing leukemia treatment acts as sites of proliferation and reservoirs for multidrug-resistant opportunistic bacteria. Severe systemic infection by multidrug-resistant bacteria in such patients with leukemia also may involve the gingiva. To prevent abnormal increases in such bacteria on the gingiva, scaling and/or root planing before chemotherapy, which reduces bleeding on brushing during the neutropenic period caused by chemotherapy, may contribute to infection control in such patients, although it was impossible in this case.

Human β defensin‐1 and ‐2 expression in the gingiva of patients with specific periodontal diseases

beta defensin antimicrobial peptides are important in epithelial innate immunity, and their differential expression is associated with periodontal diseases. The aims of this study were to determine the mRNA expression of human beta defensin-1 and -2 in the gingival tissue of patients with gingivitis, aggressive periodontitis and chronic periodontitis, and to evaluate the relationship between defensin expression and type and/or severity of periodontal destruction. Fifteen patients in each group with gingivitis, aggressive periodontitis and chronic periodontitis, and 10 healthy subjects, were included in the study (n=55). The periodontal status of the subjects was determined by periodontal clinical measurements and radiographical evaluations. Transcriptional levels of human beta defensin-1 and -2 genes in gingival samples were assessed by using the quantitative real-time polymerase chain reaction technique, and the data were evaluated statistically by the relative expression Software Tool 2 for groupwise comparisons. Expression of the human beta defensin-1 gene was lower in gingivitis and aggressive periodontitis groups, and significantly higher in the chronic periodontitis group, than in the control group (p<0.001). Human beta defensin-2 mRNA expression in the gingivitis group was lower than in the control group; however, the difference was statistically significant only in half of the gingivitis patients (p<0.001). Human beta defensin-2 mRNA levels were higher in some chronic periodontitis patients, but lower in the others when compared with the control group (p<0.001). Expression of the human beta defensin-2 gene increased in the aggressive periodontitis group relative to the control group. This study suggests that human beta defensin-1 and -2 genes in the gingival epithelium show differential expression in patients with specific periodontal diseases, and aggressive and chronic periodontitis types demonstrate different gingival beta defensin-1 and -2 expression patterns.

Tissue engineering of teeth using adult stem cells

Tooth development, a process which occurs in the developing embryo, involves the reciprocal and sequential signalling between epithelial and mesenchymal tissue of the developing first branchial arch. The oral epithelium produces the first inductive signals for odontogenesis at around E10.0, which trigger off a cascade of events that result in the formation of a tooth. We have engineered a tooth in vitro by harnessing the basic principles of odontogenesis and the inductive capability of the oral epithelium of the developing embryo. We replaced the mesenchymal portion of the developing mandibular primordium with aggregates of stem cells from embryos as well as stem cells taken from adult mice. The cell aggregates were covered with embryonic epithelium from E10.0 mouse embryos to form recombinant explants. In vitro culture of these recombinant explants resulted in the induction of early tooth marker genes in the cell aggregates, indicating that the cells were able to respond to the odontogenic signals produced by the oral epithelium. In vivo culture of explants resulted in the induction of Dspp within the cell aggregates indicating that tooth tissue was present. Three recombinant explants, where the cell aggregates consisted of adult bone marrow cells, produced teeth. To determine whether the oral cavity would be able to sustain the growth of an implanted tooth germ, E14.5 molar rudiments were implanted into the diastema region of the maxilla of adult mice. The resulting teeth appeared to be normal in size and were connected to the underlying bone. These experiments are an indication that it is possible to induce odontogenesis and engineer a tooth using adult cells of non-dental origin. They also indicate that developing tooth germs could be successfully implanted into the gingiva of patients.

Total proteoglycan and chondroitin-4-sulfate levels in gingiva of patients with various types of periodontitis.

The aim of the present study was to investigate the total proteoglycan (PG) and chondroitin-4-sulfate (C4S) levels in gingival tissue samples obtained from patients with aggressive periodontitis (AgP) and chronic periodontitis (CP) before therapy (baseline) and 1 month after completion of non-surgical periodontal therapy. Gingival tissue samples were obtained from 10 AgP and 10 CP patients before initiation of treatment (baseline) and 1 month after non-surgical periodontal treatment. The control group comprised 10 systemically and periodontally healthy subjects. Total PG and C4S levels were determined by biochemical techniques. PG levels were analyzed using a modified Bitter and Muir method. C4S assay was carried out using chondroitin sulphate lyase AC and chondroitin-6 sulphate sulphohydrolase enzymes. The results were tested statistically using parametric tests. The clinical periodontal parameters demonstrated significant decreases in the periodontitis groups (P<0.05) after treatment, and there was no significant difference between AgP and CP groups at baseline and after treatment (P>0.05). At baseline, total PG and C4S levels in both of the periodontitis groups were significantly lower than that of the control group (P<0.05). One month after the non-surgical periodontal treatment, total PG levels in the periodontitis groups were comparable to the control group (P>0.05), whereas C4S levels in the AgP group were significantly lower than the other study groups (P<0.05). In the CP group, total PG and C4S levels increased significantly (P = 0.001 and P = 0.006, respectively) after non-surgical periodontal treatment, but they did not increase in the AgP group (P>0.05). The significant increases observed in total proteoglycan and chondroitin-4-sulfate levels after non-surgical periodontal treatment in the CP group but not in the AgP group may suggest that healing patterns differ between the two periodontitis types in terms of PG and C4S composition of extracellular matrix.

Spontaneous gingival antibody production to Fusobacterium nucleatum outer membrane in patients with adult periodontitis

The local antibody response to Fusobacterium nucleatum outer membrane (FnOM) was analyzed in patients with adult periodontitis (AP) at the single cell level. Furthermore, we analyzed whether periodontal hygienic treatment could alter the antibody response. The number of IgG- and IgM-producing cells were investigated in gingival samples collected from 20 patients with AP. The patients were divided into 2 groups, before (BT, n = 9) and after (AT, n = 11) periodontal hygienic treatment. Four healthy gingival samples were used as controls. The results obtained showed that local antibody production against FnOM occurred in gingiva of patients with AP, but not in healthy gingiva. The IgG anti-FnOM was the predominant isotype observed. However, there was no statistically significant difference between the BT and AT groups. These results indicate that periodontal hygienic treatment was not sufficient to alter significantly the number of IgG- and IgM-secreting cells present in gingival tissue of AP patients, but it promoted a reduction of IgG anti-FnOM secreting cells. The presence of anti-FnOM antibodies in AP but not in control patients indicates that this bacteria may play a role in the pathogenesis of periodontal disease.

Stimulation by interleukin-1 of interleukin-6 production by human periodontal ligament cells

Interleukin-1(IL-1), a cytokine present in the gingiva and crevicular fluid of patients with periodontitis and in the periodontal ligament (PDL) of experimentally moved teeth, has multiple biological activities, including the ability to elicit bone resorption. Interleukin-6, also found in the gingiva of patients with periodontitis, may induce osteoclastic bone resorption through an effect on osteoclastogenesis. Here IL-6 production and its gene expression in response to recombinant IL-1β were examined in primary cultures of PDL cells. IL-1β stimulated IL-6 production by these cells in a dose- and time-dependent manner; this increase in IL-6 production was much higher than that in human gingival fibroblasts. In situ hybridization, using a synthetic oligonucleotide DNA probe of the IL-6 gene, revealed that most PDL cells expressed IL-6 mRNA in response to IL-1β treatment. The finding that IL-6 is produced by PDL cells and is regulated by IL-1β has revealed a potentially important mechanism for controlling alveolar bone resorption.

Distribution of immunoglobulin isotypes including IgA subclasses in adult, juvenile, and rapidly progressive periodontitis

The plasma cell population in gingival biopsies from 3 groups of patients with adult, juvenile, and rapidly progressive periodontitis was characterized with respect to the distribution of individual immunoglobulin isotypes, including IgA subclasses, by paired immunofluorescence staining. The median ratios of IgG:IgA plasma cells in gingival connective tissue from the 3 groups were 2.7 (range 2.0-6.5), 3.0 (1.4-6.2), and 2.0 (1.2-4.0), respectively. Cells staining for intracellular IgM were found in low numbers in all biopsies (range 0.3-6.3% of all plasma cells). No statistically significant differences were observed between the 3 patient groups. In all 3 groups, the IgA plasma cell population was predominantly of the IgA1 isotype. One function of IgA seems to be to dampen inflammatory side-effects of other immune effector systems. The demonstrated predominance of IgA1 plasma cells indicates that the majority of IgA produced locally in gingivae of patients with periodontal diseases is susceptible to the IgA1-specific proteases excreted by important members of the disease-associated subgingival microflora. This may be an important factor in the apparently uncontrolled inflammation and tissue degradation taking place in the marginal periodontium during active periodontal disease.

HNK‐1+ (Leu‐7) cells and natural killer cell activity in inflamed human gingival tissue

The presence of HNK-1 (Leu-7)-positive cells and natural killer (NK) cell activity was determined in human periodontal tissues. Gingival tissues obtained from 25 adult patients were processed for analysis utilizing a HNK-1 (Leu-7) mouse monoclonal antibody. A subpopulation of non-adherent lymphoid cells obtained by collagenase digestion of inflamed gingival tissues from 10 patients was examined for the presence of large granular lymphocytes (LGL) by May-Grünwald-Giemsa staining and for NK cell activity against K562 cells by a 51Cr release cytotoxicity assay. HNK-1+ cells were identified in gingival tissue sections of 21 patients, and were present in or close to discrete foci of plasma cells. HNK-1+ cells were scarce in mildly inflamed or uninflamed tissues sections. LGL were identified in 9 of 10 gingival single-cell suspensions and constituted approximately 5% of the gingival cell population. NK cell-mediated cytolysis, at varying effector/target cell ratios, was observed for 3 of 4 enriched gingival mononuclear cell populations. Gamma-interferon (INF-gamma) preincubation of enriched gingival effector cells from 5 additional patients resulted in a 43% increase in NK cell activity. The finding of increased HNK-1+ cells with gingival inflammation suggests that these cells may play a role in tissue damage, as well as in modulation of B cell activity, in gingivae of patients with periodontal disease.