Untreated Adult Periodontitis Research Articles

Digital Scanning Radiographic Image Analysis of Alveolar Bone Loss in Individuals with Untreated Adult Periodontitis and Aggressive Periodontitis: A Cross-Sectional Study

Digital Scanning Radiographic Image Analysis of Alveolar Bone Loss in Individuals with Untreated Adult Periodontitis and Aggressive Periodontitis: A Cross-Sectional Study

Subgingival microbial profiles in refractory periodontal disease.

The purpose of the present investigation was to examine subgingival microbial profiles associated with refractory periodontitis and to seek such profiles in periodontally healthy, periodontally well-maintained elder and untreated periodontitis subjects. 36 subjects were defined as refractory on the basis of further attachment loss after scaling and root planing, surgery and systemically administered antibiotics. A total of 890 subgingival plaque samples (mean/subject=24.7) were taken from the mesial aspect of each tooth in each subject at baseline and individually processed for their content of 40 subgingival taxa using checkerboard DNA-DNA hybridization. Cluster analysis was performed on mean within subject species counts using the chord coefficient and an average unweighted linkage sort. Significant differences among clusters for individual and complexes of species were sought using the Kruskal Wallis test. The microbial profiles of the refractory subjects were compared with those of 27 periodontally healthy subjects (n plaque samples=708), 35 periodontally well-maintained elder subjects (n plaque samples=801) and 115 untreated adult periodontitis subjects (n plaque samples=2871). 28 of 36 refractory subjects fell into 4 clusters with >29% similarity. 10 of 40 species and 4 of 7 complexes differed significantly among clusters. Profile (Cluster) I (n=4) was characterized by high proportions of "yellow" and "green" complex species, profile II (n=3) by low total counts and high proportions of "orange" and "purple" complex species, profile III (n=9) by high total counts and counts of Actinomyces and "purple" complex species, profile IV (n=12) by high proportions of "red" and "orange" complex species. The mean profiles of each cluster were subjected to cluster analysis with microbial data from 4380 (mean 24.7) baseline subgingival plaque samples from 27 periodontally healthy, 35 treated, well-maintained elders and 115 untreated adult periodontitis subjects. 12 clusters were formed with >41% similarity. 3 of the refractory profiles were detected in 3 cluster groups. Profile II in a cluster of 1 healthy, 1 elder and 4 untreated periodontitis subjects; profile III in a cluster of 1 healthy, 2 elder and 12 periodontitis subjects; Profile IV, with 1 healthy and 5 untreated periodontitis subjects. The profile not detected in non refractory subjects was dominated by Streptococcus species. 9 clusters did not harbor refractory profiles. 11.1% of healthy, 8.6% of elder and 18.3% of periodontitis subjects were in clusters exhibiting refractory microbial profiles. 4 subgingival microbial profiles were detected among refractory subjects. "Refractory microbial profiles" could be detected in subjects who had not yet exhibited refractory disease.

Periodontal bone loss in Chinese subjects with untreated early-onset and adult periodontitis: a cross-sectional study using digital scanning radiographic image analysis.

The purpose of this investigation was to evaluate the differences in radiographic alveolar bone loss (RABL) in Taiwanese subjects with early-onset periodontitis (EOP) and adult periodontitis (AP) using the digital scanning radiographic image analysis (DSRIA). A total of 4,262 teeth from 178 individuals (96 males and 82 females) were examined for RABL due to EOP and AP. The subjects with EOP and a comparison group with AP were identified from the Periodontal Clinic population (College of Dental Medicine, Kaohsiung Medical University). The following criteria were used to classify subjects with EOP and AP during the past 20 years. The RABL of teeth were calculated using a computer system equipped with Microstation 95 software, under 10 X magnification of the radiographs. Quantity assessment of RABL using the DSRIA showed that: (1) the means of RABL of maxillary and mandibular anterior teeth in the EOP group were significant greater than those in the AP group when the two sample t-test was used. (2) The greatest values of mean RABL of affected sites in the EOP group occurred most commonly in the first molars and mandibular incisors, whereas, in the AP group, the greatest values of mean RABL of affected sites occurred most commonly in the first and second molars. (3) Molars had the greatest mean RABL followed by incisors, premolars and canines. (4) The mean RABL increased with increasing age. We conclude that the features of naturally progressing alveolar bone loss at the molar and incisor sites in untreated subjects with the EOP and AP revealed that the mean RABL in the EOP group was faster and greater than that in the AP group.

Soluble CD14 levels in gingival crevicular fluid of subjects with untreated adult periodontitis.

This study determined soluble CD14 (sCD14) levels in gingival crevicular fluid (GCF) and their potential relationship to periodontal conditions in adult periodontitis. GCF was collected from 15 patients with untreated adult periodontitis. sCD14 levels were determined by ELISA and presented as total amount (ng/site) and concentration (microg/ml). The periodontal examination consisted of plaque index (PI), bleeding index (BI), probing depth (PD), and clinical attachment level (CAL). PD and CAL were measured with an electronic probe. sCD14 was detected in all 15 subjects and was found in 59% (62/105) of the sampled sites. The percentage of sites with sCD14 varied greatly, ranging from 14% to 100%. The mean total amount of sCD14 was 1.71+/-0.40, range 0.03 to 5.41 ng/site; the concentration of sCD14 was 14.04+/-4.15, range 0.16 to 51.74 microg/ml. No significant difference in clinical data was found between the sites with and without detectable levels of sCD14. However, on the basis of the individual profile of sCD14 levels, i.e., those individuals with >50% of the sites containing sCD14 and mean levels of sCD14 >5.0 microg/ml, the 15 subjects were divided into a high sCD14 group (9 subjects) and a low sCD14 group (6 subjects). Compared to the high group, the low group showed greater mean PD and a higher percentage of sites with PD > or = 5.0 mm (P <0.05). Consistent with this, sCD14 concentrations showed a negative correlation with PD (r(s) = -0.636, P = 0.0174). The present study shows that sCD14 levels in GCF varied greatly among subjects with untreated adult periodontitis. Individuals with higher levels of sCD14 in GCF and more sites containing sCD14 had fewer deep pockets. The negative correlation between GCF sCD14 levels and probing depth implies a crucial role of sCD14 in bacterially induced periodontal destruction. The relationship between GCF sCD14 levels and probing depth warrants further investigations.

Bacteremia Due to Periodontal Probing: A Clinical and Microbiological Investigation

Infective endocarditis can occur in susceptible individuals due to bacteremia of oral origin. The aim of this study was to investigate the occurrence of bacteremia caused by full mouth periodontal probing. Forty patients, 20 with adult periodontitis (10 males, 10 females; mean age 43.0 years) and 20 with chronic gingivitis (11 males, 9 females; mean age 35.5 years) were investigated. Prior to and immediately following periodontal probing, 20 mL of venous blood were obtained from each patient and inoculated into aerobic and anaerobic blood culture bottles and incubated. Negative bottles were monitored continuously for 3 weeks before being discarded. Bottles which signalled positive were subcultured and isolates identified to genus level. Periodontal probing consisted of measuring pockets at 6 points around each tooth and recording the presence or absence of bleeding. A plaque index (PI) was assessed on the 6 Ramfjord teeth. Probing caused bacteremia of oral origin in 8 (40%) of the periodontitis patients and 2 (10%) of the gingivitis patients. Streptococcus spp. were the most common isolates in both groups. Compared with the gingivitis group the odds ratio (OR) for bacteremia in the periodontitis group was 5.993 (95% CI 1.081 to 33.215). Bleeding on probing (OR 1.025, 95% CI 1.004 to 1.047) and mean probing depth per tooth (OR 1.444, 95% CI 1.055 to 1.977) were significantly associated with bacteremia. No significant correlations were found between bacteremia and age, number of teeth probed, smoking status, PI, or total probing depth. Patients with untreated adult periodontitis are at greater risk of bacteremia due to periodontal probing than patients with chronic gingivitis. For individuals at risk of infective endocarditis, radiographic assessment prior to periodontal probing would be advisable to identify those with periodontitis so that appropriate antibiotic prophylaxis can be provided.

Granulocyte elastase activity and PGE2 levels in gingival crevicular fluid in relation to the presence of subgingival periodontopathogens in subjects with untreated adult periodontitis.

This study aimed to determine the association between the levels of granulocyte elastase and prostaglandin E2 (PGE2) in GCE and the concomitant presence of periodontopathogens in untreated adult periodontitis (AP). GCF and subgingival plaque were sampled by paper strips and paper points respectively, from various periodontal sites in 16 AP subjects. Granulocyte elastase activity in GCF was analyzed with a low molecular weight substrate specific for granulocyte elastase, pGluProVal-pNA, and the maximal rate of elastase activity (MR-EA, mAbs/min/site) was calculated. PGE2 levels in GCF were determined by radioimmunoassay. 5 species-specific DNA probes were used to detect the presence of A. actinomyceterncomitans (A.a., ATCC 43718), B. forsythus (B.f, ATCC 43037), P. gingivalis (P.g., ATCC 33277), P. intermedia (P.i., ATCC 33563), and T. denticola (T.d., ATCC 35405), with a sensitivity of 10(3) cells/paper point. No A.a. was detectable from all sites sampled. The predominant combination of species detected was B.f., P.g., P.i. & T.d. and it was significantly higher at periodontitis sites (68%) than at healthy (7%) or gingivitis sites (29%) (p<0.05). Overall, MR-EA values were strongly correlated with PGE2 levels (r=0.655, p<0.001), especially at these periodontitis sites co-infected by B.f., P.g., P.i. & T.d. (r=0.722, p<0.001). The periodontitis sites co-infected by the 4 species were observable from 15 subjects. These sites were sub-grouped into 8 subjects with a high MR-EA and 7 subjects with a low MR-EA. The PGE2 levels in the high MR-EA group were significantly higher than in the low MR-EA group (p<0.05). No significant differences in clinical or bacterial data were found between the two groups. While within the high MR-EA group, similar results were found between the paired periodontitis sites in each subject with highest and lowest MR-EA values. This study shows that the local host response to bacterial challenge in untreated periodontal pockets is diverse in terms of the intensity of inflammatory response measured by granulocyte elastase and PGE2 levels in GCE A more thorough evaluation of the risk for active periodontal disease may involve the combined approaches to the test of the dynamic bacteria-host relations.

Site‐Specific Attachment Level Change Detected by Physical Probing in Untreated Chronic Adult Periodontitis: Review of Studies 1982‐1997

Site-specific attachment level change, detected from sequential physical probing measurements, is currently the most common method of determining the progression/regression or stability of disease status in subjects with chronic adult periodontitis. The sensitivity and accuracy of detection is dependent on the type of probe used, the recording method, the measurement error, and the method of data analysis. In recent years, there has been world-wide interest in developing instruments and methods to minimize measurement error. Published data report disturbingly wide variation in the prevalences and rates of site-specific attachment level change which are difficult to reconcile with biological likelihood. The present paper aims to summarize the salient points from the key studies and to compare the results. The literature between 1982 and 1997 was reviewed for studies in which site-specific attachment level change was detected by physical probing methods in patients with chronic adult periodontitis. The review documents 23 studies by probe generation, compares methods and results and summarizes the results according to the thresholds and probe type used. The 23 studies used an array of probe types from the 3 probe generations. From this review, we conclude that: 1) There are surprisingly few papers which have addressed the question of site-specific attachment level change in untreated chronic adult periodontitis. 2) There are considerable differences in the probes used, in the thresholds achieved, in the number of measurements taken, in the number of subjects and sites studied, and in the duration of the studies. Valid comparisons between studies are, therefore, rarely possible. 3) Only 8 out of 23 papers from 1982 to 1997 have adequate data. Most papers report only losing sites and therefore ignore many of the measurements recorded. Only one paper describes losing sites, gaining sites, and sites showing exacerbation/remission patterns of change. 4) The range of changes described show such variation that it has to be concluded that we cannot reliably detect site-specific attachment level change by physical probing and thus, at the end of the 20th century, we have no clear idea of the natural history of this disease.

Prediction and diagnosis of attachment loss by enhanced chemiluminescent assay of crevicular fluid alkaline phosphatase levels.

The current study aimed to apply a novel enhanced chemiluminescence assay in the analysis of gingival crevicular fluid (GCF) alkaline phosphatase (ALP) levels from patients with untreated adult periodontitis. 3666 sites in 25 patients were monitored prior to and after attachment loss was detected with a Florida disc probe. Parameters assessed were, relative attachment level, probing pocket depth, occurrence of bleeding on probing (single episode), GCF volume (microliter), total ALP levels (microIU/30 s sample time) and ALP concentration (IU/l). After recruiting patients to the study, all measures were taken at baseline and 3 months later, prior to the institution of non-surgical periodontal therapy at active sites. Thresholds for determining attachment loss were calculated using a modification of the tolerance method. The mesio-buccal sites of all teeth had GCF samples collected. The size of individual patient thresholds used to define whether attachment loss had occurred, was dependent upon the discomfort felt by that patient during electronic probing, with a positive correlation existing between discomfort on probing (10 cm visual analogue scale) and threshold size (R = 0.52, p < 0.049). A total of 274 sites (7.5%) experienced attachment loss of which 39 sites had GCF samples available for analysis. Total ALP levels were significantly higher at baseline for sites that progressed to attachment loss than paired controls (p < 0.003), but all other parameters showed no differences (p > 0.1). There were significant increases in total ALP levels and GCF volumes for active sites between baseline and 3 month measures (p < 0.01), but not for control sites or test site ALP concentration (p > 0.8). The diagnostic accuracy for GCF ALP as a predictor of future attachment loss (threshold 900 microIU/30 s) was 64%, with +ve and -ve predictive values of 62% and 68%. When a threshold of 1300 microIU/30 s was selected for ALP as a marker of recent or currently active disease, diagnostic accuracy and +ve/-ve predictive values were 77% and 77%/76%, respectively. These results indicate that total GCF ALP levels may serve as a predictor of future or current disease activity.

Efficacy of systemically administered acetylsalicylic acid plus scaling on periodontal health and elastase‐α1‐proteinase inhibitor in gingival crevicular fluid

The purpose of this proof of principle trial was to assess whether conventional periodontal therapy and systemically administrated acetylsalicylic acid (ASA) are functionally synergistic when combined in the treatment of periodontitis. A total of 30 patients with untreated moderate to severe adult periodontitis were enrolled into the study and were given placebo q.i.d. between the baseline and 6-week examination, and acetylsalicylic acid (ASA) 500 mg q.i.d. between the 6-week and 12-week examinations. In addition, they received supra- and subgingival scaling in 1 quadrant after baseline examination and in 2 further randomly selected quadrants after the 6-week examination. The study design resulted in the following 4 therapies: (1) scaling plus ASA 500 mg q.i.d.; (2) scaling plus placebo q.i.d.; (3) ASA 500 mg q.i.d. alone; (4) placebo q.i.d. alone. Two-way analysis of variance showed functional synergism of ASA and scaling, resulting in a therapeutic efficacy approximately equivalent to the sum of each individual therapeutic efficacy (i.e., ASA alone and scaling alone) in reducing gingival inflammation and pocket probing depth over the 6-week observation period (interaction: p > 0.05). Only the effect of ASA was significant in reducing the concentration of elastase-alpha 1-proteinase inhibitor in gingival crevicular fluid (GCF E-alpha 1-PI) (p < 0.001), reduction in GCF E-alpha 1-PI concentrations by ASA may indicate a decreased risk in periodontal disease progression. The results suggest that the combination of therapies and their different mechanisms of action, i.e., reduction of bacterial plaque and inhibition of destructive components of the immune responses, may result in functionally synergistic therapeutic efficacies in patients with untreated adult periodontitis.

Periodontal microbiota of mobile and non-mobile teeth.

The mechanism of accelerated periodontal destruction around teeth with occlusal trauma and increased mobility remains unclear. One possibility is that tooth mobility creates a subgingival environment conducive to overgrowth by periodontal pathogens. This study compared the subgingival microflora in mobile and non-mobile teeth of 35 adults on supportive maintenance therapy and 15 with untreated adult periodontitis. In each subject, subgingival paper-point samples were obtained from a mobile tooth with a probing depth of 4 mm or greater and from a non-mobile tooth with similar probing depth and gingival index. Samples were transported in VMGA III medium. Pockets around mobile teeth harbored significantly higher proportions of Campylobacter rectus (P = 0.001) and Peptostreptococcus micros (P = 0.05) than pockets with non-mobile teeth. Mobile teeth also tended to show elevated levels of Porphyromonas gingivalis, but this did not reach statistical significance. This study suggests that tooth mobility may constitute a risk for periodontal breakdown due to an increased subgingival occurrence of specific periodontopathogens. This hypothesis needs to be verified in longitudinal clinical and microbiological studies.

Humoral immune responses to Porphymmonas gingivalis and Actinobacillus actinomycetemcomitans in adult periodontitis and rapidly progressive periodontitis

The relationships between various forms of periodontal disease and the avidities of serum antibodies of all 3 immunoglobulin (Ig) classes (IgG, IgM and IgA) to Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans were investigated. Twenty-four patients with untreated adult periodontitis and twelve untreated patients diagnosed as suffering from the early-onset form of periodontitis, rapidly progressive periodontitis, were studied. The latter group were matched for age and sex to healthy controls. Antibody titres were measured and avidity (expressed as molarity) was further assayed using the thiocyanate elution method. Avidity has previously been shown to relate to the biological function of antibody. IgM avidities to P. gingivalis were lower in the rapidly progressive periodontitis group than in the adult periodontitis group (0.54 M vs 0.74 M). IgG avidities tended to be lower in the former than in the latter group (0.58 M vs 0.92 M). In accordance with other workers, seropositivity was defined as an immunoglobulin titre more than twice the median level of control sera. Only 2 of the rapidly progressive periodontitis group were seropositive. Interestingly, the seronegative rapidly progressive periodontitis patients were significantly different (0.53 M vs 0.92 M). The data that patients with various forms of periodontal disease appear to produce antibodies of differing avidity to P. gingivalis suggest that the quality of the humoral immune response to suspected periodontopathogens may have a bearing on the aetiology of periodontal disease.

Microbial associations of 4 putative periodontal pathogens in Sudanese adult periodontitis patients determined by DNA probe analysis.

The few previous cultivation studies on the in vivo associations between various periodontal microbial species have shown several positive and negative associations. The present investigation utilized DNA probe analysis to examine possible in vivo associations between the periodontal pathogens Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, and Bacteroides forsythus in subgingival plaque samples obtained from 25 Sudanese untreated adult periodontitis patients. The standard paper point technique was used to sample 99 sites with a mean probing depth of 6.8 mm (range 6.0 to 10.0). Microbial associations were determined by detecting the effect of the presence or absence of one species (effector) on the occurrence of the other 3 species (target). The Wilcoxon signed rank test was used to examine variations in occurrence of each target bacteria in the presence or absence of the effector. In addition, the Spearman's rank correlation test was used to assess the relationship between the level of each bacteria to that of the other 3. Results showed bacterial associations with the following effector-on-target effects: F. nucleatum (P < 0.01 Wilcoxon; P < 0.001 Spearman) >> P. gingivalis (P < 0.01 Wilcoxon; P < 0.001 Spearman), and B. forsythus (P < 0.05 Wilcoxon; P < 0.001 Spearman) > P. intermedia (P < 0.01 Spearman). The study demonstrated positive associations between the 4 species investigated, while no neutral or negative associations were revealed. The most striking finding was the effect exerted by F. nucleatum on the colonization of P. intermedia; P. intermedia was never detected in a site unless F. nucleatum was also present.

Histological evaluation of interleukin-1 beta and collagen in gingival tissue from untreated adult periodontitis.

Interleukin-1 beta (IL-1 beta) may be related to the pathological processes associated with periodontitis, primarily due to its ability to induce collagenase, increase neutrophil chemotaxis, and stimulate bone resorption. This study was designed to histologically quantitate IL-1 beta positive cells from various histologic fields in untreated gingivitis/early periodontitis (G/EP) versus moderate/severe periodontitis (M/SP) gingival tissues, and associate these with collagen loss. Two gingival biopsies from 8 patients were collected, one from a G/EP site and one from a M/SP site. Mouse monoclonal antibodies in combination with an avidin-biotin-peroxidase system were used to stain for IL-1 beta, while the van Gieson method was used to stain for collagen in serial sections. Collagen loss in G/EP (35%) and M/SP (52%) fields was consistent with gingivitis and periodontitis, respectively. IL-1 beta positive cells in combined coronal/sulcular (Co/Su) and apical/sulcular (Ap/Su) fields (nearest the bacterial insult) were significantly more numerous compared to combined coronal/middle (Co/Mi) and apical/middle (Ap/Mi) fields (p < 0.05). While numbers and percentages of IL-1 beta positive cells were generally higher in M/SP biopsies, differences were not significant. Further, there was no correlation between the number of IL-1 beta positive cells and percent collagen loss. However, a significant correlation between IL-1 beta positive cells and corresponding gingival crevicular fluid IL-1 beta concentrations was noted (r = 0.65, p = 0.01). Through the use of immunohistochemistry, this study demonstrated that the presence of IL-1 beta + cells does not appear to have a direct association with collagen loss.

Salivary collagenase, elastase‐and trypsin‐like proteases as biochemical markers of periodontal tissue destruction in adult and localized juvenile periodontitis

The profile of salivary proteases and their cellular origin, with special reference to polymorphonuclear leukocytes and bacteria, was studied in localized juvenile periodontitis and compared with adult periodontitis and healthy controls. General proteolytic activity in saliva as well as collagenase, elastase-like and trypsin-like activity was measured. In addition, the sensitivity of salivary collagenase of patients with localized juvenile periodontitis to doxycycline inhibition was studied. The saliva of localized juvenile periodontitis patients contained low amounts of collagenase compared with adult periodontitis saliva, and almost all salivary collagenase was found to exist in endogenously active form, as was found to be the case also in adult periodontitis patients and healthy controls. The salivary collagenase of localized juvenile periodontitis patients was relatively insensitive to 100 mumol/l doxycycline but was completely inhibited by 600 mumol/l doxycycline, reflecting rather matrix metalloproteinase-1 (fibroblast-type) than matrix metalloproteinase-8 (polymorphonuclear leukocyte) enzyme. The saliva of localized juvenile periodontitis patients also contained low amounts of elastase-like activity compared with the saliva of untreated adult periodontitis patients. Scaling and root planing caused a significant decrease in elastase-like activity in the saliva of adult periodontitis patients. General proteolytic and trypsin-like activities were also low in the saliva of localized juvenile periodontitis patients. Furthermore, the reducing agent beta-mercaptoethanol did not activate or inhibit the salivary trypsin-like activity of localized juvenile periodontitis or adult periodontitis patients, although the reductant readily activated partially purified Porphyromonas gingivalis trypsin-like protease in a characteristic manner.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunoglobulin isotype distribution of locally produced autoantibodies to collagen type I in adult periodontitis

Production of antibodies to collagen type I was analyzed by means of an enzyme-linked immunospot (ELISPOT) assay in patients with chronic adult periodontitis (AP) before and after periodontal hygiene treatment. Anti-collagen type I antibody-secreting cells were found among mononuclear cells enzymatically eluted from inflamed gingiva in 9 of 15 patients with untreated AP and in 4 of 14 hygiene-treated patients with a varied isotype distribution. A notably high prevalence of IgG and IgM isotypes was observed for the anti-collagen antibodies in untreated patients. With wide variation, chronic AP was characterized by a high frequency of spontaneous IgG and low numbers of IgA and IgM-producing cells. Periodontal hygiene treatment significantly reduced the number of IgA and IgM-secreting cells. Although AP is not an autoimmune disease in the accepted sense, our results indicate that local autoimmune reactions to collagen type I are common in untreated AP, implying an interplay between periodontal infection and autoimmunity.

The plasma cell at the advancing front of the lesion in chronic periodontitis

This study analyses the ultrastructure of the plasma cell population of periodontitis-affected soft tissue close to the advancing front of interdental lesions. Biopsies from 20 patients and 3 control volunteers were examined: 5 with treated adult periodontitis (AP), 5 with untreated AP, 5 with treated juvenile or post-juvenile periodontitis (JP) and 5 with untreated JP. Plasma cell (PC) counts increased significantly (p less than 0.05) with lesion severity. They were absent from epithelium and sparse in the clinically healthy control specimens. Degenerate PC tended to be more numerous within JP tissue but differences were not significant (p greater than 0.05) when compared to AP. Intact plasma cells were never seen within JP superficial connective tissue. Russell bodies were small and few in number. The presence of degenerated plasma cells indicated normal formation and release of immunoglobulins within the tissues of AP and JP. Increased counts of degenerate PC and tissue destruction in JP suggested a correlation, possibly attributable to anti-collagen antibody secretion.

Antibodies to Bacteroides gingivalis in patients with treated and untreated periodontal disease.

It is proposed that the development of periodontal disease is associated with rising levels of serum and gingival crevice fluid (GCF) IgG antibodies to specific organisms, while treatment of periodontal disease is associated with a decline in specific IgG antibodies. This study examined the immune response to Bacteroides gingivalis, a suspected periodontal pathogen, in serum and GCF of patients with adult periodontitis. Three groups of subjects were studied: (1) patients with untreated adult periodontitis, (2) patients with treated adult periodontitis, and (3) patients with gingivitis (controls). An enzyme-linked immunosorbent assay was employed using whole formalinized B. gingivalis (ATCC 33277) as antigen. Results showed that the untreated adult periodontitis patients had a humoral immune response to B. gingivalis, producing significantly higher serum levels of IgG antibody to that organism than did patients with treated adult periodontitis (p less than or equal to 0.01) or gingivitis (p less than or equal to 0.005). The untreated patients also demonstrated a local immune response to B. gingivalis in that their GCF levels of IgG antibody to that organism were also significantly higher than levels in treated adult periodontitis patients (p less than or equal to 0.005) and gingivitis patients (p less than or equal to 0.001). These results are consistent with reports by other investigators. However, ratios of GCF antibody to serum antibody in the untreated adult periodontitis group were not significantly higher than ratios in the other two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Intra-oral distribution of black-pigmented Bacteroides species in periodontitis patients.

In this study the occurrence of black‐pigmented Bacteroides on oral mucous membranes and in saliva was investigated. For this purpose untreated adult periodontitis patients were selected on the basis of clinical parameters. Bacteroides gingivalis was isolated from the subgingival area of all 8 patients. Other sites from which B. gingivalis was recovered were the tonsillar area, the gingiva and the tongue. Six of the 8 patients had B. gingivalis in saliva in numbers ranging from 6 × 106 to 20 × 106/ml. Bacteroides intermedius was also widespread through the oral cavity, including the saliva. The results show that these black‐pigmented Bacteroides species do occur outside the periodontal pocket and that the intra‐oral spread of these bacteria can take place via saliva.

Serum IgA and IgG antibodies to Treponema vincentii and Treponema denticola in adult periodontitis, juvenile periodontitis and periodontally healthy subjects

13 patients with untreated adult periodontitis (AP) were compared to 8 subjects free of periodontal disease (H) with respect to plaque index (PlI), gingival index (GI), probing depth (PD) and differential counts of subgingival bacterial morphotypes from a pooled sample of 6 surfaces with the greatest probing depth. Serum antibody levels to T. vincentii and T. denticola strains were also determined in these subjects as well as in the sera from 5 subjects with localized juvenile periodontitis (LJP). Subjects with AP had significantly elevated proportions of spirochetes and motile rods and lower proportions of coccoid cells than H subjects. They also exhibited significantly higher PlI and GI scores and greater probing depths. Antibody levels were normalized against a standard serum and expressed as ELISA units (EU). IgA and IgG antibody levels to all tested spirochete strains were significantly elevated in AP subjects as compared to subjects in group H or subjects with LJP. No significant differences in antibody titers were detectable between the H and LJP groups with respect to any of the tested strains. No significant correlation could be demonstrated between serum antibody titers to any of the oral spirochete strains tested and the proportions of oral spirochetes determined microscopically.