Occurrence of Porphyromonas gingivalis, Bacteroides forsythus, and Treponema denticola in periodontally healthy and diseased subjects as determined by an ELISA technique

The aim of this study was to assess by means of an ELISA technique, the occurrence of 3 putative periodontopathogens, Porphyromonas gingivalis, Bacteroides forsythus, and Treponema denticola, in 3 clinically-defined adult periodontal conditions. Thirty systemically-healthy subjects were selected and grouped into 3 categories according to their periodontal health: 1) 10 periodontitis subjects (PS), having moderate adult chronic periodontitis; 2) 10 untreated gingivitis subjects (UGS), exhibiting no signs of periodontal destruction but presenting with clinical signs of mild gingivitis; and, 3) 10 treated gingivitis subjects (TGS), having the same clinical status as UGS, but who received a thorough prophylaxis treatment within the past 7 to 14 days prior to the baseline examination. A total of 60 samples were collected subgingivally from the six Ramfjord teeth per subject in each group and ELISA analysis was carried out to give a semiquantitative estimate of P. gingivalis. B. forsythus, and T. denticola. The immunologic detection method suggested the presence of antigens of P. gingivalis, B. forsythus, and T. denticola in subjects from each of the 3 groups. When a global analysis for the 3 disease groups was performed at one time, statistically significant differences were found among the ELISA scores of the 3 bacterial species. For example, comparisons of the ELISA scores showed that the concentrations of P. gingivalis differed significantly when comparing TGS to UGS and PS, but not when examining UGS/PS. The ELISA scores for B. forsythus were significantly different between TGS and PS. Mean concentrations of T. denticola were significantly different when comparing PS to TGS or UGS, whereas no difference was found between the latter categories. Within the limited scope of this study, the concentration of antigens detectable from putative periodontopathogens like P. gingivalis, B. forsythus, and T. denticola differed among the 3 diseased groups, with periodontitis subjects often showing the greatest level of antigens. Thus, it is reasonable to expect that, when using sensitive immunological detection methods, antigens of suspected periodontal pathogens can be found irrespective of the individual's clinical status. However, while detectable in the periodontal sites, the concentrations of these microorganisms are most likely to be above the threshold necessary to induce clinically-significant disease. Studies with larger sample size and standardized antigens are necessary to determine if the groups we found not to differ, were, in fact, different.

Flow cytometric approach to human polymorphonuclear leukocyte activation induced by gingival crevicular fluid in periodontal disease

In gingival pockets of patients with periodontal disease, polymorphonuclear leukocytes (PMN) are in contact with a peculiar exudate, the gingival crevicular fluid (GCF). Because of the pivotal role played by PMN in periodontal disease, we evaluated the ability of GCF in modulating normal human PMN. GCF was obtained from two gingival sites with severe periodontitis (SP) and two gingival sites with only mild periodontitis (MP) in 12 patients. Purified PMN were exposed to GCF from SP and MP sites and, as a control, to sterile culture medium. GCF activity was evaluated by monitoring the modulation of membrane molecules relevant to cell function. Compared to control medium, GCF from SP and MP sites was able to induce an activation status in PMN evidenced by an increased CD11b (62 +/- 9% and 28 +/- 7%, respectively) and f-Met-Leu-Phe (56 +/- 5% and 31 +/- 7%, respectively) receptor expression, with a concomitant reduction of CD62L expression (56 +/- 8% and 23 +/- 7%, respectively). Thus, reflecting the clinical status, GCF from SP sites was significantly more efficient in affecting PMN than GCF from MP sites. Cell size modifications, evaluated as an additional indicator of PMN activation, were consistent with membrane molecule modulation. The difference in PMN-activating capacity between SP and MP was abrogated by the successful completion of an appropriate periodontal therapy that dramatically improved clinical status. This is the first direct demonstration that GCF from periodontitis has the capacity to activate normal resting PMN and that this capacity reflects the magnitude of the inflammatory process that takes place in the gingiva.

Influence of gingival crevicular washing on the expression of polymorphonuclear leukocyte membrane receptors before and after periodontal therapy

Extensive data demonstrate that polymorphonuclear leukocytes (PMN) are the predominant cell type involved in periodontal disease and that gingival crevicular fluid constituents are influenced by the inflamed gingiva. The aim of the present study was to evaluate the ability of gingival crevicular washing (GCW) (a dilution of gingival crevicular fluid) from periodontal sites in different clinical conditions of modulating the PMN membrane receptors involved in motility, adhesion and phagocytosis before and after periodontal treatment. 10 patients affected by adult periodontitis (AP) were selected. From each patient, 2 test sites (TS) were chosen on the basis of a probing depth > 5 mm and attachment loss, and 2 control sites (CS) with probing depth < 3 mm without. Modifications of membrane receptor density of PMN from healthy donors incubated with GCW harvested from TS and CS was evaluated using fluorescent probes and flow cytometry. Compared to CS-GCW, TS-GCW before therapy increased the expression of the beta 2 integrin CD11b and the chemotactic receptor for the oligopeptide N-formyl methionyl leucyl phenylalanine (FMLP-R) while it reduced the expression of L-selectin. GCW collected from the same TS after the successful completion of periodontal treatment did not influence PMN receptors, indicating that the clinical improvement paralleled the disappearance of the PMN modulating capability contained in TS-GCW before therapy. In conclusion, the present data illustrate the relevant modifications occurring at PMN membrane in chronic adult periodontitis exerted by GCW obtained by a simple fluid collection technique. Thus, monitoring gingival crevicular fluid PMN activating capability may help disclose the presence of chronic periodontitis and may be useful in assessing successful treatment.

[Interleukin-1 beta in the gingival tissues of patients with periodontitis: immunohistochemical data]

Interleukin-1 beta (Il-1 beta) is a cytokine which is considered to play a role in inducing the inflammatory reaction and the bone resorption that takes place in periodontal disease. With the aim of studying the presence and location of Il-1 beta positive cells in this disease, human gingival tissues from 12 patients with periodontitis and from 4 healthy control subjects were examined by immunohistochemical analysis. The cytokine was detected in all the patients having untreated periodontitis, although its content in gingival tissues revealed considerable variations among subjects. Il-1 beta was mainly localized within macrophage-like cells. Il-1 beta positive cells were not present in normal gingival tissue; however in 2 of the subjects considered normal there were few Il-1 beta positive cells in small areas of inflammation present in proximity of the dento-gingival junction.

[The clinical and microbiological evaluation of the efficacy of oral irrigation on the periodontal tissues of patients wearing fixed orthodontic appliances]

The aim of the present study has been the evaluation of the effectiveness of oral irrigation with or without toothbrushing and dental flossing, in individuals treated with fixed orthodontic appliances, on controlling the development of dental plaque and, hence, of gingivitis. Eight individuals with a good general and oral status have been chosen. Before the experimental period, they received instructions about oral hygiene with toothbrushing and dental flossing and then they have been monitored to verify they were doing well. At the time T0, the upper tooth have been banded, three Periodontal Indexes (Plaque Index according to Silness and Loe, Modified Gingival Index according to Lobene and Gingival Bleeding Index according to Ainamo and Bay) registered and subgingival plaque samples from the premolars' gingival sulcus collected in order to point out the total anaerobes bacterial counts, the rates of motile bacteria, spirochetes, Gram positive and Gram negative cocci and bacteria, by means of optical and dark field microscopy and of cultural methods. For their oral hygiene, the patients had to use, in the right side toothbrush and dental floss (Control 1), in the left side the oral irrigator alone (Test 1). One month later (time T1), the lower teeth have been banded, too. In the right side the patients had to use toothbrush and dental floss (Control 2), while in the left one they used the same devices as Control 2 plus the oral irrigator (Test 2). At the time T1 Periodontal Indexes and Microbiological analyses have been extended to all the four quadrants.(ABSTRACT TRUNCATED AT 250 WORDS)

[The comparative evaluation of the efficacy of surgical and nonsurgical periodontal therapy in relation to the oral hygiene conditions and the severity of the lesions]

A retrospective longitudinal study was carried out to evaluate the efficacy of surgical and nonsurgical periodontal therapy in reducing pocket depth values. This evaluation was made in relation to the strictness with which patients observed professional and domestic oral hygiene and in relation to pretreatment pocket depth values. Results showed that the two forms of periodontal therapy offer comparable results in terms of pockets reduction of either restricted or considerable depth, whereas the most important element in order to achieve therapeutic success was the observation of an effective professional and domestic plaque control.

General considerations in the treatment of periodontal disease: infection control, medications, and wound healing

Although it is difficult to accurately predict the results of periodontal therapy, it may be possible to improve the success of therapy if the patient is considered from an immunologic, microbiologic, social, and behavioral point of view, as a heterogenous entity. The success or failure of a particular treatment can be related to the host's personal response to a therapeutic procedure rather than to the technique used.

[Modifications in the clinical and microbiological parameters of the periodontal tissues after the removal of overhanging class-II amalgam fillings]

A short-term longitudinal study was carried out to assess how microbiological and clinical characteristics, measured surrounding periodontal sites with amalgam class II fillings intentionally made to overhang, vary following their replacement with a correct form of filling. The results of the study showed a significant reduction of the total bacterial count and the percentages of Gram-negative and anaerobic organisms spreading from overhanging fillings to non-overhanging fillings. The paper concludes that, as has been already demonstrated in the case of onlays, there are both qualitative and quantitative variations in the subgingival plaque in the presence of overhanging fillings which can lead to periodontal damage.

[Periodontal therapy. II. The possible interpretations of the therapeutic results from surgical and nonsurgical treatment]

The authors put forward four different explanations to justify the similarity of published results on the efficacy of different techniques of periodontal therapy. It is stressed that over and above the purely doctrinal evaluation of results obtained using different forms of periodontal therapy, it is indispensable to draw up a treatment protocol for each case taking into account the specific conditions and requirements of the patient to be treated.

[The reliability of different groups of sample teeth in assessing the status of periodontal disease in epidemiological studies]

The possibility of evaluating periodontal disease status in a given population by examining a limited number of sample teeth is of undoubted value in epidemiological studies. To this end, a cross-section study was performed to assess whether the dental sample proposed by Ramfjord effectively reflects the entire dentition status in terms of the main Clinical Indices of Periodontal Disease, in particular pocket depth. In addition, two randomly selected samples of six teeth were also evaluated using the same criteria. On the basis of their findings, the Authors confirm the epidemiological validity of Ramfjord's dental sample and stress that different groups of sample teeth may be efficaciously used to assess the periodontal disease status of the entire dentition in epidemiological studies.

[Periodontal therapy. I. The working philosophies]

Periodontal treatment has recently been evaluated by numerous research projects which have confirmed its validity and clarified the indications and limits of treatment. In this review the authors discuss and analyse the results achieved using different techniques of periodontal therapy; moreover, attention is focused on the apparent similarity of results obtained using conservative and surgical methodologies.

[Use of the interproximal brush]

Interdental brushes are often recommended for interdental cleaning in people with destruction of periodontal tissue and open interproximal spaces. The purpose of this investigation was to determine how frequently interdental brush can reach the interdental spaces in individuals with and without papilla destruction. An outstanding percentage of brush-penetration trough interproximal spaces has been observed in patients with no gingival recession and no loss of attachment.

[Role of endotoxins in periodontal disease]

The Authors, through a review of the literature, analyzed the role played by Endotoxins in the pathogenesis of the periodontal lesions. It is furthermore considered the therapeutic problem of the necessity of a complete removal of such substances from the dental root in arder to obtain a radicular surface which could allow a good healing of the periodontal lesions.

[The age factor in periodontics]

In the past, the age of an individual was considered an important factor in the development of periodontal disease and its treatment. Elderly patients were considered to be at higher risk and have a worse prognosis than younger patients who constituted a low risk category for serious periodontal destruction. Through a critical review of the literature it is pointed out that at the moment age as such can no longer be considered a conditioning factor in the evolution of periodontitis and in its treatment. Rather, it is the proneness of individuals to periodontal disease that is of primary importance in determining periodontal damage, in its prognostic evaluation and in its treatment.

[Efficacy of chlorhexidine as a gel and as a mouthwash]

In a short-term longitudinal study the authors intended to compare the effectiveness in controlling plaque formation and gingival inflammation of a 1% chlorhexidine gel to the one of a 0.2% chlorhexidine solution. The gel, used once a day, resulted as good as the chlorhexidine solution, but showed a localized activity.

[Antiinflammatory drugs in periodontology. Therapeutic perspectives]

The authors, through a critical review of the literature, describe the effects of antiinflammatory drugs on periodontal disease as they result from experimental trials and epidemiological observations. Furthermore the authors emphasize the possible application of such pharmacological substances in the near future as an additional instrument in the therapy of periodontal disease.

[Comparative evaluation of 2 antiplaque mouthwashes containing chlorhexidine and sanguinarine]

The results obtained in a short-term longitudinal study suggest that sanguinarine mouthrinses are less effective in plaque control than those containing chlorhexidine. It is concluded that the real clinical effectiveness of sanguinarine mouthrinses has to be further studied in clinical trials.

Rapidly progressive periodontitis. Neutrophil chemotaxis inhibitory factors associated with the presence of Bacteroides gingivalis in crevicular fluid

In the last few years several bacteriological and immunological studies have investigated the role of bacteria and immune defects in order to establish the etiopathogenesis of periodontal disease. With regard to the immune system, a defect in polymorphonuclear neutrophil (PMN) chemotaxis has been frequently reported in patients with rapidly progressive or juvenile periodontitis. The purpose of this study was to investigate in five patients with rapidly progressive periodontitis and normal chemotaxis of peripheral blood PMNs the presence of chemotaxis inhibitory activity in gingival fluid and to relate such activity to three types of bacteria, often involved in rapidly evolving periodontal lesions, that are able to inhibit in vitro PMN chemotaxis: Bacteroides gingivalis, Capnocytophaga sp., and Actinobacillus actinomycetemcomitans. We found strong inhibitory activity in three of these patients. This activity was consistently associated with the finding of B. gingivalis in gingival pockets. We cannot rule out, however, that other substances not of bacterial origin could be responsible for such inhibitory activity. The strict association with B. gingivalis, known to secrete blocking factors, is highly suggestive, although this data must be considered preliminary.