Periodontitis, Dental Procedures, and Young-Onset Cryptogenic Stroke

Periodontitis is associated with an increased risk of ischemic stroke, and the risk may be particularly high among young people with unexplained stroke etiology. Thus, we investigated in a case-control study whether periodontitis or recent invasive dental treatments are associated with young-onset cryptogenic ischemic stroke (CIS). We enrolled participants from a multicenter case-control SECRETO study including adults aged 18 to 49 y presenting with an imaging-positive first-ever CIS and stroke-free age- and sex-matched controls. Thorough clinical and radiographic oral examination was performed. Furthermore, we measured serum lipopolysaccharide (LPS) and lipotechoic acid (LTA) levels. Multivariate conditional regression models were adjusted for stroke risk factors, regular dentist visits, and patent foramen ovale (PFO) status. We enrolled 146 case-control pairs (median age 41.9 y; 58.2% males). Periodontitis was diagnosed in 27.5% of CIS patients and 20.1% of controls (P < 0.001). In the fully adjusted models, CIS was associated with high periodontal inflammation burden (odds ratio [OR], 95% confidence interval) with an OR of 10.48 (3.18-34.5) and severe periodontitis with an OR of 7.48 (1.24-44.9). Stroke severity increased with the severity of periodontitis, having an OR of 6.43 (1.87-23.0) in stage III to IV, grade C. Invasive dental treatments performed within 3 mo prestroke were associated with CIS, with an OR of 2.54 (1.01-6.39). Association between CIS and invasive dental treatments was especially strong among those with PFO showing an OR of 6.26 (1.72-40.2). LPS/LTA did not differ between CIS patients and controls but displayed an increasing trend with periodontitis severity. Periodontitis and recent invasive dental procedures were associated with CIS after controlling for multiple confounders. However, the role of bacteremia as a mediator of this risk was not confirmed.

Quorum-sensing molecule dihydroxy-2,3-pentanedione and its analogs as regulators of epithelial integrity

BACKGROUND AND OBJECTIVE

Quorum-sensing molecules regulate the behavior of bacteria within biofilms and at the same time elicit an immune response in host tissues. Our aim was to investigate the regulatory role of dihydroxy-2,3-pentanedione (DPD), the precursor of universal autoinducer-2 (AI-2), and its analogs (ethyl-DPD, butyl-DPD and isobutyl-DPD) in the integrity of gingival epithelial cells.

MATERIAL AND METHODS

Human gingival keratinocytes were incubated with four concentrations (10 μmol L^-1 , 1 μmol L^-1 , 100 nmol L^-1 and 10 nmol L^-1 ) of DPD and its analogs for 24 hours. The numbers of viable cells were determined using a proliferation kit, matrix metalloproteinase (MMP)-2 and -9 activities were determined by gelatin zymography, and expression of occludin protein and occludin mRNA were determined by western blotting and RT-qPCR, respectively.

RESULTS

Increased cell proliferation was observed in gingival keratinocytes incubated with 100 nmol L^-1 of butyl-DPD. MMP-9 activity was elevated in cells incubated with 10 μmol L^-1 of ethyl-DPD. On the other hand, MMP-2 activity did not show any significant change when gingival keratinocytes were incubated with or without DPD or analogs. Western blot analyses demonstrated five forms (105, 61, 52.2, 44 and 37 kDa) of occludin. Incubation with 1 μmol L^-1 and 100 nmol L^-1 of DPD and with 10 nmol L^-1 of ethyl-DPD increased dimeric (105 kDa) forms of occludin, while incubation with 100 nmol L^-1 of isobutyl-DPD increased monomeric (61 kDa) forms. DPD and ethyl-DPD decreased, and 100 nmol L^-1 of isobutyl-DPD and 10 nmol L^-1 of butyl-DPD increased, the monomeric (52.2 kDa and 44 kDa) forms of occludin, whereas ethyl-DPD decreased and isobutyl-DPD increased, the low-molecular-weight (37 kDa) forms. According to RT-qPCR analysis, the exposure of gingival keratinocytes to 10 μmol L^-1 of isobutyl-DPD up-regulated expression of occludin.

CONCLUSION

The results indicate that isobutyl-DPD has the potential to enhance the integrity of the epithelium by stimulating the formation of occluding, without affecting the proliferation or gelatinolytic enzyme activities of the exposed cells. The modulatory effect of an AI-2 analog on the epithelial cell response is shown for the first time.

Clonal Persistence of Oral Fusobacterium nucleatum in Infancy

Once established, early-colonizing bacterial species tend to persist in the mouth. To obtain detailed information on the population dynamics of early-colonizing oral anaerobes, we examined the clonal diversity and persistence of clones among oral Fusobacterium nucleatum populations during the first 2 yrs of life. Consecutive salivary samples from 12 infants, collected at 2, 6, 12, 18, and 24 mos of age, yielded a total of 546 F. nucleatum isolates for clonal typing with arbitrarily primed PCR (AP-PCR). Up to 7 AP-PCR types were simultaneously detected in each sample. In 11 out of the 12 infants examined, AP-PCR types persisted for up to 1 yr. Strain turnover rate was high during the first year of life, but then the occurrence of persistent clones increased. This study indicates a wide genetic diversity within the species and provides evidence for the increasing persistence of F. nucleatum clones in the oral cavity with age.

Mannose-binding lectin gene polymorphism in relation to periodontal infection

BACKGROUND AND OBJECTIVE

Mannose-binding lectin (MBL) plays an important role in innate immunity. MBL deficiency is usually caused by mutations in exon 1 of the MBL structural gene (MBL2). Our aim was to investigate MBL2 polymorphisms and their relation to salivary levels of periodontal inflammatory/tissue destruction markers and two major periodontitis-associated bacteria.

MATERIAL AND METHODS

Salivary samples from 222 subjects were available for genotyping by pyrosequencing. The subjects between 40 and 60 years of age and having a minimum of 20 teeth were divided into three periodontal groups: 80 had generalized periodontitis, 65 had localized periodontitis and 77 were periodontitis-free. A comparison between their MBL2 genotypes and salivary detection rates and levels of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis as well as interleukin -1β, matrix metalloproteinase -8, and tissue inhibitor of matrix metalloproteinase (TIMP)-1 was performed.

RESULTS

The frequencies of the MBL2 wild-type (A/A), heterozygote variants (A/O) and homozygote variants (O/O) were 69.4%, 26.6% and 4%, respectively. In A. actinomycetemcomitans-positive subjects having homozygote or heterozygote MBL2 variants, the salivary concentrations of IL-1β (p = 0.010) were elevated and those of TIMP-1 (p = 0.001) were decreased. In addition their matrix metalloproteinase -8/TIMP-1 ratio was higher (p < 0.001) and they had more pocket teeth (p = 0.012) than subjects negative for A. actinomycetemcomitans.

CONCLUSION

Our findings indicate that the carriage of A. actinomycetemcomitans may facilitate extended periodontal inflammation and destruction in subjects with a variant form of human MBL2.

Longitudinal study of salivary proteinases during pregnancy and postpartum

BACKGROUND AND OBJECTIVE

Matrix metalloproteinases (MMPs) and their regulators are connected to periodontal inflammation and destruction. However, the presence and role of the salivary MMPs in pregnancy-related gingivitis are not well known. Our longitudinal study aimed to monitor salivary proteinase levels and possible changes, and relate them to periodontal status during pregnancy and postpartum.

MATERIAL AND METHODS

Salivary samples were collected from 30 periodontally healthy pregnant women five times (once during each trimester, 4-6 wk after delivery and after lactation) and, as their controls, from 24 non-pregnant women three times (during successive months). Periodontal examination included visible plaque index, bleeding on probing, probing pocket depth and clinical attachment level measurements. Matrix metalloproteinase-8 levels were measured by immunofluorometric assay, and MMP-2 and MMP-9 levels and molecular forms by gelatin zymography. Salivary elastase, myeloperoxidase and tissue inhibitor of matrix metalloproteinase-1 levels were measured by ELISA.

RESULTS

Elastase concentrations maintained stable during the follow-up, while myeloperoxidase concentrations increased significantly after delivery. During pregnancy, MMP-8 concentrations were significantly lower than postpartum concentrations, being lowest during the second trimester and highest after delivery, and varying inversely to pregnancy gingivitis, observed as elevated percentages of bleeding on probing and probing pocket depth during the second and third trimester. In pregnant women, the highest MMP-2 and MMP-9 levels were found in saliva after lactation. In the control group, both clinical and enzymological findings remained stable during the follow-up period.

CONCLUSION

Our results suggest that hormonal changes during pregnancy induce or enhance susceptibility to gingivitis, while salivary proteinase and myeloperoxidase levels are reduced.

Stimulation of epithelial cell matrix metalloproteinase (MMP-2, -9, -13) and interleukin-8 secretion by fusobacteria

BACKGROUND/AIMS

Bacterial pathogens involved in periodontal diseases exert their destructive effects primarily by stimulating the host cells to increase their secretion of proinflammatory cytokines and matrix metalloproteinases (MMPs). This study aimed to determine the epithelial cell matrix metalloproteinase and interleukin-8 (IL-8) secretion upon exposure to fusobacteria.

METHODS

Eight different oral and non-oral Fusobacterium strains were incubated with HaCaT epithelial cells. Gelatin zymography and Western blot analysis were performed to detect collagenase 3 (MMP-13), gelatinase A (MMP-2), gelatinase B (MMP-9), and IL-8 secretion by epithelial cells.

RESULTS

All Fusobacterium strains, especially Fusobacterium necrophorum ATCC 25286, Fusobacterium nucleatum ATCC 25586, and Fusobacterium varium ATCC 51644, increased MMP-9 and MMP-13 secretion. Fusobacterium simiae ATCC 33568, and to a lesser extent F. nucleatum and F. necrophorum, increased epithelial MMP-2 secretion. F. nucleatum and F. necrophorum also increased IL-8 secretion. F. varium ATCC 27725, a strain that only weakly stimulated MMP production, strongly increased the IL-8 production, suggesting that their expression is differently regulated.

CONCLUSION

We conclude that the pathogenic potential of fusobacteria may partly result from their ability to stimulate secretion of MMP-9, MMP-13, and IL-8 from epithelial cells.

First isolation of Clostridium difficile PCR ribotype 027 in Finland

On 18 October 2007, the first case of Clostridium difficile PCR ribotype 027-associated disease was detected in Finland.

Effect of triclosan/copolymer-containing toothpaste on the association between plaque and gingival bleeding: a randomized controlled clinical trial

AIM

To study longitudinal associations between plaque and gingival bleeding and multilevel variance/covariance structures after introducing triclosan-containing toothpaste.

MATERIAL AND METHODS

A 10-week, randomized, two-arm, double-masked, controlled clinical trial was conducted in 34 healthy, non-smoking females with plaque-induced gingivitis. Clinical periodontal examinations were repeated every other week. At week 4, test toothpaste containing 0.24% sodium monofluorophosphate, 0.3% triclosan, and 2% polyvinyl-methyl ether maleic acid; or control toothpaste containing 0.76% sodium monofluorophosphate and 0.1% sodium fluoride, were randomly distributed.

RESULTS

Multivariate multilevel models indicated that, after introducing experimental toothpastes, subject random error was reduced from 0.6 to below 0.2. The odds ratio (OR) of bleeding on probing (BOP) was about 30% less in the test than in the control group (p<0.01). At the end of the experiment, ORs for BOP and plaque index scores 1-3 (reference 0) were 2.1-2.4 in the control group, but 1.1-1.9 in the test group (p<0.05). No effects on plaque levels and calculus were observed.

CONCLUSIONS

Multivariate multilevel modelling allows the study of fixed and random effects of experimental toothpastes on gingival inflammation in small sample. Triclosan appears to attenuate the causal association between supragingival plaque and gingival bleeding in gingivitis.

Variance components of gingival thickness

OBJECTIVES

Distinct periodontal phenotypes have been identified by cluster analysis, which is an explorative method with very low external validity. The aim of the present study was to investigate variance components of facial gingival thickness in young adults with mild gingivitis.

MATERIAL AND METHODS

Thirty-three non-smoking females, 18-23 years of age, with mild or moderate plaque-induced gingivitis participated. Gingival thickness was measured at every tooth present by use of ultrasound technology to the next 0.1 mm with a lowest measurement of 0.5 mm. Periodontal probing depth and clinical attachment level were measured with a pressure-controlled probe. Gingival bleeding index was assessed after probing on a 0-2 scale, where 1 was slight, and 2 was profuse bleeding on probing. The Silness-Loe plaque index was recorded. Multilevel variance components and random intercept models were built.

RESULTS

A 2-level (subject, tooth) variance component model of gingival thickness without any explanatory variable revealed an intercept (mean) of 0.93 +/- 0.02 mm. Subject variation of gingival thickness amounted to 4.2% of the total variance. Addition of tooth- and subject-related covariates to the model revealed, after adjusting for tooth type, an association with periodontal probing depth (estimated coefficient 0.067 +/- 0.025), and considerable association with average bleeding index (-0.395 +/- 0.149) and plaque index (0.125 +/- 0.048). Variation at the tooth level was drastically reduced; subject variation amounted to 5.2%.

CONCLUSION

Gingival thickness is mainly associated with tooth-related variables. Bleeding tendency is higher if gingiva is thin. Subject variability related to periodontal phenotype may add to the total variance, however, to a very low extent.

Clostridium clostridioforme: a mixture of three clinically important species

Clostridium clostridioforme shows much variability in phenotypic and antimicrobial susceptibility tests, suggesting it may be more than a single species even though all strains share unique morphology. This study was designed to determine if there are multiple species and, if so, to demonstrate the differences that exist between them. A total of 107 strains of C. clostridioforme were investigated by sequencing of the 16S rRNA gene, phenotypic studies, and antimicrobial susceptibility testing. In addition, clinical data from patients whose infections yielded an organism identified as C. clostridioforme was reviewed. Data from the above studies revealed three principal species in what has been called C. clostridioforme: Clostridium bolteae, C. clostridioforme, and Clostridium hathewayi. Each species may be distinguished by certain phenotypic tests. All three species were involved in infections, including bacteremia. C. clostridioforme appears to be associated with more serious or invasive human infections than the other two species in the group. Resistance to penicillin G is common and is due to beta-lactamase production. Resistance to clindamycin and moxifloxacin is also seen. The three species differ in terms of virulence and antimicrobial resistance. "C. clostridioforme" actually represents three distinct species that are different in terms of 16S rRNA sequences, phenotypic characteristics, and antimicrobial susceptibility. It is important for microbiology laboratories to distinguish between these species and for clinicians to be aware of the differences between them.

Impact of antimicrobial exposure and beta-lactamase-producing bacteria on salivary beta-lactamase activity in infancy

Beta-lactamase production by oral bacteria is common in infancy and is associated with use of antimicrobial agents in infants. The present longitudinal study aimed to examine the frequency of salivary beta-lactamase activity (SbetaA), to compare SbetaA with the presence of beta-lactamase-producing (beta+) aerobic and anaerobic species in saliva, and to estimate the impact of antimicrobial exposure on the emergence of SbetaA in healthy infants during their first year of life. At 6 months, SbetaA was detected in 46% infants; 89% SbetaA-positive infants and 55% SbetaA-negative infants harboured beta+ species at this time (OR 7.08; CI 1.31-38.34). At 12 months, SbetaA was detected in 54% infants. Exposure to antimicrobials during the first year of life increased the risk (OR 2.60; CI 0.72-9.36) of having SbetaA.

Age-related frequency of penicillin resistance of oral Veillonella

Veillonella spp. are early colonizing inhabitants in the mouth. As part of studies on penicillin resistance among oral indigenous anaerobic microbiota in childhood, the aim of the present longitudinal study was to examine the emergence of resistant strains in Veillonella populations. Altogether 305 Veillonella isolates from saliva of 49 healthy infants followed from 2 to 24 months of age were examined for their in vitro susceptibility to penicillin G and, further, 20 penicillin-resistant isolates representing 5 MIC categories to ampicillin, amoxicillin, amoxicillin/clavulanate, cefoxitin, and beta-lactamase production. In infants positive for oral Veillonella, the recovery rate of penicillin-resistant (MIC >/=2 microg/ml) strains increased with age up to 68%, however, most infants simultaneously harbored penicillin-susceptible strains. During the follow-up, the MIC(50) increased from 0.5 microg/ml to 2 microg/ml. In addition to penicillin G, 8/20 strains also showed reduced susceptibility to ampicillin and/or amoxicillin but none produced beta-lactamase. Our study suggests other mechanisms than enzymatic degradation of beta-lactam ring for resistance of oral Veillonella to penicillin.

Establishment of streptococci in the upper respiratory tract: longitudinal changes in the mouth and nasopharynx up to 2 years of age

As part of a series of longitudinal studies on the development of the indigenous microflora of the upper respiratory tract, the establishment of streptococci in the oral cavity and nasopharynx and IgA1 protease production by the early streptococcal flora was examined in 50 healthy Caucasian infants at the ages of 2, 6, 12, 18 and 24 months. In the oral cavity, streptococci were found in all infants on every sampling occasion, Streptococcus mitis biovar 1 being the main finding in each age group. S. salivarius and S. mitis biovar 2 reached their highest prevalence during the first year of life, whereas the prevalence of S. oralis and S. sanguis showed no significant increase before 12 months of age. Salivary streptococci mainly consisted of the above-mentioned species during the follow-up period. In contrast to the oral cavity, no stable colonisation pattern was observed for viridans streptococci in the nasopharynx. S. mitis biovar 1 and S. pneumoniae, a traditional respiratory pathogen, were the principal streptococcal species among nasopharyngeal isolates. IgA1 protease production by early streptococci was common in infancy. Among the oral streptococcal microflora, S. mitis biovar 1 (especially during the first year of life) and S. oralis and S. sanguis constituted the main species responsible for this enzyme activity. In the nasopharynx, IgA1 protease was produced by S. mitis biovar 1, S. oralis and S. pneumoniae. In conclusion, streptococcal colonisation differs in these two close habitats in the upper respiratory tract.

Phenotypic identification of Actinomyces and related species isolated from human sources

Recent advancements in chemotaxonomic and molecular biology-based identification methods have clarified the taxonomy of the genus Actinomyces and have led to the recognition of several new Actinomyces and related species. Actinomyces-like gram-positive rods have increasingly been isolated from various clinical specimens. Thus, an easily accessible scheme for reliable differentiation at the species level is needed in clinical and oral microbiology laboratories, where bacterial identification is mainly based on conventional biochemical methods. In the present study we designed a two-step protocol that consists of a flowchart that describes rapid, cost-efficient tests for preliminary identification of Actinomyces and closely related species and an updated more comprehensive scheme that also uses fermentation reactions for accurate differentiation of Actinomyces and closely related species.

The Prevotella intermedia group organisms in young children and their mothers as related to maternal periodontal status

Currently, the Prevotella intermedia group includes three biochemically and phylogenetically related species: Prevotella intermedia, Prevotella nigrescens, and the newly described Prevotella pallens. The two first-named species are mentioned with varying emphasis in connection with periodontal diseases, while such a connection of P. pallens is not known. Mothers serve as a plausible source of bacteria to their children, and conceivably, a mother with periodontitis as a recurrent reservoir of periodontally infecting organisms. In the present study, 23 mothers and their young children were examined for the presence of the P. intermedia group organisms in relation to maternal periodontal status (I: periodontal health, II: initial periodontitis, and III: advanced periodontitis). Species differentiation was based on established biochemical methods, electrophoretic mobility patterns, SDS-PAGE, and DNA hybridization. P. intermedia was not recovered from children but nearly exclusively from mothers in group III, thus confirming its association with periodontitis. P. nigrescens and P. pallens were frequently found in mothers and children. To determine bacterial transmission between a mother and her child, 72 isolates from 13 mother-child pairs were analyzed by arbitrarily primed PCR (AP-PCR). Similar AP-PCR types of P. nigrescens and/or P. pallens were recovered from 3/4 pairs in group I, 2/5 pairs in group II, and none in group III. Our results indicate that different species within the P. intermedia group have a different colonization pattern in childhood and that the periodontal status reflects qualitatively their presence in maternal saliva. Intra-familial transmission of P. nigrescens and P. pallens can occur in early childhood, however similar AP-PCR types were most obvious within periodontally healthy mother-child pairs.

Development of oral bacterial flora in young children

The intimate relationship with bacteria is a fundamental factor in the health status of an individual. After birth infants are exposed to continuous person-to-person and environmental contacts with microbes, and the development of the indigenous microflora begins on the surfaces of the human body. In a developing ecosystem microbial colonization may easily occur because of the still inadequate host response. Adhesion is the initial event in the colonization of bacteria. In the mouth, only mucosal surfaces are available during the first months of life. After teeth emerge, the number of attachment sites and potential niches increases significantly. Bacteria adhere not only to oral surfaces but also to each other, forming multigeneric communities where specific partner relationships influence their composition and stability. Viridans streptococci and a strictly anaerobic species, Fusobacterium nucleatum, are of interest in this context. The oral colonization pattern differs between individuals already in infancy; variable bacterial load in saliva of attendants and other close contacts and the frequency of this bacterial exposure may partly account for individual differences. In addition, the exposure of an infant to antibiotics affects the quality of colonizing bacteria. This article presents an overview of the age-related acquisition of oral bacteria and the role of the indigenous oral microflora in health and disease.

Oral colonization with Actinomyces species in infants by two years of age

In early childhood, the human mouth is already colonized by actinomycetes. Due to recent taxonomic changes within the genus Actinomyces, up-to-date data are warranted on the time and succession of different Actinomyces species in the oral cavity. By using a longitudinal study design and culture techniques, we examined the age-related occurrence of Actinomyces species in saliva from 39 healthy infants at 2, 6, 12, 18, and 24 months of age. Altogether 428 Actinomyces isolates were available for this study. Identification was based on biochemical tests and gas chromatographic demonstration of metabolic end-products, and when needed, cellular fatty acid profiles were determined. The frequency of the total actinomycetal flora increased from 31% to 97% within 2 years. A. odontolyticus was the most prominent Actinomyces colonizer at all five sampling occasions. A. naeslundii was the second most common Actinomyces sp. but was not detected before the age of 1 year. As a novel observation, we found A. graevenitzii in the oral cavity. The number of A. graevenitzii isolates indicates that this species is not just occasionally present in infants' mouths. We also found A. viscosus, A. gerencseriae, A. israelii, and A. georgiae. Based on the present results, we suggest that A. odontolyticus is the main primary Actinomyces species on oral mucosal surfaces in infants up to 2 years of age.

Beta-lactamase production in Prevotella intermedia, Prevotella nigrescens, and Prevotella pallens genotypes and in vitro susceptibilities to selected antimicrobial agents

The present study investigated the beta-lactamase production of 73 Prevotella intermedia, 84 Prevotella nigrescens, and 14 Prevotella pallens isolates and their in vitro susceptibilities to six antimicrobial agents. The P. intermedia and P. nigrescens isolates were recovered from oral and extraoral samples obtained from subjects in two geographic locations from 1985 to 1995. The clonality of the beta-lactamase-positive and beta-lactamase-negative isolates and the clustering of the genotypes were studied by arbitrarily primed-PCR fingerprinting. beta-Lactamase production was detected in 29% of P. intermedia isolates, 29% of P. nigrescens isolates, and 57% of P. pallens isolates. No difference in the frequencies of beta-lactamase production by P. intermedia and P. nigrescens between isolates from oral and extraoral sites, between isolates obtained at different time periods, or between P. intermedia isolates from different geographic locations was observed. However, the P. nigrescens isolates from the United States were significantly more frequently (P = 0.015) beta-lactamase positive than those from Finland. No association between the genotypes and beta-lactamase production or between the genotypes and the sources of the isolates was found. The penicillin G MICs at which 90% of the isolates were inhibited were 8 microg/ml for P. intermedia, 8 microg/ml for P. nigrescens, and 16 microg/ml for P. pallens. For the beta-lactamase-negative isolates, the corresponding values were 0.031, 0.031, and 0.125 microg/ml, and for the beta-lactamase-positive isolates, the corresponding values were 16, 8, and 32 microg/ml. All isolates were susceptible to amoxicillin-clavulanate, cefoxitin, metronidazole, azithromycin, and trovafloxacin. The MICs of amoxicillin-clavulanate and cefoxitin were relatively higher for the beta-lactamase-positive population than for the beta-lactamase-negative population.

Oral colonization by anaerobic bacteria during childhood: role in health and disease

Anaerobes constitute a significant part of bacterial communities in human mouths. Their ability to colonize and survive in the environment, where remarkable changes occur during early childhood, is fundamental for oral homeostasis. However, relatively little is known of the time of colonization and succession of anaerobic species in the oral cavity. This article presents an up-to-date review on the development of the oral anaerobic microflora in respect to age, and in addition, considers some aspects of the role of oral anaerobes in health and disease.

Establishment of oral anaerobes during the first year of life

Anaerobic species constitute a significant part of the bacterial community of the mouth. Although the time and species involved in the primary colonization of infants are of great importance by forming the basis for further colonization, the development of the oral anaerobic microflora with age is still inadequately understood. In the present study, time and succession of colonization of oral anaerobes were longitudinally examined in 44 healthy Caucasian infants at 2, 6, and 12 months of age. Unstimulated saliva samples were quantitatively cultured on non-selective Brucella blood agar and several selective media for the isolation of anaerobic micro-organisms. The most frequent anaerobic finding in two-month-old infants was Veillonella spp. The Prevotella melaninogenica group also represented early colonizing species, and the frequency increased remarkably during the first year of life, whereas the Prevotella intermedia group organisms seemed to be late colonizers. Fusobacterium nucleatum, non-pigmented Prevotella spp., and Porphyromonas catoniae were occasional findings in subjects at 2 months but frequent findings in those at one year of age. F. nucleatum was the most frequent strictly anaerobic species in one-year-old infants; other fusobacteria were also occasionally found. The frequency of facultative/micro-aerophilic corroding rods and Capnocytophaga spp. started to increase toward the end of the first year. Except for the common presence of facultative/micro-aerophilic Actinomyces spp., other anaerobic gram-positive species were only occasionally present in these infants. Once established, early-colonizing species tended to persist in the mouth. Our longitudinal study demonstrated the establishment of several anaerobic species with steadily increasing frequencies during the first year of life.

Beta-lactamase production by oral anaerobic gram-negative species in infants in relation to previous antimicrobial therapy

The frequency of beta-lactamase production in gram-negative bacteria has increased considerably during recent years. In this study, beta-lactamase production by oral anaerobic gram-negative rods isolated from saliva was longitudinally examined for 44 Caucasian infants at the ages of 2, 6, and 12 months in relation to their documented exposure to antibiotics. Isolates showing decreased susceptibility to penicillin G (1 microg/ml) were examined for beta-lactamase production by using a chromogenic cephalosporin disk test. beta-Lactamase-positive, gram-negative anaerobic species were found in 11, 55, and 89% of each age group, respectively. beta-Lactamase production was most frequent among organisms of the Prevotella melaninogenica group. At 12 months, 73% of the infants harbored beta-lactamase-producing members of the P. melaninogenica group, 55% had nonpigmented Prevotella species, 25% had Porphyromonas catoniae, 23% had Fusobacterium nucleatum, and 5% had Capnocytophaga species. Several beta-lactamase-producing species could be simultaneously found in the infants' mouths. The presence of beta-lactamase-producing species was significantly associated with the infants' exposure to antibiotics through antimicrobial treatments given to the infants and/or their mothers.

Age-related acquisition of oral and nasopharyngeal yeast species and stability of colonization in young children

The occurrence and stability of colonization of oral yeast species and strains was determined from 40 healthy children during a 22-month follow-up at the ages 2, 6, 12, 18 and 24 months. In addition, salivary samples were obtained from the mothers at baseline (2 months) to study the role of the mother as the source of yeasts for the child. Yeasts were recovered at least once from 17/40 (43%) children by the age of 2 years. Of the 40 children, 11 (28%) were yeast-positive at multiple sampling occasions. No significant differences were found in recovery frequency of yeasts at different ages. Candida parapsilosis was isolated in 18/33 (55%) yeast-positive samples, and it predominated (share of positive findings 76%) at ages 12 to 24 months. The same yeast species was rarely detected in successive follow-up samples and thus on species level yeasts were transient colonizers in the developing oral flora of the children. Of the mothers 20/40 (50%) harbored yeasts. Candida albicans was recovered from 19/20 (95%) of the yeast-positive mothers and C. parapsilosis from none. Only 7/20 (35%) of the mothers with a yeast-positive finding had a yeast-positive child. In 5/7 (71%) of these mother-child pairs, both harbored the same yeast species (C. albicans) and in 3/5 (60%) of the pairs the AP-PCR profiles of the yeast isolates were identical suggesting possible transmission. In children, significant relationships (Fisher's exact-test, P < 0.05) were found between recovery of yeasts and use of pacifier at age over 12 months, eruption of first teeth at age over 6 months, mother cooling the child's food by blowing and mother cleaning the child's pacifier in her own mouth. In mothers, a significant relationship existed between recovery of yeasts and use of antibiotics.

beta-lactamase production and antimicrobial susceptibility of oral heterogeneous Fusobacterium nucleatum populations in young children

Oral Fusobacterium nucleatum populations from 20 young, healthy children were examined for beta-lactamase production. Ten children (50%) harbored, altogether, 25 beta-lactamase-positive F. nucleatum isolates that were identified as F. nucleatum subsp. polymorphum, F. nucleatum subsp. nucleatum, and F. nucleatum subsp. vincentii (J. L. Dzink, M. T. Sheenan, and S. S. Socransky, Int. J. Syst. Bacteriol. 40:74-78, 1990). In vitro susceptibility of these beta-lactamase-producing and 26 non-beta-lactamase-producing F. nucleatum isolates was tested with penicillin G, amoxicillin-clavulanic acid, tetracycline hydrochloride, metronidazole, trovafloxacin, and azithromycin. Except for penicillin G, the antimicrobials exhibited good activity against all F. nucleatum isolates.

Phylogenetic characterization and proposal of a new pigmented species to the genus Prevotella: Prevotella pallens sp. nov

Complete 16S rRNA gene sequences of three representative strains of anaerobic, Gram-negative, pigmented, moderately saccharolytic, indole-positive bacteria isolated from the oral cavity of humans were determined. According to comparative analyses of the rRNA sequence data, this organism represents a previously unknown species within the genus Prevotella. In addition, 22 representative strains and 21 reference strains (including 11 Prevotella intermedia and 10 Prevotella nigrescens strains) were subjected to multilocus enzyme electrophoretic analysis. The strains were consistently separated into three clearly distinct groups, corresponding to their previous entities. On the basis of the present phylogenetic results that confirmed our biochemical and genetic data, we propose a new species, Prevotella pallens. The type strain is NCTC 13042 (= AHN 10371).

Biochemical and genetic characterization of a Prevotella intermedia/nigrescens-like organism

Thirty-three previously non-typable faintly pigmented Gram-negative anaerobic bacterial isolates, biochemically most closely related to Prevotella intermedia and Prevotella nigrescens, were analysed for enzymic reactions, cellular fatty acid (CFA) composition, electrophoretic mobility of malate and glutamate dehydrogenases, hybridization with P. intermedia and P. nigrescens species-specific oligonucleotide probes and, for genetic heterogeneity, by arbitrarily primed PCR (AP-PCR). P. intermedia ATCC 25611T and P. nigrescens ATCC 33563T were run in parallel for comparison. Twenty-nine isolates originated from the normal oral flora of 18 subjects (including five mother-child pairs), and four isolates from various infections. Except for a negative lipase reaction, enzymic profiles of the test isolates were similar to those of P. intermedia and P. nigrescens. Clustering of CFAs, electrophoretic mobility patterns, hybridization with DNA probes for P. intermedia and P. nigrescens, and AP-PCR band patterns of the test isolates differed from those of the type strains of P. intermedia and P. nigrescens, suggesting the existence, in humans, of a new anaerobic species of pigmented, moderately saccharolytic, indole-positive Gram-negative rods.

beta-lactamase production by oral pigmented Prevotella species isolated from young children

The frequency of beta-lactamase production by oral pigmented Prevotella species isolated from 23 healthy young children and the minimal inhibitory concentrations (MICs) for 186 available beta-lactamase-positive isolates were examined by using the chromogenic cephalosporin disk test (AB BIODISK, Solna, Sweden) and the Etest (AB BIODISK) and/or the agar dilution method of the National Committee for Clinical Laboratory Standards (Villanova, PA, USA), respectively. beta-Lactamase-positive Prevotella melaninogenica strains were isolated from all children, and more than two-thirds of the Prevotella denticola and Prevotella loescheii strains isolated from the children were beta-lactamase-positive. The beta-lactamase-producing Prevotella intermedia group consisted of Prevotella nigrescens and the P. intermedia/ P. nigrescens-like organism (PINLO); P. intermedia was not found. Only two P. nigrescens isolates but most of the PINLO isolates produced beta-lactamase. The MICs for beta-lactamase-producing strains varied between 0.38 and 64 micrograms/mL. beta-Lactamase production by oral pigmented Prevotella species colonizing young children is already frequent. The phenomenon should be taken into account in the treatment of pediatric anaerobic infections of oral origin.

Distribution and genetic analysis of oral Prevotella intermedia and Prevotella nigrescens

A total of 344 Prevotella intermedia and nigrescens group isolates from 59 subjects were identified by hybridization with nonradioactively labeled species-specific oligonucleotide probes. Identification of 20 P. intermedia and 46 P. nigrescens isolates was confirmed by analyzing the electrophoretic mobilities of malate and glutamate dehydrogenase enzymes. A total of 111 isolates (32%) were identified as P. intermedia and 233 isolates (68%) as P. nigrescens. Identification performed with oligonucleotide probes and with malate and glutamate dehydrogenase electrophoresis matched perfectly. The distribution of oral P. intermedia and P. nigrescens in various periodontal status groups was investigated in periodontally healthy or diseased individuals. To reveal intra- and interindividual genetic diversity and possible intrafamilial transmission, P. intermedia and P. nigrescens isolates from 16 to 59 subjects, representing 8 married couples, were ribotyped. The stability of colonization was examined in 12 of the 59 subjects, of whom 6 received periodontal treatment and 6 were untreated. All children and periodontally healthy adults and most subjects with initial periodontitis (13/21) harbored only P. nigrescens. Of the 20 subjects with advanced periodontitis, 7 harbored both P. intermedia and P. nigrescens, 7 only P. intermedia and 6 only P. nigrescens. One or two ribotypes of P. intermedia and/or P. nigrescens were found intraindividually. The spouses in 5 of the 8 married couples shared an identical ribotype of P. intermedia or P. nigrescens, whereas ribotypes from unrelated subjects were mostly unique. Colonization was stable, since the same ribotypes were found 1-6 months apart in both periodontally treated and untreated subjects. In conclusion, the study indicates that P. intermedia and P. nigrescens may occur simultaneously in the oral cavity, the colonization is stable and P. intermedia is associated with periodontal diseases. Ribotyping revealed considerable genetic heterogeneity in unrelated subjects, whereas isolates obtained from spouses could represent the same ribotype, which suggests transmission of these species.

Transmission of oral Prevotella melaninogenica between a mother and her young child

Most likely, young children acquire their oral microflora by frequent transfer of bacteria between family members. The possible transmission of obligately anaerobic Prevotella melaninogenica recovered from 11 mother-child pairs was examined by ribotyping. One to 18 isolates (mean 13) per child from different oral sampling sites and 4 to 17 (mean 10) isolates per mother from stimulated salivary samples, collected on 2 occasions, were analyzed. On sampling, the mean ages of the children were 4 months and 32 months, respectively. Restriction endonucleases KpnI and ClaI were chosen for the digestion of chromosomal DNA. DNA fragments were electrophoretically separated, blotted onto a nylon membrane and hybridized with rRNA operon of Escherichia coli. DNA-DNA hybrids were detected immunologically. Extensive genetic heterogeneity, 101 distinct ribotypes, was observed among 248 P. melaninogenica isolates studied. Both mothers and children harbored several (up to 7) ribotypes which, apart from 3 ribotypes, were distinguishable in unrelated subjects. Several P. melaninogenica ribotypes were detected on both sampling occasions over 2 years apart. Identical ribotypes were found in 6 of the 11 mother-child pairs, 1 to 2 similar ribotypes per pair. This suggests the transmission of P. melaninogenica between the mother and her child, probably via maternal saliva. However, the unique ribotypes found in these children also indicate that other sources besides the mother influence the oral colonization of young children.

The oral gram-negative anaerobic microflora in young children: longitudinal changes from edentulous to dentate mouth

Eruption of primary teeth has a great influence on the oral environment by providing suitable niches for bacterial colonization. The composition of oral gram-negative anaerobic microflora was investigated in 21 young children (mean age 32 months) with primary dentition. The bacterial findings of samples were compared with those of the same children collected at their edentulous infant period (mean age 3 months). During the primary period, 2 samples were collected from each child: a sample with dental floss from gingival margin of 2 teeth and stimulated saliva pooled with a mucosal swab sample. Both samples were cultured aerobically and anaerobically using nonselective and selective media. Prevotella melaninogenica, nonpigmented Prevotella spp., Fusobacterium nucleatum group and Capnocytophaga spp. were found in all children at the older age, whereas they occurred in edentulous mouth in 76%, 62%, 67% and 19%, respectively. The occurrence of Prevotella loescheii increased from 14% to 90%, Prevotella intermedia from 10% to 67%, Leptotrichia spp. from 24 to 71%, Campylobacter (Wolinella) spp. from 5 to 43% and Eikenella corrodens from 5 to 57%. Only the occurrence of Bacteroides gracilis and Veillonella spp. remained at about the same level. Species not isolated from the edentulous mouth, such as Prevotella denticola, Fusobacterium spp. other than the F. nucleatum group and Selenomonas spp. were now detected in 71%, 71% and 43% of the children. The stability of the colonizing P. melaninogenica strain(s) in the oral cavity was determined by using ribotyping; 1-2 isolates per child from the edentulous infant period of 9 children and 3-15 isolates per child from their primary dentition period were analyzed.(ABSTRACT TRUNCATED AT 250 WORDS)

The most frequently isolated gram-negative anaerobes in saliva and subgingival samples taken from young women

Stimulated saliva and a pooled subgingival sample from the first molars were collected from 30 Caucasian women (mean age 30 years) for the presence of gram-negative anaerobic bacteria. The samples were inoculated on nonselective and selective media. The gram-negative anaerobic species occurring in the oral cavity of more than 50% of the subjects were selected for further analysis. Fusobacterium nucleatum and Prevotella melaninogenica were not recovered from subgingival sites without a simultaneous recovery in saliva. When positive subgingivally, Leptotrichia spp., nonpigmented Prevotella spp., Prevotella intermedia, Capnocytophaga spp., Bacteroides gracilis and Prevotella loescheii were simultaneously detected from saliva in 76%, 72%, 64%, 64%, 61% and 55% of the subjects, respectively. Intraindividually, the proportions of F. nucleatum, nonpigmented Prevotella spp., Leptotrichia spp., B. gracilis and P. loescheii of the anaerobic flora were quite similar in the salivary and subgingival samples. Capnocytophaga spp. and P. intermedia were present in higher proportions in subgingival samples than in saliva, whereas P. melaningogenica was present in higher proportions in saliva. Our data indicate that many oral gram-negative anaerobes are frequently recovered from stimulated saliva. Furthermore, when subgingivally positive, most subjects harbored these anaerobes simultaneously in saliva.

Pigmented Prevotella species in the periodontally healthy oral cavity

Pigmented Prevotella spp. have been connected with oral infections as well as being part of the healthy gingival flora. The aim of this study was to determine the presence of pigmented Prevotella spp. in saliva and gingival crevice samples from periodontally healthy adults. Twelve Caucasian female subjects (mean age 28 years, range 21-36 years) with no pockets > or = 4 mm, nor bleeding after probing were selected for this study. Paraffin-stimulated saliva was collected first; then, a pooled subgingival bacterial sample was taken with a sterile curette from mesiobuccal surfaces of all first molars. The samples were inoculated on to non-selective and selective media and incubated anaerobically. The most frequent species isolated were Pr. melaninogenica, Pr. intermedia and Pr. loescheü, found in 11, ten and nine subjects, respectively. The mean percentage of the total cultivable anaerobic microflora in salivary/subgingival samples were 14.7/0.6 for Pr. melaninogenica, 3.1/5.3 for Pr. intermedia and 2.6/1.2 for Pr. loescheii. Pr. denticola was found in one saliva sample and Pr. corporis, in two subgingival samples only. The number of different pigmented Prevotella spp. in the same mouth was 2-4 (mean 2.75). In conclusion, Pr. melaninogenica, Pr. intermedia and Pr. loescheii seem to be common microorganisms in the periodontally healthy oral cavity.

Relationship between oral gram-negative anaerobic bacteria in saliva of the mother and the colonization of her edentulous infant

Various gram-negative anaerobic bacterial species can be detected in the oral flora of edentulous infants. However, knowledge of the initial infection source is still scarce. Thirty Caucasian mothers (mean age 30 years) and their edentulous infants (mean age 3 months) were examined for the possible similarity of the oral gram-negative anaerobic flora. Paraffin-stimulated saliva was collected from the mothers. A pooled swab sample from mucosal surfaces and unstimulated saliva were collected from the infants. The samples were inoculated on nonselective and selective media and cultured aerobically and anaerobically. All of the 30 mothers harbored Fusobacterium nucleatum and 29 mothers Prevotella melaninogenica in their saliva. The salivary levels of P. melaninogenica, F. nucleatum, nonpigmented Prevotella spp., Prevotella intermedia and Prevotella loescheii exceeded 10(4) CFU/ml in about half of the 30 mothers. At this maternal salivary level, the infants' colonization frequency of P. melaninogenica and F. nucleatum was doubled. A positive correlation between maternal salivary concentration and infant's colonization was found for P. melaninogenica. No positive association was found with nonpigmented Prevotella spp., P. intermedia and P. loescheii. It can be speculated that maternal saliva may act as a source of some gram-negative anaerobes in the oral microflora of edentulous infants as early as before tooth eruption.

The early colonization of gram-negative anaerobic bacteria in edentulous infants

The occurrence of oral gram-negative anaerobes was examined in 30 edentulous infants (mean age 3 months, range 1-7 months). One pooled swab sample from mucosal surfaces (cheeks, palate, tongue) and one saliva sample was taken from each infant. The samples were cultured aerobically and anaerobically using non-selective and selective media. Prevotella (Bacteroides) melaninogenica was the most frequently isolated anaerobe, found in 70% of the infants. The other common anaerobes were Fusobacterium nucleatum, Veillonella spp. and nonpigmented Prevotella (Bacteroides) spp., found in 60%, 57% and 57% of the infants, respectively. Of corroding bacilli, Bacteroides gracilis was detected in 23% of the infants, Wolinella spp. and microaerophilic Eikenella corrodens in one infant (3% each). Leptotrichia spp., microaerophilic Capnocytophaga spp., Prevotella (Bacteroides) loescheii and Prevotella (Bacteroides) intermedia were found in 17%, 13%, 13% and 7% of the infants, respectively. In addition to these 30 infants, 21 edentulous infants were investigated for the presence of Actinobacillus actinomycetemcomitans only. A. actinomycetemcomitans was not detected in any of the 51 edentulous infants. The number of different anaerobic bacterial species in the same mouth varied from 0 to 7. No anaerobic bacteria were detected in 3 of 30 children (10%). These data suggest that various anaerobic bacterial species readily colonize the edentulous mouth in infants.

Are certain oral pathogens part of normal oral flora in denture-wearing edentulous subjects?

A complete loss of teeth may eliminate some pathogenic bacteria for lack of a suitable habitat for colonization. The occurrence of Actinobacillus actinomycetemcomitans, black-pigmented Bacteroides, mutans streptococci, lactobacilli and yeasts was investigated in 51 edentulous subjects with complete denture(s); mean age 74 years (range 44-92 years). None of the subjects had received antibiotics during the preceding 6 months. Four swab samples per subject were taken from the fitting surface of the upper denture, from the palate, buccal mucosae and dorsum of the tongue. At least 0.5 ml of stimulated saliva was collected into a sterile tube. The samples were cultivated aerobically and anaerobically using nonselective and selective media. A. actinomycetemcomitans was not found in any of the samples. Black-pigmented Bacteroides were found in 49 (96%) and yeasts in 25 (49%) of the subjects. Of the 49 saliva samples, 41 (84%) yielded mutans streptococci and 45 (92%) lactobacilli. In contrast to black-pigmented Bacteroides, mutans streptococci and lactobacilli, A. actinomycetemcomitans may not belong to the normal oral flora of edentulous subjects wearing dentures.