Staphylococcus aureus and other bacteria in untreated periodontitis.

Whether the subgingival microbiota differ between individuals with chronic and those with aggressive periodontitis, and whether smoking influences bacterial composition, is controversial. We hypothesized that the subgingival microbiota do not differ between sites in individuals with chronic or aggressive periodontitis, or by smoking status. Bacterial counts and proportional distributions were assessed in 84 individuals with chronic periodontitis and 22 with aggressive periodontitis. No differences in probing pocket depth by periodontal status were found (mean, 0.11 mm; 95% CI, 0.6 to 0.8, p = 0.74). Including Staphylococcus aureus, Parvimonas micra, and Prevotella intermedia, 7/40 species were found at higher levels in those with aggressive periodontitis (p < 0.001). Smokers had higher counts of Tannerella forsythia (p < 0.01). The prevalence of S. aureus in non-smokers with aggressive periodontitis was 60.5%. The null hypothesis was rejected, in that P. intermedia, S. aureus, and S. mutans were robust in diagnosing sites in individuals with aggressive periodontitis. S. aureus, S. sanguinis, and T. forsythia differentiated smoking status.

Clinical and microbiological analysis of subjects treated with Brånemark or AstraTech implants: a 7-year follow-up study.

AIMS: To assess the impact of different implant systems on the clinical conditions and the microbiota at implants, and whether the presence of bacteria at tooth sites was predictive of the presence at implant sites. MATERIALS AND METHODS: Subjects with either AstraTech or Brånemark in function for 7 years were enrolled. Sub-gingival bacterial samples at tooth and implant sites were collected with sterile endodontic paper points, and analyzed by the checkerboard DNA-DNA hybridization method (40 species). RESULTS: Fifty-four subjects, 27 supplied with AstraTech (n=132 implants) and 27 with Brånemark (n=102) implants, were studied. Test tooth sites had significantly less evidence of bleeding on probing (P<0.001) and presence of plaque (P<0.001) than implant test sites. Implant sites presented with deeper probing pocket depth than tooth sites (mean difference: 1.1 mm, standard error of differences: 0.08, 95% confidence intervals (CI): 0.9-1.3, P<0.001). Tannerella forsythia (P<0.05), Capnocytophaga sputigena (P<0.05), Actinomyces israelii (P<0.05) and Lactobacillus acidophilus (P<0.05) were found at higher levels at tooth surfaces. No differences in bacterial load for any species were found between the two implant systems. The odds of being present/absent at tooth and implants sites were only significant for Staphylococcus aureus [odds ratio (OR): 5.2 : 1, 95% CI: 1.4-18.9, P<0.01]. CONCLUSIONS: After 7 years in function, implants presented with deeper probing depths than teeth. S. aureus was commonly present at both teeth and implants sites. S. aureus at tooth sites was predictive of also being present at implant sites.

Chlorhexidine and preservation of sound tooth structure in older adults. A placebo-controlled trial.

The Trial to Enhance Elderly Teeth Health (TEETH) was designed to test the impact of regular rinsing with a 0.12% chlorhexidine (CHX) solution on tooth loss, and the causes of tooth loss (caries, periodontal disease and trauma) were also investigated. This paper reports on the effectiveness of a 0.12% CHX solution for controlling caries using a tooth surface (coronal and root) survival analysis. A total of 1,101 low income elders in Seattle (United States) and Vancouver (Canada), aged 60-75 years, were recruited for a double-blind clinical trial and assigned to either a CHX (n = 550) or a placebo (n = 551) mouth rinse. Subjects alternated between daily rinsing for 1 month, followed by weekly rinsing for 5 months. All sound coronal and root surfaces at baseline were followed annually for up to 5 years. At each follow-up examination, those tooth surfaces with caries, restored, or extracted were scored as 'carious'. The hazard ratio associated with CHX for a sound surface to become filled, decayed, or extracted was 0.87 for coronal surfaces (95% confidence interval: 0.71-1.14, p = 0.20) and 0.91 for root surfaces (95% confidence interval: 0.73-1.14, p = 0.41). These findings suggest that regular rinsing with CHX does not have a substantial effect on the preservation of sound tooth structure in older adults.

Association of Endodontic Lesions with Coronary Artery Disease.

An endodontic lesion (EL) is a common manifestation of endodontic infection where Porphyromonas endodontalis is frequently encountered. EL may associate with increased risk for coronary artery disease (CAD) via similar pathways as marginal periodontitis. The aim of this cross-sectional study was to delineate the associations between EL and CAD. Subgingival P. endodontalis, its immune response, and serum lipopolysaccharide were examined as potential mediators between these 2 diseases. The Finnish Parogene study consists of 508 patients (mean age, 62 y) who underwent coronary angiography and extensive clinical and radiographic oral examination. The cardiovascular outcomes included no significant CAD ( n = 123), stable CAD ( n = 184), and acute coronary syndrome (ACS; n = 169). EL was determined from a panoramic tomography. We combined data of widened periapical spaces (WPSs) and apical rarefactions to a score of EL: 1, no EL ( n = 210); 2, ≥1 WPS per 1 apical rarefaction ( n = 222); 3, ≥2 apical rarefactions ( n = 76). Subgingival P. endodontalis was defined by checkerboard DNA-DNA hybridization analysis, and corresponding serum antibodies were determined by ELISA. In our population, 50.4% had WPSs, and 22.8% apical rarefactions. A total of 51.2% of all teeth with apical rarefactions had received endodontic procedures. Subgingival P. endodontalis levels and serum immunoglobulin G were associated with a higher EL score. In the multiadjusted model (age, sex, smoking, diabetes, body mass index, alveolar bone loss, and number of teeth), having WPSs associated with stable CAD (odds ratio [OR] = 1.94, 95% confidence interval [95% CI] = 1.13 to 3.32, P = 0.016) and highest EL score were associated with ACS (OR = 2.46, 95% CI = 1.09 to 5.54, P = 0.030). This association was especially notable in subjects with untreated teeth with apical rarefactions ( n = 59, OR = 2.72, 95% CI = 1.16 to 6.40, P = 0.022). Our findings support the hypothesis that ELs are independently associated with CAD and in particular with ACS. This is of high interest from a public health perspective, considering the high prevalence of ELs and CAD.

Oral presentation of posttransplantation lymphoproliferative disorders. An unusual manifestation.

Cyclosporine, an immunosuppressive agent widely used in organ transplantation, has several undesirable side effects, including gingival hyperplasia, which occurs in up to 70% of patients. Another complication associated with use of cyclosporine and other immunosuppressants is an increased incidence of malignancies. Long-term use of cyclosporine also is associated with a spectrum of hyperproliferative disorders ranging from reactive lymphoid hyperplasia to aggressive malignant lymphomas. While cyclosporine-related lymphoproliferative disorders have been widely reported, they have not been described in the oral cavity as the first manifestation of this disease. We report on two cardiac transplantation patients with a history of cyclosporine use who presented initially with oral symptoms of lymphoproliferative disorder. Both had erythematous to cyanotic and hyperplastic gingiva. On gingivectomy, the fixed tissue was soft, glistening, and tan colored, in contrast to the usual firm, white, cyclosporine-associated, benign gingival fibrous hyperplasia. Histologically, a dense, diffuse infiltrate of lymphoplasmacytoid cells with vesicular nuclei, prominent nucleoli, a moderate amount of cytoplasm, and high mitotic activity was observed. Immunocytochemical studies confirmed that the cells were monoclonal for lambda light chains in one patient and kappa light chains in the other. The cells from one patient were positive for CD45, while both patients were negative for CD20 and all nonhematopoietic antigens tested. Both tissues were strongly positive for Epstein-Barr virus. Morphology and immunocytochemistry findings are consistent with a posttransplant lymphoproliferative disorder. These are the first two reported cases of cyclosporine-associated posttransplant lymphoproliferative disorders presenting as gingival hyperplasia.

Horizontal alveolar bone loss and vertical bone defects in an adult patient population.

The objectives of the present investigation were to analyze intraoral radiographs and to study 1) the distribution of the distance between the cemento-enamel junction (CEJ) and the alveolar bone level (BL) and 2) the prevalence and severity of vertical defects, and furcation lesions in 416 individuals seeking dental care. Full mouth radiographs were enlarged 7.5 times and the mesial and distal distances between CEJ and bone level were measured. The extent of interradicular molar radiolucencies was also measured. Images of 10,282 teeth were studied. Subjects were between 15 to 94 years (mean age: 47.2, S.D.+/-15.2). On average they had 24.8 teeth (S.D.+/-5.5). The mean distance CEJ-BL increased significantly up to age 45 (r2=0.07; beta=0.29; P < 0.0001) and remained stable thereafter r2=0.09, beta=-0.02, N.S.). The mean distance CEJ-bone level was 1.4 mm (S.D.+/-0.7) in the 15 to 24 age group; 3.0 (S.D.+/-1.5) in the 45 to 54 age group; and 3.02 (S.D.+/-1.4) in the 75 to 94 age group. No vertical defects were found in 163 participants (39.3%); vertical defects > or = 3.0 mm were found in 30.2% (126). Mesial defects were significantly more common that distal defects (P < 0.001). The extent of horizontal bone loss was correlated to extent of vertical defects (r2=0.88; P < 0.0001). The number of remaining teeth was not associated with horizontal or vertical bone loss. In conclusion, the study indicated that few of the individuals had extensive horizontal bone loss. Vertical defects suitable for guided tissue regeneration procedures however, were found in many patients.

Alveolar bone levels in AIDS and HIV seropositive patients and in control subjects.

Alveolar bone levels were studied from intraoral radiographs of 24 non-hospitalized patients with AIDS, 17 HIV seropositive subjects, and 39 matched control subjects. The AIDS/HIV subjects were seeking dental care in a faculty practice. The matched control subjects came from those non-HIV-infected patients seeking dental care at the University of Washington. Magnified intraoral radiographs were used to assess the distance between the cemento-enamel junction (CEJ) and the alveolar bone level (BL). The extent of vertical defects and furcation invasions was also assessed. The mean age of the AIDS, HIV, and control subjects was 38.9 +/- 6.6 years, 37.1 +/- 7.6, and 39.9 +/- 5.6, respectively, and was not statistically different. Among the AIDS patients, 75% were smokers, while 88.2% of the HIV subjects were cigarette smokers. Therefore, the matched control subjects were also smokers to the same extent. The mean difference in distance CEJ-BL was 0.1 mm (mesial) and 0.3 mm (distal) and greater in the HIV/AIDS group than in the control group, but not statistically different. No vertical defects > or = 3.0 mm were found in 69.2% of the control subjects and in 58.5% of the combined HIV/AIDS group. None of the HIV/AIDS subjects had more than 5 defects > 3.0 mm, while 7.6% of the control subjects had such defects. Significant associations were found between smoking and extent of alveolar bone loss (distance) (P < 0.001) as well as the number and extent of vertical defects (P < 0.01), but were not associated with HIV status. The extent of furcation invasions, as read radiographically, did not differ between groups. In conclusion, smoking but not HIV status was the primary factor for alveolar bone loss.

Direct detection of Porphyromonas gingivalis in Macaca fascicularis dental plaque samples using an oligonucleotide probe.

Oligonucleotide probes complementary to the hypervariable regions of the 16S rRNA of Porphyromonas gingivalis, and previously shown to specifically identify human P. gingivalis strains to the species level, were tested for their ability to recognize P. gingivalis from nonhuman primates (Macaca fascicularis), either as distinct isolates or in subgingival dental plaque. The 32P-labeled probes hybridized with all 147 monkey isolates identified as P. gingivalis by morphology and biochemistry, but did not hybridize with any of the 331 isolates representing 17 genera of bacteria unrelated to P. gingivalis, or to the more closely related P. endodontalis and P. asaccharolytica. This corresponds to sensitivities and specificities of 100%. Of 76 M. fascicularis plaque samples, P. gingivalis was detected by probe and culture in 67. Of 26 human plaque samples taken from separate individuals free of periodontal disease, 23 failed to demonstrate P. gingivalis by probe or culture. The results of the combined 102 monkey and human plaque samples indicate that, when compared to culture as the "gold standard," the P. gingivalis probe had a sensitivity of 96%, a specificity of 87%, and an overall agreement with culture of 93%. These results reveal that the oligonucleotide probes used to identify P. gingivalis are specific for this organism, and give results comparable to culture methods for detecting the presence of P. gingivalis in M. fascicularis dental plaque.

Efficacy of a sonic toothbrush on inflammation and probing depth in adult periodontitis.

This single-blind, 8-week study compared the efficacy of a sonic toothbrush and a manual brush in 40 patients with adult periodontitis. Qualitative clinical indices and quantitative laboratory methods were used to monitor the periodontal status of 3 pockets 5 to 7 mm deep in each subject. Patients were randomly assigned either a sonic or manual toothbrush. The two groups were comparable with respect to age, gender, and anatomical location of the test sites. Data were collected from all sites at baseline and at 2, 4, and 8 weeks. Over the 8-week period, both groups showed significant improvements in the clinical indices used. Descriptive statistics indicated the sonic brush group had greater improvement than the manual group in the clinical parameters (gingival index, bleeding index, probing depth, and clinical attachment level). Gingival crevicular fluid (GCF) flow was significantly lower in the sonic brush group (P = 0.018). Considerable variation was present in the levels detected for both inflammatory cytokines tested, however, concentration of interleukin-1 beta was significantly lower in the GCF of sonic group patients (P = 0.05), while concentration of interleukin-6 was significantly reduced in both groups (P < or = 0.05) (t tests). Under these conditions, there is some evidence to suggest that the sonic toothbrush is more beneficial in resolving inflammation in patients with moderate periodontal disease.

Short-term responses to periodontal therapy in insulin-dependent diabetic patients.

This investigation studied relative changes in periodontal conditions of 18 insulin-dependent diabetic patients. Measures of gingival inflammation, crevicular fluid aspartate aminotransferase (AST) levels, probing depth and attachment levels, the presence of three periodontal pathogens (Porphyromonas gingivalis, Bacteroides forsythus, and Actinobacillus actinomycetemcomitans) and serum antibody titers to these bacteria, and blood sugar levels (glycosylated hemoglobin, HbAlc) were studied before and 2 months after non-surgical debridement. Antibody titers to the same bacteria were also studied in sera from 18 sex- and age-matched periodontally healthy and non-diabetic subjects. Periodontal conditions showed significant improvement. The mean probing depth at 4 of the worst sites selected in each patient decreased from 5.7 mm to 4.8 mm (p < 0.0001). The mean full width probing depth changed from 2.9 mm (s.d. +/- 0.2) to 2.5 mm (s.d. +/- 0.3). A mean gain of 0.4 mm attachment level was recorded (P < 0.0001). The mean AST value decreased from 1009 microIU to 518 microIU (P < 0.006). Minimal differences in mean glycosylated hemoglobin values (HbAlc) were noticed before and after treatment. A. actinomycetemcomitans was never detected. P. gingivalis was present at 7% of the sites both before and after treatment. B. forsythus was found at 29% of sites (50% of patients) before and at 36% of sites (61% of patients) after treatment. Positive associations were found between the presence of B. forsythus and AST values, gingival index, probing depth, and attachment level (P < 0.05). Baseline serum IgG titers to P. gingivalis were significantly lower in the patients with diabetes (9.5 ELISA units vs. 28.5 ELISA units in the healthy controls). IgG titers to B. forsythus did not differ between diabetic and non-diabetic subjects. No changes in IgG titers occurred after treatment. Clinical improvements after mechanical non-surgical therapy in patients with insulin-dependent diabetes mellitus were modest after 2 months. Treatment did not eliminate B. forsythus and P. gingivalis and did not affect IgG titer responses. More intense therapy, and longer follow-up times, may be necessary to see more pronounced clinical and systemic effects.

Effects of antibiotic treatment on clinical conditions and bacterial growth with guided tissue regeneration.

Mucogingival flaps were reflected over pairs of mandibular molar teeth with Class II furcation invasions. The dimensions of the furcations were measured. The teeth were debrided and an expanded polytetrafluoroethylene (e-PTFE) membrane was placed and retained over one furcation of each pair (test site) for 4 weeks. The second site served as a control. Eight patients (group 1) with 12 e-PTFE sites received no antibiotic. Seven patients (group 2) with 12 e-PTFE sites were administered amoxicillin/clavulanate potassium for 10 days. Paper-points were used to collect bacterial samples and clinical indices were recorded at baseline and weekly for 4 weeks. Paper-point samples and the e-PTFE collected at week 4 were sonicated and analyzed by DNA probes for seven putative pathogens. At baseline no parameter showed statistical differences between groups or sites. At week 1 significantly greater levels of Prevotella intermedia type I (P < 0.05) and Fusobacterium nucleatum (P < 0.01) were found in group 1. At week 4, paper-point samples from test sites (P < 0.05) and e-PTFE materials (P < 0.001) showed significantly higher presence of Bacteroides forsythus in group 1. No significant microbial changes were found for control sites over time or between groups. The total bacterial load at test sites over time increased similarly for patients administered or not administered the antibiotic. Clinical signs of inflammation were significantly greater in group 1 and associated with the presence of B. forsythus (P < 0.01).

Effects of antibiotic treatment on clinical conditions with guided tissue regeneration: one-year results.

The one-year results of a regenerative procedure in patients treated with or without antibiotics are presented. Expanded polytetrafluoroethylene (ePTFE) was placed over mandibular molar Class II furcation invasions and retained for four weeks. The patients in group 1 received no antibiotics; patients in group 2 received amoxicillin/clavulanate potassium during the first 10 post-operative days. The initial differences in tested microorganisms and post-surgical inflammation indicated that the use of the antibiotic might enhance the long-term outcome. After one year, the reduction in mean probing depth of the furcation invasions was 2.0 +/- 1.2 mm for group 1 and 1.8 +/- 1.1 mm for group 2. An overall gain of 0.8 mm of clinical attachment was found. Twenty-two of the 24 sites were re-entered. Wide individual variations were found but the changes between pre-treatment and one-year data for any of 6 linear measurements of hard tissue landmarks did not differ between groups or between pre-treatment and re-entry. A combination of an overall loss of 0.4 mm alveolar bone at the crest and 0.3 mm gain of bone at the bottom of the furcation defects was found. Volumetric analysis indicated an average 32% bone fill for both groups, ranging from a decrease in defect volume by 84% (gain) to an increase of the size of the furcation invasion by 66% (loss). A decrease in defect volume > 30% was found at 7 sites from each group. The antibiotic may have controlled initial inflammation, but 12 months later it had no direct effect on bone regeneration or soft tissue attachment.

Treatment of periodontitis by local administration of minocycline microspheres: a controlled trial.

BACKGROUND: Periodontitis is an inflammatory condition of tooth-supporting tissues that is usually treated by mechanical removal of plaque and microorganisms that adhere to teeth. This treatment, known as scaling and root planing, is not optimally effective. Adjunctive therapy with locally delivered antimicrobials has resulted in improved clinical outcomes such as probing depth reduction. This article reports on the efficacy and safety of locally administered microencapsulated minocycline. METHODS: Seven hundred forty-eight (748) patients with moderate to advanced periodontitis were enrolled in a multi-center trial and randomized to 1 of 3 treatment arms: 1) scaling and root planing (SRP) alone; 2) SRP plus vehicle; or 3) SRP plus minocycline microspheres. The primary outcome measure was probing depth reduction at 9 months. Clinical assessments were performed at baseline and 1, 3, 6, and 9 months. RESULTS: Minocycline microspheres plus scaling and root planing provided substantially more probing depth reduction than either SRP alone or SRP plus vehicle. The difference reached statistical significance after the first month and was maintained throughout the trial. The improved outcome was observed to be independent of patients' smoking status, age, gender, or baseline disease level. There was no difference in the incidence of adverse effects among treatment groups. CONCLUSIONS: Scaling and root planing plus minocycline microspheres is more effective than scaling and root planing alone in reducing probing depths in periodontitis patients.

Evaluation of a single-tooth implant.

Fifty-nine commercially pure titanium implants in 59 subjects were compared with internal control teeth for 3 years. Nineteen coated implants of identical design were placed in 17 of the subjects and compared with the titanium implants. Demographic data, microbial DNA, aspartate aminotransferase levels, Plaque Index, width of adjacent keratinized tissue, probing depths, bleeding on probing, relative attachment levels, mobility, and radiographic bone height were studied. The only statistically significant changes over time were improved plaque scores in the subjects and slight bone loss around the implants. There were no differences between the 2 types of implants. Mobility was less and probing depth and bleeding on probing were greater in the implant sites than in the control sites.

Early implant failures in patients treated with Brånemark System titanium dental implants: a retrospective study.

Implant failure has been associated with factors such as poor bone quality, insufficient bone volume, implant instability, unfavorable implant loading, and smoking habits. Infections and host responses may also be important factors in dental implant failure. The objectives of the present study were to identify various explanatory factors associated with titanium implant failure. Forty subjects with stage 1 non-osseointegrated titanium dental implants (NOTI) ad modum Brånemark and 40 age- and gender-matched control subjects with successfully osseointegrated titanium implants (SOTI) were studied. Clinical data and gamma G immunoglobulin (IgG) antibody titers were studied. An independent t test revealed that significantly longer implants were placed in subjects with SOTI (P < .05). Statistically significant differences in bone shape and resorption (BSR) scores were found between SOTI and NOTI (P < .05). Logistic regression analysis identified 3 significant explanatory outcome variables: serum antibody avidity scores for Bacteroides forsythus (P < .0001), serum antibody titers to Staphylococcus aureus (P < .001), and the BSR scores (P < .05). Antibody avidity to B forsythus and antibody titer to S aureus were therefore the 2 most important factors associated with early implant failures and with a significant predictive ability. This indicates that immunologic factors are involved in osseointegration.

Periodontal conditions in medically compromised elderly subjects: assessments of treatment needs.

Periodontal conditions were studied in 42 dentate elderly subjects (mean age, 84.1 +/- 8.0 years). None of them had received recent dental care or was routinely seen by a dentist. Overall, they had 20.2 +/- 7.1 teeth (range, 6-32). The CPITN was used to assess periodontal status. Twenty-nine percent of all sextants were either edentulous or had only one remaining tooth. The overall oral hygiene was poor (Plaque Index, 1.8 +/- 0.5) and gingival inflammation severe (Gingival Index, 1.9 +/- 0.8). Significant correlations were found between: Gingival and Plaque Indices (r = 0.82, p < 0.001), and pocket depth and Gingival Index (r = 0.38, p < 0.05). Plaque Index was negatively correlated to the number of remaining teeth (r = -0.43, p < 0.050). Age and remaining teeth were negatively correlated (r = -0.38, p < 0.05). Thirty percent of the posterior sextants had a CPITN score of "4," and 75% of the posterior sextants had at least one site with a pocket depth 4 mm. Only 2.9% of all sites demonstrated pocket depth 6 mm and these sites were distributed among 67% of the subjects. The CPITN index was correlated to the mean pocket depth for the various sextants, the correlation varying between r = 0.67, p < 0.001 (upper right posterior) and 0.36, p < 0.05 (upper left posterior) sextants. The total manpower estimated to complete initial therapy for 42 patients was approximately 63 hours by a dentist and 85 hours by a dental hygienist.

Oral health and medical status in dentate low-income older persons.

Oral and medical conditions of 295 low-income dentate older persons (17% African-Americans, 14.5% Asians, 11.5% Hispanics, and 57% Caucasians) were studied. The mean age was 72 (SD +/- 6.8; range, 60-91). Oral examinations were performed, stimulated saliva was collected, and interviews were conducted regarding oral health attitudes, knowledge, and behaviors. Past history of restorative care, defined by filled coronal surfaces, differed by ethnicity, with Caucasian elders having most filled surfaces (p < 0.001). Ethnic minority elders had significantly poorer periodontal health (p < 0.001), with the worst conditions in Asians. Low salivary flow (< 0.01 mL/min) was found in 31% using medications known to cause hyposalivation. Frequent diseases were arthritis (46%), hypertension (39%), heart disease (25.2%), and diabetes (8.5%). Hypothyroidism was associated with low flow rate (F = 13.2, p < 0.0003). Seventy percent reported that they had never smoked. Smokers had deeper probing depths (chi 2 = 11.98, p < 0.05) and more gingival recession (F = 8.08, p < 0.001). Women on hormone replacement therapy (HRT) had less calculus (F = 11.33, p < 0.01) and fewer sites with probing depths > 5 mm (F = 8.99, p < 0.003). The present study found few associations between physical and oral health and ethnicity. The benefits of HRT for women's periodontal health and the effects of hypothyroidism on stimulated salivary flow are noteworthy.

Comparison of the effects of cetylpyridinium chloride with an essential oil mouth rinse on dental plaque and gingivitis - a six-month randomized controlled clinical trial.

OBJECTIVE: To compare the effects of an experimental mouth rinse containing 0.07% cetylpyridinium chloride (CPC) (Crest Pro-Health) with those provided by a commercially available mouth rinse containing essential oils (EOs) (Listerine) on dental plaque accumulation and prevention of gingivitis in an unsupervised 6-month randomized clinical trial. MATERIAL AND METHODS: This double-blind, 6-month, parallel group, positively controlled study involved 151 subjects balanced and randomly assigned to either positive control (EO) or experimental (CPC) mouth rinse treatment groups. At baseline, subjects received a dental prophylaxis procedure and began unsupervised rinsing twice a day with 20 ml of their assigned mouthwash for 30 s after brushing their teeth for 1 min. Subjects were assessed for gingivitis and gingival bleeding by the Gingival index (GI) of Löe & Silness (1963) and plaque by the Silness & Löe (1964) Plaque index at baseline and after 3 and 6 months of rinsing. At 3 and 6 months, oral soft tissue health was assessed. Microbiological samples were also taken for community profiling by the DNA checkerboard method. RESULTS: Results show that after 3 and 6 months of rinsing, there were no significant differences (p=0.05) between the experimental (CPC) and the positive control mouth rinse treatment groups for overall gingivitis status, gingival bleeding, and plaque accumulation. At 6 months, the covariant (baseline) adjusted mean GI and bleeding sites percentages for the CPC and the EO rinses were 0.52 and 0.53 and 8.7 and 9.3, respectively. Both mouth rinses were well tolerated by the subjects. Microbiological community profiles were similar for the two treatment groups. Statistically, a significant greater reduction in bleeding sites was observed for the CPC rinse versus the EO rinse. CONCLUSION: The essential findings of this study indicated that there was no statistically significant difference in the anti-plaque and anti-gingivitis benefits between the experimental CPC mouth rinse and the positive control EO mouth rinse over a 6-month period.

Immunization of Macaca fascicularis against experimental periodontitis using a vaccine containing cysteine proteases purified from Porphyromonas gingivalis.

INTRODUCTION: Periodontitis is a common infectious disease to which Porphyromonas gingivalis has been closely linked, in which the attachment tissues of the teeth and their alveolar bone housing are destroyed. We conducted a study to determine if immunization using a purified antigen could alter the onset and progression of the disease. METHODS: Using the ligature-induced model of periodontitis in Macaca fascicularis, we immunized five animals with cysteine protease purified from P. gingivalis and used an additional five animals as controls. Alveolar bone loss was measured by digital subtraction radiography. RESULTS: Immunization induced high titers of specific immunoglobuin G serum antibodies that were opsonic. Total bacterial load, levels of P. gingivalis in subgingival plaque and levels of prostaglandin E(2) in gingival crevicular fluid were significantly reduced. Onset and progression of alveolar bone loss was inhibited by approximately 50%. No manifestations of toxicity were observed. CONCLUSIONS: Immunization using a purified protein antigen from P. gingivalis inhibits alveolar bone destruction in a ligature-induced periodontitis model in M. fascicularis.

Impact of sample storage on detection of periodontal bacteria.

BACKGROUND/AIMS: Information on the impact of sample storage prior to analysis by DNA methods is limited. The aim of this study was to investigate the effect of subgingival sample storage on bacterial detection and enumeration. MATERIAL AND METHODS: Subgingival plaque samples were studied by a) checkerboard DNA-DNA hybridization by immediate processing, b) storage at + 4 degrees C for 6 weeks, c) storage at - 20 degrees C for 6 months or d) storage at - 20 degrees C for 12 months. RESULTS: No differences in total DNA were found between protocol 1 and 2, or between protocol 3 and 4. Protocol 1 yielded 2.4 times more total bacterial DNA than did protocol 3 (P < 0.001). Actinobacillus actinomycetemcomitans and Campylobacter gracilis were detected in 21.1% of the immediately processed samples but only in 6.6% of the samples after 12 months of storage. Similar changes were noticed for Treponema denticola, which was detected in 22.3% and 9.2%, respectively. Streptococci spp., Fusobacterium nucleatum and Tannerella forsythia did not seem to be affected by storage. In contrast, the level of Campylobacter rectus detection frequency changed from 2.6% if processed immediately to 15.8% if samples were stored for 12 months. CONCLUSIONS: In longitudinal clinical studies including microbiological samples and processed with DNA-DNA hybridization methods, samples should be stored for the same period of time before processing to avoid loss of microbiological information.