Metronidazole may display anti-inflammatory features in periodontitis treatment: A scoping review.

AIM: Metronidazole (MTZ) is an antimicrobial agent used to treat anaerobic infections. It has been hypothesized that MTZ may also have anti-inflammatory properties, but the evidence is limited and has not been previously reviewed. Thus, this scoping review aimed to answer the following question: "What is the evidence supporting anti-inflammatory properties of metronidazole that are not mediated by its antimicrobial effects?" METHODS: A scoping review was conducted according to the PRISMA-ScR statement. Five databases were searched up to January 2023 for studies evaluating the anti-inflammatory properties of MTZ used as monotherapy for treating infectious and inflammatory diseases. RESULTS: A total of 719 records were identified, and 27 studies (21 in vivo and 6 in vitro) were included. The studies reported experimental evidence of MTZ anti-inflammatory effects on (1) innate immunity (barrier permeability, leukocyte adhesion, immune cell populations), (2) acquired immunity (lymphocyte proliferation, T-cell function, cytokine profile), and (3) wound healing/resolution of inflammation. CONCLUSION: Taken together, this scoping review supported a potential anti-inflammatory effect of MTZ in periodontitis treatment. We recommend that future clinical studies should be conducted to evaluate specific MTZ anti-inflammatory pathways in the treatment of periodontitis.

Cannabinoids in Periodontology: Where Are We Now?

INTRODUCTION: Cannabinoids are a well-documented treatment modality for various immune and inflammatory diseases, including asthma, chronic obstructive pulmonary disease, Crohn's disease, arthritis, multiple sclerosis, and a range of neurodegenerative conditions. However, limited information is available regarding the therapeutic potential of cannabinoids in treating periodontal disease. OBJECTIVE: The objective of this study is to analyze the current evidence on the antibacterial and immunomodulatory effects of cannabis and its role in the healing and regeneration processes within periodontal tissues. RESULTS: This review discusses the potential role of cannabinoids in restoring periodontal tissue homeostasis. CONCLUSIONS: The examination of the endocannabinoid system and the physiological effects of cannabinoids in the periodontium suggests that they possess immunomodulatory and antibacterial properties, which could potentially promote proper tissue healing and regeneration.

Biochemical and X-ray micro-computed tomographic analyses of critical size bone defects grafted with autogenous bone and mercerized bacterial cellulose membranes salified with alendronate.

OBJECTIVES: This study aimed to evaluate the repair of critical-sized bone defects grafted with autogenous bone and mercerized bacterial cellulose membranes (BCm) salified with alendronate (ALN). METHODS: Forty-eight male Wistar rats underwent surgery to create a 5 mm-diameter bone defect in the calvarium. The removed bone was particularized, regrafted into the defect, and covered by a BCm according to the group: control group (CG), simply mercerized BCm; group 1 (G1), negatively charged BCm (BCm-CM-) salified with ALN; and group 2 (G2), positively charged BCm (BCm-DEAE+) salified with ALN. Serum samples were collected preoperatively and before euthanasia to analyze osteoprotegerin (OPG), parathyroid hormone (PTH), sclerostin (SOST), and fibroblast growth factor 23 (FGF23) levels. The animals were euthanized after 15 or 60 d. Calvaria were analyzed using quantitative microtomography (µCT). RESULTS: There was an increased level of PTH in the CG compared to the G2 group, at day 60 (p = 0.019). When analyzing the same group over time, G1 presented an increased FGF23 level on days 15 and 60 (p < 0.05). CG presented an increase in PTH (p = 0.037) at day 60. The µCT analysis detected increased trabecular separation on day 15 in G2 compared to G1 (p = 0.040). CONCLUSIONS: Salification of ionized BCm with ALN had no direct effect on bone repair; however, BCm-CM- increased the levels of FGF23 over time. BCm-DEAE+ decreased PTH levels compared to mercerized BCm. BCm-CM-salified with ALN-induced superior bone quality, with respect to trabecular separation, compared to BCm-DEAE+.

Oral Versus Gastrointestinal Mucosal Immune Niches in Homeostasis and Allostasis.

Different body systems (epidermis, respiratory tract, cornea, oral cavity, and gastrointestinal tract) are in continuous direct contact with innocuous and/or potentially harmful external agents, exhibiting dynamic and highly selective interaction throughout the epithelia, which function as both a physical and chemical protective barrier. Resident immune cells in the epithelia are constantly challenged and must distinguish among antigens that must be either tolerated or those to which a response must be mounted for. When such a decision begins to take place in lymphoid foci and/or mucosa-associated lymphoid tissues, the epithelia network of immune surveillance actively dominates both oral and gastrointestinal compartments, which are thought to operate in the same immune continuum. However, anatomical variations clearly differentiate immune processes in both the mouth and gastrointestinal tract that demonstrate a wide array of independent immune responses. From single vs. multiple epithelia cell layers, widespread cell-to-cell junction types, microbial-associated recognition receptors, dendritic cell function as well as related signaling, the objective of this review is to specifically contrast the current knowledge of oral versus gut immune niches in the context of epithelia/lymphoid foci/MALT local immunity and systemic output. Related differences in 1) anatomy 2) cell-to-cell communication 3) antigen capture/processing/presentation 4) signaling in regulatory vs. proinflammatory responses and 5) systemic output consequences and its relations to disease pathogenesis are discussed.

Systemic Th17 response in the presence of periodontal inflammation.

BACKGROUND: The relationship between periodontitis and the pathogenesis of other inflammatory diseases, such as diabetes, rheumatoid arthritis and obesity has been an important topic of study in recent decades. The Th17 pathway plays a significant role in how local inflammation can influence systemic inflammation in the absence of systemic pathology. OBJECTIVE: To determine Th17 biased-cells in systemically healthy patients in the presence of generalized chronic periodontitis. METHODOLOGY: A total of 28 patients were recruited without systemic inflammatory pathology, which was determined by clinical history, the Health Assessment Questionnaire (HAQ) and rheumatoid factor detection. Of these patients, 13 were diagnosed as healthy/gingivitis (H/G) and 15 as generalized chronic periodontitis (GCP). Th17 (CD4+CD161+) cells and Th17IL23R+ (CD4+CD161+IL-23R+) cells were quantified by flow cytometry, based on the total cells and on the lymphocyte region, termed the "enriched population" (50,000 events for each). RESULTS: The percentages of Th17 cells of the H/G and periodontitis groups were similar on total cells and enriched population (19 vs 21.8; p=4.134 and 19.6 vs 21.8; p=0.55). However, Th17IL23R+ cells differ significantly between periodontally healthy patients and generalized chronic periodontitis patients in both total cell (0.22% vs 0.65%; p=0.0004) and enriched populations (0.2% vs 0.75%; p=0.0266). CONCLUSIONS: GCP patients (otherwise systemically healthy) were characterized by increased Th17-proinflammatory cell phenotype positive for the IL-23 receptor in peripheral blood. The proportion of Th17 cells that are negative for the IL-23 receptor in the peripheral blood of systemically healthy patients seemed to be unaffected by the presence or absence of chronic periodontitis.

Systemic Th17 response in the presence of periodontal inflammation

Abstract The relationship between periodontitis and the pathogenesis of other inflammatory diseases, such as diabetes, rheumatoid arthritis and obesity has been an important topic of study in recent decades. The Th17 pathway plays a significant role in how local inflammation can influence systemic inflammation in the absence of systemic pathology. Objective: To determine Th17 biased-cells in systemically healthy patients in the presence of generalized chronic periodontitis. Methodology: A total of 28 patients were recruited without systemic inflammatory pathology, which was determined by clinical history, the Health Assessment Questionnaire (HAQ) and rheumatoid factor detection. Of these patients, 13 were diagnosed as healthy/gingivitis (H/G) and 15 as generalized chronic periodontitis (GCP). Th17 (CD4+CD161+) cells and Th17IL23R+ (CD4+CD161+IL-23R+) cells were quantified by flow cytometry, based on the total cells and on the lymphocyte region, termed the "enriched population" (50,000 events for each). Results: The percentages of Th17 cells of the H/G and periodontitis groups were similar on total cells and enriched population (19 vs 21.8; p=4.134 and 19.6 vs 21.8; p=0.55). However, Th17IL23R+ cells differ significantly between periodontally healthy patients and generalized chronic periodontitis patients in both total cell (0.22% vs 0.65%; p=0.0004) and enriched populations (0.2% vs 0.75%; p=0.0266). Conclusions: GCP patients (otherwise systemically healthy) were characterized by increased Th17-proinflammatory cell phenotype positive for the IL-23 receptor in peripheral blood. The proportion of Th17 cells that are negative for the IL-23 receptor in the peripheral blood of systemically healthy patients seemed to be unaffected by the presence or absence of chronic periodontitis.

Gingival crevicular fluid levels of cytokines/chemokines in chronic periodontitis: a meta-analysis.

AIMS: To compare gingival crevicular fluid (GCF) cytokines/chemokines levels between periodontally healthy subjects and subjects diagnosed with chronic periodontitis (ChP), before and after non-surgical periodontal treatment, and to establish their predictive value for periodontal disease progression. METHODS: Studies indexed in MEDLINE and EMBASE published in English, Portuguese and Spanish were eligible for this review. Database searches up to December 2015, and manual search of the reference list from reviews and selected articles was performed. Only studies providing data on GCF cytokines/chemokines levels in subjects diagnosed with ChP and periodontally healthy controls were included. Cross-sectional, case series, single-arm clinical studies, randomized controlled trials and prospective/retrospective cohort studies were included. Meta-analyses were conducted for those cytokines/chemokines with at least three available studies. RESULTS: GCF levels of IL-1ß, IL-6, IFN-γ and MCP-1/CCL2 were significantly higher in subjects diagnosed with ChP than periodontally healthy subjects. A significant decrease in GCF levels of IL-1ß and IL-17 was observed after non-surgical periodontal treatment, whereas a significant increase was observed for IL-4. CONCLUSION: Evidence for significant differences between periodontal health and ChP was observed for a few cytokines and one chemokine. No conclusions could be drawn with regards to increased risk of disease progression.

[Effect of periodontal therapy on the subgingival microbiota in preeclamptic patients]. / Efecto del tratamiento periodontal sobre la microbiota subgingival en pacientes con preeclampsia.

INTRODUCTION: Few studies have described subgingival microbiota in pregnant women with mild preeclampsia. OBJECTIVE: Clinical periodontal and subgingival microbiota changes were identified in pregnant women with mild preeclampsia after periodontal treatment. MATERIALS AND METHODS: In a secondary analysis of a randomized clinical trial, 57 preeclamptic women were studied at Hospital Universitario del Valle in Cali, Colombia. Thirty one women were randomized to the periodontal intervention group (subgingival scaling and planing ultrasonic and manual) during pregnancy and 26 to the control group (supragingival prophylaxis). Periodontal clinical parameters and subgingival microbiota were characterized at the time of acceptance into the study and again at postpartum. Eight periodontopathic bacteria and 2 herpesviruses were assessed by polymerase chain reaction. Chi-square, McNemar or Student's t tests were used, with a significance level of p≤0.05. RESULTS: Both groups were comparable in the clinical and microbiological variables at baseline. Periodontal treatment reduced the average pocket depth in the intervention group from 2.4±0.3 to 2.3±0.2 mm (p<0.001) and in control group 2.6±0.4 to 2.44±0.4 mm, (p<0.001) and bleeding index 16.4±1.5% to 7.9±0.7% in the intervention group(p<0.001) and 17.1±1.8% to 10±0.9% in the control group (p=0.002). The frequency of detection of microorganisms did not differ significantly between groups. CONCLUSION: Scaling/root planning and supragingival prophylaxis significantly reduced the probing depth and gingival bleeding index. Periodontal treatment was not more effective than prophylaxis in reducing periodontopathic organisms or herpesvirus.

Efecto del tratamiento periodontal sobre la microbiota subgingival en pacientes con preeclampsia / Effect of periodontal therapy on the subgingival microbiota in preeclamptic patients

Introducción. Pocos estudios han descrito la microbiota subgingival en mujeres embarazadas con preeclampsia leve. Objetivo. Identificar cambios periodontales y de la microbiota subgingival en mujeres embarazadas con preeclampsia, después del tratamiento periodontal. Materiales y métodos. En un análisis secundario de un ensayo clínico de asignación aleatoria, se estudiaron 57 pacientes con preeclampsia en el Hospital Universitario del Valle de Cali. Se asignaron al azar 31 al grupo de intervención periodontal (detartraje y alisado subgingival ultrasónico y manual) durante su embarazo y otras 26 al grupo control (profilaxis supragingival). Se determinaron los parámetros clínicos periodontales y la microbiota subgingival a la inclusión al estudio y en el posparto. Se evaluaron 8 bacterias periodontopáticas y 2 virus herpes por reacción en cadena de la polimerasa. Se usaron las pruebas de ji al cuadrado, test de McNemar o t de Student, con un nivel de significancia de p≤ Resultados. Los grupos fueron comparables en las variables clínicas y microbiológicas al inicio del estudio. El tratamiento periodontal redujo el promedio de la profundidad de bolsa en el grupo de intervención de 2,44±0,31 a 2,31±0,24 mm (p=0,000) y en el grupo control de 2,58±0,37 a 2,44±0,39 mm (p=0,000),y el índice de sangrado, de 16,4±1,5 a 7,9±0,7 % en el primero (p=0,000), y de 17,1±1,8 a 10±0,9 %, en el segundo (p=0,002). La frecuencia de detección de microorganismos no varió de manera significativa entre los grupos. Conclusión. El raspaje y alisado radicular, así como la profilaxis supragingival, redujeron de manera significativa la profundidad a la sonda y el índice de sangrado gingival. El tratamiento periodontal no fue más efectivo que la profilaxis para reducir los organismos periodontopáticos o los virus herpes.

Introduction. Few studies have described subgingival microbiota in pregnant women with mild preeclampsia. Objective. Clinical periodontal and subgingival microbiota changes were identified in pregnant women with mild preeclampsia after periodontal treatment. Materials and methods. In a secondary analysis of a randomized clinical trial, 57 preeclamptic women were studied at Hospital Universitario del Valle in Cali, Colombia. Thirty one women were randomized to the periodontal intervention group (subgingival scaling and planing ultrasonic and manual) during pregnancy and 26 to the control group (supragingival prophylaxis). Periodontal clinical parameters and subgingival microbiota were characterized at the time of acceptance into the study and again at postpartum. Eight periodontopathic bacteria and 2 herpesviruses were assessed by polymerase chain reaction. Chi-square, McNemar or Student´s t tests were used, with a significance level of p≤0.05. Results. Both groups were comparable in the clinical and microbiological variables at baseline. Periodontal treatment reduced the average pocket depth in the intervention group from 2.4±0.3 to 2.3±0.2 mm (p<0.001) and in control group 2.6±0.4 to 2.44±0.4 mm, (p<0.001) and bleeding index 16.4±1.5% to 7.9±0.7% in the intervention group(p<0.001) and 17.1±1.8% to 10±0.9% in the control group (p=0.002). The frequency of detection of microorganisms did not differ significantly between groups. Conclusion. Scaling/root planning and supragingival prophylaxis significantly reduced the probing depth and gingival bleeding index. Periodontal treatment was not more effective than prophylaxis in reducing periodontopathic organisms or herpesvirus.

Periodontal treatment effects on endothelial function and cardiovascular disease biomarkers in subjects with chronic periodontitis: protocol for a randomized clinical trial.

BACKGROUND: Periodontal disease (PD) is an infectious clinical entity characterized by the destruction of supporting tissues of the teeth as the result of a chronic inflammatory response in a susceptible host. It has been proposed that PD as subclinical infection may contribute to the etiology and to the pathogenesis of several systemic diseases including Atherosclerosis. A number of epidemiological studies link periodontal disease/edentulism as independent risk factor for acute myocardial infarction, peripheral vascular disease, and cerebrovascular disease. Moreover, new randomized controlled clinical trials have shown an improvement on cardiovascular surrogate markers (endothelial function, sICAM, hsPCR level, fibrinogen) after periodontal treatment. Nonetheless, such trials are still limited in terms of external validity, periodontal treatment strategies, CONSORT-based design and results consistency/extrapolation. The current study is designed to evaluate if periodontal treatment with scaling and root planning plus local delivered chlorhexidine improves endothelial function and other biomarkers of cardiovascular disease in subjects with moderate to severe periodontitis. METHODS/DESIGN: This randomized, single-blind clinical trial will be performed at two health centers and will include two periodontal treatment strategies. After medical/periodontal screening, a baseline endothelium-dependent brachial artery flow-mediated dilatation (FMD) and other systemic surrogate markers will be obtained from all recruited subjects. Patients then will be randomized to receive either supragingival/subgingival plaque cleaning and calculus removal plus chlorhexidine (treatment group) or supragingival plaque removal only (control group). A second and third FMD will be obtained after 24 hours and 12 weeks in both treatment arms. Each group will consist of 49 patients (n = 98) and all patients will be followed-up for secondary outcomes and will be monitored through a coordinating center. The primary outcomes are FMD differences baseline, 24 hours and 3 months after treatment. The secondary outcomes are differences in C-reactive protein (hs-CRP), glucose serum levels, blood lipid profile, and HOMA index. DISCUSSION: This RCT is expected to provide more evidence on the effects of different periodontal treatment modalities on FMD values, as well as to correlate such findings with different surrogate markers of systemic inflammation with cardiovascular effects. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT00681564.

Why must physicians know about oral diseases?

BACKGROUND: Poor oral health reflects social inequalities, hence the prevention of oral diseases should be a priority in developed and underdeveloped countries around the world. Medical practitioners must play an active role in oral health promotion. SUMMARY: Proper knowledge of oral diseases is crucial in medical practice due to the following reasons: (a) Periodontal disease is associated with multiple systemic conditions of medical interest, (b) a large number of systemic diseases have oral manifestations, (c) many drugs are associated with oral adverse drug reactions, (d) physicians are generally not sufficiently trained to detect oral cancer manifestations, (e) physicians could play a pivotal role in oral public health, and (f) early detection of oral diseases by physicians could improve the oral health status of the population. CONCLUSIONS: Physicians need to get more involved in oral health promotion. Moreover, oral health education should be included in the curriculum of future medical students.

Toothbrush contamination in family members

Objective: The purpose of this study was to determine the bacterial contamination of toothbrushes in family members. Materials and Methods: One hundred and two healthy subjects were included in this descriptive study. Every individual was examined clinically and microbiologically using the CPITN index and collecting subgingival plaque samples. Each participant received a toothbrush for home use and after one month they returned it to the investigators. All toothbrushes were cultured to determine the presence of periodontopathic bacteria and enteric rods. Wilkoxon signed rank test and t student test (P d"0.05) were used to compare differences in the subgingival microbiota and toothbrush contamination and CPITN index among family members. Results: A high proportion of toothbrushes resulted highly contaminated with enteric rods (P d"0.001) compared to the subgingival environment where periodontopathic bacteria were more prevalent. The most frequent microorganisms found in toothbrushes used by parents and children for one month were Enterobacteriaceae, Pseudomonadaceae species (>50 percent) and Fusobacterium spp (30 percent). Conclusions: High levels of enteric rods were commonly detected in toothbrushes used for 1 month among members of the families. These opportunistic organisms may have an important role in oral infections including gingivitis and periodontitis. Monthly replacement or disinfection of the toothbrush can reduce the risk of bacterial transmission/translocation and thus diminish the incidence of biofilm associated oral diseases.

Apoptosis de fibroblastos gingivales en periodontitis / Apoptosis of gingival fibroblasts in periodontitis

Introducción: Los fibroblastos gingivales humanos (FGH) tienen un papel importante en la enfermedad periodontal, pues alteran su normal funcionamiento en respuesta a estímulos pro-inflamatorios. Se cree que los fibroblastos se pueden eliminar anormalmente por medio de apoptosis en periodontitis. El propósito de este estudio es determinar y cuantificar la apoptosis de FGH en biopsias del periodonto de individuos sanos y con enfermedad periodontal. Métodos: Se realizó un estudio clínico descriptivo de corte transversal en personas con diagnóstico de salud periodontal (S), gingivitis (G) y periodontitis crónica (PC). Se tomaron biopsias escisionales y se hicieron tinciones inmunohistoquímicas (hematoxilina-eosina, caspasa-3 y vimentina). Las placas se interpretaron por histopatología y se digitalizaron para cuantificar las células apoptóticas. Todos los datos se analizaron con un software estadístico para encontrar diferencias significativas (p<0.05). Resultados: La población celular total de fibroblastos tuvo un promedio de 430±67.6 en los individuos sanos y una disminución significativamente progresiva en gingivitis (270±37.1) y periodontitis crónica (206.5±69.8) (p<0.05). La expresión de fibroblastos apoptóticos por campo aumentó de acuerdo con las severidades de la enfermedad [28±16 en sanos (6.5%); 31±17 en gingivitis (11.5%) y 51±24 en periodontitis (24.8%.), (p<0.001)]. La relación entre la expresión de fibroblastos apoptóticos y la profundidad de la bolsa periodontal no fue significante (p>0.5, r²=0.02); mientras que para las células inflamatorias se encontró una relación proporcional significativa (p<0.05, r²=0.2018).

Introduction: Human gingival fibroblasts (HGF) have an important role in the periodontal immune response. The fibroblasts alter their normal behavior in response to pro-inflammatory cytokines. It is believed that HGF can be diminished and/or eliminated by means of apoptosis. The purpose of this study was to determine and to quantify apoptosis of HGF in periodontium biopsies from healthy and chronic periodontitis patients. Methods: A clinical cross-sectional study in people with healthy periodontium (S), gingivitis (G) and chronic periodontitis (PC) patients was carried out. The periodontal biopsies were obtained and immunostained by means of: hematoxylin-eosin, caspase-3, vimentin and caspase-vimentin double-staining for specific visualization of apoptotic fibroblasts. Histopathological and digital analyses were performed. Descriptive statistics were applied to categorical and nominal variables. Results: Total cell population of HGF had an average of 430±67.6 cells/field in healthy people, and a significantly progressive decrease in gingivitis (270±37.1) and chronic periodontitis groups (206.5±69.8) (p<0.05). As for total population of inflammatory cells, an increase was noticed in gingivitis (191.8±50.1) and a decrease in periodontitis (109.3±21.7) without statistical significance. The expression of apoptotic HGF per field increased accordingly to the severity of the disease [28±16 in health (6.5%); 31±17 in gingivitis (11.5%) and 51±24 in periodontitis (24.8%), p<0.001]. Similar findings were observed for inflammatory cells with different percentage expression [17±13 in health (23%); 28±19 in gingivitis (14.6%) and 47±35 in periodontitis (43.1%), p<0.05]. The relationship between the percentage of expression of apoptotic cells and probing pocket depth was proportional but not significant (p>0.5, r²=0.02); while for the inflammatory cells a significant relationship was observed (p<0.05, r²=0.2018).

Periodontal disease severity is related to high levels of C-reactive protein in pre-eclampsia.

OBJECTIVE: Recent studies have shown that pre-eclamptic women present a high prevalence of periodontitis, suggesting that active periodontal disease may play a role in the pathogenesis of pre-eclampsia. The present study analysed the effect of periodontal disease in the concentrations of serum high-sensitivity C-reactive protein (hs-CRP), and its association with pre-eclampsia. METHODS: A case-control study was carried out in Cali-Colombia, comprised of 398 pregnant women (145 cases and 253 controls) who were believed to have periodontal disease, between 28 and 36 weeks of gestational age. Pre-eclampsia cases were defined as blood pressure > or = 140/90 mmHg and proteinuria > or = 0.3 g/24 h. Controls were pregnant women with normal blood pressure, without proteinuria, matched by maternal age, gestational age and body mass index. Sociodemographic data, obstetric risk factors, periodontal state, subgingival microbial composition and hs-CRP levels were determined in both groups. RESULTS: The case and control groups were comparable for sociodemographic characteristics. In women with pre-eclampsia and confirmed periodontal disease (n = 138), hs-CRP levels increased according to the severity of the disease (gingivitis median 4.14 mg/dl; mild periodontitis median 4.70 mg/dl; moderate/severe periodontitis median 8.8 mg/dl; P = 0.01). A similar tendency was observed in controls with periodontal disease (n = 251), but it did not reach statistical significance (gingivitis median 5.10 mg/dl; mild periodontitis median 5.12 mg/dl; moderate/severe periodontitis median 6.90 mg/dl; P = 0.07). A significant difference in hs-CRP levels was observed in pre-eclamptic women with moderate/severe periodontitis compared to controls (P = 0.01). CONCLUSION: These findings suggest that chronic periodontitis may increase hs-CRP levels in pregnant women and lead to complications such as pre-eclampsia.

Demographic, clinical, and microbial aspects of chronic and aggressive periodontitis in Colombia: a multicenter study.

BACKGROUND: The microbial profile of periodontal disease varies among different human populations. This study evaluated the demographic, clinical, and microbiologic aspects of periodontitis in a multigeographic sample in Colombia. METHODS: Three hundred twenty-five patients with chronic periodontitis (CP), 158 patients with aggressive periodontitis (AgP), and 137 healthy-gingivitis controls from five regions of the country were studied. Clinical, microbial, and sociodemographic data were collected. Microbiologic identification was performed using polymerase chain reaction 16S rRNA gene on pooled subgingival samples, and the presence of Gram-negative enteric rods was evaluated by culture. Bivariate and multivariate logistic regression analyses were conducted. RESULTS: Porphyromonas gingivalis occurred in 71.5% of individuals with periodontitis, Tannerella forsythensis occurred in 58.5%, Campylobacter rectus occurred in 57.5%, Actinobacillus actinomycetemcomitans occurred in 23.6%, and enteric rods occurred in 34.5%. P. gingivalis was more common in CP and AgP than controls. A. actinomycetemcomitans was increased in AgP compared to controls and patients with CP. T. forsythensis, C. rectus, and Eikenella corrodens had a low presence in the West Pacific and Central regions, and enteric rods were increased in the Central region (P <0.05). Other sociodemographic factors were not associated with these microorganisms. CONCLUSIONS: Geographic regions do not influence the microbiota, but the microbiota may vary by geographic region. P. gingivalis, T. forsythensis, and C. rectus are the most prevalent periodontophatic microorganisms in Colombia. A. actinomycetemcomitans was more common in AgP, and a large percentage of the population studied had enteric rods in the subgingival plaque.

Occurrence of periodontopathic and superinfecting bacteria in chronic and aggressive periodontitis subjects in a Colombian population.

BACKGROUND: Differences in the composition of subgingival microbiota in periodontitis have been observed in different geographic locations. Some of these microbial differences could have clinical significance. This study describes clinical parameters and the composition of the subgingival microbiota in chronic periodontitis (CP) and aggressive periodontitis (AgP) patients in a Colombian population. METHODS: Clinical parameters (probing depth, clinical attachment level, bleeding on probing, and plaque index) and plaque samples from 68 CP, 12 AgP, and 30 periodontally healthy subjects were analyzed. Subgingival samples were processed using culture, biochemical tests, and polymerase chain reaction for the detection of periodontal and superinfecting pathogens. The analysis of variance, chi(2), and Kruskal-Wallis tests were used to evaluate differences between groups for clinical parameters and microbiologic composition (P

Frequency of detection of periodontopathic and superinfecting bacteria in HIV-positive patients with periodontitis.

OBJECTIVE: The aim of this investigation was to establish the frequency of detection of periodontopathic bacteria and Gram-negative enteric rods in HIV-positive (HIV+) patients with periodontitis. MATERIALS AND METHODS: Clinical parameters and microbiological samples were obtained from 31 HIV+ periodontitis (H+PG) patients, 32 HIV-negative (HIV-) periodontitis (H-PG) patients and 32 systemically and periodontally healthy (CG) patients. Microbial samples were analyzed using culturing techniques for periodontopathic and superinfecting microorganisms. The ANOVA test was used to assess differences in the clinical parameters, and the Chi square and two-tailed Mann Whitney tests were used to find differences in the composition of the microbiota (p < 0.05). RESULTS: The frequency of detection of periodontopathic bacteria was higher in HIV- periodontitis patients (p < 0.05) compared to HIV+ and healthy subjects. In contrast, HIV+ patients harbor higher levels of superinfecting microorganisms (p < 0.05). Pseudomonas aeruginosa, Enterobacter cloacae and Klebsiella pneumoniae were identified. CONCLUSIONS: The frequency of detection and levels of periodontopathic bacteria were higher in the HIV- periodontitis patients compared to HIV+ patients and healthy subjects. In contrast, levels of superinfecting bacteria were found to be elevated in HIV+ periodontitis patients. Special attention should be paid to the presence of periodontopathic and superinfecting bacteria in these patients in order to avoid further periodontal and systemic complications.

Microorganismos inusuales en surcos y bolsas periodontales / Unusual microorganisms in gingival sulcus and periodontal pockets

Introducción: Los microorganismos de la familia Enterobacteriaceae, los bacilos Gram negativos no fermentadores y ciertas especies de Candida se han considerado como inusuales en quienes sufren enfermedad periodontal, y en ellos el tratamiento mecánico o antimicrobiano puede ser poco efectivo para resolver o controlar la progresión de la enfermedad. Objetivos: Analizar los perfiles microbiológicos en individuos sanos y en pacientes con diagnóstico de periodontitis crónica y periodontitis agresiva, determinar la frecuencia de los microorganismos inusuales y las posibles asociaciones con algunos microorganismos periodontopáticos en la base de datos del laboratorio de microbiología oral y periodontal en Cali. Materiales y métodos: Se estudiaron los informes microbiológicos de 356 pacientes en un período de 41 meses. Las variables analizadas fueron: diagnóstico periodontal, recuento total de colonias, porcentaje de aislamiento de diez microorganismos periodontopáticos y de otros inusuales como miembros de la familia Enterobacteriaceae, bacilos Gram negativos no fermentadores y levaduras. Resultados: Se analizaron 202 (56.7%) informes de pacientes con periodontitis crónica, 139 (39.1%) de periodontitis agresiva y 15 (4.2%) de individuos periodontalmente sanos. La presencia de microorganismos inusuales de tipo entérico fue 36% y la prevalencia de levaduras 7% en las personas con periodontitis. No se encontraron diferencias significantes entre los tres diagnósticos clínicos con respecto a la presencia de microorganismos entéricos y levaduras. La mayor prevalencia de organismos entéricos correspondió a los géneros Klebsiella, Enterobacter y a bacilos Gram negativos no fermentadores. Se encontraron asociaciones estadísticamente significativas entre la presencia o ausencia de microorganismos infrecuentes con la de algunos microorganismos periodontopáticos en los individuos con enfermedad periodontal.

Introduction: Microorganisms of the Enterobacteriaceae family, non-fermentative Gram negative rods and species of Candida (yeast) have been considered as unusual microorganisms in patients with periodontitis, where antimicrobial and mechanical treatment have been often ineffective to solve or control the disease progression. Objectives: To analyze the microbiological profiles in periodontally healthy individuals, and in chronic and aggressive periodontitis patients; to determine the frequency of detection of unusual microorganisms and the possible associations with some periodontopathic bacteria in an oral microbiology laboratory database in Cali. Material and methods: Microbiological reports of 356 patients were analyzed in a period of 41 months. The variables were periodontal diagnosis, total colony counts, percentage of isolation of ten periodontal bacteria, Enterobacteriaceae spp; non-fermentative Gram negative rods and yeasts were also included in the analyses. Results: Reports of 202 (56.7%) patients with chronic periodontitis, 139 (39.1%) of patients with aggressive periodontitis and 15 (4.2%) of periodontally healthy individuals were found. The presence of unusual microorganisms of the Enterobacteriaceae family was 36% and the prevalence of yeast was 7% in the periodontitis patients. Among the three clinical diagnoses no significant differences were found with respect to the presence of enteric organism and yeasts. The greatest prevalence of enteric organisms belonged to Klebsiella spp, Enterobacter and non-fermentative Gram negative rods. Significant associations were found between the presence and absence of unusual microorganisms related to Actinobacillus. actinomycetemcomitans.

Clinical and microbiological characterization of periodontal abscesses.

BACKGROUND/AIM: The knowledge of clinical features, microbial composition and susceptibility to antimicrobials of periodontal abscesses has recently improved. This descriptive clinical and microbiological study provides more information on the characteristics of periodontal abscesses. MATERIALS AND METHODS: Clinical parameters and subgingival samples were examined from 54 subjects presenting 60 periodontal abscesses. Samples were cultured for anaerobic and facultative bacteria, and data were expressed as frequency detection and mean proportion of isolation for microorganisms. Selected isolates of Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Prevotella intermedia/nigrescens were used to test susceptibility to amoxicillin, azithromycin, tetracycline and metronidazole. Statistical descriptive analysis was conducted. RESULTS: Most periodontal abscesses were present in patients with ongoing Chronic Periodontitis. Bleeding on probing, tumefaction and suppuration were present in almost all abscesses. Affected teeth were lower anterior teeth, upper anterior teeth and lower molars. The subgingival microbiota was composed of periodontal pathogens such as Fusobacterium spp. (75%), P. intermedia/nigrescens (60%), P. gingivalis (51%) and A. actinomycetemcomitans (30%). Some periodontopathogens showed antimicrobial resistance to tetracycline, metronidazole and amoxicillin, but not to azithromycin. CONCLUSIONS: Periodontal abscesses showed typical clinical features associated with untreated periodontitis, and the organisms identified were important periodontopathic bacteria. Rationale use of antibiotic adjunctive therapy in abscess treatment should be taken into account.

Terapia periodontal del futuro / Periodontal therapy in the future

La investigación biomédica en odontología genera una importante cantidad de evidencia científica que mejora los actuales esquemas de tratamiento de las enfermedades que afectan la cavidad oral en los humanos. Este artículo revisa el diagnóstico de la periodontitis, la etiopatogénesis de la enfermedad periodontal y las repercusiones de estos avances en el tratamiento convencional de las periodontitis