Hyposalivation, oral health, and Candida colonization in independent dentate elders.

Hyposalivation is an important problem in elders and could interfere with several oral functions and microbial ecology. While the number of independent elders who retain more natural teeth increases worldwide, few studies examined hyposalivation in this population. Thus, this study aims to examine relationships between hyposalivation, oral health conditions and oral Candida colonization in independent dentate elders and evaluate factors associated with salivary flow and Candida carriage. We conducted a cross-sectional study in fifty-three dentate elders (≥65 years old with at least 4 pairs of posterior occlusal contacts) with no, or well-controlled, systemic conditions. Participants were interviewed for medical history, subjective dry mouth symptoms, oral hygiene practices and denture information. Unstimulated and stimulated salivary flow rates, objective dry mouth signs, gingival, tongue-coating, and root-caries indices were recorded. Stimulated saliva was cultured on Sabouraud-dextrose agar for Candida counts. Candida species were identified using chromogenic Candida agar and polymerase chain reaction. Statistical significance level was set at p<0.05. The results showed that hyposalivation was associated with higher gingival and tongue-coating indices (p = 0.003 and 0.015, respectively), but not root-caries index. Hyposalivation was also associated with higher prevalence of oral Candida colonization (p = 0.010; adjusted OR = 4.36, 95% confidence interval = 1.29-14.72). These two indices and Candida load were negatively correlated with unstimulated and stimulated salivary flow rates. Interestingly, non-albicans Candida species were more prevalent in denture wearers (p = 0.017). Hence, hyposalivation is a risk factor for poorer oral health and oral Candida colonization in independent dentate elders. Because of its potential adverse effects on oral and systemic health, hyposalivation should be carefully monitored in elders.

Diversity of the oral microbiome between dentate and edentulous individuals.

BACKGROUND: Measurement of saliva microbes is promoted as a way to detect oral and systemic disease, yet there is a multitude of factors that affect the oral microbiome. The salivary microbiome is influenced by oral biofilm of shedding (epithelial) and non-shedding (tooth) surfaces. METHODS: To gauge the ability of salivary microbial analytics to distinguish between edentulous and dentate oral conditions, we looked for differences in the saliva microbiome of subjects with and without teeth. Fifty-two dentate and 49 edentulous subjects provided stimulated saliva samples. 16S rRNA gene sequencing, QIIME-based data processing, and statistical analysis were done using several different analytical approaches to detect differences in the salivary microbiome between the two groups. RESULTS: Bacteria diversity was lower in the edentulous group. Remarkably, all 31 of the most significant differences in taxa were deficits that occur in the edentulous group. As one might expect many of these taxa are attributed to dental plaque and gingival sulcus associated bacteria. CONCLUSION: In sum, the measurement of 16S rRNA genes in the bacteria of the saliva can be used to reproducibly measure differences in the oral microbiome that occur with edentulism, mainly the lack of tooth and tooth-related structures.

Invasive fungal rhinosinusitis with palatal erosion in an elderly edentulous patient with uncontrolled diabetes: report of a rare case.

OBJECTIVES: To report a rare case of chronic invasive fungal rhinosinusitis with palatal erosion. BACKGROUND: Restoring and maintaining oral health of diabetic elderly patients with increased risk of infections is a challenge to the dentist. Patients suffering from uncontrolled diabetes are susceptible to fungal infections. Palatal erosion due to fungal rhinosinusitis is rare. MATERIALS AND METHODS: Case report of a 65 years old illiterate female patient from low socio-economic strata, suffering from uncontrolled diabetes and poor systemic health presenting with chronic invasive fungal rhinosinusitis leading to palatal erosion. CONCLUSION: Such a case is a diagnostic challenge to a dentist. Therefore understanding the disease process and its possible outcomes is desirable. The treatment warrants a multidisciplinary approach.

Does the Prevalence of Periodontal Pathogens Change in Elderly Edentulous Patients after Complete Denture Treatment?

PURPOSE: To determine if wearing complete dentures can cause changes in prevalence of some of the most common periodontal pathogens in elderly edentulous patients. The need for understanding the composition of oral microflora in edentulous patients has been recognized by some authors, but no studies have dealt with the changes that occur in periodontal pathogens' prevalence as a result of complete dentures. MATERIALS AND METHODS: A total of 30 edentulous elderly (average age 71) patients participated in the study. Complete dentures were fabricated for each patient, and the residual alveolar ridges were swabbed before denture insertion. After a period of 6 months swabs were taken again. Identification of P. intermedia, A. actinomycetemcomitans, P. gingivalis, T. forsythia, T. denticola, and F. nucleatum was done by the polymerase chain reaction (PCR) method and primers specific for each microorganism. RESULTS: A noticeable increase in the presence of periodontal pathogens was observed after 6 months of denture wearing; targeted bacteria were identified in 17 pre-insertion samples compared to 28 post-insertion samples. The McNemar test was used to compare the prevalence of periodontal pathogenic bacteria before and after dental treatment. p<0.05 indicated statistical significance. Three microorganisms showed a statistically significant difference between the first and second swabbing-A. actinomycetemcomitans (6.7% vs. 40.0%, p = 0.006), P. intermedia (30.0% vs. 73.3%, p = 0.004), and T. forsythia (6.7% vs. 30.0%, p = 0.004). There was also an increase in bacteria co-associations 6 months post-insertion of complete dentures. CONCLUSIONS: The results of the present study suggested that wearing complete dentures caused a considerable increase of periodontopathic bacteria prevalence in elderly patients. Better understanding of oral microflora and the impact dental treatment has on bacterial colonies is important in modern dentistry.

Analysis of P. gingivalis, T. forsythia and S. aureus levels in edentulous mouths prior to and 6 months after placement of one-piece zirconia and titanium implants.

BACKGROUND: It has been suggested that completely edentulous patients harbour fewer periodontopathic bacteria compared with dentate patients, due to the removal of the subgingival periodontal environment. However, reappearance of certain microbes has been reported after the placement of implants in these patients. AIM: The aim of this study was to determine whether the periodontopathic bacteria Porphyromonas gingivalis and Tannerella forsythia, as well as the non-periodontopathic bacterium, Staphylococcus aureus, emerged in edentulous patients 6 months after placement of one-piece zirconia and titanium implants. MATERIALS AND METHODS: Twenty-six patients were included in the study (titanium = 13, zirconia = 13). Microbial samples were collected from the tongue prior to implant placement and 6 months after implant placement from both the tongue and from around the implants. A qRT-PCR assay using SYBR green/ROX chemistry was used for the detection and quantification of rgp, nuc and karilysin single-copy gene of P. gingivalis, T. forsythia and S. aureus, respectively. Positive controls used in the study were pure bacterial gDNA purified from cultures of P. gingivalis and S. aureus, a cloned sequence of the karilysin gene for T. forsythia, a plaque sample positive for P. gingivalis and T. forsythia, and nasal gDNA for S. aureus. RESULTS: The results show that prior to implant placement, all three bacterial species were below the lower limit of quantification in all edentulous patients. The samples collected from the tongue and around the implants remained below the lower limit of quantification for each of the three species. However, all positive controls used in the study were detectable in the samples. qPCR standard curves showed correlation coefficients >0.97 and efficiencies >94.5% (slope range -3.19 to -3.46) for each of the SYBR green PCR assays. CONCLUSION: The results of this study indicate that the tested organisms did not emerge 6 months after implant placement irrespective of the nature of the implant biomaterial. A further follow-up of at least 2 years post-implantation of these patients is suggested to determine whether there are any changes in the oral microbiota and whether such changes are associated with the development of peri-implant disease.

Changes in oral microflora after full-mouth tooth extraction: a prospective cohort study.

AIM: The aim of the study was to evaluate the effect of full-mouth tooth extraction on the oral microflora, with emphasis on the presence and load of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis. MATERIAL AND METHODS: Adult patients (n = 30), with moderate to advanced periodontitis and scheduled for full-mouth tooth extraction, were consecutively selected. Prior to and 1 and 3 months after full-mouth tooth extraction saliva, tongue, buccal and gingival mucosa and subgingival plaque/prosthesis samples were obtained. Aerobic and anaerobic culture techniques and quantitative real-time polymerase chain reaction (qPCR) were employed for the detection of oral pathogens. RESULTS: Full-mouth tooth extraction resulted in reduction below detection level of A. actinomycetemcomitans and P. gingivalis in 15 of 16 and 8 of 16 previously positive patients using culture techniques and qPCR, respectively. Those patients remaining qPCR positive showed a significant reduction in load of these bacteria. CONCLUSION: Full-mouth tooth extraction significantly changes the oral microflora. These changes include reduction of A. actinomycetemcomitans and P. gingivalis, frequently to levels below detection threshold. In some patients, A. actinomycetemcomitans and P. gingivalis can persist in the edentulous oral cavity up to 3 months after full-mouth tooth extraction.

Molecular analysis of oral bacteria in dental biofilm and atherosclerotic plaques of patients with vascular disease.

BACKGROUND: Oral bacteria have been detected in atherosclerotic plaques at a variable frequency; however, the connection between oral health and vascular and oral bacterial profiles of patients with vascular disease is not clearly established. The aim of this study was to evaluate the presence of oral bacterial DNA in the mouth and atherosclerotic plaques, in addition to assessing the patients' caries and periodontal disease history. METHODS: Thirty samples of supragingival and subgingival plaque, saliva and atherosclerotic plaques of 13 patients with carotid stenosis or aortic aneurysm were evaluated, through real-time polymerase chain reaction, for the presence of Streptococcus mutans (SM), Prevotella intermedia (PI), Porphyromonas gingivalis (PG) and Treponema denticola (TD). All patients were submitted to oral examination using the DMFT (decayed, missing and filled teeth) and PSR (Periodontal Screening and Recording) indexes. Histopathological analysis of the atherosclerotic plaques was performed. RESULTS: Most of the patients were edentulous (76.9%). SM, PI, PG and TD were detected in 100.0%, 92.0%, 15.3% and 30.7% of the oral samples, respectively. SM was the most prevalent targeted bacteria in atherosclerotic plaques, detected in 100% of the samples, followed by PI (7.1%). The vascular samples were negative for PG and TD. There was a statistically significant difference (p<0.05) between the presence of PG and TD in the oral cavity and vascular samples. CONCLUSION: SM was found at a high frequency in oral and vascular samples, even in edentulous patients, and its presence in atherosclerotic plaques suggests the possible involvement of this bacterium in the disease progression.

Differences in peri-implant microflora between fully and partially edentulous patients: a systematic review.

BACKGROUND: The current evidence suggests that the oral microflora differs between individuals who are fully edentulous (FES) and those who are partially edentulous (PES). It is unknown whether this leads to differences in peri-implant microflora when implants are installed. The aim of the study is to compare the submucosal peri-implant microflora between FES and PES. METHODS: A systematic review was conducted. The MEDLINE, Embase, and Cochrane databases were searched for publications up to September 1, 2012. To reduce methodologic variations, only studies reporting in the same article about the submucosal peri-implant microflora of FES and PES were selected. RESULTS: Eleven publications describing 10 studies were selected. Because of numerous differences among the selected studies, no meta-analysis could be performed. Six of 10 studies showed a significant difference in the composition of the submucosal peri-implant microflora in healthy and peri-implant mucositis conditions between FES and PES, with the latter showing a potentially more pathogenic composition. However, microbiologic results were not unanimous among the studies. CONCLUSIONS: In healthy and peri-implant mucositis conditions, PES harbor a potentially more pathogenic peri-implant microflora than FES. The current data are insufficient for a clear conclusion regarding peri-implantitis cases. Overall, because of the lack of a meta-analysis, the variability in microbiologic outcomes and the limited number of studies available, the current evidence seems not to be robust.

Comparative analysis of colony counts of different species of oral streptococci in saliva of dentulous, edentulous and in those wearing partial and complete dentures.

OBJECTIVES: To study and compare the number of colony forming units of Streptococcus mutans, Streptococcus sanguis, Streptococcus salivarius, Streptococcus mitis and Streptococcus milleri in dentulous, edentulous and in those wearing partial and complete dentures by using semi-quantitative culture method of saliva samples with calibrated standard loop. MATERIALS: Sterile specimen collection bottles, Mitis salivarius agar plates, Standard loop, Candle jar, Incubator, Colony counter. METHODOLOGY: Study population consisted of 100 subjects with 25 in each group, with an age range of 40 to 80 years, who were attending the Department of Community Dentistry and Prosthodontics at MNR Dental College, Sangareddy, Hyderabad. Unstimulated saliva samples were collected from patients and inoculated on to Mitis salivarius agar plates using calibrated standard loop. The plates were then incubated anaerobically at 37°C for 24 hours and left at room temperature for further 24 hours. Using a colony counter, the number of colonies of each species was counted. RESULTS: Streptococcus mutans and Streptococcus mitis predominates in the dentulous group, Streptococcus sanguis in complete denture group, Streptococcus salivarius in edentulous group and Streptococcus milleri in removable partial denture group. CONCLUSION: The results of our study are in accordance with the previous studies, which have sought to differentiate different groups of mutans streptococci using a simple calibrated standard loop.

Oral microbial colonization in laryngectomized patients as a possible cofactor of biofilm formation on their voice prostheses.

AIM: Biofilm formation on voice prostheses, which are used for voice rehabilitation in laryngectomized patients, is a main cause of device failure. The aim of this study was to assess whether the presence of periodontal pathogens in the biofilm on voice prostheses is related to that in the oral cavity and associated with the periodontal status of the patients. METHODS: Thirty-one laryngectomized patients were invited to participate, 13 of whom met exclusion criteria. The remaining 18 were classified according to the community periodontal index of treatment needs (community periodontal index of treatment needs (CPITN), grades 0-4). Biofilm samples from the oral cavity and voice prostheses were analysed by PCR-based hybridization for 11 pathogens. RESULTS: All dentate patients required periodontal treatment (CPITN-3: n = 4, CPITN-4: n = 8); the remaining six were edentulous. The diversity (i.e. number of bacterial species detected) of pathogens detected on the voice prostheses correlated significantly positively with the diversity of pathogens in the oral cavity and with clinical parameters. Furthermore, the diversity of pathogens differed significantly between dentate and edentulous patients. CONCLUSIONS: Results emphasize the oral cavity as an important source of bacteria for biofilm formation on voice prostheses. Whether these pathogens reduce the lifetime of the device by increased biofilm formation and/or increase the risk of silicone deterioration requires further study.

[Oral ecosystem in elderly people]. / L'écosystème buccal chez le patient âgé

The mouth is a complex natural cavity which constitutes the initial segment of the digestive tract. It is an essential actor of the vital functions as nutrition, language, communication. The whole mouth (teeth, periodontium, mucous membranes, tongue) is constantly hydrated and lubricated by the saliva. At any age, a balance becomes established between the bacterial proliferations, the salivary flow, the adapted tissular answer: it is the oral ecosystem. The regulation of this ecosystem participates in the protection of the oral complex against current inflammatory and infectious pathologies (caries, gingivitis, periodontitis, candidiasis). In elderly, the modification of the salivary flow, the appearance of specific pathologies (root caries, edentulism, periodontitis), the local conditions (removable dentures), the development of general pathologies, the development of general pathologies (diabetes, hypertension, immunosuppression, the insufficient oral care are so many elements which are going to destabilize the oral ecosystem, to favor the formation of the dental plaque and to weaken oral tissues. The preservation of this ecosystem is essential for elderly: it allows to eat in good conditions and so to prevent the risks of undernutrition. The authors describe the oral physiopathology (oral microflora, salivary secretion) and the strategies to be adopted to protect the balance of the oral ecosystem in geriatric population.

Impact of tooth loss on oral and systemic health.

Periodontitis is a primarily bacterial infection that is common in dentate individuals, while denture stomatitis is a predominantly fungal infection that is common among denture wearers. Both infections may increase a patient's risk for chronic systemic infection dissemination, and may in turn increase the risk of chronic, inflammatory-based systemic diseases. Systemic diseases for which chronic oral infections are believed to confer attributable risk include atherosclerotic and coronary disease, stroke, chronic obstructive pulmonary disease, diabetes, and hypertension. It appears that invasive oral pathogens trigger a systemic inflammatory response via mediators released by the cardiovascular system and liver, putting the patient at increased risk for these diseases. Data comparing gene expression between denture wearers with and without denture stomatitis (and associated Candida albicans infections) has demonstrated unique up- and down-regulation patterns for a number of genes. It appears that down-regulated genes (whose functions are thereby diminished) are associated with reduced epithelial barrier integrity. By contrast, there appears to be an association between up-regulated genes (which have enhanced function) and inflammatory responses that facilitate the ability of C. albicans to bind with and penetrate the oral mucosa. Molecular biological approaches suggest that future therapeutic development could target reducing either the local inflammatory processor, the binding and attachment of C. albicans to the oral mucosa, or both. Ongoing investigations are attempting to incorporate interventions into matrices, to provide a local and sustained presence to therapeutic interventions.

Comparative analysis of salivary bacterial microbiome diversity in edentulous infants and their mothers or primary care givers using pyrosequencing.

Bacterial contribution to oral disease has been studied in young children, but there is a lack of data addressing the developmental perspective in edentulous infants. Our primary objectives were to use pyrosequencing to phylogenetically characterize the salivary bacterial microbiome of edentulous infants and to make comparisons against their mothers. Saliva samples were collected from 5 edentulous infants (mean age = 4.6±1.2 mo old) and their mothers or primary care givers (mean age = 30.8±9.5 y old). Salivary DNA was extracted, used to generate DNA amplicons of the V4-V6 hypervariable region of the bacterial 16S rDNA gene, and subjected to 454-pyrosequencing. On average, over 80,000 sequences per sample were generated. High bacterial diversity was noted in the saliva of adults [1012 operational taxonomical units (OTU) at 3% divergence] and infants (578 OTU at 3% divergence). Firmicutes, Proteobacteria, Actinobacteria, and Fusobacteria were predominant bacterial phyla present in all samples. A total of 397 bacterial genera were present in our dataset. Of the 28 genera different (P<0.05) between infants and adults, 27 had a greater prevalence in adults. The exception was Streptococcus, which was the predominant genera in infant saliva (62.2% in infants vs. 20.4% in adults; P<0.05). Veillonella, Neisseria, Rothia, Haemophilus, Gemella, Granulicatella, Leptotrichia, and Fusobacterium were also predominant genera in infant samples, while Haemophilus, Neisseria, Veillonella, Fusobacterium, Oribacterium, Rothia, Treponema, and Actinomyces were predominant in adults. Our data demonstrate that although the adult saliva bacterial microbiome had a greater OTU count than infants, a rich bacterial community exists in the infant oral cavity prior to tooth eruption. Streptococcus, Veillonella, and Neisseria are the predominant bacterial genera present in infants. Further research is required to characterize the development of oral microbiota early in life and identify environmental factors that impact colonization and oral and gastrointestinal disease risk.

Microbial changes after full-mouth tooth extraction, followed by 2-stage implant placement.

BACKGROUND: Recent studies showed that qPCR could detect bacteria related to periodontitis and peri-implantitis in a low concentration after full-mouth tooth extraction. This study monitored the microbiota from tooth extraction, over 9 months of full edentulism, up to 1 year after abutment connection. MATERIAL AND METHODS: Ten patients with severe periodontitis were recruited. Six months after tooth extraction, implants were inserted. Three to 6 months later, they were connected to abutments. Plaque samples were collected from the tongue dorsum, saliva, and subgingival area (teeth/implants) before extraction up to 1 year after abutment connection, and analysed via culture, qPCR, and checkerboard technology. RESULTS: A reduction in the total amount of aerobic and anaerobic CFU/ml was observed. The concentration of Porphyromonas gingivalis and Tannerella forsythia (qPCR and checkerboard) in the saliva and, to a lower extent, on the tongue dorsum reduced. For Prevotella intermedia, changes were negligible and no changes could be detected for Aggregatibacter actinomycetemcomitans. The pristine subgingival niches were quickly colonized by key pathogens. Their final concentration remained low, while the detection frequencies remained very high over time. CONCLUSION: Complete edentulation results in a significant reduction of bacteria related to periodontitis and peri-implantitis, with the exception of A. actinomycetemcomitans, which might indicate that key pathogens can survive without pockets.

Characterization of the normal bacterial flora in peri-implant sulci of partially and completely edentulous patients.

PURPOSE: To characterize the normal bacterial flora and evaluate the presence of periodontopathogenic bacteria around dental implants and to correlate them with the periodontal flora or, in completely edentulous patients, the alveolar gingival flora. MATERIALS AND METHODS: Clinical and radiographic parameters were recorded to exclude peri-implantitis in 34 partially edentulous and 19 completely edentulous patients. Partially edentulous patients were subdivided into two subgroups based on the depth of the periodontal pocket: ≤ 4 mm (n = 19) and > 4 mm (n = 15). Microbial samples were collected from peri-implant sulci, the deepest periodontal sulci, and, for completely edentulous patients, from the alveolar gingiva. Predominant aerobic bacteria were determined by microbiologic culturing, and multiplex polymerase chain reaction was used to detect five periodontopathogenic bacteria: Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, Prevotella intermedia, and Actinobacillus actinomycetemcomitans. RESULTS: In all the examined patients, oral streptococci were the most frequent aerobic peri-implant bacteria. The frequency of four periodontopathogenic bacteria in tooth sulci (A actino?mycetemcomitans, P gingivalis, T forsythensis, T denticola) was significantly higher around natural teeth with deeper periodontal pockets, but there was no significant difference in the frequency of the same bacteria in peri-implant sulci in the two partially edentulous subgroups. In contrast, there were no such bacteria in the peri-implant sulci or the alveolar gingiva of completely edentulous patients. CONCLUSIONS: In healthy peri-implant sulci, oral streptococci constitute the predominant bacterial flora. In partially edentulous patients four periodontopathogenic bacteria were detected around implants, and none of these bacteria were found around implants in completely edentulous patients.

Candida-associated denture stomatitis in type 2 diabetes mellitus.

OBJECTIVE: To describe the clinical appearance of Candida-associated denture stomatitis (DS) in subjects with type 2 diabetes (T2DM). The relationships between the types of DS, oral complaints and associated conditions were assessed in terms of glycemic control as determined by glycated hemoglobin (HbA1c) measurements. MATERIALS AND METHODS: Demographic and clinical data were obtained from questionnaires and oral examinations of 110 edentulous patients with T2DM and 50 control subjects. RESULTS: Type II DS commonly occurred in diabetics (57.3% vs 30%; p=0.002) together with DS related oral complaints (60.9% vs 24%; p<0.001) compared with controls. Burning sensation of the mouth (BS) was the most common complaint. Dryness of the oral mucosa (DOM) (50.9% vs 6%; p<0.001), angular cheilitis (26.4% vs 8%; p=0.01) and glossitis (27.3% vs 6%; p=0.003) occurred more frequently in diabetics. Oral complaints and associated conditions of DS coincided with elevated HbA1c levels (p<0.001). Diabetics with extensive type of inflammation had higher HbA1c levels than type I/III DS subjects (p<0.001). CONCLUSIONS: Diffuse type of inflammation was associated with T2DM. BS and DOM were the most common oral complaints. Inadequately controlled diabetes with Candida-associated DS was linked to a high incidence of an extensive type of inflammation, oral complaints and associated conditions.

Determinants of serum IgG responses to periodontal bacteria in a nationally representative sample of US adults.

AIM: To assess the distribution of elevated antibody titres to multiple periodontal bacteria, including established/putative pathogens and health-related species, by selected demographic, behavioural, and oral- and general health-related characteristics. METHODS: Data from 8153 >or=40-year-old participants from the third National Health and Nutrition Examination Survey were used, including 1588 edentulous individuals. We used checkerboard immunoblotting to assess serum IgG levels to 19 periodontal species. Thresholds for elevated antibody responses were defined for each species using the 90th percentile titre in periodontal healthy participants, using two alternative definitions of periodontitis. RESULTS: Edentulous individuals showed lower antibody responses than dentate participants, notably for titres to "red complex" species and Actinobacillus actinomycetemcomitans. Elevated titres to Porphyromonas gingivalis were twice as prevalent in participants with periodontitis than in periodontal healthy individuals. Non-Hispanic blacks and Mexican-Americans were more likely to display elevated titres for P. gingivalis compared with non-Hispanic whites (22.9%versus 19.4%versus 9.5%). Current smokers were significantly less likely to exhibit high titres to multiple bacteria than never smokers. CONCLUSION: Demographic, behavioural, and oral- and general health-related characteristics were strong determinants of systemic antibody responses to periodontal bacteria in a nationally representative sample of US adults.

Do elderly edentulous patients with a history of periodontitis harbor periodontal pathogens?

OBJECTIVES: The presence of periodontal pathogens in the oral cavity may impact implant survival. Therefore, this study aimed to determine the prevalence of Campylobacter rectus, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Tannerella forsythia, Treponema denticola, Eikenella corrodens and Parvimonas micra in a specific elderly population with a history of periodontitis who have never worn dentures. MATERIAL AND METHODS: Thirty dentate subjects (mean age 61.7+/-7.05 years) and 30 edentulous subjects (mean age 65.8+/-8.05 years) were included in this cross-sectional study. Microbiological samples of cheek mucosa and the dorsum of the tongue were taken from all subjects. In addition, sulcus samples were taken from the dentate group. All samples were analysed using a bacterial DNA-specific polymerase chain reaction. RESULTS: All the pathogens studied were detected in dentate and edentulous subjects. When cheek and tongue samples were combined, C. rectus, A. actinomycetemcomitans and E. corrodens presented with a similar prevalence in both groups, whereas the other species were more prevalent specifically in the dentate group (P<0.05). In dentate subjects, P. intermedia and T. denticola were present in higher frequencies in the cheek mucosa (26.67% and 66.67%, respectively), whereas P. gingivalis and T. forsythia were more prevalent in the tongue samples (26.67% and 56.67%, respectively). CONCLUSIONS: Periodontal pathogens may persist in the oral cavity of edentulous subjects who have had periodontal disease, even 1 year after the extraction of all teeth and in the absence of other hard surfaces in the mouth.

Oral environmental factors affecting number of microbes in saliva of complete denture wearers.

The purpose of this study was to clarify which oral environmental factors affected number of microbes in saliva in an edentulous environment. We enrolled 68 edentulous subjects in the study. Numbers of total anaerobic bacteria and Candida species in saliva were determined. Age, sex, un-stimulated salivary flow rate, pH and viscosity of saliva, histatin level in saliva, tongue coating status, tongue pressure, denture plaque status, material of denture base, duration of edentulism, frequency of self oral health care and number of cigarettes per day were also investigated as oral environmental factors. Correlation between number of total anaerobic bacteria or Candida species and each oral environmental factor was determined with the Spearman rank correlation coefficient. Stepwise logistic regression analysis was used to identify which factors were significantly associated with level of total anaerobic bacteria and Candida species. Correlation and stepwise logistic regression analyses revealed associations between un-stimulated salivary flow rate, tongue coating status, denture plaque status or frequency of self oral health care and number of total anaerobic bacteria. The correlation analysis showed a significant correlation between age and number of total anaerobic bacteria. Stepwise logistic analysis revealed associations between pH of saliva or viscosity of saliva and level of anaerobic bacteria; it also revealed associations between histatin level in saliva or un-stimulated salivary flow rate and level of Candida species. We conclude that salivary flow rate, in particular, affects number of salivary microbes in an edentulous environment.

Do periodontopathogens disappear after full-mouth tooth extraction?

AIM: To monitor the intra-oral microbiological changes after full-mouth extraction using quantitative polymerase chain reaction (qPCR). MATERIAL AND METHODS: Nine patients with severe, aggressive periodontitis, for whom a full-mouth tooth extraction was the only remaining treatment option were recruited. Before and 6 months after extraction, microbial samples were obtained (tongue, saliva and subgingival plaque) and analysed by qPCR. RESULTS: The elimination of subgingival niches, by extraction of all natural teeth, resulted in a 3-log reduction of Porphyromonas gingivalis and Tannerella forsythia, and more modest reductions of Aggregatibacter actinomycetemcomitans and Prevotella intermedia. However, the detection frequencies of these periodontopathogens in saliva and on the tongue remained unchanged after full-mouth tooth extraction. CONCLUSION: In contrast to what has been believed so far, full-mouth tooth extraction does not result in eradication of all periodontopathogens but only in a significant reduction. The clinical consequences of this observation remain speculative.