Bactericidal and clinical efficacy of photochemotherapy in acute necrotizing ulcerative gingivitis.

AIM: This study was designed to investigate the clinical and microbiological parameters with photochemotherapy (PCT) against conventional debridement (CD) among patients with necrotizing ulcerative gingivitis (NUG). MATERIALS AND METHODS: Patients with a diagnosis of NUG were divided into two groups: 'Group-PCT' that underwent indocyanine green-mediated PCT with adjunctive mechanical debridement, and Group-CD that underwent mechanical debridement with adjunctive 3 % hydrogen peroxide/chlorhexidine rinse. Clinical inflammatory gingival parameters including full-mouth plaque scores (FMPS), bleeding scores (FMBS), and probing depth (PD) were measured. Counts of Treponema microdentium, Fusobacterium nucleatum and Prevotella intermedia were assessed using polymerase chain reaction technique. All assessments were done at baseline, 3 weeks and 6 weeks. RESULTS: Twenty-six participants were contacted and agreed to participate in the trial. The mean age of participants in group-PCT was 24.5 years while the mean age of patients in group-CD was 26.7 years. FMPS showed significant but equal reduction in both the groups at 3 weeks and 6 weeks (p < 0.01). The reduction in mean FMBS was higher in the group-PCT at 6 weeks follow-up (p < 0.05). All bacterial levels reduced from baseline to follow-up with both PCT and CD groups (p < 0.05). Group-PCT showed significantly reduced counts of T. microdentium and F. nucleatum at 3 weeks and 6 weeks compared with group-CD (p = 0.024). Equal reduction was shown for P. intermedia between both the groups at 3 and 6 weeks, respectively. CONCLUSION: Application of adjunctive photochemotherapy was both clinically and microbiologically effective in the treatment of NUG.

The Salivary Microbiome and Oral Cancer Risk: a Pilot Study in Fanconi Anemia.

Fanconi anemia (FA) is a rare genetic disease characterized by chromosomal instability and impaired DNA damage repair. FA patients develop oral squamous cell carcinoma (OSCC) earlier and more frequently than the general population, especially after hematopoietic stem cell transplantation (HSCT). Although evidence of an etiological role of the local microbiome and carcinogenesis has been mounting, no information exists regarding the oral microbiome of FA patients. The aim of this study was to explore the salivary microbiome of 61 FA patients regarding their oral health status and OSCC risk factors. After answering a questionnaire and receiving clinical examination, saliva samples were collected and analyzed using 16S rRNA sequencing of the V3-V4 hypervariable region. The microbial profiles associated with medical and clinical parameters were analyzed using general linear models. Patients were young (mean age, 22 y) and most had received HSCT ( n = 53). The most abundant phyla were Firmicutes [mean relative abundance (SD), 42.1% (10.1%)] and Bacteroidetes [(25.4% (11.4%)]. A history of graft-versus-host disease (GVHD) ( n = 27) was associated with higher proportions of Firmicutes (43.8% × 38.5%, P = 0.05). High levels of gingival bleeding were associated with the genera Prevotella (22.25% × 20%), Streptococcus (19.83% × 17.61%), Porphyromonas (3.63% × 1.42%, P = 0.03), Treponema (1.02% × 0.28%, P = 0.009), Parvimonas (0.28% × 0.07%, P = 0.02) and Dialister (0.27% × 0.10%, P = 0.04). Finally, participants transplanted over 11 y ago showed the highest levels of Streptococcus (18.4%), Haemophilus (12.7%) and Neisseria (6.8%). In conclusion, FA patients that showed poor oral hygiene harbored higher proportions of the genera of bacteria compatible with gingival disease. Specific microbial differences were associated with a history of oral GVHD and a history of oral mucositis.

Complementary clinical effects of red complex bacteria on generalized periodontitis in a caucasian population.

OBJECTIVES: To relate five periodontopathogenic bacteria, including the red complex, to the severity, extent, and inflammation of the periodontal lesion in Caucasian patients with generalized aggressive and chronic periodontitis and to explore whether tobacco use is associated with a specific bacterial profile. MATERIALS AND METHODS: A cross-sectional and analytic study was conducted in patients with aggressive and chronic periodontitis. Data were gathered on socio-demographic and periodontal variables, and RH-PCR was used to determine subgingival bacterial profile. Linear and logistic regression analyses were performed. RESULTS: The study included 60 patients with aggressive and 123 with chronic periodontitis. Total red complex bacteria count was higher in aggressive periodontitis, mainly due to T. denticola (P = 0.015). In both periodontitis types, models showed an association between T. forsythia count and probing depth (B = 0.157, P = 0.030) and between T. denticola count and higher bleeding scores (B = 2.371, P = 0.027). Smoking did not affect the red complex bacteria count in either disease. CONCLUSIONS: The prevalence of red complex bacteria was similar between aggressive and chronic periodontitis, but their count was higher in the former. In both diseases, T. forsythia was associated with greater severity and T. denticola with more severe bleeding. Tobacco smoking was not associated with the presence of red complex bacteria in either disease.

Comparative molecular analysis of bacterial species associated with periodontal disease.

Periodontal disease is an inflammatory disorder affecting the supporting teeth structures, including gingiva, periodontal ligament and alveolar bone, causing loss of connective tissue, reabsorption of alveolar bone and formation of periodontal pockets. The aim of this study is to find a correlation between bacterial growth and periodontal disease. Fifty-seven patients aged between 21 and 65 years, median age 46 years, were enrolled. According to gingival pocket depth, ranging from 3 to 7 mm, patients were divided into two groups: the first (30 patients, 53%) with deep pockets ³ 5 mm and the second (27 patients, 47%) less than 5 mm. The samples taken were processed for microbiological analysis by absolute quantitative real-time Taq-Man technique. Patients affected by periodontal disease were 32 (56%) and patients with gingival bleeding were 35 (61%). This data showed that the presence, the type and the bacterial load in gingival pockets were strongly correlated with gingival depth, periodontal disease and gingival bleeding. Quantitative microbiological analysis is a key point to improve patient compliance, allowing to choose the specific antibiotic treatment. avoiding antibiotic resistance and ensuring the successful outcome of therapy for periodontal disease.

Response of chronic gingivitis to hygiene therapy and experimental gingivitis. Clinical, microbiological and metabonomic changes.

PURPOSE: To compare the clinical, microbiological and metabonomic profiles of subjects with high and low levels of chronic gingival bleeding during a controlled oral hygiene regimen intervention including sequential phases of rigorous therapeutic oral hygiene followed by experimental gingivitis (EG). METHODS: Two cohorts of qualified study subjects with differences in gingival bleeding on probing levels at their baseline clinical examination were entered into the study. These two cohorts were followed through three separate study phases including a 1-week baseline phase, a 2-week phase of rigorous oral hygiene including dental prophylaxis, and a 3-week EG phase of no oral hygiene to encourage relapse of gingivitis. The 58 subjects were assessed during each phase of the study for clinical presentation of gingivitis and concurrently had plaque sampled for real-time polymerase chain reaction (RTPCR) microbiological characterization and salivary lavage samples for 'systems biology' metabonomics assessment by 1H-NMR. RESULTS: Subjects presenting with different levels of gingival bleeding on probing when they entered the study responded differently to rigorous oral hygiene and EG. Specifically, the high bleeding cohort responded sluggishly to rigorous oral hygiene and exhibited markedly greater relapse to gingivitis during EG. RTPCR analysis showed changes in bacterial populations that were associated with study phases, particularly the increases in putative periodontal pathogens during EG. However, the microbiological profiles of high- and low-susceptibility gingival bleeding patients were largely similar. Metabonomic analysis likewise revealed significant changes in metabolite composition during study phases associated with differences in plaque toxicity, especially the short chain carboxylic acids propionate and n-butyrate, which tracked clinical changes in gingivitis severity. Systems analysis of metabonomic changes suggested differences between cohorts, although analysis to date has not elucidated whether these differences are causative (population predictive) or simply diagnostic of clinical status within populations.

Clinical and microbiological efficacy of systemic roxithromycin as an adjunct to non-surgical periodontal therapy in treatment of chronic periodontitis. A randomized, double-blinded, placebo-controlled clinical trial.

PURPOSE: The objective of this randomized clinical trial was to evaluate the clinical and microbiological effects of systemic administration of roxithromycin (RXM) as an adjunct to non-surgical periodontal therapy (NSPT) in the treatment of individuals with moderate to severe chronic periodontitis (CP). METHODS: 70 individuals (38 males and 32 females, aged 25 to 60 years) with moderate to severe CP were randomly allocated into two groups. 35 individuals were allocated to full mouth SRP+RXM while 35 individuals were allocated to SRP+ Placebo group. The clinical parameters evaluated were probing depth (PD), clinical attachment level (CAL), gingival index (GI), plaque index (PI) and % bleeding on probing sites (%BOP) at baseline (B/L), 1-, 3- and 6-month intervals while microbiologic parameters included percentage of sites positive for periodontopathic bacteria A. actinomycetemcomitans, P. gingivalis and T. forsythia at B/L, 3 and 6 months using polymerase chain reaction. RESULTs: Both groups showed improved clinical and microbiologic parameters over 6 months. RXM group showed a statistically significant reduction in mean PD and CAL gain as compared to the placebo group (P < 0.0001). There was reduction in percentage of sites positive for periodontopathic bacteria over the duration of the study in both groups and a statistically significant reduction in the number of sites positive for A. actinomycetemcomitans in RXM group (P < 0.001).

Clinical and antimicrobial efficacy of a controlled-release device containing chlorhexidine in the treatment of chronic periodontitis.

A controlled-release device (CRD) containing chlorhexidine gluconate, such as PerioCol(™)CG (Eucare Pharmaceuticals Pvt. Ltd,, Chennai, India), for subgingival application has little reported data with clinical as well as antimicrobial efficacy. This study evaluated clinical and subgingival microbial changes on using indigenously developed PerioCol™CG as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. Forty posterior first molar sites having probing pocket depth ≥ 5 mm were selected and divided into two groups, with 20 sites in each group, in a split-mouth design. Group A (test site) was treated with SRP and PerioCol(™)CG, while group B (control site) was treated with SRP alone. Subgingival microbial samples were collected at baseline and 1 month after the initial SRP, while probing depth (PD), clinical attachment level (CAL) and gingival index (GI) were recorded at baseline, after 1 month and after 3 months. Microbial detection of Porphyromonas gingivalis (P. gingivalis) and Tannerella forsythia (T. forsythia) was done by means of polymerase chain reaction (PCR). A significant improvement was observed in all clinical measures in sites treated with PerioCol(™)CG as compared to the control sites during the study period. Also, there was a statistically significant reduction in the proportion of occurrence of P. gingivalis and T. forsythia after intervention in test sites as compared to control sites. Our data suggest that SRP combined with subgingival administration of PerioCol™CG has a significantly better and prolonged effect compared to SRP alone on the PD, clinical attachment loss and elimination of periodontopathogens.

Cytokine expression in peri-implant crevicular fluid in relation to bacterial presence.

AIM: The aim was to assess clinical inflammatory parameters, cytokine levels and bacterial counts in samples from implant crevicular fluid in cases with untreated peri-implantitis. MATERIAL AND METHODS: Several bacterial species known to up-regulate pro-inflammatory cytokines have been associated with peri-implantitis. The Luminex magnet bead technology was used to study cytokines in crevicular fluid. The checkerboard DNA-DNA hybridization method was used to study bacterial counts in samples from 41 implants (41 individuals). RESULTS: Profuse bleeding and suppuration was found in 25/41 (61.0%) of the implants. The reliability of duplicate cytokine processing was high. In the presence of profuse bleeding, higher pg/ml levels of IL-1ß (p = 0.02), IL-8 (p = 0.04), TNF-α (p = 0.03) and VEGF (p = 0.004) were found. Higher concentrations of IL-1ß were found in the presence of suppuration, and if Escherichia coli (p = 0.001) or Staphylococcus epidermidis (p = 0.05) could be detected. CONCLUSION: Profuse bleeding and/or suppuration in untreated peri-implantitis can be associated with higher concentrations of IL-1ß, IL-8, TNF-α and VEGF in peri-implant crevicular fluid. A higher concentration of IL-1ß in peri-implant crevicular fluid was found in samples that were positive for E. coli or S. epidermidis.

How do peri-implant mucositis and gingivitis respond to supragingival biofilm control - an intra-individual longitudinal cohort study.

PURPOSE: This single-arm study to compare the gingival with peri-implant mucosal inflammatory response to a mechanical supragingival-supramucosal biofilm control program. MATERIALS AND METHODS: Twenty-two participants (55.7 ± 11.2 years) with both gingivitis and periimplant mucositis were examined at days 0, 30 and 390 (full mouth/6 sites per tooth/implant [TTH/IMPL]) for visible plaque (VPI), gingival bleeding (GBI), modified plaque (mPlI) and bleeding indexes (mBI), probing depth (PD) and bleeding on probing (BOP). The biofilm control was carried out weekly in the first month and every 3 months thereafter. An intention-to-treat analysis was performed (drop-out rate = 8) and linear models were used against comparisons in order to look at the clustering of TTH/IMPL by each individual. RESULTS: VPI/mPlI and GBI/mBI reduced from day 0 onwards. Intra-group reductions (P < 0.05) were observed at day 30. PD values (in mm) were higher (P < 0.001) for IMPL than for TTH [mean difference (95% CI) at day 0: -1.10 (-1.58 to -0.63); day 30: -0.88 (-1.28 to -0.48); and day 390: -0.60 (-0.84 to -0.33)], where both groups showed reductions (P < 0.05) throughout the study. BOP was greater (P = 0.00001) for IMPL at baseline [mean difference (95% CI): -0.24 (-0.31 to -0.17)] but reduced (P = 0.00001) and showed similar levels to TTH from day 30 onwards. With regard to sites with the greatest PD, BOP reduced (P < 0.05) in both IMPL and TTH, with greater PD reductions observed for IMPL (P = 0.00001). CONCLUSIONS: The supragingival-supramucosal biofilm control benefited both teeth and implants.

Effects of doxycycline on clinical, microbiological and immunological parameters in well-controlled diabetes type-2 patients with periodontal disease: a randomized, controlled clinical trial.

AIM: To evaluate the clinical, microbiological and immunological effects of systemic doxycycline as an adjunct to scaling and root planing (SRP) in chronic periodontitis patients with well-controlled type 2 diabetes. MATERIALS AND METHODS: Sixty-six patients compliant to oral hygiene (Hygiene Index <20%) allocated to either a test (systemic doxycycline for 21 days) or a control (placebo) group participated in the present randomized controlled trial (RCT). Clinical assessments were recorded at baseline, 3 and 6 months after therapy and included clinical attachment level (CAL), set as the primary outcome of the study, probing pocket depth (PPD), recession (RE) and bleeding on probing (BOP). At the same time points, counts of 15 subgingival species were evaluated by "checkerboard" DNA-DNA hybridization, gingival crevicular fluid samples were analysed for matrix metalloproteinase-8 (MMP-8) by ELISA and HbA1c levels were determined. Comparisons between and within groups were performed by non-parametric tests (Mann-Whitney, Wilcoxon signed-ranks and z-test for proportions with Bonferroni corrections) at the 0.05 level. RESULTS: No major differences were noticed in clinical and microbiological parameters of periodontal disease or levels of MMP-8 between the two groups. CONCLUSIONS: Adjunctive systemic doxycycline does not seem to significantly enhance the effects of SRP in well-controlled diabetes type 2 patients.

Effect of 2 elastomeric ligatures on microbial flora and periodontal status in orthodontic patients.

INTRODUCTION: The aim of this study was to compare the effects of a nonconventional elastomeric ligature (Slide; Leone, Florence, Italy) with those of a conventional elastomeric ligature (Ormco, Orange, Calif) on microbial flora and periodontal status in orthodontic patients. METHODS: A total of 13 orthodontic patients scheduled for fixed orthodontic treatment were selected for this study. The use of Slide and conventional elastomeric ligatures in fixed orthodontic appliances was tested. Microbial and periodontal records were obtained before bonding and 1 and 5 weeks after bonding. For the statistical analysis and calculations, SPSS software (version 15.0; SPSS, Chicago, Ill) was used. In the statistical decisions, P <0.05 values were accepted as significantly different. RESULTS: No significant differences between Slide and conventional elastomeric ligatures were evident at 1 week or 5 weeks after bonding, with regard to gingival index, plaque index, gingival bleeding index, or pocket depth scores (P >0.05). Similarly, aerobic and anaerobic bacteria counts did not differ significantly on the surface or on the elastics (P >0.05). CONCLUSIONS: Although the Slide ligatures cover the total surface of the bracket, they do not cause significantly more plaque accumulation or periodontal problems than do the conventional elastomeric ligatures.

Detection and quantification of periodontal pathogens in smokers and never-smokers with chronic periodontitis by real-time polymerase chain reaction.

BACKGROUND: The purpose of the present investigation is to compare the presence and number of periodontal pathogens in the subgingival microbiota of smokers versus never-smokers with chronic periodontitis and matched probing depths (PDs) using real-time polymerase chain reaction (RT-PCR). METHODS: Forty current smokers and 40 never-smokers, matched for age, sex, and mean PD of sampling site, were included in this investigation. A full-mouth periodontal examination was performed, and a pooled subgingival plaque sample was collected from the deepest site in each quadrant of each participant. To confirm smoking status, expired carbon monoxide (CO) concentrations were measured with a CO monitor. The presence and quantification of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were determined using RT-PCR. RESULTS: Smokers had greater overall mean PD (P = 0.001) and attachment loss (P = 0.006) and fewer bleeding on probing sites (P = 0.001). An association was observed between smoking status and the presence of A. actinomycetemcomitans (P <0.001). The counts of A. actinomycetemcomitans (P <0.001), P. gingivalis (P = 0.042), and T. forsythia (P <0.001) were significantly higher in smokers. CONCLUSIONS: Smokers showed significantly greater amounts of P. gingivalis, A. actinomycetemcomitans, and T. forsythia than never-smokers. There was a significant association between smoking and the presence of A. actinomycetemcomitans.

Clinical and microbiological effects of levofloxacin in the treatment of Aggregatibacter actinomycetemcomitans-associated periodontitis: a randomized placebo-controlled clinical trial.

AIM: To evaluate the clinical and microbiological effects of systemic levofloxacin (LFX) in subjects with Aggregatibacter actinomycetemcomitans-associated chronic periodontitis (AA-ACP). MATERIALS AND METHODS: Subjects with severe periodontitis with subgingival detection of A. actinomycetemcomitans were randomly divided into two treatment groups; a test group (n = 35) that received scaling and root planing (SRP) and LFX (500 mg o.d.) and a control group (n = 34) that received SRP and placebo (o.d.) for 10 days. Plaque index (PI), gingival index (GI), percent of sites with bleeding on probing (% BoP), probing depth (PD) and clinical attachment level (CAL) were recorded and subgingival plaque samples were cultivated for detection of A. actinomycetemcomitans at baseline to 6 months at various intervals. RESULTS: Subjects receiving LFX showed the greatest improvements in mean PD and CAL. The difference in the reduction of PD and CAL in the two groups was significant at 1, 3 and 6 months for PD and 3 and 6 months for CAL (p < 0.05). The inter-group difference in PI, GI and % BoP was not significant at any interval. Detectable levels of A. actinomycetemcomitans were significantly less in the test group 3 and 6 months post-therapy. CONCLUSION: Systemic LFX as an adjunct to SRP improves clinical outcomes and suppresses A. actinomycetemcomitans below detectable levels.

Recovery of putative periodontal pathogens from curette sampling at different depths of periodontal lesions: an in vivo cross-sectional clinical study.

OBJECTIVE: The aim of this study was to evaluate the effect of the depth of curette sample collection from periodontal lesions on the recovery of putative periodontal pathogens using real-time polymerase chain reaction (PCR). METHODS: Twenty-two periodontal pockets 6 to 8 mm deep with bleeding on probing at a single-rooted tooth were sampled, yielding 66 separate samples. Curette samples were obtained at three different levels of the periodontal lesion (orifice, shallow--2 mm into the pocket; or base of lesion), and processed using PCR to identify 10 periodontal pathogens. The chi-square procedure was used to determine whether probe depth affected the distribution of bacterial counts observed. A repeated measures analysis of variance tested the hypotheses related to level of probe and microorganism on mean rank of bacterial counts. RESULTS: The effect of probe level on mean bacterial counts depends on the type of microorganism. Likewise, the effect of microorganism type on mean bacterial counts significantly depends on probe level, where sampling from 2 mm into the periodontal pocket was found to yield significantly higher results than sampling from the orifice. Overall mean counts of pathogenic microorganisms were found to differ significantly across the three probe depths. The microorganisms differed in their observed levels over all three probe levels. Further analysis found several significant differences that characterize the nature of the interaction between probe level and microorganism type. CONCLUSION: There is significant difference in the amount of putative periodontal pathogens at varying depths of the pocket when sampled with a periodontal curette.

Periodontal pathogens and respiratory diseases- evaluating their potential association: a clinical and microbiological study.

OBJECTIVE: To evaluate whether any potential association exists between respiratory diseases such as chronic obstructive pulmonary disease (COPD) and periodontal health status clinically and or microbiologically. MATERIALS AND METHODS: Fifty patients of COPD (test group) and 50 Patients without COPD (control group) were recruited for the study with more than 20 years of age with at least six natural teeth. All the patients were nonsmokers. Periodontal health was assessed by measuring clinical attachment loss (CAL) and gingival bleeding by using William's graduated periodontal probe. Microbiological evaluation was done by collecting sputum samples of the subjects with respiratory diseases to find out any periodontal pathogen in the lung fluid. RESULT AND CONCLUSION: The results showed that the subjects with COPD had significantly more bleeding sites (i.e. >20%) and had more of the clinical mean attachment loss (2.84 ± 0.66) than those without COPD. On the basis of the observed results of the study, we can hypothesize that the risk for COPD appeared to be significantly elevated when attachment loss was found to be severe. CLINICAL SIGNIFICANCE: It is conceivable that oral interventions that improve oral health status may prove to lower the severity of lung infection in susceptible populations.

Clinical and subclinical effects of power brushing following experimental induction of biofilm overgrowth in subjects representing a spectrum of periodontal disease.

AIM: Investigate short-term effects of power brushing following experimental induction of biofilm overgrowth in periodontal disease states. MATERIALS AND METHODS: Overall, 175 subjects representing each of five biofilm-gingival interface (BGI) periodontal groups were enrolled in a single-blind, randomized study. After stent-induced biofilm overgrowth for 21 days subjects received either a manual or a power toothbrush to use during a 4 weeks resolution phase. At baseline and during induction and resolution, standard clinical parameters were measured. Subclinical parameters included multikine analysis of 13 salivary biomarkers and 16s Human Oral Microbe Identification Microarray (HOMIM) probe analysis of subgingival plaque samples. RESULTS: All groups exhibited significantly greater reductions in bleeding on probing (BOP) (p = 0.002), gingival index (GI) (p = 0.0007), pocket depth (PD) (p = 0.04) and plaque index (p = 0.001) with power brushing compared to manual. When BGI groups were combined to form a shallow PD (PD ≤ 3 mm) and a deep PD group (PD > 4 mm) power brushing reduced BOP and GI in subjects with both pocket depths. Power brushing significantly reduced IL-1ß levels at resolution while changes in bacterial levels showed non-significant trends between both brushing modalities. CONCLUSIONS: Short-term changes in select clinical parameters and subclinical salivary biomarkers may be useful in assessing efficacy of power brushing interventions in a spectrum of periodontal disease states.

Differential expression of mitogen activating protein kinases in periodontitis.

AIM: Following toll-like receptor (TLR) engagement, lipopolysaccharide (LPS) can stimulate the expression of pro-inflammatory cytokines thus activating the innate immune response. The production of inflammatory cytokines results, in part, from the activation of kinase-induced signalling cascades and transcriptional factors. Of the four distinct classes of mitogen-activated protein kinases (MAPK) described in mammals, p38, c-Jun N-terminal activated kinases (JNK1-3) and extracellular activated kinases (ERK1,2) are the best studied. Previous data have established that p38 MAPK signalling is required for inflammation and bone loss in periodontal disease pre-clinical animal models. MATERIALS & METHODS: In this study, we obtained healthy and diseased periodontal tissues along with clinical parameters and microbiological parameters. Excised fixed tissues were immunostained with total and phospho-specific antibodies against p38, JNK and ERK kinases. RESULTS: Intensity scoring from immunostained tissues was correlated with clinical periodontal parameters. Rank correlations with clinical indices were statistically significantly positive (p-value < 0.05) for total p38 (correlations ranging 0.49-0.68), phospho-p38 (range 0.44-0.56), and total ERK (range 0.52-0.59) levels, and correlations with JNK levels also supported association (range 0.42-0.59). Phospho-JNK and phospho-ERK showed no significant positive correlation with clinical parameters of disease. CONCLUSION: These data strongly implicate p38 MAPK as a major MAPK involved in human periodontal inflammation and severity.

Clinical and microbiologic effect of nonsurgical periodontal therapy on patients with chronic or aggressive periodontitis.

OBJECTIVE: To evaluate the changes in the clinical parameters, and the prevalence and quantities of three major periodontopathic bacteria, namely Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Tannerella forsythia, in subgingival plaque collected from patients with generalized chronic periodontitis (GCP) or generalized aggressive periodontitis (GAgP) in response to nonsurgical periodontal therapy. METHOD AND MATERIALS: 73 GCP patients and 57 GAgP patients were enrolled in this study. Clinical parameters, including probing depth (PD), clinical attachment loss (CAL), and Sulcus Bleeding Index (SBI) were measured. The prevalence and quantities of the three bacteria collected from the subgingival plaque were detected by real-time PCR. Both clinical and microbiologic parameters were evaluated at baseline, 4, and 12 weeks after the nonsurgical periodontal treatment. RESULTS: PD, CAL, and SBI were significantly improved in GCP and GAgP groups at 4 and 12 weeks after nonsurgical periodontal therapy, compared to the baseline levels. The prevalence and quantities of P gingivalis in GCP at baseline (82.19% and 3.35E+5) were statistically higher than those found in GAgP (66.67% and 1.08E+5; P < .05). After therapy, the prevalence and quantities of the three bacteria were sufficiently reduced in both groups at 4 and 12 weeks. There was no significant difference in improvement of clinical and microbiologic parameters between the GCP and GAgP patients after treatment. CONCLUSION: There was a difference in P gingivalis prevalence and quantity between the GCP and GAgP patients at baseline. In addition, nonsurgical periodontal therapy was effective in the treatment of clinical symptoms and the major periodontopathic bacterial control between GCP and GAgP patients.

Subgingival root brushing in deep human periodontal pockets.

OBJECTIVE: The short-term clinical and microbiological effects of patient-applied subgingival root brushing were assessed on untreated deep human periodontal pockets. METHODS: Assessments of plaque, bleeding on probing, probing depth, total cultivable subgingival counts, and cultivable counts and proportions of six putative periodontal pathogens were carried out at baseline and after 14 days on two contralateral > or = 6 mm bleeding interproximal posterior sites in each of 11 adults with untreated chronic periodontitis. One of the sites was randomly assigned to daily patient-applied subgingival root brushing for 14 days, and the other to remain with the patient's pre-existing tooth brushing and flossing regimen. No other periodontal therapy was performed during the 14 test days. RESULTS: Significant reductions in plaque, bleeding on probing, probing depth, total subgingival counts, and levels of putative periodontal pathogens were found after 14 days of subgingival root brushing. Subgingival root brushing nearly eliminated bleeding on probing at test sites, reduced probing depths by a mean of 1.8 mm, and reduced cultivable subgingival proportions of six evaluated putative periodontal pathogens from a cumulative total of 14.1% to 0.8%. In comparison, no significant clinical or microbiological changes were detected after 14 days where the patient's pre-existing oral hygiene regimen remained unaltered. CONCLUSIONS: Subgingival root brushing over 14 days, in properly trained patients, induced favorable clinical and microbiological changes in deep periodontal pockets > or = 6 mm even in the absence of professional subgingival debridement.

Primary gingival tuberculosis diagnosis: a difficult endeavor.

AIM: To highlight the importance of considering tuberculosis in the differential diagnosis even in the absence of confirmation from several investigations and diagnostic aides. BACKGROUND: Tuberculosis is a common infectious granulomatous disease caused by various strains of mycobacteria. An oral lesion when seen in association with tuberculosis is very rare and in most cases is noticed secondary to pulmonary forms. CASE REPORT: We report a case of primary gingival tuberculosis in 20-year-old female patient who presented with treatment resistant gingivitis. Patient had no evidence of disease elsewhere in the body and several diagnostic tests also failed to reveal the presence of the causative organism. Resolution of gingivitis was noted following a therapeutic trial of antitubercular drugs. CONCLUSION: Therefore the importance of including tuberculosis in the differential diagnosis of inflammatory disorder of the gingiva is very essential in order to avoid one of the most lethal forms of infections often overlooked. CLINICAL SIGNIFICANCE: It is essential to consider tuberculosis as one of the differential diagnosis in India even when several diagnostic tests are negative for tuberculosis.