Evaluation of periodontitis in hospital outpatients with major depressive disorder. A focus on gingival and circulating cytokines.

An imbalance in stimulated cytokine production is associated with the etiopathogenesis of numerous diseases such as major depressive disorder (MDD) and periodontal disease. Increased cytokine levels have been reported in the gingival crevicular fluid (GCF) of patients with MDD. Thirty-six outpatients with MDD participated in this study. Each outpatient was age-matched (± 3 years) with a healthy control (n=36). The patients were controlled for race and smoking habits. Unstimulated and stimulated interleukin 6 (IL-6), interleukin 1ß (IL-1ß), and interferon-γ (INF-γ) production in whole blood culture (WBC) and IL-6 and IL-1ß levels in the GCF were evaluated. Circulating levels of IL-6 and IL-1ß (unstimulated) as well as GCF IL-1ß were modestly lower in MDD patients, compared to the levels in age-matched controls (Mann-Whitney, p=0.002, 0.0075, ANCOVA, p=0.025, respectively). In the unstimulated group, there was no correlation between the levels of circulating IL-6 and GCF IL-6 (r=0.07, p=0.67), and between the levels of circulating IL-1ß and the IL-1ß level in the CGF (r=-0.08, p=0.63). In the LPS stimulation group, there was no correlation between the levels of circulating levels of IL-6 and GCF IL-6 (r=0. 02, p=0.91) or between the circulating IL-1ß and GCF IL-1ß (r=0.13, p=0.42). We observed modest immunosuppression in MDD patients (evaluated by no stimulation whole blood culture [WBC]), especially in patients with melancholic depression, chronic depression, and severe depression.

Scaling and Root Planning decreases the Number of Melanosomes within Keratinocytes in Human Gingiva: Ultrastructural Analysis of Three Cases.

AIM: The aim of the present report was to evaluate the number of melanosomes within keratinocytes on pigmented gingiva, after and before scaling and root planning. MATERIALS AND METHODS: Inflamed gingiva biopsies were taken from three patients (group 1). Forty days after scaling and root planning, biopsies were collected from the homologous contralateral areas (group 2). Samples were fixed in 2% glutaraldehyde-2.5% formaldehyde (freshly prepared from paraformaldehyde) in 0.1 M sodium cacodylate buffer, pH 7.4 for 4 hours, and then processed for transmission electron microscopy. Eighty electron micrographs were evaluated for recording the number of granules by a cross-section grid. The granules that were on intersections were recorded as well as the points that appeared on the cytoplasm for calculating the volumetric density (Vd), i.e the volume that the melanosomes occupied into the cytoplasm of keratinocytes. The presence of melanosomes in different stages of maturation and distribution into the cells were recorded with the aid of a magnifying glass. For the statistical analysis, a student t-test was applied. RESULTS: Results of the present report showed that melanosomes within keratinocytes were present in a higher number in inflamed gingiva A (11.08 ± 1.47), B (3.16 ± 0.38) and C (4.92 ± 0.89) and decreased after resolving of gingival inflammation A (9.46 ± 0.88), B (1.73 ± 0.25) and C (0.76 ± 0.18). CONCLUSION: There is a possibility that inflammation influences the intensity of gingival melanin pigmentation. CLINICAL SIGNIFICANCE: The periodontal treatment appears to have an effect on gingival melanin pigmentation.

Subgingival ultrasonic instrumentation of residual pockets irrigated with essential oils: a randomized controlled trial.

AIM: To evaluate the clinical efficacy of subgingival ultrasonic instrumentation irrigated with essential oils (EOs) of residual periodontal pockets. MATERIAL AND METHODS: Sixty-four individuals with chronic periodontitis were invited to participate in this randomized, double-blind, parallel, and placebo-controlled clinical trial. All subjects received non-surgical periodontal therapy. After re-evaluation (baseline), residual pockets (pocket depth ≥5 mm) received test (ultrasonic instrumentation irrigated with EOs) or control therapy (ultrasonic instrumentation irrigated with negative control). Probing pocket depth (PPD), gingival recession (R), clinical attachment level (CAL), bleeding on probing (BOP), and plaque were assessed at baseline and after 4, 12, and 24 weeks. Differences between groups and changes over the course of time were analysed according to a generalized linear model. RESULTS: There was a significant reduction in PPD and BOP, as well as a significant CAL gain in the two groups (p<0.001). Nevertheless, there were no differences between the groups at any time of the study. When only initially deep pockets (PPD ≥7 mm) were analysed, a significantly greater CAL gain (p=0.03) and PPD reduction (p=0.01) was observed in the test group. CONCLUSION: The adjunctive use of EOs may promote significant CAL gain and PPD reduction in deep residual pockets.

Controle químico do biofilme dentário supragengival: revisão de literatura / Chemical control of supragingival dental biofilm

A remoção mecânica da placa bacteriana é a forma mais utilizada de higiene bucal. Entretanto, muitos indivíduos não apresentam destreza e motivação suficientes para realizar uma correta higienização. Assim, o uso complementar de agentes químicos tem sido estudado como um modo de superar as deficiências na higiene bucal. O objetivo deste trabalho foi apresentar uma revisão sobre o uso de produtos para higiene bucal contendo agentes químicos destinados ao controle da placa bacteriana supragengival. Foram revisados estudos in vitro e ensaios clínicos dos seguintes agentes químicos: clorexidina, óleos essenciais, triclosan, cloreto de cetilpiridínio e novos produtos como delmopinol e dióxido de cloro. Os autores concluem que diversos estudos demonstram a eficácia de enxaguatórios contendo clorexidina e óleos essenciais, assim como dentifrícios contendo triclosan. No entanto, mais estudos são necessários para comprovar a eficácia dos demais agentes químicos.

Early dental plaque formation on toothbrushed titanium implant surfaces.

PURPOSE: To evaluate the qualitative and quantitative differences on dental plaque formation on two different roughness titanium implant surfaces, i.e. machined and titanium plasma sprayed, as well as the amount of plaque removal by regular toothbrushing after 72-hour plaque accumulation. METHODS: Eight systemically healthy subjects were recruited from the patient pool of a private dental practice. All patients underwent oral hygiene instruction and full mouth prophylaxis. Subsequently, maxillary casts from all patients were obtained and removable 0.7 mm-thick acetate stents without occlusal contact points were fabricated to support four titanium specimens of 4 x 2 x 2 mm divided into two groups (machined and plasma sprayed). Subjects were instructed to wear the stents for 72 hours, full time, removing them only during regular oral hygiene. Subsequently, the appliances were immediately repositioned and then the test side was brushed for 20 seconds. At the end of the 72-hour period, the stents were removed and prepared for microbiological analysis. RESULTS: Both machined and plasma sprayed brushed surfaces presented statistically significant fewer bacteria than non-brushed surfaces. Similarly, regarding surface roughness, machined surfaces presented a total number of bacteria significantly smaller than those presented by plasma sprayed surfaces (P < 0.05). Statistically, the non-brushed machined turned surfaces presented a greater amount of Streptoccocus sp. when compared to the brushed machined surfaces. It was concluded that rough surfaces accumulated more dental plaque than polished surfaces. Both brushed surfaces presented less plaque accumulation, however, implant brushing was more effective on machined surfaces.

Herpes viruses in periodontal compromised sites: comparison between HIV-positive and -negative patients.

AIM: The objective of this study was to compare the frequency of herpes simplex virus type 1 (HSV-1), Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) in subgingival plaque, saliva and peripheral blood of HIV-positive and-negative patients with periodontal disease. MATERIAL AND METHODS: Fifty HIV-positive subjects (23 with gingivitis, 27 with periodontitis) and 50 healthy HIV-negative patients with chronic periodontitis were included in the study. Parameters of probing depth (PD), clinical attachment level (CAL), gingival index and plaque index were recorded. The samples were processed for viral identification by the nested polymerase chain reaction technique. RESULTS: HCMV was the most prevalent virus in HIV-positive (82%) and-negative patients (84%), and the detection in the three samples was similar (p>0.05). HSV-1 was the least prevalent virus in both groups, being detected in similar frequencies in oral sites and in peripheral blood. EBV-1 was found more frequently in saliva and subgingival plaque of HIV-positive patients than in HIV-negative patients (p< or =0.05). CONCLUSIONS: EBV-1 was more frequently recovered in oral sites of HIV-positive patients than in HIV-negative patients.

Local delivery of chlorhexidine gluconate in patients with aggressive periodontitis.

The aim of this randomized, controlled, single-blinded trial was to evaluate the effectiveness of a biodegradable chlorhexidine chip as an adjunctive therapy to scaling and root planing. Eleven consecutive patients with aggressive periodontitis were recruited for this study. Each volunteer provided four sites with probing depth > or = 5 mm. Two sites received scaling and root planing (SRP) and placement of the chlorhexidine chip (PC), and the other two sites received scaling and root planing only. The clinical outcomes were measured at baseline, 6 weeks and 3 months after treatment. All patients completed the trial. None of the volunteers reported any adverse effect. Both groups showed a significant reduction in periodontal pocket depth (PPD) and gain in clinical attachment level (CAL) after treatment. However, there were no significant differences in the clinical parameters between the groups after 6 weeks and after 3 months. Sites presenting probing depths > or = 8 mm at baseline treated with SRP + PC demonstrated greater reduction in PPD and a greater CAL gain than sites treated with SRP alone after 6 weeks and after 3 months. The authors concluded that the adjunctive use of the biodegradable chlorhexidine chip resulted in greater reduction of PPD and additional gain in CAL in deep pockets (PPD > or = 8 mm) in patients with aggressive periodontitis when compared to scaling and root.

Fibromatose gengival hereditária: relato de caso clínico / Hereditary gingival fibromatosis: a case report

A fibromatose gengival hereditária (FGH) é uma desordem genética rara, caracterizada pelo crescimento fibroso acentuado do tecido gengival maxilar e mandibular. Geralmente, desenvolve-se como uma desordem isolada, mas pode estar presente em outras síndromes. O presente artigo relata o caso clínico de paciente, gênero masculino, 34 anos, apresentando crescimento gengival generalizado, envolvendo maxila e mandíbula, com recobrimento parcial das coroas dentárias. Por apresentar alteração cardíaca, os procedimentos cirúrgicos deste paciente foram realizados em várias etapas. Devido ao comprometimento estético e a pedido do paciente, o tratamento cirúrgico iniciou-se pela região anterior da maxila. Foram realizados procedimentos a retalho com excisão da margem gengival para remover o excesso de tecido gengival. A avaliação histológica das biópsias gengivais confirmou o diagnóstico clínico de FGH. O pós-operatório cirúrgico foi satisfatório com melhora considerável da aparência do paciente.

Hereditary gingival fibromatosis (HGF) is a rare genetic oral disorder, characterized by a gradually progressive enlargement of the maxillary and mandibular gingiva. It usually develops as an isolated disorder but can be present in other syndromes. A case of a 34-year-old man is reported who presented a generalized gingival overgrowth, involving the maxillary and mandibular arches and covering part ofthe teeth. Due to cardiac condition, surgical procedures in this patient were carried out per sextants. Due to thea esthetic involvement and patient’s request, the surgical treatment was initiated in the anterior region of maxilla. Surgical procedures included mucoperiostal flaps with internalbevel incision to remove the excess tissue. Histological examination of gingival specimens supported the clinical diagnosis of HGF. The post operative course was uneventful and patient’s appearance improved considerably.

Effectiveness of a triclosan/copolymer dentifrice on dental plaque and gingivitis in Brazilian individuals with cerebral palsy.

This randomized clinical trial investigated the effect of a dentifrice containing triclosan on the reduction of dental plaque and gingivitis in institutionalized individuals with cerebral palsy. Fifty-seven residents were randomly allocated to a test group (n=28, dentifrice with triclosan) and a control group (n=29, conventional dentifrice). A single calibrated investigator performed examinations at baseline and after three months. The amount of dental plaque was assessed, and gingivitis was measured. The caretakers performed brushing with dentifrice. After three months, there was a significant reduction in the plaque index in both groups, but there was no difference between the two groups. There was a significant reduction in gingivitis only in the test group, and the difference between groups was significant after three months. The authors concluded that the dentifrice with triclosan reduced interdental bleeding in the studied population.

Analysis of IL-1A(-889) and TNFA(-308) gene polymorphism in Brazilian patients with generalized aggressive periodontitis.

Generalized aggressive periodontitis (GAP) comprises a group of periodontal diseases characterized by the rapid destruction of periodontal tissues which affect young individuals who generally present no systemic disorders. Polymorphisms in the interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha) genes have been associated with an increased severity of chronic periodontitis. The objective of the present study was to evaluate the association between IL-1A (-889) and TNFA (-308) gene polymorphisms and GAP. One hundred nonsmoking subjects were selected, including 30 with GAP and 70 without periodontal disease. Gene polymorphisms were analyzed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. For IL-1 (-889), the frequency of genotype 1/1 was 54.3% in the control group and 56.7% in the study group. The frequency of genotype 1/2 was 37.1% in the control group and 40% in the study group. Genotype 2/2 was detected at a frequency of 8.6% and 3.3% in the control and study groups, respectively. For TNFA, genotype 1/1 was present in 68.6% of control subjects and in 80.0% of patients with GAP, while the frequency of genotype 1/2 was 27.1% in the control group and 20% in the study group. Genotype 2/2 was present in 4.3% of control subjects and was not detected in the study group. The frequencies of allele 1 and allele 2 of the IL-1A (-889) gene were 72.9% and 27.1%, respectively, in the control group and 76.7% and 23.3% in the GAP group. For the TNFA (-308) gene, the frequency of allele 1 was 82.15% in the control group and 90% in the study group, whereas the frequency of allele 2 was 17.85% in the control group and 10% in the study group. Statistical analysis revealed no significant difference in allele distribution for either gene between the two groups. No association was observed between GAP and IL-1A (-889) and TNFA (-308) gene polymorphisms in Brazilian patients.

Inter-relação entre outras condições sistêmicas e as doenças periodontais / Relationship between Periodontal Disease and other Systemic Conditions

Além do tabagismo e da diabetes mellitus, reconhecidos fatores de risco das doenças periodontais, algumas doenças ou condições sistêmicas têm sido associadas a maior prevalência destas doenças. Serão abordados neste trabalho a inter-relação entre o estresse, a osteoporose, a obesidade e ouso de alguns medicamentos e as doenças periodontais.

Incidence of tacrolimus-induced gingival overgrowth in the absence of calcium channel blockers: a short-term study.

AIM: The aim of this study was to determine the incidence and severity of gingival overgrowth (GO) induced by tacrolimus (Tcr) compared with ciclosporin A (CiA) in the absence of calcium channel blockers (CCB) in renal transplant recipients. METHODS: Forty patients (20 Tcr and 20 CiA) were evaluated before and 30 and 90 days after kidney transplantation. Demographic (age, gender) and periodontal parameters were recorded for all patients. Patients taking CCB at any time during the study were excluded from the investigation. RESULTS: The mean GO score was significantly lower (p=0.014) in the Tcr group (6.4%) compared with the CiA group (17.9%) after 90 days of immunosuppressive therapy. At 90 days post-transplant, clinically significant GO was observed in four patients of the CiA group and in two of the Tcr group. This difference was not statistically significant (0.66). CONCLUSION: No significant difference in the incidence of clinically significant GO was observed between the CiA and Tcr groups up to 90 days of immunosuppressive therapy.

Occurrence of Porphyromonas gingivalis in patients with periodontitis in Brazil

A proposta deste estudo foi avaliar a ocorrência de P. gingivalis em pacientes com periodontite no Brasil e investi-gar se existe associação entre sua ocorrência com gênero e faixa etária. Análise foi realizada em 1386 resultados de exames microbiológicos de amostras da microbiota subgengival de pacientes com periodontite. Coleta foi realizada por periodontistas em clínicas privadas e processadas por cultura em laboratório clínico de microbiologia oral. O teste qui-quadrado foi usado para verificar a associação da ocorrência de P. gingivalis com gênero e faixa etária. Foi observado que 59% dos exames foram realizados em mulheres e 41% em homens, com a maioria dos indivíduos apre-sentando 40 anos ou mais de idade (64,3%). A ocorrência de P. gingivalis foi de 17,8%. Não houve diferença quanto à presença desta bactéria nas diferentes faixas etárias, mas houve ocorrência significativamente mais alta nos homens. Foi observado que, apesar da faixa etária, a ocorrência de P. gingivalis foi sempre maior nos homens. Foi concluído que a ocorrência de P. gingivalis em pacientes com periodontite no Brasil foi de 17,8% sendo associada com gênero, mas não associada com faixa etária.

Triclosan - agente quimioterápico utilizado como coadjuvante no controle de placa bacteriana e gengivite / Triclosan - chemotherapeutic agents for bacterial dental plaque control and gingivitis

O Triclosan é um quimioterápico que apresenta propriedades antimicrobianas, antiinflamatórias e analgésicas e, atualmente, vem sendo incorporado em enxaguatórios bucais e dentifrícios. O objetivo deste trabalho é informar o clínico quanto ao uso, vantagens e desvantagens desse quimioterápico.

Triclosan is an antimicrohial, anti-inflammatory and analgesic chemotherapeutic agent that has been added to dentifrices and oral rinses. The aim of this paper is inform the clinician about the properties, advantages and disadvantages of this product.

Ocorrência de microorganismos superinfectantes em indivíduos brasileiros com periodonte após tratamento periodontal não-cirúrgico / Occurrence of superinfecting microorganisms in Brazilian periodontitis subjects after non-surgical treatment

Alguns microrganismos como enterobactérias, pseudomonas e leveduras não são frequentemente encontrados na bolsa periodontal. São considerados microrganismos oportunistas devido à maior frequência de detecção em casos de imunocomprometimento sistêmico ou utilização indiscriminada de antibióticos. Apresentam diversos fatores de virulência e seu papel na doença periodontal está sob investigação. No Brasil, alguns estudos foram realizados para avaliar a ocorrência destes microrganismos na cavidade bucal, mas com amostras pequenas ou com populações específicas ou de outros nichos bucais que não o subgengival. O objetivo deste trabalho é avaliar a ocorrência e a distribuição regionalmente geográfica de espécies de microrganismos superinfectantes (enterobactérias, pseudomonas e leveduras) na microbiota subgengival de indivíduos brasileiros com periodontite, após diversos tipos de tratamento periodontal. Para isso, foram utilizados os resultados de 1386 culturas microbiológicas de amostras de biofilme subgengival obtidas de indivíduos de várias regiões do Brasil, realizados no período de 1997 a 2003, em um laboratório especializado em microbiologia bucal, localizado na cidade de São Paulo (SP). As metodologias de coleta das amostras e processamento laboratorial seguiram um protocolo. Após a tabulação, os dados foram submetidos à análise estatística descritiva. A ocorrência total de microrganismos superinfectantes foi de 16,4%. Pseudomonas, Enterobactérias e Candida sp. foram isoladas de 5,1%, 1,5% e 9,8% das amostras subgengivais, respectivamente. Houve diferença estatisticamente significativa entre a ocorrência de pseudomonas na região Sul quando comparada às ocorrências nas regiões Nordeste (p=0,005) e Sudeste (p=0,03). Dentro dos limites do estudo, pode-se concluir que foi observada baixa ocorrência de microrganismos superinfectantes. A área geográfica influenciou apenas a ocorrência de pseudomonas.

Tacrolimus (fk 506), um agente imunosupressor de interesse ao periodontista: revisão de literatura / Tacrolimus (FK 506), an immunosuppressive agent of interest to the periodontist

O crescimento gengival é um efeito colateral indesejável associado ao uso de agentes imunossupressores como a ciclosporina-A (CsA). Até o presente momento, ainda é desconhecida a influência individual de cada um dos fatores como a presença de placa bacteriana, dosagem e duração da terapia imunossupressora, entre outros, no desenvolvimento do aumento gengival. Além disso, os estudos visando a prevenção e o tratamento dessa alteração gengival têm apresentado resultados controversos. Alguns autores obtiveram grande redução do crescimento gengival após a remoção dos fatores irritantes locais, enquanto outros não tiveram o mesmo resultado. O surgimento de uma nova droga imunossupressora como alternativa à CsA parece ser uma opção interessante na redução dos efeitos colaterais nos tecidos periodontais. Essa nova droga é o tacrolimus ou FK 506, um imunossupressor mais potente que a CsA e que, segundo os estudos recentes, parece não estar associado ao crescimento gengival podendo assim ser utilizado como substituto da CsA em casos de crescimento gengival.

Avaliação do estado de saúde bucal de indivíduos com insuficiência renal terminal candidatos a transplante renal / Periodontal health parameters in patients with end stage renal disease

O objetivo deste estudo foi avaliar o estado de saúde bucal de indivíduos com insuficiência renal terminal candidatos a transplante renal que realizavam tratamento no Hospital do Rim e Hipertensão - Universidade Federal de São Paulo (UNIFESP). Foram examinados 51 sujeitos, 24 (47%) homens e 27 (53%) mulheres, acima de 18 anos, que realizavam hemodiálise e concordaram em participar do estudo após ler e assinar o termo de consentimento livre e esclarecido. Os parâmetros clínicos avaliados foram: Profundidade Clínica de Sondagem (PCS), Nível Clínico de Inserção (NCI), Índice de Placa (IP), Índice Gengival (IG) e Índice CPO-D. Para todos os dados obtidos foi feita uma análise descritiva incluindo médias e Desvio Padrão (DP). Os resultados mostraram que 30% dos sujeitos apresentaram IG entre grau 1 e 2, indicando presença de inflamação gengival de leve à moderada. Além disso, os sujeitos apresentaram um total de 173 dentes cariados, 291 dentes perdidos e 228 dentes restaurados. O estudo também observou que cerca de 74% dos indivíduos realizavam a escovação de uma a duas vezes por dia e 52,94% dos sujeitos estavam por mais de três anos sem avaliação odontológica. Os autores concluíram que as médias de dentes cariados, perdidos e obturados e dos parâmetros clínicos periodontais indicam que estes sujeitos necessitam de orientação e tratamento odontológico, sendo fundamental a participação do cirurgião dentista no tratamento multidisciplinar para o restabelecimento da saúde destes indivíduos. Os resultados dessa investigação contribuirão para o desenvolvimento de um protocolo odontológico de prevenção e tratamento para a população de portadores de insufici-ência renal, que tem crescido de 10% a 15% anualmente.

A clorexidina como coadjuvante no controle do biofilme dental durante o tratamento ortodôntico / The use of chlorhexidine in the biofilm control during the orthodontic treatment

O uso da clorexidina como adjunto a remoção mecânica do biofilme dental deve ser levado em consideração para os indivíduos que apresentam dificuldades de higienização bucal. Seu uso, porém deve ser bem-indicado e prescrito da maneira correta para evitar o aparecimento dos efeitos colaterais.

The use of chlorhexidine associated to the mechanic removal of the dental biofilm must be taken in consideration for the individuals that present difficulties of oral hygiene. Its use, however must well be indicated and be prescribed in the correct way to prevent the appearance of the collateral effect.

Uso racional de antimicrobianos sistêmicos em periodontia / Rational use of systemic antimicrobial agents in periodontics

Antimicrobianos sistêmicos podem ser usados com coadjuvantes da terapia periodontal mecânica. Devem ser indicados em casos retratários de doença periodontal e para pacientes com periodontite agressiva. A terapia antimicrobiana deve setar baseada na composição da microbiota subgengival, devido à variabilidade no perfil da sensibilidade a antimicrobianos dos microrganismos. O uso indiscriminado de antibióticos pode provocar resistência bacteriana, portanto agentes antimicrobianos devem ser prescritos com base no diagnóstico microbiológico.

Relationship of subgingival and salivary microbiota to gingival overgrowth in heart transplant patients following cyclosporin A therapy.

BACKGROUND: Severe gingival overgrowth (GO) is induced in patients taking cyclosporin A (CsA) following organ transplantation. Determining which patient will develop GO is still not possible. The purpose of this study was to establish an association between CsA and gingival overgrowth in heart transplant patients taking into account periodontal and microbiological conditions. METHODS: Thirty patients (10 female, 20 male; range: 13 to 67 years; mean age: 44.89) undergoing CsA treatment were evaluated using the gingival index (GI), plaque index (PI), probing depth (PD), and clinical attachment level (CAL). Subgingival samples collected from the deepest site of each quadrant and saliva samples were submitted to microbial analysis. All patients had at least 12 teeth. Exclusion criteria were the use of antibiotics and/or having undergone periodontal treatment 6 months prior to the study. Patients were divided in two groups: with gingival (GO+) and without gingival overgrowth (GO-). RESULTS: There were no statistically significant differences between the GO+ and GO- groups when CsA dosage, time since transplant, GI, PI, PD, and CAL were compared. Microbiological examination of the subgingival samples detected the following microorganisms: Actinobacillus actinomycetemcomitans (23%), Porphyromonas gingivalis (36%), Prevotella intermedia (93%), Fusobacterium sp. (66%), Campylobacter rectus (30%), Micromonas micros (66%), enteric rods (0%), and yeasts (30%). A positive association between M. micros and the GO+ group was found (P < 0.001). Yeasts were detected in 30% of the subgingival and saliva samples. CONCLUSIONS: Clinical parameters were not sufficient to determine which patients would develop GO. However, colonization by M. micros might play a role in the etiology of GO.