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PubMed1985

Relationship between some subgingival bacteria and periodontal pocket depth and gain or loss of periodontal attachment after treatment of adult periodontitis.

We studied the association between post-treatment periodontal disease activity and subgingival Bacteroides gingivalis, Bacteroides intermedius, spirochetes and motile rods. 20 adults, 22-62 years, with moderate-to-severe periodontitis participated in a split-mouth treatment study. All individual quadrants received supragingival cleaning and in addition, subgingival scaling and a NaHCO3-NaCl-H2O2 slurry, subgingival scaling alone, slurry alone, or no subgingival treatment. Post-treatment periodontal disease status was determined over a period of 12 months by changes in probing periodontal pocket depth and probing periodontal attachment level. Subgingival specimens obtained by paper point-sampling were evaluated for B. gingivalis and B. intermedius using indirect immunofluorescence and for spirochetes and motile rods using bright light phase contrast microscopy. A total of 142 periodontitis lesions representing all 4 quadrants of the 20 subjects were studied. The relationship between clinical data and bacteria was analyzed using logistic regression. The probability of the study organisms being present in subgingival sites at 3 to 6 months after treatment increased with increased residual pocket depth. The presence of B. gingivalis showed a strong positive association (p less than 0.004) with loss of periodontal attachment. A significant association was also found for spirochetes (p less than 0.008) but not for motile rods (p greater than 0.35) or B. intermedius (p greater than 0.13). Similar results were obtained at 12 months after therapy, except that the presence of motile rods was significantly associated with loss of periodontal attachment (p less than 0.03). Caution must be exercised when using B. gingivalis or spirochetes to evaluate treatment efficacy. If the presence of these organisms was utilized to indicate progressing periodontitis, many active lesions could be identified, and only 1 to 17% and 13 to 43% of sites in remission at 3-6 months after therapy would be expected to harbor B. gingivalis and spirochetes, respectively. The consequences of treating periodontal sites in remission would mainly be limited to cost and inconvenience. However, since several active periodontitis lesions did not reveal the organisms, treatment decisions based solely on the absence of the organisms may result in the omission of needed therapy. As a practical consideration, periodontal treatment should be continued as long as B. gingivalis and maybe spirochetes are detectable in the subgingival microflora. In the absence of these organisms, and until additional periodontal pathogens have become known, the decision to continue or conclude periodontal therapy must b

Adult↗
PubMed1985

Antimicrobial irrigation of deep pockets to supplement oral hygiene instruction and root debridement. I. Bi-weekly irrigation.

64 sites with probing pocket depth greater than or equal to 6 mm from 11 patients were treated with plaque control instruction and one episode of root planning. Subsequently, selected sites in each patient were irrigated with either chlorhexidine, tetracycline, saline or served as non-irrigated control sites. Irrigation immediately followed instrumentation, and was repeated every 2 weeks for 24 weeks. Healing was monitored at 8, 16, and 24 weeks clinically and at 7, 15, and 23 weeks with subgingival washings for determination of % as well as total number of spirochetes. The following changes were apparent from comparing pooled site means at 24 weeks with pretreatment data: (1) bleeding sites decreased from 62 of 64 sites initially to 22 of 64 at 24 weeks; (2) spirochetes decreased from 34% to 2%; (3) probing pocket depths decreased from 7.6 to 4.7 mm; (4) probing attachment levels showed a gain of 1.2 mm. The improvement of the chlorhexidine and tetracycline irrigated sites was similar to that of the saline irrigated and non-irrigated control sites. Thus, biweekly chlorhexidine, tetracycline or saline irrigation of deep pockets did not appear to augment the effects of non-surgical periodontal therapy.

Adult↗
PubMed1985

The microbial morphotypes associated with periodontal health and adult periodontitis: composition and distribution.

Subgingival plaque samples were obtained from 162 sites in 27 adult periodontitis patients and 162 sites in 27 healthy patients using a standardized lavage technique. The distribution of 10 different microbial morphotypes was determined by darkfield microscopy. The lavage technique selectively samples the loosely adherent plaque at the base of the periodontal pocket and not the tooth-associated, adherent plaque. This standardized technique permits quantitative comparisons of numerical density of morphotype composition at different sites, in addition to qualitative comparisons or relative proportions. There was a significant positive association between the numerical density of each morphotype within the non-adherent plaque and the number of sites at which the organism was detected in both healthy and diseased subjects. A previously undescribed darkfield morphotype, has been detected with this method. This morphotype, a small motile coccobacillus (S-MO-CB) has been found to be the numerically dominant species in both health and disease. This morphotype has been recovered in pure culture following passage through a 0.4 mu filter and includes organisms of the Wollinella and Campylobacter genus. Non-motile organisms comprised less than 1-2% of the sample from healthy and diseased sites. Motile forms, such as spirochetes, had a high frequency of detection in healthy individuals. Analysis of pooled plaque samples revealed that the prevalence of cocci and fusiforms was significantly elevated in patients with healthy periodontium, as compared to patients with adult periodontitis. In adult periodontitis patients, the frequency of occurrence of medium spirochetes, filaments and small nonmotile rods was significantly elevated in pooled plaque. Analysis of individual sites indicated that the proportion and numerical density of most morphotypes within the non-adherent plaque were not significantly different in disease as compared to health. Disease is characterized by an increased % of small spirochetes and fusiforms at each site. At diseased sites which harbor small spirochetes, the numerical density is elevated four-fold, as compared to healthy sites which have small spirochetes. The numerical density of other morphotypes is not significantly different comparing healthy sites to diseased sites. Thus, the increase in the % of small spirochetes in disease in due to a site-localized four-fold increase in numerical density within the non-adherent plaque.

Adult↗
PubMed1986

Darkfield microscopy of subgingival plaque of an urban black population with poor oral hygiene.

A low socio-economic community residing in Crossroads, Cape Town, consists of people who originated from the Eastern Cape areas of the Ciskei and Transkei. These individuals have had virtually no dental care, with the exception of emergency treatment for pain. A darkfield microscopic study of a random sample of 52 individuals was undertaken to determine the predominant morphological forms in the subgingival plaque of this population. Spirochetes were found to constitute 42.1% and motile rods, 7.7%, of the total darkfield microscopic count. Clinical assessment of the periodontal status of 100 individuals revealed the following mean values; plaque index (PI) = 1.44, gingival index (GI) = 1.31, probing depth (PD) = 2.35 mm and loss of attachment = 0.64 mm. Subgingival calculus deposits were present in 42% of the group and little or no mobility of the teeth was evident. Poor oral hygiene resulted in 90% of the tooth surfaces of the sampled population in Crossroads being covered with plaque, yet these individuals appear to be resistant to periodontitis. The high proportions of spirochetes and motile rods found in the subgingival plaque of this group were not indicative of periodontitis and therefore, fail to confirm the findings of other investigators.

Adolescent↗
PubMed1986

A new method for assessing the % of spirochaetes in subgingival plaque.

A new method for counting the numbers of spirochaetes in subgingival plaque is described. The technique involves the combined use of a negative stained preparation, dark field microscopy, and an image analysing system. Advantages of the method include: smears need not be made until 2 days after sampling, and can be examined microscopically for up to 1 year after preparation; reproducibility of counts are more than 90% and the data can be computerised. The new method should prove useful in the routine assessment of subgingival plaque from patients with various forms of periodontitis, and in epidemiological surveys.

Aniline Compounds↗
PubMed1986

Clinical and microbiological effects of sustained release chlorhexidine in periodontal pockets.

Previous studies have shown that a 3-day exposure of the pocket flora to the sustained release of chlorhexidine significantly reduced the relative numbers of spirochetes and motile rods in periodontal pockets to negligible amounts. By 14 days post-treatment, their numbers had returned to pre-treatment levels. The present study extended the exposure time of the pocket flora to the sustained release of chlorhexidine in an attempt to prolong the suppression of the microbial flora for a clinically significant period of time. Clinical parameters were also studied. Sustained release devices (SRD) were inserted into 13 pockets from 8 patients. Pocket depth ranged between 5 and 8 mm. The SRD's were replaced every 3 days to give a total exposure of 9 days. Plaque index (PlI), bleeding on probing and pocket depth were measured, and bacterial samples taken for dark field microscopy and anaerobic culture. There was a marked decrease in the relative proportions of spirochetes and motile rods and the total anaerobic count post-treatment. Pocket depth was reduced in all 13 pockets. These results indicate that a prolonged exposure to chlorhexidine suppresses the pocket flora to negligible amounts and reduces pocket depth for up to 11 weeks post-treatment.

Adult↗
PubMed1986

Dark ground microscopy in relation to 3 clinical parameters of chronic inflammatory periodontal disease.

This paper examines the relationships between 3 clinical parameters: pocket depth, gingival index, and bleeding index and 2 laboratory parameters: spirochaete counts and motility counts on the basis of analysis of 883 observations made in the mouths of 41 patients. The results were consistent with the findings of other studies in that deeper pockets tended to harbour higher %s of spirochaetes and motile organisms. The same overlap between all the parameters in general and between spirochaetes and pocket depth in particular as existed in our previous study was demonstrably evident. 8% of shallow pockets had spirochaete counts in excess of 20% and 79% of deep pockets had spirochaete counts of less than 20, 18% having no demonstrable spirochaetes. These results are consistent with those of our previous study and with the findings of Evian et al. that even in pockets of the order of 7 mm, the proportions of spirochaetes found varies from what may be expected at healthy sites to what may be expected at diseased sites.

Bacteria↗
PubMed1986

The habitat of periodontopathic micro-organisms.

The purpose of the present study was to investigate the significance of oral mucosal surfaces as a habitat of periodontopathic micro-organisms. For this investigation, 7 young adults were selected for an experimental gingivitis study. At the start of the experiment, bacterial samples were taken by means of a sterile swab from 4 oral mucosal surfaces: the buccal mucosa, the vestibular fold, the dorsum of the tongue and a tonsil. All individuals were asked to abstain from oral hygiene procedures in 1 quadrant of the mouth for a period of 23 days. At the end of this period, plaque samples were taken from 4 tooth surfaces by means of a sterile periodontal probe just coronal from the gingival margin. The study included evaluation of spirochetes and motile organisms by means of phase-contrast microscopy and of black-pigmented Bacteroides, Fusobacterium, Actinomyces, Actinobacillus actinomycetemcomitans and Capnocytophaga by means of cultural studies. Results showed a relationship between the prevalence of motile organisms and black-pigmented Bacteroides in samples from both the mucosal surfaces and the 23-day-old plaque. In addition, a relationship was found between the presence of motile organisms on the dorsum of the tongue at the start of the experiment and their prevalence in the 23-day-old plaque. It was suggested that the dorsum of the tongue may function as a nidus for periodontopathic micro-organisms.

Actinomyces↗
PubMed1986

The prevalence of spirochetes in the subgingival microbiota of Tanzanian and Dutch children.

The subgingival microflora of 71 Tanzanian and 77 Dutch prepurberty children was analyzed by dark-field microscopy. Spirochetes were observed in almost every Tanzanian child and in 66% of the Dutch children. The predominant spirochetes were small and medium sized; large spirochetes were infrequently observed in the rural Tanzanian children and at the bleeding sites of the Dutch children. Further differences in the %s of cocci, rods and fusiforms indicated that the subgingival microflora of Tanzanian children is different from that of Dutch children. Generally, spirochetes occurred at higher %s and frequency at bleeding sites than at non-bleeding sites in both populations. However, the non-bleeding sites in the Tanzanian children had a higher prevalence of spirochetes than the bleeding sites in Dutch children. It is concluded that spirochetes are members of the normal flora of prepuberty children, that in children gingivitis is associated with increased proportions of spirochetes and that the presence of spirochetes in the gingival crevice is not dependent upon gingival inflammation.

Age Factors↗
PubMed1987

Distribution of morphologically different micro-organisms associated with active periodontal lesions.

The morphological composition of the subgingival plaque associated with active periodontitis lesions and comparable inactive control lesions were determined in a 36-year-old patient with advanced periodontal disease. Monthly measurements of the clinical attachment level were subjected to linear regression analysis as a function of time. Attachment loss was recorded during the monitoring period at 10 sites, with loss of 2 mm or more at 6 sites. Plaque samples taken from these 6 sites and from 6 control sites with similar clinical conditions were not of uniform composition. Active lesions harboured on average 46% more cocci and twice as many large spirochetes as inactive control lesions. A linear regression analysis of the proportions of different morphotypes in the subgingival plaque versus the calculated monthly attachment loss rate at the time of sampling provided only very weak correlations, if at all. The observations made in the patient under investigation suggest that there is no great probability of suspected differences in the floras of active and inactive lesions being detected by dark-field analysis alone. The role of motile rods and spirochetes may have been over-rated hitherto.

Adult↗
PubMed1988

Microbial succession in recolonizing deep periodontal pockets after a single course of supra- and subgingival debridement.

In the present study, the effect of supra and subgingival plaque debridement on the dynamics of the subgingival microflora in deep pockets was investigated. 8 adult periodontitis patients participated in the study. In each patient, 4 clinically diseased sites were investigated microbiologically by phase contrast microscopy for the determination of both the %s as well as the total numbers of spirochetes and motile rods and by anaerobic cultivation for the determination of the different black-pigmented Bacteroides species. After base-line examination, patients were treated by mechanical removal of supra- and subgingival plaque deposits. 2 and 8 weeks after treatment, clinical and microbiological parameters were re-evaluated. During the experimental period, no oral hygiene procedures were performed in order to achieve fast recolonization of the pockets. Treatment resulted in a significant reduction in probing pocket depth and gain of probing attachment. 2 weeks after treatment, no further improvements could be observed. A positive correlation was found between the reduction in probing pocket depth and decrease in Bacteroides gingivalis (P less than 0.009) and between gain in probing attachment and reduction in the % of B. gingivalis (P less than 0.009). No correlation between these clinical parameters and B. intermedius, spirochetes or motile rods was apparent. An inverse relationship between B. gingivalis and B. intermedius was observed. We found that changes in %s of spirochetes and motile rods are not correlated with changes in total numbers of these bacterial groups. It was concluded that monitoring of %s of micro-organisms may not supply rational information on the microbiological conditions of the subgingival area.

Adult↗
PubMed1988

Microbial colonization patterns of loosely adherent subgingival plaque in adult periodontitis.

Periodontal plaque is a complex bacterial ecosystem that carries an innate history of colonization, selection and maturation. Detailed examination of this balanced environment can reveal developmental sequences and certain interrelationships, much like an archeological record, that can provide insight in the understanding of plaque formation and maturation. For the present investigation, methods are employed which enable the retrospective elucidation of the historical data of plaque development and the nature of bacterial interactions. Nonparametric statistical methods are used to analyze risk, agreement and interdependence, following analytical techniques which are well established in medical epidemiology, but not generally employed in dentistry. The fundamental concept is that many organisms which are present in plaque prefer or require a pre-existing bacterial miliue for colonization and growth to steady-state level. Plaque samples and Ramfjord attachment level measurements were obtained from 60 adult periodontitis patients. Loosely adherent plaque was sampled and different morphotypes were enumerated by darkfield microscopy. The colonization of small spirochetes (S-SP) within the loosely adherent plaque was essential for the colonization of medium spirochetes (M-SP), odds ratio = 15.7 and filaments (FIL), odds ratio = 22.2. Thus, a temporal colonization sequence is inferred for FIL and M-SP, both requiring S-SP as a prerequisite morphotype. Medium spirochetes, in turn, are required for fusiform (FUS) colonization. M-SP also enhance the colonization of FIL and large motile rods (L-MO-R) within the loosely adherent plaque. These morphotypes were inferred to be sequentially interdependent, each preferring or requiring the presence of the preceding morphotype.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Longitudinal study of untreated periodontitis (II). Microbiological findings.

11 volunteer subjects with advanced chronic periodontitis participated in a 1-year longitudinal clinical and microbiological study. Subgingival plaque was collected at each of 7 visits from 148 pre-selected sites in the left jaw quadrants (test sites) and on the first and last visits, only from 117 sites in the left jaw quadrants (control sites). All sites were examined clinically at each of the 7 visits, and the microbiological markers investigated were the % spirochaetes and % black pigmented Bacteroides species in subgingival plaque. At the completion of the study, the sequential changes in probing attachment level at each site were subjected to regression analysis to determine the direction and extent of attachment change. Possible correlations between attachment change and % spirochaetes or % black-pigmented bacteroides were investigated using both individual sites and individual subjects. No significant differences were observed in either of the microbial variables between test and control sites. Possible correlations between the microbiological markers and attachment changes were investigated at baseline, at the 12-month visit and using the microbial data accumulated over all 7 visits. Significant differences were observed only at the 12-month visit when the % spirochaetes of both test and control sites were significantly lower in subjects showing the greatest improvement in attachment level. Overall, these results indicate that quantification of either spirochaetes or black-pigmented Bacteroides species cannot be used reliably to identify or predict disease-active sites.

Adult↗
PubMed1988

Clinical and microbiological effects of root debridement in periodontal furcation pockets.

The aim of the present study was to investigate longitudinally over 52 weeks the clinical and microbiological effects of plaque control and root debridement at molar furcation sites. The results were compared with changes at non-molar sites. 24 non-molar sites and 31 grade II molar furcation sites with probing depth greater than or equal to 5.0 mm were monitored in 11 patients. Clinical measurements consisted of plaque scores, probing depths, and changes in probing attachment level. Microbiological monitoring was carried out with phase-contrast microscopy and anaerobic culturing. The debridement resulted in improvement in probing measurements and microbiological counts for both groups of sites. A slightly less favorable clinical response was noted for molar furcation sites. Higher post-operative microbiological counts were found throughout the 52-week observation period for molar furcation sites. Sites with probing attachment loss showed higher microbial counts and higher proportions of spirochetes, black pigmented colony forming units (CFU), and Bacteroides gingivalis CFU than sites with probing attachment gain. Individual site analysis, however, demonstrated marked variations of the microbiological counts at the different postoperative time points. In the few available sites undergoing probing attachment loss, no apparent association between target micro-organisms and periodontal deterioration was observed.

Adult↗
PubMed1989

Effects of 6 months use of an antiseptic mouthrinse on supragingival dental plaque microflora.

This study was undertaken to determine whether long-term use (6-months) of an antiseptic mouthrinse (Listerine Antiseptic, Warner Lambert Co., Morris Plains, NJ, USA) led to an undesirable succession of oral pathogens or the emergence of resistant microbial forms. Supragingival plaque was collected from 83 subjects before treatment and after either 3 or 6 months use of either the active antiseptic or a 5% hydroalcohol control. Subjects rinsed with their assigned mouthrinse twice daily under supervision. The plaque samples were analyzed for microbial content by darkfield microscopy, culture on a series of nonselective and selective bacterial media, and by recognition of microbial forms by recognition of distinct colony on a nonselective medium. Statistical analysis of the results revealed no significant microbial shifts including no significant increases in presumptive oral pathogens, spirochetes, black-pigmented Bacteroides, Streptococcus mutans, or Candida albicans. Additionally, no detectable rise in either staphylococci or enteric bacteria, potential opportunistic pathogens, was observed.

Adolescent↗
PubMed1989

Treatment of recurrent periodontal disease by root planing and Ornidazole (Tiberal). Clinical and microbiological findings.

The purpose of this study was to evaluate the use of Ornidazole as an adjunct to root planing in the therapy of patients suffering from recurrent periodontal disease. In 10 individuals who had previously been treated with scaling, root planing and periodontal surgery and who had followed a regular maintenance program including recall visits every 3-5 months for 1-7 years, 2 sites with recurrent periodontitis and 1 shallow site were selected. Reinfected sites had a record of losing clinical attachment of more than 3 mm since the completion of initial therapy, were bleeding upon probing and had a mean pocket probing depth of 7.85 +/- 1.31 mm. They had been reinstrumented several times by a registered dental hygienist, when clinical signs of recurrence of disease had appeared and the root surfaces were judged to be smooth and free of deposits. Clinical parameters were recorded and microbial samples were collected twice prior to retreatment. Then, 500 mg Ornidazole, to be taken twice a day for 10 days, was administered, and the whole dentition was thoroughly scaled and root planed. At day 10 as well as 2, 5, 8 and 11 months thereafter, samples were again obtained. At baseline, reinfected sites showed over 20% spirochetes, over 20% motile rods and over 9% fusiform organisms in darkfield preparations of subgingival plaque samples. Culturally, over 1/10 of organisms were identified as black pigmenting Bacteroides and in 18% of all baseline samples collected, B. gingivalis was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Relationship of subgingival plaque flora to lysosomal and cytoplasmic enzyme activity in gingival crevicular fluid.

Examining the relationships among indicators of the acute inflammatory response in gingival crevicular fluid (GCF) and specific bacterial species in subgingival plaque may provide indications of which bacterial species or groups of species may be associated with potentially destructive host-derived processes. Here we report on the relationship of the subgingival plaque flora to the activity of mammalian forms of the enzymes beta-glucuronidase (beta G), lactate dehydrogenase (LDH), and arylsulfatase (AS) in GCF from a total of 54 4-6 mm periodontal sites from 13 periodontitis patients. Sites were scored for probing depth (PD) and bleeding on probing, and GCF was collected using filter paper strips inserted into the sulcus for 30 s, eluted in buffer and assayed for enzyme activity. 1 week later, the patients were again evaluated for PD and bleeding, and subgingival plaque was removed with a curette oriented toward the pocket epithelium. Plaque samples were examined by darkfield microscopy and cultured anaerobically on selective and non-selective media. Various groups of bacteria, including species of black pigmenting Bacteroides (BPB), Fusobacterium sp., Capnocytophaga sp, Streptococcus sanguis, and total facultative organisms were enumerated. Relationships among the enzymes and bacterial groups expressed as colony-forming unit (CFU) counts or as a % of the total cultivable flora were assessed by Spearman correlation analysis. beta G levels were significantly correlated with populations of spirochetes, B. intermedius, B. gingivalis, and total lactose negative BPB's. Correlation between beta G and F. nucleatum sp. or Capnocytophaga sp. approached but did not reach statistically significant levels. In contrast, LDH activity showed a significant positive correlation with levels of B. gingivalis and total lactose negative BPB's. AS levels were significantly correlated only with B. gingivalis. beta G and LDH showed a significant negative correlation with levels of coccoid forms. Thus, beta G, an acid hydrolase which can serve as a marker for primary granule release from polymorphonuclear leukocytes, was most closely correlated with the micro-organisms found in other studies to be associated with chronic adult periodontitis.

Arylsulfatases↗
PubMed1989

Scanning electron microscopic examination of pocket wall epithelium and associated plaque in localized juvenile periodontitis.

The purpose of this investigation was to describe the morphologic characteristics of epithelial-associated plaque in periodontal pockets of patients with localized juvenile periodontitis (LJP). 25 tissue specimens obtained from 10 adolescent patients were examined by scanning electron microscopy. Specimens were evaluated to determine the following specific features: (1) distribution of microbial colonies on the epithelial surface; (2) topographic features of pocket epithelium associated with microbial colonies; and (3) the predominante microbial morphologic types comprising the colonies. Observations made during this investigation revealed the following. (1) The surface epithelium in the coronal one-third of the pocket wall was essentially healthy in appearance and exhibited no distinct microbial colonies or unusual topographic features. (2) The surface epithelium in the middle one-third area featured randomly-dispersed microbial colonies consisting of 3 major morphotypes: cocci, bacilli and coccobacilli. Also in this zone, there was morphologic evidence of microbial penetration of the epithelial barrier along intercellular spaces. (4) The apical one-third zone was characterized by lymphocytic infiltration, epithelial cavitation and ulcerations, and singular organisms entrapped in fibrin meshworks. There were no distinct microbial colonies in this zone, although individual spirochetes, fusiforms, filamentous organisms, and short and long rods were observed.

Adolescent↗