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Dental focal infections are extraoral manifestations caused by oral pathogens. Pathological oral conditions, such as periapical inflammation and periodontitis, can cause bacteremia. Dissemination of oral pathogens to nonoral sites can subsequently cause infections in extraoral tissues and organs. Cardiovascular infections and brain abscesses are the most common of these. The course of such infections can be lethal. In order to improve patient care, a closer collaboration between dental and medical caregivers is necessary.Dentale focale infecties zijn extraorale ontstekingen die worden veroorzaakt door orale pathogenen. Orale aandoeningen als periapicale ontsteking of parodontitis kunnen bacteriëmie veroorzaken. Disseminatie van orale pathogenen kan vervolgens leiden tot infecties in extraorale organen en weefsels. Hierbij komen cardiovasculaire infecties en hersenabcessen het meest frequent voor. Dergelijke infecties kunnen levensbedreigend verlopen. Om de patiëntenzorg te kunnen verbeteren is intensievere samenwerking tussen tandheelkundige en geneeskundige zorgverleners noodzakelijk.

Een student fiscaal recht van 26 jaar meldt zich in op een avond bij de dienstdoende tandarts. De patient blijkt na zich in zijn duim gesneden te hebben onwel te zijn geworden, waarbij hij met zijn kin op zijn bureaublad is terechtgekomen. Hij meldt zich bij de spoedeisende dienst waar de losse kroonfragmenten worden verwijderd en in de prullenbak worden gedeponeerd. De dienstdoende tandarts verwijst hem door naar een implantoloog voor het plaatsen van implantaten. De student vist de fragmenten uit de prullenbak, waarna een ontdekkingsreis begint langs diverse tandheelkundige specialisten.

Clinical microbiology now occupies an important place in periodontics and oral implant dentistry as a supplementary diagnostic tool and in planning treatment, particularly with respect to the rational use of antibiotics. This view is in line with the emphatic call by the World Health Organization and the European Union for the prudent use of antibiotics due to the global increase in resistance to antibiotics. Furthermore side effects may occur, such as the disturbance of the microbial intestinal and oral microflora, sometimes leading to serious pathological conditions. Hyposalivation following the use of antibiotics may lead to an oral environmental condition in which caries may develop faster than usual.Klinische microbiologie neemt inmiddels een belangrijke plaats in binnen de parodontologie en de orale implantologie als aanvullend diagnosticum en voor behandelplanning, vooral bij het rationeel gebruik van antibiotica. Deze zienswijze sluit aan bij de nadrukkelijke oproep van de World Health Organization en de Europese Unie om prudent om te gaan met antibiotica vanwege een wereldwijde toename in antibioticumresistentie. Daarnaast kunnen antibiotica bijwerkingen geven zoals verstoring van de darmflora en het orale milieu met soms ernstige pathologie tot gevolg. Hyposalivatie na antibioticumgebruik kan leiden tot een mondmilieu waarin cariës zich sneller kan ontwikkelen.

De aanwijzingen voor een verband tussen systemische ziekten en parodontitis zijn het sterkst bij diabetes mellitus type 2 en hart- en vaatziekten. Er is sprake van een matig verband van parodontitis met zwangerschapscomplicaties en reumatoïde artritis. Parodontale behandeling draagt gemiddeld genomen bij aan een verlaging van de systemische ontsteking en een verbetering van de conditie van het bloedvatenstelsel. Bij diabetespatiënten kan parodontale behandeling ook een positief effect hebben op de metabole regulatie. Er is onvoldoende bewijs dat parodontale behandeling een positief effect kan hebben op afgeleide parameters van zwangerschapscomplicaties en reumatoïde artritis.

AimSystematic review and meta-analyses to study the robustness of observations that treatment of periodontitis improves the atherosclerotic profile.Material and MethodsLiterature was searched in Medline-PubMed, Cochrane CENTRAL and EMBASE, based on controlled periodontal intervention trials, including also a non-intervention group. Data were extracted and meta-analyses were performed.ResultsFrom 3928 screened studies, 25 trials met the eligibility criteria. These trials enrolled 1748 periodontitis patients. Seven trials enrolled periodontitis patients that were otherwise healthy, 18 trials recruited periodontal patients with various co-morbidities, such as CVD or diabetes. None of the trials used hard clinical endpoints of CVD. However, improvement of endothelial function has been consistently reported. Meta-analyses demonstrated significant weighted mean difference (WMD) for hsCRP (−0.50 mg/l, 95% CI:−0.78; −0.22), IL-6 (−0.48 ng/l, 95% CI: −0.90; −0.06), TNF-α (−0.75 pg/ml, 95% CI: −1.34; −0.17), fibrinogen (−0.47 g/l, 95% CI: −0.76; −0.17), total cholesterol (−0.11 mmol/l, 95% CI: −0.21; −0.01) and HDL-C (0.04 mmol/l, 95% CI: 0.03; 0.06) favouring periodontal intervention. Importantly, periodontitis patients with co-morbidity benefitted most from periodontal therapy; significant WMD were observed for levels of hsCRP (−0.71 mg/l, 95% CI: −1.05; −0.36), IL-6 (−0.87 ng/l, 95% CI: −0.97; −0.78), triglycerides (−0.24 mmol/l, 95% CI: −0.26; −0.22), total cholesterol (−0.15 mmol/l, 95% CI: −0.29; −0.01), HDL-C (0.05 mmol/l, 95% CI: 0.03; 0.06) and HbA1c (−0.43%, 95% CI: −0.60; −0.25).ConclusionsThis systematic review and meta-analyses demonstrate that periodontal treatment improves endothelial function and reduces biomarkers of atherosclerotic disease, especially in those already suffering from CVD and/or diabetes.

In the eighties of the former century it was observed that individuals had different modes of development of periodontitis, largely for unknown reasons. It was assumed that periodontal disease developed as a result of the presence of virulent micro-organisms in combination with an inadequate host response. The concept of this (im)balance in host parasite interactions developed further, in part because of new research techniques. With respect to oral bacteria it was shown that periodontal pathogens like Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia are risk factors for periodontitis. Furthermore, genetic polymorphisms (SNP's) have been shown to modulate the host response against the periopathogens. Medical and lifestyle factors, e.g. diabetes mellitus, smoking, psychological stress and, to a minor extent, also hormonal changes can have an impact on the progression of periodontitis. All this information contributes to determining the individual risk profile of a patient for developing periodontitis and for estimating the prognosis of periodontal treatment and maintenance care on an individual basis.

Periodontitis may exert an infectious and inflammatory burden, evidenced by increased C-reactive protein (CRP). This burden may impair blood glucose control (HbA1c). The aim of our study was to analyze whether periodontitis severity as measured with the periodontal inflamed surface area (PISA) and CRP predict HbA1c levels in a group of healthy Indonesians and a group of Indonesians treated for type 2 diabetes mellitus (DM2). A full-mouth periodontal examination, including probing pocket depth, gingival recession, clinical attachment loss, plaque index and bleeding on probing, was performed in 132 healthy Indonesians and 101 Indonesians treated for DM2. Using these data, PISA was calculated. In addition, HbA1c and CRP were analyzed. A validated questionnaire was used to assess smoking, body mass index (BMI), education and medical conditions. In regression analyses, it was assessed whether periodontitis severity and CRP predict HbA1c, controlling for confounding and effect modification (i.e., age, sex, BMI, pack years, and education). In healthy Indonesians, PISA and CRP predicted HbA1c as did age, sex, and smoking. In Indonesians treated for DM2, PISA did not predict HbA1c. Periodontitis may impair blood glucose regulation in healthy Indonesians in conjunction with elevated CRP levels. The potential effect of periodontitis on glucose control in DM2 patients may be masked by DM2 treatment. Clinical relevance: periodontitis may impair blood glucose control through exerting an inflammatory and infectious burden evidenced by increased levels of CRP.

Objectives Plaque is never fully removed by brushing and may act as a reservoir for antibacterial ingredients, contributing to their substantive action. This study investigates the contribution of plaque-left-behind and saliva towards substantivity of three antibacterial toothpastes versus a control paste without antibacterial claims. Materials and methods First, volunteers brushed 2 weeks with a control or antibacterial toothpaste. Next, plaque and saliva samples were collected 6 and 12 h after brushing and bacterial concentrations and viabilities were measured. The contributions of plaque and saliva towards substantivity were determined by combining control plaques with experimental plaque or saliva samples and subsequently assessing their viabilities. Bacterial compositions in the various plaque and saliva samples were compared using denaturing gradient gel electrophoresis. Results The viabilities of plaques after brushing with Colgate-Total® and Crest-Pro-Health® were smaller than of control plaques and up to 12 h after brushing with Crest-Pro-Health® plaques still contained effective, residual antibacterial activity against control plaques. No effective, residual antibacterial activity could be measured in saliva samples after brushing. There was no significant difference in bacterial composition of plaque or saliva after brushing with the different toothpastes. Conclusions Plaque-left-behind after mechanical cleaning contributes to the substantive action of an antibacterial toothpaste containing stannous fluoride (Crest-Pro-Health®). Clinical relevance The absorptive capacity of plaque-left-behind after brushing is of utmost clinical importance, since plaque is predominantly left behind in places where its removal and effective killing matter most. Therewith this study demonstrates a clear and new beneficial effect of the use of antibacterial toothpastes.

The aim of this study was to compare acute action by killing or disrupting oral biofilms through the use of antimicrobial toothpastes and mouthrinses in vitro and to investigate substantive action by absorption of antimicrobials in a biofilm. Biofilms from freshly collected human saliva were grown in 96-well microtitre plates. After removal of saliva, the wells of the microtitre plates were washed with sterile water (control), or exposed to a dilution series of mouthrinses (Corsodyl, Listerine, Meridol, Crest Pro Health) or to toothpaste slurries (Prodent Coolmint, Colgate Total, Zendium Classic, Crest Pro Health, Oral B Pro Expert, Crest Cavity Protection). Acute action was concluded from reduced continued (16 h) growth of treated biofilms with respect to the control. Substantive action was studied by exposing dead biofilms to mouthrinses or to toothpaste slurry. Substantive action through the absorption and subsequent release of antimicrobials from biofilm was concluded from reduced growth on top of the treated biofilms. All formulations showed acute action at the highest concentrations studied. Further dilution yielded loss of efficacy, or even stimulation of biofilm growth. Antimicrobial absorption in and the release of effective concentrations of antimicrobials from dead biofilms, was demonstrated for three selected antimicrobial products, indicating that antimicrobials remain bio-available for substantive action on new biofilms.

Objectives: To evaluate the antimicrobial efficacies of two toothpaste formulations containing natural antimicrobials (herbal extracts and chitosan) against oral biofilms of different composition and maturational status.Methods: Bacteria from a buffer suspension or fresh saliva were adhered for 2 h to a salivary conditioning film and subsequently grown for 16 h. Dual-species biofilms were prepared from Actinomyces naeslundii T14V-J1 and Streptococcus oralis J22, whilst multi-species biofilms were grown from freshly collected human saliva. Biofilms were exposed to 25 wt% toothpaste supernatants. A chlorhexidine-containing mouthrinse and a buffer were used as positive- and negative-controls, respectively. Antibacterial efficacy was concluded from acute killing, bacterial removal, prevention of bacterial re-deposition and continued killing during re-deposition.Results: The herbal- and chitosan-based supernatants showed immediate killing of oral biofilm bacteria, comparable with chlorhexidine. Moreover, exposure of a biofilm to these supernatants or chlorhexidine, yielded ongoing killing of biofilm bacteria after exposure during re-deposition of bacteria to a matured 16 h biofilm, but not to a much thinner initial biofilm formed by 2 h adhesion only. This suggests that thicker, more matured biofilms can absorb and release oral antimicrobials.Conclusions: Supernatants based on herbal- and chitosan-based toothpastes have comparable immediate and ongoing antibacterial efficacies as chlorhexidine. Natural antimicrobials and chlorhexidine absorb in oral biofilms which contributes to their substantive action. (C) 2010 Elsevier Ltd. All rights reserved.

Background: Associations between periodontitis and cardiovascular and autoimmune diseases are most often assessed in patients with a particular cardiovascular or autoimmune disease. To prevent selection bias, this study assesses the existence of associations between periodontitis and cardiovascular and autoimmune diseases in patients attending a dental or periodontal clinic.Methods: Data were collected from 1,276 randomly selected dental records from patients attending a dental (n = 588) or periodontal (n = 688) clinic. Data on the prevalence of cardiovascular and autoimmune diseases were obtained from a validated health questionnaire. Data on the presence of periodontitis were taken from patients' dental records.Results: In uncontrolled analyses, the prevalence of hypertension, diabetes mellitus (DM), and rheumatoid arthritis (RA) is significantly increased in patients with periodontitis. Controlled for confounding, periodontitis was associated with DM, with an odds ratio of 4 (1.03 to 15.3), in the dental clinic. DM was not associated with periodontitis in periodontal clinics. Hypertension does not seem to be associated with periodontitis when controlling for confounders. Periodontitis may be associated with RA in both clinic types.Conclusions: The increased prevalence of cardiovascular and autoimmune diseases among patients with periodontitis attending dental or periodontal clinics may, at least in part, be influenced by confounding. However, the increased prevalence of DM and RA in patients with periodontitis could not be explained by confounding. J Periodontol 2010;81:1622-1628.

In vitro plaque removal studies require biofilm models that resemble in vivo dental plaque. Here, we compare contact and non-contact removal of single and dual-species biofilms as well as of biofilms grown from human whole saliva in vitro using different biofilm models. Bacteria were adhered to a salivary pellicle for 2 h or grown after adhesion for 16 h, after which, their removal was evaluated. In a contact mode, no differences were observed between the manual, rotating, or sonic brushing; and removal was on average 39%, 84%, and 95% for Streptococcus mutans, Streptococcus oralis, and Actinomyces naeslundii, respectively, and 90% and 54% for the dual- and multi-species biofilms, respectively. However, in a non-contact mode, rotating and sonic brushes still removed considerable numbers of bacteria (24-40%), while the manual brush as a control (5-11%) did not. Single A. naeslundii and dual-species (A. naeslundii and S. oralis) biofilms were more difficult to remove after 16 h growth than after 2 h adhesion (on average, 62% and 93% for 16- and 2-h-old biofilms, respectively), while in contrast, biofilms grown from whole saliva were easier to remove (97% after 16 h and 54% after 2 h of growth). Considering the strong adhesion of dual-species biofilms and their easier more reproducible growth compared with biofilms grown from whole saliva, dual-species biofilms of A. naeslundii and S. oralis are suggested to be preferred for use in mechanical plaque removal studies in vitro.

Aim: To test recolonization of periodontal lesions after full-mouth scaling and root planing (FM-SRP) or multiple session-SRP (MS-SRP) in a randomized clinical trial and whether FM-SRP and MS-SRP result in different clinical outcomes. Materials and Methods: Thirty-nine subjects were randomly assigned to FM-SRP or MS-SRP groups. At baseline and after 3 months, probing pocket depth (PPD), plaque index (PlI) and bleeding on probing (BoP) were recorded. At baseline, immediately after treatment, after 1, 2, 7, 14 and 90 days, paper point samples from a single site from the maxillary right quadrant were collected for microbiological analysis of five putative pathogens by polymerase chain reaction. Results: FM-SRP and MS-SRP resulted in significant reductions in PPD, BoP and PlI and the overall detection frequencies of the five species after 3 months without significant differences between treatments. Compared with MS-SRP, FM-SRP resulted in less recolonization of the five species, significantly for Treponema denticola, in the tested sites. Conclusion: FM-SRP and MS-SRP result in overall clinically and microbiologically comparable outcomes where recolonization of periodontal lesions may be better prevented by FM-SRP.

The aim of this study was to determine the contribution of plaque and saliva towards the prolonged activity, also called substantivity, of three antimicrobial mouthrinses (Listerine®, Meridol®, Crest Pro Health®), used in combination with a toothpaste (Prodent Coolmint®). Volunteers brushed for 4 weeks with a toothpaste without antimicrobial claims, while during the last 2 weeks half of the volunteers used an antimicrobial mouthrinse in addition to brushing. At the end of the experimental period, plaque and saliva samples were collected 6 h after oral hygiene, and bacterial concentrations and viabilities were determined. The contribution of plaque and saliva towards substantivity was assessed by combining plaque obtained after mechanical cleaning only with plaque and saliva obtained after additional use of an antimicrobial rinse. Subsequently, resulting viabilities of the combined plaques were determined. The viabilities of plaque samples after additional rinsing with mouthrinses were lower than of plaque obtained after mechanical cleaning only, regardless of the rinse involved. Moreover, plaque collected 6 h after rinsing with antimicrobial mouthrinses contained a surplus of antimicrobial activity. Only Listerine showed decreased viability in saliva, but none of the mouthrinses showed any residual antimicrobial activity in saliva. The findings indicate that plaque left behind after mechanical cleaning contributes to the prolonged substantivity of antimicrobial mouthrinses.

Background: Currently, a large variety of classifications is used for periodontitis as a risk factor for other diseases. None of these classifications quantifies the amount of inflamed periodontal tissue, while this information is needed to assess the inflammatory burden posed by periodontitis. Aim: To develop a classification of periodontitis that quantifies the amount of inflamed periodontal tissue, which can be easily and broadly applied.Material and Methods: A literature search was conducted to look for a classification of periodontitis that quantified the amount of inflamed periodontal tissue. A classification that quantified the root surface area affected by attachment loss was found. This classification did not quantify the surface area of inflamed periodontal tissue, however. Therefore, an Excel spreadsheet was developed in which the periodontal inflamed surface area (PISA) is calculated using clinical Attachment Level (CAL), recessions and bleeding on probing (BOP).Results: The PISA reflects the surface area of bleeding pocket epithelium in square millimetres. The surface area of bleeding pocket epithelium quantifies the amount of inflamed periodontal tissue. A freely downloadable spreadsheet is available to calculate the PISA.Conclusion: PISA quantifies the inflammatory burden posed by periodontitis and can be easily and broadly applied.

Objective: To study the relationship between vitamin C and the severity of periodontitis.Material and Methods: The study population consisted of subjects from the Malabar/Purbasari tea estate on West Java, Indonesia. In 2002, clinical measurements were performed in 128 subjects, including evaluation of plaque, bleeding on probing, pocket depth and attachment loss. In 2005, 123 out of 128 subjects could be retrieved who were present at the examination of 2002. Blood samples were taken to measure plasma vitamin C levels. Information about the subject's dietary habit was obtained by means of a personal interview guided by a questionnaire.Results: Plasma levels of vitamin C ranged from 0.02 to 34.45 mg/l with a mean of 7.90 mg/l (+/- 5.35). The correlation coefficient between plasma vitamin C level and periodontal attachment loss was -0.199 (p Conclusion: The negative association between plasma vitamin C levels and periodontal attachment loss suggests that vitamin C deficiency may contribute to the severity of periodontal breakdown.

Objective: Pre-eclampsia is a complication of pregnancy characterized by systemic vascular dysfunction and pathological changes in placental arteries. Growing evidence of chronic infection as an aetiological factor in vascular diseases prompted us to study maternal periodontal disease in subjects with early-onset pre-eclampsia (Methods: A case-control study was carried out on 17 early-onset pre-eclamptic women and 35 controls with uncomplicated pregnancies in a period of 3-28 months postpartum. All were Caucasians. Full-mouth periodontal examinations were performed to determine the periodontal condition. Subgingival-plaque samples were analysed by anaerobic culture techniques for the presence of seven bacterial periodontal pathogens. Potential confounders as age, smoking, educational level and body mass index were determined.Results: Severe periodontal disease was found in 82% of the pre-eclamptic and in 37% of the control group (p=0.009). After adjusting for age, smoking and educational level, the odds ratio was 7.9 (95% CI: 1.9-32.8). The periodontopathic microorganism Micromonas micros was more prevalent in the case group (p=0.040) while Campylobacter rectus was more prevalent in the control group (p=0.047).Conclusion: These results indicate that Caucasian women with a recent history of early-onset pre-eclampsia have a worse periodontal condition, as compared with women with uncomplicated deliveries.

Bacteria play an important role in the initiation and progression of periodontal diseases and are part of a biofilm, which can contain over 100 different species. The aim of the present study was to show the potential of denaturing gradient gel electrophoresis (DGGE) as a tool for the detection of clinically relevant species and to compare the results of detection by DGGE with those by PCR and culturing. Hybridization of the bands from the DGGE profiles with species-specific probes was developed to confirm the band positions in the marker obtained with reference strains. The sensitivities of DGGE compared to those of cultivation for the detection of Actinobacillus actinomycetemcomitans , Porphyromonas gingivalis , Prevotella intermedia , and Tannerella forsythensis were 100, 100, 88, and 100%, respectively; and the sensitivities of DGGE compared to those of PCR were 100, 90, 88, and 96%, respectively. DGGE as a diagnostic tool could easily be extended to other species, as shown for Treponema denticola , which could be detected in 48% of the samples. Three different groups of A. actinomycetemcomitans serotypes could be distinguished by DGGE (i.e., a group comprising serotypes a, d, e, and f; a group comprising serotype b; and a group comprising serotype c). Amplicons from P. gingivalis and T. denticola migrated to the same position in the gel, and P. intermedia produced multiple bands. In the present study we show that the DGGE profiles represent clinically relevant species which can be detected by hybridization with species-specific probes. With DGGE, large numbers of samples can be analyzed for different species simultaneously, and DGGE may be a good alternative in periodontal microbial diagnostics.

Objective: To identify risk factors, risk predictors and risk determinants for onset and progression of periodontitis. Material and Methods: For this longitudinal, prospective study all subjects in the age range 15-25 years living in a village of approximately 2000 inhabitants at a tea estate on Western Java, Indonesia, were selected. Baseline examination was carried out in 1987 and follow-up examinations in 1994 and 2002. In 2002, 128 subjects could be retrieved from the original group of 255. Baseline examination included evaluation of plaque, bleeding on probing, calculus, pocket depth, attachment loss and presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, spirochetes and motile microorganisms. Results: The mean attachment loss increased from 0.33 mm in 1987 to 0.72 mm in 1994 and 1.97 mm in 2002. Analysis identified the amount of subgingival calculus and subgingival presence of A. actinomycetemcomitans as risk factors, and age as a risk determinant, for the onset of disease. Regarding disease progression, the number of sites with a probing depth >= 5 mm and the number of sites with recession were identified as risk predictors and male gender as a risk determinant. Conclusion: Screening of these parameters early in life could be helpful in the prevention of onset and progression of periodontal diseases.

Verkleuring van gebitselementen en mucosa bij gebruik van chloorhexidine is een ongewenste bijwerking. Om verkleuring tegen te gaan is er aan chloorhexidine een antiverkleuringssysteem (ADS) toegevoegd. Onderzoek heeft aangetoond dat deze formulering verkleuring reduceert. In een recent experimenteel gingivitisonderzoek laten de auteurs zien dat chloorhexidine met ADS (Curasept ADS 212) minder verkleuring geeft dan de positieve controle (chloorhexidine zonder ADS), maar dat de antiplaque- en de antigingivitiswerking door de toevoeging van het ADS significant is gereduceerd. De chloorhexidine met ADS werkte klinisch niet beter dan de placebo (water).

OBJECTIVE: Pregnant individuals of many species, including humans, are more sensitive to various bacteria or their products as compared with non-pregnant individuals. Pregnant individuals also respond differently to different bacteria or their products. Therefore, in the present study, we evaluated whether the increased sensitivity of pregnant women to bacterial products and their heterogeneous response to different bacteria was associated with differences in whole blood cytokine production upon stimulation with bacteria or their products.METHODS: Blood samples were taken from healthy pregnant and age-matched non-pregnant women and ex vivo stimulated with bacteria or LPS from Porphyromonas Gingivalis (Pg) or E-coli for 24 hrs. TNFα, IL-1ß, IL-6, IL-12 and IL-10 were measured using a multiplex Luminex system.RESULTS: We observed a generally lower cytokine production after stimulation with Pg bacteria or it's LPS as compared with E-coli bacteria. However, there was also an effect of pregnancy upon cytokine production: in pregnant women the production of IL-6 upon Pg stimulation was decreased as compared with non-pregnant women. After stimulation with E-coli, the production of IL-12 and TNFα was decreased in pregnant women as compared with non-pregnant women.CONCLUSION: Our results showed that cytokine production upon bacterial stimulation of whole blood differed between pregnant and non-pregnant women, showing that the increased sensitivity of pregnant women may be due to differences in cytokine production. Moreover, pregnancy also affected whole blood cytokine production upon Pg or E-coli stimulation differently. Thus, the different responses of pregnant women to different bacteria or their products may result from variations in cytokine production.

Background/aims: In an Indonesian population deprived of regular dental care, the experienced progression of disease between baseline (1987) and follow-up (1994) was investigated in relation to the composition of the subgingival microbiota at follow-up. At baseline the age ranged from 15 to 25 years. Clinical and microbiological evaluation was completed in 158 of the 167 subjects available at follow-up. Methods: Plaque index (PI), pocket depth (PD), bleeding on probing (BOP), and attachment loss (AL) were scored at the approximal surfaces of all teeth and subgingival calculus on the approximal surfaces of the Ramfjord teeth only (number of sites with subgingival calculus: NSC). A pooled sample of the deepest pocket in each quadrant was evaluated using microbiological culture techniques. Results: At baseline the mean values of the clinical parameters were AL=0.35 mm, PI=1.01, BOP=0.80 PD=3.25 mm and NSC=6.04 and at follow-up AL=0.75 mm, PI=1.16, BOP=1.19, PD=3.34 mm and NSC=5.85. All parameters except PD and NSC showed a statistically significant increase. At follow-up the prevalence of Actinobacillus actinomycetemcomitans was 40%, of Porphyromonas gingivalis 67%, of Prevotella intermedia 66%, of Fusobacterium nucleatum 79%, of Bacteroides forsythus 16%, of Campylobacter rectus 4%, and of P. micros 6%. No differences in clinical parameters were found between groups with or without these micro-organisms. In 129 subjects AL of greater than or equal to2 mm at greater than or equal to1 site was found. Logistic regression shelved three significant odds-ratio's for experienced progressive periodontitis: Plaque index (12.2), gender (3.4) and Actinobacillus actinomycetem-comitans (2.9). Conclusions: The results of this retrospective study suggest that plaque is the most important parameter related to experienced disease progression, and that the presence of A. actinomycetemcomitans may be associated with increased chance of disease progression.

In this study, the prevalence and serotype distribution of Porphyromonas gingivalis in an Indonesian population (n=158) is described. The relationship between subgingival P. gingivalis and periodontal attachment loss was investigated. The serotype distribution and periodontal parameters were studied. Serotyping was also used to study person-to-person transmission between siblings and between spouses. Approximately 50% of the subjects had periodontal attachment loss greater than or equal to 3 mm at 1 or more recorded sites. The population was divided into 2 subgroups based on the presence or absence of P. gingivalis. No differences in plaque index, pocket depth, clinical attachment loss, bleeding upon probing, % of sites with greater than or equal to 3 mm clinical attachment loss and % of sites with probing pocket depth greater than or equal to 5 mm, were observed between both sub-populations. All known 6 capsular serotypes were found in the study population, with the exception of the K1 type. Detection of 1 of the known P. gingivalis serotypes was not related with the amount of clinical attachment loss. In 3 out of 29 sibships with more than one member positive for P. gingivalis, an identical P. gingivalis serotype was found. None of the 15 couples in the study shared an identical P. gingivalis serotype, indicating that transmission is probably not a common phenomenon in this population.

OBJECTIVE: Periodontitis, mostly associated with Porphyromonas gingivalis, has frequently been related to adverse pregnancy outcomes. We therefore investigated whether lipopolysaccharides of P. gingivalis (Pg-LPS) induced pregnancy complications in the rat. METHODS: Experiment 1: pregnant rats (day 14) received increasing Pg-LPS doses (0.0-50.0 μg kg-1 bw; n = 2/3 p per dose). Maternal intra-aortic blood pressure, urinary albumin excretion, placental and foetal weight and foetal resorptions were documented. Experiment 2: 10.0 μg kg-1 bw (which induced the highest blood pressure together with decreased foetal weight in experiment 1) or saline was infused in pregnant and non-pregnant rats (n = 7/9 p per group). Parameters of experiment 1 and numbers of peripheral leucocytes as well as signs of inflammation in the kidney and placenta were evaluated. RESULTS: Pg-LPS infusion in pregnant rats increased maternal systolic blood pressure, reduced placental weight (dose dependently) and decreased foetal weight and induced foetal resorptions. It, however, did not induce proteinuria or a generalised inflammatory response. No effects of Pg-LPS were seen in non-pregnant rats. CONCLUSION: Pg-LPS increased maternal blood pressure, induced placental and foetal growth restriction, and increased foetal resorptions, without inducing proteinuria and inflammation. Pg-LPS may therefore play a role in pregnancy complications induced by periodontitis. PMID:24112943 doi: 10.1111/odi.12177

The aim of the present investigation was to study longitudinally the periodontal condition of married couples. The data are derived from a longitudinal study in a young population living in a remote village in Indonesia and showing a relatively high prevalence of periodontal destruction. In 23 married couples, clinical measurements were carried out in 1987 and 1994. During the latter examination, a pooled gingival sample was obtained for microbiological evaluation. In 1994, the mean age of the group was 29.1 years and the couples were married for on the average 10 years. In each couple, the partner showing in 1994 the highest score for mean loss of attachment (LA) was classified as the diseased proband and the other partner as the spouse. Evaluation of the clinical data showed that: (1) the diseased probands already had in 1987 a worse periodontal condition compared to that of the spouses; (2) in both groups the mean LA increased during the 7-year period; (3) the difference in mean LA between diseased probands and spouses increased between 1987 and 1994. The microbiological evaluation revealed a relatively high prevalence of Actinobacillus actinomycetemcomitans (50%), Porphyromonas gingivalis (67%) and Prevotella intermedia 61%. Analysis showed no differences in microbiota between diseased probands and spouses. The 23 Actinobacillus actinomycetemcomitans positive subjects included 2 positive couples. Furthermore, the 31 Porphyromonas gingivalis and 28 Prevotella intermedia positive subjects included 9 and 7 positive couples respectively. In conclusion, 10 years of cohabitation showed no influence on the periodontal condition of the spouses.

Objective: Although the exact reason is not known, encapsulated gram-negative Porphyromonas gingivalis strains are more virulent than non-encapsulated strains. Since difference in virulence properties may be due to difference in cytokine production following recognition of the bacteria or their products by the host inflammatory cells, we compared cytokine production following stimulation with bacteria or lipopolysaccharides (LPS) of a non-encapsulated and an encapsulated P. gingivalis strain (K- and K1).Design: Tumour necrosis factor-alpha (TNF-alpha) production following stimulation of the cell-line Mono Mac 6 with bacteria or LPS of both P. gingivalis strains was determined using flow cytometry. Furthermore, we investigated the effects of the two P. gingivalis strains or their LPS on TNF-alpha and Interleukin (IL-1 beta, IL-6, IL-12 and IL-10) production in whole blood using Luminex. In both experiments, Escherichia coli bacteria and LPS were used as a reference.Results: Both P. gingivalis strains induced lower cytokine production than E. coli with the exception of IL-6. P. gingivalis K1 bacteria elicited a higher overall cytokine production than P. gingivalis K-. In contrast, P. gingivalis K1 LPS stimulation induced a lower cytokine production than P. gingivalis K- LPS.Conclusions: Our findings suggest that the encapsulated P. gingivalis K1 bacteria induce higher cytokine production than the non-encapsulated P. gingivalis K-. This was not due to its LPS. The stronger induction of cytokines may contribute to the higher virulence of P. gingivalis K1. (C) 2012 Elsevier Ltd. All rights reserved.

To investigate a possible role for salivary blood-group antigens in the relative frequencies of selected periodontal pathogens and commensal oral micro-organisms, we studied the clinical and microbiological condition in young adults with or without blood group reactive substances in saliva (secretors or non-secretors respectively). Clinical measurements were recorded at the Ramfjord teeth in 81 1st-year dental students. In addition, presence of interproximal loss of attachment (LA) was assessed at sites with a pocket depth of ≥4 mm. Microbiological samples were taken from one of the Ramfjord teeth (site without inteproximal LA), from interproximal sites of ≥4 mm in conjunction with LA, and from the saliva. The samples were analyzed for the presence of Actinomyces naesiundii, Actinomyces viscosus, Campylobacter rectus, Fusobacterium nucleatum, Peptostreptococcus micros, Prevotella intermedia. Porphyromonas gingivalis and Actinobacillius actinomycetemcomitans. Clinically, no statistically significant differences were found in the periodontal status between secretors (78% of our population) and n on-secretors. Furthermore, the occurrence of the monitored micro-organisms was not correlated to the secretor status. It is concluded that bacterial colonization with the micro-organisms tested in this study, apparently occurred independent of secretor status. Among the periodontal pathogens, only P. intermedia was more frequently recovered from the saliva of subjects with interproximal LA (49%) than in those without (33%; p=0.03). This finding was irrespective of the secretor status. Therefore, P. intermedia may be an important micro-organism in relation to the onset of periodontal destruction in young adults.

It has been shown that patients with localized juvenile periodontitis (LJP) often harbor Actinobacillus actinomycetemcomitans in the subgingival area. However, little is known of the oral microflora in non-LJP juvenile periodontitis patients with less extensive disease. The purpose of this study was to describe the microflora and clinical parameters of young adults with minor to moderate periodontitis during treatment for a period of 1 year. Eleven patients 15 to 16 years of age were studied. All of them had 4 to 8 mm loss of attachment at minimally one site, but the typical clinical description of localized juvenile periodontitis was an exclusion criterion in this study. Microbiological examination of the deepest periodontal pocket and of the tongue revealed that 6 patients harbored Actinobacillus actinomycetemcomitans and 5 harbored Porphyromonas gingivalis. Almost all subjects showed relatively high proportions of Prevotella intermedia, Campylobacter rectus, motile organisms, and spirochetes. On the basis of clinical and microbiological parameters the 11 patients could be assigned to 1 of 2 groups. Six cases had moderate periodontal breakdown with loss of attachment at 7 to 44 sites. All harbored A. actinomycetemcomitans and 5 of them P. gingivalis. These 6 cases responded relatively well to initial treatment despite the continued presence of A. actinomycetemcomitans. The other group consisted of 5 cases with relatively minor periodontal breakdown; i.e, 1 or 2 sites with 4 to 6 mm loss of attachment. Neither A. actinomycetemcomitans nor P. gingivalis was detected in the deepest pocket of these patients. All 5 responded well to initial treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

In de mei-editie van het Nederlands Tijdschrift voor Tandheelkunde werd het redactioneel commentaar gewijd aan de vraag in hoeverre de behandeling van parodontitis bij patiënten met diabetes mellitus zinvol zou zijn. B.G. Loos, W. J. Teeuw, V. Gerdes en F. Abbas geven een reactie op dit commentaar en betogen dat behandeling van parodontitis bij patiënten met diabetes mellitus altijd zin heeft.

This review evaluates the possible relationship between periodontal disease and pre-eclampsia, a major pregnancy complication. A generalized inflammatory response plays an important role in the pathogenesis of pre-eclampsia. Because periodontal disease is a low-grade inflammatory state, periodontal disease might contribute to the pathogenesis of pre-eclampsia.A literature search of PubMed, EMBASE and CINAHL until August 2010 revealed 12 eligible observational studies and three randomized-controlled trials (RCTs). It appeared difficult to compare these studies, due to variations in definitions of periodontal disease and pre-eclampsia, timing of periodontal examination and inadequate control for confounding factors. Eight observational studies reported a positive association, while four studies found no association. None of the RTCs reported reductions in pre-eclamptic rate after periodontal therapy during pregnancy. Therefore, it is questionable whether periodontal disease plays a causal role in the pathogenesis of pre-eclampsia. The observed association in eight observational studies might be the result of induction of periodontal disease due to the pre-eclamptic state or it may be an epiphenomenon of an exaggerated inflammatory response to pregnancy. Larger RCTs with pre-eclampsia as the primary outcome and pathophysiological studies are required to explore causality and to dissect biological mechanisms involved.

Background: The prevalence of diabetes mellitus type 2 (DM2) in Indonesia is high and still rising. Periodontitis is associated with DM2. No study has investigated this association in Indonesia, nor has any study investigated this association using a variety of methods to operationalize periodontitis. The present study compares prevalence and severity of periodontitis in patients with DM2 to healthy controls, using different methods to operationalize periodontitis.Methods: A total of 78 subjects with DM2 and 65 healthy control subjects underwent a full-mouth periodontal screening assessing probing depth, gingival recession, plaque index, and bleeding on probing. Using these measurements, the prevalence and severity of periodontitis was operationalized in various ways. Differences in the prevalence and severity of periodontitis between subjects with DM2 and healthy subjects were analyzed using univariate analyses. In regression analyses, the prevalence and severity of periodontitis were predicted on the basis of DM2 presence, controlling for confounders and effect modification.Results: Prevalence of periodontitis was significantly higher in subjects with DM2 compared to healthy subjects, showing odds ratios of 5.0 and 6.1. Likewise, periodontitis severity was significantly higher in subjects with DM2.Conclusion: Indonesian subjects with DM2 had more prevalent and more severe periodontitis than healthy Indonesian subjects, independent of confounding factors or the methods used to operationalize periodontitis. J Periodontol 2011; 82:550-557.

Periodontitis and caries are infectious diseases of the oral cavity in which oral biofilms play a causative role. Moreover, oral biofilms are widely studied as model systems for bacterial adhesion, biofilm development, and biofilm resistance to antibiotics, due to their widespread presence and accessibility. Despite descriptions of initial plaque formation on the tooth surface, studies on mature plaque and plaque structure below the gum are limited to landmark studies from the 1970s, without appreciating the breadth of microbial diversity in the plaque. We used fluorescent in situ hybridization to localize in vivo the most abundant species from different phyla and species associated with periodontitis on seven embedded teeth obtained from four different subjects. The data showed convincingly the dominance of Actinomyces sp., Tannerella forsythia, Fusobacterium nucleatum, Spirochaetes, and Synergistetes in subgingival plaque. The latter proved to be new with a possibly important role in host-pathogen interaction due to its localization in close proximity to immune cells. The present study identified for the first time in vivo that Lactobacillus sp. are the central cells of bacterial aggregates in subgingival plaque, and that Streptococcus sp. and the yeast Candida albicans form corncob structures in supragingival plaque. Finally, periodontal pathogens colonize already formed biofilms and form microcolonies therein. These in vivo observations on oral biofilms provide a clear vision on biofilm architecture and the spatial distribution of predominant species.

In the present study, the relationship between bleeding/plaque ratio, family history of diabetes mellitus and oral glucose tolerance pattern were investigated in 85 non-diabetic individuals without periodontal breakdown. In this group, no relationship between bleeding/plaque ratio, family history of diabetes mellitus and impaired glucose tolerance was found. The results of the present study suggest that the observed variation in bleeding/plaque ratio cannot be explained by impaired glucose tolerance or family history of diabetes mellitus. It is hypothesized that in subjects with impaired glucose tolerance, the periods of elevated blood glucose values may be too short to introduce tissue changes.

Purpose: This study evaluated the in vitro plaque inhibitory effect of triclosan-coated polyglactin 910 sutures in the absence and presence of an additional antiplaque agent commonly used after oral surgery.Materials and Methods: Triclosan-coated sutures were incubated for 4 hours in freshly collected human saliva and, when appropriate, subsequently treated with an antiplaque rinse containing chlorhexidine-cetyl pyridinium as active components. Sutures without a triclosan-coating served as a control.Results: Triclosan-coated sutures harbored similar amounts of plaque as did uncoated sutures. Exposure to the antiplaque rinse caused significant decreases in viable organisms for uncoated and triclosan-coated sutures. However, after application of the antiplaque rinse, more micro-organisms were found on triclosan-coated than on uncoated sutures.Conclusion: Sutures coated with triclosan do not provide a sufficient antimicrobial effect to prevent in vitro colonization by oral bacteria, whereas use in combination with a chlorhexidine-cetyl pyridinium-containing antiplaque rinse appears to be counterproductive. (C) 2011 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 69:980-985, 2011

Nesse W, Linde A, Abbas F, Spijkervet FKL, Dijkstra PU, de Brabander EC, Gerstenbluth I, Vissink A. Dose-response relationship between periodontal inflamed surface area and HbA1c in type 2 diabetics. J Clin Periodontol 2009; 36: 295-300. doi: 10.1111/j.1600-051X.2009.01377.x.A dose-response relationship between the amount of inflamed periodontal tissue and HbA1c level, might be indicative for a causal association between periodontitis and type 2 diabetes.To assess a dose-response relationship between the periodontal inflamed surface area (PISA), as a measure of the amount of inflamed periodontal tissue, and HbA1c levels in type 2 diabetics.Forty consecutive dentate type 2 diabetics attending their general practitioner for regular check-up, underwent full-mouth probing pocket depth and bleeding on probing assessment. From these data PISA was calculated. HbA1c levels were retrieved from patients' medical files. The dose-response relationship between PISA and HbA1c levels was assessed using multiple linear regression analyses, controlling for factors that might influence PISA or HbA1c levels.The higher the PISA of type 2 diabetics was, the higher their HbA1c levels were. On a group level, an increase of PISA with 333 mm(2) was associated with a 1.0 percentage point increase of HbA1c, independent of the influence of other factors.On a group level, there is a dose-response relationship between PISA and HbA1c in type 2 diabetics. This might be an indication of a causal relationship between type 2 diabetes and periodontitis.

A total of 242 subjects including 138 untreated severe periodontitis patients and 104 patients with refractory periodontal disease, previously treated for severe periodontitis, were examined for the occurrence of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and Bacteroides intermedius. Pooled subgingival samples of representative periodontal lesions were used for anaerobic cultivation on blood agar and for the enumeration of A. actinomycetemcomitans on selective TSBV medium. 97% of the untreated patients were infected with one or more of the test micro-organisms. In this patient group, the occurrence of A. actinomycetemcomitans, B. gingivalis and B. intermedius was 54%, 48% and 63%, respectively. The prevalence of A. actinomycetemcomitans positive patients appeared to be age related and decreased with increasing age. Likewise, the number of patients solely infected with A. actinomycetemcomitans decreased with increasing age. The prevalence of B. gingivalis infected patients appeared to increase with increasing age. These phenomena were not observed in the refractory periodontitis patients. The occurrence of A. actinomycetemcomitans, B. gingivalis and B. intermedius in the refractory periodontitis group was 55%, 27% and 59%, respectively. A statistical significant difference in the prevalence of B. gingivalis was found between the untreated and the refractory periodontitis patients. In both patient groups, the relative proportion of A. actinomycetemcomitans was significantly higher in subjects with this bacterium as the sole indicator micro-organism than in patients who, besides being infected with A. actinomycetemcomitans, were also infected with black-pigmented Bacteroides species. Furthermore, in comparison with untreated patients, unsuccessfully treated patients solely infected with A. actinomycetemcomitans had on average a lower number but also a higher mean % of this bacterium.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of the present study was to investigate the effect of mechanical oral hygiene procedures on bleeding on probing in relation to age and periodontal status. The study was carried out on 49 individuals divided into 7 experimental groups according to age and having been either treated for destructive periodontal disease or having an intact healthy periodontium. In order to eliminate any pre-existant gingival inflammation, all subjects received a carefully controlled oral hygiene program. At the start of the experiment, all subjects were instructed to abstain from oral hygiene procedures for 24 h. Thereafter, clinical baseline measurements were carried out, including bleeding on probing (BOP) using a standardized probing pressure. Next, all subjects cleaned their teeth according to their normal oral home care protocol using a multitufted toothbrush, toothpicks and interdental brushes. BOP scores were again assessed 30 min after completed tooth cleaning procedures. The results revealed a significant increase in BOP after the mechanical oral hygiene procedures in every individual in all experimental groups (p less than 0.05). Further analysis showed that the increase in BOP was independent of the periodontal status of the subjects. However the BOP scores after mechanical oral hygiene procedures were higher in the young age groups. It was concluded that the diagnostic predictability of BOP in the treatment of periodontal diseases might be affected by temporarily elevated BOP scores shortly after mechanical oral hygiene procedures.

In the present study, the relationship between bleeding/plaque ratio, family history of diabetes mellitus and oral glucose tolerance pattern were investigated in 85 non-diabetic individuals without periodontal breakdown. In this group, no relationship between bleeding/plaque ratio, family history of diabetes mellitus and impaired glucose tolerance was found. The results of the present study suggest that the observed variation in bleeding/plaque ratio cannot be explained by impaired glucose tolerance or family history of diabetes mellitus. It is hypothesized that in subjects with impaired glucose tolerance, the periods of elevated blood glucose values may be too short to introduce tissue changes.

Aim: To study transmission of Porphyromonas gingivalis in a population living in a remote area in Southern Java, Indonesia.Material and Methods: Subgingival plaque samples from 167 subjects with varying degrees of periodontal breakdown were obtained and cultured for the presence of P. gingivalis. After extraction and purification of bacterial DNA, amplified fragment length polymorphism technique was applied to genotype the bacterial isolates. Computer-assisted analysis of the bacterial DNA profiles was used to study distribution of P. gingivalis genotypes within family units.Results: One hundred and five of the 167 (63%) subjects were culture positive for P. gingivalis. In total, 371 P. gingivalis isolates were obtained from the 105 subjects. Of the 105 subjects, 30 were siblings representing 13 families. In six of the 13 families (46%), identical P. gingivalis genotypes were found among siblings. In the study group of 105 subjects, 13 married couples were identified of which both spouses were culture positive for P. gingivalis. None of the 13 couples shared an identical P. gingivalis genotype. Twenty P. gingivalis-positive subjects had spouses that were culture negative for P. gingivalis.Conclusions: In this study population, vertical transmission of P. gingivalis has occurred within family units, most likely from parents to children. Transmission of P. gingivalis between spouses could not be established.

Hendri Susanto*, Dewi Agustina*, Frank Abbas#, Arjan Vissink † * Universitas Gadjah Mada, Faculty of Dentistry, Department of Oral Medicine, Yogyakarta, Indonesia # University of Groningen, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, Groningen, the Netherlands † University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Groningen, the Netherlands

Objectives: The purpose of this split-mouth study was to evaluate the clinical response of enamel matrix proteins (EMPs, Emdogain Gel((R))) in intra-osseous defects with or without a combined application of a tetracycline-coated expanded polytetrafluoroethylene barrier membrane (e-PTFE, Gore-Tex((R))).Methods: Twelve pairs of intra-osseous periodontal defects in 11 patients received the application of EMPs on the exposed root surface (EMP). One of the two defects received randomly, as an adjunct to EMP treatment, a tetracycline-coated e-PTFE membrane (MEMP). At baseline, 6- and 12-month probing pocket depth (PPD), clinical attachment level (CAL) and probing bone level (PBL) were measured.Results: After 12 months, the EMP defects showed a significant mean PPD reduction of 2.86 +/- 0.75 mm, a mean gain in CAL of 1.28 +/- 2.04 mm, a mean PBL gain of 1.63 +/- 1.21 mm and a mean increase of recession (REC) of 1.56 +/- 2.30 mm. The MEMP defects showed a significant mean PPD reduction of 3.02 +/- 1.55 mm, a mean gain in CAL of 1.65 +/- 1.29 mm, a mean PBL gain of 1.58 +/- 1.92 mm and a mean increase of REC of 1.38 +/- 1.63 mm. Except for significantly more post-operative discomfort at the MEMP sites, no significant differences were found between EMP and MEMP defects.Conclusion: Within the limits of this study, it is concluded that in the treatment of intra-osseous defects with EMP, the adjunctive use of a tetracycline-coated e-PTFE membrane failed to show more gain of CAL and PBL.

This article describes the clinical procedure and outcome of surgical treatment of gingival recessions with the adjunctive use of Emdogain gel, an enamel matrix derivative bioactive material for periodontal reconstructive surgery. Six cases with gingival recession on maxillary canines are presented with 12 months of follow-up. Initial gingival recession averaged 4.8 mm, with a mean probing pocket depth of 2.2 mm. At the 12-month follow-up, a mean of 3.5 mm of root coverage was observed (ie, 73% root coverage, range 60% to 100%). Probing pocket depth averaged 1.7 mm, indicating a 4-mm gain of clinical attachment (range 3 to 5 mm). On a clinical level, mucogingival surgery in combination with the application of Emdogain gel results in predictable root coverage and gain of clinical attachment while maintaining shallow pockets.

Background: When the subgingival presence of periodontal pathogens is studied in groups of patients or populations, mostly a number of the deepest sites is sampled. The mean clinical parameters of these deep sites are also frequently used as a the descriptor of the clinical situation of these subjects. It can be questioned, whether these 4 deep sites are capable of predicting a full-mouth situation. Aim: The purpose of the present retrospective study was to investigate to what extent the experienced progression of periodontitis as measured in the deepest approximal pocket in each quadrant reflects the disease progression at the approximal sites on a full-mouth level. Methods: A data set of a 7-year longitudinal study of 158 young subjects (69 male, 89 female, 15–25 years of age at baseline) was used. Clinical assessments included plaque index (PI), pocket depth (PD) and attachment loss (AL) at baseline (1987) and follow-up (1994). Measurements were made at the approximal surfaces of all teeth. The deepest pocket in each quadrant was determined at follow-up. Changes of the clinical parameters between baseline and follow-up were calculated both as full-mouth mean scores as well as for these 4 deepest sites. A regression analysis was used to evaluate the relationship between full-mouth score and the 4 test sites. Results: For disease progression between baseline and follow-up, significant correlation coefficients were observed between the 4-site and full-mouth mean changes (PD: 0.80, AL: 0.70, PI: 0.77). Regression coefficients were 0.51 for PD, 0.35 for AL and 0.55 for PI. The precision of the estimate for the full-mouth mean, as predicted by the 4-site mean, is determined by the residual standard deviation. This was for PD 0.31 mm, for AL 0.31 mm and for PI 0.29. Compared to the between-patient standard deviation of the full-mouth means, the residual standard deviations were high. Conclusion: In the present population, a reasonable to good correlation between full-mouth and 4-sites data was observed. However, the high residual standard deviation in the regression analysis illustrates the inaccuracy for the 4-sites data when used as a descriptive for changes in the periodontal condition on a full-mouth level. Data evaluating progression of periodontitis based on a limited number of diseased sites should be interpreted cautiously.

Background, aims: In order to investigate the role of various putative clinical and microbiological risk markers, a longitudinal study was initiated in a young population deprived of regular dental care. In 1987 all inhabitants in the age range 15-25 years living in a village with approximately 2000 inhabitants at a tea estate on Western Java, Indonesia, were examined clinically and microbiologically. In total, 167 subjects of the original group of 255 adolescents were re-examined in 1994. The material presented in this paper describes the clinical periodontal condition at baseline (1987) and at follow-up (1994), 7 years later. Furthermore, the relationship between progression of the disease and baseline clinical and microbiological data was assessed. Methods: Plaque index (PI), bleeding on probing (BOP), pocket depth (PD), and attachment loss (AL) were scored at the approximal surfaces of the vestibular aspects of all teeth. The number of approximal surfaces of the Ramfjord teeth showing subgingival calculus was recorded. At baseline, the dorsum of the tongue, the buccal gingiva in the upper jaw, the saliva and the deepest bleeding pocket without clinical loss of attachment were sampled for microbiological examination with phase contrast microscopy and indirect immunofluorescence. Results: Mean values at baseline and at follow-up were PI: 1.01 and 1.15, BOP: 0.80 and 1.16, PD 3.26 mm and 3.32 mm, AL: 0.33 mm and 0.73 mm, respectively. All parameters except PD showed a statistically significant increase over the 7-year period. The prevalence of the studied bacteria irrespective of the sample site was: A. actinomycetemcomitans 53%, P. gingivalis 88%, P. intermedia 100%, spirochetes 89% and motile micro-organisms 100%. At the full mouth level, logistic regression showed significant odds ratios for progressive disease with age (1.15), subgingival calculus (1.20) and subgingival presence of A. actinomycetemcomitans (4.61). Presence of any of the selected micro-organisms on the mucous membranes was not related with progressive disease. In order to study local factors to explain local disease activity, each subject was characterized using the sampled pocket, which was the deepest bleeding pocket without LA at baseline, as a single response site per patient. In this constrained design, the main statistical factors associated with progressive disease were presence of motile micro-organisms and the plaque score. Conclusions: This study identified 3 main risk markers for disease progression at the full mouth level: age, amount of subgingival calculus and subgingival presence of A. actinomycetemcomitans.

At present, several risk factors for the initiation and progression of periodontitis have been identified. In order to investigate the role of various potential clinical and microbiological risk factors and indicators, a longitudinal study was initiated in a young population deprived from regular dental care. The present communication describes the baseline cross-sectional data obtained in 1987 in terms of the clinical periodontal condition and prevalence of periodontal bacteria in the oral cavity. All inhabitants in the age range 15-25 years of a village with approximately 2000 inhabitants at a tea estate on Western Java, Indonesia, were examined clinically and microbiologically. In total, 255 adolescents, comprising 130 males and 125 females participated in the study. Samples for bacteriological examination were taken from the gingiva, the dorsum of the tongue, and the saliva. Plaque index, bleeding upon probing, pocket depth, and attachment loss (AL) were scored on the approximal surfaces from the vestibular aspect of all teeth as well as the mid-vestibular and mid-lingual aspects of the Ramfjord teeth. Calculus was scored only on the 4 surfaces of the Ramfjord teeth. Following the clinical measurements, the deepest bleeding pocket with no clinical loss of attachment was sampled for microbiological examination. In addition, in 37 subjects a deep bleeding (greater than or equal to 4 mm) with at least 4 mm of attachment loss was sampled. Moderate periodontitis (max. AL 3-4 mm) was found in 26% of the population, advanced periodontitis (max. AL greater than or equal to 5 mm) in 8%, whereas 66% of the population showed no or minor periodontitis (max. AL 0-2 mm). Actinobacillus actinomycetemcomitans was found in 57% of the population, Porphyromonas gingivalis in 87%, Prevotella intermedia and motile rods in all cases and spirochetes in 89%. P. gingivalis (66%), A. actinomycetemcomitans (37%) and spirochetes (63%) were, of all the sampled sites of the oral cavity, most frequently detected in pockets without attachment loss. Motile rods were most prevalent on the tongue and in the saliva (92% and 89%, respectively). A high prevalence of the investigated periodontal bacteria was detected both in the pockets without and with attachment loss. No significant association between the clinical periodontal parameters and the prevalence of the microorganisms was observed at a patient level. At a site level, both P. gingivalis and spirochetes were more prevalent in sites with attachment loss. The actual role of these putative periodontal pathogens may be elucidated more extensively, when longitudinal data on the present population become available.

The subgingival microflora in a patient with localized juvenile periodontitis was studied. Of the 97 sites investigated, 28 (29%) showed attachment loss. A correlation was found between the number of Actinobacillus actinomycetemcomitans cells and the clinical attachment level and probing pocket depth. Of the 97 test sites, 70 (73%) were positive for A. actinomycetemcomitans. Of the total number of A. actinomycetemcomitans cells isolated from this patient, more than 99% were found at sites with attachment loss

As a result of an epidemiological survey on the periodontal status of young adults, a school was found with a relatively high number of subjects showing loss of attachment (18 out of 87). In 10 of these subjects the microflora of one pocket and of the dorsum of the tongue was investigated with special reference to black-pigmented species and Actinobacillus actinomycetemcomitans. Prevotella intermedia was the most prevalent species, being found in 9 patients. A. actinomycetemcomitans was isolated from 3 subjects and Porphyromonas gingivalis from 2 subjects. To determine whether cross-infection had occurred, the P. intermedia, P. gingivalis, and A. actinomycetemcomitans isolates were examined by restriction endonuclease analysis of the DNA after digesting with one or a combination of the endonucleases Pst I, Bam HI, and Hind III. Evaluation of the restriction endonuclease typing method showed it to be sensitive and useful for the typing of P. intermedia, P. gingivalis, and A. actinomycetemcomitans. Using this restriction endonuclease typing method, all isolates of A. actinomycetemcomitans, P. gingivalis, and P. intermedia obtained from single individuals showed different digest patterns. We conclude that in the present study bacterial cross-infection did not occur among subjects in this school.