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0303-6979
Porphyromonas gingivalis,
Bacteroides forsythus and other
putative periodontal pathogens in
subjects with and without
periodontal destruction
van Winkelhoff AJ, Loos BG, van der Reijden WA, van der Velden U.
Porphyromonas gingivalis, Bacteroides forsythus and other putative periodontal
pathogens in subjects with and without periodontal destruction. J Clin Periodontol
2002; 29: 102301028. C Blackwell Munksgaard, 2002.
Abstract
Background and aims: Bacteria play an essential role in the pathogenesis of destructive periodontal disease. It has been suggested that not all bacteria associated with periodontitis may be normal inhabitants of a periodontally healthy
dentition. In particular, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans have been isolated infrequently from subjects without periodontitis.
The aim of the present study was to compare prevalence and proportions of a
number of periodontal bacteria in periodontitis patients and control subjects.
Material and methods: In all, 116 consecutive subjects diagnosed with moderate
to severe periodontitis (mean age 42.4) and 94 subjects without radiographic
evidence of alveolar bone loss (mean age 40.4) were recruited for the study. The
gingival condition in the control group varied between gingival health and various
degrees of gingivitis. In patients, the deepest pocket in each quadrant was selected
for microbiological sampling. In control subjects all mesial and distal sites of all
first molars were selected for sampling. All paper points from a patient were
pooled and processed for anaerobic cultivation within 6 h after sampling. Clinical variables of sampled sites included bleeding index, probing pocket depth and
clinical attachment level.
Results: A. actinomycetemcomitans, P. gingivalis, Prevotella intermedia, Bacteroides forsythus, Fusobacterium nucleatum and Peptostreptococcus micros were
significantly more often prevalent in patients than in controls. The highest odds
ratios were found for P. gingivalis and B. forsythus (12.3 and 10.4 resp.). Other
odds ratios varied from 3.1 to 7.7 for A. actinomycetemcomitans and P. micros,
respectively. Absolute numbers of target bacteria were all higher in patients, but
only the mean percentage of B. forsythus was significantly higher in patients in
comparison to controls (P 0.001).
Conclusions: A. actinomycetemcomitans, P. gingivalis, P. intermedia, B. forsythus,
F. nucleatum and P. micros are all significant markers for destructive periodontal disease in adult subjects. Based on calculated odds ratios, B. forsythus
and P. gingivalis are the strongest bacterial markers for this disease and are
infrequently cultured from subjects without periodontal bone loss.
1024
The study population included 116 consecutive adult patients who were referred to the Department of Periodontology for diagnosis and treatment of
periodontitis. A further 94 adult control subjects volunteered who were
registered for restorative dental procedures or who visited the dental school
for regular dental check-ups.
All subjects were both verbally and
written informed about the purpose of
the investigation. The study was approved by the Medical Ethical Committee of our institution.
For each periodontitis patient a set of
full mouth dental radiographs was
available and the individual number of
teeth present was determined. Subsequently, for each patient all teeth were
radiographically examined on the mesial and distal aspects. Patients suffered
from moderate to severe periodontitis
according to criteria by Kornman et al.
(1997). Control subjects were included
if they were not missing more than one
tooth per quadrant (the 3rd molar excluded), and if they had at all interproximal sites a distance between the
cemento-enamel junction and the alveolar bone crest of 2 mm on bitewing radiographs 1 year old. The gingival condition of the control subjects
varied between gingival health and various degrees of gingivitis.
Clinical and sampling procedures
Periodontal pathogens
Table 1. Age, gender and clinical characteristics of sampled sites of a control group and an
adult group of periodontitis patients. Standard deviations are expressed in brackets
Age
Gender (female/male)
No. teeth
Mean Plaque Index (%)
Mean Bleeding Index
Mean Pocket Depth (mm)
Mean Attachment Loss (mm)
Control
subjects
(n94)
Periodontitis
Patients
(n116)
P-value
40.4 (11.9)
50/44
27.6 (1.7)
70.7 (27.0)
0.87 (0.57)
3.1 (0.43)
*
42.4 (9.8)
72/44
26.5 (3.2)
66.9 (34.7)
1.11 (0.40)
6.3 (1.26)
6.9 (1.50)
NS
NS
0.001
NS
0.003
0.0005
*This measurement has not been taken in controls (see Materials and methods).
NS, not statistically significant.
1025
Discussion
Table 2. Number (%) of subjects culture positive for distinct bacterial species in the subgingival
plaque of a control group and a group of adult patients with periodontitis
Control
subjects
(n94)
Actinobacillus
actinomycetemcomitans
Porphyromonas gingivalis
Prevotella intermedia
Bacteroides forsythus
Peptostreptococcus micros
Fusobacterium nucleatum
Campylobacter rectus
12 (12.8)
10
65
45
63
80
13
(10.6)
(69.1)
(47.9)
(67.0)
(85.1)
(13.8)
Periodontitis
patients
(n116)
36 (31.0)
69
102
105
109
111
24
(59.5)
(87.9)
(90.5)
(94)
(95.7)
(20.7)
P-value
0.002
0.001*
0.001
0.001
0.001
0.014
NS
Odds ratio
(95% CI)
3.1 (1.56.3)
12.3
3.3
10.4
7.7
3.9
1.6
(5.826.2)
(1.66.6)
(5.021.8)
(3.218.4)
(1.3511.2)
(0.83.4)
1026
Fig. 1. Odds ratios and 95% confidence intervals of different periodontal bacterial species in
adult periodontitis.
Table 3. Total CFU and mean CFU (SD) of bacterial species in the subgingival plaque of a
control group and of a group of adult patients with periodontitis in culture positive subjects
CFU 104
Control
subjects
(n94)
Periodontitis
patients
(n116)
P-value
Total CFU
A. actinomycetemcomitans
P. gingivalis
P. intermedia
B. forsythus
P. micros
F. nucleatum
C. rectus
3377.6 (12873.4)
5.6. (9.0)
152.6 (267.3)
71.5 (148.2)
44.2 (107.1)
177.2 (739.2)
80.2 (261.8)
3.6 (3.9)
5674.3
94.1
2365.7
427.6
409.9
221.6
241.8
81.5
0.001
0.003
0.002
0.001
0.001
0.001
0.001
0.001
(7060.4)
(165.9)
(4058.7)
(1033.4)
(545.3)
(312.4)
(417.5)
(89.8)
Table 4. Mean percentages (SD) of bacterial species in the subgingival plaque of culture positive subjects of a control group and of a group of adult patients with periodontitis
A. actinomycetemcomitans
P. gingivalis
P. intermedia
B. forsythus
P. micros
F. nucleatum
C. rectus
Control
subjects
(n94)
Periodontitis
patients
(n116)
P-value
2.6
17.4
6.0
3.8
5.8
4.9
2.0
3.5
28.7
5.8
9.1
4.7
5.6
2.4
NS
0.052
NS
0.001
NS
NS
NS
(4.1)
(21.8)
(8.1)
(5.2)
(7.5)
(5.11)
(2.0)
(8.8)
(21.3)
(6.2)
(9.6)
(5.4)
(7.1)
(2.3)
Periodontal pathogens
periodontitis, also the mean number of
CFU and the mean proportion of this
microorganism were significantly lower
in controls compared to periodontitis
patients (Tables 3 and 4). This implies
that this microorganism is a strong
marker for destructive periodontal disease (AAP position paper, American
Academy of Periodontology 1996). Recently, Tran et al. (2001) found a prevalence of 81.8% of B. forsythus in subjects with a low prevalence and severity
of adult periodontitis. They showed
that in these subjects, repeated detection of B. forsythus was correlated with
attachment loss at the subject but not
on a site level (odds ratio 5.3, P 0.038,
CI 1.322.5).
Mean proportions for all other bacterial markers were not different in control subjects and periodontitis patients.
This may indicate that, with the exception of B. forsythus and possibly P. gingivalis, there is little proportional
change in the composition of the subgingival microflora between periodontal health and periodontitis.
In summary, based on the present
culture data, the odds of detecting P.
gingivalis were 12.3-fold higher in subjects with periodontitis than in agematched controls. Also, B. forsythus
showed a strong relationship with periodontitis, with an odds ratio of 10.4.
Both microorganisms seem the strongest markers of destructive periodontal
disease. Lower, but significant, odds ratios were also found for A. actinomycetemcomitans, P. intermedia, F. nucleatum and P. micros.
Resume
Zusammenfassung
Porphyromonas gingivalis, Bacteroides forsythus und andere mutmaliche Parodontalpathogene bei Patienten mit oder ohne parodontalen Abbau
Grundlagen und Ziele: Bakterien spielen in
der Pathogenese der destruktiven Parodontalerkrankung eine essentielle Rolle. Es wurde
behauptet, dass nicht alle mit Parodontitis
assoziierten Bakterien normale Besiedler eines parodontal gesunden Gebisses seien. Speziell Porphyromonas gingivalis und Actinobacillus actinomycetemcomitans wurden selten bei Personen ohne Parodontitis gefunden.
Das Ziel der vorliegenden Studie war es, bei
Parodontitispatienten und Kontrollpersonen,
fr eine Anzahl von parodontalen Bakterien,
die Prvalenz und den relativen Anteil an der
Gesamtflora zu vergleichen.
Material und Methoden: Insgesamt wurden
116 aufeinanderfolgende Patienten (Durchschnittsalter 42,4 Jahre) mit moderater bis
schwerer Parodontitis und 94 Personen
1027
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