Periodontal disease is the clinical result of a complex interaction between the host and plaque bacteria. Although a specificity to some degree is found for Actinobacillus actinomycetemcomitans in localized juvenile periodontitis (LJP), it has been difficult to obtain evidence for a specific etiological role of the bacteria associated with periodontal disease in adults. What we see is the net result of host-parasite interactions which in an unpredictable moment accumulate and exceed the threshold of tissue integrity. This hypothesis is concomitant with the view of periodontal disease as a polymicrobial infection, predominantly anaerobic, which occurs commonly in the oral cavity or elsewhere in the body. Some micro-organisms (risk markers) occur more frequently than others and may significantly determine the outcome of this host-parasite interaction. Microbiological sampling and analysis seem to be of limited value in risk assessment; however, they can be used as tools in diagnosis in LJP patients and acute infections, and in treatment decision and therapy control in "refractory" patients. Suspected pathogens (risk markers) are Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and some species of spirochetes, while the roles of Prevotella intermedia, Bacteroides forsythus, Fusobacterium nucleatum, Campylobacter rectus, and Peptostreptococcus micros are more uncertain. The presence of periodontopathogens as well as enterics, Staphylococcus aureus and Candida especially, should be considered in patients with systemic individual disorders-e.g., diabetes mellitus, neutropenia, agranulocytosis, and AIDS-or with implants.
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References
1.
Alaluusua S., Asikainen S. (1988). Detection and distribution of Actinobacillus actinomycetemcomitans in the primary dentition. J Periodontol59:504-507.
2.
Asikainen S., Alaluusua S., Kleemola-Kujala E. (1991). A 2-year follow-up on the clinical and microbiological conditions of periodontium in teenagers. J Clin Periodontol18:16-19.
3.
Baelum V., Fejerskov O., Manji F. (1988). Periodontal disease in adult Kenyans. J Clin Periodontol15:445-452.
4.
Bonta Y., Zambon JJ, Genco RJ, Neiders ME (1985). Rapid identification of periodontal pathogens in subgingival plaque: comparison of indirect immunofluorescence microscopy with bacterial culture for detection of Actinobacillus actinomycetemcomitans . J Dent Res64 :793-798.
5.
Christersson LA, Slots J., Rosling BG, Genco RJ (1985). Microbiological and clinical effects of surgical treatment of localized juvenile periodontitis. J Clin Periodontol12:465-476.
6.
Christersson LA, Zambon JJ, Dunford RG, Grossi SG, Genco RJ (1989). Specific subgingival bacteria and diagnosis of gingivitis and periodontitis. J Dent Res68:1633-1639.
7.
Dahlen G., Wikstrom M. (1988). Sources of variation in the evaluation of subgingival microbiota. In: Guggenheim B, editor, Periodontology today. Int. Congr. Zürich. Basel: Karger, 141-149.
8.
Dahlen G., Fabricius L., Holm SE, Möller Å. (1987). Interactions within a collection of eight bacterial strains isolated from a monkey dental root canal. Oral Microbiol Immunol2:164-170.
9.
Dahlen G., Wikstrom M., Renvert S., Gmür R., Guggenheim B. (1990a). Biochemical and serological characterization of Bacteroides intermedius strains isolated from the deep periodontal pocket . J Clin Microbiol28:2269-2274.
10.
Dahlen G., Renvert S., Wikstrom M., Egelberg J. (1990b). Reproducibility of microbiological samples from periodontal pockets. J Clin Periodontol17:73-77.
11.
Dahlen G., Manji F., Baelum V., Fejerskov O. (1992). Putative periodontopathogens in "diseased" and "non-diseased" persons exhibiting poor oral hygiene. J Clin Periodontol19:35-42.
12.
Dahlen G., Pipattanagovit P., Rosling B., Moller Åjr (1993). A comparison between VMGA and RTF as transport medium for saliva and subgingival samples. OralMicrobiollmmunol (in press).
13.
Dzink JL, Socransky SS, Haffajee AD (1988). The predominant cultivable microbiota of active and inactive lesions of destructive periodontal diseases. JClin Periodontol15 :316-323.
14.
Ebersole JL, Taubman MA, Smith DJ, Frey E. ( 1988). Serological classification of Bacteroides from the human oral cavity. J Periodont Res23:22-27.
15.
Ebersole JL, Brunsvold M., Steffensen B., Wood R., Holt SC ( 1991). Effects of immunization with Porphyromonas gingivalis and Prevotella intermedia on progression of ligature-induced periodontitis in the nonhuman primate Macaca fascicularis. Infect Immun59:3351-3359.
16.
Fabricius L., Dahlen G., Holm SE, Moller Ajr (1982). Influence of combinations of oral bacteria on periapical tissues of monkeys. Scand J Dent Res90:200-206.
17.
Fine DH ( 1992). Incorporating new technologies in periodontal diagnosis into training programs and patient care: A critical assessment and a plan for the future. JPeriodontol63:383-393.
18.
French CK, Savitt ED, Simon SL, Eklund SM, Chen MC, Klotz LC, et al. (1986). DNA probe detection of periodontal pathogens . Oral Microbiol Immunol1:58-62.
19.
Genco RJ, Loos BG ( 1991). The use of genomic DNA fingerprinting in studies of the epidemiology of bacteria in periodontitis. J Clin Periodont18:396-405.
20.
Gmür R., Hrodek K., Saxer UP, Guggenheim B. (1986). Double-blind analysis of the relation between adult periodontitis and systemic host response to suspected periodontal pathogens . Infect Immun52:768-777.
21.
Gmür R., Strub JR, Guggenheim B. (1989). Prevalence of Bacteroides forsythus and Bacteroides gingivalis in subgingival plaque of prosthodontically treated patients on short recall. J Periodont Res24:113-120.
22.
Goene RJ, Winkel EG, Abbas F., Rodenburg JP, van Winkelhoff AJ, de Graaff J. (1990). Microbiology in diagnosis and treatment of severe periodontitis. A report of four cases. J Periodontol61:61-64.
23.
Greenstein G. (1988). Microbiologic assessments to enhance periodontal diagnosis. J Periodontol59:508-515.
24.
Greenstein G., Caton J. (1990). Periodontal disease activity: A critical assessment . J Periodontol61:543-552.
25.
Gunsolley JC, Tew JG, Gooss C., Marshall DR, Burmeister JA, Schenkein HA (1990). Serum antibodies to periodontal bacteria. J Periodontol61:412-419.
26.
Gunsolley JC, Chinchilli VN, Savitt ED, Killoy W., Darack AP, Christersson LA, et al. (1992). Analysis of site specific periodontal bacteria sampling schemes. J Periodontol63:507-514.
27.
Haffajee AD, Socransky SS, Smith C., Dibart S. ( 1991). Relation of baseline microbial parameters to future periodontal attachment loss. J Clin Periodontol18:744-750.
28.
Haffajee AD, Socransky SS, Smith C., Dibart S. (1992). The use of DNA probes to examine the distribution of subgingival species in subjects with different levels of periodontal destruction . J Clin Periodontol19:84-91.
29.
Holt SC, Ebersole J., Felton J., Brunsvold M., Komman KS (1988). Implantation of Bacteroides gingivalis in nonhuman primates initiates progression of periodontitis. Science239:55-57.
30.
Johnson NW, Griffiths GS, Wilton Jma, Maiden Mfj, Curtis MA, Gillett IR, et al. (1988). Detection of high-risk groups and individuals for periodontal diseases. J Clin Periodontol15:276-282.
31.
Kornman KS, Robertsson PD (1985). Clinical and microbiological evaluation of therapy for juvenile periodontitis. J Periodontol56:443-446.
32.
Lindhe J., Nyman S. (1975). The effect of plaque control and surgical pocket elimination in the establishment and maintenance of periodontal health. A longitudinal study of periodontal therapy in cases of advanced disease. J Clin Periodontol2:67-79.
33.
Lindhe J., Hamp SE, Loe H. ( 1975). Plaque induced periodontal disease in beagle dogs. A 4-year clinical radiographical and histological study. J Periodont Res10:243-255.
34.
Listgarten MA (1965). Electronmicroscopic observations on the bacterial flora of acute necrotizing ulcerative gingivitis. J Periodontol36:328-338.
35.
Listgarten MA (1988). A rationale for monitoring the periodontal microbiota after periodontal treatment. J Periodontol59:439-444.
36.
Listgarten MA, Hellden L. (1978). Relative distribution of bacteria of clinically healthy and periodontally diseased sites in humans. J Clin Periodontol5:115-132.
37.
Listgarten MA, Slots J., Nowotny AH, Oler J., Rosenberg J., Gregor B., et al. (1991). Incidence of periodontitis recurrence in treated patients with and without cultivable Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis: A prospective study. J Periodontol62:377-386.
38.
Loe H., Theilade E., Jensen S. (1965). Experimental gingivitis in man. J Periodontol36:177-187.
39.
Loe H., Anerud A., Boysen H., Morrison E. (1986). Natural history of periodontal disease in man. Rapid, moderate and no loss of attachment in Sri Lankan laborers 14-46 years of age. J Clin Periodontol13:431-444.
Loesche WJ (1986). The identification of bacteria associated with periodontal disease and dental caries by enzymatic activity methods. Oral Microbiol Immunol1:65-70.
42.
Loesche WJ, Bretz WA, Lopatin D., Stoll J., Rau CF, Hillenburg KL, et al. (1990). Multi-center clinical evaluation of a chairside method for detecting certain periodontopathic bacteria in periodontal disease . J Periodontol61:189-196.
43.
Loos B., Claffey N., Crigger M. (1988). Effects of oral hygiene measures on clinical and microbiological parameters of periodontal disease. J Clin Periodontol15:211-216.
44.
Loos BG, DyerDW, WhittamTS, SelanderRK (1993). Genetic structure of populations of Porphyromonas gingivalis associated with periodontitis and other oral infections. Infect Immun61:204-212.
MacFarlane TW, Jenkins Wmm, Gilmour WH, McCourtie J., McKenzie D. (1988). Longitudinal study of untreated periodontitis . J Clin Periodontol15:331-337.
47.
Maiden Mfj, Carman RJ, Curtis MA, Gillett IR, Griffiths GS, Sterne Jac, et al. (1990). Detection of high-risk groups and individuals for periodontal diseases: laboratory markers based on the microbiological analysis of subgingival plaque. J Clin Periodontol17:1-13.
48.
Mandell RL, Socransky SS (1988). Microbiological and clinical effects of surgery plus doxycycline on juvenile periodontitis. J Periodontol59:373-379.
49.
Mayrand D., McBride BC (1980). Ecological relationships in bacteria involved in a simple mixed anaerobic infection. Infect Immun24:44-50.
50.
Mayrand D., Holt S. ( 1988). Biology of asaccharolytic black-pigmented Bacteroides species. Microbiol Rev52 :134-152.
51.
Moller Ajr (1966). Microbiological examination of root canals and periapical tissues of human teeth. Odontol Tidskr74:1-380.
52.
Mombelli A., McNabb H., Lang NP ( 1991). Blackpigmenting Gram-negative bacteria in periodontal disease. I. Topographic distribution in the human dentition. J Periodont Res26:201-307.
53.
Moore Wec (1987). Microbiology of periodontal disease. J Periodont Res22:335-341.
54.
Moore Wec, Moore LH, Ranney RR, Smibert RM, Burmeister JA, Schenkein HA (1991). The microflora of periodontal sites showing active destructive progression. J Clin Periodontol18:729-739.
55.
Neiders ME, Chen PB, Suido H., Reynolds HS, Zambon JJ, Shlossman M., et al. (1989). Heterogeneity of virulence among strains of Bacteroides gingivalis. J Periodont Res24:192-198.
Papapanou P., Sellen A., Wennstrom JL, Dahlen G. (1993). An analysis of subgingival microflora in randomly selected subjects. Oral Microbiol Immunol8:24-29.
58.
Renvert S., Wikstrom M., Dahlen G., Slots J., Egelberg J. (1990a). Effect of root debridement on the elimination of Actinobacillus actinomycetemcomitans and Bacteroides gingivalis from periodontal pockets. J Clin Periodontol17:345-350.
59.
Renvert S., Wikstrom M., Dahlen G., Slots J., Egelberg J. (1990b). On the inability of root debridement and periodontal surgery to eliminate Actinobacillus actinomycetemcomitans from periodontal pockets. J Clin Periodontol17:351-355.
60.
Renvert S., Nilveus R., Dahlen G., Slots J., Egelberg J. (1990c). 5-yearfollow-up of periodontal intraosseous defects treated by root planing or flap surgery. J Clin Periodontol17 :356-363.
61.
Renvert S., Wikstrom M., Helmersson M., Dahlen G., Claffey N. (1992). Comparative study of subgingival microbiological sampling techniques. J Periodontol63:797-801.
62.
Savitt ED, Socransky SS (1984). Distribution of certain subgingival microbial species in selected periodontal conditions. J Periodont Res19:111-123.
63.
Savitt ED, Strzempko MN, Vaccaro KK, Peros WJ, French CK (1988). Comparison of cultural methods and DNA probe analyses for the detection of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis, and Bacteroides intermedius in subgingival plaque samples. J Periodontol59:431-438.
64.
Savitt ED, Keville MW, Peros WJ (1990). DNA probes in the diagnosis of periodontal microorganisms . Arch Oral Biol35:153S-159S.
65.
Shah HN, Garbia SE (1992). Biochemical and chemical studies on strains designated Prevotella intermedia. Proposal of a new pigmented species Prevotella nigrescens sp. nov. IntJ System Bacteriol42:542-546.
66.
Slots J. (1982). Selective medium for isolation of Actinobacillus actinomycetemcomitans. J Clin Microbiol15:606-609.
67.
Slots J. (1986). Bacterial specificity in adult periodontitis. J Clin Periodontol13:912-917.
68.
Slots J., Listgarten MA (1988). Bacteroides gingivalis, Bacteroides intermedius and Actinobacillus actinomycetemcomitans in human periodontal diseases. J Clin Periodontol15:85-93.
69.
Slots J., Rams TE ( 1991). New views on periodontal microbiota in special patient categories. J Clin Periodontol18 :411-420.
70.
Slots J., Rosling B. (1983). Suppression of the periodontopathic microflora in juvenile periodontitis by systemic tetracycline. J Clin Periodontol10:465-486.
71.
Slots J., Emrich LJ, Genco RJ, Rosling BG (1985a). Relationship between some subgingival bacteria and periodontal pocket depth and gain or loss of periodontal attachment after treatment of adult periodontitis. JClin Periodontol12:540-552.
72.
Slots J., Hafstrom C., Rosling B., Dahlen G. (1985b). Detection of Actinobacillus actinomycetemcomitans and Bacteroides gingivalis in subgingival smears by the indirect fluorescent-antibody technique. J Periodont Res20:613-620.
73.
Slots J., Bragd L., Wikstrom M., Dahlen G. (1986). The occurrence of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis, and Bacteroides intermedius in destructive periodontal disease in adults. J Clin Periodontol13 :570-577.
74.
Socransky SS (1979). Criteria for the infectious agents in dental caries and periodontal disease. J Clin Periodontol6:16-21.
75.
Socransky SS, Haffajee AD (1990). Microbial risk factors for destructive periodontal diseases. In: Bader J, editor. Risk assessments in dentistry. Chapel Hill (NC): University of North Carolina Dental Ecology, 79-90.
76.
Socransky SS, Haffajee AD, Dzink JL (1988a). Relationship of subgingival microbial complexes to clinical features at the sampled sites. J Clin Periodont15:440-444.
77.
Socransky SS, Haffajee AD, Dzink JL, Hillman JD (1988b). Associations between microbial species in subgingival plaque samples. Oral Microbiol Immunol3:1-7.
78.
Socransky SS, Haffajee AD, Smith C., Dibart S. (1991 ). Relation of counts of microbial species to clinical status at the sampled site. J Clin Periodontol18:766-775.
79.
Sundqvist GK, Eckerbom MI, Larsson AP, Sjogren UT (1979). Capacity of anaerobic bacteria from necrotic dental pulps to induce purulent infections. Infect Immun25:685-693.
80.
Sundqvist G., Bloom GD, Enberg K., Johansson E. (1982). Phagocytosis of Bacteroides melaninogenicus and Bacteroides gingivalis in vitro by human neutrophils. J Periodont Res17:113-121.
81.
Syed SA, Loesche WJ (1972). Survival of human dental plaque flora in various transport media. Appl Microbiol24 :638-644.
82.
Taichman NS, Simpson DL, Sakurada S., Cranfield M., Dirienzo J., Slots J. (1987). Comparative studies of the biology of Actinobacillus actinomycetemcomitans leukotoxin in primates. Oral Microbiol Immunol2:97-104.
Van Oosten Mac, Mombelli A., Gusberti FA, Lang NP ( 1988). Black-pigmented Bacteroides and spirochetes in the subgingival microbiota of prepubertal schoolchildren. J Periodont Res23:199-203.
85.
Van Steenbergen Tjm, Kastelein P., Touw Jja, de Graaff J. (1982). Virulence of black-pigmented Bacteroides strains from periodontal pockets and other sites in experimentally induced skin lesions in mice. J Periodont Res17:41-49.
86.
Van Winkelhoff AJ, Carlee AW, de Graaff J. (1985). Bacteroides endodontalis and other black-pigmented Bacteroides species in odontogenic abscesses. Infect Immun49:494-497.
87.
Van Winkelhoff AJ, van der Velden U., de Graaff J. (1987). Microbial succession in recolonization of deep periodontal pockets after a single course of supra- and subgingival debridement . J Clin Periodontol15:116-122.
88.
Van Winkelhoff AJ, van Steenbergen Tjm, de Graaff J. (1988). The role of black-pigmented Bacteroides in human oral infections. J Clin Periodontol15:145-155.
89.
Van Winkelhoff AJ, Rodenburg JP, Goene RJ, Abbas F., Winkel EG, de Graaff J. (1989). Metronidazole plus amoxycilline in the treatment of Actinobacillus actinomycetemcomitans associated periodontitis. J Clin Periodontol16:128-131.
90.
Van Winkelhoff AJ, Tijhof CJ, de Graaff J. (1992). Microbiological and clinical results of metronidazole plus amoxicillin therapy in Actinobacillus actinomycetemcomitans-associated periodontitis. J Periodontol63:52-57.
91.
Wachsmuth K. (1986). Molecular epidemiology of bacterial infections: Examples of methodology and investigations of outbreaks. Rev Infect Dis8:682-692.
92.
Wennstrom JL, Dahlen G., Svensson J., Nyman S. (1987). Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and Bacteroides intermedius: predictors of attachment loss?Oral Microbiol Immunol2:158-163.
93.
Wikstrom M., Renvert S., Dahlen G., Johnsson T. (1991). Variance in recovery of periodontitis-associated bacteria caused by sampling technique and laboratory processing. Oral Microbiol Immunol6:102-106.
94.
Wikstrom M., Renvert S., Johnsson T., Dahlen G. (1993). Microbial associations in periodontitis sites before and after treatment. Oral Microbiol Immunol (in press).
95.
Wolff LF, Liljemark WF, Pihlstrom BL, Schaffer EM, Aeppli DM, Bandt CL (1988). Dark-pigmented Bacteroides species in subgingival plaque of adult patients on a rigorous recall program. J Periodont Res23:170-174.
96.
Wolff LF, Anderson L., Sandberg GP, Aeppli DM, Shelbourne CE (1991). A fluorescence immunoassay for detecting periodontal pathogens in plaque. J Clin Microbiol29:16451651.
Zambon JJ (1985). Actinobacillus actinomycetemcomitans in human periodontal disease. J Clin Periodontol12:1-20.
99.
Zambon JJ, Christersson LA, Slots J. (1983). Actinobacillus actinomycetemcomitans in human periodontal disease: Prevalence in patient groups and distribution of biotypes and serotypes within families. J Periodontol54:707-711.
100.
Zappa U., Reinking-Zappa M., Graf H., Gmür R., Savitt E. (1990). Comparison of serological and DNA probe analyses for detection of suspected periodontal pathogens in subgingival plaque samples . Arch Oral Biol35:161S-164S.
