Candida albicans and Candida dubliniensis in Periodontitis in Adolescents and Young Adults.

AIM: This study aims to evaluate the association of Candida albicans and Candida dubliniensis with periodontitis in adolescents and young adults in a Moroccan population. METHODS: 426 subjects aged between 12 and 25 years were recruited for the study. A pool of plaque sample was taken. Samples were cultured on Sabouraud Chloramphenicol medium at 37°C for 24-48 hours and then identified by the Vitek 2 YST system. Clinical data and presence of Candida albicans and Candida dubliniensis were analyzed using Jamovi (Version 1.8). RESULTS: Candida albicans was observed in 25 subjects among 68 diseased patients (37%) and in 60 subjects among 358 healthy patients (17%). It can be reported that under normal yeast conditions, there is a statistically significant difference between these two groups (P < 0.001). Candida dubliniensis was more prevalent in periodontitis than in healthy subjects (P=0.026). Regarding clinical variables, subgroups of periodontitis subjects showed significant statistical differences for periodontal probing depth, clinical attachment loss, and number of decayed teeth in advanced periodontitis in comparison with initial or mild periodontitis. The results also indicate that the presence of the two species of Candida is not related to gender or age (P > 0.05) nor related to the severity of the periodontal disease in this population. CONCLUSION: Within the limits of our study, Candida albicans is more frequently associated with periodontitis. The potential role of C. albicans in periodontitis pathogenesis is very complex. More studies on biofilm associated with different forms of periodontitis are necessary. It is also important to assess the coexistence of periodontitis and caries and the associated biofilms.

Antimicrobial susceptibilities of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis strains from periodontitis patients in Morocco.

BACKGROUND AND OBJECTIVE: Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis have been frequently isolated in periodontitis patients in Morocco. Its persistence after the subgingival debridement of the biofilm has been correlated with worse clinical outcomes. The aim of this study was to evaluate the antimicrobial susceptibilities of A. actinomycetemcomitans and P. gingivalis, to amoxicillin, amoxicillin plus clavulanate, metronidazole, and azithromycin. In addition, microbiological profiles of patients harbouring A. actinomycetemcomitans, P. gingivalis, or both were compared. MATERIAL AND METHODS: In 45 consecutive periodontitis Moroccan patients, subgingival samples were taken and processed by culture. Twenty-four A. actinomycetemcomitans and 30 P. gingivalis colonies were isolated (54 strains) and susceptibility tests, using the epsilometric method, were run for amoxicillin, amoxicillin plus clavulanate, metronidazole, and azithromycin. Minimum inhibitory concentrations for 50 (MIC50) and 90% (MIC90) of the organisms were calculated. RESULTS: The prevalence of A. actinomycetemcomitans and P. gingivalis was 79.5 and 84.4%, respectively. A. actinomycetemcomitans showed susceptibility to amoxicillin, amoxicillin plus clavulanate, while 28% of the isolated strains were resistant to azithromycin and 61.7% towards metronidazole. No P. gingivalis resistance towards amoxicillin, amoxicillin plus clavulanate, metronidazole, and azithromycin was found. CONCLUSION: A. actinomycetemcomitans and P. gingivalis were frequently detected in Moroccan patients with periodontitis, while antimicrobial resistance was only detected for A. actinomycetemcomitans to metronidazole and azithromycin. CLINICAL RELEVANCE: A. actinomycetemcomitans resistance against some antimicrobials in periodontitis patients in Morocco can influence the selection of the therapeutic approaches.

Characterization of A. actinomycetemcomitans strains in subgingival samples from periodontitis subjects in Morocco.

OBJECTIVE: Aggregatibacter actinomycetemcomitans, specially its highly leucotoxic strain (JP2 clone), represents an etiological factor for the onset and progression of aggressive types of periodontitis. The aims of this investigation were to investigate the most relevant periodontal pathogens in the subgingival microbiota of periodontitis patients from Morocco and to describe the clinical and microbiological characteristics of subjects positive for A. actinomycetemcomitans, including serotype, leukotoxin gene, and operon of the cytolethal distending toxin (cdt) distribution. MATERIAL AND METHODS: In consecutive Moroccan subjects diagnosed of periodontitis, subgingival samples were taken and processed by culture. From the positive samples for A. actinomycetemcomitans, one to three isolates were subcultured and characterized by means of polymerase chain reaction (PCR), assessing their specific serotype distribution, the variation in the sequences of the leukotoxin gene, and the operon of the cdt. RESULTS: Twenty-one (35.6 %) out of 59 periodontitis patients harbored A. actinomycetemcomitans. These patients demonstrated statistically significant deeper pockets (p = 0.035) and higher proportions of P. micra (p = 0.045) than did the negative group. The 39 studied isolates were serotype "b"; in 16 out of 17 patients, there was mono-colonization with this serotype. Five isolates, from two patients, presented the 530-bp deletion in the leukotoxin's promoter region. Thirty-two isolates (78 % of the strains) were cdt-positive. CONCLUSION: A. actinomycetemcomitans was frequently found (35.6 %) in our sample. All strains were serotype "b," and most (78 %) were also cdt-positive. The JP2 strain type was only detected in 12.2 % of the strains. CLINICAL RELEVANCE: A. actinomycetemcomitans can be frequently found in Morocco. This fact can influence the therapeutic approach of this type of patients.

[Cowden syndrome]. / Le syndrome de Cowden.

INTRODUCTION: Cowden syndrome is rare; oral symptoms are not always diagnosed. This case of Cowden syndrome was revealed by gingival hypertrophy. OBSERVATION: A 21-year-old female patient consulted for gingival hypertrophy and multiple papules in the mouth. She had a history of thyroid lobectomy due to a goiter. The gingival papillomatosis and the goiter suggested a Cowden syndrome. The diagnosis was confirmed clinically by facial skin papules. DISCUSSION: Cutaneous and oral lesions are usually the first symptoms of the syndrome. Diffuse gingival papillomatosis may suggest a Cowden syndrome and should lead to screen for associated symptoms. A high-risk diagnosis of breast and thyroid cancer is associated to Cowden syndrome and the patient should have a yearly follow-up.

[Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis in aggressive periodontitis in Morocco -- preliminary study]. / Aggregatibacter actinomycetemcomitans et Porphyromonas gingivalis dans les parodontites agressives au Maroc-- Etude preliminaire.

OBJECTIVE: The microbial eatiology of aggressive perodontitis is different worldwidly. The purpose of this study was to determine the presence or absence of two anaerobic, highly pathogenic bacteria, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis (P.g) in aggressive periodontitis in a Moroccan population. MATERIAL AND METHODS: Our study involved a sample of 32 subjects, 20 with aggressive periodontitis and 12 with a healthy periodontium. A pool of bacterial samples was performed in each patient looking for Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis by the method of bacterial culture. RESULTS AND CONCLUSION: Microbiological analysis showed an association of the presence of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis with aggressive periodontitis in Morocco. Porphyromonas gingivalis would be less present than Aggregatibacter actinomycetemcomitans in aggressive periodontitis in Morocco (30% vs 83%)(p < or = 0.05%). However, given the small sample size other studies are necessary.

Screening for periodontopathogenic bacteria in severe chronic periodontitis in a Moroccan population.

OBJECTIVE: Bacteria play an important role in destructive periodontitis. The aim of this study was to screen for five highly pathogenic bacteria: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola, in Moroccan patients presenting with severe chronic periodontitis and to compare results with those of patients presenting with severe aggressive periodontitis. MATERIALS AND METHODS: Twenty-three patients were included at the periodontology unit (School of dental medicine, University Mohammed 5 Souissi, Rabat, Morocco). The study was made on two groups: a test group of patients presenting with severe chronic periodontitis, and a control group of patients presenting with severe aggressive periodontitis. Plaque sampling was performed at the four deepest sites in each patient. The five studied bacteria were detected by PCR. RESULTS: The prevalence of A. actinomycetemcomitans and T. denticola was relatively low in the test group (13.3% and 20% respectively) compared with controls (37.5% and 37.5% respectively), without any statistical difference between the two groups. Furthermore, P. gingivalis and T. forsythia were frequently detected in both groups, without any statistical difference. CONCLUSION: The results of this preliminary study proved the presence of the studied periodontopathogenic bacteria both in severe chronic periodontitis and severe aggressive periodontitis.

Antibacterial activity of essential oils against periodontal pathogens: a qualitative systematic review.

Periodontal diseases are among the most common infectious diseases that lead to the destruction of periodontal tissues. Anaerobic gram-negative bacteria (Aggregatibacter actinomecetemcomitans, Porphyromonas gingivalis, Fusobacterium nucleatum...) isolated from periodontal lesions, have been shown to be related to the onset and progression of periodontal disease. Given the incidence of periodontitis, increased resistance of oral bacteria to antibiotics and adverse effects of some antibacterial agents currently used in dentistry, there is a need for alternative products that are safe and effective, for prevention and treatment of these diseases. Essential oils considered traditional medicines are viewed as good alternatives. In Morocco, a wide producer of essential oils, the high prevalence of aggressive periodontitis, related to virulent periodontal bacteria isolated from pockets in Moroccan adolescents and because of the reasons evoked above, the search of a new natural agent has become a necessity. In this qualitative systematic review, the virulence and increased antibiotic resistance of periopathogens, involved in periodontitis, will be exposed, justifying the use of alternative natural agents such as essential oils-based. Studies that have investigated the efficacy of such plant-derived medicines on periodontal pathogens will be described and discussed.

Microbiological and immunological characteristics of young Moroccan patients with aggressive periodontitis with and without detectable Aggregatibacter actinomycetemcomitans JP2 infection.

Cross-sectional and longitudinal studies identify the JP2 clone of Aggregatibacter actinomycetemcomitans as an aetiological agent of aggressive periodontitis (AgP) in adolescents of northwest African descent. To gain information on why a significant part of Moroccan adolescents show clinical signs of periodontal disease in the absence of this pathogen we performed comprehensive mapping of the subgingival microbiota of eight young Moroccans, four of whom were diagnosed with clinical signs of AgP. The analysis was carried out by sequencing and phylogenetic analysis of a total of 2717 cloned polymerase chain reaction amplicons of the phylogenetically informative 16S ribosomal RNA gene. The analyses revealed a total of 173 bacterial taxa of which 39% were previously undetected. The JP2 clone constituted a minor proportion of the complex subgingival microbiota in patients with active disease. Rather than identifying alternative aetiologies to AgP, the recorded infection history of the subjects combined with remarkably high concentrations of antibodies against the A. actinomycetemcomitans leukotoxin suggest that disease activity was terminated in some patients with AgP as a result of elimination of the JP2 clone. This study provides information on the microbial context of the JP2 clone activity in a JP2-susceptible population and suggests that such individuals may develop immunity to AgP.

Stability of the JP2 clone of Aggregatibacter actinomycetemcomitans.

The JP2 clone of Aggregatibacter actinomycetemcomitans is strongly associated with aggressive periodontitis. To obtain information about colonization dynamics of the JP2 clone, we used PCR to examine its presence in 365 Moroccan juveniles from whom periodontal plaque samples were collected at baseline and after one and two years. Periodontal attachment loss was measured at baseline and at the two-year follow-up. At baseline, 43 (12%) carriers of the JP2 clone were found. Nearly half (44 %) of these were persistently colonized with the clone. The relative risk for the development of aggressive periodontitis, adjusted for the concomitant presence of other genotypes of A. actinomycetemcomitans, was highest for individuals continuously infected by the JP2 clone (RR = 13.9; 95% CI, 9.0 to 21.4), indicating a relationship between infectious dose and disease, which further substantiates the evidence for the JP2 clone as a causal factor in aggressive periodontitis.

[Vascular epulis or lobular capillary hemangioma]. / L'épulis vasculaire ou l'hémangiome capillaire lobulaire.

Vascular epulide or Lobular capillary hemangioma is a form of epulide which is marked by an inflammatory infiltrate rich of blood vessels. Angiogenic factors seem to be responsible of the important vascular proliferation. Therapeutic implications include cautions toward hemorrhagic risk. Complete ablation is also required to avoid the risk of high recurrence.

[Negative effects of tobacco on the periodontium in a Moroccan population]. / L'effet négatif du tabac sur le parodonte dans une population marocaine.

OBJECTIVE: Several studies have reported an association between smoking and periodontal destruction. The aim of this study was to investigate the harmful effect of tobacco on the periodontal condition of a Moroccan population. MATERIALS AND METHODS: It was an exposed-non exposed study of 42 patients: 21 smokers and 21 non-smokers selected from patients attending the department of periodontology in Rabat. Smokers should have smoked at least 2 years. Periodontal variables were assessed clinically (level of plaque, degree of gingival inflammation, probing depth, attachment loss, and gingival recession) and periapical radiographs. RESULTS: There was no difference of age or level of plaque between smokers and no smokers. For the others variants, smokers had more inflammation than non smokers (GI = 1.83 versus 1.45; p = 0.03), a number of attachment loss (45.5 for smokers, and 13.6 for non smokers; p = 0.01) and periodontal pockets (26 for smokers, and 6.3 for non smokers; p = 0.01) more important and with more severe damage (AL (attachment loss) = 1.33 in smokers versus 0.72 in non smokers; p = 0.01). The number of surfaces with bone loss is higher in smoker's group than non smoker's group (25 versus 6.36; p < 0.001). The severity of bone resorption is also important (1.26 versus 0.43; p < 0.001). There wasn't a statistically significant difference concerning gingival recessions. CONCLUSIONS: This study suggests that tobacco has a negative effect in the periodonte of the studied Moroccan population. In smokers' patients, the prevalence of risk to develop a periodontitis is higher. In such patients, the probing depth, attachment loss and its severity, increase significantly. Level of periodontal bone is significantly decreased in patients who consume tobacco.

Association between sharing of toothbrushes, eating and drinking habits and the presence of Actinobacillus actinomycetemcomitans in Moroccan adolescents.

BACKGROUND/AIMS: Actinobacillus actinomycetemcomitans is frequently detected in dental plaque collected from Moroccan adolescents, and has been shown to be associated with clinical attachment loss in this population. The aim of this study was to assess whether behaviors such as the sharing of toothbrushes, and eating and drinking habits were associated with the presence of A. actinomycetemcomitans in Moroccan adolescents. MATERIALS AND METHODS: A total of 121 adolescents were clinically examined. Interviews regarding sharing of toothbrushes, eating and drinking habits were performed, and plaque samples were collected and analyzed for A. actinomycetemcomitans with different leukotoxin promoter types by polymerase chain reaction. Based on eating and drinking habits, the study population was divided in a low risk behavior group (LRB) and a high risk behavior group (HRB). RESULTS: No association was found between the sharing of toothbrushes and the presence of A. actinomycetemcomitans. The odds ratios between the HRB and LRB group for being positive for the JP2 type, for non-JP2 types, and for any type of A. actinomycetemcomitans were 4.74 (95% CI 0.55; 40.71), 2.49 (95% CI 1.03; 5.97), and 2.97 (95% CI 1.28; 6.91), respectively. The difference in the mean number of teeth with a clinical attachment loss of > or = 3 mm between the HRB and the LRB group was 0.91(95% CI 0.09; 1.72). CONCLUSION: Sharing of toothbrushes does not seem to be associated with the presence of A. actinomycetemcomitans in young Moroccans. Eating and drinking habits conducive to exchange of saliva are positively associated with presence of A. actinomycetemcomitans, and with a higher level of clinical attachment loss.

The highly leukotoxic JP2 clone of Actinobacillus actinomycetemcomitans and progression of periodontal attachment loss.

The JP2 clone of Actinobacillus actinomycetemcomitans has been implicated in the etiology of periodontitis in adolescents. The aim of this two-year longitudinal study was to describe clinical attachment loss (CAL) progression and to assess its association with baseline occurrence of the JP2 and non-JP2 types of A. actinomycetemcomitans. Clinical re-examination of 121 adolescents in Morocco was performed. Progression of CAL > or = 1 mm, > or = 2 mm, > or = 3 mm, and > or = 4 mm on at least one site was found in 58%, 48%, 22%, and 6% of the subjects, respectively. Subjects who, at baseline, harbored the JP2 clone had a significantly higher progression of CAL than did subjects harboring non-JP2 types of A. actinomycetemcomitans. Subjects harboring non-JP2 types displayed a marginally higher CAL progression than did subjects who were culture-negative for A. actinomycetemcomitans.

Early-onset periodontitis in Morocco is associated with the highly leukotoxic clone of Actinobacillus actinomycetemcomitans.

A particular clone (JP2) of Actinobacillus actinomycetemcomitans with increased leukotoxin production has been isolated from individuals with early-onset periodontitis (EOP). The aim of this study was to determine the frequency of carriers of this clone and its association with EOP in Moroccan schoolchildren. Of 217 plaque samples, 131 (60.4%) were culture-positive for A. actinomycetemcomitans. A total of 19 of these isolates had a 530-bp deletion in the leukotoxin promoter region characteristic of the JP2 clone. A strong association between the presence of A. actinomycetemcomitans with the 530-bp deletion and EOP was found (adjusted OR = 29.4; 95% Cl = 8.3 - 104.4; p < 0.0005), while no association could be demonstrated between the presence of A. actinomycetemcomitans without the deletion and EOP (adjusted OR = 1.3; 95% CI = 0.5 -2.9; p = 0.750). The study demonstrates that the endemic presence, in a human population, of the highly leukotoxic JP2 clone may result in an unusually high prevalence of EOP.