Dental status in nursing home residents with domiciliary dental care in Sweden.

OBJECTIVE: To describe the dental health status of elderly people in nursing homes receiving domiciliary dental care. DESIGN: Case note review. CLINICAL SETTING: Nursing homes in 8 Swedish counties. PARTICIPANTS: Care dependent elderly people (≥65 years). METHODS: Clinical data, including the number of remaining natural teeth, missing and decayed teeth (manifest dental caries) and root remnants, recorded by dentists according to standard practices. Medical and dental risk assessments were performed. RESULTS: Data were available for 20,664 patients. Most were women (69.1%), with a mean age of 87.1 years (SD 7.42, range 65-109). The mean age for men was 83.5 years (SD 8.12, range 65-105). Two or more medical conditions were present in most of the population. A total of 16,210 individuals had existing teeth of whom 10,974 (67.7%) had manifest caries. The mean number of teeth with caries was 5.0 (SD 5.93) corresponding to 22.8% of existing teeth. One in four individuals were considered to have a very high risk in at least one professional dental risk assessment category. CONCLUSIONS: Care dependent elderly in nursing homes have very poor oral health. There is a need to focus on the oral health-related quality of life for this group of frail elderly during their final period of life.

Reconstruction of Peri-implant Osseous Defects: A Multicenter Randomized Trial.

There is a paucity of data for the effectiveness of reconstructive procedures in the treatment of peri-implantitis. The objective of this study was to compare reconstruction of peri-implant osseous defects with open flap debridement (OFD) plus porous titanium granules (PTGs) compared with OFD alone. Sixty-three patients (36 female, 27 male; mean age 58.4 y [SD 12.3]), contributing one circumferential peri-implant intraosseous defect, were included in a multinational, multicenter randomized trial using a parallel-group design. After OFD and surface decontamination using titanium brushes and hydrogen peroxide, 33 defects received PTGs. The implants were not submerged. All patients received adjunctive perioperative systemic antibiotics. The primary outcome variable (defect fill) was assessed on digitalized radiographs. Clinical measurements of probing depth (PPD), bleeding on probing (BoP), suppuration, and plaque were taken by blinded examiners. After 12 mo, the test group (OFD plus PTG) showed a mean radiographic defect fill (mesial/distal) of 3.6/3.6 mm compared with 1.1/1.0 in the control group (OFD). Differences were statistically significant in favor of the test group (P < 0.0001). The OFD plus PTG group showed a mean reduction in PPD of 2.8 mm compared with 2.6 mm in the OFD group. BoP was reduced from 89.4% to 33.3% and from 85.8% to 40.4% for the test and control groups, respectively. There was no significant difference in complete resolution of peri-implantitis (PPD ≤4 mm and no BoP at six implant sites and no further bone loss), because this finding was accomplished at 30% of implants in the test group and 23% of implants in the control group. Reconstructive surgery using PTGs resulted in significantly enhanced radiographic defect fill compared with OFD. However, limitations in the lack of ability to discern biomaterial from osseous tissue could not be verified to determine new bone formation. Similar improvements according to clinical measures were obtained after both surgical treatment modalities (ClinicalTrials.gov NCT02406001).

The effect of different mouth rinse products on intra-oral halitosis.

AIM: To evaluate the effect of different mouth rinses 12 h after rinsing on genuine intra-oral halitosis. MATERIALS AND METHODS: Twenty-four adults with halitosis were included in a double-blind, crossover, randomized clinical trial. Halitosis was evaluated 12 h after rinsing with placebo and five mouth rinse products containing zinc acetate and chlorhexidine diacetate; zinc lactate, chlorhexidine and cetylpyridinium chloride; zinc acetate and chlorhexidine diacetate with reduced amounts of mint and menthol; zinc chloride and essential oil; and chlorine dioxide using the organoleptic method and a gas chromatograph. Test periods were separated by 1 week. RESULTS: Hydrogen sulphide (H2 S), methyl mercaptan (MM) and the organoleptic scores (OLS) were significantly reduced 12 h following rinsing with all substances compared to placebo (P < 0.05). H2 S was more effectively reduced after rinsing with zinc acetate and chlorhexidine diacetate and zinc acetate and chlorhexidine diacetate with reduced amounts of mint and menthol compared to rinsing with zinc chloride and essential oil (P < 0.05), and significantly lower values of MM were obtained after rinsing with zinc acetate and chlorhexidine diacetate compared to zinc lactate, chlorhexidine and cetylpyridinium chloride (P < 0.05). The percentage effectively treated individuals (H2 S (<112 ppb), MM (<26 ppb) and OLS score <2) varied from 58% percentage (zinc acetate and chlorhexidine diacetate) to 26% (zinc chloride and essential oil). CONCLUSION: All treatments resulted in reduction in halitosis 12 h after rinsing compared to placebo. H2 S and MM were most effectively reduced by zinc acetate and chlorhexidine diacetate.

Erythrocyte antioxidant protection of rose hips (Rosa spp.).

Rose hips are popular in health promoting products as the fruits contain high content of bioactive compounds. The aim of this study was to investigate whether health benefits are attributable to ascorbic acid, phenols, or other rose-hip-derived compounds. Freeze-dried powder of rose hips was preextracted with metaphosphoric acid and the sample was then sequentially eluted on a C(18) column. The degree of amelioration of oxidative damage was determined in an erythrocyte in vitro bioassay by comparing the effects of a reducing agent on erythrocytes alone or on erythrocytes pretreated with berry extracts. The maximum protection against oxidative stress, 59.4 ± 4.0% (mean ± standard deviation), was achieved when incubating the cells with the first eluted meta-phosphoric extract. Removal of ascorbic acid from this extract increased the protection against oxidative stress to 67.9 ± 1.9%. The protection from the 20% and 100% methanol extracts was 20.8 ± 8.2% and 5.0 ± 3.2%, respectively. Antioxidant uptake was confirmed by measurement of catechin by HPLC-ESI-MS in the 20% methanol extract. The fact that all sequentially eluted extracts studied contributed to protective effects on the erythrocytes indicates that rose hips contain a promising level of clinically relevant antioxidant protection.

Clinical and microbiological analysis of subjects treated with Brånemark or AstraTech implants: a 7-year follow-up study.

AIMS: To assess the impact of different implant systems on the clinical conditions and the microbiota at implants, and whether the presence of bacteria at tooth sites was predictive of the presence at implant sites. MATERIALS AND METHODS: Subjects with either AstraTech or Brånemark in function for 7 years were enrolled. Sub-gingival bacterial samples at tooth and implant sites were collected with sterile endodontic paper points, and analyzed by the checkerboard DNA-DNA hybridization method (40 species). RESULTS: Fifty-four subjects, 27 supplied with AstraTech (n=132 implants) and 27 with Brånemark (n=102) implants, were studied. Test tooth sites had significantly less evidence of bleeding on probing (P<0.001) and presence of plaque (P<0.001) than implant test sites. Implant sites presented with deeper probing pocket depth than tooth sites (mean difference: 1.1 mm, standard error of differences: 0.08, 95% confidence intervals (CI): 0.9-1.3, P<0.001). Tannerella forsythia (P<0.05), Capnocytophaga sputigena (P<0.05), Actinomyces israelii (P<0.05) and Lactobacillus acidophilus (P<0.05) were found at higher levels at tooth surfaces. No differences in bacterial load for any species were found between the two implant systems. The odds of being present/absent at tooth and implants sites were only significant for Staphylococcus aureus [odds ratio (OR): 5.2 : 1, 95% CI: 1.4-18.9, P<0.01]. CONCLUSIONS: After 7 years in function, implants presented with deeper probing depths than teeth. S. aureus was commonly present at both teeth and implants sites. S. aureus at tooth sites was predictive of also being present at implant sites.

Oral health status in individuals with dementia living in special facilities.

AIM: The aim of this review was to retrieve data describing the oral health status of individuals with dementia living in special facilities. MATERIALS AND METHODS: A literature search on the MEDLINE database (Entrez PubMed) was performed. The literature search yielded 208 papers, of which seven publications were selected for evaluation. RESULTS: From the available studies poorer oral hygiene, decreased saliva flow rates and a higher caries incidence were reported in individuals with dementia living in special facilities when compared with healthy individuals. Oral health problems were more pronounced in the severe stage of the disease. CONCLUSIONS: There is limited scientific data describing the oral health status of individuals with dementia living in special facilities. However, available data indicate that individuals with dementia living in special facilities have more oral health problems than individuals without dementia.

Factors behind change in knowledge after a mass media campaign targeting periodontitis.

The aim of this study was to investigate changes in knowledge before and after a mass media campaign, in relation to social attributes, care system attributes and oral health aspects. The study was based on a questionnaire in a cohort design, sent out to 900 randomly sampled people aged 50-75 in Sweden. The response rate to the questionnaire before and after the campaign was 70% and 65% respectively. Sixty-four percent answered both questionnaires. Two questions addressed knowledge, while 10 questions aimed to measure social attributes, care system attributes and oral health aspects. Data were analysed for bivariate relations as to change in knowledge and social attributes, care system attributes and oral health aspects. Data were also analysed in multiple regression analysis with knowledge before, knowledge after and knowledge differences as dependent variables. The results showed that there were a number of independent variables with influence on the dependent variables. Of the social attributes, secondary education gave almost 10% (P < 0.001) better knowledge both before and after the campaign. Among care system attributes, high care utilization was related to knowledge both before and after the campaign. The most important factors for knowledge about periodontitis were education, care utilization and perceived importance of oral health. In conclusion, this study demonstrates that mass media might increase knowledge about periodontitis as a health promotion strategy.

Implant therapy in partially edentulous, periodontally compromised patients: a review.

AIM: The purpose of the present study was to perform a review using a systematic approach to evaluate the long-term (>/=5 years) success of implants placed in partially edentulous patients with a history of periodontitis as evidenced by loss of supporting bone and implant loss. MATERIAL & METHODS: An electronic search of the National Library of Medicine, Washington DC (Medline-PubMed) was performed using specific search terms to identify studies assessing, in periodontitis patients, the success of implants with regard to bone level outcomes. Search was performed on abstracts registered up to October 2003. RESULTS: The searches identified 877 abstracts. Titles and abstracts were independently screened by two reviewers (G.A.W. & K.M.B.) to identify publications that met the inclusion criteria. Review of these abstracts resulted in 13 publications for detailed review. These papers were reviewed by the three authors. Finally four papers which met the criteria of eligibility were independently selected by the three reviewers. CONCLUSION: Based on the limited data, it seems justified to conclude that the outcome of implant therapy in periodontitis patients may be different compared to individuals without such a history as evidenced by loss of supporting bone and implant loss.

Impaired cytotoxicity in Papillon-Lefèvre syndrome.

Papillon-Lefèvre syndrome (PLS), palmoplantar hyperkeratosis with periodontitis, has been genetically characterized. However, suspected associated immune dysfunctions remain elusive. The purpose of this study was to evaluate peripheral blood lymphocyte levels and natural killer (NK) cell cytotoxicity in PLS. Twenty patients and 20 healthy controls were examined. Peripheral blood lymphocytes were analyzed by flow cytometry for surface markers. NK cell cytotoxicity against K562 cells was determined by means of a 51Cr release assay. White blood cell differential and proportions of B-, T-, T-helper, T-suppressor, and NK cells revealed only sporadic borderline variations from control values. In contrast, NK cell cytotoxicity was consistently and severely depressed (32-53% of control values) in all patients. To the best of our knowledge, this newly described impairment of NK cell cytotoxic function is the first consistent immune dysfunction reported in PLS. This suggests that the impaired NK cell cytotoxicity might contribute to the pathogenesis of PLS-associated periodontitis.

Periodontal treatment of patients with Papillon-Lefèvre syndrome: a 3-year follow-up.

BACKGROUND/AIM: Conventional mechanical periodontal treatment of Papillon-Lefevre syndrome (PLS) has often been reported to fail. This study describes the outcome of a non-surgical periodontal therapy including antimicrobial treatment of nine patients diagnosed with PLS. The patients originate from a total of 15 children and adolescents with PLS for which clinical characteristics are presented. METHODS: Clinical examination including conventional periodontal measurements. Initial treatment including oral hygiene instruction, scaling and root planing and systemic amoxicillin-metronidazole therapy for 6 weeks. After that the patients were enrolled in a 3-month recall maintenance program. In addition to this mechanical supportive maintenance treatment, tetracycline was prescribed and used continuously for 1.5 years. RESULTS/CONCLUSION: On five patients who were showing acceptable standard of oral hygiene and also compliance with the antibiotic medication, development of periodontitis on erupting teeth was prevented and disease activity on the previously periodontally involved teeth controlled during a 3-year period. Poor results of treatment were observed for three patients, all siblings. These patients failed to comply with the medication and also failed to improve their oral hygiene.

Patient-based assessments of clinical periodontal conditions in relation to alveolar bone loss.

BACKGROUND: Limited subject-based information exists on the relationship between clinical and radiographic periodontal data. AIMS: To use subject-based data to assess the extent of concurrence between clinical and radiographic information, and to study what clinical information best predicts alveolar bone loss (ABL). MATERIAL AND METHODS: Subject-based data on smoking habits, bleeding on probing, plaque scores, pocket probing depth (PD), and evidence of alveolar BL were obtained, and functional periodontal pentagon risk diagrams (PPRDs) were studied from 168 consecutive subjects attending a medical clinic. RESULTS: The mean age of the subjects was 62.7 years (SD+/-9.0). The average number of teeth was 21.3 (SD+/-8.0) with on average 5.6 molars remaining (SD+/- 3.9). In this subject cohort, 33.1% had never smoked, 44.2% had quit smoking, and 22.7% were currently smokers. Mean plaque and bleeding scores were high or 60.2% (SD+/-24.0) and 53.1% (SD+/-23.6), respectively. PDs >or=6.0 mm were found in 55.9% of the subjects. Binary logistic regression analysis demonstrated that tooth loss and proportional plaque scores were the predominant factors included in the equations associated with ABL. Wald coefficients varied between 3.99 and 9.15, and with p-values between 0.05 and 0.01. When included, the PPRD score became the exclusive factor at several cut-off levels (Wald's coefficients between 19.8 and 15.6, p<0.001). Consequently, the best receiver operator curve was identified for the PPRD at the >40% cut-off ABL level (area under the curve: 0.81; 95% CI: 0.74-0.89; p<0.001). CONCLUSIONS: The number of teeth lost and the proportion of plaque scores provided significant predictive factors for ABL. The functional PPRD demonstrated an exclusive and highly predictable association with ABL. Subject-based proportional data for PDs >4.0 mm provided poor substitute measures for the extent of ABL.

Oral health problems in elderly rehabilitation patients.

A combination of poor oral hygiene and dry mouth may be hazardous to the oral health status. However, systematic assessments in order to detect oral health problems are seldom performed in the nursing care of the elderly. The aims of this study were to investigate the occurrence of oral health problems measured using the Revised Oral Assessment Guide (ROAG) and to analyse associations between oral health problems and age, gender, living conditions, cohabitation, reason for admission, number of drugs, and functional and nutritional status. One registered nurse performed oral health assessments using ROAG in 161 newly admitted elderly patients in rehabilitation care. Oral health problems were found in 71% of the patients. Thirty per cent of these patients had between four and eight problems. Low saliva flow and problems related to lips were the most frequent oral health problems. Problems in oral health status were significantly associated with presence of respiratory diseases (problems with gums, lips, alterations on the tongue and mucous membranes), living in special accommodation (low saliva flow, problems with teeth/dentures and alterations on the tongue), being undernourished (alterations on the tongue and low saliva flow) and being a woman (low saliva flow). The highest Odds ratio (OR) was found in problems with gums in relation with prevalence of respiratory diseases (OR 8.9; confidence interval (CI) 2.8-27.8; P < 0.0005). This study indicates the importance of standardised oral health assessments in order to detect oral health problems which can otherwise be hidden when the patients are admitted to the hospital ward.

Tensile strength, histological and immunohistochemical observations of periodontal wound healing in the dog.

This study was designed to study wound strength at the dentine/connective tissue interface and at the bone/connective tissue interface following full thickness flap surgery. Flaps of uniform dimension were outlined in four young adult beagle dogs using a standardised double bladed knife and vertical incisions 10 mm apart, which extended 8 mm apical to the gingival margin. Bone was removed from half the sites (eight sites in each dog), giving 32 flaps replaced on dentine and 32 sites on bone. A tensile force was applied using a microprocessor force gauge at 1, 2, 3, 7, 10, 14, 21, and 28 days. Mean tensile strengths were markedly weaker for the dentine/flap interface. At 7 days the value for flaps to dentine was 1.82 N, in contrast to 5.08 N for flaps replaced on bone. Inflammatory cell counts tended to fall markedly at 3 days for both modalities, but were higher for the dentine/flap modality at all time points. Fibroblast density peaked at 7-14 days but did not vary with type of flap over the time points studied. The amounts of fibrin were greater for the dentine/flap interface at all time points but decreased for both flap types as time progressed. Collagen type V was localised to the basement membrane and blood vessels and tended to show more foci for flaps replaced on dentine. Procollagen levels showed little change over the healing interval for both flap/bone and flap/dentine interfaces. Type III collagen synthesis was at peak levels during the first week. These findings would support efforts to stabilise periodontal flaps at early time points, especially those on dentine.

Effect of a triclosan-containing toothpaste supplemented with 10% xylitol on mutans streptococci in saliva and dental plaque. A 6-month clinical study.

The aim of the present investigation was to evaluate the effect of the combination of triclosan and xylitol in toothpaste on mutans streptococci (MS) in saliva and dental plaque. 155 individuals with >10(5) MS/ml saliva were included in a 6-month double-blind clinical study. They were divided into three groups (n = 51-52) balanced according to their MS counts at baseline. Each group used one of the following types of dentifrice: (1) Colgate Total with the addition of 10% xylitol (Total-Xylitol), (2) Colgate Total and (3) Colgate Total without triclosan and without xylitol. Whole saliva and pooled plaque samples were obtained after 2, 4 and 6 months. When comparing the MS counts within the groups for saliva and plaque samples, Total-Xylitol showed significant reduction at all three sampling occasions (p < 0.001). Mean reduction at the 6-month sample for saliva was 0.81/ml and for plaque 0.89 per sample (log values). ANOVA revealed significant differences between Total-Xylitol and the two other products at 6 months for MS in saliva and dental plaque. The conclusion from this 6- month study is that the addition of 10% xylitol to a triclosan-containing dentifrice reduces the number of MS in saliva and dental plaque.

A systematic review on the use of residual probing depth, bleeding on probing and furcation status following initial periodontal therapy to predict further attachment and tooth loss.

BACKGROUND: Chronic periodontitis affects many adults. Initial cause related therapy (ICRT) is aimed at elimination of factors causing disease progression. OBJECTIVES: To use a systematic review process of peer reviewed publications to assess the predictive value of residual probing depths (PD), bleeding on probing (BOP) and furcation involvement (FI) in determining further loss of attachment and tooth loss following ICRT. MATERIAL AND METHODS: An electronic search of the Cochrane Oral Health Group specialized register, MEDLINE and EMBASE, was performed using specific search terms to identify studies assessing the predictive value of residual probing depths (PD), bleeding on probing (BOP) and furcation involvement (FI) in determining further loss of attachment and tooth loss following ICRT. RESULTS: The searches resulted in 941 uniquely identified studies. Titles and abstracts were then independently screened by two reviewers (S.R. and G.R.P.) to identify publications that met specific inclusion criteria. The agreement between the reviewers was assessed and statistical analysis failed to demonstrate a difference between the two reviewers (kappa-value: 0.94, P = 0.003). Detailed review of 47 included publications resulted in acceptance of one publication which utilized data based on patient as unit of observation. This study included 16 subjects over 42 months demonstrating that residual probing depths are predictive of further disease progression whereas persisting bleeding on probing are not. CONCLUSIONS: Data based on one study suggest that residual probing depths are predictive of further disease progression. The implications for carefully designed multicentre randomized clinical control trials are many.

Evidence of a founder effect for four cathepsin C gene mutations in Papillon-Lefèvre syndrome patients.

We describe a mutation and haplotype analysis of Papillon-Lefèvre syndrome probands that provides evidence of a founder effect for four separate cathepsin C mutations. A total of 25 different cathepsin C mutations have been reported in 32 families with Papillon-Lefèvre syndrome (PLS) and associated conditions. A characteristic of these findings is the diversity of different cathepsin C mutations that have been identified. To evaluate the generality of cathepsin C mutations, PLS probands representative of five reportedly unrelated Saudi Arabian families were evaluated by mutational and haplotype analyses. Sequence analysis identified two cathepsin C gene mutations: a novel exon 7 G300D mutation was found in the proband from one family, while probands from four families shared a common R272P mutation in exon 6. The R272P mutation has been previously reported in two other non-Saudi families. The presence of the R272P mutation in probands from these four Saudi families makes this the most frequently reported cathepsin C mutation. To distinguish between the presence of a possible founder effect or a mutational hot spot for the R272P mutation, we performed haplotype analysis using six novel DNA polymorphisms that span a 165 kb interval containing the cathepsin C gene. Results of haplotype analysis for genetic polymorphisms within and flanking the cathepsin C gene are consistent with inheritance of the R272P mutation "identical by descent" from a common ancestor in these four Saudi families. Haplotype analysis of multiple PLS probands homozygous for other cathepsin C mutations (W249X, Q286X, and T153I) also supports inheritance of each of these mutations from common ancestors. These data suggest that four of the more frequently reported cathepsin C mutations have been inherited from common ancestors and provide the first direct evidence for a founder effect for cathepsin C gene mutations in PLS. Identification of these six short tandem repeat polymorphisms that span the cathepsin C gene will permit haplotype analyses to determine other founder haplotypes of cathepsin C mutations in additional PLS families.

Osseointegrated implants in a patient with Papillon-Lefèvre syndrome. A 4 1/2-year follow up.

BACKGROUND: The Saudi female reported in this study was diagnosed with Papillon-Lefèvre syndrome. She had lost all her teeth, including third molars, at the age of 18 years. METHOD: She was wearing full dentures for 7 years, before 5 titanium implants were installed in the mandible. RESULTS: 4 1/2 years after the implant installation, the treatment was clinically and radiographically successful. Neither A. actinomycetemcomitans nor P. gingivalis were detected at any of the implants. This very encouraging result does not differ from what is generally reported in edentulous medically healthy patients. CONCLUSION: The use of implants could considerably enhance future therapeutic options for the severely dentally compromised patients with Papillon-Lefèvre syndrome.

Microbial findings at failing implants.

The aim of this study was to evaluate qualitative differences in the subgingival microbiota at titanium implants, ad modum Brånemark, demonstrating clinical and radiographic signs of loss of supporting tissues (peri-implantitis) as compared to implants surrounded by healthy tissues. A total of 37 patients demonstrating 1 or more implants with bone loss > or = 3 threads, bleeding on probing and/or suppuration and 51 patients with clinically healthy mucosa and no bone loss were recruited for the study. In each patient subgingival bacterial samples were obtained using paper-points, and subjected to microbiological analysis by culture. The two types of clinical conditions showed distinct bacterial profiles. For implants with peri-implantitis putative periodontal pathogens, such as Porphyromonas gingivalis, Prevotella intermedia/Prevotella nigrescens and Actinobacillus actinomycetemcomitans, were found in 60% of the cases and microorganisms primarily not associated with periodontitis, such as Staphylococcus spp., enterics and Candida spp., were found in 55% of the peri-imaplant lesions. In contrast, implants surrounded by healthy tissue demonstrated a microbiota associated with periodontal health. The results indicate that the microbiota of the healthy peri-implant sulci is similar to that from corresponding conditions around teeth. However, in peri-implant areas staphylococci, enterics and yeasts were found almost as frequently as periopathogens indicating differences as compared to the microbiota around periodontitis affected teeth. A microbiological diagnosis may therefore be of guidance for the choice of antimicrobial treatment in patients with peri-implant infection.

Testing an oral assessment guide during chemotherapy treatment in a Swedish care setting: a pilot study.

Oral complications are common in patients with haematological malignancies who undergo chemotherapy treatment. A pilot study including 16 haematological patients was carried out to evaluate the oral status using an Oral Assessment Guide (OAG) and to test the reliability of the OAG. The oral assessments were made daily by registered nurses at a Department of Internal Medicine in Sweden. Once a week a dental hygienist made the oral assessments independent of the registered nurses in order to provide data for calculations of inter-rater reliability. All patients had varying degrees of alterations in the oral cavity, especially in the mucous membranes, teeth/dentures and gums. The inter-rater agreement between the nurses and the dental hygienist was good for saliva and swallow, and moderate for voice and gums. Assessments to detect alterations in the oral cavity afford the opportunity for early and individualized interventions and may decrease the risk of oral infections. It is necessary to train the nurses to ensure high levels of reliability in the oral assessments. The OAG seems to be a reliable and clinical useful tool for assessing the oral cavity status and determining changes.

Subgingival microbial profile of Papillon-Lefèvre patients assessed by DNA-probes.

The prevalence of 18 selected bacterial species was assessed by means of "checkerboard" DNA-DNA hybridisation in a group of 12 Saudi-Arabian adolescents with Papillon-Lefèvre syndrome. A total of 36 tooth sites were investigated. The patients exhibited severe periodontal disease with deep pockets. All 12 patients harboured the putative bacterial pathogens P. intermedia, F. nucleatum, P. micros and S. intermedius while T. denticola, B. forsythus, P. nigrescens, E. corrodens, S. noxia and C. rectus were recovered from 11 patients. P. gingivalis was recovered from 9 patients and 18 sites while corresponding figures for A. actinomycetemcomitans were 8 and 19, respectively. A number of the investigated species (B. forsythus, T. denticola, P. intermedia, C rectus) reached high levels (> or =10(6) cells) in more than 1/2 of the patients. On the other hand, bacteria such as A. actinomycetemcomitans and P. gingivalis were infrequently encountered at high levels in these subgingival samples. In conclusion, the analysis failed to demonstrate a PLS-specific profile of the subgingival infection, since the bacterial composition of the sampled sites closely resembled that characterising deep pockets in adult periodontitis patients.