Effects of Probiotics Mouthwash on Levels of Red Complex Bacteria in Chronic Periodontitis Patients: A Clinico-microbiological Study.

AIM: The red complex includes Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, which are recognized as the most important pathogens and are the indicators of infection in chronic periodontal disease. This study was to assess the levels of red complex bacteria in chronic periodontitis patients following treatment with probiotic mouthwash. MATERIALS AND METHODS: Twenty chronic periodontitis patients with ages ranging from 18 to 55 years were recruited for the study. The control group was given placebo mouthwash and the study group was given probiotic mouthwash. After clinical monitoring and scaling and root planing, the collected plaque samples at baseline and 14th day were transferred for microbiological analysis by transport media for Conventional Multiplex Polymerase Chain Reaction. RESULTS: On the 14th day, all the clinical parameters were significantly reduced in the study group with gingival index (p = 0.003 HS) and plaque index (p = 0.001 VHS). In the study group, there was significant bacterial cell reduction with T. denticola (p = 0.041 S) and T. forsythia (p = 0.037 S). CONCLUSION: In patients with chronic periodontitis, treatment with probiotic mouthwash significantly reduces the levels of red complex bacteria. CLINICAL SIGNIFICANCE: The use of probiotic mouthwash could be a useful adjunct to scaling and root planing in chronic periodontitis.

Revelation of Viral - Bacterial Interrelationship in Aggressive Periodontitis via Polymerase Chain Reaction: A Microbiological Study.

BACKGROUND: Periodontal disease is one of the most common and complex disease affecting mankind. Being multifactorial in etiology it encompasses a variety of infectious entities with various unique microbial constellations and immune responses. A bacteriologic cause alone seems insufficient in explaining several clinical features of the periodontal disease. Recent studies suggest that periodontal herpes viruses comprise an important source of triggering periodontal tissue destruction. The following study aims to assess human cytomegalovirus (HCMV), Epstein-Barr virus (EBV-I) interaction with the established periodontopathic bacteriae, Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa) in pathogenesis of aggressive periodontitis (AgP) using Hotstart polymerase chain reaction (PCR). MATERIALS AND METHODS: A total of 30 subjects, 15 with AgP and 15 healthy controls contributed random subgingival plaque samples. PCR methodology was used to identify the subgingival herpesviruses, Pg, and Aa. Yates corrected Chi-square test was employed to identify a statistical association between herpesviruses and periodontopathic bacteriae. RESULTS: Findings suggested that viruses may be pertinent to disease progression. The prevalence of the periodontopathic bacteria Aa was found in 53.33% (P = 0.0168, S) and Pg in 40% (P = 0.2155, NS) of the AgP patients. Herpesviruses, HCMV and EBV-I were found to have a prevalence of 46.67% (P = 0.039, S) and 40% (P = 0.084, NS). The viral and bacterial co-infection was found to be 77.78% (P = 0.0002, S) with Aa and HCMV. CONCLUSION: The present data reveals, viruses may exert periodontopathic effect by causing local immunosupression which may set a stage for the subgingival colonization and multiplication of periodontal bacteriae. Further studies are needed to develop an understanding into the significance of herpesviruses in human periodontitis which, may allow for improved diagnosis, more specific therapy and ultimately disease prevention.

C-reactive Protein as Predict of Increased Carotid Intima Media Thickness in Patients with Chronic Periodontitis.

BACKGROUND: C-reactive protein (CRP) - a prototypic marker of inflammation has been shown to be elevated in chronic periodontitis (CP) and also been shown to predict cardiovascular events. Increased carotid intima media thickness (CIMT) has been recently recognized as surrogate marker for atherosclerosis. In this context, we studied to correlate between CIMT and CRP in CP and to know whether CRP predicts the cardiovascular risk in CP. MATERIALS AND METHODS: The study consisted of 30 systemically healthy subjects aged over 40 years - 15 subjects with CP as cases and 15 subjects with no periodontitis as controls. All subjects were subjected to measurement of CRP levels and CIMT in addition to detailed periodontal evaluation. Quantitative determination of CRP was done by turbidimetric immunoassay. IMT of the common carotid arteries was estimated bilaterally using B-mode ultrasound at 6 sites. Positive CRP was defined as more than 10 mg/l. RESULTS: Mean CRP levels were significantly higher in subjects with CP (19.58 ± 17.03), then in non CP (NCP) (5.54 ± 1.63, P < 0.004). Mean CIMT value was significantly higher in subjects with CP (1.09 ± 0.45) than in NCP (0.57 ± 0.06, P < 0.001) and all periodontal indices correlated well with CIMT. Further, there was significant correlation between CRP and increased CIMT in subjects with CP (r = 0.863, P < 0.001). CONCLUSIONS: The present study indicates CRP as a possible underlying pathway in the association between periodontal disease and the observed CIMT. CRP can be used as a risk predictor for atherosclerosis in patients with CP.

Potential effect of neutrophil functional disorders on pathogenesis of aggressive periodontitis.

INTRODUCTION: Leukocytes play a key role in maintaining the balance between an effective host defence response to microorganisms and periodontal tissue destruction. Neutrophil dysfunction has been associated with increased susceptibility to periodontal diseases. We undertook this study to determine to what extent neutrophil dysfunction constitutes to the pathogenesis of aggressive periodontitis (AgP) in tropical country like ours. MATERIALS AND METHODS: Age- and sex-matched groups consisting of 20 subjects each of generalized aggressive periodontitis (GAP)-cases and nonperiodontitis (NP)-controls. diabetes mellitus, HIV infection, prolonged antibiotic use and smoking were excluded. Each neutrophil function was assessed using the chemotactic assay using case in, phagocytosis assay, candidacidal assay (for intracellular killing) and NBT assay (for respiratory burst failure). STATISTICAL ANALYSIS USED: Student's t-test, Fisher's exact test and Chi-square test. RESULTS: In the study 17 out of 20 subjects (85%) had at least one abnormal neutrophil assay either hypofunctional or hyperfunctional of which 16 (80%) had hypofunctional assays and 8 (40%) had hyperfunctional assays. Defective phagocytosis was the commonest (50%) followed by chemotactic defect (45%), defective respiratory burst (40%) and defective intracellular killing (30%). Mean of chemotaxis assay was significantly less in AgP when compared to controls (103 vs 129 µm, p=0.002), similarly for phagocytic defect (3.45 vs 4.65, p≤0.001) and with candidacidal assay (26.80 vs 37.35, p<0.001). CONCLUSION: The prevalence of neutrophil dysfunction, predominantly hypofunctional, was significantly very high in GAP patients with few even having hyperactive respiratory burst function. Multiple level neutrophil defects could account for the aggressive nature of AgP even in apparently healthy subjects.