Oral microbiome of deep and shallow dental pockets in chronic periodontitis.

We examined the subgingival bacterial biodiversity in untreated chronic periodontitis patients by sequencing 16S rRNA genes. The primary purpose of the study was to compare the oral microbiome in deep (diseased) and shallow (healthy) sites. A secondary purpose was to evaluate the influences of smoking, race and dental caries on this relationship. A total of 88 subjects from two clinics were recruited. Paired subgingival plaque samples were taken from each subject, one from a probing site depth >5 mm (deep site) and the other from a probing site depth ≤3mm (shallow site). A universal primer set was designed to amplify the V4-V6 region for oral microbial 16S rRNA sequences. Differences in genera and species attributable to deep and shallow sites were determined by statistical analysis using a two-part model and false discovery rate. Fifty-one of 170 genera and 200 of 746 species were found significantly different in abundances between shallow and deep sites. Besides previously identified periodontal disease-associated bacterial species, additional species were found markedly changed in diseased sites. Cluster analysis revealed that the microbiome difference between deep and shallow sites was influenced by patient-level effects such as clinic location, race and smoking. The differences between clinic locations may be influenced by racial distribution, in that all of the African Americans subjects were seen at the same clinic. Our results suggested that there were influences from the microbiome for caries and periodontal disease and these influences are independent.

Prevalence of periodontopathogens in a black Brazilian secluded community matched with a black urban population.

OBJECTIVE: To evaluate the prevalence of periodontopathogens according to periodontal profile in a black Brazilian secluded community matched with an urban black population. PARTICIPANTS: A total of 84 subjects were selected, 42 (mean age 25.7 sd 18.0 years) from a secluded community called Santo Antonio do Guapore (SAG) and 42 (mean age 25.4 sd 18.1 years) from an urban area of Sao Paulo State (SPT). METHODS: Participants received clinical examinations as follows: periodontal pocket depth; clinical attachment loss; plaque and gingival indexes. After examination, the secluded population was classified as periodontal health (13), gingivitis (15) or periodontitis (14). Then, 182 urban volunteers were screened and 42 subjects were selected matched for the variables: periodontal diagnosis, age (+/- 2 years) and gender. Samples were taken for microbial analysis. Genomic DNA for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Campylobacter rectus, Tannerella forsythia and Prevotella intermedia was provided by polymerase chain reaction. RESULTS: Except for C. rectus, all pathogens were present in both groups with no statistically significant difference. In particular, C. rectus was more prevalent only in gingivitis subjects from the SPT group (p<0.05). A high frequency of periodontopathogens was related to the severity of periodontal disease. CONCLUSION: In general, the prevalence of the examined periodontopathogens in this study did not differ between a secluded black Brazilian population and an urban black population.

Periodontal disease progression and glycaemic control among Gullah African Americans with type-2 diabetes.

AIM: To evaluate associations between glycaemic control and periodontitis progression among Gullah African Americans with type-2 diabetes mellitus (T2DM). MATERIALS AND METHODS: From an ongoing clinical trial among T2DM Gullah, we extracted a cohort previously in a cross-sectional study (N=88). Time from baseline (previous study) to follow-up (trial enrollment, before treatment interventions) ranged 1.93-4.08 years [mean=2.99, standard deviation (SD)=0.36]. We evaluated tooth site-level periodontitis progression [clinical attachment loss (CAL) worsening of > or =2 mm, periodontal probing depth (PPD) increases of > or =2 mm and bleeding on probing (BOP) from none to present] by glycaemic control status (well-controlled=HbA(1c)<7%, poorly-controlled=HbA(1c)> or =7%) using multivariable generalized estimating equations logistic regression, nesting tooth sites/person. RESULTS: Poorly-controlled T2DM (68.18%) was more prevalent than well-controlled T2DM (31.82%). Proportions of tooth sites/person with CAL progression between baseline and follow-up ranged 0.00-0.59 (mean=0.12, SD=0.12), while PPD and BOP progression ranged 0.00-0.44 (mean=0.09, SD=0.11) and 0.00-0.96 (mean=0.24, SD=0.18), respectively. Site-level PPD at baseline was a significant effect modifier of associations between poorly-controlled T2DM and site-level CAL and PPD progression [adjusted odds ratios (OR) according to poorly-controlled T2DM among PPD at baseline=3, 5 and 7 mm, respectively: CAL progression=1.93, 2.64, and 3.62, PPD progression=1.98, 2.76, and 3.84; p<0.05 for all]. Odds of site-level BOP progression were increased (OR=1.24) for poorly-controlled T2DM, yet the results were not significant (p=0.32). CONCLUSIONS: These findings from a distinct, homogenous population further support the clinical relevance of identifying patients with poor glycaemic control and periodontitis, particularly among those with disparities for both diseases.

Differences in subgingival microflora of Korean and German periodontal patients.

PURPOSE: The goal of this study was to characterize the microbiological profile in samples of subgingival plaque taken from periodontal patients with different ethnic origin. METHODS: 178 patients (n=90 from South Korea and n=88 from Germany; age: 45.4 +/- 10.4 years) were diagnosed with severe generalized periodontitis. In all patients the deepest pocket of each quadrant was sampled for subgingival plaque. The four samples per patient were pooled and subsequently analysed with a 16s-RNA-gene probe test. RESULTS: Prevalence of Aggregatibacter actinomycetemcomitans was significantly higher in German patients (47.7%) compared to Korean patients (26.7%) (p < 0.01, chi(2)-test). For Tannerella forsythia and porphyromonas gingivalis, differences between Germans and Koreans were not as pronounced. A statistically significant difference could also be found for Treponema denticola (Germans: 95.5%, Koreans: 81.1%, p < 0.01, chi(2)-test). After logarithmic transformation, bacterial counts differed for all microorganisms under investigation between Germans and Koreans, even after using a General Linear Model/Analysis of Covariance (GLM/ANCOVA) to adjust for gender, age, smoking status, pocket probing depths (PPD) of sampled teeth, and gingival bleeding index (GBI). CONCLUSION: Depending on their ethnic origin, the microbiological profile of pooled subgingival plaque sample seems to differ significantly between patients of Caucasian and Asian ethnic origin.

[Periodontal conditions and diabetes mellitus in the Japanese-Brazilian population]. / Condições periodontais e diabetes mellitus na população nipo-brasileira.

OBJECTIVE: To evaluate the relationship between diabetic status and periodontal conditions in the Japanese-Brazilian population. METHODS: The sample consisted of 1,315 subjects, of both sexes, first (Issei) and second (Nisei) generations, aged 30 to 92 years, living in Bauru, Brazil. Edentulism and presence of 6 null sextants were the exclusion criteria for the sample. The Community Periodontal Index and Periodontal Attachment Loss Index were determined using the probing of 10 teeth in a sample of 831 subjects. The diagnosis of diabetes mellitus was based on fasting blood sugar and blood sugar 2 hours after 75 mg of glucose overload. Statistical analysis was conducted using Kappa test and Chi-square test. RESULTS: Regarding periodontal conditions, 25.5% of the sample were healthy people, 12.5% showed bleeding on probing, 49.4% calculus, 10.4% pockets of 4-5 mm deep, and 2.2% pockets deeper than 6 mm. The percentage of subjects with an attachment loss of 0-3 mm was 24.2%; 4-5 mm, 36.7%; 6-8 mm, 23.7%; 9-11 mm, 11.3%; and up to 12 mm or more, 4.1%. The association between the periodontal condition and diabetes mellitus showed no statistical significance (p<0.05), although diabetic subjects have a higher percentage of deeper pockets and attachment loss >6 mm than non-diabetics, as tested by Chi-square test. CONCLUSIONS: Epidemiological studies relating oral health and systemic disease, such as diabetes mellitus, can provide important contributions for preventing the worsening of such diseases.

Comparison of periodontal disease status of adults in two untreated indigenous populations of Guatemala, Central America.

OBJECTIVE: To compare the periodontal disease levels of two distinct indigenous populations of Guatemala, Central America, to determine whether differences exist. MATERIAL AND METHODS: Cross-sectional studies were performed in adults from the communities of San Juan La Laguna, SJLL (n = 125) and Tzununa (n = 54). In both cases, full-mouth pocket probing depths (PPDs) and clinical attachment levels (CALs) were measured by a single examiner, and the same examiner was employed in both studies. Recession at each site was derived from PPD and CAL measures. RESULTS: Tooth number did not differ significantly between SJLL and Tzununa (28.0 and 27.2, respectively). With respect to periodontal disease status, the percentage of sites with PPD >or= 5, 6 and 7 mm did not differ significantly, although mean PPD was significantly greater in the Tzununa sample (P = 0.01). Mean CAL and percentage of sites with CAL >or= 4, 5, 6 and 7 mm was significantly greater in SJLL than in Tzununa (P < 0.005) and the difference increased with age. Mean recession was also significantly greater in SJLL than Tzununa (P < 0.005), as was the percentage of sites with recession >or= 3 mm (P = 0.02), 4 mm (P = 0.002) and 5 mm (P = 0.008). CONCLUSION: The disease levels differed between these two indigenous Guatemalan communities. Whether this has a primarily environmental or genetic basis remains to be elucidated. :

Prevalence of suspected periodontal pathogens identified using ELISA in adolescents of differing ethnic origins.

The aim of this study was to determine the prevalence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia in a group of adolescents and investigate the association of these organisms with various clinical parameters. A total of 527, 11-13-year-old children, of whom 333 (63%) were white Caucasian, 187 (35%) Indo-Pakistani and 7 (1%) Afro-Caribbean, participated in the study. Subgingival plaque samples, collected from the mesio-buccal of both upper first permanent molars using sterile paper points, were stored in phosphate buffered saline with 0.01% thiomersal and analysed for the presence of A. actinomycetemcomitans, P. gingivalis and P. intermedia using ELISA. The mesio-buccal sites of both upper 1st permanent molars were also examined and the presence/absence of supragingival plaque, subgingival calculus, bleeding on probing and pocket depths greater than 3 mm were recorded. The % of white Caucasian children in whom the monoclonal antibody identified at least 1 site with A. actinomycetemcomitans, P. gingivalis and P. intermedia were 4%, 3% and 2%, respectively, and for Indo-Pakistanis were 3%, 17% and 2%. The difference for P. gingivalis was statistically significant (p < 0.001). The associations between the clinical parameters and the 3 organisms were considered separately for both upper first molar sites. The prevalence of P. gingivalis was higher for sites with subgingival calculus, pockets > 3 mm and bleeding on probing (p < 0.01).

Periodontal health in adopted children of Asian origin living in Sweden.

In the present study the periodontal condition of a group of adopted 6-17 year-old children of Asian origin living in Sweden was compared with that of age- and sex matched Sweden children. Thirty-one Asian children and 31 Swedish children participated. Data on general health for all the children and on age at arrival for the Asian children was collected by interview. A clinical examination included recording of presence of plaque, supragingival calculus, bleeding on probing, probing depth, and caries. Radiographs were used to determine marginal bone loss (distance between the cemento-enamel junction and the marginal bone level > 2 mm), proximal calculus, and proximal caries. In addition, previously taken and filed radiographs of the primary dentition of the older children and current radiographs of the younger children with primary teeth were analysed to determine the prevalence of bone loss and calculus. The children of Asian origin showed a significantly higher number of surfaces with plaque and bleeding on probing. No significant differences were noted in the number of individuals with probing depths > or = 4 mm, supragingival calculus, or radiographic calculus. Three of the Asian and none of the Swedish children displayed radiographic bone loss. The retrospective analysis of all available radiographs from the primary dentition showed that 9 of 29 (31%) Asian children and 2 of 29 (7%) Swedish children had experienced bone loss in primary teeth.

Periodontal status in the United States, 1988-1991: prevalence, extent, and demographic variation.

This paper reports estimates of the periodontal status of US population derived from data from Phase 1 of the Third National Health and Nutrition Examination Survey conducted by the National Institute of Dental Research from 1988-1991. A total of 7,447 dentate individuals 13 years of age and older, representing approximately 160.3 million civilian non-institutionalized Americans, received a periodontal assessment. Measurements of gingival bleeding, gingival recession level, periodontal pocket depth, and calculus were made by dental examiners. Assessments were made at the mesiobuccal and mid-buccal sites of all fully erupted permanent teeth present in two randomly selected quadrants, one maxillary and one mandibular. All data were weighted and standard errors calculated by special software to adjust for the effect of sample design. Although over 90% of persons 13 years of age or older had experienced some clinical loss of attachment (LA), only 15% exhibited more severe destruction (LA > or = 5 mm). Prevalence of moderate and severe LA and gingival recession increased with age, while prevalence of pockets > or = 4 mm or > or = 6 mm did not. These data suggest that the increasing prevalence of LA with age is more associated with increasing prevalence of recession than with changes in the prevalence of pockets or age. The extent or number of affected sites with advanced conditions for loss of attachment, pocket depth, or recession was not large for any age group. Differences in prevalence of moderate and severe loss of attachment, moderate and deep pockets, and recession were found among gender and race-ethnicity groups. Females exhibited better periodontal health than males, and non-Hispanic whites exhibited better periodontal health than either non-Hispanic blacks or Mexican-Americans.

Periodontal conditions in Vietnamese immigrant children in Sweden.

The aim of the present study was to compare the periodontal health in Vietnamese immigrant children in Sweden with that of native Swedish children. The study groups consisted of 42 6-17-year-old Vietnamese children and 42 age- and sex-matched Swedish children. Information on systemic health was obtained by interview. Clinical examination included recordings of dental plaque, supragingival calculus, bleeding on probing, probing depth, clinical attachment loss and caries. Radiographs were evaluated for presence of marginal bone loss, proximal calculus and proximal caries. In addition, previously obtained and filed radiographs were used as a supplement in order to evaluate if the children at any time point during the ages 4-11 years had experienced proximal calculus or bone loss in the primary dentition. The Vietnamese children showed significantly higher number of sites with bleeding on probing and with probing depths > or = 4 mm. Radiographic calculus was found in 55% of the Vietnamese and in 2% of the Swedish children. 5 Vietnamese children and 1 Swedish child showed periodontal bone loss at the time of examination. In all children except 1, the bone loss was confined to primary teeth. The retrospective analysis of available radiographs from the primary dentition showed that 28% of the Vietnamese children and 5% of the Swedish children had experienced bone loss in their primary teeth during the ages 4-11 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Periodontal pathogens in the shallow pockets of immigrants from developing countries.

The aim of this study was to examine the distribution of typical periodontitis-associated microorganisms in refugees arriving from non-industrialized countries, and to relate the presence of these organisms to the periodontal condition of the subjects. Thirty males between 35-44 years of age were surveyed. Dental plaque, calculus, gingivitis, loss of attachment, and probing depths were recorded for all surfaces. A total of 90 microbiological samples were taken with paper points from mesial sites of teeth 16, 36 and 41. Microbiological test sites were grouped by probing depths and loss of attachment. Only 16.8% of all surfaces had probing depths > 3 mm, although 90.7% of surfaces had loss of attachment > 1 mm. Twenty-one sites with obvious periodontal destruction (PD > 3 mm, LA > 2 mm) showed the greatest recovery of Porphyromonas gingivalis (66.7%). However, 51 sites with minimal periodontal disease (PD < or = 3 mm, LA < 2 mm) and with no gingival recession also showed a relatively high detection frequency of P. gingivalis (34.1%). Twenty-four of these samples came from 12 patients with no pockets > 5 mm and with less than 10% of all sites yielding pockets > 3 mm. The detection frequencies of Prevotella intermedia (91.6%), Bacteroides forsythus (25.0%), Wolinella spp. (33.3%) and Actinobacillus actinomycetemcomitans (50.0%) were similar in these sites compared with periodontitis sites. Morphologically distinct isolates, from 19 individuals positive for A. actinomycetemcomitans, were serotyped by indirect immunofluorescence.(ABSTRACT TRUNCATED AT 250 WORDS)

Early onset periodontitis in the United States of America.

A National Survey of the Oral Health of U.S. children aged 5 to 17 was conducted by the National Institute of Dental Research during the 1986-87 school year. Eleven thousand and seven adolescents aged 14 to 17 years received a periodontal assessment. Their patterns of loss of periodontal attachment as assessed by probing at mesial sites were used to classify adolescents as cases of early onset periodontitis. Approximately 0.53% of adolescents nation-wide were estimated to have localized juvenile periodontitis (LJP), 0.13% to have generalized juvenile periodontitis (GJP), and 1.61% to have incidental loss of attachment (LA) (greater than or equal to 3 mm on 1 or more teeth). The total number of adolescents affected were not trivial. Close to 70,000 adolescents in the U.S. were estimated to have LJP in 1986-87. More destructive GJP affected an estimated 17,000 adolescents. Another 212,000 adolescents were estimated to have incidental LA. Blacks were at much greater risk for all forms of early onset periodontitis than whites. Males were clearly more likely (4.3 to 1) to have GJP than females when other variables were statistically controlled. Gender associations were more complicated for LJP because gender interacted with race. Black males were 2.9 times as likely to have LJP as black females. In contrast, white females were more likely than white males to have the disease by about the same odds. When interactions among demographic variables exist, caution must be taken in comparing results from different studies.

Periodontal disease in adolescents: some clinical and microbiologic correlates of attachment loss.

The influence of several clinical and microbiological variables on the site-specific risk of attachment loss was studied in Navajo Indian adolescents aged 14-19. Diagnoses were made at mesio-buccal sites of the four first permanent molars. Case-control analytical methods were used, with A. actinomycetemcomitans, B. gingivalis, and B. intermedius considered the "risk" variables, and with calculus, gingival bleeding, age, and gender treated as possible confounders. The presence of B. intermedius significantly increased the likelihood that attachment loss would be diagnosed at a site (odds ratio = 2.86). However, this association was confounded by calculus and gingival bleeding; when either or both were present, the effect of B. intermedius was markedly weaker. Step-wise multiple logistic regression analyses showed that, of the variables considered, the combination of calculus, gingival bleeding, and B. intermedius gave the most parsimonious explanation of the presence of attachment loss. The chance that attachment loss would be diagnosed was increased five times when calculus was present, 16.5 times in the presence of both calculus and gingival bleeding, and 37 times when these variables plus B. intermedius were observed at a particular site.

The relationship between periodontal conditions and perceptions of periodontal health among Pakistani immigrants in Norway.

The purpose of the present study was to assess the periodontal status of Pakistani immigrants in Norway, a Third World population in an industrialized country. The findings were related to treatment needs, socio-demographic variables and cultural beliefs about periodontal health. The mean number of remaining teeth ranged from 27.7 in the 20-24-year-old age group to 25.1 in the group of 35-year-olds and older. Very few of the study population had no plaque or no subgingival calculus. Only 7.5% of the participants exhibited no bleeding at any index teeth. Age and residence in Pakistan were the strongest predictors of subgingival calculus and pocket depth. Those from the rural areas of Pakistan had deeper pockets than those from the cities. The data showed a population with high prevalences of teeth with plaque, subgingival calculus and frequent gingival bleeding, but few sites with deep pockets. A periodontal treatment need index would indicate a substantial amount of treatment time. The present study suggests that also the perceived periodontal conditions, should be taken into account when periodontal services and health education strategies are planned. The concept of periodontal illness is introduced, defined as a person's perceptions and interpretations of periodontal symptoms.