Microbiological Effects of Sodium Hypochlorite/-Amino Acids and Cross-linked Hyaluronic Acid Adjunctive to Non-surgical Periodontal Treatment.

PURPOSE: To investigate the microbiological outcomes obtained with either subgingival debridement (SD) in conjunction with a gel containing sodium hypochlorite and amino acids followed by subsequent application of a cross-linked hyaluronic acid gel (xHyA) gel, or with SD alone. MATERIALS AND METHODS: Forty-eight patients diagnosed with stages II-III (grades A/B) generalised periodontitis were randomly treated with either SD (control) or SD plus adjunctive sodium hypochlorite/amino acids and xHyA gel (test). Subgingival plaque samples were collected from the deepest site per quadrant in each patient at baseline and after 3 and 6 months. Pooled sample analysis was performed using a multiplex polymerase chain reaction (PCR)-based method for the identification of detection frequencies and changes in numbers of the following bacteria: Aggregatibacter actinomycetemcomitans (A.a), Porphyromonas gingivalis (P.g), Tannerella forsythia (T.f), Treponema denticola (T.d), and Prevotella intermedia (P.i). RESULTS: In terms of detection frequency, in the test group, statistically significant reductions were found for P.g, T.f, T.d and P.i (p < 0.05) after 6 months. In the control group, the detection frequencies of all investigated bacterial species at 6 months were comparable to the baseline values (p > 0.05). The comparison of the test and control groups revealed statistically significant differences in detection frequency for P.g (p = 0.034), T.d (p < 0.01) and P.i (p = 0.02) after 6 months, favouring the test group. Regarding reduction in detection frequency scores, at 6 months, statistically significant differences in favour of the test group were observed for all investigated bacterial species: A.a (p = 0.028), P.g (p = 0.028), T.f (p = 0.004), T.d (p <0.001), and P.i (p = 0.003). CONCLUSIONS: The present microbiological results, which are related to short-term outcomes up to 6 months post-treatment, support the adjunctive subgingival application of sodium hypochlorite/amino acids and xHyA to subgingival debridement in the treatment of periodontitis.

Method for screening antimicrobial gels against multi-species oral biofilms.

We described a microtiter plate-based method that was effectively tailored for testing gel formulations against oral multispecies biofilms established on peg-lids. This method lifts the limitations imposed mainly by the anaerobic nature of the targeted bacterial species and the viscous properties of the targeted treatments.

Integron gene cassettes harboring novel variants of D-alanine-D-alanine ligase confer high-level resistance to D-cycloserine.

Antibiotic resistance poses an increasing threat to global health. To tackle this problem, the identification of principal reservoirs of antibiotic resistance genes (ARGs) plus an understanding of drivers for their evolutionary selection are important. During a PCR-based screen of ARGs associated with integrons in saliva-derived metagenomic DNA of healthy human volunteers, two novel variants of genes encoding a D-alanine-D-alanine ligase (ddl6 and ddl7) located within gene cassettes in the first position of a reverse integron were identified. Treponema denticola was identified as the likely host of the ddl cassettes. Both ddl6 and ddl7 conferred high level resistance to D-cycloserine when expressed in Escherichia coli with ddl7 conferring four-fold higher resistance to D-cycloserine compared to ddl6. A SNP was found to be responsible for this difference in resistance phenotype between the two ddl variants. Molecular dynamics simulations were used to explain the mechanism of this phenotypic change at the atomic scale. A hypothesis for the evolutionary selection of ddl containing integron gene cassettes is proposed, based on molecular docking of plant metabolites within the ATP and D-cycloserine binding pockets of Ddl.

Inhibitory effect of Streptococcus salivarius K12 and M18 on halitosis in vitro.

BACKGROUND: The aim of the study was to observe the antimicrobial activity of Porphyromonas gingivalis and Treponema denticola as well as the effect on reducing volatile sulfur compounds (VSCs). MATERIALS AND METHODS: After P. gingivalis and T. denticola were cultured with or without Streptococcus salivarius K12 and M18, VSCs were measured by Oral Chroma. In order to analyze the mechanism for malodor control, the antimicrobial activity of S. salivarius K12 and M18 against P. gingivalis and T. denticola was assessed. SPSS 21.0 was used for data analysis with the Kruskal-Wallis and Jonckheere-Terpstra tests. Mann-Whitney test was applied for post hoc analysis. RESULTS: P. gingivalis and T. denticola VSC levels were reduced by high concentrations of S. salivarius K12 and M18 during coculture. The concentrations were lower than those of single culture (p < .05). An antimicrobial effect was detected on P. gingivalis, and T. denticola by 50% S. salivarius K12 and M18. The spent culture medium and whole bacteria of S. salivarius K12 and M18 reduced the levels of VSCs below the amount in a single culture of P. gingivalis and T. denticola (p < .05). CONCLUSION: S. salivarius K12 and M18 decreased the levels of VSCs originating from P. gingivalis and T. denticola.

Efficacy of antimicrobial photodynamic and photobiomodulation therapy against Treponema denticola, fusobacterium nucleatum and human beta defensin-2 levels in patients with gingivitis undergoing fixed orthodontic treatment: A clinic-laboratory study.

BACKGROUND: Evidence suggests that molecular pathways are involved in human ß-defensin (hBD)-2 mRNA regulation in human gingival epithelial cells stimulated with periodontal bacteria. This clinical and laboratory study evaluated the efficacy of two laser therapies including antimicrobial photodynamic therapy (aPDT) and photobiomodulation (PBM) therapy as an adjunct to ultrasonic scaling (US) on the gingival crevicular fluid (GCF) levels of hBD-2 and subgingival Treponema denticola (T. denticola) and Fusobacterium nucleatum (F. nucleatum) spp., in patients undergoing fixed orthodontic therapy and gingivitis. MATERIALS AND METHODS: Forty-five patients undergoing fixed orthodontic treatment were randomly divided into three groups based on the type of treatment rendered: Group-I: aPDT as an adjunct to US, Group-II: PBM as an adjunct to US and, Group-III: US alone. Full-mouth plaque scores (FMPS), bleeding on probing (FMBOP) and probing depth (PD) were assessed. GCF was collected for estimation of hBD-1 using enzyme-linked immunosorbent assay. Plaque samples were used to quantify T. denticola and F. nucleatum spp by quantitative polymerase chain reaction. All clinical and laboratory investigations were carried out at baseline (T0), day 30 (T30) and day 60 (T60). RESULTS: FMPS and FMBOP showed statistically significant reduction in all groups at T30 and T60 from T0. No inter-group differences were observed between any groups at follow-up. Mean PD remained stable for Group-II and Group-III, while Group-I showed progressive reduction at T60. The GCF levels of hBD-2 progressively decreased in Group-I (aPDT) while the levels increased slightly at T60 in Group-III. The levels in Group-II (PBM) remained stable from T30 to T60. Statistically significant reduction was seen for Group-I when compared with Group-II and Group-III at T60 (p = 0.045). A significant reduction was observed for T. denticola in only Group-I patients at T30 (p = 0.031) and T60 (p = 0.047). A significant reduction was seen in both Group-I and Group-II patients at T30 and T60. The number of sites with BOP was correlated with both bacterial species (Table 4). Only T. denticola showed positive correlation to mean BOP after correcting for multiple testing. CONCLUSION: aPDT and PBM showed similar improvement in gingival inflammatory and microbiological parameters compared to US. aPDT assisted in modest reduction of hBD-2 in patients undergoing fixed orthodontic treatment.

Efficacy of ß-caryophyllene for periodontal disease related factors.

OBJECTIVE: This study aimed to investigate the antimicrobial activity of ß-caryophyllene against periodontopathogens as well as its inhibitory effects on the expression of inflammatory cytokines and production of volatile sulfur compounds by lipopolysaccharide and periodontopathogenic enzymes, respectively. DESIGN: The antimicrobial activity of ß-caryophyllene againstPorphyromonas gingivalis, Tannerella forsythia, and Treponema denticola was investigated via a susceptibility assay using a microplate reader. THP-1 cells were treated with lipopolysaccharide in the presence or the absence of ß-caryophyllene, and the expression and production of inflammatory cytokines were then analyzed by a real-time reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay. After fluorescence-labelling lipopolysaccharide, the effect of ß-caryophyllene on the binding of lipopolysaccharide to the cell wall was investigated via flow cytometry. The spent culture media of P. gingivalis was shaken with or without ß-caryophyllene and gaseous volatile sulfur compounds (VSCs) were measured by a gas chromatograph. RESULTS: ß-caryophyllene showed strong the antimicrobial activity against periodontopathogens. It also reduced lipopolysaccharide-induced expression and production of cytokines, thereby inhibiting the binding of lipopolysaccharide-binding to toll-like receptors by interfering with the complex of lipopolysaccharide and CD14 or lipopolysaccharide-binding protein. ß-caryophyllene also inhibited the emission of gaseous VSCs produced byP. gingivalis. CONCLUSIONS: ß-caryophyllene may improve periodontal health via antimicrobial activity against periodontopathogens, reducing inflammation caused by lipopolysaccharide, and by neutralizing VSCs.

Effects of sub-minimal inhibitory concentrations of antibiotics on the morphology and surface hydrophobicity of periodontopathic anaerobes.

It has been reported that sub-minimal inhibitory concentrations (sub-MICs) of antibiotics are capable of altering bacterial surface properties and phenotype. In this study, the effects of sub-MICs of certain antibiotics on surface hydrophobicity, cell morphology, and protein profile were ascertained using Fusobacterium nucleatum, Porphyromonas gingivalis and Treponema denticola strains, which are pathogenic bacterial species in periodontal diseases. The MICs of antibiotics were determined by culturing bacteria in media supplemented with serially diluted antibiotic solutions, and sub-MIC of antibiotics was used. The effect of sub-MIC of antibiotics on cell morphology was determined by scanning electron microscopy. Microscopic observation of F. nucleatum and P. gingivalis grown at a sub-MIC of amoxicillin revealed cell enlargement. T. denticola grown at a sub-MIC of doxycycline also showed cell elongation. The relative surface hydrophobicity determined by measuring the ability of the bacteria to absorb n-hexadecane revealed an increase in surface hydrophobicity of F. nucleatum grown at sub-MIC of penicillin and amoxicillin, but a decrease with metronidazole; whereas increased hydrophobicity was observed in T. denticola grown at sub-MIC of doxycycline, metronidazole and tetracycline. The surface hydrophobicity of P. gingivalis increased only when grown in sub-MIC of metronidazole. The protein expression profile of the treated bacteria differed from their respective controls. These results confirmed that sub-MIC concentrations of antibiotics can affect the phenotype, surface properties and morphology of periodontal pathogenic anaerobic bacteria.

Effects of the nitric oxide releasing biomimetic nanomatrix gel on pulp-dentin regeneration: Pilot study.

Successful disinfection alongside complete endodontic tissue regeneration and revascularization are the most desired clinical outcomes of regenerative endodontics. Despite reported clinical successes, significant limitations to the current regenerative endodontic procedure (REP) have been elucidated. To improve the current REP, an antibiotics and nitric oxide (NO) releasing biomimetic nanomatrix gel was developed. The study evaluates antibacterial effects of an antibiotics and NO releasing biomimetic nanomatrix gel on multispecies endodontic bacteria. Antibiotics, ciprofloxacin (CF) and metronidazole (MN) were mixed and encapsulated within the NO releasing biomimetic nanomatrix gel. The gel was synthesized and self-assembled from peptide amphiphiles containing various functional groups. Antibacterial effects of the antibiotics and NO releasing biomimetic nanomatrix gel were evaluated using bacterial viability assays involving endodontic microorganisms including clinical samples. Pulp-dentin regeneration was evaluated via animal-model experiments. The antibiotics and NO releasing biomimetic nanomatrix gel demonstrated a concentration dependent antibacterial effect. In addition, NO alone demonstrated a concentration dependent antibacterial effect on endodontic microorganism. An in vivo analysis demonstrated the antibiotics and NO releasing biomimetic nanomatrix gel promoted tooth revascularization with maturation of root canals. An optimal concentration of and NO releasing nanomatrix gel is suggested for its potential as a root treatment material for REP and an appropriate protocol for human trials. Further investigation is required to obtain a larger sample size and decide upon ideal growth factor incorporation.

The Effects of Antimicrobial Peptide Nal-P-113 on Inhibiting Periodontal Pathogens and Improving Periodontal Status.

Periodontal disease consists of chronic gingival inflammation characterized by both degradation of the periodontal connective tissue and alveolar bone loss. Drug therapy is used as an auxiliary treatment method in severe chronic periodontitis, aggressive periodontitis, and periodontitis-associated systemic disease. Nal-P-113, a modified antimicrobial peptide, specifically replaces the histidine residues of P-113 with the bulky amino acid ß-naphthylalanine, and our previous studies have verified that this novel peptide is not toxic to the human body within a certain concentration range. The objective of the present study was to evaluate the effect of Nal-P-113 on periodontal pathogens and periodontal status in clinical studies. In a split-mouth clinical trial, the pocket depth and bleeding index values tended to decrease in the experimental group compared with those in the control group. SEM results verified that Nal-P-113 restrained the maturation of plaque. Based on real-time polymerase chain reaction, the levels of Fusobacterium nucleatum, Streptococcus gordonii, Treponema denticola, and Porphyromonas gingivalis in subgingival plaque were decreased when the subjects were given Nal-P-113. Bacterial growth curve analysis and a biofilm susceptibility assay verified that Nal-P-113 at a concentration of 20 µg/mL restrained the growth of S. gordonii, F. nucleatum, and P. gingivalis and biofilm formation. Therefore, Nal-P-113 effectively reduces periodontal pathogens and ameliorates periodontal status.

Confocal fluorescence imaging to evaluate the effect of antimicrobial photodynamic therapy depth on P. gingivalis and T. denticola biofilms.

BACKGROUND: Porphyromonas gingivalis and Treponema denticola are both principally implicated in the incidence of both periodontal disease and peri-implantitis. Recent studies have demonstrated that these bacteria exhibit symbiotic growth in vitro and a synergistic virulence in co-infection of animal models. Found at varying depths throughout the biofilm, these bacteria present a significant challenge to traditional antimicrobial treatment modalities. Antimicrobial photodynamic therapy (aPDT) has yielded high success against bacterial biofilms, namely those found in the oral cavity. Data on the use of aPDT against these particular periodontal pathogens is, however, scarce. Here, we studied the qualitative killing efficacy and depth of drug and laser penetration into defined P. gingivalis and T. denticola biofilms. METHODS: P. gingivalis and T. denticola were incubated under anaerobic (10%CO2, 10%H2, 80%N2) conditions for two days in diluted TSB with PBS (TYGVS for T. denticola maintenance) to elicit biofilm growth on coverslip-modified polystyrene dishes. Treated biofilms were exposed to a purpurin-based sensitizer (25 µg/mL in DMSO) for 30 min, and then aPDT was carried out using a diode laser at 664 nm. Light doses of 15 and 45 J/cm2 were used. All biofilms were then exposed to Filmtracer™ LIVE/DEAD® Biofilm Viability Kit (Cat No. L10316). Qualitative analysis was performed using a Zeiss LSM 510 Meta NLO Confocal Microscope with attached Zeiss Axioimager Z1 and Axiovert 200 M for visual data collection, and images were processed using the ZEN Digital Imaging for Light Microscopy software suite. Analysis was performed in 2 × 3 stacks to assess the entire depth of both the biofilm and presumed drug/laser penetration. RESULTS: Initial planktonic studies confirmed that the bacteria in question were present in the grown cultures and susceptible to aPDT exposure. Biofilm control groups were found to have significant levels of surviving bacterial colonies. Both treatment groups featured complete bacterial kill throughout the entirety of the biofilm (average: 23.17 µm; range: 18.13-27.20 µm). CONCLUSIONS: The efficacy of the purpurin-based PS and aPDT is demonstrated to be effective at both high and low light doses. Bacterial kill was fully efficacious at each visualized biofilm layer (1.01 µm/z-level). This study serves as a proof of concept for future studies that must consider appropriate treatment parameters, including the amount of applied PS, and laser dose. These findings indicate that aPDT is a method that can be used to eliminate microorganisms associated with biofilms implicated in the etiology of peri-implantitis and periodontitis at large.

The effects of different restorative materials on periodontopathogens in combined restorative-periodontal treatment.

Objective The aim of the study was to evaluate the association between subgingival restorations and the target periodontopathogenic bacteria (Pg, Td and Pi) in subgingival biofilm during one year after combined restorative-periodontal treatment. Material and Methods Seventeen systemically healthy subjects, who were positive for the presence of three cervical lesions associated with gingival recessions in three different adjacent teeth, were included in the study. A total of 51 combined defects were treated with connective tissue graft plus a nanofilled composite resin (NCR+CTG), a resin-modified glass ionemer cement (RMGI+CTG) and a fluoride-releasing resin material with pre-reacted glass (PRG), called giomer (Giomer+CTG). Periodontal clinical measurements and subgingival plaque samples were obtained from all combined defects at baseline and at 6 and 12 months after the surgery. The number of bacteria were evaluated by the real-time polymerase chain reaction (qPCR) method. Results No statistically significant difference in the amount of DNA copies of Pg, Td and Pi was observed in any of the groups at any time points (p>0.05). In addition, there was no statistically significant difference in the amount of DNA copies of the bacteria at baseline and at 6 and 12 months postoperatively, regardless of treatment group (p>0.05). Conclusion This study suggests that subgingivally placed NCR, RMGI and giomer restorations can show similar effects on periodontopathogenic bacteria in the treatment of gingival recessions that are associated with noncarious cervical lesions (NCCLs).

The effects of different restorative materials on periodontopathogens in combined restorative-periodontal treatment

Abstract Objective The aim of the study was to evaluate the association between subgingival restorations and the target periodontopathogenic bacteria (Pg, Td and Pi) in subgingival biofilm during one year after combined restorative-periodontal treatment. Material and Methods Seventeen systemically healthy subjects, who were positive for the presence of three cervical lesions associated with gingival recessions in three different adjacent teeth, were included in the study. A total of 51 combined defects were treated with connective tissue graft plus a nanofilled composite resin (NCR+CTG), a resin-modified glass ionemer cement (RMGI+CTG) and a fluoride-releasing resin material with pre-reacted glass (PRG), called giomer (Giomer+CTG). Periodontal clinical measurements and subgingival plaque samples were obtained from all combined defects at baseline and at 6 and 12 months after the surgery. The number of bacteria were evaluated by the real-time polymerase chain reaction (qPCR) method. Results No statistically significant difference in the amount of DNA copies of Pg, Td and Pi was observed in any of the groups at any time points (p>0.05). In addition, there was no statistically significant difference in the amount of DNA copies of the bacteria at baseline and at 6 and 12 months postoperatively, regardless of treatment group (p>0.05). Conclusion This study suggests that subgingivally placed NCR, RMGI and giomer restorations can show similar effects on periodontopathogenic bacteria in the treatment of gingival recessions that are associated with noncarious cervical lesions (NCCLs).

Inhibition of malodorous gas formation by oral bacteria with cetylpyridinium and zinc chloride.

OBJECTIVE: The antimicrobial efficacy of zinc- (ZnCl2) and cetylpyridinium-chloride (CPC) and their inhibition capacity on volatile sulfur compound (VSC) production by oral bacterial strains were investigated. DESIGN: Minimum inhibitory concentrations (MIC) and growth curves were determined for ZnCl2, CPC, and CPC with ZnCl2 solutions against eight oral microorganisms (Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, Tannerella forsythia, Staphylococcus aureus and Streptococcus mutans) known to be involved in the pathophysiology of both halitosis and periodontal disease. Gas chromatography was applied to measure VSCs (H2S, CH3SH, (CH3)2S) production levels of each strains following exposure to the solutions. RESULTS: ZnCl2 and CPC effectively inhibited growth of all eight strains. ZnCl2 was generally more effective than CPC in suppressing bacterial growth excluding A. actinomycetemcomitans, P. intermedia, and T. forsythia. Synergism between CPC and ZnCl2 was shown in A. actinomycetemcomitans. The MIC for CPC was significantly lower than ZnCl2. VSC production was detected in five bacterial strains (A. actinomycetemcomitans, F. nucleatum, P. gingivalis, T. denticola, and T. forsythia). Each bacterial strain showed unique VSCs production profiles. H2S was produced by F. nucleatum, P. gingivalis, and T. denticola, CH3SH by all five strains and (CH3)2S by A. actinomycetemcomitans, F. nucleatum, P. gingivalis, and T. denticola. Production of CH3SH, the most malodorous component among the three major VSCs from mouth air was evident in F. nucleatum and T. forsythia. CONCLUSION: Both ZnCl2 and CPC effectively inhibit bacterial growth causative of halitosis and periodontal disease, resulting in a direct decrease of bacterial VSCs production.

Microbiologic Response to Periodontal Therapy and Multivariable Prediction of Clinical Outcome.

BACKGROUND: This study assesses the microbiologic effects of a two-phase antimicrobial periodontal therapy and tested microbiologic, clinical, and biologic markers as prognostic indicators for clinical success. METHODS: Eighty patients with chronic or aggressive periodontitis received periodontal treatment supplemented with 375 mg amoxicillin plus 500 mg metronidazole, three times daily for 7 days. In group A, antibiotics were given during the first non-surgical phase (T1); in group B, antibiotics were given during the second surgical phase (T2). Six microorganisms, group assignment, demographic and clinical variables, peak values of 15 cytokines, and nine acute-phase proteins in serum were evaluated as potential predictors of at least one site with probing depth (PD) >4 mm and bleeding on probing (BOP) at 12 months post-therapy. RESULTS: T1 decreased the counts of Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia (Pi), and Treponema denticola significantly more in group A than group B. Aggregatibacter actinomycetemcomitans and Parvimonas micra (Pm) showed a significant decrease only if the treatment was supplemented with antibiotics, i.e., T1 in group A, or T2 in group B. After T2, differences between groups were no longer significant. A multivariable model including four parameters revealed a predictive value of Pm (odds ratio [OR] = 4.38, P = 0.02) and Pi (OR = 3.44, P = 0.049) and yielded moderate accuracy for predicting the treatment outcome (area under the curve = 0.72). Host-derived factors and treatment sequence were not significantly associated with the outcome. CONCLUSIONS: Long-term microbiologic outcomes of periodontal therapy with adjunctive antibiotics either in T1 or T2 were similar. Detection of Pm before therapy was a predictor for persistence of sites with PD >4 mm and BOP at 12 months post-treatment.

The C-terminal region of the major outer sheath protein of Treponema denticola inhibits neutrophil chemotaxis.

Treponema denticola is an oral spirochete strongly associated with severe periodontal disease. A prominent virulence factor, the major outer sheath protein (Msp), disorients neutrophil chemotaxis by altering the cellular phosphoinositide balance, leading to impairment of downstream chemotactic events including actin rearrangement, Rac1 activation, and Akt activation in response to chemoattractant stimulation. The specific regions of Msp responsible for interactions with neutrophils remain unknown. In this study, we investigated the inhibitory effect of truncated Msp regions on neutrophil chemotaxis and associated signaling pathways. Murine neutrophils were treated with recombinant protein truncations followed by assessment of chemotaxis and associated signal pathway activation. Chemotaxis assays indicate sequences within the C-terminal region; particularly the first 130 amino acids, have the strongest inhibitory effect on neutrophil chemotaxis. Neutrophils incubated with the C-terminal region protein also demonstrated the greatest inhibition of Rac1 activation, increased phosphoinositide phosphatase activity, and decreased Akt activation; orchestrating impairment of chemotaxis. Furthermore, incubation with antibodies specific to only the C-terminal region blocked the Msp-induced inhibition of chemotaxis and denaturing the protein restored Rac1 activation. Msp from the strain OTK, with numerous amino acid substitutions throughout the polypeptide, including the C-terminal region compared with strain 35405, showed increased ability to impair neutrophil chemotaxis. Collectively, these results indicate that the C-terminal region of Msp is the most potent region to modulate neutrophil chemotactic signaling and that specific sequences and structures are likely to be required. Knowledge of how spirochetes dampen the neutrophil response is limited and Msp may represent a novel therapeutic target for periodontal disease.

Treponema denticola invasion into human gingival epithelial cells.

Host cell invasion is important for periodontal pathogens in evading host defenses and spreading into deeper areas of the periodontal tissue. Treponema denticola has been implicated in a number of potentially pathogenic processes, including periodontal tissue penetration. Here we tested the ability of T. denticola strains to invade human gingival epithelial cells (HGEC). After 2 h infection, intracellular location of T. denticola cells was confirmed by confocal laser scanning microscopy (CLSM). Results from an antibiotic protection assay following [(3)H]uridine labeling indicated that invasion efficiency reached a maximum at 2 h after infection. Internalized T. denticola cells were still observed in HGEC at 24 h by CLSM. A dentilisin deficient mutant exhibited significantly decreased invasion (p < 0.05) compared with the wild-type strain. In inhibition assays, phenylmethylsulfonyl fluoride and metabolic inhibitors such as methyl-ß-cyclodextrin and staurosporine significantly reduced T. denticola invasion. Under CLSM, T. denticola colocalized with GM-1 ganglioside-containing membrane microdomains in a cholesterol-dependent manner. These results indicated that T. denticola has the ability to invade into and survive within HGECs. Dentilisin activity of T. denticola and lipid rafts on HGEC appear to play important roles in this process.

Microbiological and Clinical Effects of Sitafloxacin and Azithromycin in Periodontitis Patients Receiving Supportive Periodontal Therapy.

Sitafloxacin (STFX) is a newly developed quinolone that has robust antimicrobial activity against periodontopathic bacteria. We previously reported that oral administration of STFX during supportive periodontal therapy was as effective as conventional mechanical debridement under local anesthesia microbiologically and clinically for 3 months. The aim of the present study was to examine the short-term and long-term microbiological and clinical effects of systemic STFX and azithromycin (AZM) on active periodontal pockets during supportive periodontal therapy. Fifty-one patients receiving supportive periodontal therapy were randomly allocated to the STFX group (200 mg/day of STFX for 5 days) or the AZM group (500 mg/day of AZM for 3 days). The microbiological and clinical parameters were examined until 12 months after the systemic administration of each drug. The concentration of each drug in periodontal pockets and the antimicrobial susceptibility of clinical isolates were also analyzed. The proportions of red complex bacteria, i.e., Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, which are the representative periodontopathic bacteria, were significantly reduced at 1 month and remained lower at 12 months than those at baseline in both the STFX and AZM groups. Clinical parameters were significantly improved over the 12-month period in both groups. An increase in the MIC of AZM against clinical isolates was observed in the AZM group. These results indicate that monotherapy with systemic STFX and AZM might be an alternative treatment during supportive periodontal therapy in patients for whom invasive mechanical treatment is inappropriate. (This study has been registered with the University Hospital Medical Information Network-Clinical Trials Registry [UMIN-CTR] under registration number UMIN000007834.).

pyrF as a Counterselectable Marker for Unmarked Genetic Manipulations in Treponema denticola.

The pathophysiology of Treponema denticola, an oral pathogen associated with both periodontal and endodontic infections, is poorly understood due to its fastidious growth and recalcitrance to genetic manipulations. Counterselectable markers are instrumental in constructing clean and unmarked mutations in bacteria. Here, we demonstrate that pyrF, a gene encoding orotidine-5'-monophosphate decarboxylase, can be used as a counterselectable marker in T. denticola to construct marker-free mutants. T. denticola is susceptible to 5-fluoroorotic acid (5-FOA). To establish a pyrF-based counterselectable knockout system in T. denticola, the pyrF gene was deleted. The deletion conferred resistance to 5-FOA in T. denticola. Next, a single-crossover mutant was constructed by reintroducing pyrF along with a gentamicin resistance gene (aacC1) back into the chromosome of the pyrF mutant at the locus of choice. In this study, we chose flgE, a flagellar hook gene that is located within a large polycistronic motility gene operon, as our target gene. The obtained single-crossover mutant (named FlgE(in)) regained the susceptibility to 5-FOA. Finally, FlgE(in) was plated on solid agar containing 5-FOA. Numerous colonies of the 5-FOA-resistant mutant (named FlgE(out)) were obtained and characterized by PCR and Southern blotting analyses. The results showed that the flgE gene was deleted and FlgE(out) was free of selection markers (i.e., pyrF and aacC1). Compared to previously constructed flgE mutants that contain an antibiotic selection marker, the deletion of flgE in FlgE(out) has no polar effect on its downstream gene expression. The system developed here will provide us with a new tool for investigating the genetics and pathogenicity of T. denticola.

Antimicrobial effectiveness of cetylpyridinium chloride and zinc chloride-containing mouthrinses on bacteria of halitosis and peri-implant disease.

PURPOSE: To clarify the antimicrobial efficacy of zinc chloride (ZnCl2) and cetylpyridinium chloride (CPC) by testing their impact on the growth of seven bacterial strains known to be involved in the pathophysiology of both peri-implant disease and halitosis-Staphylococcus aureus, Streptococcus mutans, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Treponema denticola, and Tannerella forsythia. MATERIALS AND METHODS: A time-response growth curve was obtained. Commercial mouthrinses with CPC, ZnCl2, or both were added to the media in a final concentration of 0.25% CPC, 2.5% ZnCl2, and 2.5% ZnCl2 with 0.25% CPC. RESULTS: Both CPC and ZnCl2 effectively inhibited the growth of almost all bacterial strains tested except T denticola. ZnCl2 was generally more effective in suppressing bacterial growth than CPC. ZnCl2 with CPC showed the greatest inhibitory activities on almost all strains of bacterial growth except for P gingivalis and T denticola, followed by ZnCl2, then CPC, thus suggesting the possibility of a synergistic effect of the two agents. P gingivalis exhibited a different pattern because ZnCl2 showed the most significant inhibitory effect. CPC did not show growth inhibitory effects on T denticola, but ZnCl2 did. CONCLUSION: Zinc and CPC effectively inhibit bacterial growth that causes both halitosis and peri-implant disease. The effect is even more powerful when applied in combination.

Qat Chewing and Periodontal Pathogens in Health and Disease: Further Evidence for a Prebiotic-Like Effect.

AIM: Qat chewing has been reported to induce subgingival microbial shifts suggestive of prebiotic-like properties. The objective here was to assess the effect of qat chewing on a panel of classical and new putative periopathogens in health and periodontitis. MATERIALS AND METHODS: 40 qat chewers and 40 nonchewers, equally stratified by periodontal health status, were recruited. Taqman, real-time PCR was used to quantify total bacteria, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Parvimonas micra, Filifactor alocis, Synergistetes, and TM7s in pooled subgingival biofilm samples. Differences in microbial parameters between the study groups were analysed using ordinal regression. RESULTS: In health, the qat chewers harboured significantly lower relative counts of P. gingivalis, T. forsythia, Synergistetes, and TM7s after adjustment for multiple comparisons (P ≤ 0.007). At nominal significance level, they also carried lower counts of TM7s and P. micra (P ≤ 0.05). In periodontitis, the chewers had lower counts of all taxa; however, only T. denticola withstood correction for multiple comparisons (P ≤ 0.0063). CONCLUSIONS: Qat chewing is associated with lower proportions of periopathogens, particularly in subjects with healthy periodontium, which supports previous reports of its prebiotic-like properties. This potentially beneficial biological effect can be exploited by attempting to isolate the active fraction.