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Severe Periodontitis (severe + periodontitis)

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Medical Sciences	95%

Selected Abstracts

Severe periodontitis is associated with systemic inflammation and a dysmetabolic status: a case,control study

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 11 2007
Luigi Nibali
Abstract Background and Aim: A cluster of metabolic factors defines a syndrome that predisposes to diabetes and cardiovascular disease. Chronic infections such as periodontitis might alter these individual metabolic factors and the systemic inflammatory burden. The aim of this study was to investigate the association between severe periodontitis and increase in inflammatory and metabolic risk factors for cardiovascular disease. Materials and Methods: We examined 302 patients with severe periodontitis and 183 healthy controls, and we collected a blood sample from each subject in order to investigate differences in inflammatory (leukocyte numbers and differential counts) and metabolic markers (lipids and glucose). Results: After correcting for differences in age, gender, smoking and ethnicity, periodontitis subjects exhibited a low-grade systemic inflammation (increased white cell counts, 1.10±1.02 × 109/l, 95%CI 1.05,1.15, p=0.0001), dyslipidemia [lower high-density lipoprotein cholesterol, 1.14±1.03 mmol/l, 95%CI 1.08,1.20, p<0.0001 and higher low-density lipoprotein cholesterol, 1.12±1.03, 95%CI 1.05,1.19, p<0.0001) and increased non-fasting serum glucose levels (1.04±1.01 mmol/l, 95%CI 1.02,1.06, p=0.01) when compared with controls. The associations were confirmed in a subpopulation of Caucasian non-smokers. A trend for a dose dependent effect of the number of periodontal pockets on the tested inflammatory and metabolic markers was observed. Conclusions: These data suggest a possible link between severe generalized periodontitis, systemic inflammation and a dysmetabolic state in otherwise healthy individuals. [source]

Impact of periodontal preventive programmes on the data from epidemiologic studies

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2005
Per E. Gjermo
Abstract This report provides only circumstantial evidence for the impact of programmes on periodontal epidemiology. The prerequisites for programmes and campaigns are described, and epidemiologic data on periodontal disease are compared with known changes in factors that may be affected by such activities. Unfortunately, parameters for periodontal disease as a process are not available. Only variables indicating irreversible effects on the periodontal status can be obtained. A lack of appropriate studies creates additional problems. This review indicates that preventive programmes and campaigns to improve oral hygiene have affected periodontal epidemiologic data concerning gingivitis and mild/moderate periodontitis favourably. Severe periodontitis seems not to have been influenced by such activities. Smoking is strongly associated with the severity of periodontitis. Therefore, a positive effect may be anticipated following the smoking cessation campaigns currently introduced worldwide. However, because of the irreversible nature of our epidemiologic parameters, it will take decades before any effect may be evident. It is recommended that periodontal epidemiology should be revitalized by introducing a nominalistic categorization instead of the changing essentialistic approaches used so far in order to facilitate the interpretation of data. [source]

Bone mineral content and bone metabolism in young adults with severe periodontitis

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 6 2001
Nina Von Wowern
Abstract Objectives: To clarify in young adults with severe periodontitis (1) whether the bone mineral content (BMC) or density (BMD) in the mandible/other skeletal sites and the systemic bone metabolism differed from normal and (2) whether mandibular/forearm BMC did change during the 5 to 10-year follow-up. Material and Methods: 24 young otherwise normal patients with verified severe periodontitis were included, of which 20 attended the follow-up visit. Mandibular/forearm BMC was measured at both visits by dual-photon absorptiometry, supplemented with femoral neck/lumbar spine BMD measurements at follow-up visit by dual-energy X-ray absorptiometry. Serum alkaline phosphatase/ionized calcium, urinary excretion of pyridinoline/deoxy-pyridinoline were analysed at the follow-up visit. A conventional periodontal examination was performed at both visits. Results: Mandibular BMC was significantly below normal mean BMC at both visits. The mandibular Z-scores were ,2.00 in 33.3% (8/24). BMC/BMD in the remaining sites and the values for bone markers did not differ from normal. Mandibular/forearm BMC was stable while a significant aggravation of alveolar bone loss occurred during the trial without change of probing depth. Conclusions: Severe periodontitis in young adults seems to be a local disorder associated with relatively low BMC in the jaws without systemic alterations of BMC/BMD and bone metabolism. Zusammenfassung Zielsetzung: Abklärung ob bei jungen Erwachsenen mit schwerer Parodontitis (1) der Mineralgehalt und die Dichte des Knochens im Unterkiefer bzw. anderen Teilen des Skeletts sowie deer Knochenstoffwechsel sich von normalen Verhältnissen unterscheiden und (2) ob sich der Mineralgehalt des Unterkiefer- bzw. des Unterarmknochens während eines Beobachtungszeitraums von 5 bis 10 Jahren verändern. Material und Methoden: 24 allgemein gesunde Patienten mit schwerer Parodontitis nahmen an der Studie teil von denen 20 an der Nachuntersuchung teilnahme. Der Mineralgehalt des Unterkiefer- bzw. Unterarmknochens wurde bei beiden Untersuchungen mittels Dual-Photonen-Absorptiometrie bestimmt. Zusätzlich wurden bei der Nachuntersuchung die Knochendichte des Obserschenkelhalses und der Lendenwirbel mittels Dual-Energie-Röntgen-Absorptiometrie erfaßt. Die Serumkonzentrationen alkalischer Phosphatase sowie der Kalzium-Ionen und die Ausscheidung von Pyridinolin sowie Desoxypyridinolin im Urin wurden bei der Nachuntersuchung analysiert. Zu jedem Untersuchungstermin fand eine klinische Untersuchung der parodontalen Verhältnisse statt. Ergebnisse: Der Mineralgehalt des Unterkieferknochens lag zu beiden Untersuchungsterminen unter den mittleren Normalwerten. Die Z-Werte des Unterkiefers lagen in 8 von 24 Fällen (33.3%) ,2.00. Der Mineralgehalt und die Dichte des Knochens der übrigen Regionen und die Werte der Knochenmarker unterschieden sich nicht von den Normalwerten. Der Mineralgehalt des Unterkiefer- und Unterarmknochens verhielt sich während des Untersuchungszeitraumes stabil, während es zu einer deutlichen Verschlimmerung des alveolären Knochenabbaus ohne Veränderung der Sondierungstiefen kam. Schlußfolgerungen: Bei schwerer Parodontitis bei jungen Erwachsenen scheint es sich um eine lokale Störung mit relativ geringem Mineralgehalt der Kieferknochen zu handeln ohne systemische Veränderungen von Mineralgehalt und Dichte des Knochens bzw. des Knochenstoffwechsels. Résumé Le but de cette étude était de connaître chez les jeunes adultes souffrant de parodontite sévère (1) si le contenu en minéraux osseux (BMC) ou la densité (BMD) dans des sites mandibulaires ou du squelette et le métabolisme osseux systémique étaient différents par rapport à ceux de personnes normales et (2) si le BMC de la mandibule ou de l'avant-bras changeait durant une période de suivi de 5 à 10 années. 24 patients normaux mais souffrant de parodontite sévère ont été inclus dans cette investigation mais seul 20 ont poursuivi l'étude. Le BMC de la mandibule et de l'avant-bras ont été mesurés aux 2 sites par absorptiométrie par photon double, avec également des mesures BMD au niveau du fémur et de la colonne vertébrale lors de la visite de suivi par absorptiométrie par RX àénergie double. Le calcium ionisé par phosphatase alcaline sérique et l'excrétion urinaire de pyridinoline/deoxypyridinoline ont été analysés lors de l'examen de suivi. Un examen parodontal conventionnel a été effectué aux 2 visites. Le BMC mandibulaire était significativement inférieur au BMC moyen normal lors des deux visites. Les scores Z mandibulaires étaient ,2.00 dans 33.3% (8/24) des cas. BMC/BMD dans les sites restants et les valeurs des marqueurs osseux ne différaient pas des normaux. BMC mandibulaire/avant-bras était stable tandis qu'une aggravation significative de la perte osseuse alvéolaire se produisait durant l'étude sans changement de la profondeur au sondage. La parodontite sévère chez les jeunes adultes semble être un désordre local associéà un BMC relativement bas dans les mâchoires sans altération systémique de BMC/BMD ni du métabolisme osseux. [source]

Biochemical and mutational analyses of the cathepsin c gene (CTSC) in three North American families with Papillon Lefèvre syndrome

HUMAN MUTATION, Issue 1 2002
Y. Zhang
Abstract Papillon Lefèvre syndrome (PLS) is an autosomal recessive disorder characterized by palmoplantar hyperkeratosis and severe periodontitis. The disease is caused by mutations in the cathepsin C gene (CTSC) that maps to chromosome 11q14. CTSC gene mutations associated with PLS have been correlated with significantly decreased enzyme activity. Mutational analysis of the CTSC gene in three North American families segregating PLS identified four mutations, including a novel mutation p.G139R. All mutations were associated with dramatically reduced CTSC protease enzyme activity. A homozygous c.96T>G transversion resulting in a p.Y32X change was present in a Mexican PLS proband, while one Caucasian PLS proband was a compound heterozygote for the p.Y32X and p.R272P (c.815G>C) mutations. The other Caucasian PLS proband was a compound heterozygote for c.415G>A transition and c.1141delC mutations that resulted in a p.G139R and a frameshift and premature termination (p.L381fsX393), respectively. The c.415G>A was not present in more than 300 controls, suggesting it is not a CTSC polymorphism. Biochemical analysis demonstrated almost no detectable CTSC activity in leukocytes of all three probands. These mutations altered restriction enzyme sites in the highly conserved CTSC gene. Sequence analysis of CTSC exon 3 confirmed the previously reported p.T153I polymorphism in 4 of the 5 ethnically diverse populations studied. © 2002 Wiley-Liss, Inc. [source]

Metabolic syndrome, insulin resistance, and periodontitis: a cross-sectional study in a middle-aged French population

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 7 2010
Catherine Benguigui
Benguigui C, Bongard V, Ruidavets J-B, Chamontin B, Sixou M, Ferrières J, Amar J. Metabolic syndrome, insulin resistance and periodontitis: a cross-sectional study in a middle-aged French population. J Clin Periodontol 2010; 37: 601,608. doi: 10.1111/j.1600-051X.2010.01571.x. Abstract Aim: Metabolic syndrome consists of a cluster of clinical and biological abnormalities, influenced by insulin resistance and promoting cardiovascular diseases. We examined the relationships between metabolic syndrome, its various components, insulin resistance, and periodontitis. Materials and Methods: The study included 276 subjects (35,74 years) recruited within a cross-sectional survey on cardiovascular risk factors. Twenty-one were excluded because of infectious risk or total tooth loss. Clinical attachment loss (CAL), probing pocket depth (PD), gingival and plaque indexes were recorded. Periodontitis was classified into moderate and severe forms. Results: The mean age was 58, 41% of the subjects had moderate and 39% had severe periodontitis. In univariate comparisons, periodontitis was associated with metabolic syndrome (p=0.050), most of its components, and HOMA index (homoeostasis model assessment of insulin resistance). After adjustment for confounders, only HOMA index remained associated with severe periodontitis (odds ratio [OR]=3.97 [95% confidence interval: 1.22,12.9], OR=3.78 [1.14,12.5] for third and fourth versus the first quartile of the HOMA index, respectively). The HOMA index was also associated with the number of periodontal sites with CAL4 mm, CAL5 mm, or PD4 mm (greater number for higher HOMA-index values). This relationship disappeared in never-smokers. Conclusions: Our data support the relationships between metabolic disturbances and periodontitis, with a central role of insulin resistance. [source]

Heterogeneity of systemic inflammatory responses to periodontal therapy

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2009
Jan H. Behle
Abstract Aims: We investigated the effect of comprehensive periodontal therapy on the levels of multiple systemic inflammatory biomarkers. Material and Methods: Thirty patients with severe periodontitis received comprehensive periodontal therapy within a 6-week period. Blood samples were obtained at: 1-week pre-therapy (T1), therapy initiation (T2), treatment completion (T3), and 4 weeks thereafter (T4). We assessed the plasma concentrations of 19 biomarkers using multiplex assays, and serum IgG antibodies to periodontal bacteria using checkerboard immunoblotting. At T2 and T4, dental plaque samples were analysed using checkerboard hybridizations. Results: At T3, PAI-1, sE-selectin, sVCAM-1, MMP-9, myeloperoxidase, and a composite summary inflammatory score (SIS) were significantly reduced. However, only sE-selectin, sICAM, and serum amyloid P sustained a reduction at T4. Responses were highly variable: analyses of SIS slopes between baseline and T4 showed that approximately 1/3 and 1/4 of the patients experienced a marked reduction and a pronounced increase in systemic inflammation, respectively, while the remainder were seemingly unchanged. Changes in inflammatory markers correlated poorly with clinical, microbiological and serological markers of periodontitis. Conclusions: Periodontal therapy resulted in an overall reduction of systemic inflammation, but the responses were inconsistent across subjects and largely not sustainable. The determinants of this substantial heterogeneity need to be explored further. [source]

Severe periodontitis is associated with systemic inflammation and a dysmetabolic status: a case,control study

Antimicrobial profiles of periodontal pathogens isolated from periodontitis patients in the Netherlands and Spain

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2005
A. J. Van Winkelhoff
Abstract Background and Aim: Antimicrobial resistance of periodontal pathogens towards currently used antibiotics in periodontics has been investigated in a previous study. Microbial resistance in the periodontal microflora was more frequently observed in Spanish patients in comparison with Dutch patients. The aim of the present study was to compare antimicrobial susceptibility profiles of five periodontal bacteria isolated from periodontitis patients in Spain and in the Netherlands. Material and Methods: Subgingival plaque samples from adult patients with periodontitis were collected and cultured on selective and non-selective plates. Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum and Micromonas micros were isolated and used for minimal inhibitory concentration tests using the Epsilometer (E-test) technique. Eight different antibiotics were tested on all bacterial isolates. MIC50 and MIC90 values for each antibiotic and each species were determined and the percentage of resistant strains was calculated. Results: Significantly higher MIC values were noted in Spanish strains of F. nucleatum for penicillin, ciprofloxacin, of P. intermedia for penicillin, amoxicillin and tetracycline, of M. micros for tetracycline, amoxicillin and azithromycin, and of P. gingivalis for tetracycline and ciprofloxacin. Based on breakpoint concentrations, a higher number of resistant strains in Spain were found in F. nucleatum for penicillin, amoxicillin and metronidazole, in Prevotella intermedia for tetracycline and amoxicillin, and in A. actinomycetemcomitans for amoxicillin and azithromycin. Resistance of P. gingivalis strains was not observed for any of the antibiotics tested both in Spain and the Netherlands. Conclusions: Differences exist in the susceptibility profiles of periodontal pathogens isolated from periodontitis patients in Spain and in the Netherlands. This implicates that antibiotic susceptibility testing is necessary to determine efficacy of antimicrobial agents. Also, clinical studies with antibiotics should take these differences into account. The information from the present study indicates that it may not be possible to develop uniform protocols for usage of antibiotics in the treatment of severe periodontitis in the European Union. [source]

Serum IgG to heat shock proteins and Porphyromonas gingivalis antigens in diabetic patients with periodontitis

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 6 2002
Tom J. Sims
Abstract Background: Past studies have reported a correlation between the presence and severity of periodontitis and serum antibody titers to species-specific antigens of Porphyromonas gingivalis or to cross-reactive antigens, such as lipopolysaccharide (LPS) and heat shock proteins (HSP), shared between P. gingivalis and other bacteria. Our recent study of periodontal treatment outcome in insulin-dependent (type 1) diabetes mellitus patients with severe periodontitis (IDDMI/periodontitis) resulted in two key findings: 1. serum glutamic acid decarboxylase autoantibody (GAD65 Ab) levels were significantly associated with periodontal pocket depth change (PDC) and 2. serum IgG titers to P. gingivalis cells were positively associated with GAD65 Ab level in seropositive (GAD65 Ab +) patients. We have therefore hypothesized that profiles of serum autoantibody levels and IgG titers, to P. gingivalis -specific antigens may be useful in assessing risk for refractory periodontitis in such patients. Aim: To determine whether PDC resulting from non-surgical periodontal treatment can be predicted using profiles of baseline IgG titers to P. gingivalisspecific antigens, human HSP, and GAD65. Methods: PDC was assessed two months after non-surgical periodontal treatment of 7 GAD65 Ab + and 11 GAD65 AbIDDM/periodontitis patients. Pretreatment titers to GAD65, recombinant human heat shock proteins (HSP90, HSP70, and HSP60), and various P. gingivalis antigens were measured using radioligand precipitation or enzyme-linked immunosorbent (ELISA) assays and compared to the same measurements for 154 recent-onset IDDM patients and 46 non-diabetic controls. Results: Median titers (ELISA units) to HSP90 and HSP70 were significantly higher than non-diabetic controls for GAD65 Ab + (p°= 0.002) and GAD65 Ab- (p =,0.034) IDDM/periodontitis patients, respectively. Multivariate regression analysis indicated significant partial correlation of PDC with log-transformed titers to HSP90 (r =,, 0.62, p = 0.008), HSP70 (r =,+ 0.62, p = 0.009), GAD65 (r =,, 0.60, p = 0.01) and P. gingivalis LPS (r = , 0.5 1, p = 0.04). Furthermore, hierarchical clustering of baseline profiles of log-transformed HSP90, HSP70, and GAD65 Ab titers sorted patients into two distinct clusters with significantly different median PDC (1.45 min, n = 10 vs. 0.65 min, n = 8; p = 0.016, Mann,Whitney). Conclusion: Pretreatment profiles of serum antibody titers to HSP90, HSP70, GAD65, and P. gingivalis LPS may be useful for predicting which patients with IDDM/periodontitis will have a poor response to non-surgical periodontal therapy. [source]

Bone mineral content and bone metabolism in young adults with severe periodontitis

Amoxicillin plus metronidazole in the treatment of adult periodontitis patients

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2001
A double-blind placebo-controlled study
Abstract Background, aims: The aim of this double-blind, parallel study was to evaluate the adjunctive effects of systemically administered amoxicillin and metronidazole in a group of adult periodontitis patients who also received supra- and subgingival debridement. Methods: 49 patients with a diagnosis of generalised severe periodontitis participated in the study. Random assignment resulted in 26 patients in the placebo (P) group with a mean age of 40 years and 23 patients in the test (T) group which had a mean age of 45 years. Clinical measurements and microbiological assessments were taken at baseline and 3 months after completion of initial periodontal therapy with additional placebo or antibiotic treatment. Patients received coded study medication of either 375 mg amoxicillin in combination with 250 mg metronidazole or identical placebo tablets, every 8 hours for the following 7 days. Results: At baseline, no statistically significant differences between groups were found for any of the clinical parameters. Except for the plaque, there was a significantly larger change in the bleeding, probing pocket depth (PPD) and clinical attachment level (CAL) in the T-group as compared to the P-group after therapy. The greatest reduction in PPD was found at sites with initial PPD of 7 mm, 2.5 mm in the P-group and 3.2 mm in the T-group. The improvement in CAL was most pronounced in the PPD category 7 mm and amounted to 1.5 mm and 2.0 mm in the P- and T-groups, respectively. No significant decrease was found in the number of patients positive for any of the test species in the P-group. The number of patients positive for Porphyromonas gingivalis, Bacteroides forsythus and Prevotella intermedia in the T-group showed a significant decrease. After therapy there was a significant difference between the P- and the T- group in the remaining number of patients positive for P. gingivalis, B. forsythus and Peptostreptococcus micros. 4 subgroups were created on the basis of the initial microbiological status for P. gingivalis positive (Pg-pos) and negative patients (Pg-neg) in the P- and the T-groups. The difference in reduction of PPD between Pg-pos and Pg-neg patients was particularly evident with respect to the changes in % of sites with a probing pocket depth 5 mm. This % decreased from 45% at baseline to 23% after treatment in the Pg-pos placebo subgroup and decreased from 46% to 11% in the Pg-pos test subgroup (p0.005). In contrast, the changes in the proportions of sites with a probing pocket depth 5 mm in the Pg-neg placebo and Pg-neg test subgroup were similar, from 43% at baseline to 18% after treatment versus 40% to 12%, respectively. Conclusions: This study has shown that systemic usage of metronidazole and amoxicillin, when used in conjunction with initial periodontal treatment in adult periodontitis patients, achieves significantly better clinical and microbiological results than initial periodontal treatment alone. Moreover, this research suggests that especially patients diagnosed with P. gingivalis benefit from antibiotic treatment. Zusammenfassung Zielsetzung: Das Ziel dieser placebokontrollierten Doppelblindstudie mit parallelen Gruppen war es, die zusätzlichen Effekte der systemischen Gabe von Amoxicillin und Metronidazol bei Patienten mit Erwachsenenparodontitis zu untersuchen, bei denen auch eine supra- und subgingivale Instrumentierung durchgeführt worden war. Material und Methoden: 49 Patienten mit einer generalisierten schweren Erwachsenenparodontitis nahmen an der Studie teil. Zufällige Zuweisung der Therapien führte zu 26 Patienten in der Placebo-Gruppe (P) mit einem mittleren Alter von 40 und 23 Patienten in der Test-Gruppe (T) mit einem mittleren Alter von 45 Jahren. Klinische Messungen und mikrobiologische Untersuchungen wurden zu Beginn der Therapie sowie 3 Monate nach parodontaler Initialbehandlung mit zusätzlicher Placebo- bzw. Antibiotikagabe durchgeführt. Nachdem alle Zähne mit pathologisch vertieften Taschen subgingival instrumentiert worden waren, erhielten die Patienten eine kodierte Studienmedikation, die entweder aus 375 mg Amoxicillin und 250 mg Metronidazol oder identisch aussehenden Placebotabletten bestand, die die Patienten für 7 Tage alle 8 Stunden einnehmen sollten. Ergebnisse: Zu Beginn der Studie bestand kein statistisch signifikanter Unterschied zwischen den Versuchsgruppen hinsichtlich klinischer Parameter. Nicht für den Plaque Index, aber für Sondierungsblutung, Sondierungstiefen (ST) und klinische Attachmentlevel (PAL) kam es in der T-Gruppe zu signifikant stärkeren Veränderungen im Vergleich zur P-Gruppe. Die stärkste ST-Reduktion bzw. die größten Attachmentgewinne wurden bei Stellen gefunden, die initial ST 7 mm aufgewiesen hatten: P-Gruppe: ST=2.5 mm, PAL=1.5 mm; T-Gruppe: ST=3.2 mm, PAL=2.0 mm. Für keines der untersuchten Parodontalpathogene wurde eine signifikante Reduktion in der P-Gruppe beobachtet, während sich in der T-Gruppe eine signifikante Reduktion für Porphyromonas gingivalis, Bacteroides forsythus und Prevotella intermedia ergab. Nach Therapie ergab sich ein statistisch signifikanter Unterschied zwischen T- und P-Gruppe hinsichtlich Persistenz von P. gingivalis, B. forsythus und Peptostreptococcus micros. Entsprechend dem initialen mikrobiologischen Status für P. gingivalis wurden 4 Untergruppen gebildet: P. gingivalis positive (Pg+) oder (Pg,) Patienten in der T-bzw. P-Gruppe. Der Unterschied zwischen Pg+ und Pg, Patienten war besonders groß hinsichtlich der Veränderung des %-Anteils der Stellen mit ST5 mm. Dieser verringerte sich in der Pg+ P-Untergruppe von 45% auf 23% und in der Pg+ T-Untergruppe von 46% auf 11% (p0.005). Im Unterschied dazu war die Reduktion des Anteils der ST 5 mm in der Pg, P- und T-Untergruppen gleich: P-Gruppe: 43% auf 18%; T-Gruppe von 40% auf 12%. Schlußfolgerungen: Die systemische Gabe von Amoxicillin und Metronidazol zusätzlich zu subgingivaler Instrumentierung bei Patienten mit Erwachsenenparodontitis führt zu signifikant günstigeren klinischen und mikrobiologischen Ergebnissen als die konventionelle Therapie allein. Insbesondere Patienten mit P. gingivalis scheinen von dieser unterstützenden antibiotischen Therapie zu profitieren. Résumé Le but de cette étude parallèle en double aveugle était d'évaluer les effets supplémentaires apportés par l'administration d'amoxicilline et de metronidazole dans un groupe de patients atteints de parodontite de l'adulte qui ont reçu également un débridement supra et sous gingival. 49 patients présentant un diagnostic de parodontite généralisée sévère participèrent à l'étude. La composition des groupes sélectionnés au hasard, était de 26 patients dans le groupe placebo (P) avec un âge moyen de 40 ans et 23 patients dans le groupe test (T) avec une moyenne d'âge de 45 ans. Des mesures cliniques et des prélèvements microbiologiques étaient réalisés initialement et 3 mois après la fin de la thérapeutique parodontale initiale complétée par un placebo ou un traitement antibiotique. Les patients recevaient des médicaments codés pour l'étude de 375 mg amoxicilline combiné avec 250 mg de metronidazol ou des comprimés placebo identiques, toutes les 8 heures pendant les 7 jours suivants. Initalement, aucune différence statistiquement significative entre les groupes n'était observée, pour aucun des paramètres cliniques. En dehors de la plaque, il y avait une modification plus élevée significative pour le saignement, la profondeur de poche au sondage (PPD) et le niveau clinique d'attache (CAL) dans le groupe T, par rapport au groupe P, après traitement. La plus grande réduction pour PPD était observée pour les sites ayant une profondeur de poche au sondage intiale>ou égale à 7 mm, 2.5 mm dans le groupe P et 3.2 mm dans le groupe T. L'amélioration du CAL était plus prononcée pour la catégorie >ou égale à 7 mm et allait jusqu'à 1.5 et 2.0 mm dans les groupes P et T, respectivement. Aucune diminution significative n'était trouvée pour le nombre de patients positifs pour n'importe quelle espèce test dans le groupe P. Le nomber de patients positifs pour Porphyromonas gingivalis, Bacteroides forsythus et Prevotella intermedia dans le groupe T présentait une diminution significative. Après thérapeutique, il y avait une différence significative entre les groupe P et T, en ce qui concerne le nombre de patients positifs pour P. gingivalis, B. forsythus et Peptostreptococcus micros. 4-sous groupes furent créés sur la base de l'état microbiologique pour les patients positifs àP. gingivalis (Pg-pos), et négatifs (Pg-neg), dans les groupes P et T. La différence de réduction de PPD entre les patients Pg-pos et Pg-neg était particulièrement évidente en ce qui concernait les changements en % de sites présentant une profondeur de poche au sondage >ou égale à 5 mm. Ce % diminuait de 45% initialement à 23% après traitement dans le sous-groupe Pg-pos placebo et de 46% à 11% dans le sous-groupe Pg-pos test (p<0.005). A l'inverse, les changements observés dans les proportions de sites avec une profondeur de poche au sondage >5 mm dans les sous-groupes Pg-neg placebo et Pg-neg test étaient similaires, de 43% initialement à 18% après traitement contre 40% à 12% respectivement. En conclusion, cette étude a montré que l'utilisation systèmique de metronidazole et d'amoxicilline, lorsqu'elle est utilisée en complément du traitement parodontal initial chez des patients atteints de parodontite de l'adulte, donne, de façon significative, de meilleurs résultats cliniques et microbiologiques qu'un traitement parodontal initial seul. De plus, cette recherche suggère que les patients porteurs du P. gingivalis bénéficient particulièrement d'un traitement antibiotique. [source]

Autocrine growth factors in human periodontal ligament cells cultured on enamel matrix derivative

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2001
Staale P. Lyngstadaas
Abstract Objective: Enamel extracellular matrix proteins in the form of the enamel matrix derivative EMDOGAIN® (EMD) have been successfully employed to mimic natural cementogenesis to restore fully functional periodontal ligament, cementum and alveolar bone in patients with severe periodontitis. When applied to denuded root surfaces EMD forms a matrix that locally facilitates regenerative responses in the adjacent periodontal tissues. The cellular mechanism(s), e.g. autocrine growth factors, extracellular matrix synthesis and cell growth, underlying PDL regeneration with EMD is however poorly investigated. Material and Methods: Human periodontal ligament (PDL) cells were cultured on EMD and monitored for cellular attachment rate, proliferation, DNA replication and metabolism. Furthermore, intracellular cyclic-AMP levels and autocrine production of selected growth factors were monitored by immunological assays. Controls included PDL and epithelial cells in parallel cultures. Results: PDL cell attachment rate, growth and metabolism were all significantly increased when EMD was present in cultures. Also, cells exposed to EMD showed increased intracellular cAMP signalling and autocrine production of TGF-,1, IL-6 and PDGF AB when compared to controls. Epithelial cells increased cAMP and PDGF AB secretion when EMD was present, but proliferation and growth were inhibited. Conclusion: Cultured PDL cells exposed to EMD increase attachment rate, growth rate and metabolism, and subsequently release several growth factors into the medium. The cellular interaction with EMD generates an intracellular cAMP signal, after which cells secrete TGF-,1, IL-6 and PDGF AB. Epithelial cell growth however, is inhibited by the same signal. This suggest that EMD favours mesenchymal cell growth over epithelium, and that autocrine growth factors released by PDL cells exposed to EMD contribute to periodontal healing and regeneration in a process mimicking natural root development. [source]

Microbiology of destructive periodontal disease in adolescent patients with congenital neutropenia

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 11 2000
A report of 3 cases
Abstract Background, aims: Congenital neutropenia is one condition that may predispose for destructive periodontal disease at a young age. In this report, we describe the microbiology of 3 adolescent patients with congenital neutropenia two of whom suffered from severe periodontitis. Method: Microbiological testing of the parents was also performed in 1 case. DNA fingerprinting was used to study transmission of putative periodontal pathogens in this case. From 1 patient with periodontitis, Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were isolated; a 2nd periodontitis patient was infected with P. gingivalis. A 3rd patient had gingivitis only and no A. actinomycetemcomitans or P. gingivalis were found. Results: Using the amplified fragment length polymorphism DNA fingerprinting technique, bacterial transmission between the father and a patient was shown for A. actinomycetemcomitans but not for P. gingivalis. [source]

Experimental periodontitis in mice selected for maximal or minimal inflammatory reactions: increased inflammatory immune responsiveness drives increased alveolar bone loss without enhancing the control of periodontal infection

JOURNAL OF PERIODONTAL RESEARCH, Issue 4 2009
A. P. F. Trombone
Background and Objective:, Inflammatory immune reactions that occur in response to periodontopathogens are thought to protect the host against infection, but may trigger periodontal destruction. However, the molecular and genetic mechanisms underlying host susceptibility to periodontal infection and to periodontitis development have still not been established in detail. Material and Methods:, In this study, we examined the mechanisms that modulate the outcome of Aggregatibacter (Actinobacillus) actinomycetemcomitans -induced periodontal disease in mice mouse strains selected for maximal (AIRmax) or minimal (AIRmin) inflammatory reactions. Results:, Our results showed that AIRmax mice developed a more severe periodontitis than AIRmin mice in response to A. actinomycetemcomitans infection, and this periodontitis was characterized by increased alveolar bone loss and inflammatory cell migration to periodontal tissues. In addition, enzyme-linked immunosorbent assays demonstrated that the levels of the cytokines interleukin-1,, tumor necrosis factor-, and interleukin-17 were higher in AIRmax mice, as were the levels of matrix metalloproteinase (MMP)-2, MMP-13 and receptor activator of nuclear factor-,B ligand (RANKL) mRNA levels. However, the more intense inflammatory immune reaction raised by the AIRmax strain, in spite of the higher levels of antimicrobial mediators myeloperoxidase and inducible nitric oxide synthase, did not enhance the protective immunity to A. actinomycetemcomitans infection, because both AIRmax and AIRmin strains presented similar bacterial loads in periodontal tissues. In addition, the AIRmax strain presented a trend towards higher levels of serum C-reactive protein during the course of disease. Conclusion:, Our results demonstrate that the intensity of the inflammatory immune reaction is associated with the severity of experimental periodontitis, but not with the control of A. actinomycetemcomitans periodontal infection, suggesting that the occurrence of hyperinflammatory genotypes may not be an evolutionary advantage in the complex host,pathogen interaction observed in periodontal diseases. [source]

Analysis of the capsular polysaccharide biosynthesis locus of Porphyromonas gingivalis and development of a K1-specific polymerase chain reaction-based serotyping assay

JOURNAL OF PERIODONTAL RESEARCH, Issue 6 2008
J. Brunner
Background and Objective:,Porphyromonas gingivalis is a gram-negative obligate anaerobe that is strongly associated with severe periodontitis. Previous reports showed an association of P. gingivalis capsular polysaccharide with virulence. The K1 capsular polysaccharide was found to be more immunostimulatory than the other serotypes. Our objective was to explore the genetic background of the capsule biosynthesis (K-antigen) locus in a representative group of K1 serotype strains. Material and Methods:, We used restriction fragment length polymorphism, polymerase chain reaction (PCR) and DNA sequencing to study the capsular polysaccharide locus in P. gingivalis K1 strains. For serotyping by double immunodiffusion and PCR we used 32 strains of P. gingivalis, including strains of all six known K serotypes. Results:, All tested K1 strains showed high conservation of the capsular polysaccharide locus, although a DNA re-arrangement was found in two strains. Based on this information a K1-specific PCR-based serotyping assay was designed. The specificity and sensitivity of this test were confirmed using non-K1 P. gingivalis serotypes. Conclusion:, The capsular polysaccharide locus of P. gingivalis is conserved but may vary slightly among K1 strains. The new K1 serotyping assay presented here is much faster than double immunodiffusion and can detect K1 strains in a very selective and sensitive way. This method may therefore be clinically relevant in the detection of the virulent P. gingivalis K1 serotype. [source]

The infrabony defect and its determinants

JOURNAL OF PERIODONTAL RESEARCH, Issue 6 2006
C. -K.
Background and Objective:, The purpose of this study was to assess the defect width of infrabony defects in a cross-sectional study and to evaluate whether the defect width is a function of defect depth. Material and Methods:, Complete sets of intra-oral radiographs of patients with severe periodontitis, which exhibited at least one infrabony defect, were digitised and evaluated. The following parameters were measured: depth and width of the infrabony defect, defect angle, and width of the interdental spaces. Results:, Fifty-one patients (26 women), ranging from 21 to 73 yr of age (48.5 ± 13.4 yr), contributed a total of 1272 teeth with 135 infrabony defects (10.6%). Seventeen infrabony defects were located at sites without a neighboring tooth. Infrabony defects were statistically more prevalent in the mandible (n = 82) than in the maxilla (p = 0.013), and more prevalent at mesial sites (n = 92) than at distal sites (p < 0.001). At infrabony defects, the width of interdental spaces at the most coronal extension of the alveolar crest could be measured only at sites with neigboring teeth 2.67 ± 0.78 mm (range: 1.19,5.70 mm). Analysis failed to reveal a statistically significant difference between defect width at sites with (2.64 ± 0.82 mm) and sites without (2.76 ± 0.70 mm) a neighboring tooth. Multilevel regression analysis revealed narrow defect angles to be related to deep infrabony defects, whereas width of the interdental space and distal location were related to wide defects. Conclusion:, Defect angle depended on defect depth and defect width was not different at sites with or without a neighboring tooth. Even in severe periodontitis, infrabony defects are found only at a minority of teeth. [source]

Phenotypical and functional analysis of T cells in periodontitis

JOURNAL OF PERIODONTAL RESEARCH, Issue 4 2001
M. D. A. Petit
To explore aspects of cellular immune responses in the pathogenesis of periodontitis we analyzed phenotype and function of peripheral T cells. Two groups of subjects participated: one group consisted of 10 highly susceptible patients with severe periodontitis (mean age 29 years) and a control group consisted of 10 age, gender and race matched subjects with gingivitis. From all subjects peripheral blood was collected. The results showed that the numbers of CD3+, CD4+ and CD8+ T cells as well as the CD4/CD8 ratio, and the proliferative capacity of T cells, were not different between the two groups of subjects. Also, proportions of naive and memory T cells for both the CD4+ and CD8+ subpopulations were not different. Functional heterogeneity within the CD4+ and CD8+ T cell compartments was determined by intracellular analysis of interferon- ,(IFN- ,) and interleukin-4 (IL-4) production. On the basis of these latter analyses among CD4+ and CD8+ cells, T helper (Th) 1 or Th2 function and T cytotoxic (Tc) 1 or Tc2 function, respectively, could be deduced. No significant differences in proportions of CD4+ and CD8+ T cells positive for intracellular IFN- , or IL-4 were observed between periodontitis patients and gingivitis controls; however a higher level of intracellular IL-4 in CD8+ T cells was seen in periodontitis patients. This might indicate that there is a shift towards a Tc2 function within the CD8+ T cell subpopulation. The current explorative study suggests that further research into the role of CD8+T cells in the pathogenesis of periodontitis is warranted. [source]

Antigenic group II chaperonin in Methanobrevibacter oralis may cross-react with human chaperonin CCT

MOLECULAR ORAL MICROBIOLOGY, Issue 2 2010
K. Yamabe
Summary Methanobrevibacter oralis is an archaeal species frequently isolated from sites of severe periodontitis. However, its pathogenic roles remain unclear. Here, we aimed to isolate group II chaperonin from M. oralis and examine its antigenicity. The genes encoding two chaperonin subunits (Cpn-1 and Cpn-2) were cloned from M. oralis using polymerase chain reaction and genome walking procedures. Recombinant proteins Cpn-1 and Cpn-2 were generated, and the reactivities of sera from patients with periodontitis were examined by Western immunoblotting. The open reading frames of Cpn-1 and Cpn-2 genes consisted of 1641 and 1614 base pairs, respectively. Putative ATP-binding domains conserved among the chaperonin family were observed in both genes. The deduced amino acid sequences of the two genes showed 28.8,40.0% identity to each of the subunits of human CCT (CCT1,8). Thirty and 29 of 36 patients' sera reacted with the recombinant Cpn-1 and recombinant Cpn-2, respectively. Western immunoblotting using antiserum against human CCT subunits indicated that anti-CCT3 and anti-CCT8 antibodies recognized recombinant Cpn-1. In addition, anti-CCT1, CCT3, CCT6, and CCT8 antibodies recognized an antigen of approximately 60 kDa in M. oralis. The results suggested that the chaperonin subunits of M. oralis were antigenic molecules that were recognized by periodontitis patients and that may cross-react with human chaperonin CCT. [source]

Frequency of 530-bp deletion in Actinobacillus actinomycetemcomitans leukotoxin promoter region

MOLECULAR ORAL MICROBIOLOGY, Issue 5 2000
A. Contreras
Actinobacillus actinomycetemcomitans strains showing a 530-bp deletion in the promoter region of the leukotoxin gene operon elaborate high amounts of leukotoxin that may play a role in the pathogenesis of periodontal disease. This study used polymerase chain reaction detection to determine the occurrence of the 530-bp deletion in 94 A. actinomycetemcomitans strains from individuals of various ethnic backgrounds. Eleven blacks and one Hispanic subject but no Caucasian or Asian subjects showed the 530-bp deletion in the leukotoxin promoter region, suggesting that the deletion is mainly a characteristic of individuals of African descent. A. actinomycetemcomitans strains exhibiting a deletion in the leukotoxin promotor region occurred both in individuals having severe periodontitis and in adolescents revealing no evidence of destructive periodontal disease. [source]

Kostmann syndrome or infantile genetic agranulocytosis, part one: Celebrating 50 years of clinical and basic research on severe congenital neutropenia

ACTA PAEDIATRICA, Issue 12 2006
GÖRAN CARLSSON
Abstract Congenital neutropenia in man was first reported 50 years ago by the Swedish paediatrician Rolf Kostmann. He coined the term "infantile genetic agranulocytosis" for this condition, which is now known as Kostmann syndrome. Recent studies have demonstrated a lack of antibacterial peptides and severe periodontitis in these patients despite recombinant growth factor treatment. Moreover, an increased degree of apoptosis of myeloid progenitor cells in the bone marrow has been shown. Conclusion: Future studies should aim to clarify the underlying molecular genetic defect in Kostmann syndrome. [source]