It is becoming increasingly apparent that periodontitis consists of mixture of diseases, most of which respond favorably to traditional mechanical therapy. Among these variants of the disease, some appear to be associated with unusual microbial infections and defective host defenses. Many of these fail to respond to conventional treatment. The recognition that some forms of periodontitis are refractory to standard periodontal therapy has given rise to a new classification of peridontitis. A series of 1692 subgingival microbial samples sent to a diagnostic microbiology laboratory included 738 samples that could be identified as compatible with a clinical diagnosis of refractory or recurrent periodontitis. In descending order of prevalence the associated microbiota included Bacteroides forsythus(85%),Fusobacterium species(78%), Spirochetes(67%), Campylobacter rectus(64%), Porphyromonas gingivalis(59%), Peptostreptococcus micros(58%), motile rods(46%), Prevotella intermedia(33%), Eikenella corrodens(13%), Capnocytophaga species(12%), and Actinobacillus actinomycetemcomitans(6%). Antibiotic resistance to tetracycline, penicillin G, or metronidazole was particularly noticeable for Fusobacterium species, Capnocytophaga species, and Actinobacillus actinomycetemcomitans. It was largely absent for Campylobacter rectus. No antibiotic data were obtained for Porphyromonas gingivalis or Bacteroides forsythus, as these species were detected by immunofluorescence. The results indicate that a substantial number of microorganisms associated with refractory periodontitis are variably resistant to commonly-used antibiotics. Diagnostic microbiology must be considered an essential adjunct to the therapist faced with periodontal lesions refractory to conventional treatment.
Actinobacillus ; Aggregatibacter actinomycetemcomitans ; Anti-Bacterial Agents ; Bacteroides ; Campylobacter ; Campylobacter rectus ; Capnocytophaga ; Classification ; Diagnosis ; Drug Resistance, Microbial* ; Eikenella ; Fluorescent Antibody Technique ; Fusobacterium ; Humans ; Metronidazole ; Microbiota ; Penicillin G ; Peptostreptococcus ; Periodontitis* ; Porphyromonas ; Porphyromonas gingivalis ; Prevalence ; Prevotella ; Tetracycline

PURPOSE: Specific bacteria are believed to play an important role in chronic periodontitis. Although extensive microbial analyses have been performed from subgingival plaque samples of periodontitis patients, systemic analysis of subingival microbiota has not been carried out in a Korean population so far. The purpose of this study was to investigate the prevalence of 29 putative periodontal pathogens in Korean chronic periodontitis patients and evaluate which pathogens are more associated with Korean chronic periodontitis. MATERIAL AND METHODS: A total of 86 subgingival plaque samples were taken from 15 chronic periodontits(CP) patients and 13 periodontally healthy subjects in Korea. CP samples were obtained from the deepest periodontal pocket (>3 mm probing depth[PD]) and the most shallow periodontal probing site (< or =3 mm PD) in anterior tooth and posterior tooth, respectively, of each patient. Samples in healthy subjects were obtained from 1 anterior tooth and 1 posterior tooth. Polymerase chain reaction (PCR) of 16S ribosomal DNA (rDNA) of subgingival plaque bacteria was performed. Detection frequencies(% prevalence) of 29 putative periodontal pathogens were investigated as bacterium-positive sites/total sites RESULTS: With the exception of Olsenella profuse and Prevotella nigrescens, the sites of diseased patients generally showed higher prevalence than the healthy sites of healthy subjects for all bacteria analyzed. Tanerella forsythensis (B.forsythus), Campylobacter rectus, Filifactor alocis, Fusobacterium nucleatum, Porphyromonas endodontalis and Porphyromonas gingivalis were detected in more than 80% of sites with deep probing depths in CP patients. In comparison between the sites (deep or shallow PD) of CP patients and the healthy sites of healthy subjects, there was statistically significant difference(P <0.05) of prevalence in T.forsythensis (B.forsythus), C.rectus, Dialister invisus, F.alocis, P.gingivalis and Treponema denticola. CONCLUSION: Our results demonstrate that the four putative periodontal pathogens, T.forsythensis (B.forsythus), C.rectus, P.gingivalis and F.alocis are closely related with CP patients in the Korean population.
Bacteria ; Campylobacter rectus ; Chronic Periodontitis ; DNA, Ribosomal ; Fusobacterium nucleatum ; Humans ; Korea ; Metagenome ; Periodontal Pocket ; Periodontitis ; Polymerase Chain Reaction ; Porphyromonas endodontalis ; Porphyromonas gingivalis ; Prevalence ; Prevotella nigrescens ; Tooth ; Treponema

OBJECTIVETo evaluate the prevalence of putative periodontal microorganism in Chinese patients with aggressive periodontitis (AgP).

METHODSA total of 72 subgingival plaque samples were collected from 55 AgP patients and 17 healthy subjects. Seven putative periodontal microorganisms including Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythensis (Tf), Treponema denticola (Td), Campylobacter rectus (Cr), Prevotella intermedia (Pi) and Prevotella nigrescens (Pn) were detected by using 16S rRNA based polymerase chain reaction (PCR).

RESULTSThe prevalence of Aa in AgP patients was very low (1.8%), while Pg, Tf, Td and Cr were more frequently detected in AgP patients (prevalence: 81.8%, 83.6%, 80% and 81.8%) than in healthy controls (prevalence: 17.6%, 11.8%, 5.9%, 29.4%, P < 0.01).

CONCLUSIONSThe prevalence of Pg, Tf, Td and Cr were very high in aggressive periodontitis patients, and the combination of these bacteria may play an important role in AgP.

Adolescent ; Adult ; Aggregatibacter actinomycetemcomitans ; isolation & purification ; Aggressive Periodontitis ; microbiology ; Bacterial Typing Techniques ; Campylobacter rectus ; isolation & purification ; Case-Control Studies ; Dental Plaque ; microbiology ; Dental Plaque Index ; Female ; Humans ; Male ; Polymerase Chain Reaction ; Treponema denticola ; isolation & purification ; Young Adult

PURPOSE: Few studies have examined periodontal pathogens from saliva samples in periodontally healthy young adults. The purposes of this study were to determine the prevalence of periodontopathic bacteria and to quantify periodontal pathogens in saliva samples using real-time polymerase chain reaction (PCR) assays in periodontally healthy Korean young adults under 35 years of age. METHODS: Nine major periodontal pathogens were analyzed by real-time PCR in saliva from 94 periodontally healthy young adults. Quantification of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Fusobacterium nucleatum, Campylobacter rectus, Peptostreptococcus anaerobius, and Eikenella corrodens was performed by DNA copy number measurement. RESULTS: F. nucleatum and E. corrodens were detected in all subjects; the numbers of positive samples were 87 (92.6%), 91 (96.8%), and 90 (95.7%) for P. gingivalis, P. anaerobius, and C. rectus, respectively. Other pathogens were also detected in periodontally healthy subjects. Analysis of DNA copy numbers revealed that the most abundant periodontal pathogen was F. nucleatum, which was significantly more prevalent than all other bacteria (P < 0.001), followed by P. anaerobius, P. gingivalis, E. corrodens, C. rectus, and T. denticola. There was no significant difference in the prevalence of each bacterium between men and women. The DNA copy number of total bacteria was significantly higher in men than in women. CONCLUSIONS: Major periodontal pathogens were prevalent in the saliva of periodontally healthy Korean young adults. Therefore, we suggest that the development of periodontal disease should not be overlooked in periodontally healthy young people, as it can arise due to periodontal pathogen imbalance and host susceptibility.
Aggregatibacter actinomycetemcomitans ; Bacteria ; Bacterial Load ; Campylobacter rectus ; Chronic Periodontitis ; DNA ; Eikenella corrodens ; Female ; Forsythia ; Fusobacterium nucleatum ; Healthy Volunteers ; Humans ; Male ; Peptostreptococcus ; Periodontal Diseases ; Porphyromonas gingivalis ; Prevalence ; Prevotella intermedia ; Real-Time Polymerase Chain Reaction ; Saliva ; Treponema denticola ; Young Adult

PURPOSE: The purpose of this randomized single-blind controlled trial was to elucidate the clinical and antimicrobial effects of daily phototherapy (PT) as an adjunct to scaling and root planing (SRP) in patients with chronic periodontitis. METHODS: The study was conducted from December 2013 to May 2014 at Ewha Womans University Mokdong Hospital, Seoul, Korea. Forty-one patients with mild to moderate chronic periodontitis were randomly divided into two therapeutic groups in a 1:1 ratio: SRP+PT and SRP (control) groups. All participants underwent full-mouth SRP. PT was performed thrice a day for a month by using electric toothbrushes with embedded light-emitting diodes. Plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing were assessed before (baseline) and four weeks after (follow-up) the treatment. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Fusobacterium nucleatum, Parvimonas micra, Campylobacter rectus, Eikenella corrodens, Streptococcus mutans, and Streptococcus sobrinus levels were detected by a real-time polymerase chain reaction at the same points in time. RESULTS: The clinical parameters improved in both the groups. At the follow-up assessment, PPD was significantly decreased in the SRP+PT group (P=0.00). Further, PPD and CAL showed significantly greater changes in the SRP+PT group than in the SRP group (PPD, P=0.03; CAL, P=0.04). P. gingivalis and T. forsythia levels decreased in this group, but no significant intergroup differences were noted. CONCLUSIONS: Adjunctive PT seems to have clinical benefits, but evidence of its antimicrobial effects is not sufficient. Long-term studies are necessary to develop the most effective PT protocol and compare the effectiveness of PT with and without exogenous photosensitizers.
Aggregatibacter actinomycetemcomitans ; Campylobacter rectus ; Chronic Periodontitis* ; Dental Scaling ; Eikenella corrodens ; Female ; Follow-Up Studies ; Forsythia ; Fusobacterium nucleatum ; Hemorrhage ; Humans ; Korea ; Periodontal Index ; Periodontitis ; Photochemotherapy ; Photosensitizing Agents ; Phototherapy* ; Porphyromonas gingivalis ; Prevotella intermedia ; Real-Time Polymerase Chain Reaction ; Root Planing ; Seoul ; Streptococcus mutans ; Streptococcus sobrinus ; Treponema denticola