Escolar Documentos
Profissional Documentos
Cultura Documentos
MICROBIAL
FLORA
PRESENTED BY :
DR . PRIYA SATHYAMURTHY
CONTENTS
Introduction
Taxonomy
terminologies
Classification
Ecosystem
Oral microflora
Oral econiches
Ecological relationships
Microbial complexes
Colonization of micro-organisms in the form of biofilm
Specific bacteria in periodontal diseases
Association of plaque microorganisms with
periodontal disease
Conclusion
References
MICRO ORGANISM
A microorganism (from the Greek: mikros, "small" and
organisms, "organism") is a microscopic organism,
which may be a single cell or a multi-cellular organism.
Single-celled microorganisms were the first forms of
life to develop on Earth, approximately 34 billion
years ago.
The possibility that microorganisms exist was
discussed for many centuries before their discovery in
the 17th century.
TAXONOMY
Taxonomy
Classification of living organisms into groups
TERMINOLOGIES
Species: A collection of
microbial strains that share many
properties and differ significantly
from other groups of strains
Strain:
Mechanism of
pathogenesis
Transmission
Adherence
Invasion
Colonization
Damage
Exit
Survival
Prokaryotes
Prokaryotes are organisms that
lack a cell nucleus and the other
membrane bound organelles.
They are almost always
unicellular.
Consisting of two domains,
bacteria and archaea.
CELL STRUCTURE OF
PROKARYOTE
1.- flagella
2.- pili (fimbriae)
3.- capsules
4.- slime layer
BACTERIA
They lack a nucleus and other membranebound organelles, and can function and
reproduce as individual cells, but often
aggregate in multicellular colonies. Their
genome is usually a single loop of DNA.
ARCHAEA
EUKARYOTES
Most living things that are visible to the naked eye in
their adult form are eukaryotes, including humans.
Unlike bacteria and archaea, eukaryotes contain
organelles such as the cell nucleus, the Golgi
apparatus and mitochondria in their cells.
SHAPES
: DARK FIELD
ATMOSPHERE
AEROBIC : That can survive and grow
in an oxygenated environment.
Amicroaerophileis amicroorganismthat
requiresoxygento survive, but requires
environments containing lower levels of oxygen
than are present in theatmosphere.
ANAEROBIC
Obligate anaerobes, which are harmed by the
presence of oxygen. Bacteroides, Clostridium,
Fusobacterium,, Porphyromonas, Prevotella,
Aerotolerant organisms, which cannot use
oxygen for growth, but tolerate its presence
Facultative anaerobes, which can grow
without oxygen but use oxygen if it is present.
Staphylococcus spp., Streptococcus spp.,
Escherichia coli, Listeria spp.
TEMPERATURE
PSYCHROPHILIC: Temperatures below
15 degrees.
MESOPHILIC: temperatures between 20
-45 degrees.
THERMOPHILIC : temperatures above
60 degrees
BACTERIAL METABOLISM
pH :
Neutrophil
Acidophil
68
Alkalophil
10.5
29
ECOLOGICAL
NICHE
&
Anicheis a term describing the way of life of
a species.
ECOSYSTEM
Each species is thought to have a separate,
unique niche.
Holozoic
nutrition
Heterotrophic
nutrition
Saprophytic
nutrition
Parasitic
nutrition
ORAL MICROFLORA
THE SOURCE OF
MICROORGANISMS
At birth the oral cavity is sterile but rapidly
becomes colonized from the environment,
particularly from the mother in the first feeding.
Newborn
6 months
Tooth eruption
Child to adult
FORMATION OF THE
ECOSYSTEM
Dynamic Equilibrium:
(1) Swallowing, Mastication, Or Blowing The Nose
(2) Tongue And Oral Hygiene Implements
(3) The Wash-out Effect Of The Salivary, Nasal, And
Crevicular Fluid Outflow
(4) Active Motion Of The Cilia (Nasal And Sinus Walls).
Most organisms can only survive in the oropharynx
when they adhere to either the soft tissues or the
hard surfaces (teeth, dentures, and implants).
40
41
Shedding surface:
The tongue;
ORAL ECONICHES
Hard structures teeth, providing
various locations for colonization:
Subgingival;
Supragingival;
MUCOSAL SURFACES:
These include the palate, cheek and tongue, which
have cells which are constantly replaced due to
the normal wear-and-tear of the mouth;
The different mucosal surfaces also have different
properties which contribute to the presence of
different types of bacteria:
The presence of the numerous crypts on tongue
allows for bacteria to be protected from the
normal shedding and removal by saliva flow,
Hence species not found elsewhere, such as
obligate anaerobes, can be found on the dorsum
of the tongue.
MUCOSAL RESERVOIR
SITES
Some oral species can invade epithelial
cells:
This requires communication between
bacteria and cells;
Bacteria subvert the cell to take them in:
Take control of the cytoskeleton;
Can live and grow inside;
Veillonella spp.;
S. oralis, S. sanguis;
Peptostreptococcus spp.
Neisseria;
Haemophilus;
Veillonella.
DENTAL ECONICHES
SUPRAGINGIVAL PLAQUE:
Gram positive MO;
Facultative anaerobes:
Streptococcus;
Actinomyces;
Gram negative:
Veillonella, Haemophilus,
Bacteroides
SUBGINGIVAL PLAQUE
From
negative rods:
Porphyromonas
gingivalis;
Porphyromonas
endodontalis;
Prevotella
melaninogenica;
Prevotella
intermedia;
Prevotella
loesheii;
Prevotella
denticola.
SUBGINGIVAL TOOTH
SURFACES
ORAL FLUIDS
Oral surfaces washes of two liquids:
Saliva;
Gingival fluid;
MICROORGANISMS IN SALIVA
Microbial composition of saliva is the most
similar to the tongue.
By acting as a buffer, saliva maintains the pH
of the mouth, ensuring the optimal growth of
the resident colonies;
Most of the microbes present in the mouth
utilize the glycoproteins and proteins in the
saliva as their main source of nutrition;
Proteins and glycoproteins of saliva are
responsible for the formation of the pellicle.
SALIVARY FLOW
It is responsible for the removal of nonendogenous bacteria which is unable to adhere to
specific sites in the mouth;
Areas which receive markedly less saliva flow,
such as deep gingival crevices, proximal spaces
and occlusal fissures, tend to have significantly
higher levels of bacterial buildup;
Saliva is carrying bacteria - the main source of
microbial transmission between individuals;
Saliva also circulates bacteria within the oral
cavity, resulting in re-colonization of oral surfaces
where the microflora might be removed via
mechanical forces such as cleaning.
GINGIVAL CREVICULAR
FLUID:
The flow of this fluid removes foreign microbes
which do not adhere to these surfaces;
For the resident population, the flow of
crevicular fluid provides these organisms with a
source of nutrition.
NORMAL - RESIDENT
FLORA
In a healthy body, the internal tissues
- blood, brain, muscle, etc., are
normally free of microorganisms;
However, the surface tissues - skin
and mucous membranes, are
constantly in contact with
environmental organisms and become
readily colonized by various microbial
species;
The mixture of organisms regularly found at any
anatomical site is referred to as thenormal
flora or resident flora, some researchers
prefer the term "indigenous microbiota".
RESIDENT MICROFLORA
Typical microflora of a econiche;
Microorganisms are separated and grouped according to
the different conditions of life;
Resident microflora has an important function in host:
Digestive and nutritional;
Competition with pathogenic microflora.
PATHOGENICITY OF
Microflora usually is non-pathogenic and form an
MICROFLORA
integral part of the host;
FUNCTION OF MICROFLORA
Colonization resistance is firstly achieved through the
saturation of oral surfaces with preexisting resident
bacteria, which reduces the available sites left for the
attachment of exogenous organisms;
Essential nutrients derived from the saliva and various
proteins in the oral cavity are also more effectively utilized
by the resident microflora, which inhibits infections via
competition for resources;
TRANSIENT MICROBIOTA
Transient microbes are just passing through;
Although they may attempt to colonize the same areas of
the body as do resident microbiota, transients are unable
to remain in the body for extended periods of time due to:
Competition from resident microbes;
Elimination by the bodys immune system;
Physical or chemical changes within the body that discourage
the growth of transient microbes.
OPPORTUNISTIC MICROBES
ENDOGENOUS MICROFLORA
That is microflora already present in the body, but has
previously been inapparent or dormant.
EXOGENOUS MICROFLORA
ECOLOGICAL RELATIONSHIPS
Independence
Life free from influences, management or control of
other organisms.
Dependence
MICROBIAL RELATIONSHIPS
Neutral;
Synergistic.
NEUTRAL
SYNERGY
Example of synergy
ANTAGONISM
Relationship of two microbial species living together,
yielding inhibition of their function, and less effect on the
independent operation of each one of them.
Mechanisms of microbial
Competition for adhesion receptors or for nutrients;
antagonism
Hydrogen peroxide:
Dairy complex;
Antibiotics;
Enzymes;
Bacteriocins.
AN EXAMPLE OF MICROBIAL
ANTAGONISM
S. mutans and Lactobacillus produce lactic acid
thereby producing an acidic environment;
It inhibits the growth of S.sanguis and S. oralis,
and gram negative microorganisms;
Separation by bacteriocins inhibit gram
positive microorganisms.
ANTIMICROBIAL
AGENTS
Fluorides have depressing
effect on microbial
attachment.
Reducing sugar transport;
Reduce their glycolytic activity;
Suppress the acid tolerance of gram +
microorganisms,
ADVERSE EFFECTS
GRAM-NEGATIVE FACULTATIVE
RODS
Enterobacteriaceae
Hemophilus influenzae
Eikenella corrodens
Actinobacillus
Actinomycetemcomitans
GRAM-POSITIVE ANAEROBIC
COCCI
Peptostreptococcus sp
GRAM-NEGATIVE ANAEROBIC
COCCI
Diphtheroids
Corynebacterium
GRAM-POSITIVE ANAEROBIC
RODS
Actinomyces israelii
A. odonotolyticus
A. Viscosus
Lactobacillus
GRAM-NEGATIVE AEROBIC OR
FACULTATIVE COCCI
Eubacterium
Neisseria sicca
N. Flavescens
SPIROCHETES
YEASTS
Treponema denticola
T. Microdentium
Candida albicans
Geotrichum sp.
Protozoa
Mycoplasma
Entamoeba gingivalis
Tirchomonas tenax
Mycoplasma orale
M. pneumoniae
Growth
on
hard
surfaces
Production
of Insol.
Extracellular
Polysaccharide
Production
of Acid
Cariogeni Endoc
carditis
isolates
S mutans
+++
S sanguis
++
++
S mitis
+
_
+
_
+
_
+++
S milleri
S
salivarius
DISTRIBUTION OF STREPTOCOCCI
IN THE ORAL
CAVITY
Species
Cheek
Tongue
Saliva
Tooth
S.mutans
+/-
++
S. mitis
+++
+++
+++
+++
S. salivarius
++
++
Porphyromonas: P. gingivalis
Prevotella: P. intermedia
Fusobacterium: F. nucleatum periodontal
pathogen;
Actinobacillus/Aggregatibacter:
A.actinomycetemcomitans associated with
aggressive periodontitis;
Treponema: group important in acute
periodontal conditions i.e ANUG;
Neisseria;
Veillonella.
85%
Remainder
Bacteria
Streptococci
Veillonella
Gram positive Diptheroids
Gram negative anaerobic rods
5-7%
Neissaeria
2%
Lactobacilli
1%
77
E. gingivalis
found in soft calculus,periodontal pockets and infection of tonsils
Can become opportunistic
pathogen
T.tenax
only parasitic flagellate in
oral cavity
--number increases in periodontitis
78
TEMPERATURE
Relatively constant - 34-36 ;
The temperature is variable on the teeth and mucosa;
When microorganisms colonize they are exposed to
extreme temperatures;
Lactobacillus;
Str. mutans;
REDOX
POTENTIAL
AND
Under the action of the enzymes some of the
ANAEROBIOSIS
components are subjected to oxidation, and
others to reduction;
These processes depend on the oxygen and
their redox potential;
In a predominance, reduction processes have a
negative redox potential and develop
anaerobic microorganisms;
Positive redox potential are seen in buccal and
palatal mucosa and the posterior part of the
tongue;
Negative redox potential are seen in
approximal surfaces, fissures and gingival
sulcus.
NUTRIENTS
Desquamated epithelial cells;
Gingival fluid;
Saliva;
Residues from host`s food;
Products of metabolism of other
microbial species.
HOST FACTORS
Hormonal changes;
Stress;
Genetic factors.
Nonspecific protection:
Mucin;
Antimicrobial factors:
Lysozyme;
Lactoferrin;
Salivary peroxidase;
Histatine-rich peptides;
Cistatin;
Leukocytes;
Complement.
REMOVAL OF THE
The majority of microorganisms in the mouth is removed
MICROORGANISMS
by washing action of saliva;
MUCIN
Provides a protective coating of enamel and mucosa;
Catches microorganisms and antigens like in a trap;
Limits microorganisms penetration into tissues;
Eliminates microorganisms with continuous updating
of mucin layer combined with washing action of
saliva flow;
As part of pelicle protects teeth from
demineralization.
COLONIZATION OF
MICRO-ORGANISMS
IN THE ORAL CAVITY
ADHESION
Adhesins can be of the microbial surface and receptors on
oral surfaces
The association of bacteria within mixed biofilms is not
random, rather there are specific associations among
bacterial species.
Socransky et al (1998)
MICROBIAL ADHESINS
Constructed of:
Polysaccharides;
Lipoteichoic acid;
Glycosyltransferase;
Carbohydrate-binding proteins;
BACTERIAL COMPONENTS
Mucin;
Glycosyltransferase;
Glycoproteins;
Glucans.
Amylase;
Lysozyme;
IgA, IgG;
Proline-rich proteins.
BACTERIAL ATTACHMENT TO A
SURFACE CAN BE DIVIDED INTO
SEVERAL DISTINCT PHASES
Primary and reversible adhesion;
Secondary and irreversible adhesion;
Biofilm formation.
CO-AGGREGATION
Coaggregation interactions are believed to
contribute to the development of biofilms by two
routes:
Adsorption:
DENTAL BIOFILM
95
BIOFILM
BIOFILM FORMATION
EXOPOLYSACCHARIDES THE
BACKBONE
OF BIOFILMS
The bulk
of the biofilm consists of the matrix or
glycocalyx and is composed predominantly of water
and aqueous solutes.
The dry material is a mixture of
Exopolysaccharides, proteins, salts, and cell
material.
Exopolysaccharides (EPS), produced by the bacteria
in the biofilm, are the major components of the
biofilm making up 5095% of the dry weight.
They play a major role in maintaining the integrity
of the biofilm as well as preventing desiccation and
attack by harmful agents.
In addition, they may also bind essential nutrients
such as cations to create a local nutritionally rich
98
1 colonizers (Gram+)
Streptococci bind pellicle
proteins from saliva DENT 5302;
2 colonizers (Gram-)
Bridge species - F.
nucleatum
Bind other bacteria
3 colonizers (Gram-)
Porphyromonas gingivalis
ECOLOGICAL
SUCCESSION
INTER-SPECIES COMMUNICATION
Streptococci ferment CHO;
Excrete lactic acid;
Veillonella use lactate made by
Strep for nutrition;
They are biofilm buddies.
Strep can make amylase;
Starch-digesting enzyme;
Enhances lactate excretion;
INTERSPECIES COLLABORATION O
2
Streptococcus
cristatus:
Facultative species:
Fusobacterium nucleatum:
Robust anaerobe;
Binding to strep improves
survival when O2 is present;
Porphyromonas gingivalis:
Sensitive anaerobe;
Coaggregation essential to
survival when O2 is present.
COLLABORATIVE INVASION
F. nucleatum invades
epithelial cells;
S. cristatus does not
invade cells;
After coaggregation, S.
cristatus is carried inside
by F. nucleatum.
Streptococcus cristatus thus coaggregates with F.
nucleatum
Primary
Colonizer
s
1. Streptococcus gordonii
2. Streptococcus intermedius
3. Streptococcus mitis
4. Streptococcus oralis
5. Streptococcus sanguinis
6. Actinomyces gerencseria
7. Actinomyces israelii
8. Actinomyces naeslundii
9. Actinomyces oris
10.Aggregatibacter actinomycetemcomitans
serotype a
11.Capnocytophaga gingivalis
12.Capnocytophaga ochracea
13.Capnocytophaga sputigena
14.Eik enella corrodens
15.Actinomyces odontolyticus
16.Veillonella parvula
106
Secondar
y
Colonizer
s
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Campylobacter gracilis
Campylobacter rectus
Campylobacter showae
Eubacterium nodatum
Aggregatibacter actinomycetemcomitans
serotype b
Fusobacterium nucleatum ssp nucleatum
Fusobacterium nucleatum ssp vincentii
Fusobacterium nucleatum ssp polymorphum
Fusobacterium periodonticum
Parvimonas micra
Prevotella intermedia
Prevotella loescheii
Prevotella nigrescens
Streptococcus constellatus
Tannerella forsythia
Porphyromonas gingivalis
Treponema denticola
107
103 bacteria.
108
Subgingival
Tissue
associated
109
Supra gingival
Sub gingival
Grams stain
Gram + or -ve
Mainly Gram ve
Morphotypes
Cocci, branching
rods, filaments &
spirochaetes
Energy Metabolism
Facultative, some
anaerobic
Mainly anaerobic
Energy source
Mainly ferment
carbohydrate
Many proteolytic
forms
Motility
Few
Many
Pathology
Gingivitis &
periodontitis
112
MICROBIOLOGY OF
PERIODONTAL DISEASES
ARE THERE TRUE ORAL PATHOGENS?
Classic concept of a pathogen
Not normally present
Produces virulence factors
Damage host directly (e.g. toxins)
Induce host to damage itself (immune responses)
SIMILARITY BETWEEN
PERIODONTAL DISEASES AND
OTHER INFECTIOUS
DISEASES
114
115
HISTORICAL PERSPECTIVE
Investigators in the period from 18801930
suggested four distinct groups of microorganisms
as possible etiologic agents; amoeba,
spirochetes, fusiforms, and streptococci.
116
AMOEBA
They found higher proportions of amoeba in
lesions of destructive periodontal diseases than in
samples taken from sites in healthy mouths or
mouths with gingivitis.
The role of amoeba in periodontal disease was
questioned by some authors because amoeba
were found in sites with minimal or no disease
and could not be detected in many sites with
destructive disease and because of the failure of
emitin to ameliorate the symptoms of the disease.
SPIROCHETES
118
FUSIFORMS
The third group of organisms that were frequently suggested to be
etiologic agents of destructive periodontal diseases, including
Vincents infection, were the spindle-shaped fusiforms.
These organisms were originally recognized on the basis of their
frequent appearance in microscopic examination of subgingival
plaque samples.
The organisms were first related to periodontal disease by Plaut
(1894).
Vincent (1899) distinguished certain pseudomembranous lesions of
the oral cavity and throat from diphtheria and recognized the
important role of fusiforms and spirochetes in this disease.
STREPTOCOCCI
These microorganisms were proposed on the basis of cultural
examination of samples of plaque from subgingival sites of
periodontal disease.
The selection of the streptococci may have been predicated upon
the fact these were the only species that could be consistently
isolated from periodontitis lesions using the cultural techniques of
that era.
119
ACTINOBACILLUS ACTINOMYCETEMCOMITANS
Aclinobaciltus" refers to the internal star-shaped morphology of
its bacterial colonies on solid media (Colebrook 1920) and to the short
rod or bacillary shape of individual cells (Lieske 1921, Slots 1982).
This is a small, non-motile, Gram-negative, saccharolytic,
capnophilic, round-ended rod.
This species was first recognized as a possible periodontal
pathogen in lesions of localized juvenile periodontitis. (Newman et al
1976, Slots 1980, Chung et al 1989) .
Subjects harboring A. actinomycetemcomitans with the 530 bp
deletion were 22.5 times more likely to convert to LJP (Bueno et al
1998).
120
121
122
PORPHYROMONAS GINGIVALIS:
It is a Gram negative, anaerobic, non motile, asaccharolytic rods
that usually exhibit coccal to short rod morphologies.
P. gingivalis is a member of the much investigated black
pigmented Bacteroides group. Initially they were grouped into a
single species, B. melaninogenicus (Bacterium melaninogenicum,
Burdon 1928).
123
TANNERELLA FORSYTHIA
Third consensus periodontal pathogen, B. forsythus, was first
described in 1979 (Tanner et al. 1979) as a fusiform
Bacteroides.
The organism is a Gram negative, anaerobic, spindle shaped,
highly pleomorphic rod.
B. forsythus was detected more frequently and in higher
numbers in active periodontal lesions than inactive lesions (Dzink
et al 1988).
This species has been shown to produce trypsin like
proteolytic activity (BANA test positive, Loesche et al 1992)
and induce apoptotic cell death (Arakawa et al 2000).
124
SPIROCHETES
These are Gram negative, anaerobic, helical shaped, highly motile
microorganisms that are common in many periodontal pockets.
Clearly, a spirochete has been implicated as the likely
etiologic agent of acute necrotizing ulcerative gingivitis
(Listgarten & Socransky 1964).
126
PREVOTELLA INTERMEDIA/PREVOTELLA
NIGRESCENS
P. intermedia is the second black pigmented Bacteroides to
receive considerable interest in pathogenesis of chronic
periodontitis.
It is a Gram negative, short, round-ended anaerobic rod.
They have been shown to be particularly elevated in acute
necrotizing ulcerative gingivitis (Loesche et al 1982), and also in
certain forms of periodontitis (Herrera et al 2000, Papapanou et
al 2000).
127
128
FUSOBACTERIUM NUCLEATUM
animalis.
This species is the most common isolate found in cultural
studies of subgingival plaque samples comprising app. 7-10% of
total isolates. (Moore et al 1985).
The species can induce apoptotic cell death in mononuclear
and polymorphonuclear cells (Jewett et al 2001).
Acts as microbial bridge facilitating coaggregation
129
between early and Late colonizers.
CAMPYLOBACTER RECTUS
C. rectus is a Gram negative, anaerobic, short, motile vibrio. The
organism is unusual in that it utilizes H2 or formate as its energy
source.
It was first described as a member of the vibrio
corroders, eventually shown to include members of a new genus
Wolinella and Eikenella corrodens.
It was found in higher numbers in disease sites as compared
with healthy sites and more in sites exhibiting active periodontal
destruction.(Rams et al 1993).
Like A. actinomycetemcomitans, C. rectus has been shown to
produce a leukotoxin. These are the only two oral species known
to possess this characteristic (Gillespie et al 1992).
130
EIKENELLA CORRODENS
E. corrodens is a Gram negative, capnophilic, asacharolytic,
regular, small rod with blunt ends.
This species was found more frequently in sites of periodontal
destruction as compared with healthy sites and higher levels in active
sites (Tanner et al 1987).
In tissue culture system, E. corrodens has been shown to
stimulate the production of matrix metalloproteinase (Dahan et al
2001) and IL-6 and IL-8 (Yumoto et al 1999).
131
PEPTOSTREPTOCOCCUS MICROS
P. micros is a Gram positive, anaerobic, small, asaccharolytic
coccus.
Two genotypes can be distinguished with the smooth
genotype being more frequently associated with periodontitis
lesions than the rough genotype (Kremer et al. 2000).
P. micros was found to be in higher numbers at sites of
periodontal destruction as compared with healthy sites
(Papapanou et al 2000, Riggio et al 2001).
132
SELENOMONAS SPECIES
The selenomonas spp. are Gram negative, curved,
saccharolytic rods and may be recognized by their curved shape,
tumbling motility and, in good preparations, by the presence of a
tuft of flagella inserted in the concave side.
Moore et al (1987) described six genetically and
phenotypically distinct groups isolated from oral cavity and
found at a higher proportion of shallow sites (PD>4mm) in chronic
periodontitis.
133
EUBACTERIUM SPECIES
Certain Eubacterium species have been suggested as possible
periodontal pathogens due to their increased levels in disease
sites. (Moore et al 1985).
E. nodatum, Eubacterium brachy and Eubacterium timidum
are Gram positive, strictly anaerobic, small somewhat
pleomorphic rods.
Some of these species elicited elevated antibody responses
in subjects with destructive periodontitis. (Martin et al 1988)
134
PATHOGENS STRENGTH OF
RELATIONSHIP WITH DISEASE
135
GINGIVITIS
The microbial load at diseased sites is greater, with
approximately 104 to 106 bacteria.
136
CHRONIC PERIODONTITIS
Cultivation of plaque microorganisms from sites of chronic
periodontitis reveals high percentages of anaerobic (90%) and
gram negative (75%) bacterial species.
Certain gram-negative bacteria with pronounced virulence
properties have been strongly implicated as etiologic agents
(e.g. P. gingivalis and Tannerella forsythensis).
137
GENERALIZED AGGRESSIVE
PERIODONTITIS
The subgingival flora in patients with generalized
aggressive periodontitis resembles that in other forms of
periodontitis.
The predominant subgingival bacteria in patients with
generalized aggressive periodontitis are P. gingivalis, T.
forsythensis A. actinomycetemcomitans, and Campylobacter
species.
139
NECROTIZING ULCERATIVE
GINGIVITIS/PERIODONTITIS
The majority of the spirochetes (treponemes)
associated with necrotizing ulcerative gingivitis are
uncultivable, but it is clear that they constitute a very
large and diverse group.
More than 50% of the isolated species were strict
anaerobes with P. gingivalis and F. nucleatum accounting for
7-8% and 3.4%, respectively.
140
PERIODONTAL ABSCESSES
The bacteria isolated from abscesses are similar to those
associated with chronic and aggressive forms of periodontitis.
An average of approximately 70% of the cultivable flora in
exudates from periodontal abscesses are gram-negative and
about 50% are anaerobic rods.
Periodontal abscesses revealed a high prevalence of the
following putative pathogens: F. nucleatum (70.8%), P. micros
(70.6%), P. intermedia (62.5%), P. gingivalis (50.0%), and T.
forsythensis (47.1%).
Enteric bacteria, coagulase-negative staphylococci, and
Candida albicans have also been detected.
141
PERIIMPLANTITIS
Studies have shown that microbiota associated with
periimplantitis are comparable to that of periodontitis (high
proportion of anaerobic gram negative rods, motile organisms,
and spirochetes).
Species such as A. actinomycetemcomitans, P. gingivalis, T.
forsythia, P. micros, C. rectus, Fusobacterium, and
Capnocytophaga are often isolated from failing sites.
Other species such as Pseudomonas aeruginosa,
enterobacteriaceae, Candida albicans and staphylococci, are also
frequently detected around implants.
142
VACCINES
Three types of vaccines were employed for the control of
periodontal diseases. These included vaccines prepared from pure
cultures of streptococci, and other oral organisms, autogenous
vaccines, and stock vaccines such as Van Cotts vaccine,
Goldenbergs vaccine or Inava Endocorps vaccine.
These vaccines were administered systemically or locally in the
periodontal tissues.
Autogenous vaccines were prepared from the dental plaque of
patients with destructive periodontal diseases.
Plaque samples were removed from the diseased site, sterilized
by heat, and/or by immersion in iodine or formalin solutions, then
re-injected into the same patient, either in the local periodontal
lesion or systemically.
Proponents of all three techniques claimed great efficacy for the
vaccination methods employed, while others using the same
techniques were more sceptical.
143
144
146
147
TRANSLOCATION AND
MECHANICAL DEBRIDEMENT
To reduce chance of intraoral transmission, one stage, Full
mouth disinfection has been introduced by Leuven group
in the 1990s
This strategy attempts to eradicate, or atleast suppress,
periopathogens in short time not only from the periodontal
pockets, but also from all their intraoral habitats(mucous
membrane, tongue, and saliva)
148
REFERENCES
1. Textbook of Microbiology- Anantnarayan
2. Carranzas clinical periodontology. 9th edition
3. Clinical Periodontology and Implant dentistry, Jan Lindhe, 4th edition.
Blackwell munksgaard.
4. PD Marsh: Plaque as a biofilm: pharmacological principles of drug
delivery and action in the sub- and supragingival environment. Oral
Diseases (2003) 9 (Suppl. 1), 1622
5. Anne. D. Haffajee & sigmund.S. Socransky. Microbial etiological
agents of destructive periodontal diseases. Periodontology 2000, Vol.
5, 1994, 78-1
6. Tatsuj Nishihara & Takeyoshi koseki. Microbial etiology of
Periodontitis. Periodontology 2000, Vol. 36, 2004, 1426.