Diana Marcela Castillo

Detection of specific periodontal microorganisms from bacteraemia samples after periodontal therapy using molecular-based diagnostics.

AIM The aim of this study was to assess the presence of subgingival pathogens in peripheral blood samples from periodontitis patients before and after scaling and root planing (Sc/RP) using nested polymerase chain reaction (nested PCR). MATERIALS AND METHODS Peripheral blood samples were obtained from 42 patients with severe generalized chronic or aggressive periodontitis. In each patient, four samples of peripheral blood were drawn at different times: immediately before the Sc/RP procedure; immediately after Sc/RP; 15 and 30 min. post-Sc/RP. Blood samples were analysed for bacteraemia with anaerobic culturing and nested PCR, using universal bacterial primers that target the 16S-rRNA gene of most bacteria, subsequently re-amplified with specific primers to Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Eikenella corrodens, Campylobacter rectus and Prevotella intermedia, using a modified phenol-chloroform method for DNA extraction. RESULTS Presence of specific periodontal pathogens in peripheral blood after treatment was detected in 54.8% of the patients, in 47.6% with anaerobic culturing and in 19% with nested PCR. In 16.6%, the periodontal pathogens were detected before Sc/RP. P. gingivalis and A. actynomicetemcomitans were the pathogens most frequently detected in the bloodstream before and after Sc/RP. CONCLUSIONS Nested PCR demonstrated the presence of DNA from periodontal pathogens in blood samples in severe periodontitis patients before, during and after periodontal therapy. The use of these molecular-based techniques may improve the accuracy from the results obtained by haemoculture.

Microbiome and Microbial Biofilm Profiles of Peri-Implantitis: A Systematic Review

BACKGROUND This systematic review assesses microbiologic profiles of peri-implantitis, periodontitis, and healthy implants based on studies that evaluated microbial biofilms and entire microbiomes to establish their similarities and differences. METHODS The Medical Literature Analysis and Retrieval System Online via PubMed, Excerpta Medica Database, and Cochrane Central Register of Controlled Trials, were searched without language restrictions through July 30, 2016. Observational studies that evaluated microbial profiles or entire microbiomes of peri-implantitis compared with healthy implants or periodontitis were considered eligible for inclusion. A descriptive summary was created to determine quantity of data and interstudy variations. RESULTS Of 126 potentially eligible articles, 26 were included in this study. Twenty-one of these articles evaluated the microbiologic profile of peri-implantitis versus healthy implants or periodontitis using conventional microbiologic techniques. Five articles evaluated the entire microbiome using genomic sequencing. Teeth with periodontitis, healthy implants, or implants with peri-implantitis were colonized by periodontal microorganisms. Porphyromonas gingivalis and especially Prevotella intermedius/nigrescens were often identified at peri-implantitis sites. Peri-implantitis sites were also colonized by uncultivable asaccharolytic anaerobic Gram-positive rods and anaerobic Gram-negative rods, which were not frequently identified in teeth with periodontitis or healthy implants. Opportunistic microorganisms were not found very frequently in peri-implantitis sites. CONCLUSIONS Peri-implantitis represents a heterogeneous mixed infection that includes periodontopathic microorganisms, uncultivable asaccharolytic anaerobic Gram-positive rods and other uncultivable Gram-negative rods, and, rarely, opportunistic microorganisms such as enteric rods and Staphylococcus aureus. Sequencing methods that evaluate the entire microbiome improve identification of microorganisms associated with peri-implantitis.

Periodontal Disease in Individuals With a Genetic Risk of Developing Arthritis and Early Rheumatoid Arthritis: A Cross-Sectional Study

BACKGROUND Recent consensus emphasizes the importance of studying individuals at risk for rheumatoid arthritis (pre-RA) and those with early RA (eRA). Periodontal tissues have been recently evaluated, but these studies are limited. To evaluate the periodontal condition, immunoglobulin (Ig)G subclasses against Porphyromonas gingivalis in individuals with pre-RA and eRA were compared with controls to establish an association between periodontal infection markers and rheumatic activity. METHODS Rheumatologic and periodontal condition was evaluated in 119 individuals with pre-RA, 48 patients with eRA, and matched controls. P. gingivalis IgG1 and IgG2 were analyzed. C-reactive protein, erythrocyte sedimentation rate (ESR), rheumatoid factor, anticitrullinated protein antibodies (ACPAs), and RA activity were measured. The groups were compared with McNemar test and paired t-test. Conditional logistic regression was performed for pre-RA confounders, and χ(2) test was used to evaluate periodontal variables and RA activity indices. RESULTS Pre-RA individuals showed significantly higher levels of plaque index (P = 0.01) and bleeding on probing (P = 0.03) and higher severity of periodontal disease (P = 0.02). Periodontitis was associated with pre-RA (odds ratio, 3.39; 95% confidence interval, 1.64 to 7.01) but not with eRA. In pre-RA, P. gingivalis-specific IgG2 was associated with ACPAs (P = 0.049) and disease severity visual analog scale (P = 0.03). In eRA, IgG2 against P. gingivalis was associated with ESR (P = 0.046) and ACPAs (P = 0.04). P. gingivalis was associated with ACPAs (P = 0.04). CONCLUSIONS This study shows that individuals with pre-RA have significant inflammatory periodontal involvement. There was a significant association between IgG against P. gingivalis and ACPAs in pre-RA and markers of RA activity in individuals with eRA.

Is the Treatment with Biological or Non-biological DMARDS a Modifier of Periodontal Condition in Patients with Rheumatoid Arthritis?

BACKGROUND AND OBJECTIVE Experimental models suggest the use of different therapy protocols in rheumatoid arthritis (RA) as modulators on periodontal condition. This study evaluated the effects of conventional drug treatment and anti-TNF therapy in patients with RA on microbiological and periodontal condition, establishing the association of markers of periodontal infection with indexes of rheumatic activity. MATERIALS AND METHODS One hundred seventy nine individuals with RA were evaluated (62 with anti-TNF-. and 115 with only DMARDs). The periodontal evaluation included plaque and gingival indexes, bleeding on probing (BOP), clinical attachment loss (CAL), pocket depth (PD) and subgingival plaque samples for microbiological analysis. Rheumatologic evaluations included a clinical examination, rheumatoid factor (RF), antibodies against cyclic-citrullinated peptides (ACPAs), and activity markers (DAS28-ERS), high sensitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR). RESULTS Anti-TNF-alpha therapy influenced periodontal microbiota with a higher frequency of T. denticola (p=0.01). Methotrexate combined with leflunomide exhibited a higher extension of CAL (p=0.005), and anti-TNF-alpha therapy with methotrexate was associated with a lower extension of CAL (p=0.05). The use of corticosteroids exerted a protective effect on the number of teeth (p=0.027). The type of DMARD affected P. gingivalis, T. forsythia and E. nodatum presence. Elevated ACPAs titers were associated with the presence of red complex periodontal pathogens (p=0.025). Bleeding on probing was associated with elevated CPR levels (p=0.05), and ESR was associated with a greater PD (p=0.044) and presence of red complex (p=0.030). CONCLUSION Different pharmacological treatments for RA affect the clinical condition and subgingival microbiota.

Ácido Hipocloroso: una Nueva Alternativa como Agente Antimicrobiano y para la Proliferación Celular para Uso en Odontología

El acido hipocloroso (HOCl) es un potente antimicrobiano no antibiotico utilizado en medicina clinica para el control de infecciones y reparacion de heridas. In vivo el HOCl es sintetizado por celulas del sistema inmune para el control del agente patogeno durante la fagocitosis y ha sido sintetizado y estabilizado en el laboratorio con potenciales aplicaciones profilacticas y terapeuticas en medicina humana. El efecto antimicrobiano, antinflamatorio y en la proliferacion celular lo hacen una sustancia que debe ser mas evaluada para uso clinico en otras areas de salud. Existe un interes en el desarrollo de nuevas sustancias antimicrobianas de uso topico en odontologia para el control del biofilm dental, la inflamacion gingival y para la cicatrizacion de heridas de la mucosa oral. Se presenta una revision de la literatura de los principales efectos del HOCl que sustentan su investigacion y uso en odontologia.

Eficacia Desinfectante Del Acido Hipocloroso Sobre Cepas Con Poder Patogénico De Cavidad Oral

Objetivo: Evaluar La Eficacia Antimicrobiana Del acido Hipocloroso Sobre Microorganismos Con Potencial Patogenico En Cavidad Oral. Metodo: Se Evaluo La Efectividad Antimicrobiana Y Anti Fungica Del acido Hipocloroso En Concentraciones De 125, 250, 500, 1000 Y 1500 Ppm A Diferentes Tiempos De Accion: 1, 5, 10 Y 15 Minutos, Sobre Diferentes Cepas Bacterianas ATCC Y Sobre Candida Albicans ATCC 90028. Se Empleo La Tecnica De Kelsey Maurer, Verificando La Presencia O Ausencia De Unidades Formadoras De Colonias (UFC). Cada Ensayo Se Realizo Por Triplicado Con Sus Respectivos Controles De Viabilidad. Resultados: Se Logro Inhibicion Bacteriana A Una Concentracion De 500 Ppm Durante 1 Minuto Para S. Sanguis, S. Mutans, E. Faecalis, E. Corrodens, C. Rectus, F. Nucleatum, E. Cloacae, K. Oxytoca Y K. Pneumoniae. Los Resultados Indican Que El acido Hipocloroso Se Constituye Como Una Alternativa Antimicrobiana Para Bacterias Con Capacidad Patogenica En La Cavidad Oral. Conclusiones: La C. Albicans Se Inhibio A Una Concentracion De 500 Ppm Por 10 Minutos, Lo Que Indica Bajo Poder Anti Fungico. Se Requieren Estudios Clinicos Para Evaluar La Efectividad Del acido Hipocloroso In Vivo.

Higher Levels of Secretory IgA Are Associated with Low Disease Activity Index in Patients with Reactive Arthritis and Undifferentiated Spondyloarthritis

Introduction Both reactive arthritis (ReA) and undifferentiated spondyloarthritis (uSpA) belong to the group of autoinflammatory diseases called spondyloarthritis (SpA). Hypotheses have been proposed about a relationship between the intestinal mucosa and inflammation of joint tissues. The role of immunoglobulin IgA or secretory immunoglobulin A (SIgA) in the inflammatory and/or clinical activity of patients with SpA remains poorly understood. Objective To evaluate the status of total IgA and SIgA, and the association among the levels of SIgA, IgA, IgA anti-Chlamydia trachomatis, and anti-Shigella spp. with the disease activity measures, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, was compared in a cohort of patients with ReA and uSpA and healthy subjects. Methods This was a cross-sectional study. The serum concentrations of SIgA, IgA anti-C. trachomatis, anti-Shigella spp., and total IgA were measured. Disease activity was measured in each patient by means of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS). Statistical analysis did include as bivariate evaluation, comparisons by Student’s t-test, Kruskal–Wallis test, and U Mann–Whitney test, with a multivariate evaluation by principal components analysis (PCA). A correlation analysis was carried out using the Pearson correlation coefficient and a linear regression models. All analysis were made using Stata version 11.2® for Windows, R V3.3.21. Statistical significance was defined a p-value <0.05. Results In all, 46 patients (78.2% men; mean age, 34.8 ± 12.3 years) and 53 controls (41% men; mean age, 32 ± 11.4 years) were included in the study. The mean serum levels of SIgA were higher in SpA patients than in healthy subjects (p < 0.001). Only SIgA levels correlated with disease activity: BASDAI (r = −0.42, p = 0.0046), ASDAS-CRP (r = −0.37, p = 0.014), and ASDAS-ESR (r = −0.45, p = 0.0021). The negative correlation between SIgA and all activity indices was higher in HLA-B27-positive patients (BASDAI r = −0.70, p = 0.0009, ASDAS-CRP r = −0.58, p = 0.0093, and ASDAS-ESR r = −0.57, p = 0.0083). The PCA showed three factors: the first component was constituted by variables referred as clinical activity measures, the second did include the serological activity markers, and the last component was compounded by age and symptoms time. Conclusion Elevated serum levels of SIgA were found to be related with low disease activity in patients with ReA and uSpA.

Viability and Effects on Bacterial Proteins by Oral Rinses with Hypochlorous Acid as Active Ingredient.

This study investigated the effect of hypochlorous acid (HOCl) rinses and chlorhexidine (CHX) on the bacterial viability of S. mutans, A. israelii, P. gingivalis, A. actinomycetemcomitans, E. corrodens, C. rectus, K. oxytoca, K. pneumoniae and E. cloacae. The percentage of live bacteria was tested by fluorescence method using Live/Dead kit(r) and BacLight (Molecular Probes(r)) and compared between groups by the Kruskal-Wallis and U Mann-Whitney tests with Bonferroni correction (p value<0.012). The effect of HOCl and CHX on total proteins of P. gingivalis and S. mutans was determined by SDS-PAGE. CHX showed a higher efficacy than HOCl against S. mutans, A. israelii, E. corrodens and E. cloacae (p<0.001) while HOCl was more effective than CHX against P. gingivalis, A. actinomycetemcomitans, C. rectus and K. oxytoca (p=0.001). CHX and HOCl had similar efficacy against K. pneumoniae. Proteins of P. gingivalis and S. mutans were affected similarly by HOCl and CHX. HOCl reduced the bacterial viability especially in periodontopathic bacteria, which may support its use in the control of subgingival biofilm in periodontal patients.

OP0171 Leptin levels, overweight and p gingivalis presence contribute to the mechanism of systemic inflammation in first-degree relatives of rheumatoid arthritis individuals

Background Association studies in rheumatoid arthritis (RA) have been focused in the pre-clinical phases of the disease in first-degree relatives (FDR). Data has shown that obesity, ACPA and the periodontal condition may modulate the severity and the clinical presentation of RA Objectives To investigate the levels of adipokines in FDR and establish their association with the state of rheumatic and periodontal condition Methods 124 FDR individuals and 124 healthy controls matched by age and gender were included. Rheumatologic (clinical and serological markers) and periodontal assessment was performed. It was quantified the adiponectin, leptin, IL6 levels. HLA-DRB1 was determined. Serum markers of RA (rheumatoid factor, erythrocyte sedimentation rate, C reactive protein (CRP), and APCA. P gingivalis and IgG1/IgG2 P gingivalis were measured. Radiographs of hands and feet were evaluated the Sharp-van der Heijde score. An association analysis was made to evaluate the relationship between adipokines and periodontal, rheumatologic conditions using X2 test, and logistic regression model was performed to confirm this associations Results In FDR group, 71.77% were women with a mean age of 39.24±12.22 years. 37.09% had overweight and 4.83% had obesity. Among the controls, 70.97% were women, with an average age of 39.31±12.30 years. 27.41% had overweight and 4.83% had obesity. Leptin levels were found in 37.66% vs 18.42% in controls(p=0.002). In FDR, 60.48% had periodontal disease of which 62.66% moderate, P gingivalis in 62.10%. In controls, 55.64% had periodontal disease, of which 63.76% moderate with 42.74% P gingivalis positive (p=0.002). In the FDR, radiography of hands and feet showed in 25.28% of them had some alteration, 68.18% had ≥1 erosion, 45.45% had ≥1 joint space narrowing and in 6.89% juxtaarticular osteopenia. An association of leptin levels with the low economic level was found p=0.006 and high levels of leptin in individuals with BMI ≥30 p=0.031. IL6 was found to be associated with severity of periodontal disease, with higher levels being found frequently in mild periodontal disease p=0.039.The condition of FDR was significantly associated with high leptin levels adjusted for presence of swollen joints, presence of P gingivalis and low levels of IL6 OR=2,57, 95% CI: 1.14 to 5.95. In this group, the individual with leptin at moderate levels adjusted with BMI >25, has a lower probability of presenting CRP >3 mg/L OR=0.43 95% CI: 0.20 to 0.90. Conclusions High levels of leptin, the presence of P gingivalis and swollen joints may be relevant conditions associated with the development of RA in FDR.Leptin levels and overweight can modulate the production of acute phase proteins in this group of individuals contributing to the mechanism of systemic inflammation. The clinical implications of our findings propose regulated exercise programs, oral hygiene, and weight control in FDR Reference [1] Unriza-Puin S, et al. Clin Rheumatol2017;28(36):799–806. Disclosure of Interest None declared

AB0201 Influence of siga on clinical activity markers in spa patients with non-radiographic and peripheral compromise

Background There are previous evidence about inflammatory signs related with the intestinal mucosa in spondyloarthritis patients with seronegative arthritis and them relation with articular inflammatory activity. It is uncertain the role of these serological markers on the inflammatory/clinical activity in patients with SpA Objectives To establish the relationship among activity variables and indices, and soluble markers associated to mucosal associated lymphoid tissue in a group of SpA patients. Methods Patients were selected by rheumatologists with the ESSG criteria. Levels of SIgA, IgA, IgA Chlamydia trachomatis, Shigella spp, Yersinia ssp, Campilobacter ssp and Salmonella ssp, CRP,ESR,HLA-B27,BASDAI,ASDAS-CRP and ASDAS-ESR were determined. A principal components analysis (PCA), Poisson Regression and multiple correspondence analysis were performed to find relationships between clinical and laboratory variables and SIgA. This study was approved for Ethics Committee. Results 46 patients were included (78.2% males with a mean age 34.8±12.3 years). It was reported at least one gastrointestinal sing in 69.2% of patients:abdominal bloating (45%), abdominal pain (43%); all patients showed at least one musculoskeletal symptom, 69.5% enthesitis, 63% inflammatory back pain and 58.6% arthritis, as well as 43.4% previous infection and 47.8% presented HLA-B27.The PCA showed three principal factors which cover a contribution of 82.2% to explain the SIgA variation.The ASDAS-CRP, ASDAS-ESR, BASDAI variables which provide the 47.12%;the regression model shows an inverse association among SIgA and BASDAI (prevalence ratio (PR):0.43, 95% CI:0.26–0.70 p=0.001), ASDAS-CRP (PR:0.72, 95% CI:0.24–0.95 p=0.021) and ASDAS-ESR (PR:0.69, 95% CI:0.39–0.95 p=0.007); however, a risk was demonstrated among BASDAI and Yersinia IgA (PR:1.68 95% CI:1.03–2.74 p=0.036) and between ASDAS-CRP with HLA-B27 (PR:1.62 95% CI:1.18–2.19 p=0.0002). There was a relationship between the absence of clinical activity (ASDAS-CRP, ASDAS-ESR and BASDAI), previous infection, Yersinia IgA with SIgA Q1 (27.8–43.0 ug/mL); the presence of arthritis, Salmonella IgA, and high levels of CRP and ESR were related with SIgA Q2; SIgA levels among (Q3)12.2–18.0 ug/mL were associated with inflammatory back pain, obesity and Salmonella IgA <1/1600. High scores of BASDAI and ASDAS-CRP, absence of previous infection had a strong relation with low levels of SIgA. Conclusions SIgA serum level were the only one serologic maker, which had an inverse correlation with all clinical activity variables of disease, previous infection and some specific antibodies associated with intestinal mucosal infection, suggesting a protective role of this molecular shape of IgA that is characteristic of mucosal immune responses References Mantis NJ. Mucosal Immunol (2011) 4:603–11. Disclosure of Interest None declared