Jorgen Slots

Microbial Pathogenicity Black-pigmented Bacteroides species, Capnocytophaga species, and Actinobacillus actinomycetemcomitans in Human Periodontal Disease: Virulence Factors in Colonization, Survival, and Tissue Destruction

There have been many advances in the past decade in our knowledge of the microflora associated with periodontal diseases, the potential of specific periodontal bacterial species to destroy periodontal tissues, and the host responses to bacterial infections of the periodontium. It is the purpose of this and an accompanying paper, to present important features of the host-parasite interaction in human periodontal disease. The present communication emphasizes characteristics of periodontopathic bacteria which may enable them initially to colonize the host, to survive in the periodontal pocket, and possibly to invade the gingival tissue despite potentially effective host defense systems, and to destroy the collagenous periodontal ligament, the alveolar bone, and other tissue components surrounding the tooth. It seems reasonable to assume that a bacterial species must possess factors applicable to most if not all of the above aspects of the infectious process of periodontal disease in order to produce periodontitis.

Host Responses Host Responses in Periodontal Diseases

Great progress has been made in our understanding of the pathogenesis of periodontal disease, the primary role of bacteria as etiologic agents, and the critical modifying role of host responses. It is useful to consider several stages in the pathogenesis of periodontal disease - (a) colonization, (b) invasion, (c) destruction, and (d) healing - and to place into perspective the various host responses as they may affect each of these four stages (Table 5). With respect to colonization, although very little direct evidence is available, it is reasonable to suggest that antibodies, either secretory or serum-derived, acting by virtue of their ability to block attachment, could inhibit colonization by immune reduction of adherence mechanisms. With respect to invasion of the tissue, it appears that phagocytes, particularly the neutrophils, are important, acting in concert with opsonic antibody and complement in ingesting and killing the periodontal microflora before or during the early invasive process. A major advance in our understanding of the pathogenesis of periodontal diseases is the realization that the virulence of periodontopathic bacteria relates to their leukaggressive properties, allowing them to evade neutrophil protective mechanisms. Invasion of the periodontal tissues by bacterial products may be inhibited by the complexing of these products with antibody with the formation of antigen-antibody complexes that are phagocytosed and digested, particularly by scavenger phagocytes such as the macrophage. With respect to the destructive phase of periodontal disease, it is clear that the direct effect of lymphocytes mediated either through direct cytotoxic activity, or through biologically-active destructive lymphokines (such as alpha-lymphotoxin and osteoclast activating factor), can lead to tissue destruction. Macrophages, through the production of monokines, collagenase, and reactive oxygen species, can also lead to tissue destruction. The direct effects of bacterial toxins or enzymes which can lead to tissue destruction can be inhibited by complexing with antitoxic or enzyme-neutralizing antibodies. With respect to healing and fibrosis, very little direct information is available; however, it is possible that the lymphocytes and macrophages affect fibrosis by the production of chemotactic factors for fibroblasts which would be expected to bring them to the area of periodontal inflammation and also by production of fibroblast-activating factors, which then cause the fibroblasts to proliferate and produce collagen which replaces lost collagen or results in fibrosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Salient Biochemical Characters of Actinobacillus actinomycetemcomitans.

A total of 136 strains of Actinobacillus actinomycetemcomitans were studied for 135 features. All isolates were small nonmotile capnophilic gram-negative rods which grew with no requirement of X or V growth factors. They all decomposed hydrogen peroxide, were oxidase-negative and benzidine-positive, reduced nitrate, produced strong alkaline and acid phosphatases, and fermented fructose, glucose and mannose. Variable fermentation results were obtained with dextrin, maltose, mannitol and xylose. Some isolates produced small amounts of gas. Representative strains of Haemophilusaphrophilus were morphologically and biochemically quite similar to A. actinomycetemcomitans. Characters which should prove to be useful to identify and distinguish these two species include catalase reaction, fermentation of lactose, starch, sucrose and trehalose, and resistance to sodium fluoride. This information allows a rapid diagnosis by species and may be helpful in studies of infections involving these organisms.

Antibiotic Susceptibility of Anaerobic Bacteria from the Human Oral Cavity

Anaerobic, agar-dilution, minimal inhibitory concentrations (MICs) of 18 antibiotics are given for the numerically important bacterial groups from the human oral cavity. Strains are divided into susceptibility categories using the guidelines for interpretation of MICs suggested by the National Committee for Clinical Laboratory Standards. These guidelines are based on data on antibiotic concentrations attainable in serum following various dosage regimens. MICs are also compared with attainable gingival fluid levels where these are known. The highest percentages of strains were susceptible to tetracycline, with 89% of the 139 strains tested susceptible to serum levels and 97% conditionally susceptible to attainable gingival fluid levels. Ninety-eight percent of strains were conditionally susceptible to attainable gingival fluid levels of minocycline, but many strains, including Actinobacillus actinomycetemcomitans, were only moderately susceptible to attainable serum levels of this tetracycline analogue. Carbenicillin was effective against most groups of organisms, with the important exception of A. actinomycetemcomitans, at serum levels attainable with oral formulations of carbenicillin. Only 2% of the total strains tested were resistant to penicillin, while 33% of strains were categorized as moderately susceptible. Clindamycin was active against many strains of Gram-negative bacteria but was not active against A. actinomycetemcomitans, some Bacteroides, Eikenella corrodens, or the anaerobic vibrios. Metronidazole was active against A. actinomycetemcomitans, all five groups of oral Bacteroides tested, and against Capnocytophaga species. Chloramphenicol was active against A. actinomycetemcomitans, but not against most of the other groups of oral organisms. Nearly all groups contained strains non-susceptible to serum levels attainable with the usual doses of erythromycin, spiramycin, vancomycin, kanamycin, neomycin, streptomycin, doxycycline, oxytetracycline, or chlortetracycline; several strains were resistant to maximum attainable serum levels of each of these antibiotics except doxycycline.

The Relationship Between the Periodontal Microflora and Alveolar Bone Loss in Macaca Arctoides

Several investigators have studied intensively for the last five years the subgingival microflora associated with various clinical entities of human periodontal disease (13,16). These studies have all been cross-sectional in nature. Although of considerable interest, the available data cannot provide information as to whether an organism initiates, contributes to the progression of, or is secondary to the pathological changes.