RESUMEN
INTRODUCTION: The aim of this study was to investigate the microbiologic and immunologic factors related to orthodontic treatment-induced gingival enlargement (GE). METHODS: Our study included 12 patients with GE undergoing fixed orthodontic treatment and 12 periodontally healthy controls. At baseline, periodontal variables, subgingival plaque samples, and gingival crevicular fluid (GCF) samples were taken from 2 preselected sites in both the GE and the control groups. The levels of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Treponema denticola and Tannerella forsythia were determined by real-time polymerase chain reaction. GCF interleukin (IL)-1ß and transforming growth factor-beta 1 (TGF-ß1) were detected by enzyme-linked immunosorbent assay (Invitrogen, Camarillo, Calif). Periodontal therapy was given to the GE group, and all parameters were reassessed after 4 weeks. RESULTS: At baseline, the GE group showed higher prevalences of the 5 periodontal pathogens than did the control group (P <0.05). IL-1ß and TGF-ß1 levels at the GE sites were also significantly higher than those at the control sites (P <0.05). Four weeks after periodontal therapy, the GE group showed significant improvements in the clinical parameters associated with significant reductions of P gingivalis, A actinomycetemcomitans, and T denticola. The levels of IL-1ß decreased significantly compared with the baseline (P <0.05), whereas there was no significant change in TGF-ß1 levels (P >0.05). CONCLUSIONS: Periodontal pathogens might have a relationship with the initiation and development of orthodontic treatment-induced GE. Inflammatory cytokines (IL-1ß and TGF-ß1) can also be considered as contributing factors.
Asunto(s)
Sobrecrecimiento Gingival/etiología , Aparatos Ortodóncicos/efectos adversos , Ortodoncia Correctiva/efectos adversos , Adolescente , Antiinfecciosos Locales/uso terapéutico , Bacterias Anaerobias/aislamiento & purificación , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Niño , Clorhexidina/uso terapéutico , ADN Bacteriano/análisis , Placa Dental/microbiología , Índice de Placa Dental , Femenino , Sobrecrecimiento Gingival/inmunología , Sobrecrecimiento Gingival/microbiología , Sobrecrecimiento Gingival/terapia , Humanos , Interleucina-1beta/biosíntesis , Masculino , Ortodoncia Correctiva/instrumentación , Desbridamiento Periodontal , Índice Periodontal , Estadísticas no Paramétricas , Factor de Crecimiento Transformador beta1/biosíntesisRESUMEN
OBJECTIVE: To investigate the effect of putative periodontopathogenic bacteria on the development of drug-induced gingival overgrowth (GO) in renal transplant recipients. METHODS: A total of 57 patients undergoing cyclosporine treatment were divided into two groups according to GO index: with gingival overgrowth (group A) and without gingival overgrowth (group B). Demographic, pharmacologic and periodontal data were analyzed. The real-time polymerase chain reaction (PCR) method was used to detect and quantify five putative periodontopathogenic bacteria, including Porphyromonas gingivalis (Pg), Actinobacillus actinomycetemcomitans (Aa), Prevotella intermedia (Pi), Treponema denticola (Td) and Tannerella forsythia (Tf) in subgingival samples. Moreover, the relationship between the bacterial amount and the severity of GO was analyzed. RESULTS: Group A presented a significantly higher plaque index, sulcus bleeding index and probing depth than group B (P < 0.01). The occurrences of Pg, Td, and Tf in the group A (96%, 82% and 89%) were significantly increased compared with those in the group B (69%, 55% and 66%, P < 0. 05), respectively. The prevalence of Pg, Td, and Tf in the group A (79%) was markedly higher than that in the group B (38%, P < 0.01). The bacterial amount of Pg, Td, Tf and Pi were enhanced along with the severity of GO. However, the bacterial amount of Aa had no difference between two groups. CONCLUSIONS: Pg, Td, and Tf may have a significant relationship with the development of GO.
Asunto(s)
Ciclosporina/efectos adversos , Sobrecrecimiento Gingival/inducido químicamente , Sobrecrecimiento Gingival/microbiología , Adulto , Aggregatibacter actinomycetemcomitans/aislamiento & purificación , Técnicas de Tipificación Bacteriana , ADN Bacteriano , Femenino , Humanos , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa/métodos , Porphyromonas gingivalis/aislamiento & purificación , Prevotella intermedia/aislamiento & purificación , Treponema denticola/aislamiento & purificaciónRESUMEN
OBJECTIVE: The purpose of this study was to identify the presence of periodontal microrganisms in 35 renal transplant patients before the transplant procedure. STUDY DESIGN: At each time point, clinical parameters were recorded and subgingival plaque samples were collected from 4 different sites at days 30 and 90 after surgery. Samples were plated onto selective and nonselective media to determine total colony counts and the presence of putative periodontal pathogens. After transplant surgery, patients received immunosuppressive therapy. RESULTS: Statistical analysis of the microbiologic data showed significant changes between time points. An increase in total counts of microrganisms was observed on day 90 after surgery. As a side effect of cyclosporine, 14 patients developed gingival overgrowth. Beta-hemolytic Streptococcus was more frequently detected in patients who did not present gingival overgrowth 90 days after surgery. CONCLUSION: Quantitative and qualitative changes of the subgingival microflora can occur 90 days after transplant surgery, while patients are still under immunosupressive drugs.
Asunto(s)
Placa Dental/microbiología , Sobrecrecimiento Gingival/microbiología , Trasplante de Riñón , Pérdida de la Inserción Periodontal/microbiología , Adolescente , Adulto , Bacterias Anaerobias/aislamiento & purificación , Candida/aislamiento & purificación , Recuento de Colonia Microbiana , Femenino , Sobrecrecimiento Gingival/inducido químicamente , Bacterias Gramnegativas/aislamiento & purificación , Humanos , Inmunosupresores/uso terapéutico , MasculinoRESUMEN
OBJECTIVES: We investigated the relationship between phenytoin-induced gingival overgrowth (GO) and the harboring of periodontal bacteria. MATERIALS AND METHODS: Periodontal conditions and subgingival bacterial profiles were examined in 450 sites of 75 subjects. A polymerase chain reaction method was used to detect six bacterial species; Porphyromonas gingivalis (Pg), Actinobacillus actinomycetemcomitans (Aa), Tannerella forsythia, Treponema denticola (Td), Prevotella intermedia (Pi), and Prevotella nigrescens (Pn). Genetic variations of the Pg fimA gene were also examined. Bacterial occurrence was compared with the severity of GO, and alterations in the bacterial occurrence rate and quantities were monitored following periodontal treatment. RESULTS: The occurrences of Aa, Td, Pi, Pn, and Pg with type II fimA (type II Pg) were significantly associated with the severity of GO. Td occurrence was reduced in association with gingival improvement following ultrasonic scaling, however, no such relationship was observed with Aa, Pi, Pn, and Pg. In addition, Pg and Pi markedly persisted after treatment. Clinical improvement of the sites, following an Er:YAG laser treatment, significantly associated with quantitative reduction of Pg in improved sites, however, not that of Pi. CONCLUSION: Type II Pg and Td were each found to have a significant relationship with the development and deterioration of GO.
Asunto(s)
Proteínas Fimbrias/genética , Sobrecrecimiento Gingival/microbiología , Porphyromonas gingivalis/química , Porphyromonas gingivalis/patogenicidad , Treponema denticola/patogenicidad , Adolescente , Adulto , Aggregatibacter actinomycetemcomitans/patogenicidad , Anticonvulsivantes/efectos adversos , Bacteroides/patogenicidad , Niño , Placa Dental/microbiología , Raspado Dental , Femenino , Variación Genética , Sobrecrecimiento Gingival/inducido químicamente , Sobrecrecimiento Gingival/terapia , Humanos , Terapia por Láser , Masculino , Fenitoína/efectos adversos , Reacción en Cadena de la Polimerasa , Porphyromonas gingivalis/genética , Prevotella/patogenicidadRESUMEN
BACKGROUND: Severe gingival overgrowth (GO) is induced in patients taking cyclosporin A (CsA) following organ transplantation. Determining which patient will develop GO is still not possible. The purpose of this study was to establish an association between CsA and gingival overgrowth in heart transplant patients taking into account periodontal and microbiological conditions. METHODS: Thirty patients (10 female, 20 male; range: 13 to 67 years; mean age: 44.89) undergoing CsA treatment were evaluated using the gingival index (GI), plaque index (PI), probing depth (PD), and clinical attachment level (CAL). Subgingival samples collected from the deepest site of each quadrant and saliva samples were submitted to microbial analysis. All patients had at least 12 teeth. Exclusion criteria were the use of antibiotics and/or having undergone periodontal treatment 6 months prior to the study. Patients were divided in two groups: with gingival (GO+) and without gingival overgrowth (GO-). RESULTS: There were no statistically significant differences between the GO+ and GO- groups when CsA dosage, time since transplant, GI, PI, PD, and CAL were compared. Microbiological examination of the subgingival samples detected the following microorganisms: Actinobacillus actinomycetemcomitans (23%), Porphyromonas gingivalis (36%), Prevotella intermedia (93%), Fusobacterium sp. (66%), Campylobacter rectus (30%), Micromonas micros (66%), enteric rods (0%), and yeasts (30%). A positive association between M. micros and the GO+ group was found (P < 0.001). Yeasts were detected in 30% of the subgingival and saliva samples. CONCLUSIONS: Clinical parameters were not sufficient to determine which patients would develop GO. However, colonization by M. micros might play a role in the etiology of GO.
Asunto(s)
Ciclosporina/efectos adversos , Placa Dental/microbiología , Sobrecrecimiento Gingival/inducido químicamente , Trasplante de Corazón , Inmunosupresores/efectos adversos , Saliva/microbiología , Adolescente , Adulto , Anciano , Distribución de Chi-Cuadrado , Femenino , Sobrecrecimiento Gingival/microbiología , Humanos , Masculino , Persona de Mediana Edad , Peptostreptococcus , Complicaciones Posoperatorias/microbiologíaRESUMEN
Renal transplant patients undergoing immunosuppressive therapy may experience periodontal side-effects such as gingival overgrowth. This study evaluated the subgingival microbiota of renal transplant recipients with or without periodontal tissue destruction who may have concurrent gingival enlargement. Subgingival paper point samples taken from the deepest probing sites of 38 subjects (one per patient) were examined using direct microscopy and culture techniques. A complex microflora comprising gram-positive and gram-negative cocci, rods and filaments, fusiforms, curved rods and spirochetes was observed using microscopy. Yeasts were occasionally detected. Significantly higher proportions of gram-positive morphotypes, including gram-positive cocci, were observed in samples from periodontally healthy patients. The predominant cultivable microflora from anaerobic culture comprised several species of facultative and obligate anaerobes. Colonization of the subgingival sites by 'foreign' microbes that are normally dermal, intestinal or vaginal flora was detected in up to 50% of the samples. High mean proportions of lost or unidentified species were also occasionally noted. The results showed that the subgingival biofilm of renal transplant recipients with chronic periodontitis comprised mainly gram-negative rods and spirochetes. Besides the usual predominant cultivable subgingival microbiota associated with periodontitis, the high prevalence of unidentified and 'foreign' microbes indicates the possibility of subgingival microbial alteration in renal transplant patients.
Asunto(s)
Placa Dental/microbiología , Trasplante de Riñón , Periodontitis/microbiología , Adulto , Anciano , Bacterias Anaerobias/aislamiento & purificación , Recuento de Colonia Microbiana , Femenino , Sobrecrecimiento Gingival/inducido químicamente , Sobrecrecimiento Gingival/complicaciones , Sobrecrecimiento Gingival/microbiología , Humanos , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Periodontitis/complicaciones , Estadísticas no ParamétricasRESUMEN
BACKGROUND: Variation of integrin expression in healthy and diseased gingiva revealed a potential biological role for these cell matrix receptors during gingival remodeling. AIM: Here we determined the level of RNA and tissue localization of different integrin subunits in periodontitis and cyclosporin A-induced gingival overgrowth. METHODS: The level of expression was determined by Reverse Transcriptase Polymerase Chain Reaction in 12 periodontitis-affected patients, four patients exhibiting severe cyclosporin A-induced gingival overgrowth and seven healthy patients as controls. RESULTS: The RNA encoding for beta1, alpha2 and alpha5 integrin subunits were reduced in periodontitis gingiva. The reduction observed was stronger in cyclosporin A-treated patients as compared to the healthy controls, while RNA encoding for alpha1 subunit was increased. The RNA encoding for alpha6 integrin was only reduced in cyclosporin A-treated gingiva. Immunohistochemistry showed that i) integrin alpha2 expression is restricted to the gingival epithelium of cyclosporin A-treated patients, ii) the reduction of alpha6 integrin expression in cyclosporin A-treated gingiva is due to loss of expression at focal contacts and iii) beta1 integrin is evenly distributed in the three populations with an intensity decrease in periodontitis and cyclosporin A-treated gingiva. CONCLUSION: Taken together these results showed a role for the integrin receptors in periodontal diseases and cyclosporin A-induced gingival overgrowth.
Asunto(s)
Sobrecrecimiento Gingival/genética , Cadenas alfa de Integrinas/genética , Cadenas beta de Integrinas/genética , Periodontitis/genética , Adulto , Bacterias/aislamiento & purificación , Ciclosporina/efectos adversos , Femenino , Sobrecrecimiento Gingival/inducido químicamente , Sobrecrecimiento Gingival/microbiología , Sobrecrecimiento Gingival/patología , Humanos , Inmunosupresores/efectos adversos , Técnicas In Vitro , Masculino , Persona de Mediana Edad , Periodontitis/microbiología , Periodontitis/patología , ARN/análisis , Valores de Referencia , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Estadísticas no ParamétricasRESUMEN
BACKGROUND: The present study aimed to explain the interindividual variation in periodontitis susceptibility by differences in the initial adhesion rate of Porphyromonas gingivalis to the pocket epithelium of these individuals, and/or by inter-P. gingivalis strain differences in association capacity (adhesion and internalization). METHODS: Adhesion assays were performed on epithelial monolayers (cultured in vitro from pocket epithelium belonging to patients who were less or more susceptible to chronic adult periodontitis) using 11 genetically different clinical strains of P. gingivalis. RESULTS: Both the disease category (less susceptible versus susceptible) and the interstrain variation were found to have a significant effect (both P <0.05) on the initial bacterial association. The chronic adult periodontitis group showed significantly more association of P. gingivalis when compared to less susceptible patients (4.2 x 10(6) versus 3.5 x 10(6)). Also, the interstrain variation was significant, with strains Pg 4 and 5 representing the least and best associating bacteria (1.8 x 10(6) colony forming units for Pg 4, 9 x 10(6) for Pg 5). CONCLUSIONS: These results indicate that periodontitis susceptibility is influenced by both the interindividual differences in pocket epithelium (allowing more adhesion of P. gingivalis) or by the strain type by which the patient is infected (intra-species differences in adhesion capacity).
Asunto(s)
Adhesión Bacteriana/fisiología , Encía/microbiología , Periodontitis/microbiología , Porphyromonas gingivalis/fisiología , Adulto , Anciano , Pérdida de Hueso Alveolar/microbiología , Adhesión Bacteriana/genética , Células Cultivadas , Enfermedad Crónica , Recuento de Colonia Microbiana , Cálculos Dentales/microbiología , Índice de Placa Dental , Susceptibilidad a Enfermedades , Inserción Epitelial/microbiología , Inserción Epitelial/patología , Células Epiteliales/microbiología , Femenino , Encía/patología , Sobrecrecimiento Gingival/microbiología , Recesión Gingival/microbiología , Humanos , Masculino , Persona de Mediana Edad , Pérdida de la Inserción Periodontal/microbiología , Índice Periodontal , Bolsa Periodontal/microbiología , Bolsa Periodontal/patología , Periodontitis/patología , Porphyromonas gingivalis/clasificación , Porphyromonas gingivalis/genética , Serotipificación , Estadística como AsuntoRESUMEN
Gingival overgrowth is usually associated with systemic conditions or treatment (e.g. blood dyscrasias, anti-epileptic or immunosuppressive agents). A child is presented, who had enlarged gingiva associated with a generalized enamel defect (amelogenesis imperfecta (AI), hypoplastic type) and document the periodontal and restorative management of this case.
Asunto(s)
Amelogénesis Imperfecta/complicaciones , Sobrecrecimiento Gingival/etiología , Sobrecrecimiento Gingival/terapia , Amelogénesis Imperfecta/microbiología , Amelogénesis Imperfecta/terapia , Campylobacter/aislamiento & purificación , Niño , Femenino , Sobrecrecimiento Gingival/microbiología , Humanos , Porphyromonas gingivalis/aislamiento & purificación , Prevotella intermedia/aislamiento & purificaciónRESUMEN
The purpose of this study was to examine the composition of subgingival plaque of 140 periodontal lesions in 35 patients with cardiovascular disorders who were administered nifedipine and manifested nifedipine-induced gingival overgrowth (GO). Age was inversely associated with the GO. Plaque index and bleeding index showed a significant association with GO, while nifedipine dosage and duration of nifedipine therapy were not found to be significant predictors of GO. The gingival inflammation as expressed in the logistic regression model by the interaction term color x tone was found to be significantly associated with the GO. Statistically significant differences between the groups of comparable probing depth and different degrees of GO were detected for Propionibacterium acnes, Capnocytophaga gingivalis, Capnocytophaga ochracea, Capnocytophaga sputigena, Bacteroides gracilis, Fusobacterium mortiferum, Fusobacterium nucleatum, Fusobacterium varium and Selenomonas sputigena in deep and enlarged lesions. Significantly more frequently isolated were the bacterial species Eubacterium alactolyticum, Campylobacter concisus, C. gingivalis, C. ochracea, C. sputigena, F. mortiferum, F. nucleatum, and F. varium from the more enlarged lesions (GO >3).
Asunto(s)
Bloqueadores de los Canales de Calcio/efectos adversos , Placa Dental/microbiología , Encía/microbiología , Sobrecrecimiento Gingival/inducido químicamente , Bacterias Gramnegativas/clasificación , Bacterias Grampositivas/clasificación , Nifedipino/efectos adversos , Adulto , Factores de Edad , Anciano , Bacteroidaceae/clasificación , Bacteroidaceae/aislamiento & purificación , Bacteroides/aislamiento & purificación , Bloqueadores de los Canales de Calcio/administración & dosificación , Campylobacter/aislamiento & purificación , Capnocytophaga/clasificación , Capnocytophaga/aislamiento & purificación , Índice de Placa Dental , Eubacterium/aislamiento & purificación , Femenino , Predicción , Fusobacterium/clasificación , Fusobacterium/aislamiento & purificación , Fusobacterium nucleatum/aislamiento & purificación , Hemorragia Gingival/patología , Sobrecrecimiento Gingival/microbiología , Sobrecrecimiento Gingival/patología , Bolsa Gingival/patología , Gingivitis/inducido químicamente , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Nifedipino/administración & dosificación , Índice Periodontal , Propionibacterium acnes/aislamiento & purificaciónRESUMEN
Heart transplant patients take several medications that could affect their periodontal health. Gingival overgrowth associated with cyclosporin (immunosuppressant agent) and nifedipine (calcium channel blocker) is well documented. Candidal infections often develop because of immune suppression. This report describes the clinical and histopathological changes in the gingival tissues of a heart transplant patient and their management. The gingival tissues exhibited pronounced enlargement. The gingivae were lobulated, and the surface of the lobulations was pebbly and granular. Biopsies showed lobules of fibrous connective tissue covered by stratified squamous epithelium. The outer surfaces were dotted with numerous smaller papillations. Candidal hyphae were present in the superficial layers of the epithelium. The extensive papillary lesions appear to be related to candidiasis and constitute a condition which is best designated as papillary stomatitis. Hyperplastic gingival tissues were excised, and the patient was placed on periodic maintenance. One-year postoperative follow-up showed minor gingival growth.
Asunto(s)
Sobrecrecimiento Gingival/cirugía , Gingivectomía , Trasplante de Corazón , Bloqueadores de los Canales de Calcio/efectos adversos , Candidiasis Bucal/complicaciones , Tejido Conectivo/patología , Ciclosporina/efectos adversos , Epitelio/microbiología , Epitelio/patología , Fibrosis , Estudios de Seguimiento , Hiperplasia Gingival/patología , Hipertrofia Gingival/patología , Sobrecrecimiento Gingival/inducido químicamente , Sobrecrecimiento Gingival/microbiología , Sobrecrecimiento Gingival/patología , Humanos , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Nifedipino/efectos adversos , Estomatitis/microbiología , Estomatitis/patologíaRESUMEN
The effect of cyclosporin-A (CyA) on the dentogingival flora of ferrets with healthy and experimentally induced periodontal breakdown was studied. Five animals were given 10 mg/kg/d CyA. At the start of the experiments (day 0), ligatures were placed around 4 teeth in the right upper and lower jaws; corresponding contralateral teeth on the left side served as control. On days 0 and 28 (end of the experiment), microbiological samples were collected from the gingival sulcus of the experimental and the control teeth and from closely located gingival mucosa membrane. The samples were subjected to viable counts and to darkfield microscopic analyses. On day 0, facultative anaerobic rods, mainly Pasteurella spp, Alcaligenes spp, Corynebacterium spp. and Rothia spp dominated in the viable counts. No anaerobic bacteria were detected in the viable counts. On day 28 spirochetes increased in the experimental gingival sulcus samples and anaerobic bacteria appeared in most of the samples and constituted 40-60% of the total cultivable flora; Fusobacterium necrophorum and Eubacterium spp. predominated in the samples from the experimental sites. The results of the present study were compared with those of our previous investigation of ferrets not medicated with cyclosporin but also subject to experimental ligature periodontitis. Eubacterium spp. were absent in the animals not treated with cyclosporin, while this species was frequently present in the immunosuppressed ferrets. The results indicate that the presence of the large numbers of gram negative rods and of anaerobic bacteria may have enhanced the inflammatory process and further provoked the gingival overgrowth observed.