Page 28 - GP Fall Final 2017

microbial aggregates within periodontal pockets, their destruction is dependent on disrupting the
stability of the biofilm.
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When reviewing the OMT laboratory analysis, connections can be made to known behaviors of
the putative pathogens. For instance, although Aggregatibacter actinomycetemcomitans is known
to be a particularly aggressive periodontal pathogen, it is isolated most often in cases of juvenile
periodontitis. It is not a common isolate from many adult samples. Parvimonas micra is
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implicated in peri-implantitis, whereas Prevotella intermedia group uses steroid hormones as
growth factors and may be found in higher numbers in pregnant women. Fusobacterium
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nucleatum, an orange complex species can bind to epithelial cells which then provide a nutrient
source and environment (reduce the site oxygen) conducive to the increased growth of
Porphyromonas gingivalis, a red complex pathogen. Bacteria in the red and orange complexes
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act as co-aggregates for each other so treatment of one has to be designed with the others in
mind. Together, the bacteria are synergistic and much more virulent than alone. Understanding
periodontal treatment success from a microbiological standpoint depends on examining
inflammatory nature of periodontal disease in isolation; they depend on colonization periodontal treatment success from a
and how it contributes to systemic levels within the biofilm to support their growth microbiological standpoint depends on
of inflammation. As clinicians, we cannot and nutrition. Not only is their virulence examining interaction synergisms. 16
interaction synergisms.
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ignore the body of knowledge identifying affected by their place in the multilayered
how treatment of chronic inflammatory microbial aggregates within periodontal The sampling process is simple, can be
dental disease can improve systemic pockets, their destruction is dependent on completed in minutes and involves collecting
The sampling process is simple, can be completed in minutes and involves collecting salivary
conditions such as type 2 diabetes mellitus disrupting the stability of the biofilm. 12 salivary samples from periodontal pockets
and cardiovascular disease. We should also using paper points. At present only two labs
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be aware that any patient with persistent When reviewing the OMT laboratory in the country conduct a complete culturing
samples from periodontal pockets using paper points. At present only two labs in the country
low-level inflammation from periodontal analysis, connections can be made to and sensitivity testing of the oral samples--
disease is more likely to have higher than known behaviors of the putative pathogens. Temple University in Philadelphia and
conduct a complete culturing and sensitivity testing of the oral samples-- Temple University in
usual levels of proinflammatory cytokines, For instance, although Aggregatibacter University of North Carolina in Chapel
cellular injury throughout the body from actinomycetemcomitans is known to be Hill. Upon request, the testing laboratories
the spread of oral bacterial toxins, and a particularly aggressive periodontal will send a kit (Figure 2) with the necessary
Philadelphia and University of North Carolina in Chapel Hill. Upon request, the testing
higher risk of pulmonary diseases (in high- pathogen, it is isolated most often in items for sampling and transport. Once
risk patients) through the spread of bacteria cases of juvenile periodontitis. It is not a collected, the sample should be sent out to
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laboratories will send a kit (Figure 2) with the necessary
from the oropharynx to the respiratory common isolate from many adult samples. the laboratory via overnight delivery.
tract. 10 Parvimonas micra is implicated in peri-
implantitis, whereas Prevotella intermedia
items for sampling and transport. Once collected, the
In recognizing the need to sustainably group uses steroid hormones as growth
restore periodontal health, what should we factors and may be found in higher numbers
expect from OMT? The following (Figure in pregnant women. Fusobacterium
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1) is a list of periodontal pathogens whose nucleatum, an orange complex species can
presence, when above established threshold bind to epithelial cells which then provide
levels, is known to be linked to periodontal a nutrient source and environment (reduce
disease. 11 the site oxygen) conducive to the increased
Prevotella intermedia group Gram-negative obligate anaerobe 6 | P a ge

PUTATIVE PERIODONTAL PATHOGENS
Gram-negative facultative anaerobe;
Fusobacterium nucleatum Gram-negative obligate anaerobe
Aggregatibacter actinomycetemcomitans
non-motile
Porphyromonas gingivalis Gram-negative anaerobe; non-motile; Figure 2. Laboratory kit.
Parvimonas micra Gram-positive anaerobe The process of bacterial culture and
rod-shaped
Tannerella forsythia Gram-negative anaerobe sensitivity testing begins with placement
of the saliva samples in a medium that
Campylobacter rectus Gram-negative facultative anaerobe; motile encourages growth and colonization of
Gram-negative obligate anaerobe
Prevotella intermedia group
Fusobacterium nucleatum Gram-negative obligate anaerobe the bacteria. Gram stain is applied. (The
Streptococcus constellatum Gram-positive anaerobe; non-motile staining method, developed in the 1800s by
Parvimonas micra Gram-positive anaerobe Danish microbiologist Hans Gram utilizes
crystal violet dye to identify two large
Campylobacter rectus Gram-negative facultative anaerobe; groups of bacteria. The thick cell-walled
motile
Other/Opportunistic species Enteric species; Candida albicans; Staph. group of bacteria holds more dye, stains
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Gram-positive anaerobe; non-motile
Streptococcus constellatum Aureus; Strept. intermedius purple and is designated Gram-positive.
The bacterial group with the thinner cell wall
Other/Opportunistic species Enteric species; Candida albicans; holds less dye, stains red and is designated
Staph. Aureus; Strept. intermedius Gram-negative. Adult periodontitis is
dominated by Gram-negative anaerobic
bacteria.) Antibiotics are then added to the
culture to determine which one stops the
bacterial growth and colonization. One of
the ways which antibiotics are classified is
by their ability to destroy Gram-negative
and Gram-positive bacteria.
a.actinomycetamcomitans p. micros f. nucleatum c. rectus The laboratory will generate an analytical
Figure 1. Putative periodontal pathogens. report that identifies putative periodontal
pathogens isolated from the sample, as well
as antibiotics the pathogen(s) is susceptible
Figure 1. Putative periodontal pathogens.
While much is known in the literature about growth of Porphyromonas gingivalis, a red to. It is important to understand that, with
these specific pathogens, the true periodontal complex pathogen. Bacteria in the red and today’s international medical concerns
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challenge is based in recognizing the orange complexes act as co-aggregates for about antimicrobial resistance (AMR),
complexity and layering of the microbiota each other so treatment of one has to be empirical prescribing of broad spectrum
in biofilm, the bacterial complex that is designed with the others in mind. Together, antibiotics for periodontal disease may
the foundation of periodontal disease. The the bacteria are synergistic and much be ineffective and contribute to the
While much is known in the literature about these specific pathogens, the true periodontal
pathogenic bacteria in question do not exist more virulent than alone. Understanding development of resistant bacterial strains.
challenge is based in recognizing the complexity and layering of the microbiota in biofilm, the
www.nysagd.org l Fall 2017 l GP 24
bacterial complex that is the foundation of periodontal disease. The pathogenic bacteria in
question do not exist in isolation; they depend on colonization within the biofilm to support their
growth and nutrition. Not only is their virulence affected by their place in the multilayered
5 | P a ge