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Background: Periodontal diseases are associated with dysbiosis in the oral microbial communities. Managing oral biofilms is therefore key for preventing these diseases. Management protocols often include over-the-counter antimicrobial mouth rinses, which lack data on their effects on the oral microbiome's ecology, bacterial composition, metabolic activity, and dysbiosis resilience. This study examined the efficacy of antimicrobial mouth rinses to halt dysbiosis in in vitro oral biofilms under periodontitis-simulating conditions., Methods: Multispecies oral biofilms were grown on hydroxyapatite discs (HADs) and rinsed daily with one of six mouth rinses. Positive and negative controls were included. After three rinses, biofilms were analyzed with viability quantitative polymerase chain reaction and visualized using scanning electron microscopy. Supernatants of rinsed biofilms were used for metabolic activity analysis. In addition, human oral keratinocytes were exposed to rinsed biofilms to assess their inflammatory response. All outputs were analyzed for correlation using Spearman coefficient., Results: Product-related changes were observed in the rinsed biofilms. Three of the six tested mouth rinses could significantly prevent dysbiosis with ≥30% reduction in pathobiont abundance relative to the control. These biofilms had lower metabolic activity, and the exposed human oral keratinocyte produced less interleukin-8. Interleukin-8 production correlated to both pathobiont quantity and the metabolic activity of the biofilms., Conclusion: Some mouth rinses could support biofilm resilience and stop dysbiosis evolution in the biofilm model, with a clear product-related effect. Such mouth rinses can be considered for patients under maintenance/supportive periodontal therapy to prevent/delay disease recurrence. Others are more useful for different periodontal therapy stages., (© 2024 The Authors. Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.)

Biofilms are complex polymicrobial communities which are often associated with human infections such as the oral disease periodontitis. Studying these complex communities under controlled conditions requires in vitro biofilm model systems that mimic the natural environment as close as possible. This study established a multispecies periodontal model in the drip flow biofilm reactor in order to mimic the continuous flow of nutrients at the air-liquid interface in the oral cavity. The design is engineered to enable real-time characterization. A community of five bacteria, Streptococcus gordonii -GFPmut3*, Streptococcus oralis -GFPmut3*, Streptococcus sanguinis -pVMCherry, Fusobacterium nucleatum , and Porphyromonas gingivalis -SNAP26 is visualized using two distinct fluorescent proteins and the SNAP-tag. The biofilm in the reactor develops into a heterogeneous, spatially uniform, dense, and metabolically active biofilm with relative cell abundances similar to those in a healthy individual. Metabolic activity, structural features, and bacterial composition of the biofilm remain stable from 3 to 6 days. As a proof of concept for our periodontal model, the 3 days developed biofilm is exposed to a prebiotic treatment with L-arginine. Multifaceted effects of L-arginine on the oral biofilm were validated by this model setup. L-arginine showed to inhibit growth and incorporation of the pathogenic species and to reduce biofilm thickness and volume. Additionally, L-arginine is metabolized by Streptococcus gordonii -GFPmut3* and Streptococcus sanguinis -pVMCherry, producing high levels of ornithine and ammonium in the biofilm. In conclusion, our drip flow reactor setup is promising in studying spatiotemporal behavior of a multispecies periodontal community.ImportancePeriodontitis is a multifactorial chronic inflammatory disease in the oral cavity associated with the accumulation of microorganisms in a biofilm. Not the presence of the biofilm as such, but changes in the microbiota (i.e., dysbiosis) drive the development of periodontitis, resulting in the destruction of tooth-supporting tissues. In this respect, novel treatment approaches focus on maintaining the health-associated homeostasis of the resident oral microbiota. To get insight in dynamic biofilm responses, our research presents the establishment of a periodontal biofilm model including Streptococcus gordonii , Streptococcus oralis , Streptococcus sanguinis , Fusobacterium nucleatum , and Porphyromonas gingivalis . The added value of the model setup is the combination of simulating continuously changing natural mouth conditions with spatiotemporal biofilm profiling using non-destructive characterization tools. These applications are limited for periodontal biofilm research and would contribute in understanding treatment mechanisms, short- or long-term exposure effects, the adaptation potential of the biofilm and thus treatment strategies., Competing Interests: The authors declare no conflict of interest.

In our previous studies, Chlorin-e6 (Ce6) demonstrated a significant reduction of microorganisms' viability against multi-species biofilm related to periodontitis while irradiated with blue light. However, the conjugation of Ce6 and antimicrobial peptides, and the incorporation of this photosensitizer in a nanocarrier, is still poorly explored. We hypothesized that chlorin-e6 conjugated to the antimicrobial peptide LL-37 loaded nanoemulsion could inhibit a multi-species biofilm related to periodontitis during photodynamic therapy (PDT), the pre-treatment with hydrogen peroxide was also tested. The nanoemulsion (NE) incorporated with Ce6 was characterized regarding the physiochemical parameters. Images were obtained by transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Later, the Ce6 and LL-37 incorporated in NE was submitted to UV-Vis analysis and Reactive Oxygen Species (ROS) assay. Finally, the combined formulation (Ce6+LL-37 in nanoemulsion) was tested against multi-species biofilm related to periodontitis. The formed nanoformulation was kinetically stable, optically transparent with a relatively small droplet diameter (134.2 unloaded and 146.9 loaded), and weak light scattering. The NE system did not impact the standard UV-VIS spectra of Ce6, and the ROS production was improved while Ce6 was incorporated in the NE. The combination of Ce6 and LL-37 in NE was effective to reduce the viability of all bacteria tested. The treatment with hydrogen peroxide previous to PDT significantly impacted bacterial viability. The current aPDT regimen was the best already tested against periodontal biofilm by our research team. Our results suggest that this combined protocol must be exploited for clinical applications in localized infections such as periodontal disease. - Nanoemulsion demonstrated to be an excellent nanocarrier for photodynamic application. - Chlorin-e6 incorporated in nanoemulsion showed great physicochemical and biophotonic parameters. - The combination of chlorin-e6 and LL-37 peptide in nanoemulsion is effective to eliminate periodontal pathogenic bacteria. - The treatment with hydrogen peroxide previous to PDT significantly impacted bacterial viability., Competing Interests: Declaration of Competing Interest This manuscript has been read and approved in final form by all authors and the authors declare no conflicts of interest., (Copyright © 2023. Published by Elsevier B.V.)

Several oral diseases are characterized by a shift within the oral microbiome towards a pathogenic, dysbiotic composition. Broad-spectrum antimicrobials are often part of patient care. However, because of the rising antibiotic resistance, alternatives are increasingly desirable. Alternatively, supplying beneficial species through probiotics is increasingly showing favorable results. Unfortunately, these probiotics are rarely evaluated comparatively. In this study, the in vitro effects of three known and three novel Lactobacillus strains, together with four novel Streptococcus salivarius strains were comparatively evaluated for antagonistic effects on proximal agar growth, antimicrobial properties of probiotic supernatant and the probiotic's effects on in vitro periodontal biofilms. Strain-specific effects were observed as differences in efficacy between genera and differences within genera. While some of the Lactobacillus candidates were able to reduce the periodontal pathobiont A. actinomycetemcomitans, the S. salivarius strains were not. However, the S. salivarius strains were more effective against periodontal pathobionts P. intermedia, P. gingivalis, and F. nucleatum. Vexingly, most of the Lactobacillus strains also negatively affected the prevalence of commensal species within the biofilms, while this was lower for S. salivarius strains. Both within lactobacilli and streptococci, some strains showed significantly more inhibition of the pathobionts, indicating the importance of proper strain selection. Additionally, some species showed reductions in non-target species, which can result in unexpected and unexplored effects on the whole microbiome., (© 2023. The Author(s).)

Background: Periodontitis is a chronic inflammatory gum disease associated with systemic diseases such as cardiovascular diseases., Aim: To investigate the association of systemic blood biomarkers, C-reactive protein (CRP), levels of lipopolysaccharide (LPS), and IgG levels against periodontal pathogens Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) with the stability, based on the aortic diameter, the growth rate and the eligibility for surgical intervention, of patients with abdominal aortic aneurysm (AAA)., Methods: Patients with stable AAA (n = 30) and unstable AAA (n = 31) were recruited. The anti- A. actinomycetemcomitans and anti- P. gingivalis IgG levels were analyzed by ELISA, the LPS analysis was performed by using the limulus amebocyte lysate (LAL) test, and plasma levels of CRP were determined using an immune turbidimetric method. The association between these blood systemic biomarkers, AAA features, periodontal clinical parameters and oral microbial profiles were explored. Regression models were used to test the relationship between variables., Results: The presence of antibodies against Pg and Aa, LPS and high CRP concentrations were found in all AAA patients. The IgG levels were similar in patients with stable and unstable AAA (both for Aa and Pg). Among investigated blood biomarkers, only CRP was associated with AAA stability. The amount of LPS in saliva, supra, and subgingival plaque were significantly associated with the systemic LPS (p <0.05)., Conclusions: This post-hoc study emphasizes the presence of antibodies against Pg and Aa, LPS and high CRP concentrations in all AAA patients. The presence of Pg in saliva and subgingival plaque was significantly associated with the blood LPS levels. For further studies investigating periodontitis and systemic diseases, specific predictive blood biomarkers should be considered instead of the use of antibodies alone., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Salhi, Rijkschroeff, Van Hede, Laine, Teughels, Sakalihasan and Lambert.)

Background: Periodontitis is a chronic inflammatory disease characterized by Gram-negative bacteria responsible for the degradation of tissues surrounding tooth. Moreover, periopathogens can invade the bloodstream, disseminate and promote cardiovascular disease, such as the link between Porphyromonas gingivalis and atherosclerosis. The aim of this study was to explore the relationship between the severity of periodontitis and of abdominal aortic aneurysm (AAA)., Methods: This cross-sectional study compared patients with stable AAA (n = 30) and patients with unstable AAA (n = 31) based on aortic diameter, growth rate, and eligibility for surgical intervention. Periodontal clinical parameters were recorded as well as the Periodontal Inflamed Surface Area and the Periodontal Index for Risk of Infectiousness (PIRI). Microbiological analyses were performed on saliva and supragingival and subgingival plaque. Quantification of Tannerella forsythia (Tf), Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), Fusobacterium nucleatum (Fn), and Prevotella intermedia (Pi) was done by quantitative polymerase chain reaction., Results: The two AAA groups were homogeneous for age, sex, and most risk factors except hypertension and chronic obstructive pulmonary disease. Periodontal parameters were comparable but the proportion of patients with high PIRI scores was greater in those with unstable AAA (51.6% versus 23.3%). The probing depth (PD) and the proportion of PD >6 mm were positively correlated with AAA size and thrombus volume. Several associations were found between periopathogens such as Pg and AAA diameters and volumes, but no difference could be evidenced between stable and unstable AAA groups., Conclusions: Periodontitis was highly prevalent in both stable and unstable AAA patients. Severe and progressive periodontitis (stage IV and grade C) tended to be more frequent in the group of patients with unstable AAA. Moreover, Pg was observed in all the samples (saliva, supragingival, and subgingival plaque) and was correlated with AAA diameters and volumes. The study evidenced potential relationships between periodontitis severity and size of AAA., (© 2020 American Academy of Periodontology.)

Aim: To answer the following PICOS questions: in patients with periodontitis, which is the efficacy of adjunctive systemic antimicrobials, in comparison with subgingival debridement plus a placebo, in terms of probing pocket depth (PPD) reduction, in randomized clinical trials with at least 6 months of follow-up?, Material and Methods: A systematic search was conducted: 34 articles (28 studies) were included. Data on clinical outcome variables changes were pooled and analysed using weighted mean differences (WMDs), 95% confidence intervals (CI) and prediction intervals (PIs), in case of significant heterogeneity., Results: For PPD, statistically significant benefits (p < .001) were observed in short-term studies (WMD = 0.448, 95% CI [0.324; 0.573], PI [-0.10 to 0.99]) and long-term studies (WMD = 0.485, 95% CI [0.322; 0.648], PI [-0.11 to 1.08]). Additionally, statistically significant benefits were also found for clinical attachment level, bleeding on probing, pocket closure and frequency of residual pockets. The best outcomes were observed for the combination of amoxicillin plus metronidazole, followed by metronidazole alone and azithromycin. Adverse events were more frequently reported in groups using systemic antimicrobials., Conclusions: The adjunctive use of systemic antimicrobials in periodontal therapy results in statistically significant benefits in clinical outcomes, with more frequent adverse events in test groups using systemic antimicrobials., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

There is some evidence that periodontitis increases the risk of atherothrombosis. Abdominal aortic aneurysm (AAA) is a cardiovascular disease with specific risk factors and physiopathological mechanisms that can lead to rupture in the absence of treatment. The aim of the present systematic review was to explore the influence of periodontitis on the progression of AAAs as a specific disease. A systematic search in PubMed/MEDLINE and Embase databases was performed. Human and animal studies exploring the influence of periodontal pathogens on the progression of AAA were considered for inclusion. After systematic screening, 5 articles were included in the review. Due to the heterogeneity of the selected studies, a meta-analysis could not be performed. The descriptive analyses of the studies emphasized that periodontal pathogens or their by-products contribute to systemic and local innate immunity likely to be associated with AAA physiopathology. Periodontitis seems to play a role in the development and progression of AAA. The present systematic review suggests that the presence of periodontal bacteria in the bloodstream or in situ in the vascular lesion is a risk associated with aneurysmal disease progression.

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non-periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non-dental plaque biofilm-induced gingival diseases and dental plaque-induced gingivitis. Non-dental plaque biofilm-induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque-induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque-induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non-periodontitis patient or in a currently stable "periodontitis patient" i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient-centered approach to care, and therefore, creates differences in the way in which a "case" of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations., (© 2018 American Academy of Periodontology and European Federation of Periodontology.)

Aim: To compare the clinical and microbiological performance of minimally and moderately rough implants in patients with a history of severe periodontitis., Material and Methods: Forty-eight minimally (Turned surface [Tur]) and moderately (TiUnite surface [TiU]) rough implants were placed in eighteen patients according to a split-mouth protocol. Marginal bone loss, probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing (BoP) were recorded, and microbial samples were analysed by means of quantitative PCR., Results: The amount of bone loss over the 5-year period tended to be lower along Tur when compared with that of TiU surfaces (1.0 versus 1.7 mm, p = .06). Although the clinical outcomes tended to be better for Tur surfaces, there were no significant differences between both surfaces in mean PPD (Tur: 3.1 versus TiU: 4.2 mm, p = .09) or CAL (Tur: 0.5 versus TiU: 1.7 mm, p = .06). More bone loss and deeper pockets were recorded for partially than for fully edentulous patients. The cumulative survival rate at 5-year follow-up was 95.8% for Tur, and 100% for TiU surface implants. No significant differences were found between the surfaces in counts for key pathogens., Conclusion: In patients with a history of severe periodontitis minimally rough implants showed more favourable clinical parameters after 5 years of loading, when compared with moderately rough implants., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The predation of Bdellovibrio bacteriovorus on different periodontal pathogens has already been described. However, it is necessary to consider the polymicrobial nature of periodontal disease. The current study explores the predation of Bdellovibrio on oral pathogens organized in multispecies communities. The effect of the predator was evaluated on in vitro six species communities with microbial culturing. Additionally, the effect on ex vivo subgingival plaque and saliva samples from periodontitis patients was assessed. In the latter experiment results were examined with microbial culturing, quantitative polymerase chain reaction (qPCR) and denaturing gradient gel electrophoresis (DGGE). The latter technique was used to get an overview of the whole mixed microbial population. Results showed that even in more complex models, B. bacteriovorus was still able to predate on Fusobacterium nucleatum and Aggregatibacter actinomycetemcomitans. However predation on Prevotella intermedia and Porphyromonas gingivalis could not be validated in multispecies models. The effect of Bdellovibrio was not restricted to the target bacteria. Changes in the overall ecology of the different models were evident. It could be concluded that the efficiency of predation decreased when complexity of the models increased. However, B. bacteriovorus was able to attack two important oral pathogens, F. nucleatum, and A. actinomycetemcomitans, even when present in ex vivo clinical samples. These effects still have to be validated in in vivo models to see the impact of Bdellovibrio on the whole bacterial ecology., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Unlabelled: Periodontitis is a ubiquitous and irreversible inflammatory condition and represents a significant public health burden. Severe periodontitis affects over 11% of adults, is a major cause of tooth loss impacting negatively upon speech, nutrition, quality of life and self-esteem, and has systemic inflammatory consequences. Periodontitis is preventable and treatment leads to reduced rates of tooth loss and improved quality of life. However, successful treatment necessitates behaviour change in patients to address lifestyle risk factors (e.g. smoking) and, most importantly, to attain and sustain high standards of daily plaque removal, lifelong. While mechanical plaque removal remains the bedrock of successful periodontal disease management, in high-risk patients it appears that the critical threshold for plaque accumulation to trigger periodontitis is low, and such patients may benefit from adjunctive agents for primary prevention of periodontitis., Aim: The aims of this working group were to systematically review the evidence for primary prevention of periodontitis by preventing gingivitis via four approaches: 1) the efficacy of mechanical self-administered plaque control regimes; 2) the efficacy of self-administered inter-dental mechanical plaque control; 3) the efficacy of adjunctive chemical plaque control; and 4) anti-inflammatory (sole or adjunctive) approaches., Methods: Two meta-reviews (mechanical plaque removal) and two traditional systematic reviews (chemical plaque control/anti-inflammatory agents) formed the basis of this consensus., Results: Data support the belief that professionally administered plaque control significantly improves gingival inflammation and lowers plaque scores, with some evidence that reinforcement of oral hygiene provides further benefit. Re-chargeable power toothbrushes provide small but statistically significant additional reductions in gingival inflammation and plaque levels. Flossing cannot be recommended other than for sites of gingival and periodontal health, where inter-dental brushes (IDBs) will not pass through the interproximal area without trauma. Otherwise, IDBs are the device of choice for interproximal plaque removal. Use of local or systemic anti-inflammatory agents in the management of gingivitis has no robust evidence base. We support the almost universal recommendations that all people should brush their teeth twice a day for at least 2 min. with fluoridated dentifrice. Expert opinion is that for periodontitis patients 2 min. is likely to be insufficient, especially when considering the need for additional use of inter-dental cleaning devices. In patients with gingivitis once daily inter-dental cleaning is recommended and the adjunctive use of chemical plaque control agents offers advantages in this group., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: Although the complexity of the oral ecology and the ecological differences between health and disease are well accepted, a clear view on the dynamics in relation to disease is lacking. In this study, the prevalence and abundance of 20 key oral bacteria was assessed in health and disease and more importantly a closer look was given to the inter-bacterial relationships., Materials and Methods: A blinded microbiological database was analysed in this cross-sectional, retrospective study. The database was constructed based on microbiological analyses of samples from 6308 patients, with gradations of periodontitis (healthy to periodontitis). Data concerning the abundance of 20 oral bacteria and probing pocket depth were provided., Results: Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Eubacterium nodatum, Porphyromonas micra and Porphyromonas intermedia showed a clear increase in abundance and prevalence with increasing pocket depth. Correlation matrices illustrated that almost all microorganisms were in one way correlated to other species and most of these correlations were significant. Several beneficial bacteria showed strong correlations with other beneficial bacteria., Conclusion: Knowledge on bacterial correlations can pave the way for new treatment options focusing on restoring the shifted balance., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: This randomized controlled parallel trial investigates the effect of 3D animation on the increase and recall of knowledge on periodontitis by patients with periodontitis. The effects of a 3D animation (3D animation group) were compared with narration and drawing (control group) for periodontal patient education., Material and Methods: A total of 68 periodontitis patients were stratified according to educational level and then randomly allocated to control or 3D animation groups. All patients received: (1) a pre-test (baseline knowledge), (2) a patient education video (3D animation or control video), (3) a post-test (knowledge immediately after looking at the video), and (4) a follow-up test (knowledge recall after 2 weeks). Each test contained 10 multiple-choice questions., Results: There was no significant difference in baseline knowledge. Patients receiving the 3D animations had significantly higher scores for both the post-test and the follow-up test, when compared with patients receiving sketch animations., Conclusion: 3D animations are more effective than real-time drawings for periodontal patient education in terms of knowledge recall. 3D animations may be a powerful tool for assisting in the information process., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The aim of the current study is to compare the prevalence of commensal bacteria, with beneficial properties, for healthy and diseased individuals and additionally to examine the inhibitory effect of some commercial dietary probiotics on periodontopathogens, comparing this inhibitory effect to that of orally derived beneficial bacteria., Methods: Subgingival plaque samples from 35 patients (healthy and periodontitis patients) were analyzed. Growth inhibition of the periodontal pathogens Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, and Aggregatibacter actinomycetemcomitans was examined using the agar overlay technique and agar well diffusion method. The quantification of the inhibitory effect was checked with the agar well diffusion method., Results: Using the agar overlay technique, the prevalence of strains antagonistic toward P. gingivalis, A. actinomycetemcomitans, and F. nucleatum was found to be higher in healthy individuals than in individuals with periodontitis, but this could not be validated by the agar well diffusion assay. Compared with the antagonistic activity of the isolated strains, the probiotic strains overall showed a stronger inhibition of the periodontal pathogens., Conclusion: It was shown that some oral bacteria can cause antagonism toward periodontopathogens, and these observations underline the therapeutic potential of applications that stimulate oral health by the application of beneficial effector strains.

Aim: The aim of this study was to radiologically evaluate the impact of replacement therapy by monitoring bone density changes and alveolar bone level in periodontal pockets in a dog model., Material and Methods: Eight male beagle dogs with moderate periodontitis were enrolled in this split-mouth, double-blind randomized trial with ethical approval. Periodontal defects were surgically created bilaterally in the lower jaw. Four months later, the defects were randomly assigned to initial therapy (scaling and root planing) alone (control sites), or combined with multiple subgingival application of beneficial species. Intra-oral follow-up radiography was performed at this stage and 3 months later to verify the treatment effect., Results: The bone density within periodontal pockets treated with beneficial bacteria improved significantly after 12 weeks, while this was non-significant for the control pockets, receiving a single root planing at baseline. There was a significant increase in the bone level at the end of the study for the pockets receiving beneficial bacteria. Again, no significance was noted for the control pockets., Conclusions: This pilot study indicates the potential effect of a subgingival application of beneficial species in periodontal pockets, and illustrates the strength of standardized follow-up radiography to evaluate the effects of different treatment strategies on bone re-modelling.

Objectives: The beneficial effects of the one-stage, full-mouth disinfection remain controversial in the scientific literature. This might be due to the fact that an entire mouth disinfection with the use of antiseptics has been confused with a full-mouth scaling and root planing. This parallel, single blind RCT study aimed to compare several full-mouth treatment strategies with each other., Material and Methods: Seventy-one patients with moderate periodontitis were randomly allocated to one of the following treatment strategies: scaling and root planing, quadrant by quadrant, at two-week intervals (negative control, NC), full-mouth scaling and root planing within 2 consecutive days (FRP), or three one-stage, full-mouth disinfection (FM) protocols within 2 consecutive days applying antiseptics to all intra-oral niches for periopathogens using as antiseptics: chlorhexidine (FMCHX) for 2 months, amine fluoride/stannous fluoride for 2 months (FMF), or chlorhexidine for 2 months followed by amine fluoride/stannous fluoride for another 6 months (FMCHX+F). At baseline and after 2, 4, and 8 a series of periodontal parameters were recorded., Results: All treatment strategies resulted in significant (p<0.05) improvements of all clinical parameters over the entire duration of the study. Inter-treatment differences were often encountered. The NC group nearly always showed significant smaller improvements than the two CHX groups. The differences between the FRP or FM groups, and the two CHX groups only sporadically reached a statistical significance., Conclusion: These observations indicate that the benefits of the "OSFMD" protocol are partially due to the use of the antiseptics and partially to the completion of the therapy in a short time.

Probiotics have demonstrated oral health benefits by influencing the microbiome and the host. Although promising, their current use is potentially constrained by several restrictions. One such limiting factor lies in the prevailing preparation of a probiotic product. To commercialize the probiotic, a shelf stable product is achieved by temporarily inactivating the live probiotic through drying or freeze drying. Even though a lyophilized probiotic can be kept dormant for an extended period of time, their viability can be severely compromised, making their designation as probiotics questionable. Additionally, does the application of an inactive probiotic directly into the oral cavity make sense? While the dormancy may allow for survival on its way towards the gut, does it affect their capacity for oral colonisation? To evaluate this, 21 probiotic product for oral health were analysed for the number of viable (probiotic), culturable (CFU) and dead (postbiotic) cells, to verify whether the commercial products indeed contain what they proclaim. After isolating and uniformly lyophilizing three common probiotic species in a simple yet effective lyoprotective medium, the adhesion to saliva covered hydroxyapatite discs of lyophilized probiotics was compared to fresh or reactivated lyophilized probiotics. Unfortunately, many of the examined products failed to contain the claimed amounts of viable cells, but also the strains used were inadequately characterized and lacked clinical evidence for that unknown strain, questioning their label of a 'probiotic'. Additionally, lyophilized probiotics demonstrated low adhesive capacity compared to their counterparts, prompting the question of why fresh or reactivated probiotics are not currently used. [ABSTRACT FROM AUTHOR]

Aim: Our aim was to compare the prevalence and load of nine pathobionts in subgingival samples of healthy individuals and periodontitis patients from four different countries. Methods: Five hundred and seven subgingival biofilm samples were collected from healthy subjects and periodontitis patients in Belgium, Chile, Peru and Spain. The prevalence and load of Eubacterium brachy, Filifactor alocis, Fretibacterium fastidiosum, Porphyromonas endodontalis, Porphyromonas gingivalis, Selenomonas sputigena, Treponema denticola, Tannerella forsythia and Treponema socranskii were measured by quantitative PCR. Results: The association with periodontitis of all species, except for T. socranskii, was confirmed in all countries but Peru, where only P. endodontalis, P. gingivalis and T. denticola were found to be significantly associated. Moreover, most species showed higher loads at greater CAL and PPD, but not where there was BOP. Through Principal Component Analysis, samples showed clearly different distributions by diagnosis, despite observing a smaller separation in Peruvian samples. Conclusions: Unlike prevalence, relative load was found to be a reliable variable to discriminate the association of the species with periodontitis. Based on this, F. alocis, P. endodontalis, P. gingivalis, T. denticola and T. forsythia may be biomarkers of disease in Belgium, Chile and Spain, due to their significantly higher abundance in periodontitis patients. [ABSTRACT FROM AUTHOR]

Both in vitro and in vivo studies have shown that the probiotic Limosilactobacillus reuteri can improve oral health. Limosilactobacillus reuteri species are known to produce the antimicrobial "reuterin" from glycerol. In order to further increase its antimicrobial activity, this study evaluated the effect of the combined use of glycerol and Limosilactobacillus reuteri (ATCC PTA 5289) in view of using a synergistic synbiotic over a probiotic. An antagonistic agar growth and a multispecies biofilm model showed that the antimicrobial potential of the probiotic was significantly enhanced against periodontal pathobionts and anaerobic commensals when supplemented with glycerol. Synbiotic biofilms also showed a significant reduction in inflammatory expression of human oral keratinocytes (HOK‐18A), but only when the keratinocytes were preincubated with the probiotic. Probiotic preincubation of keratinocytes or probiotic and synbiotic treatment of biofilms alone was insufficient to significantly reduce inflammatory expression. Overall, this study shows that combining glycerol with the probiotic L. reuteri into a synergistic synbiotic can greatly improve the effectiveness of the latter. [ABSTRACT FROM AUTHOR]

There is increasing public interest in natural or herbal-based healthcare products. This trend is not only visible in supermarkets and dental practices, but also in the scientific world. An improving number of clinical trials are being conducted to validate the claims made about these products in regards to periodontal health. Among single component preparations, Aloe vera and green tea are the most studied natural ingredients. Concerning polyherbal mixtures, triphala has garnered great interest. The effects of these natural products on periodontal health is encouraging, with almost all studies showing an inhibitory effect on plaque accumulation and an improvement in gingival health. However, more studies are needed to be able to design clinical guidelines to guide the use of these natural products in periodontal practice. For most of these products, few studies are available and, moreover, the available studies are limited in duration, the number of participants, and the specific composition of the natural product is often not described in detail. [ABSTRACT FROM AUTHOR]

Aim: To answer the following PICOS question: in adult patients with periodontitis, which is the efficacy of adjunctive locally delivered antimicrobials, in comparison with subgingival debridement alone or plus a placebo, in terms of probing pocket depth (PPD) reduction, in randomized clinical trials with at least 6 months of follow‐up. Material and methods: A systematic search was conducted: 59 papers, reporting 50 different studies, were included. Data on clinical outcome variables changes were pooled and analysed using weighted mean differences (WMDs) and 95% confidence intervals (CI), and prediction intervals (PI), in case of significant heterogeneity. Results: Statistically significant differences were observed, in 6‐ to 9‐month studies, for PPD (WMD = 0.365, 95% CI [0.262; 0.468], PI [−0.29; 1.01]) and clinical attachment level (CAL) (WMD = 0.263, 95% CI [0.123; 0.403], PI [−0.43; 0.96]). For long‐term studies, significant differences were observed for PPD (WMD = 0.190, 95% CI [0.059; 0.321]), but not for CAL. For adverse events, no differences were observed. Results were affected by study design (split‐mouth versus parallel studies) and assessment (full‐ or partial‐mouth), as well as by the formulation tested. Conclusions: The use adjunctive locally delivered antimicrobials in periodontitis therapy results in statistically significant benefits in clinical outcomes, without relevant side effects. [ABSTRACT FROM AUTHOR]

Aim: To examine the adjunctive effect of a Lactobacillus reuteri probiotic (ATCC PTA 5289 & DSM 17938) on the re‐instrumentation of residual pockets. Materials and Methods: This randomized, double‐blind, placebo‐controlled study included 39 previously non‐surgically treated periodontitis patients. A re‐instrumentation was carried out, and probiotic and/or placebo drops were applied according to the study protocoll. Patients afterwards received lozenges to use 2×/day for 12 weeks. Probing pocket depth (PPD), recession, bleeding on probing and plaque levels were analysed, next to the microbiological impact. Results: No effects of the probiotic drops could be found. However, after 24 weeks, the overall PPD in the probiotic lozenges group (2.64 ± 0.33 mm) was significantly lower compared to the control lozenges (2.92 ± 0.42 mm). This difference was even more pronounced in moderate (4–6 mm) and deep (≥7 mm) pockets. In the probiotic lozenges group, there were also significantly more pockets converting from ≥4 mm at baseline to ≤3 mm at 24 weeks (67 ± 18% versus 54 ± 17%) and less sites in need for surgery (4 ± 4% versus 8 ± 6%). However, the probiotic products did not influence the microbiological counts of the periodontopathogens. Conclusion: The adjunctive consumption of L. reuteri lozenges after re‐instrumentation improved the PPD reduction, without an impact on pocket colonization with periodontopathogens. [ABSTRACT FROM AUTHOR]

Peri-implantitis can be explained using a multicausality model. Many factors are involved in the etiology of peri-implantitis, but patient compliance also plays a key role. Oral hygiene, attending recall visits, smoking behavior, and therapy comprehension are relevant factors that contribute to peri-implant health. The clinician should create the most optimal conditions for patients to facilitate adequate oral self-care and to help patients improve their oral hygiene skills. Implementation of a supportive periodontal therapy program is mandatory to control inflammation and plaque accumulation, as well as to keep the incidence of peri-implant diseases low. Patient compliance, including plaque control and dental follow-up, must be optimal. Consequently, precautions must be taken with patients treated with dental implants. [ABSTRACT FROM AUTHOR]

Background: Only recently the concept of prebiotics has been introduced in oral health. Few potential oral prebiotics have already been identified in dual species competition assays, showing a stimulatory effect on beneficial bacteria and by this suppressing the outgrowth of pathogenic species. This study aimed to validate the effect of previously identified potential prebiotic substrates on multispecies cultures by shifting the biofilm composition towards a more beneficial species dominated microbiota.Methods: A chemostat culture containing 14 model oral bacterial species was used to grow biofilms for 24 hours which subsequently were treated with prebiotic solutions three times a day for 3 consecutive days. Further the influence of environmental factors such as pH, nutrient availability, oxygen concentration and prebiotic dose on the efficacy of the prebiotic substances was investigated.Results: Three potential prebiotic substrates N-acetyl-D-mannosamine, succinic acid and Met-Pro were able to bring the beneficial proportion to > 95%. While the pH of the prebiotic solution did not have an influence on the prebiotic effect, the interplay of nutrient availability, oxygen concentration and prebiotic treatment resulted in significant changes of the microbial composition identifying N-acetyl-D-mannosamine as the most promising oral prebiotic substrate. Showing a clear dose dependent effect, concentrations of N-acetyl-D-mannosamine of 1.0 and 1.5 M resulted in a biofilm composition of 97% beneficial species.Conclusion: Introducing the prebiotic concept in oral health might reveal a valid approach for treatment and prevention of oral diseases and promote oral health. [ABSTRACT FROM AUTHOR]

Periodontal diseases and dental caries are the most common diseases of humans and the main cause of tooth loss. Both diseases can lead to nutritional compromise and negative impacts upon self-esteem and quality of life. As complex chronic diseases, they share common risk factors, such as a requirement for a pathogenic plaque biofilm, yet they exhibit distinct pathophysiologies. Multiple exposures contribute to their causal pathways, and susceptibility involves risk factors that are inherited (e.g. genetic variants), and those that are acquired (e.g. socio-economic factors, biofilm load or composition, smoking, carbohydrate intake). Identification of these factors is crucial in the prevention of both diseases as well as in their management. Aim To systematically appraise the scientific literature to identify potential risk factors for caries and periodontal diseases. Methods One systematic review (genetic risk factors), one narrative review (role of diet and nutrition) and reference documentation for modifiable acquired risk factors common to both disease groups, formed the basis of the report. Results & Conclusions There is moderately strong evidence for a genetic contribution to periodontal diseases and caries susceptibility, with an attributable risk estimated to be up to 50%. The genetics literature for periodontal disease is more substantial than for caries and genes associated with chronic periodontitis are the vitamin D receptor ( VDR), Fc gamma receptor IIA ( Fc-γ RIIA) and Interleukin 10 ( IL10) genes. For caries, genes involved in enamel formation ( AMELX, AMBN, ENAM, TUFT, MMP20, and KLK4), salivary characteristics ( AQP5), immune regulation and dietary preferences had the largest impact. No common genetic variants were found. Fermentable carbohydrates (sugars and starches) were the most relevant common dietary risk factor for both diseases, but associated mechanisms differed. In caries, the fermentation process leads to acid production and the generation of biofilm components such as Glucans. In periodontitis, glycaemia drives oxidative stress and advanced glycation end-products may also trigger a hyper inflammatory state. Micronutrient deficiencies, such as for vitamin C, vitamin D or vitamin B12, may be related to the onset and progression of both diseases. Functional foods or probiotics could be helpful in caries prevention and periodontal disease management, although evidence is limited and biological mechanisms not fully elucidated. Hyposalivation, rheumatoid arthritis, smoking/tobacco use, undiagnosed or sub-optimally controlled diabetes and obesity are common acquired risk factors for both caries and periodontal diseases. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the adjunctive effects of a Streptococcus oralis KJ3, Streptococcus uberis KJ2 and Streptococcus rattus JH145 containing probiotic tablet after scaling and root planing (SRP). Materials and Methods: Forty-eight periodontitis patients were included in this double-blind, placebo-controlled clinical trial. After root planing, patients used either a placebo or a probiotic tablet twice a day for 12 weeks. The pocket probing depth (primary outcome measure), bleeding on probing and relative attachment levels were measured at baseline, 12 and 24 weeks. At baseline, 4, 8, 12 and 24 weeks, microbiological sampling was performed and plaque and gingival indices were recorded. Results: The primary and secondary outcome measures were significantly (p < 0.05) improved at the 12- and the 24-week evaluation in both groups. However, no significant inter-group differences could be detected at any time point, except from the % of sites with plaque that were significantly lower in the probiotic group than in the control group at the 24-week evaluation. In addition, at the 12-week time point, the salivary Prevotella intermedia counts were significantly lower in the probiotic group. Conclusions: No differences were detected when comparing the adjunctive use of a placebo or the investigated streptococci containing probiotic tablet after SRP. ClinicalTrials.gov Identifier: NCT02403960. [ABSTRACT FROM AUTHOR]

The ability of Porphyromonas gingivalis to cause adult periodontitis is determined by its arsenal of virulence factors. Here, we investigated the importance of biofilm formation and bacterial dipeptidyl peptidase IV ( DPPIV) for the pathogenicity of clinical P. gingivalis isolates. In our study, the isolates with biofilm-forming capacity also showed high DPPIV activity in vitro. Moreover, DPPIV activity increased in P. gingivalis biofilms compared to planktonic cells. In a murine subcutaneous abscess model, the biofilm-forming isolates with high DPPIV activity proved to be pathogenic, while the nonbiofilm formers with low DPPIV activity did not induce abscesses. The biofilm-forming ATCC 33277 strain with low DPPIV activity was not pathogenic in mice either. Our results suggest that biofilm formation and DPPIV activity contribute to the pathogenic potential of P. gingivalis. Furthermore, we show that biofilm formation may enhance P. gingivalis virulence through an increased DPPIV activity. Because of their importance for bacterial colonization and growth, biofilm formation and DPPIV activity could present interesting therapeutic targets to tackle periodontitis. [ABSTRACT FROM AUTHOR]

Aim The aim of this randomized placebo-controlled clinical trial was to evaluate the effects of Lactobacillus reuteri-containing probiotic lozenges as an adjunct to scaling and root planing ( SRP). Material and Methods Thirty chronic periodontitis patients were recruited and monitored clinically and microbiologically at baseline, 3, 6, 9 and 12 weeks after therapy. All patients received one-stage full-mouth disinfection and randomly assigned over a test ( SRP + probiotic, n = 15) or control ( SRP + placebo, n = 15) group. The lozenges were used two times a day for 12 weeks. Results At week 12, all clinical parameters were significantly reduced in both groups, while there was significantly more pocket depth reduction ( p < 0.05) and attachment gain ( p < 0.05) in moderate and deep pockets; more Porphyromonas gingivalis reduction was observed in the SRP + probiotic group. Conclusions The results indicate that oral administration of L. reuteri lozenges could be a useful adjunct to SRP in chronic periodontitis. [ABSTRACT FROM AUTHOR]

This article discusses a study which explored whether the use of probiotics can influence the periodontal microbiota and periodontal health. It notes that this study reviewed the literature on oral probiotics' mode of action. Results of the study showed that probiotics have an effect on the oral microbiota and a more limited effect on clinical periodontal outcomes. The study recommends further trials on the use of probiotics as adjuncts to standard periodontal care.

Escribano M, Herrera D, Morante S, Teughels W, Quirynen M, Sanz M. Efficacy of a low-concentration chlorhexidine mouthrinse in non-compliant periodontitis patients attending a supportive periodontal care programme: a randomized clinical trial. J Clin Periodontol 2010; 37: 266–275. doi: 10.1111/j.1600-051X.2009.01521.x. Objective: To assess the clinical and microbiological efficacy of a 0.05% chlorhexidine and 0.05% cetyl-pyridinium chloride mouth rinse in supportive periodontal care (SPC) in patients with inadequate plaque control. Material and Methods: The study was a randomized, double-blinded, placebo-controlled clinical trial in patients with moderate to severe chronic periodontitis under SPC with an inadequate plaque control (Turesky index >1). After supragingival prophylaxis and oral hygiene reinforcement, participants rinsed twice a day for 3 months with the test or placebo solutions, in addition to conventional hygiene. Primary clinical outcome variables included plaque and gingival indices. As secondary outcomes, periodontal and microbiological variables were studied.ancova and χ2 tests were used to compare the variables. Results: Forty-seven patients (22 placebo and 25 test group) participated. After 3 months, plaque levels increased in the placebo group, while diminished in the test group ( p<0.001). Similar effects were found for bleeding on probing. The other clinical parameters did not show significant differences. Microbiological variables demonstrated inter-group significant reductions in subgingival counts of Fusobacterium nucleatum and Prevotella intermedia and a decrease of the total bacterial counts in saliva. Conclusions: The tested mouth rinse demonstrated efficacy in reducing plaque and gingivitis, as well as in decreasing the microbial load in saliva and gingival sulcus. [ABSTRACT FROM AUTHOR]

Aim: To monitor the intra-oral microbiological changes after full-mouth extraction using quantitative polymerase chain reaction (qPCR). Material and Methods: Nine patients with severe, aggressive periodontitis, for whom a full-mouth tooth extraction was the only remaining treatment option were recruited. Before and 6 months after extraction, microbial samples were obtained (tongue, saliva and subgingival plaque) and analysed by qPCR. Results: The elimination of subgingival niches, by extraction of all natural teeth, resulted in a 3-log reduction of Porphyromonas gingivalis and Tannerella forsythia, and more modest reductions of Aggregatibacter actinomycetemcomitans and Prevotella intermedia. However, the detection frequencies of these periodontopathogens in saliva and on the tongue remained unchanged after full-mouth tooth extraction. Conclusion: In contrast to what has been believed so far, full-mouth tooth extraction does not result in eradication of all periodontopathogens but only in a significant reduction. The clinical consequences of this observation remain speculative. [ABSTRACT FROM AUTHOR]

AbstractBackground, aims: Previous studies indicated that oral hygiene aids can play a rôle in the intra-oral translocation of pathogens. The survival rate of cariogenic and periodontopathogenic species on toothbrushes, with and without toothpaste, and interdental brushes was presently investigated. Material and methods: 12 periodontitis patients had their interdental spaces professionally cleaned with interdental brushes and their teeth with new toothbrushes with or without different dentifrices. Each time brushes were rinsed with tap water and stored dry at room temperature. At different time intervals an interdental brush or 4 tufts from a toothbrush were processed for vitality staining and selective and non-selective culturing procedures. Results: Immediately after rinsing, a toothbrush without toothpaste harboured 107, 108 and 107 colony forming units (CFU) of respectively aerobic, anaerobic and black pigmented species. An insignificant decrease occurred the first 24 hours and after 48 hours still 104 CFU of aerobic and anaerobic species could be cultured. No periodontopathogen remained detectable at 8 hours, except for Fusobacterium nucleatum. The proportion of vital bacteria decreased in 48 hours from 50% to 30%. Comparable results were obtained for interdental brushes. The bacterial survival rate on toothbrushes was significantly reduced by the use of a detergent containing toothpaste by 2 log at baseline, another 2 log at 4 hours and an extra log more at 8 hours for aerobic and anaerobic species. A toothpaste without detergent only had an insignificant bactericidal effect. Conclusion: Toothpaste detergents decrease the survival rate of pathogenic species on a toothbrush and can thus limit the risk for bacterial translocation. [ABSTRACT FROM AUTHOR]