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We report on a 40-year-old patient who presented with fever, right upper abdominal pain, right-sided chest pain and acute dyspnea. Imaging revealed several liver abscesses, as well as extensive right pleural empyema. Sixteen weeks previously, the patient underwent tooth extraction of the third molars (18, 28, 38, 48) and a first molar (46), and systematic closed periodontitis treatment. Four different species of the physiological microbiota of the oral cavity were detected in the pleura or liver abscess punctate (Streptococcus anginosus, Streptococcus constellatus, Actinomyces odontolyticus, Prevotella denticola). An underlying immune defect was ruled out. Ultrasound-guided drainage of liver abscesses and surgical treatment of pleural empyema by video-assisted thoracoscopy (VATS) and insertion of thoracic suction drains was performed, accompanied by targeted antibiotic therapy. Over a course of 6 weeks, the patient recovered completely. The case report illustrates severe infectious side effects of major dental interventions, and it critically summarizes current dental guideline recommendations on peri-interventional antimicrobial therapy. Therefore, a good clinical follow up after major tooth extractions is imperative., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

We present the case of an actinomycotic mycetoma of the foot due to Actinomycetes viscosus. It evolved for nine years on the foot of a 26-year-old patient from a rural environment: Douar Inezgane (city in southern Morocco). Bacteriological study of the skin and grains confirmed the diagnosis. It showed positive bacilli on direct examination and on Gram staining and in positive culture. Histological study showed a polymorphous granulomatous inflammation without signs of malignancy with actinomycotic grains. Then we retained the diagnosis of primary cutaneous actinomycosis without visceral locations. The treatment was based on antibiotics: penicillin G by intravenous infusion for five weeks, relayed orally by amoxicillin associated with trimethoprim-sulfamethoxazole for long periods. After six months of treatment, we observed a favorable outcome with reduction of the swelling, nodules, lymphadenopathy, fistula's number and extension of time of issue of grains. The current follow up is 15 months. The primary cutaneous actinomycosis is still relevant in Morocco., (Copyright © 2015. Published by Elsevier Masson SAS.)

Background: The detection of special bacterial species in patients with periodontitis is considered to be useful for clinical diagnosis and treatment. The collection of subgingival plaque samples is the common way for the determination of periodontopathic bacteria. However, recently, salivary analysis has been discussed as an advantageous future diagnostic method for periodontitis because it offers simple quantitative sampling and the possibility to assess various bacteria. The aim of this cross-sectional study is to investigate whether there is a correlation between the results of different bacterial species in saliva and subgingival plaque samples from individuals with aggressive periodontitis (AgP) and chronic periodontitis (CP)., Methods: Whole saliva and subgingival plaque samples from the deepest pocket of each quadrant were collected from 43 patients with CP and 33 patients with AgP. Twenty different bacterial species from both samplings were determined by the 16S ribosomal RNA-based polymerase chain reaction with microarray technique., Results: All bacterial species were detected in salivary and subgingival plaque samples. For Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, as well as Actinomyces viscosus, Campylobacter rectus/showae, Prevotella intermedia, Parvimonas micra, Eubacterium nodatum, and Campylobacter gracilis, a significant positive correlation between salivary and subgingival plaque samples was detected in patients with both types of periodontitis. There were no significant differences in bacteria in salivary and subgingival plaque samples between AgP and CP., Conclusion: Salivary analysis might be discussed as a potential alternative to subgingival plaque sampling for microbiologic analysis in both AgP and CP.

Introduction: The aim of the present study was to analyze the microbiota of primary and secondary/persistent endodontic infections of patients undergoing endodontic treatment with respect to clinical and radiographic findings., Methods: Samples from the root canals of 21 German patients were taken using 3 sequential sterile paper points. In the case of a root canal filling, gutta-percha was removed with sterile files, and samples were taken using sterile paper points. The samples were plated, and microorganisms were then isolated and identified morphologically by biochemical analysis and sequencing the 16S rRNA genes of isolated microorganisms., Results: In 12 of 21 root canals, 33 different species could be isolated. Six (50%) of the cases with isolated microorganisms were primary, and 6 (50%) cases were endodontic infections associated with root-filled teeth. Twelve of the isolated species were facultative anaerobic and 21 obligate anaerobic. Monomicrobial infections were found for Enterococcus faecalis and Actinomyces viscosus. E. faecalis was most frequently isolated in secondary endodontic infections (33%). Moraxella osloensis was isolated from a secondary endodontic infection that had an insufficient root canal filling accompanied by a mild sensation of pain. A new bacterial composition compromising Atopobium rimae, Anaerococcus prevotii, Pseudoramibacter alactolyticus, Dialister invisus, and Fusobacterium nucleatum was recovered from teeth with chronic apical abscesses., Conclusions: New bacterial combinations were found and correlated to clinical and radiographic findings, particularly to chronic apical abscesses. M. osloensis was detected in root canals for the second time and only in German patients., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate clinically and microbiologically the efficacy of Papacarie in the removal of carious dentin in both permanent and primary teeth., Study Design: Thirty permanent and primary molars with dentinal carious lesions were excavated and subjected to clinical and microbiological assessment before and after application of Papacarie. The gel was further tested for in vitro antimicrobial efficacy against standard cariogenic micro-organisms using agar diffusion assay., Results: Papacarie was able to differentiate between infected and affected dentin clinically along with high patient comfort during caries excavation. The mean time taken for caries removal and restoration was observed to be 4.17 +/- 0.40 min. and 8.57 +/- 0.45 min. for permanent teeth and 4.21 +/- 0.36 min. and 9.24 +/- 0.58 min. for primary teeth. There was a significant reduction in the total viable colony forming units from the dentin samples before and after application of Papacarie. It was also observed that Papacarie had no inhibitory effect on standard cariogenic microorganisms in the agar diffusion assay., Conclusions: Papacarie is an effective caries removal method clinically in both permanent and primary teeth. The number of viable microorganisms after complete caries excavation using Papacarie still appears to be high and this bacterial count should be tackled by a suitable restorative material with potent antimicrobial activity.

Aim: The effects on plaque parameters of sugar free chewing-gums (CG) sweetened with either maltitol or xylitol were assessed to better understand the role polyols can play in dental caries prevention., Materials and Methods: A double-blind, parallel, randomised, controlled study was conducted in China. Subjects (N = 258, age = 13 to 15 years-old) were divided into 4 groups: 2 receiving polyols CG, containing respectively maltitol or xylitol, a group receiving gum base (placebo) and a negative control group not receiving any gum. CG were chewed for 30 days. This corresponds to a 10 g consumption of polyol per day. Plaque parameters (growth, pH, bacteria and insoluble glucans) were evaluated throughout the experimental period., Results: All parameters studied were significantly modified with gum base compared to no-gum: plaque pH increased; plaque growth, bacteria (S. mutans, S. sobrinus, A. viscosus and Lactobacillus) and insoluble glucans decreased. Maltitol and xylitol CG led similarly to a higher plaque pH (AUC, p⋜0.05) on short (at baseline after the first CG consumption) and long term (after 4 weeks of daily CG consumption), with or without saliva stimulation compared to both control and placebo groups. They led to a decrease in plaque growth (p=0.02) over the experimental period compared to controls. Moreover, they significantly reduced the concentration of 4 cariogenic bacteria species (p⋜0.05) in dental plaque compared to gum base., Conclusion: Sugar free CG sweetened with either maltitol or xylitol can similarly reduce plaque acidogenicity compared to gum base through a decrease in oral bacteria presence. The use of a gum base placebo allowed to isolate effects on parameters involved in dental caries development specific to maltitol and xylitol, and to show these effects were similar.

Group milleri streptococci that colonize the mouth and the upper airways are generally considered to be commensal. In combination with anaerobics, they are rarely responsible for brain abscesses in patients with certain predisposing factors. Mortality in such cases is high and complications are frequent. We present a case of fatal subdural empyema caused by Streptococcus constellatus and Actinomyces viscosus in a previously healthy 7-year-old girl., (Copyright © 2011. Published by Elsevier B.V.)

Objective: to identify dominant pathogens in the periapical lesions associated with persistent apical periodontitis., Methods: thirty-three root-filled teeth with persistent apical periodontitis referred for surgical treatment were selected. Microbial samples were collected from the periapical lesions during apical surgery. Microbial identification was performed with species-specific primers prepared according to the sequence analysis data using a 16S rRNA technique., Results: among the 33 cases, in 5 cases none of the target species were detected, 6 cases showed the presence of only one species, and 22 cases showed more than two species. Porphyromonas endodontalis (45% of sample) was the most commonly detected dominant microbial species in the study sample, followed by Actinomyces viscosus (42%), Candida albicans (36%) and Porphyromonas gingivalis (27%). Fusobacterium, Actinomyces israelii and Enterococcus faecalis were also detected in 27%, 21% and 15% of the sample, respectively. The most frequently isolated species, P. endodontalis, was in most cases detected together with Actinomyces (14 cases) and P. gingivalis (6 cases). None of the lesions analysed in the present study contained Prevotella intermedia. There was no correlation in relation to the presence of sinus tracts and the bacterial species., Conclusion: a mixed population of pathogens was found in the endodontic lesions associated with persistent apical periodontitis. P. endodontalis, A. viscosus, C. albicans and P. gingivalis were the dominant species identified.

Objectives: Mini-implants are used for orthodontic bone anchorage. The reasons for a potential instability or loss of the mini-implants during treatment are multiple. Among other factors, colonization of implants with pathogenic bacteria is discussed. Therefore, the microflora associated with successful and failed mini-implants has been screened., Material and Methods: A total of 76 mini-implants collected from 25 patients were observed during regular orthodontic treatment. Bacterial samples of eight failed and - exemplarily - four successful (control) cases were subjected to a universal Bacteria-directed real-time quantitative polymerase chain reaction for quantification in combination with a microarray-based identification of 20 selected species., Results: The failure rate in the present investigation was 10.5%. The bacterial analysis did not reveal any major difference in the total amount or species composition between control and failed mini-implants. However, Actinomyces viscosus was found in four (100%) and Campylobacter gracilis in three (75%) stable controls, whereas both species were rarely found (12.5%) in failed implants., Conclusions: In the present study, the peri-implant sulcus surrounding failed orthodontic mini-implants did not show a specific aggressive bacterial flora.

Cutaneous actinomycosis is a rare presentation. Here we present a case of cutaneous actinomycosis with no history of trauma or systemic dissemination. The isolate was identified as Actinomyces viscosus by standard methods. The isolate was found to be penicillin resistant by Kirby Bauer disc diffusion method. Therefore, the patient was treated with cotrimoxazole and improved. Thus, this case highlights the importance of isolation and susceptibility testing in actinomycotic infection. The sinuses have healed, and the patient has recovered.

We report a case of primary Actinomyces viscosus endocarditis, an unusual manifestation of actinomycosis, in a 43-year-old farmer with an indolent febrile illness. As has occurred in previous cases, diagnosis was delayed in part because blood isolates were misidentified. Months later when she required aortic valve and root replacement, histologic exam of the diseased valve revealed branching filamentous organisms and the original blood isolates were retrospectively confirmed to be Actinomyces viscosus.

We report the case of a 27-year-old woman with primary actinomycosis of the breast. Diagnosis was established by culture examination of specimen recovered by fine-needle aspiration cytology (FNAC) under ultrasound guidance. To our knowledge, this is the first description in the literature of a case of primary actinomycosis of the breast caused by Actinomyces viscosus. Twenty-nine previous cases of primary actinomycosis of the breast have been published, but these were caused by the more common species Actinomyces israelii. Targeted antibiotic therapy did not ameliorate the condition, thus drainage and excision of the mass were carried out. No other medical therapy was administered. Six years after surgery, no recurrence has been observed on both ultrasonographic and mammographic examinations.

Very limited molecular epidemiological data are available on the role of Actinomyces spp. in the pathogenesis of caries in the primary dentition. Therefore, we investigated their distribution in supragingival plaque of ethnic Chinese preschool children from Singapore and Hong Kong, either with or without active caries. Plaque samples were taken from intact interproximal enamel areas using dental floss. Bacterial genomic DNA of each sample was extracted and variable regions of 16S ribosomal DNA amplified and labelled with digoxigenin. Oligonucleotide probes specific for Actinomyces bovis, Actinomyces gerencseriae, Actinomyces israelii, Actinomyces meyeri, Actinomyces odontolyticus, catalase-negative Actinomyces naeslundii (genospecies 1 and 2) and catalase-positive Actinomyces naeslundii genospecies 2 (previously Actinomyces viscosus serotype II) were used to detect these species using Southern hybridization with a Minislot and Miniblotter system. A. odontolyticus, A. gerencseriae and A. meyeri were detected with similar frequency in both Singapore and Hong Kong samples or in those with and without active caries. However, the prevalence of A. naeslundii was significantly different in the two locales (p<0.05). A. odontolyticus (88.7%), A. gerencseriae (56.6%) and A. naeslundii (50.9%) were detected in a majority of the samples and the positive hybridization signals of A. gerencseriae in the caries-active group were stronger than from the caries-free group. A. bovis and A. israelii were undetectable in any of the samples. These data imply that A. odontolyticus, A. naeslundii and A. gerencseriae may play an important role in supragingival plaque formation on primary teeth in ethnic Chinese, with others such as A. meyeri contributing., (Copyright 2003 S. Karger AG, Basel)

Species of Actinomyces have been associated with endodontic treatment that failed to heal. In this study polymerase chain reaction was used with a pair of universal primers for Actinomyces and species-specific primers to evaluate the contents of infected root canals and aspirates from abscesses or cellulitis for the presence of Actinomyces israelii, A. naeslundii, and A. viscosus. DNA was extracted from 131 clinical samples. DNA from 2 of the original 131 samples was not available for polymerase chain reaction with the universal primer for Actinomyces and A. naeslundii. DNA reacting with the universal primer for Actinomyces was detected in 72 of 129 (55.8%) clinical samples. Of those 41 of 51 (80.4%) were from infected root canals, 22 of 48 (45.8%) were from abscesses, and 9 of 30 (30%) were associated with cellulitis. A. viscosus was detected in 42 of 131 (32.1%) clinical samples. Of those 31 of 52 (59.6%) were from infected root canals, 6 of 43 (14%) were from abscesses, and 5 of 36 (13.9%) were associated with cellulitis. A. israelii was detected in 31 of 131 (23.7%) clinical samples. Of those 14 of 52 (26.9%) were from infected root canals, 11 of 43 (25.6%) were from abscesses, and 6 of 36 (16.7%) were associated with cellulitis. A. naeslundii was detected in 11 of 131 (8.5%) clinical samples. Of those 7 of 51 (13.7%) were from infected root canals, 2 of 48 (4.2%) were from abscesses, and 2 of 30 (6.7%) were associated with cellulitis.

This study evaluated the effect of sustained-release chlorhexidine varnish on orthodontic patients. Ten children, ages 10 to 16 years, participated. Bacterial levels of Streptococcus mutans and Actinomyces viscosus and total counts were evaluated in sputum samples. These counts were evaluated at 4 stages: before orthodontic treatment, at least 2 weeks after bonding of the brackets, 1 week after application of chlorhexidine varnish, and 3 weeks after application of chlorhexidine varnish. Increases in bacterial levels of S mutans and in the total bacterial count were detected after the brackets were bonded. One week after the sustained-release chlorhexidine varnish was applied, a significant decrease of total bacterial levels and S mutans was observed. This decrease persisted for 3 weeks after the first application. No significant change in A viscosus levels occurred during that period. The results provide additional evidence that sustained-release chlorhexidine varnish decreases S mutans levels in orthodontic patients with fixed appliances and therefore might be useful in preventing caries lesions.

Aims: To detect bacteriophages for Gram-positive oral pathogens in human saliva., Methods and Results: Saliva samples from 31 donors were screened for the presence of bacteriophages for Streptococcus sobrinus, Streptococcus mutans, Streptococcus salivarius, Actinomyces viscosus and Enterococcus faecalis. Bacteriophages for Enterococcus faecalis were found in seven samples. Enterococcus faecalis phages were still present in saliva re-collected from one donor one month, and one year after initial saliva collection., Conclusions: The presence and stability of the Enterococcus faecalis bacteriophages in human saliva suggests a possible role of these bacteriophages in the oral ecosystem., Significance and Impact of the Study: Phage therapy as a way to control oral bacteria might be considered.

Particulate Bioglass is a bioactive material used in the repair of periodontal defects. This material undergoes a series of surface reactions in an aqueous environment which lead to osseointegration. The aim of this study was to determine whether these reactions exerted an antibacterial effect on a range of oral bacteria. Streptococcus sanguis, Streptococcus mutans and Actinomyces viscosus were suspended in nutrient broth (NB), artificial saliva (AS) or Dulbecco's modified eagle medium plus 10% foetal calf serum (DMEM + 10%FCS), with or without particulate Bioglass. All bacteria showed reduced viability following exposure to Bioglass in all the media after 1 h. This antibacterial effect increased after 3 h. Porphyromonas gingivalis, Fusobacterium nucleatum, Prevotella intermedia and Actinobacillus actinomycetemcomitans were suspended in either BM broth or 40% horse serum (HS) in RPMI. A considerable reduction in viability was observed with all bacteria tested, in both media, compared to inert glass controls. In further experiments it was found that the viability of S. sanguis was significantly reduced following exposure to NB pre-incubated with Bioglass. Additionally, it was found that neutralisation of this highly alkaline solution eliminated the antibacterial effect. Moreover, a solution of NB and NaOH (of equivalent pH) exerted an antibacterial effect of similar magnitude to that of the solution pre-incubated with Bioglass. Thus, particulate Bioglass exerts an antibacterial effect on certain oral bacteria, possibly by virtue of the alkaline nature of its surface reactions. This may reduce bacterial colonisation of its surface in vivo.

We report a case of endocarditis caused by Actinomyces viscosus in a previously healthy young adult with no known identifiable portal of entry. Infective endocarditis caused by A viscosus is uncommon; two cases of endocarditis caused by this species have been previously reported. Primary actinomycotic endocarditis has been previously reviewed in 1993; we provide a review of additional cases since that report. In comparing our case with the other reported cases, we found that actinomycotic endocarditis (1) occurs in a wide spectrum of age, (2) affects primarily males, (3) has a high propensity for systemic embolization, and (4) has involved only native heart valves. The disease is manifested by the typical signs and symptoms of infective endocarditis and is curable with long-term penicillin therapy. The use of echocardiography in the diagnosis of endocarditis, techniques for improving the microbiologic diagnosis of endocarditis, and current indications for surgical intervention are discussed.

Endophthalmitis, attributable to Actinomyces viscosus, developed in a 78-year-old man after cataract surgery. Postoperative endophthalmitis with this organism is a rare occurrence. This report emphasizes the importance of the Actinomyces species as potential eye pathogens and presents antimicrobial susceptibility data for the isolate.

Objective: To build up the methods to prepare and determine the fimbriae of A. viscosus., Methods: Type 1 and 2 fimbriae were prepared from A. viscosus 5519 and 5951 respectively. Fimbriae were isolated from bacteria cells by mechanical shaking, obtained by collecting the supernatant after centrifugation, and purified by ammonium sulfate precipitations and gel filtration., Results: Electron microscope showed that fimbriae existed in the preparations. The immunological reaction between the fimbriae preparations and specific antibodies against fimbriae attested that they were type 1 or type 2 fimbriae., Conclusion: The present study become a foundation for further study on the biological properties of fimbriae of A. viscosus.

This study was aimed at the composition of plaques which were on the base teeth's carious sensitive sites, just after the insertion of the removable partial denture (RPD). The results showed that the ratios of bacterial detection in different teeth at the same period and those on the different sites of same teeth at different periods were not significantly different. There was a tendency that the detection ratio of the stomatococcus at the early period was higher than that of other bacteria, but at the middle period the ratios declined, and at the late period it was higher again. The detection ratio of the bacillus was on the contrary in the study. At the same time, the composition of the plaques changed significantly after the dentures had been used for 7, 14, and 21 days and 3 months. After 3 months, the ratios of the stomatococcus and the bacillas returned to their normal levels. The 3 main cariogenic bacteria were all detected in this study. The Streptococcus mutant was the dominant bacterium in the plaques and its ratio went up with the time duration. The ratio for the lower second molar was higher than that for the mandibular second premolar (P < 0.05). The detection ratios of the Actinomyces viscosus and lactobacillus were lower. In conclusion, after the insertion of RPD, the oral microbial ecosystem would be changed and the cariogenic bacteria began to implant on the surface of the base teeth. So RPD is a potential factor to cause the caries.

Clinical and microbiological effects of subgingival delivery of 10% minocycline-loaded (MC), bioabsorbable microcapsules were examined in 15 adult periodontitis patients. Patients received oral hygiene instruction 2 weeks prior to the study. At baseline (day 0) all teeth received supragingival scaling (SC); 2 quadrants received no further treatment and 1 quadrant received subgingival scaling and root planning (SRP). In the fourth quadrant, the tooth with the deepest probing sites (at least 1 site > or = 5 mm) was treated with minocycline microcapsules. The sites were evaluated at baseline and weeks 1, 2, 4, and 6. Clinical indices included bleeding on probing (BOP), probing depths (PD), and attachment loss (AL). Microbiological evaluations included percent morphotypes by phase-contrast microscopy; cultivable anaerobic, aerobic, and black-pigmented Bacteroides (BPB); and percent Porphyromonas gingivalis, Prevotella intermedia, Eikenella corrodens, and Actinomyces viscosus by indirect immunofluorescence. In the SC + MC group, BOP, PD, and AL were significantly reduced from baseline for weeks 1 to 6. BOP in the SC + MC group was significantly reduced compared to the SRP group from weeks 2 to 6. In the SC + MC group the percent of spirochetes and motile rods decreased and the percent of cocci increased after 1 week. The increased cocci and decreased motile rods were statistically greater at weeks 4 and 6 in the SC + MC group compared to the SRP group. This study demonstrates that local subgingival delivery of 10% minocycline-loaded microcapsules as an adjunct to scaling results in reduction in the percent sites bleeding on probing greater than scaling and root planning alone and induces a microbial response more favorable for periodontal health than scaling and root planing.

The localization and distribution of Porphyromonas gingivalis, Campylobacter rectus and Actinomyces viscosus were studied in human periodontal pockets. After obtaining voluntary consent from 9 patients, 12 teeth and their surrounding periodontal tissue with advanced adult periodontitis were extracted carefully so as not to change the structure of the periodontal pockets. The specimens were processed into serial sections. One of the sections was stained with Brown & Brenn-modified Gram stain to observe the distribution of bacteria. The others were stained immunohistochemically by the Labelled Streptavidin Biotin method (LSAB method) using specific rabbit antibodies against selected bacteria. Some bacteria could be found within epithelial cells. P. gingivalis was found in 9/12 of the samples examined. Small aggregates of P. gingivalis were scattered in all parts of the periodontal pockets, and some of these aggregates could be seen in close contact with the epithelium. Conversely, C. rectus was observed in 5/12 of the samples examined and was predominantly located in the middle and deep pocket zones. C. rectus tended to form large clumps in both the tooth-attached and epithelium-associated plaque area. A. viscosus was observed in 7/12 of the samples examined and was localized predominantly in the tooth-attached plaque area, especially in the shallow and middle pocket zones. Although unexpected spills of unattached plaque from periodontal pockets was possible, immunohistochemical staining with species-specific antibodies was extremely sensitive and revealed the localization and the distribution of periodontal disease-associated bacteria in human periodontal pockets.

In a previous report, it was shown that scaling and root planing (SRP) decreased mean pocket depth and attachment level in subjects with adult periodontitis, as well as the levels and prevalence of Bacteroides forsythus, Porphyromonas gingivalis and Treponema denticola. However, a subset of subjects in that study exhibited mean loss of attachment following SRP. The purpose of the present investigation was to seek clinical and microbiological differences between subjects who responded well or poorly to SRP. 57 subjects with adult periodontitis were treated by full-mouth SRP under local anaesthetic. Clinical assessments of plaque, redness, suppuration, BOP, pocket depth and attachment level were made at 6 sites per tooth prior to and 3 months post-SRP. Attachment level measurements were repeated at each visit and differences in means between visits used to assess change. 18 subjects showed mean attachment loss 3 months post-SRP (poor response group), while 39 showed mean attachment level gain (good response group). The prevalence and levels of 40 subgingival taxa in subgingival plaque samples from the mesiobuccal site of each tooth (maximum 28 sites) in each subject prior to and 3 months post-SRP were assessed using checker-board DNA-DNA hybridization. The prevalence of each species was computed for each subject and averaged across subjects in the 2 treatment-response groups at each visit. Differences between groups were sought using the Mann-Whitney test. There were no statistically significant differences between the 2 response groups in any clinical parameter prior to therapy. Subjects in the good response group showed more attachment level gain at sites with baseline pocket depths of < 4 mm, 4-6 and > 6 mm than poor response subjects. Of 40 species evaluated, A. naeslundii genospecies 2 (A. viscosus), T. denticola, C. gracilis and C. rectus were significantly higher and more prevalent pre-therapy in the good response subjects. Mean attachment level change post SRP could be predicted using multiple linear regression with A. naeslundii genospecies 2 (A. viscosus) and T. denticola as the predictor variables (r2 = 0.373, p < 0.00001). Sites that gained > or = 2 mm of attachment post therapy showed a significant decrease in the counts of P. gingivalis (7.5 +/- 3.5 to 0.2 +/- 0.2 x 10(5)), T. denticola (8.2 +/- 3.5 to 1.8 +/- 1.1 x 10(5)) and B. forsythus (11.1 +/- 5.7 to 0.3 +/- 0.2 x 10(5)). The data of the present investigation indicate that SRP is most effective in subjects and sites with high levels of the subgingival species that this therapy affects.

Microbial colonization of barrier materials used in guided tissue regeneration (GTR) is known to adversely affect treatment outcomes. The purpose of this study was to compare the rate at which 11 commonly-occurring oral bacteria species colonize three different barrier materials (collagen, expanded polytetrafluoroethylene, and polylactic acid). The study group consisted of 10 systemically healthy individuals with no history of periodontal disease and absence of antimicrobial therapy within the previous 3 months. In each patient, 4 teeth per quadrant (P1, P2, M1, M2) were selected and 3 teeth were randomly assigned as test teeth while the remaining tooth acted as a control site (i.e., natural colonization of the tooth surface). These teeth were then randomly assigned to receive one of the three barrier types (i.e., each patient received 4 barriers of each type, 1 per quadrant). A 2 x 5 mm piece of barrier material was positioned over the oral surface of the buccal marginal gingiva and secured with an external sling suture. With oral hygiene procedures suspended, one barrier of each type was collected at 1, 3, 7, and 14 days. Slot immunoblot assay demonstrated that all species types (A. actinomycetemcomitans, A. viscosus, B. melaninogenicus, F. nucleatum, P. gingivalis, P. intermedia, S. mutans, S. sanguis, Selenomonas sputigena, T. denticola, and T. vincentii) were present. Semi-quantitative scoring (scale 0 to 3) of slot blot results and analysis by chi-square ratio and Pearson correlation test indicated that while total bacteria adherence increased over time (P < 0.05), the 3 barrier types and the control sites did not differ in numbers or species of colonizing bacteria detected per time point. These results suggest that under these experimental conditions the barrier materials tested do not differ in bacteria adherence or antimicrobial properties.

Aiming to assess the presence of selected anaerobic microorganisms in root canals of human teeth with chronic apical periodontitis. 25 central and lateral upper incisors presenting with radiographic evidence of chronic apical periodontitis were studied. The pulp chamber was opened under aseptic conditions and samples of the root canal content were collected with sterile absorbent paper points, which were placed and dispersed in test tubes containing reduced transport medium RTT. Aliquots were dried on glass slides and stained by indirect immunofluorescence for detection of Actinomyces viscosus, Fusobacterium nucleatum, Porphyromonas gingivalis and Prevotella intermedia. The results showed a positive indirect immunofluorescence reaction in 24 of the 25 samples. Fourteen were positive for the specie Actinomyces viscosus, 12 for Prevotella intermedia, 10 for Fusobacterium nucleatum and 4 for Porphyromonas gingivalis. A semiquantitative assay was easily implemented for assessment of degree of infection by the organisms in individual cases.

This study describes the effects of varnish containing 40% chlorhexidine diacetate on Actinomyces naeslundii populations in plaque from human molar fissures. In each of 15 subjects two dental fissures with high levels of mutants streptococci were selected. The experimental treatment consisted of the single application of a small amount of chlorhexidine varnish onto the selected fissures. The varnish was removed 15 min after application. One month after varnish application a significant increase was observed in A. naeslundii counts while the number of mutans streptococci had decreased significantly compared with preexperimental levels. From 85 randomly selected Actinomyces isolates taken from blood agar plates before varnish application, 44% belonged to A. naeslundii genospecies 1 and 56% to A. naeslundii genospecies 2. From 106 isolates taken 1 month after chlorhexidine varnish application, 42% belonged to A. naeslundii genospecies 1 and 58% to A. naeslundii genospecies 2. At baseline 28% of A. naeslundii genospecies 1 strains were catalase-positive, but 1 month after varnish application 4% of the strains were catalase-positive (p < 0.05). It is concluded that chlorhexidine varnish application caused an increase of A. naeslundii in dental plaque, but induced no significant changes in the distribution of the two A. naeslundii genospecies.

Objectives: The ability of three oral bacteria to adhere to hydrophobic amalgam (water contact angle 60 degrees) and hydrophobic resin composites (Prisma-AP.H 56 degrees. Herculite XRV 82 degrees and Z100 89 degrees) was compared using an in vitro assay., Methods and Results: Following preincubation of the materials with human saliva, X-ray photoelectron spectroscopy showed the surfaces to adsorb carbon and nitrogen-containing compounds in a conditioning film that appeared to block the detection of Na and others in 2100 resin. Hg and Ag in amalgam, Si and Zn in Prisma AP.H resin and Ag and Na in Herculite resin. The precoating of the substrata by a proteinaceous conditioning film led to decreased binding of viable cells of Streptococcus sanguis CH3, Streptococcus salivarius HB and Actinomyces viscosus WG as compared with the adhesion to bare composites. With and without salivary coating, there was a correlation between increased bacterial hydrophobicity and increased retention on the substrata. However, there was no statistical difference in binding to the amalgam compared with the resin composites. In vitro studies showed that the bacteria autoaggregated in the presence of saliva., Conclusion: The results indicate the potential ability of normal oral flora to colonize resin composite.

The levels of selected cariogenic and obligately anaerobic bacteria have been compared in carious dentine taken from fissures, smooth surfaces, and root surfaces. The numbers of infected dentinal tubules were determined by immunohistological staining using species-specific antisera against selected bacteria. Selective localization was observed; mutans streptococci were the predominant bacteria in dentine from fissures and smooth surface coronal caries, but not from root surface caries. The proportion of mutans streptococci was higher in the shallow and middle layers of dentine from fissures and smooth surface coronal carious lesions than from the deep layers. In root surface caries, Actinomyces spp. were the predominant bacteria, and were present at higher levels in the deep layer of root lesions than in the shallow and middle layers. The proportion of Lactobacillus spp. was relatively low despite its high detection frequency in all layers of the three types of carious lesion. Immunohistological staining with species-specific antisera was able to reveal the distribution and the localization of various bacteria in carious dentine.

This study assessed the colonization of Brånemark dental implants by periodontopathic bacteria in four partially edentulous patients with a total of 10 implants. Marginal and subgingival plaque on the implants was sampled 14 days and 28 days after second-stage surgery and compared with plaque from three teeth closest to the implant sites sampled before second-stage surgery (baseline) and at 14 and 28 days. Slot immunoblot assay was used to determine the presence or absence of bacterial antigen to six different periodontopathic microorganisms. In general, colonization of marginal implant plaque occurred within 14 days, whereas subgingival colonization took longer and occurred within 28 days. It appears that Brånemark dental implants placed in partially edentulous patients may be colonized by disease-associated bacteria within 14 days of second-stage surgery.

Weanling specific pathogen-free Osborne-Mendel rats were fed a high-calcium, high-phosphorus diet with various levels of sucrose and inoculated with Streptococcus sobrinus strain 6715-13WT and Actinomyces viscosus strain OMZ-105 in order to determine whether calculus and caries could develop simultaneously. Rats consumed diets designated RC-16-5, RC-16-25, or RC-16-50 which partially replaced the corn starch component with progressively higher levels of sucrose, thus, to 5, 25, or 50% sucrose. In general, bacterial recoveries of A. viscosus declined with higher sucrose content of the diet, but a pattern of recovery for S. sobrinus was less clear with respect to dietary sucrose. S. sobrinus, however, was recovered at higher percentages from the tooth surface flora at the later two of three sampling dates. Most calculus--identified by the brittle quality, staining characteristics, and apatitic x-ray diffraction patterns of tooth surface deposits--was formed on the maxillary molars, and most carious lesions occurred on mandibular molars. While there was minimal association of the calculus score with the amount of sucrose in the diet, calculus scores increased greatly from 23 to 43 days after infectious challenge. Caries scores, of both fissure and smooth surfaces, by contrast, increased in a dose-response fashion with increasing dietary sucrose and with time. It is thus possible to induce calculus formation and caries simultaneously in specific pathogen-free Osborne-Mendel rats consuming a high-calcium and -phosphorus diet conducive to calculus formation and containing sucrose.(ABSTRACT TRUNCATED AT 250 WORDS)

A gram positive, catalase-positive Actinomyces viscosus strain has been isolated from cervicofascial carcinomatous lesion. Identification of this human strain of Actinomyces viscosus was carried out with biochemical tests. Tests for catalase, indole, nitrate reduction, methyl red reaction acetoin (VP) and gelatin hydrolysis were done by the procedure recommended by the technique described by Grencser and Slack. Carbohydrate fermentation tests were done with three basal media: Actinomyces fermentation broth, a thioglycolate fermentation base and a brain-heart infusion broth.

Coaggregations between bacterial species have been widely studied in vitro but not in the mouth. A new in vivo assay was used to measure the rate and composition of indigenous plaque formation onto bovine enamel chips covered with a continuous layer of bacteria. Chips were covered with Streptococcus oralis ATCC 10557, which coaggregated with many oral species, or Streptococcus gordonii S7, which did not coaggregate with these oral species, and placed in the mouth for 4 and 24 h. There were no differences in the number of most indigenous bacterial species isolated from the two streptococcal surfaces. However, the number of Actinomyces viscosus as a proportion of total Actinomyces spp. was significantly different on the two surfaces at 24 h. With the exception of Actinomyces naeslundii and A. viscosus removed from the S7 surface, all indigenous species increased significantly in number from 4 to 24 h, irrespective of the streptococcal surface. This study demonstrated that interbacterial coaggregation had only a limited effect on in vivo plaque development. Thus suggesting that environmental factors, growth or other adherence phenomena are dominant in in vivo plaque formation.

The distribution of Actinomyces naeslundii, Actinomyces viscosus and Actinomyces odontolyticus in healthy and diseased adult populations was studied in 3 different ways. First, supragingival plaque formation at 2 through 72 h was examined in 12 periodontally healthy adults using a removable pre-measured surface of enamel bonded to molars and premolars. Second, a cross-sectional examination of the composition of both supragingival and subgingival plaque of unknown age was conducted in 205 adults exhibiting periodontal health to moderate disease. Third, the effects of oral hygiene instruction and root planing on the subgingival microflora of a subset of 19 subjects with moderate periodontitis were examined. The evaluation of 12 adults revealed that the predominant species in early plaque formation (2, 4 and 8 h) was A. odontolyticus. A. viscosus and A. naeslundii were present in developing plaques in almost all subjects in 2-h plaque, but absent in half the subjects when 4-, 8- or 24-h plaque was examined. These two species significantly increased in numbers per mm2 enamel surface area in 48- and 72-h plaques. A. odontolyticus was not related to clinical signs of periodontal disease in 205 adults, and its subgingival proportions in plaque did not change following periodontal treatment of 19 individuals. A. naeslundii was found in significantly higher numbers in supragingival than subgingival plaques in the 205 adults examined. The mean proportion of A. naeslundii significantly decreased as the magnitude of probing depth and attachment loss increased. The proportions of A. naeslundii and A. viscosus were found to be significantly increased in subgingival plaques following periodontal treatment.

Twenty patients with residual clefts or pronounced soft tissue grooves, treated for uni- or bilateral cleft lip, alveolus, and palate were included in this study. Ten patients were recalled for dental prophylaxis at regular intervals, 10 patients were not. One microbiologic sample was obtained from the cleft area and two samples from a tooth adjacent to the cleft (sites adjacent and distant to the cleft). Between the recall and the nonrecall group there were notable differences in the presence of anaerobic Gram-negative organisms. Fusobacterium spp., Prevotella melaninogenica, and P. intermedia were more often found in nonrecall patients. While rarely seen in recall patients, spirochetes and motile rods were a common feature of nonrecall patients. The putative periodontal pathogens Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were not detected in either group. The differences between the recall and the nonrecall groups were more pronounced when the respective samples from teeth were related to each other than when the samples obtained from the clefts were compared. The cleft flora was less complex irrespective of how good maintenance was and resembled the flora of teeth of well-maintained patients. Samples from clefts were never Wolinella positive, and harbored significantly less Capnocytophaga and Actinomyces viscosus than samples from dental sites.

The effects of denture-wearing and age on the prevalence of selected bacteria of dental significance and on the carriage of opportunistic pathogens in molar plaque and whole saliva were determined in 120 healthy subjects, 41 of whom wore partial dentures. The subjects were divided into four age groups: 20-39 years (group A), 40-59 years (group B), 60-79 years (group C), and greater than or equal to 80 years (group D). The proportions, mean log10 viable counts, and isolation frequency of yeasts and lactobacilli in saliva and plaque were consistently higher in partial-denture wearers. The proportions of staphylococci and mutans streptococci were also raised in denture wearers, but these differences did not reach statistical significance. When the data were analyzed for age effects, both yeasts and lactobacilli were found to be increased in saliva with age, but statistically significant differences were generally found only between denture wearers in group D and subjects in the control group A. The isolation frequency of yeasts from plaque was also significantly higher in denture wearers of the oldest age group (D) compared with those in group A. A. viscosus predominated over A. naeslundii in the older age groups, regardless of the presence of dentures. Enterobacteria were isolated occasionally but only from the saliva of denture wearers in group D. Spirochetes and black-pigmented anaerobes were generally found in lower numbers in denture wearers. Collectively, the data show that components of the oral microflora in adults can be independently influenced by both age and the wearing of partial dentures.

Recent studies have provided evidence for human salivary proline-rich proteins (PRPs) serving as potential receptors in the acquired pellicle for Actinomyces viscosus type 1 fimbriae. We report here the isolation of mutants derived from A. viscosus T14V-J1 which are defective in binding to PRPs partially purified from parotid gland saliva. Mutagenesis with ethyl methanesulfonate preceded enrichment for cells nonreactive with PRPs by successive adsorptions with PRP-treated latex beads. Screening was accomplished by random selection of 250 isolated colonies from each of four enrichment cycles and reaction with PRP-treated latex beads in microtiter plates. Two mutants of independent origin were examined for adherence to hydroxyapatite treated with either PRPs, proline-rich glycoproteins, deglycosylated proline-rich glycoproteins, or whole saliva. Additional surface properties that were examined included agglutination with polyclonal antisera to type 1 and type 2 fimbriae, agglutination by a monoclonal antibody to type 1 fimbriae that inhibits adherence of the parent strain to saliva-treated hydroxyapatite, the ability to bind monoclonal antibody to the type 1 fimbrial subunit, and lactose-reversible coaggregation with Streptococcus sanguis 34. Both mutants exhibited reduced binding to hydroxyapatite treated with whole saliva or salivary protein preparations but were still capable of reaction with antiserum to type 1 and type 2 fimbriae. In addition, these mutants possessed the ability to bind monoclonal antibody to the type 1 fimbrial subunit in amounts comparable to the amount bound by the parent strain but were not agglutinated by the adherence-inhibiting monoclonal antibody. When considered with previously published data, these results suggest that an adhesive molecule is probably associated with type 1 fimbriae and allows for the interaction of A. viscosus with constituents in the salivary pellicle.

Clinical soft tissue examination and microbiologic findings were compared for two dental implant systems. Of 20 edentulous patients, ten had been reconstructed with a transosteal implant of gold alloy, TMI-system (Bosker), of and ten with endosseous implants of titanium (Brånemark-system). Clinical parameters evaluated included plaque, gingivitis, sulcus depth and bleeding on probing. Plaque samples from 14 patients were cultured for selected periodontal pathogens. Although some differences in soft tissue clinical behavior were identified, the incidence and prevalence of selected periodontal pathogens appeared to be similar.

This study evaluated the effect of an alternate delivery system for chlorhexidine on salivary levels of mutans streptococci (MS) and other selected oral bacteria. On the basis of salivary MS levels > or = 10(4) CFU/ml, 22 subjects were enrolled. All caries lesions were restored prior to treatment. Two pretreatment paraffin-stimulated saliva samples were obtained for culturing at least 1 week apart. Complete-arch vacuum-adapted mouthguards were individually fabricated and coated internally with a 3% w/v chlorhexidine varnish. Mouthguards were worn for an average of 7 h/night for 7 nights. Saliva samples were obtained immediately after treatment and 1 and 3 months later. There was no significant change in levels of any of the monitored bacteria between the two pretreatment samples. A significant and specific reduction in salivary MS levels was observed in the three after-treatment samples as compared with baseline values (p < 0.001, p < 0.001, p < 0.05, respectively). The levels of Actinomyces viscosus were also measured, and there was a significant reduction immediately after treatment (p < 0.05), a return to baseline values at 1 month, and a significant increase above baseline values at 3 months, (p < 0.001). There was no significant change in saliva volume, in total numbers of facultatively anaerobic bacteria, or in levels of lactobacilli or Streptococcus sanguis. This treatment system is capable of significant and specific suppression of MS levels for up to 3 months without retreatment.

This study describes the relationship between varying ascorbate intake, periodontal status, and subgingival microflora as part of a multidisciplinary investigation of ascorbic acid (AA) metabolism in young men housed for 13 weeks in a nutrition suite that provided controlled periods of ascorbic acid depletion and repletion. Twelve medically healthy non-smoking men, aged 25 to 43 years, ate a rotating four-day diet adequate in all nutrients except ascorbic acid. Following an initial baseline period during which the subjects received 250 mg AA/day, the subjects received 5 mg AA/day for a 32-day depletion period. Eight of the 12 subjects participated in a subsequent 56-day repletion period designed to replace the reduced body AA pool slowly. Plasma and leukocyte ascorbate levels, Plaque Index, Gingival Index, probing depths, and attachment level were monitored at the beginning and end of the depletion and repletion periods. Subgingival plaque samples were obtained and examined for selected organisms by indirect immunofluorescence microscopy. A uniform oral hygiene program was reinforced after each examination. Ascorbate concentrations in plasma and leukocytes responded rapidly to changes in vitamin C intake. There were no significant changes in plaque accumulation, probing pocket depth, or attachment level during the study. In contrast, gingival bleeding increased significantly after the period of AA depletion and returned to baseline values after the period of AA repletion. However, no relationship could be demonstrated between either the presence or proportion of target periodontal micro-organisms and measures of bleeding or ascorbate levels.