The Microbial Aetiology of Periodontal Diseases

Introduction: The study of the aetiology of periodontal diseases has continued for decades with much progress shown in the last two decades. Having moved through periods of “whole” plaque (with emphasis on mass) being attributed to the disease process, to “specific” species being implicated, we have finally returned to examining the oral microbiota as an ecological niche involving not only a selected few species but looking at plaque as a whole where all the players are invited to participate with their roles no longer individually defined but viewed as a team effort with recognition of their individual strengths and contributions. Recent findings using advanced technology, are confirming findings viewed by electron microscopy nearly half a century ago, but we now have the knowledge and expertise to interpret those findings with deeper understanding. This chapter will attempt to examine the microbial succession within the plaque biofilm from health to disease, bearing in mind the susceptibility of the host, the microbial heterogeneity and the expression of virulence by the putative pathogens

Oral colonization of Gram-negative anaerobes as a risk factor for preterm birth

Preterm birth significantly impacts on neonatal morbidity and mortality and is apparently increasing worldwide. Several studies have attempted to define a causative role for periodontal disease in adverse pregnancy outcomes but few have focused on the microbiology of periodontal disease in relation to these outcomes. Results: The evidence for a positive correlation is strong, supported by microbiological and immunological findings. Conflicting results are often associated with uncontrolled confounding factors. Materials and Methods: A literature search was conducted in order to establish whether or not a role exists for oral Gramnegative bacteria in adverse pregnancy outcomes. Association and intervention studies are summarized along with pathogenic potential of the Gram-negative bacteria most frequently implicated in periodontal disease.National Research Foundation of South AfricaIS

The association between gender and tooth loss in a small rural population of South Africa

Periodontal disease, which attacks the gums and supporting structures of the tooth, is one of the major causes of tooth loss in adults. Few studies on general well-being have compared the differences in oral health between men and women with studies from Europe and USA reporting that there are more edentulous women than men.Among the many factors contributing to tooth loss are poverty, availability and accessibility to dental and other health care as well as cultural traditions. This study examined a population living in a high fluoride area near Cape Town. This isolated community has until recently been unexposed to the diets and habits of the western world and have inter-married for decades. The results of this study indicated that although women had better oral hygiene habits than men, tooth loss was associated with age rather than gender.National Research Foundation of South Afric

The threat of aerobic vaginitis to pregnancy and neonatal morbidity

Aerobic vaginitis (AV) is an endogenous opportunistic infection brought about by the disruption of the normal vaginal microbiota. Its early diagnosis and treatment during pregnancy may reduce the risk of negative pregnancy outcomes. The aim of this review was to report on the aerobic bacteria most prevalent in AV and to provide evidence of the threat of untreated AV on pregnancy outcomes. More than 300 papers on preterm delivery were extracted from several research domains and filtered to include only AV-associated bacteria such as Staphylococcus aureus, Enterococcus faecalis, Escherichia coli and Group B streptococci and their association with adverse pregnancy outcomes. Due to the diverse sample groups, study techniques and outcomes, a meta-analysis was not conducted. The review revealed that the association of AV with adverse pregnancy outcomes has not been as widely researched as bacterial vaginosis (BV) and needs further investigation. Furthermore, the frequent misdiagnosis of AV coupled with the emerging antimicrobial resistance associated with bacteria implicated in AV and neonatal nosocomial infections pose a problem for prophylaxis and treatment to reduce the risk of maternal and neonatal morbidity and mortality.National Research Foundation (NRF

Examination of maternal gingival crevicular fluid for the presence of selected periodontopathogens implicated in the pre-term delivery of low birthweight infants

Background: Reports show that more than 20 million infants world-wide are born prematurely with 95% of all pre-term births occurring in developing countries. Oral colonization of Gram-negative anaerobes has been implicated as a risk factor for preterm delivery of low birth weight infants. Results: Association of bacterial species with the risk of periodontal disease and thus the risk of preterm delivery was only observed when they occurred in pairs or groups of three or more. Aa appeared to be a necessary co-factor for significant associations of bacterial groups with the variables recorded. Materials and Methods: This study comprised 200 women admitted to the department of obstetrics and gynecology of the teaching hospital of Butare in Rwanda. Gingival crevicular fluid was collected from each quadrant of the mother’s mouth (using paper points) within 24 hours of delivery. A dichotomous score of presence or absence of gingival inflammation was recorded for each patient along with demographic data such as age, marital status etc. Samples were examined by PC R for the presence of Aggregatibacter actinomycetemcomitans and selected members of the red and orange complexes described by Socransky et al. (1998), and their presence associated with age, gingival inflammation and pregnancy outcomes.National Research Foundation of South AfricaWeb of Scienc

Risk factors of preterm delivery of low birth weight (plbw) in an African population

More than 20 million infants in the world (15.5% of all births) are born with low birth weight. Ninety-five percent of them are in developing countries. The objective of this study was to examine different factors which may contribute to preterm delivery of low birth weight (PLBW) in a recent sample of Rwandan birth. The study sample included 200 randomly selected women admitted to the department of obstetrics-gynecology of the teaching hospital of Butare in Rwanda. Mothers were asked to complete a questionnaire and obstetrics records were used in order to identify factors which might pose a health risk to them and their infants. Maternal weight, height, history of previous preterm and healthy conditions of the children in the family showed a significant relationship with PLBW. Maternal level of education, number of pregnancies of the mother, urinary tract infection, sexually transmitted disease, antibiotic administration, diabetes, history of heart disease, alcohol consumption and smoking showed a relationship with PLBW but the relationship was not significant. More studies are required for a better understanding of the mechanism leading to preterm delivery of low birth infants.National Research Foundation of South Afric

HIV/Candida co-infection in Sub-Saharan African women on ART

5th FIDSSA Congress 2013: Champagne Sports Resort Drakensberg, KwaZulu Natal, South Africa - Poster Presentations.INTRODUCTION: Sub-Saharan Africa has 23.5 million cases of HIV and is home to 92% of the world’s HIV-positive pregnant women of whom 24% die of pregnancy related complications. Oral candidiasis is a common condition in HIV-AIDS patients, caused by commensal yeasts which may colonise the mucous membranes of the mouth causing morbidity due to several factors including immunosuppression, smoking, poor nutrition and the use of antibiotics. Methods: One hundred and ninety-four South African and Cameroonian HIV-positive women participated in the study. Only subjects who had white pseudomembranous plaque on the tongue or visible oral candidiasis were included. Samples were collected by scraping the patient’s oral mucosa and tongue with a sterile swab. Candida species were differentiated using selective and chromogenic media and their susceptibility to antifungal drugs was tested using the TREK Sensititre system. Results and conclusion: One hundred and ninety-six isolates, representative of six Candida species were identified. C. albicans was the predominating species, with C. glabrata and C. dubliniensis being the more frequent of the non-albicans isolates. Azole drug resistance patterns were very high for C. albicans, while C. glabrata showed high resistance patterns to echinocandins drugs. The duration of ART could be associated with the presence of different Candida species but no concrete conclusions could be drawn concerning HIV/Candida co-infection when controlling for other risk factors such as HIV stage, pregnancy, age and treatment for tuberculosis. This may be a cause for concern, particularly in the case of pregnancy, where co-infection may pose a risk for maternal morbidity and mortality.National Research Foundation of South AfricaDepartment of HE and Training approved lis

Anaerobes and bacterial vaginosis in pregnancy: virulence factors contributing to vaginal colonisation

The aetiology and pathogenesis of bacterial vaginosis (BV) is unclear but it appears to be associated with factors that disrupt the normal acidity of the vagina thus altering the equilibrium between the normal vaginal microbiota. BV has serious implications for female morbidity, including reports of pelvic inflammatory disease, adverse pregnancy outcomes, increased susceptibility to sexually transmitted infections and infertility. This paper reviewed new available information regarding possible factors contributing to the establishment of the BV vaginal biofilm, examined the proposed role of anaerobic microbial species recently detected by new culture-independent methods and discusses developments related to the effects of BV on human pregnancy. The literature search included Pubmed (NLM), LISTA (EBSCO), and Web of Science. Because of the complexity and diversity of population groups, diagnosis and methodology used, no meta-analysis was performed. Several anaerobic microbial species previously missed in the laboratory diagnosis of BV have been revealed while taking cognisance of newly proposed theories of infection, thereby improving our understanding and knowledge of the complex aetiology and pathogenesis of BV and its perceived role in adverse pregnancy outcomes.National Research Foundation of South Africa (NRF)Web of Scienc

Further evidence for periodontal disease as a risk indicator for adverse pregnancy outcomes

Although there is increasing evidence to suggest an association between periodontal disease and adverse pregnancy outcomes, the issue remains controversial. Study objective: This study tested the hypothesis that periodontal disease is a risk indicator for preterm delivery of low-birthweight infants. Materials and methods: The study sample comprised 443 pregnant women with a mean ( standard deviation) age of 24.13 ( 5.30) years. At first visit, maternal oral health status was assessed by the measurement of probing pocket depth and clinical attachment loss, and periodon- tal status was graded as absent, mild, moderate or severe. An association was sought between pregnancy outcomes and maternal periodontal status. Results: While controlling for other factors, significant associations were found between pregnancy outcomes and maternal periodontal index scores. Conclusion: This study provides further evidence that peri- odontal disease is a risk indicator for adverse pregnancy outcomes

BANA-positive plaque samples are associated with oral hygiene practices and not CD4+ T cell counts in HIV-positive patients

Background. The “red complex” microorganisms, namely, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia are considered as potential pathogens causing HIV-associated periodontal diseases. Moreover, it has been recognized that an association exists between CD4+ T cell counts and periodontal disease progression. Objective. To establish whether CD4+ T cell counts or oral hygiene plays a greater role in producing BANA-positive results in HIV-associated periodontal disease. Materials and Methods. One hundred and twenty HIV-positive patients participated in the study, and their CD4+ T cell counts were obtained from their medical records. The six Ramfjord teeth were used for evaluating periodontal clinical indices and subgingival plaque sampling. BANA test was used for the detection and prevalence of the “red complex” bacteria in plaque samples. Results.Amajority of 69.17% HIV-positive patients were BANA-positive. No significant associations were found between BANA and CD4+ T cell counts. A highly significant association was found between BANA with probing depth and clinical attachment level (P ≤ 0.0001) and between BANA and the use of interdental aids (P = 0.0168). Conclusion. HIV-associated periodontal diseases are strongly related to oral hygiene practices rather than the effect of CD4+ T cell counts, and the use of interdental aids was marked as a significant predictor of BANA-negative plaque samples.National Research Foundation of South Afric