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Southward K. and Bosy A., 2013 July. Treatment of oral malodor and periodontal disease using an antibiotic rinse. General Dentistry

The purpose of this study was to determine the effectiveness of an antibiotic rinse preparation, containing metronidazole and nystatin, in decreasing oral malodor and periodontal disease for individuals whose chief complaint was halitosis. This topical approach to oral biofilm control, by proactively managing the most pathogenic bacteria, differs from the traditional approach of reactively treating the symptoms by attempting to reduce all oral bacteria. The late Dr. Loesche, University of Michigan, School of Dentistry, had previously described these different paradigms as the specific plaque hypothesis and the non-specific plaque hypothesis, respectively. Patients in this study were measured before and after treatment for volatile sulphur compounds using a portable sulphide monitor, a digital gas chromatograph, and organoleptic assessment. The presence of periodontal disease was determined by 6-point periodontal probing, to assess pocket depth and bleeding points. Of the 1000 patient charts sent electronically to the University of Michigan for analysis, 649 participants were selected based on complete pre- and post-treatment data, and statistically analyzed by a statistician, who was an expert in case study analysis. The post-treatment reduction of oral malodor was 80% (P = 0.0001). The difference in bleeding points pre- and post-treatment was 87% (P = 0.0001). There was a decrease in the number of teeth with 6 and 7 mm pockets by 76% and teeth with 5 mm pockets decreased by 84% (P = 0.0001). Treatment with the antibiotic rinse had a positive change in the periodontal status and breath odor of these patients. These data indicate that there is considerable advantage to the use of topical antibiotic rinses. A substantial decrease in both halitosis and periodontal disease markers can be achieved without the risk of the systemic effects of an oral antibiotic.

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Pearson G., 2013 May. Using an Antibiotic Rinse System: An Adjunct in the Treatment of Periodontal Disease. Oral Health

ABSTRACT: Research has now firmly established that dental plaque should be thought of as a biofilm and that periodontitis is a biofilm associated disease. The loss of a healthy balance in the microflora of subgingival tissues appears an important determination in the development of periodontitis. The structure and behavior of biofilm is what makes treatment of these infections more difficult. It has been found that the minimal inhibitory concentration dose for antibiotics and antimicrobials for bacteria in biofilm may be 20 to 200 times higher than required for free floating or plankton bacteria. Successful management of periodontal disease requires knowledge of oral bacteria and their behavior within a biofilm. Combining full scaling and root planing with an antibiotic can result in considerable improvement consisting of an increase in normal or shallow periodontal pockets and a decrease in the number of deep periodontal pockets. Fourteen patients, eight men and six women, with refractory periodontitis were selected randomly from a periodontal practice. Microbiology samples were taken from the throat, tongue and all four quadrants. After sampling was completed, each patient had the teeth cleaned, then was given a preparation of metronidazole, nystatin and water and told to rinse three times a day for 30 seconds. They were to continue this routine for two weeks and then return to the office for a follow-up appointment. All the tests were repeated at the end of two weeks and the results compared to baseline measurements. Only 10 patients completed all the periodontal measurements and nine patients have a complete pre and post treatment microbiology report. The results provided strong evidence that an antibiotic mouth rinse containing metronidazole and nystatin is effective in the treatment of periodontitis. Gingival tissues were healthier, with fewer bleeding points and a decrease in periodontal pocket depth. This system fits within the guidelines of the American Academy of Periodontology. The results indicate that a rinse system provides a beneficial adjunct in the treatment of periodontal disease.

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Oral-Systemic Health

Bale BF, Doneen AL, Vigerust DJ., 2016 Nov 29. High-risk periodontal pathogens contribute to the pathogenesis of atherosclerosis. Postgrad Med J

Abstract. Periodontal disease (PD) is generated by microorganisms. These microbes can enter the general circulation causing a bacteraemia. The result can be adverse systemic effects, which could promote conditions such as cardiovascular disease. Level A evidence supports that PD is independently associated with arterial disease. PD is a common chronic condition affecting the majority of Americans 30 years of age and older. Atherosclerosis remains the largest cause of death and disability. Studies indicate that the adverse cardiovascular effects from PD are due to a few putative or high-risk bacteria: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola or Fusobacterium nucleatum. There are three accepted essential elements in the pathogenesis of atherosclerosis: lipoprotein serum concentration, endothelial permeability and binding of lipoproteins in the arterial intima. There is scientific evidence that PD caused by the high-risk pathogens can influence the pathogenesis triad in an adverse manner. With this appreciation, it is reasonable to state PD, due to high-risk pathogens, is a contributory cause of atherosclerosis. Distinguishing this type of PD as causal provides a significant opportunity to reduce arterial disease.

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2015 Mar 30. Oral Pathogen Found in Pancreatic Cancer Tissue. Oncotarget.

Mitsuhashi K et al. Association of Fusobacterium species in pancreatic cancer tissues with molecular features and prognosis.

A prominent oral pathogen has been detected in cancerous pancreatic tissue, according to a recent study in the journal Oncotarget. Researchers found that Fusobacterium nucleatum was found in pancreatic cancer tissue and that the tumor Fusobacterium species was significantly associated with a worse prognosis for pancreatic cancer. Pancreatic cancer is one of the most aggressive cancers, killing 94% of its victims within 5 years of diagnosis. It is the fourth leading cause of cancer-related deaths in the United States.

F. nucleatum has already been shown to play a significant role in the pathogenesis and increased mortality risk of colorectal cancers. It is one of several pathogens of oral origin that substantially impact overall health by altering the body's immune response, often working in conjunction with other pathogens to do so.

Previous studies have linked both clinical periodontal disease and the oral microbiome to risk for pancreatic cancer. Men with gum disease have a 54% increased risk of developing the disease. P. gingivalis, another oral pathogen, has likewise been implicated in the pathogenesis of pancreatic cancer, and many researchers have suggested that salivary diagnostic technology be used for early detection and assessing prognosis for this often-fatal disease.

Researchers are not yet certain exactly what role F. nucleatum plays in the carcinogenesis of pancreatic cancer, but this research builds upon what is already suspected about using microbial burden as a biomarker for cancers throughout the body. Continued research in this area will help us learn more about the oral microbiome's role in the pathogenesis of this deadly disease.

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April 30, 2012. American Academy for Oral Systemic Health (AAOSH) Position Paper on AHA Statement.

AAOSH Response to AHA Scientific Statement on the Relationship between Periodontal Disease and Atherosclerotic Vascular Disease

The medical and dental scientific communities along with their industry stakeholders and the public media at large have been justifiably intrigued for many years by the proposed connections that exist between oral inflammation and the general health of the body. Specific to this interest is the alleged associations between periodontal disease and atherosclerotic vascular disease.

AAOSH is concerned that the headlines, public statements and media reports arising from the American Heart Association's release of its Scientific Statement concerning the proposed connections between vascular disease and periodontal disease, misstate the actual findings and statements contained within the study itself.

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April 24, 2012. Bale/Doneen/Nabors response to the AHA and ADA statements regarding Periodontal Disease and Cardiovascular Disease.

The issue of the relationship between chronic inflammatory periodontal disease (PD) and cardiovascular disease has, and continues to be, a subject of intense research as well as much debate. While the literature continues to show an independent relationship between these two diseases, the issue of causation was addressed in a recent and important article by the American Heart Association. http://circ.ahajournals.org. The Circulation AHA article examined 537 peer-reviewed studies that addressed the relationship between periodontal disease and cardiovascular disease. Concluding remarks from this intense analysis were as follows: "Observational studies to date support an association between PD and asymptomatic vascular disease (ASVD) independent of known confounders. They do not, however, support a causative relationship." The American Dental Association (ADA) Council on Scientific Affairs agrees with these conclusions.

Albeit the American Heart Association (AHA) does acknowledge the value of good oral health and hygiene, they stop short of suggesting that a direct relationship between the two conditions exists. This article provides the opportunity to investigate the objective data to determine the positive aspects of the analysis. Bradley Bale, MD, Amy Doneen, MSN, ARNP, and Thomas W. Nabors, DDS, FACD have the following response to the paper and position statement of the AHA and ADA. In light of the science presented in their article coupled with the substantial burden CVD places upon our society, we cannot afford to wait for the acquisition of causality data to incorporate assessing and treating PD in an effort to minimize CV risk.

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April 18, 2012. Periodontal Disease Linked to Cardiovascular Disease. American Academy of Periodontology.

American Academy of Periodontology supports statement from American Heart Association; additional studies needed to determine causality.

CHICAGO - April 18, 2012 - The American Academy of Periodontology (AAP) supports the American Heart Association's (AHA) scientific statement "Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association?" recently published in Circulation. The statement concludes that observational studies to date support an association between periodontal disease and cardiovascular disease, independent of shared risk factors. The AHA's statement confirms the conclusions of the statements published by the AAP and the American Journal of Cardiology in 2009 and the U.S. Preventive Services Task Force in 2008.

While current research does not yet provide evidence of a causal relationship between the two diseases, scientists have identified biologic factors, such as chronic inflammation, that independently link periodontal disease to the development or progression of cardiovascular disease in some patients.

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April 18, 2012. Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association?. American Heart Association.

Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association? : A Scientific Statement From the American Heart Association

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Bosy A. 2011 February. The Oral-Systemic Link: Dentists have a responsibility to inform their patients. AORTA.
Bosy A. 2010 December. The Oral-Systemic Science: Emerging Evidence of a Strong Relationship. Oral Health.

Abstract:  Studies show conclusively that the mouth can be a source of chronic but silent infection and that dental cleanings may not eliminate the source of the infection. Research indicates that patients now rely on the dental team not just for their oral health but for their overall health. Given this responsibility, treatment of periodontal disease requires a paradigm shift. Inclusion of a microbiological assessment of oral biofilm from the tongue surface as well as the teeth will enable the clinician to screen for the presence and location of oral pathogens. Periodic sampling provides an avenue to monitor shifts in the biofilm and gives the dental team advance warning of infection.

The treatment of infection, systemic or oral, is complex and may require the short term use of antibiotics as well as other modalities. By subscribing to these changes, the practitioner is well underway to building the health care model of the future, where collaborative teams from dentistry and medicine, nutrition and pharmacy work together to assess and manage periodontitis and systemic diseases and reinforce health and wellness awareness to the public.

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Goldstep F. 2010 December. A Healthy Mouth in a Healthy Body (editorial). Oral Health.
Soder B. 2009 September 1. Opportunities for advancing dental hygiene research; Periodontitis and premature death: a longitudinal, prospective clinical trial (Clinical report). Canadian Journal of Dental Hygiene.
Friedewald, Vincent et al. 2009 July. The American Journal of Cardiology and Journal of Periodontology Editors Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease. American Journal of Cardiology. 104: 59-68. Published simultaneously in the Journal of Periodontology.
Soder B, Jin LJ, Klinge B, Soder PO. 2007. Periodontitis and premature death: a 16-year longitudinal study in a Swedish urban population. Journal of Periodontal Research. 42(4):361-366.

Background and Objective: Growing experimental evidence implicates chronic inflammation/infection due to periodontal diseases as a risk factor for death. The objective was to evaluate the role of periodontitis in premature death in a prospective study. Methods: The causes of death in 3273 randomly-selected subjects, aged 30 to 40 years, from 1985 to 2001 were registered. At baseline, 1676 individuals underwent a clinical oral examination (Group A) and 1597 did not (Group B). Mortality and causes of death from 1985 to 2001 were recorded according to ICD-9-10. Results: In Groups A (clinically examined group) and B, a total of 110 subjects had died: 40 subjects in Group A, and 70 in Group B. In Group A significant differences were present at baseline between survivors and persons who later died, with respect to dental plaque, calculus, gingival inflammation and number of missing molars in subjects with periodontitis (p < 0.001). The multiple logistic regression analysis results of the relationship between being dead (dependent variable) and several independent variables identified periodontitis with any missing molars as a principal independent predictor of death.

Conclusions: Young individuals with periodontitis and missing molars seem to be at increased risk for premature death by life-threatening diseases, such as neoplasms, and diseases of the circulatory and digestive systems.

Kim J, Amar S. 2006 September. Periodontal Disease and Systemic Conditions: A bidirectional relationship. Odontology.

For decades dentists and physicians paid close attention to their own perspective fields, specializing in medicine pertaining to the body and the oral cavity, respectfully. However, recent findings have strongly suggested that oral health may be indicative of systemic health. Currently, this gap between allopathic medicine and dental medicine is quickly closing, due to significant findings supporting the association between periodontal disease and systemic conditions such as cardiovascular disease, type 2 diabetes mellitus, adverse pregnancy outcomes and, osteoporosis. Significant effort has brought numerous advances in revealing the etiological and pathological links between this chronic inflammatory dental disease and these other conditions. Therefore, there is reason to hope that the strong evidence from these studies may guide researchers towards greatly improved treatment of periodontal infection that would also ameliorate these systemic illnesses. Hence, researchers must continue not only to uncover more information about the correlations between periodontal and systemic diseases but also to focus on positive associations that may result from treating periodontal and systemic disease as a means of ameliorating systemic diseases.

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Anne Bosy   RDH, MEd, MSc

Bosy A. 2011 February. The Oral-Systemic Link: Dentists have a responsibility to inform their patients. AORTA.
Bosy A. 2010 December. The Oral-Systemic Science: Emerging Evidence of a Strong Relationship. Oral Health.

Abstract:  Studies show conclusively that the mouth can be a source of chronic but silent infection and that dental cleanings may not eliminate the source of the infection. Research indicates that patients now rely on the dental team not just for their oral health but for their overall health. Given this responsibility, treatment of periodontal disease requires a paradigm shift. Inclusion of a microbiological assessment of oral biofilm from the tongue surface as well as the teeth will enable the clinician to screen for the presence and location of oral pathogens. Periodic sampling provides an avenue to monitor shifts in the biofilm and gives the dental team advance warning of infection.

The treatment of infection, systemic or oral, is complex and may require the short term use of antibiotics as well as other modalities. By subscribing to these changes, the practitioner is well underway to building the health care model of the future, where collaborative teams from dentistry and medicine, nutrition and pharmacy work together to assess and manage periodontitis and systemic diseases and reinforce health and wellness awareness to the public.

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Bosy A. 2006 July/August. Managing Oral Malodor. The Journal of Practical Hygiene.

Abstract:  Dental professionals should make recommendations to treat oral malodour based on their patients' individual condition. Xylitol-containing products provide a host of benefits when incorporated into a dental hygiene treatment regimen.

Bosy A. 2002 July/August. A Review of Oral Products for the Treatment of Oral Malodour. The Journal of Practical Hygiene. Supplement.

Abstract:  Oral malodour can be either a short-term, transient problem that includes morning breath or food odours or it can be a long-term, chronic problem. Commercial products support the short-term problem, but the duration of relief varies with the active ingredient. Long term, chronic problems are difficult to eliminate and require a more aggressive treatment with antimicrobial rinses such as chlorhexidine.

Bosy A. 2001. Oral Malodour - Cosmetic Problem or Chronic Infection?. Compendium of Continuing Education in Oral Hygiene. 8(2) 3-11.

Abstract:  The most common cause of oral malodour is elevated levels of volatile sulfur compounds. The production of these gases results from the action of gram-negative anaerobic bacteria on protein matter. Individuals who suffer from oral malodour experience anxiety and may exhibit antisocial behavior. Some develop a psychosomatic condition called halitophobia. Interest in treating oral malodour has increased in recent years but dentists and dental hygienists are still reluctant to address the problem. Treatment of this condition consists of good oral hygiene along with the use of antimicrobial agents, oxidizing agents, and anti-odourants such as sodium bicarbonate. Not commonly used for the treatment of oral malodour in the past, studies indicate that sodium bicarbonate should be given serious consideration. Dentifrices containing 20% or more baking soda can significantly reduce odour for up to 3 hours. Dentifrices with the zinc ion and baking soda, although still not available commercially, have an enhanced anti-odour effect.

Bosy A. 2000. Oral Malodour - Up Close and Personal. D.A.M. Dental Auxiliary Magazine. 1(1) 7-9.

Abstract:  The facts indicate that up to 50% of the population suffer from oral malodour, many finding it a chronic condition. When do people become aware of their bad breath? How do you distinguish between bad breath and normal breath? This paper discusses these issues and reviews current assessment and treatment options.

Bosy A. 1997 March. Oral Malodour: Philosophical and Practical Aspects. J. Canadian Dental Association. 63 (3) 196-201.

Abstract:  Although oral malodour or bad breath is an unpleasant condition experienced by most individuals, it typically results in transient discomfort. At least 50 per cent of the population suffer from chronic oral malodour, however, and approximately half of these individuals experience a severe problem that creates personal discomfort and social embarrassment. The mouth air of chronic malodour sufferers is tainted with compounds such as hydrogen sulphide, methyl mercaptan and organic acids, which produce a stream of foul air that is gravely offensive to the people in their vicinity. Sufferers often make desperate attempts to mask their oral malodour with mints and chewing gum, compulsive brushing and repeatedly rinsing with commercial mouthwashes. While dental diseases have been strongly associated with this condition, there is considerable evidence that dentally healthy individuals can exhibit significant levels of mouth odour. Proteolytic activity by ;microorganisms residing on the tongue and teeth results in foul-smelling compounds, and is the most common cause of oral malodour. A specialized device called the halimeter is available to measure the volatile sulphur compounds in mouth air. Many of the manufacturers of bad breath remedies claim that their products contain antibacterial mechanisms with sufficient strength to control oral malodour over long periods of time. None, however, effectively eliminate the problem. Interest in oral malodour research and clinical treatment has increased in the last few years, and this distressing problem is finally getting the attention it deserves.

Bosy A, Kulkarni GV, Rosenberg M, McCulloch CAG. 1994. Relationship of Oral Malodour to Periodontitis: Evidence of Independence in Discrete Sub-Populations. Journal of Periodontology. 65(1):37-46.

Abstract:  Associations between oral malodour, measures of periodontal disease and trypsin-like activity of periodontal pathogens on teeth and tongue were examined in 127 subjects. The volatile sulphur compounds present in mouth air were measured by halimeter and by organoleptic methods. The study showed that there was a significant contribution to oral malodour by the tongue surface. Subjects were treated with chlorhexidine gluconate to study the effect of reducing microbial colonization on oral malodour. Reductions of volatile sulphur compound levels were significant. Oral malodour in subjects with and without periodontitis was measured and the two groups were compared. The average volatile sulphur compound measurement in the 37 subjects with periodontitis was only slightly higher than the average measurement of the 90 healthy subjects. The data in this study indicate that a large proportion of individuals with oral malodour are periodontally healthy and that the surface of the tongue is a major site of oral malodour production.

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Rosenberg M, Kulkarni GV, Bosy A, McCulloch CAG. 1991 November. Reproducibility and Sensitivity of Oral Malodour Measurements with a Portable Sulphide Monitor. Journal of Dental Research.

Abstract:  Forty-one subjects with bad breath were assessed for oral malodor and periodontal status on three occasions, at intervals of approximately one week. Oral malodor was assessed by measurement of peak and steady-state volatile sulphide levels with a portable sulphide monitor and by organoleptic measurement of whole-mouth, tongue dorsum and interproximal dental odors by two independent judges. Reproducibility of measurements assessed by paired t tests and Kappa testing, demonstrated no significant differences between any of the test results from the first and second appointments.

Steady-state sulphide levels were the most reproducible of all tests. The ability of the test to detect an expected reduction of malodor following a 0.2% chlorhexidine mouthrinse regimen was investigated by comparison of test values between the second and third appointments. Following the mouthrinsing treatment, 43% reductions of peak, 47% reductions of steady-state volatile sulphide levels and 15-58% reductions in all other measurement categories were observed. The majority of the participants (22/41) had no pockets greater than 5 mm and exhibited both moderate gingival inflammation (Mean Gingival Index = 1.17) and moderate plaque accumulation (Mean Plaque Index = 1.84). Plaque Index and presence of pockets greater than 7 mm were weakly related to sulphide measurements. Whereas assessment of steady-state sulphide levels by the sulphide monitor does not constitute a direct measure of oral malodor, its relation to organoleptic measurement, superior reproducibility, objectivity and sensitivity support the use of the sulphide monitor in clinical studies.


Walter Loesche   DMD, PhD

Loesche, WJ. 1999. The Antimicrobial Treatment of Periodontal Disease: Changing the Treatment Paradigm. Critical Reviews in Oral Biology & Medicine. 10(3); 245-275.

Abstract:  Over the last 100 years methods of surgical periodontal treatment have enjoyed a history of success in improving oral health. The paradigm of care is based on the "non-specific plaque hypothesis." That is, the overgrowth of bacterial plaques cause periodontal disease, and the suppression of this overgrowth reduces disease risk. The central feature of this approach to care is the removal of inflamed gingival tissue around the teeth to reduce periodontal pocket depth, thereby facilitating plaque removal by the dentist and by the patient at home.

Over the last 30 years, with the recognition that periodontal disease(s) is caused by specific bacteria and that specific antimicrobial agents can reduce or eliminate the infection, a second paradigm has developed. This new paradigm, the "specific plaque hypothesis" focuses on reducing the specific bacteria that cause periodontal attachment loss.

The contrast between the two paradigms can be succinctly stated as follows: The antimicrobial therapy reduces the cause, while the surgical therapy reduces the result of the periodontal infection. The specific plaque hypothesis has two important implications. First with the increasing attention to evidence-based models for prevention, treatment, outcome assessment and reimbursement of care, increasing attention and financial effort will be channeled into effective preventive and treatment methods. Second, the recent observations that periodontal infections increase the risk of specific systemic health problems, such as cardiovascular disease, argues for the prevention and elimination of these periodontal infections. This review highlights some of the evidence for the specific plaque hypothesis, and the questions that should be addressed to use antimicrobial agents responsively and effectively.

Loesche, WJ. 1999. Anaerobic Periodontal Infections as Risk Factors for Medical Diseases. Current Infectious Disease Reports. 1:33-38.

Abstract:  Advanced forms of periodontal disease are associated with the overgrowth of a limited number of gram negative anaerobic species in plaques found in periodontal pockets. Double-blind clinical trials of metronidazole and doxycycline, combined with debriding of the tooth surfaces, have significantly reduced the need for periodontal surgery.

Epidemiological studies have indicated, that untreated periodontal disease could be a risk factor for pre-term delivery of low birth-weight infants, coronary heart disease and cerebral vascular accidents. This is because the gram negative anaerobic species implicated in periodontal disease (Bacteroides forsythus, Porphyromonas gingivalis, Treponema denticola) could introduce lipopolysaccharides, heat shock proteins, and pro-inflammatory cytokines into the blood stream. If periodontal disease is a risk factor for cardiovascular disease, then it is a modifiable risk factor, as periodontal disease is treatable.

Loesche WJ. 1997. Association of the oral flora with important medical diseases. Current Opinion in Periodontology. 4:21-8.

Abstract:  Recently, there have been case-control and epidemiologic investigations that strongly associate poor dental health with cardiovascular disease, preterm low birth weight infants, and early death from any cause. In a 7-year prospective study, dental disease was a significant predictor of coronary events leading to death after controlling for known coronary disease risk factors. Missing teeth displaces smoking as a risk factor for ischemic heart disease in another study. Periodontal disease was seven times more likely to be associated with a preterm delivery of a low birth weight infant than mother's age, race, number of live births, and use of tobacco or alcohol. This review examines the role of asymptomatic bacteremia as possibly explaining these associations, focusing on the bacterial load on the teeth as mediated via oral hygiene.

De Boever EH, Loesche WJ. 1995 Oct. Assessing the contribution of anaerobic microflora of the tongue to oral malodor. Journal of the American Dental Association. 126(10):1384-93.

Abstract:  Research suggests that the tongue plays an important role in the production of oral malodor. To investigate the role of tongue surface characteristics and oral bacteria in halitosis development, the authors tested associations between odor measurements, volatile sulfur compound levels, periodontal parameters, tongue surface characteristics, presence of trypsinlike activity of organisms on the tongue and teeth and bacteriological parameters in 16 participants with complaints of oral malodor. The data indicate that the proteolytic, anaerobic flora residing on the tongue plays an essential role in the development of halitosis.

Loesche WJ, Lopatin DE, Giordano J, Alcoforado G, Hujoel P. 1992 Feb. Comparison of the benzoyl-DL-arginine-naphthylamide (BANA) test, DNA probes, and immunological reagents for ability to detect anaerobic periodontal infections due to Porphyromonas gingivalis, Treponema denticola, and Bacteroides forsythus. Journal of Clinical Microbiology. 30(2):427-33.

Abstract:  Most forms of periodontal disease are associated with the presence or overgrowth of anaerobic species that could include Treponema denticola, Porphyromonas gingivalis, and Bacteroides forsythus among others. These three organisms are among the few cultivable plaque species that can hydrolyze the synthetic trypsin substrate benzoyl-DL-arginine-naphthylamide (BANA). In turn, BANA hydrolysis by the plaque can be associated with periodontal morbidity and with the presence of these three BANA-positive organisms in the plaque. In this investigation, the results of the BANA test, which simultaneously detects one or more of these organisms, were compared with the detection of these organisms by (i) highly specific antibodies to P. gingivalis, T. denticola, and B. forsythus; (ii) whole genomic DNA probes to P. gingivalis and T. denticola; and (iii) culturing or microscopic procedures. The BANA test, the DNA probes, and an enzyme-linked immunosorbent assay or an indirect immunofluorescence assay procedure exhibited high sensitivities, i.e., 90 to 96%, and high accuracies, i.e., 83 to 92%, in their ability to detect combinations of these organisms in over 200 subgingival plaque samples taken from the most periodontally diseased sites in 67 patients. This indicated that if P. gingivalis, T. denticola, and B. forsythus are appropriate marker organisms for an anaerobic periodontal infection, then the three detection methods are equally accurate in their ability to diagnose this infection. The same statement could not be made for the culturing approach, where accuracies of 50 to 62% were observed.


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