title: Utility of 5 major putative periodontal pathogens and selected clinical parameters to predict periodontal breakdown in patients on maintenance care.
abstract: The predictive utility of 5 major putative periodontopathic microbial species, "superinfecting" organisms, and several clinical periodontal parameters were assessed relative to periodontitis recurrence over a 12-month period in 78 treated adult patients participating in a 3-month maintenance care program. At baseline, pooled subgingival microbial samples were collected from each patient, and whole-mouth evaluations of probing depth, relative periodontal attachment level, furcation involvement, and indices of plaque and gingival inflammation were carried out. 67 (85.9%) subjects were culture-positive at baseline for presence of either Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Campylobacter rectus or Peptostreptococcus micros, with 48 (61.5%) subjects yielding one or more of these species at or above designated threshold proportions of > or = 0.01% for A. actinomycetemcomitans, > or = 0.1% for P. gingivalis, > or = 2.5% for P. intermedia, > or = 2.0% for C. rectus, and > or = 3.0% for P. micros. Subgingival yeasts were recovered from 12 subjects, staphylococci from 7, and enteric rods/pseudomonads from 6; however, no subjects revealed > or = 1.0% baseline proportions of these "superinfecting" organisms in subgingival specimens. Periodontitis recurrence in subjects was defined as any periodontal site exhibiting either a probing depth increase of > or = 3 mm from baseline, or a probing depth increase of > or = 2 mm from baseline together with a loss in relative periodontal attachment of > or = 2 mm from baseline. 15 (19.2%) study subjects showed periodontitis recurrence within 6 months of baseline, and 25 (32.1%) within 12 months. The mere baseline presence of the 5 major test species and "superinfecting" organisms were not significant predictors of periodontitis recurrence over 12 months. However, a 2.5 relative risk for periodontitis recurrence over 12 months was found for subjects yielding one or more of the 5 major test species at or above the designated baseline threshold proportions (p = 0.022, Mantel-Haenszel chi 2 test). The positive predictive value for periodontitis recurrence of a microbiologic analysis encompassing the 5 major test species at or above the designated threshold proportions improved with increasing time from baseline, up to approximately 42% at 12 months. Baseline variables jointly providing in multiple regression analysis the best predictive capability for periodontitis recurrence in subjects over a 12-month period were recovery of one or more of the 5 major test species at or above designated threshold proportions, the proportion of sites per subject with > or = 5 mm probing depth, and the mean whole-mouth probing depth. These findings indicate that one or more of 5 major putative periodontal pathogens in elevated subgingival proportions together with increased probing depth predispose adults on maintenance care to recurrent periodontitis.
authors: Division of Dental Medicine & Surgery, Medical College of Pennsylvania, Philadelphia, USA.
authors: T E
authors: TE
authors: Rams
authors: M A
authors: MA
authors: Listgarten
authors: J
authors: J
authors: Slots
mesh_terms: D000328:Adult; D016976:Aggregatibacter actinomycetemcomitans / Q000302:isolation & purification; D000704:Analysis of Variance; D002167:Campylobacter / Q000302:isolation & purification; D016009:Chi-Square Distribution; D015169:Colony Count, Microbial; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010462:Peptostreptococcus / Q000302:isolation & purification; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000382:microbiology; D010518:Periodontitis / Q000175:diagnosis* / Q000382:microbiology* / Q000628:therapy; D016966:Porphyromonas gingivalis / Q000302:isolation & purification; D011237:Predictive Value of Tests; D018713:Prevotella intermedia / Q000302:isolation & purification; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis; D012680:Sensitivity and Specificity