title: Experimental gingivitis, bacteremia and systemic biomarkers: a randomized clinical trial.
abstract: OBJECTIVE
  Bacteremia and systemic inflammatory markers are associated with periodontal and systemic diseases and may be linking mechanisms between these conditions. We hypothesized that in the development of gingival inflammation, systemic markers of inflammation and bacteremia would increase.
  
  
  METHODS
  To study the effect of bacteremia on systemic inflammatory markers, we recruited 80 subjects to participate in an experimental gingivitis study. Subjects were stratified based on gender, smoking and the number of bleeding sites and then randomized to one of two groups: control group (n = 40) or experimental gingivitis group (n = 40). Subjects in the control group conducted an oral hygiene regimen: brushing twice daily with a regular sodium fluoride cavity protection dentifrice and a standard manual toothbrush, flossing twice daily, and mouth rinsing with an anti-cavity fluoride rinse once daily. The experimental group stopped brushing and flossing, and used only the fluoride anti-cavity mouth rinse for 21 d.
  
  
  RESULTS
  Seventy-nine of 80 subjects were evaluable. One subject in the control group was excluded from the results due to antibiotic use during the study. Our data showed the experimental gingivitis group exhibited a significant (p < 0.05) increase in dental plaque level and gingival inflammatory indices relative to baseline and the control group but a decrease in bacteremia and soluble intercellular adhesion molecule-1 levels vs. baseline. Bacteremia was negatively correlated with gingival inflammatory indices and soluble intercellular adhesion molecule-1 levels in the experimental gingivitis group, thus negating our hypothesis.
  
  
  CONCLUSIONS
  We conclude that there are marked differences in systemic cytokine levels over the course of short-term experimentally induced gingivitis and further conclude that a long-term periodontitis study must be considered to address mechanisms whereby oral diseases may affect systemic diseases.
authors.affiliation: Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Kinane
authors.affiliation: Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Benakanakere
authors.affiliation: Department of Periodontics, Endodontics and Dental Hygiene, Center for Oral Health and Systemic Disease, University of Louisville School of Dentistry, Louisville, KY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Singleton
authors.affiliation: Health Care Research Center, Procter & Gamble Company, Mason, OH, USA.
authors.forename: A
authors.initials: A
authors.lastname: Biesbrock
authors.affiliation: Institute of Medical Microbiology and Hygiene, Philipps University Marburg, Marburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Nonnenmacher
authors.affiliation: Health Care Research Center, Procter & Gamble Company, Mason, OH, USA.
authors.forename: T
authors.initials: T
authors.lastname: He
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000175:diagnosis* / Q000473:pathology*; D015415:Biomarkers / Q000097:blood*; D016207:Cytokines / Q000097:blood*; D005260:Female; D005891:Gingivitis / Q000150:complications* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D015415:Biomarkers; D016207:Cytokines
keywords: bacteremia; experimental gingivitis; periodontal disease; systemic inflammation