Assessing bacterial risk factors for periodontitis and peri-implantitis: Using evidence to enhance outcomes
Microbial tests have their application in the dental practice. The main indication for their use has been for patients who are refractory to conventional therapy. Microbial sampling also can be used in different stages of treatment, including evaluation of a patient's status after treatment to schedule recall intervals. Refractory periodontitis includes early onset periodontitis and rapidly progressive periodontitis, a catch-all category that includes older individuals who do not respond to repeated and thorough periodontal treatment. The associated microflora of refractory periodontitis has been reported to consist of Bacteroides forsythus, spirochetes, motile rods, fusobacterium sp., P. gingivalis, campylobacter rectus, capnocytophaga, candida sp., enteric rods, staphylococcus sp., Eikenella corrodens, and Enteroccocus sp. Microbial diagnostic and antimicrobial susceptibility testing is a must in cases of refractory periodontitis. Patients with implants are also at risk for peri-implantitis. The main etiologic factors of failing and ailing implants are infection and trauma. The microflora associated with successful implants placed in edentulous patients yield low bacterial counts and are usually composed of facultative anaerobic cocci. Fusobacterium sp. are found in small percentages, while BPB are infrequently found. Implants placed in partially edentulous mouths are influenced by the presence of teeth. Teeth may serve as a reservoir for bacterial colonization. It has been hypothesized that there is a difference in the microflora between implant failure caused by trauma and failure due to infection. If the etiologic factor is infection, the microflora is represented by spirochetes and motile rods. Implants failing due to trauma demonstrate a microbial profile consistent with periodontal health. Microbial tests should be used in implant patients when pathology caused by infection is suspected. If trauma is the primary cause of pathology, antimicrobials could be used only as an adjunct to therapy. The use of microbial diagnostics should be a must in the treatment of patients with refractory forms of periodontitis and with infection-associated peri-implantitis. [M.C.R.]
Newman, M.G., and V. Marinho, Compendium, 8:958, 1994