Changes in bacterial profiles after periodontal treatment associated with respiratory quality of asthmatic children
AbstractBackground Despite the reduction phenomenon of asthma
exacerbation after dental plaque control, no scientific report has
been found to describe the link between bacterial profiles and
respiratory quality in children with asthma.
Objective To investigate association between bacterial profiles changes
and improvement in respiratory quality after periodontal treatment.
Methods Asthmatic children with FEV1 reversibility ~ 12% and
dental plaque index ~ 2 who qualified for inclusion criteria were
randomized into two groups. The treatment group was referred for
dental plaque removal by oral biology dentist and guided to perform
an individual oral health care for seven days. The control group
was observed without intervention. Each subject was assessed for
respiratory quality and bacterial profiles taken from plaque culture
before and after one week run-in period. Paired t-test and correlation
were used for statistical anayses. The study protocol was approved by
the Medical Research Ethics Committee of Dr. Soetomo Hospital.
Results Dental plaque control was performed in 18 of 36 children
with mild asthma. At follow-up, plaque analysis among the
subjects receiving dental treatment showed a significant reduction
(P<0.01) in number of microbial colony and gram negative bacilli,
corresponding by a fall in asthma score, FEV1 reversibility, and
blood eosinophil (P<O.Ol). The improvement of respiratory
quality variables were moderately associated (r>0.4; P<0.05) with
bacterial profiles changes after periodontal treatment.
Conclusions A reduced rate of gram negative bacilli colonization
in dental plaque after periodontal treatment is related to
improvement of respiratory quality of asthmatic children.
insights into the pathogenesis of asthma. J Clin Invest.
2. Walter MJ, Holtzman MJ. A centennial history of research
on asthma pathogenesis. Am Respir Cell Mol Biol.
3. Talay F, Karabay 0, Yilmaz F, Kocoglu E. Effect of inhaled
budesonide on oropharyngeal gram negative bacilli
colonization in asthma patients. Respirology. 2007; 12:76-
4. Friedrich N, Volzke H, Schwahn C, Kramer A, Junger M,
Schafer T. Inverse association between periodontitis and
respiratory allergies. Clin Exp Allergy. 2006;6:495.
5. Katancik JA, Kritchevsky S, Weyant RJ, Corby P, Bretz W,
Crapo RO, et al. Periodontitis and airway obstruction. J
6. Wiyarni, Endaryanto A, Harsono A. Effects of dental plaque
control on lung function and asthma symptoms in children.
Proceeding of the 14'h KONIKA Conference; 2008 July 5-9;
7. Marsh PD. Dental plaque as a biofilm and a microbial
community - implications for health and disease. BMC Oral
Health. 2006;6: 14.
8. Incorvaia C, Frati F, Sensi L, Riario-Sforza GG, Marcucci F.
Allergic inflammation and the oral mucosa. Recent Patents
on Inflammation Allergy Drug Discovery. 2007;1:35-8.
9. Utomo H. Management of oral infection in patient with
asthmatic symptoms. Majalah Kedokteran Gigi FKG
Universitas Airlangga. 2006;39: 120-5.
10. Rahajoe N, Supriyatno B, Setyanto DB. Pedoman nasional
asma anak. 1st ed. Jakarta: UKK Pulmonologi PP IDAI, 2004;
11. Li:ie H. The gingival index, the plaque index and the retention
index system. J Periodontal. 1967;38:610-6.
12. Utomo H, Pradopo S. The 'assisted drainage' method:
a practical dental approach in children's rhinosinusitis
management. Indonesian J of Dentistry. 2006; 13:133-6.
13. Van Winkelhoff. Microbiology in diagnosis and
treatment planning in periodontics. Int J Dent Hygiene.
14. Yawn BP, Brenneman SK, Allen-Ramey FC, Cabana MD,
Markson LE. Assessment of Asthma Severity and Asthma
Control in Children. Pediatrics. 2006; 118:322-9.
15. Barreiro TJ, Perillo I. An approach to interpreting spirometry.
Am Fam Physician. 2004;69:1107-1114.
16. Rose LF, Rudolph P, Pendill J. Effect of periodontal infection
on systemic health and well being. In: Rose LF. Periodontics
medicine, surgery, and implants. St Louis: Elsevier Mosby,
2004; p. 847-49.
17. Laurikainen K. Asthma and oral health: a clinical and
epidemiological study. Academic dissertation. Tampere:
Tampere University Press; 2002.
18. Li XJ, Kolltveit KM, Tronstad L, Olsen I. Systemic
diseases caused by oral infection Clin Microb Rev.
2000; 13:54 7-58.
19. Scannapieco FA, Bush RB, Paju S. Associations between
periodontal disease and risk for nosocomial bacterial
pneumonia and chronic obstructive pulmonary disease: a
systematic review. Ann Periodontal. 2003;8:54-69.
20. Katancik JA, Kritchevsky S, Weyant RJ, Corby P, Bretz W,
Crapo RO, et al. Periodontitis and airway obstruction. J
21. Illi S, von Mutius E, Laus, Bergmann R, Niggeman B,
Sommerfeld C, et al. Early childhood infectious diseases and
the development of asthma up to school age: a birth cohort
study. BMJ. 2001;322:390-5.
22. Bisgaard H, Hermansen MN, Buchvald F, Loland L, Halkjaer
LB, Bonnelykke K, et al. Childhood asthma after bacterial
colonization of the airway in neonates. N Engl J Med.
23. Von Mutius E. Of attraction and rejection: asthma and the
microbial world. N Engl J Med. 2007;357: 1545-6.
24. Siva R, Berry M, Pavord ID. Recent insight into the
relationship between airway inflammation and asthma. Arch
Chest Dis. 2003;59:296-9.
25. Lahiri K, Chavarkar M. Newer perspectives of childhood
asthma. MJAFI. 2004;60:214-17.
26. Scheinmann P, Pedersen S, Warner JO, De Blic J. Methods for
assessment of airways inflammation in pediatrics. Eur Respir
J. 1996; 1l:S53-8.
27. Martin RJ, Kraft M, Chu HW, Berns A, Cassell GH. A link
between chronic asthma and chronic infection. J Allergy Clin
lmmunol.200 1; 107:595-601.
28. Van Dyke TE, Serhan CN. Resolution of inflammation: a
new paradigm for the pathogenesis of periodontal diseases. J
Dent Res. 2003;82:82-90.
29. Broide DH. The Role of Bacterial Infections in Allergy:
A Clinical Paradox. & Leung DYM. Bacterial infection
and allergy. Proceeding of the 57th Annual Meeting of the
American Academy of Allergy, Asthma and Immunology;
March 16-21, 2001; New Orleans, Louisiana.
30. Collins FM. Biofilm formation, identification and removal.
Acad Dent Ther. 2006;216:398-404.
31. Thomas JG, Nakaishi LA. Managing the complexity of
dynamic biofilm. ]ADA. 2006;137:10-5.
32. Goodson JM, Palys MD, Carpino E, Regan EO, Sweeney
M, Socransky SS. Microbial changes associated with dental
prophylaxis. ]ADA. 2004; 135:1559-64.
33. Seymour GJ, Gemmell E. Cytokines in periodontal disease:
where to from here? Acta Odontol Scand. 2001;59:167-73.
34. Tulic MK, Wale JL, Holt PG, Sly PD. Modification of the
inflammatory response to allergen challenge after exposure
to bacteriallipopolysaccharides. Am J Respir Cell Mol Biol.
35. Michel O. Role of lipopolysaccharides (LPS) in asthma and
other pulmonary conditions. J Endotoxin Res. 2003;9:293.
36. Fokkema SJ, Loos BG, Slegte C, van der Velden U. A type
2 response in lipopolysaccharides (LPS)-stimulated whole
cell cultures from periodontitis patiens. Clin Exp Immunol.
37. Murakami D, Yamada H, Yajima T, Masuda A, Komune S,
Yoshikai Y. Lipopolysaccharides inhalation exacerbates allergic
airway inflammation by activating mast cells and promoting
Th2 responses. Clin Exp Allergy. 2006;311:26-33.
38. Singh], Schwartz DA. Endotoxins and the lung: Insight into
the host-environment interaction. J Allergy Clin lmmunol.
39. Gafan GP, Lucas V, Roberts GJ, Petrie A, Wilson M, Spratt
DA. Prevalence of periodontal pathogens in dental plaque
of children. J Clin Microbial. 2004;42:4141-6.
40. Tanner ACR, Milgram PM, Kent R, Mokeem SA, Page RC,
Riedy CA, et al. The microbiota of young children in tongue
and tooth samples. J Dent Res. 2002;81:52-7.
41. Martin M, Katz J, Vogel SN, Michalek SM. Differential
induction of endotoxins tolerance by lipopolysaccharides
derived from Porphyromonas gingivalis and Escherichia coli. J
42. Pulendran B, Kumar P, Cutler CW, Mohamadzadeh M, van
Dyke T, Banchereau J. Lipopolysaccharides from distinct
pathogens induces different classes of immune responses in
vivo. J lmmunol. 2001;167:5067-76.
43. Darveau RP, Pham TT, Lemley K, Reife RA, Bainbridge BW,
Coats SR, et al. Porphyromonas gingivalis lipopolysaccharides
contain multiple lipid A species that functionally interact
with both Toll-Like Receptor 2 and 4. lnfec lmmun.
44. Gemmell E, Carter CL, Grieco DA, Sugerman PB, Seymour
GJ. P. gingivalis specific T-cell lines produce Th1 and Th2
cytokines. J Dent Res. 2002;81:303-7.
45. Jotwani R, Pulendran B, Agrawal S, Cutler CW Human
dendritic cells respond to Porphyromonas gingiva/is LPS by
promoting a Th2 effector response in vitro. Eur J Immunol.
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