Subgingival plaque samples were taken from active and inactive lesions in 33 subjects exhibiting active destructive periodontal diseases. Active diseased sites were those which showed a significant loss of attachment within a 2-month interval as computed by the "tolerance method". The predominant cultivable species from 100 active sites were compared with those found in 150 inactive sites of comparable pocket depth and attachment level loss. Among the 33 subjects, W. recta, B. intermedius, F. nucleatum, B. gingivalis and B. forsythus were elevated more often in active sites; whereas, S. mitis, C. ochracea, S. sanguis II, V. parvula and an unnamed Actinomyces sp. were elevated in inactive sites. The likelihood of a site being active was increased if B. forsythus, B. gingivalis, P. micros, A. actinomycetemcomitans, W. recta, or B. intermedius were detected in that site, and decreased if S. sanguis II, the Actinomyces sp., or C. ochracea were detected.

Apical subgingival plaque samples were taken from 19 subjects exhibiting active destructive periodontal disease. The predominant cultivable Gram negative species from 50 active sites were compared to 69 inactive sites of comparable pocket depth and attachment level loss. Active disease sites were chosen which showed a significant loss of attachment within a two-month interval. Proportions of Gram negative rods were higher in active periodontal disease sites than in inactive sites. Species which were found to be significantly elevated only in active sites were Bacteroides intermedius, "fusiform" Bacteroides, Actinobacillus actinomycetemcomitans and Wolinella recta. Fusobacterium nucleatum, Capnocytophaga gingivalis and Eikenella corrodens were found in significantly increased proportions in active sites of some subjects and inactive sites of others.

Samples of subgingival plaque were taken from 275 active and inactive sites in 35 subjects with destructive periodontal diseases. The predominant cultivable microbiota was determined in each of the samples by characterizing 50 randomly selected isolates recovered on anaerobically incubated Trypticase soy agar supplemented with 5% sheep blood. Microbial associations between species were determined by computing the odds ratio of a site being infected by a “target” species in the presence of an “effector” species. Data are presented for 22 numerically dominant “effector” species and 8 “target” species which consisted of suspected periodontal pathogens. These included Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Bacteroides gingivalis, Bacteroides intermedicus, Bacteroides melaninogenicus, Peptostreptococcus micros, Streptococcus intermedius and Wolinella recta. Positive associations were considered to be relationships in which the odds ratio of detecting a “target” species was >2:1 in the presence of the “effector” species, while negative associations were defined as those in which the odds ratio of detecting the “target” species was < 0.5:1 in the presence of the “effector” species. In general, species of streptococci, an unnamed Actinomyces sp. and Propionibacterium acnes showed a negative association with the 8 suspected pathogens, while many Gram‐negative species tended to show a positive association with these suspected pathogens. There appeared to be specificity in the associations observed. For example, S. intermedius was positively associated with Streptococcus mitis and Streptococcus sanguis I, but negatively associated with Bacteroides forsythus. In contrast, W. recta was negatively associated with S. mitis and Streptococcus sanguis I, but positively associated with Bacteroides forsythus. S. sanguis II, Streptococcus uberis, P. acnes, Capnocytophaga ochracea and an unnamed Actinomyces sp. showed negative associations with 4 of the suspected periodontal pathogens, while B. gingivalis, Fusobacterium nucleatum and the Eubacterium sp. showed only positive or “neutral” associations with the “target” species. Data from this and other investigations suggest that microbial associations might play an important role in controlling the composition of subgingival plaque and, thus, be a major determinant of health or destructive periodontal diseases.

27 subjects with active destructive periodontal diseases were treated by modified Widman flap surgery and systemic tetracycline and divided into 4 groups based on pre- and post-therapy hazard rates (% of sites losing greater than 3 mm of attachment in 1 year). Pre- and post-therapy hazard rates were respectively: group I (3 subjects) less than 4 and less than 4; group II (8 subjects) greater than 4 and less than 4; group III (3 subjects) less than 4 and greater than 4; group IV (refractory group of 13 subjects) greater than 4 and greater than 4. Baseline mean pocket depths and attachment loss of groups I and II subjects were less than groups III and IV subjects and exhibited less suppuration. 6 group IV subjects lost a total of 38 teeth after therapy, in contrast to no tooth loss in subjects in the other 3 groups. Redness, bleeding on probing, plaque levels and age did not differ among groups. Subjects in the 4 groups differed in the subgingival species to which they showed elevated serum antibody responses. Group IV subjects showed elevated responses to a select range of gram-negative species, including A. actinomycetemcomitans strains Y4 or ATCC 29523, F. nucleatum and B. intermedius. No subject in any of the other groups exhibited an elevated response to B. intermedius. The mean % of each species in all sampled sites, both before and after therapy, was computed for each subject. Subjects in groups III and IV (high post-therapy hazard rates) exhibited elevated mean levels of B. forsythus, F. nucleatum, S. intermedius, E. corrodens, and B. gingivalis.(ABSTRACT TRUNCATED AT 250 WORDS)

76 subjects with prior evidence of destructive periodontal diseases were monitored clinically and immunologically every 2 months for up to 5 years. Clinical parameters measured included bleeding on probing, gingival redness, plaque accumulation, suppuration, pocket depth and attachment level. Blood samples were taken by venipuncture and serum antibody levels to a series of 18 subgingival species determined. 33 of these subjects showed evidence of active disease during the monitoring period, based on changes in attachment level measurements assessed using the tolerance method of analysis. Mean attachment loss in these 33 subjects varied from 1.4 mm to 9.0 (median value 3.4 mm) and subjects whose mean attachment level was above the median showed a higher % of pockets greater than 3 mm and more suppuration. Severity of gingival inflammation related poorly to mean attachment loss. Subgingival plaque samples were taken from the active site(s) and from control sites of equal pocket depth and attachment loss in the same active disease subjects, prior to therapy, for predominant cultivable microbiota studies. 50 randomly selected isolates were identified from each sample. Predominant cultivable species in 170 pretreatment active and inactive sites combined (8500 isolates) were enumerated. The most frequently detected species were F. nucleatum (112 sites) and S. intermedius (106 sites), although the predominant species in the samples from each subject differed. The distribution of putative pathogens differed among subjects. For example, A. actinomycetemcomitans was found in 21 samples in 11 subjects and B. forsythus was found in 18 samples from 10 individuals. Antibody response patterns to the 18 subgingival species also varied among subjects.(ABSTRACT TRUNCATED AT 250 WORDS)