Potential of Diagnostic Microbiology for Treatment and Prognosis of Dental Caries and Periodontal Diseases

Abstract

Most evidence suggests that only a finite number of bacteria are responsible for dental caries and periodontal diseases. This knowledge led to the development of microbial tests which can identify suspected pathogens. Current evaluation of the diagnostic power of microbial tests has shown that they have a low sensitivity and a low prognostic value. Despite these shortcomings, there are valid indications for microbiological-based diagnosis. Salivary microbial tests for the detection of mutans streptococci and lactobacilli may be useful, for example, in young children, oligosialic patients, and orthodontic patients. These tests can be used to monitor the success of chemopreventive measures or compliance with dietary recommendations. Microbial diagnosis may also be valuable in the treatment of early-onset periodontitis or in subjects who respond poorly to periodontal therapy. The use of microbial tests to monitor the efficacy of chemotherapy or mechanical treatment is of particular interest.

Dental Caries: A Microbiological Approach

“…In the 1950s, Keyes and Fitzgerald working with hamsters demonstrate that caries was infectious and caused by an acid-producing Streptococcus. In 1960s, accepted that the Streptococcus isolated from hamster caries was the same as S. mutans described by Clarke [27].…”

“…Porin channels are utilized by several antibiotics when entering Gram negative bacteria. Thus, the diminished expression of porins results in impermeability or decreased uptake that often leads to antibiotic resistance [27,145,153].…”

“…The most important five families of the efflux system are: MFS: Major Facilitator Superfamily; RND: Resistance Nodulation-Division; SMR: Small Multidrug Resistance; ABC: ATP Binding Cassette; and MATE: Multidrug and Toxic Extrusion [27,145].…”

Clinical Relevance of the Advanced Microbiologic and Biochemical Investigations in Periodontal Diagnosis: A Critical Analysis

“…All identified isolates of a particular bacterial species are not necessarily equally pathogenic or detrimental, for example, Aggregatibacter actinomycetemcomitans (A.a) and Porphyromonas gingivalis (P. gingivalis), and, lastly, a particular microorganism may not cause an identical disease in all infected hosts. So, the identified microorganisms represent only one aspect of this multifactorial disease [17].…”

“…Review of contemporary literature regarding the utility of microbial identification as an aid in the treatment planning of patients with periodontitis showed a limited number of studies, but the lack of appropriate controls, however, makes the interpretation of these results difficult and therefore the utility of microbial testing in developing specific treatment plans could not be ascertained. Similarly available evidence could not suggest a definitive benefit of microbiological testing as an indicator of healing or disease [12,17,19]. Although prospective studies monitoring patients after therapy would indicate that the use of microbial testing could aid in the selection of a more targeted therapy, mostly in patients with aggressive or recurrent periodontitis, again, the lack of clinical trials with adequate controls prevents from demonstrating the real value of microbial diagnosis.…”