Faculty Bibliography

Bisphosphonates (BPs) are the standard of care for patients with metastatic cancer and multiple myeloma to prevent skeletal complications (e.g., severe bone pain, pathologic fracture, etc.) and to treat osteoporosis. The cause and effect relationship between BPs and BP-related osteonecrosis of the jaws (BRONJ) is not well established. Current research suggests that bacterial biofilms may play a significant role in the pathogenesis of BRONJ. Recently, we have shown that BRONJ lesions are heavily colonized by oral bacteria and present many clinical challenges as they are difficult to culture and antibiotic resistance may result in misguided antibiotic therapy. Here we highlight the crosstalk among the oral bacteria and host immune response in BRONJ subjects. Using 16S rDNA molecular technique we characterize the total bacterial profile of BRONJ, BP and control subjects. Denaturing gradient gel electrophoresis cluster analysis revealed three clusters each representing the three groups, control, BP and BRONJ indicating that the microbiome present in tissue samples was distinct to each group. DGGE band pattern indicated that the BRONJ group had less bacterial diversity as compared to control indicating that high abundance of specific bacteria colonizing the BRONJ lesion. 16S sequencing and clonal analysis showed 6 phyla in all three groups. The phylum Firmicutes was predominant in BRONJ group (72%) followed by BP group (70%) as compared to control group (59%). The Chi-square test also showed significant differences in percent relative distribution of phyla, between control/BP groups (p<0.001), control/BRONJ (p<0.001) and BP/BRONJ (p<0.05). There was significantly increase in the gram positive bacteria in BRONJ group. PCR Array analysis indicated that the host genes responsible for antibacterial response such as MPO, CTSG, and NOD2 were significantly down regulated. Deficient innate immune responses to microorganisms together with poor healing and repair provide continuous opportunities for expanding!

Streptococcus mutans and Aggregatibacter actinomycetemcomitans are oral pathogens associated with dental caries and periodontitis, respectively. The aim of this study was to determine the colonization of these two microorganisms in the dental plaque of a group of Haitian adolescents using two different polymerase chain reaction (PCR) methods, standard PCR, and quantitative real-time PCR (qPCR) assays. Fifty-four pooled supra-gingival plaque samples and 98 pooled sub-gingival plaque samples were obtained from 104 12- to19-year-old rural-dwelling Haitians. The total genomic DNA of bacteria was isolated from these samples, and all participants also received caries and periodontal examinations. Caries prevalence was 42.2%, and the mean decayed, missing, and filled surface (DMFS) was 2.67 +/- 5.3. More than half of the adolescents (53.3%) experienced periodontal pockets (Community Periodontal Index score >/=3). S. mutans was detected in 67.3% by qPCR and 38.8% by PCR of the supra-gingival plaque samples (p < 0.01), and 36.6% by qPCR and 8.1% by PCR of the sub-gingival samples (p < 0.01). A. actinomycetemcomitans was detected in 85.1% by qPCR and 44.0% by PCR of the sub-gingival samples (p < 0.01), but the prevalence was similar, 67.3% by qPCR and 59.2% by PCR, in the supra-gingival plaque samples. Neither age nor gender was significantly correlated to the bacterial colonization. The results demonstrated a moderate-to-high prevalence of S. mutans and A. actinomycetemcomitans in the Haitian adolescent population, and qPCR is more sensitive than standard PCR in field conditions. These findings suggest that qPCR should be considered for field oral epidemiologic studies and may be necessary in investigations having major logistic challenges

In oral cavity chronic inflammation has been observed at various stages of oral squamous cell carcinomas (OSCC). This inflammation could result from persistent mucosal or epithelial cell colonization by microorganisms. There is an increasing evidence of the involvement of oral bacteria in inflammation and warrant further studies on the association of bacteria in the progression of OSCC. The objective of this study was to evaluate the diversity and relative abundance of bacteria in the saliva of subjects with OSCC. Using 454 parallel DNA sequencing, approximately 58,000 PCR amplicons that span the V4-V5 hypervariable region of ribosomal RNAs from 5 subjects were sequenced. Members of 8 phyla (divisions) of bacteria were detected. The majority of classified sequences belonged to phyla, Firmicutes (45%) and Bacteroidetes (25%). Further, a total of 52 different genera containing approximately 860 (16.51%) known species were identified, 1077 (67%) sequences belonged to various uncultured bacteria or unclassified group. The species diversity estimates obtained with abundance-based coverage estimators (ACE) and Chao1 were greater than published analyses of other microbial profiles from the oral cavity. Fifteen unique phylotypes were present in all three OSCC subjects

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Sugar consumption and caries risk: a systematic review. Burt BA, Pai S. J Dent Ed 2001;65:1017-23. REVIEWER: Yihong Li, DDS, MPH, DrPH PURPOSE/QUESTION: In the modern age of extensive fluoride exposure, do individuals with a high level of sugar intake experience a greater level of caries severity relative to those with a lower level of intake? SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Systematic review LEVEL OF EVIDENCE: Level 1: Good-quality, patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Grade A: Consistent, good-quality patient-oriented evidence

OBJECTIVE: To investigate whether a standard dental prophylaxis followed by tooth brushing with an antibacterial dentifrice will affect the oral bacterial community, as determined by denaturing gradient gel electrophoresis (DGGE) combined with 16S rRNA gene sequence analysis. METHODS: Twenty-four healthy adults were instructed to brush their teeth using commercial dentifrice for 1 week during a washout period. An initial set of pooled supragingival plaque samples was collected from each participant at baseline (0 h) before prophylaxis treatment. The subjects were given a clinical examination and dental prophylaxis and asked to brush for 1 min with a dentifrice containing 0.3% triclosan, 2.0% PVM/MA copolymer and 0.243% sodium fluoride (Colgate Total). On the following day, a second set of pooled supragingival plaque samples (24 h) was collected. Total bacterial genomic DNA was isolated from the samples. Differences in the microbial composition before and after the prophylactic procedure and tooth brushing were assessed by comparing the DGGE profiles and 16S rRNA gene segments sequence analysis. RESULTS: Two distinct clusters of DGGE profiles were found, suggesting that a shift in the microbial composition had occurred 24 h after the prophylaxis and brushing. A detailed sequencing analysis of 16S rRNA gene segments further identified 6 phyla and 29 genera, including known and unknown bacterial species. Importantly, an increase in bacterial diversity was observed after 24 h, including members of the Streptococcaceae family, Prevotella, Corynebacterium, TM7 and other commensal bacteria. CONCLUSION: The results suggest that the use of a standard prophylaxis followed by the use of the dentifrice containing 0.3% triclosan, 2.0% PVM/MA copolymer and 0.243% sodium fluoride may promote a healthier composition within the oral bacterial community.

Protease inhibitor cocktails are routinely added to clinical samples used for proteomic studies to inactivate proteases. As these same samples are often used for microbial studies, we determined whether the addition of protease inhibitors could affect the quantitative or qualitative assessment of microbial profiles. Twenty-two saliva samples were collected and processed immediately with or without the addition of a protease inhibitor cocktail. Conventional cultivation methods were used to evaluate total bacterial growth. Total genomic DNA was isolated and a specific 16S rRNA gene-targeted region was PCR-amplified and separated by denaturing gradient gel electrophoresis. A combination of 1D sodium dodecyl sulfate polyacrylamide gel electrophoresis and LC-MS/MS methods was used to determine the effect of the protease inhibitors on the integrity of salivary proteins and peptides. Interestingly, no significant differences were observed in either the bacterial growth and composition or the integrity of salivary proteins between the two groups. Correlation coefficients between the paired samples for total cultivable microbiota (r(2) =0.847), total mutans streptococci (r(2) =0.898), total oral lactobacilli (r(2) =0.933), and total Streptococcus mutans (r(2) =0.870) also exceeded expected values. The results suggest that the addition of a protease inhibitor cocktail in saliva samples does not impact the growth of oral microbiota or compromise the ability to characterize its composition.

The oral biofilm community consists of >800 microbial species, of which Streptococcus mutans is considered a primary pathogen for dental caries. The genomic island, TnSmu2, of S. mutans comprises >2% of the genome. In this study, we demonstrate that TnSmu2 harbors a gene cluster encoding nonribosomal peptide synthetases (NRPS), polyketide synthases (PKS), as well as accessory proteins and regulators involved in non-ribosomal peptide (NRP) and polyketide (PK) biosynthesis. Interestingly, the sequences of these genes and their genomic organizations and locations are highly divergent among different S. mutans strains, yet each TnSmu2 region encodes NRPS/PKS and accessory proteins. Mutagenesis of the structural genes and putative regulatory genes in strain UA159, UA140, and MT4653 resulted in colonies that were devoid of their yellow pigmentation (for UA140 and MT4653). In addition, these mutant strains also displayed retarded growth under aerobic conditions and in the presence of H2O2. HPLC profiling of cell surface extracts identified unique peaks that were missing in the mutant strains, and partial characterization of the purified product from UA159 demonstrated that it is indeed a hybrid NRP/PK, as predicted. A genomic survey of 94 clinical S. mutans isolates suggests that TnSm2 gene cluster may be more prevalent than previously recognized

Several methods for determining the diversity of Lactobacillus spp were evaluated with the purpose of developing a realistic approach for further studies. The patient population was comprised of young children with an oral disease called severe early childhood caries. The ultimate goal of these studies was to ascertain the role of lactobacilli in the caries process. To accomplish that goal, we evaluated several methods and approaches for determining diversity including AP-PCR, chromosomal DNA fingerprinting, denaturing gradient gel electrophoresis, and 16S rRNA gene sequencing. Central to these methods was the gathering and screening of isolates from cultivation medium. Using various estimates of diversity, we addressed the question as to how many isolates represent the overall diversity and how cultivation compares to non-cultivation techniques. Finally, we proposed a working approach for achieving the goals outlined framed by both practical constraints in terms of time, effort and efficacy while yielding a reliable outcome