Publication: Detección de herpesvirus y bacterias periodontopatógenas en muestras de fluido crevicular gingival y saliva en periodontitis crónica
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2016-04-21
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Universidad Complutense de Madrid
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Abstract
En los últimos 15 años, se ha sugerido que ciertos herpesvirus, en particular, el citomegalovirus (CMV) y el virus de Epstein-Barr (VEB), podrían tener cierto papel en el inicio y progresión de las enfermedades periodontales. Sin embargo, en la mayoría de los trabajos, no se han podido obtener resultados concluyentes. Por otro lado, aunque el método de referencia actual para el estudio microbiológico de los patógenos periodontales es la toma de muestras en fluido crevicular gingival (FCG), se ha propuesto a la saliva como método diagnóstico alternativo, dadas sus ventajas en la sencillez y rapidez en la toma. Los objetivos del presente trabajo fueron evaluar la prevalencia del CMV y del VEB, así como la posible asociación de estos virus con cinco bacterias periodontopatógenas (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia y Treponema denticola) en muestras de FCG y saliva, en sujetos con periodontitis crónica y en controles sanos. Por otro lado, se quería estudiar la asociación entre estos patógenos con los parámetros clínicos de enfermedad, tanto en FCG y saliva. Por último, se pretendía determinar la concordancia entre la muestra de FCG y saliva para la detección de estos microorganismos, a fin de constatar la utilidad de la saliva como método diagnóstico alternativo a la toma en FCG. Se realizó un estudio epidemiológico clínico y microbiológico transversal, con un diseño de casos-controles, constituido por 24 pacientes diagnosticados de periodontitis crónica generalizada moderada (grupo periodontitis crónica) y por 24 individuos periodontalmente sanos (grupo control). Se realizó un examen periodontal a todos los sujetos, registrando: índice de placa, profundidad de sondaje, nivel de inserción clínico y sangrado al sondaje. Se tomaron muestras de FCG y saliva. Para la detección de ADN de CMV y VEB se efectuó una PCR en tiempo real, mientras que para la detección del ADN de las cinco bacterias patógenas se empleó una PCR múltiple seguida por hibridación reversa...
Periodontal diseases are considered as inflammatory conditions affecting the periodontium that are known to have a primarily multi-bacterial aetiology. In the last 15 years, however, several studies have suggested that certain viruses might play a role in the pathogenesis of gingivitis and periodontitis. In particular, DNA from herpesviruses such as human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) have been detected in high percentages of subgingival plaque samples and saliva from patients with chronic and aggressive periodontitis, gingivitis and HIV-associated periodontitis. In contrast, very low prevalence of such viruses has been detected in periodontally healthy individuals. Other investigations revealed an association between the detection of these viruses and recognized periodontopathogenic bacteria in periodontitis patients, and between the detection of viruses and periodontal disease activity. Based on these data, a new pathogenesis model for periodontitis suggesting a herpesviral-bacterial coinfection has been proposed. Thereby, the ability of these herpesviruses to induce inmmunosuppression and a possible direct cytopathic effect on fibroblasts, keratinocytes and inflammatory cells have been proposed as possible mechanisms of periodontal pathogenesis. However, maintenance of this model is challenged by studies that could not confirm an increased prevalence of these herpesviruses in chronic and aggressive periodontitis patients or that could not find differences in the viral load between shallow and deep pockets. This inconsistency might be due to methodological reasons or differences in the investigated populations. Most of the previous findings were based on ultrasensitive molecular techniques (nested PCR); a drawback of this screening assay is the falsepostive results..
Periodontal diseases are considered as inflammatory conditions affecting the periodontium that are known to have a primarily multi-bacterial aetiology. In the last 15 years, however, several studies have suggested that certain viruses might play a role in the pathogenesis of gingivitis and periodontitis. In particular, DNA from herpesviruses such as human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) have been detected in high percentages of subgingival plaque samples and saliva from patients with chronic and aggressive periodontitis, gingivitis and HIV-associated periodontitis. In contrast, very low prevalence of such viruses has been detected in periodontally healthy individuals. Other investigations revealed an association between the detection of these viruses and recognized periodontopathogenic bacteria in periodontitis patients, and between the detection of viruses and periodontal disease activity. Based on these data, a new pathogenesis model for periodontitis suggesting a herpesviral-bacterial coinfection has been proposed. Thereby, the ability of these herpesviruses to induce inmmunosuppression and a possible direct cytopathic effect on fibroblasts, keratinocytes and inflammatory cells have been proposed as possible mechanisms of periodontal pathogenesis. However, maintenance of this model is challenged by studies that could not confirm an increased prevalence of these herpesviruses in chronic and aggressive periodontitis patients or that could not find differences in the viral load between shallow and deep pockets. This inconsistency might be due to methodological reasons or differences in the investigated populations. Most of the previous findings were based on ultrasensitive molecular techniques (nested PCR); a drawback of this screening assay is the falsepostive results..
Description
Tesis inédita de la Universidad Complutense de Madrid de la Facultad de Odontología del Departamento de Estomatología III, leída el 27-11-2015