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Transmission of Periodontal Bacteria and Models of Infection J Clin Periodontol 2005; 32 (Suppl. 6): 16–27 Copyright r Blackwell Munksgaard 2005 A. J. Van Winkelhoff and K. Boutaga Transmission of periodontal Academic Centre for Dentistry Amsterdam, Department of Oral Microbiology, bacteria and models of infection Amsterdam, The Netherlands Van Winkelhoff AJ, Boutaga K. Transmission of periodontal bacteria and models of infection. J Clin Periodontol 2005; 32 (Suppl. 6): 16–27. r Blackwell Munksgaard, 2005. Abstract Background: Bacteria play an essential role in the aetiology of periodontitis. Most bacterial species isolated from subgingival plaque are indigenous to the oral cavity. Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis are detected infrequently in periodontal health, which makes these species prime candidates to study person-to-person transmission. The aim of the present study was to review the literature on transmission of these periodontal bacterial species. Method: We review the literature on bacterial typing techniques and summarize the information on clonal distribution of A. actinomycetemcomitans and P. gingivalis in family units based on different typing techniques in order to establish the likelihood for person-to-person transmission of these periodontal pathogens. Results: Vertical transmission of A. actinomycetemcomitans is estimated to be between 30% and 60%, whereas vertical transmission of P. gingivalis has rarely been observed. Horizontal transmission between spouses ranges between 14% and 60% for A. actinomycetemcomitans and between 30% and 75% for P. gingivalis. There is some evidence to show that cohabitation with a periodontitis patient influences the periodontal status of the spouse; however, substantially more information is needed to prove this hypothesis. Conclusions: Transmission of putative periodontal pathogens between family members has been shown. The clinical consequences of these events have been poorly documented. Based on the current knowledge, screening for and prevention of transmission of specific virulent clones of A. actinomycetemcomitans may be feasible and effective in preventing some forms of periodontal disease. P. gingivalis is usually recovered from diseased adult subjects, and transmission of this pathogens seems largely restricted to adult individuals. Horizontal transmission of P. gingivalis may Key words: bacteria; transmission; therefore be controlled by periodontal treatment involving elimination or significant periodontitis; infection; bacterial typing suppression of the pathogen in diseased individuals and by a high standard of oral hygiene. Accepted for publication 1 April 2005 Epidemiology is the study of the factors lococcus aureus can cause hard- and cause opportunistic infections. When the that affect the distribution of diseases in soft-tissue infections when penetrating composition of the normal microflora is populations, including infectious dis- the natural barriers of the skin or the disturbed, after or during antimicrobial eases that are spread by pathogenic mucosa. Oral streptococci may cause therapy for instance, resistant microor- organisms. transient bacteraemia following dental ganisms can emerge and cause infection Microorganisms that are indigenous extraction or tonsillectomy and may (Helovuo & Paunio 1989, Helovuo et al. to the host and are referred to as com- cause subacute bacterial endocarditis in 1993). Infections caused by commensal mensal, or resident organisms, can cause susceptible individuals. These microor- microorganisms are called endogenous infections. They can initiate disease ganisms can survive in the new environ- infections for which transmission of when they disseminate from their nor- ment if they are able to attach to the microorganisms from host to host is not mal ecological niche to sterile body sites surface of the host and are able to resist needed. In the oral cavity an increase as, for instance, is the case in urinary the local host immune responses. Often, of the bacterial load and a concomitant tract infection caused by Escherichia a change of the innate immunity is shift in the microbial composition of coli from the colon. Indigenous Staphy- necessary for commensal pathogens to the dental plaque can cause gingivitis. 16 Periodontal bacteria 17 Unlike exogenous bacterial disease, with a complex microflora such as infec- 20,000 contaminated droplets. Talking endogenous infections (1) have no defin- tious bowel diseases (Crohn and ulcera- is also a source of airborne particles, able incubation period, (2) are not com- tive colitis), vaginitis and periodontal although the number of organisms that municable in the usual sense, (3) do not disease, the matter of transmission is is shed is significantly less. Whether result in clinically recognizable immu- more complex. periodontal bacteria can be transmitted nity, and (4) involve bacterial agents First, some general principles of bac- via aerosols is currently not known. found in the normal microflora. These terial transmission are discussed. Then, Staphylococci are often transferred by agents are often characterized by a low the rationale for studying the transmis- dust from contaminated clothing, beds intrinsic pathogenicity and cause disease sion of two periodontal pathogens, Acti- and contaminated objects. when they appear either in unusual body nobacillus actinomycetemcomitans and Some systemic infections are caused sites or in greatly increased concentra- Porphyromonas gingivalis, is provided. by transmission of pathogens from tion in or near their usual habitats. Subsequently, studies on the distribution animals (zoonoses), which serve as a Microorganisms that do not normally of these periodontal species in popula- reservoir. Humans can be infected via occur in a healthy host and can cause tions and in families are summarized. milk (brucellosis, tuberculosis), car- disease upon infection in a significant Different typing methods are briefly casses (anthrax, tularaemia), contami- proportion of the recipients are called described, and data on distribution of nated swimming water (leptospirosis) exogenous pathogens (Salyers & Whitt genotypes among families are pre- or wounds. 1994). Most human pathogens not only sented. Finally, routes of transmission Biting/sticking arthropods can serve occur in diseased subjects, but also in of both pathogens and the possible clin- as vectors and may transfer bacteria, healthy carriers, who provide a reservoir ical consequences of transmission are rickettsiae and viruses from an animal and serve as a focus. It is suspected that discussed. reservoir by a cycle of infection (in lice, epidemics can be initiated by recombi- fleas or ticks). Often, these latter infec- nation between strains from different tions are not readily transmitted from carriers. Exogenous pathogens need to Transmission person to person. overcome the conditions of the environ- ment such as ultraviolet light, drying The behaviour of a pathogenic micro- and temperature. To survive these con- organism depends upon the interaction Vertical and horizontal transmission ditions, they have developed different between the host, the pathogen and the When transmission is directly from par- strategies such as spore formation (Clos- environment. Changes in any of these ents to offspring (via ovum, placenta, tridium, Bacillus), encapsulation (Myco- factors will affect the likelihood of milk, blood, saliva) it is referred to as bacterium) and survival in intermediate transmission. Host factors affect the vertical. Transmission is called horizon- hosts such as the rabies virus in animals chance of exposure to a microorganism, tal when an individual infects unrelated or Legionella pneumophila in amoebae. the possibility for colonization and the individuals by contact, respiratory or Organisms with moderate survival response to colonization, i.e. develop- faecal–oral spread. Examples of diseases potential can be transmitted by spread- ment of infection. Host factors include, that may spread by vertical transmission ing in air on droplet nuclei (viruses). among others, sexual behaviour, hygiene, are rubella, cytomegalovirus, syphilis, Some bacterial pathogens are extremely occupation, nutrition, immunity and gen- toxoplasma (pre-natal), gonococcal/chla- delicate and cannot survive outside the eral health. Microbial factors include mydial conjunctivitis (perinatal) and host, e.g. Neisseria gonorrhoea. Trans- infectiousness, pathogenicity, virulence hepatitis B (post-natal). Polio, influenza, mission of this type of pathogen is and survival in human and animal hosts, tuberculosis and typhoid are examples of achieved by direct mucosal contact including resistance towards immune diseases that are horizontally transmitted. between individuals. responses and drugs. Communicable diseases are infections Environmental factors such as tem- that are capable of spreading from person perature, humidity and oxygen tension Essential factors for transmission are determinants of the survival of to person. This is not the case with all The source infections. A subject with infective endo- microbes outside the host. carditis caused by Streptococcus sanguis When the source of the infection is may suffer from an infection that is not restricted to actively diseased indivi- Mechanisms of transmission able to spread from a patient to another duals, isolation measures are effective person. Communicable microorganisms Many bacteria are transmitted from per- in eradication of the infectious agents. are not always pathogenic and not all son to person primarily
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