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71]

Review Article

Polymerase chain reaction: A molecular

diagnostic tool in periodontology
Rajendran Maheaswari, Jaishree Tukaram Kshirsagar, Nallasivam Lavanya

Department of Abstract:
Periodontics, This review discusses the principles of polymerase chain reaction (PCR) and its application as a diagnostic
Tamil Nadu Government tool in periodontology. The relevant MEDLINE and PubMed indexed journals were searched manually and
Dental College and electronically by typing PCR, applications of PCR, PCR in periodontics, polymorphism studies in periodontitis,
Hospital, Chennai, and molecular techniques in periodontology. The searches were limited to articles in English language and the
Tamil Nadu, India articles describing PCR process and its relation to periodontology were collected and used to prepare a concise
review. PCR has now become a standard diagnostic and research tool in periodontology. Various studies reveal
that its sensitivity and specificity allow it as a rapid, efficient method of detecting, identifying, and quantifying
organism. Different immune and inflammatory markers can be identified at the mRNA expression level, and also
the determination of genetic polymorphisms, thus providing the deeper insight into the mechanisms underlying
the periodontal disease.
Key words:
Applications of polymerase chain reaction, identification of periodontal organisms, molecular techniques in
periodontology, mRNA expression, polymerase chain reaction

INTRODUCTION variations in homologous DNA sequences; it

Access this article online
Website:
www.jisponline.com A clinical diagnosis of periodontal disease
is made by measuring the loss of
connective tissue attachment on the root
DOI:
10.4103/0972-124X.176391 surface (clinical attachment loss) and loss of
Quick Response Code:
alveolar bone (radiographic bone loss).[1] But
the clinical diagnosis does not indicate the
cause, pathogenesis, clinical course, progress,
and prognosis of the disease. In addition to the
conventional examination, various diagnostic
methods play a vital role in the confirmation of
the clinical diagnosis.
The traditional culture methods have inherent
advantages, but have shortcomings, including the
need to preserve bacterial vitality, the inability
to detect low numbers of microorganisms
with a detection limit averaging 10 3 –10 4
bacterial cells, labor intensiveness, need for
experienced personnel, strict sampling, transport
conditions, and a prolonged period of time
before results. [2] Other microbiological tests
such as dark field microscopy are not able to
Address for detect the nonmotile periodontal pathogen, and
correspondence: immunodiagnostic methods like flow cytometry,
Dr. Rajendran Maheaswari, immunofluorescence assay, etc., and enzymatic
No. 5, Poes 4th assays can lead to false positive results and
Street, Teynampet, cross‑reactions.[3]
Chennai ‑ 600 018,
Tamil Nadu, India.
The molecular biological techniques analyze
E‑mail: drmaheaswari@
yahoo.com deoxyribonucleic acid (DNA), ribonucleic
acid (RNA), and protein. Restriction fragment
Submission: 30‑09‑2015 length polymorphism (RFLP) was the DNA
Accepted: 16‑12‑2015 profiling genetic technique that exploited
was laborious, time‑consuming, expensive, and
needed large sample. The nucleic acid probe, a
nucleic acid molecule artificially synthesized and
labelled for detection of a specific organism has
the limitation of cross‑reactivity.[3] Hybridization
refers to the pairing of complementary DNA
strands to produce double stranded nucleic acid
and the checkerboard DNA‑DNA hybridization
technology used for epidemiological research, and
ecologic studies require sophisticated laboratory
equipment and expertise.[3] Polymerase chain
reaction (PCR) overcomes the above limitations
and is capable of detecting even one copy of the
searched DNA targets from clinical microbiologic
samples.[4]
The subgingival microbiota in patients with
periodontitis is complex and the difference
in plaque composition serves as the basis for
the clinical application of microbiological
techniques in the diagnosis and therapy control
This is an open access article distributed under the terms of the
Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0
License, which allows others to remix, tweak, and build upon
the work non‑commercially, as long as the author is credited
and the new creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com
How to cite this article: Maheaswari R, Kshirsagar JT,
Lavanya N. Polymerase chain reaction: A molecular
diagnostic tool in periodontology. J Indian Soc
Periodontol 2016;20:128-35.

128 © 2016 Indian Society of Periodontology | Published by Wolters Kluwer - Medknow

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Maheaswari, et al.: PCR: A molecular diagnostic tool in periodontology
of progressive and refractory forms of periodontitis.[5] The
development of PCR has generated vast benefits in genetic
analysis for the study of gene expression and diagnosis of
genetic diseases. Genetic analysis using PCR for identification
of susceptibility of an individual to periodontitis will help in the
determination of the type and frequency of treatment. Studies
based on PCR for the determination of mRNA expression
of various immune and inflammatory markers are useful in
understanding the pathogenesis of periodontitis.
The MEDLINE and PubMed databases were searched
manually and electronically in English language by typing
PCR, applications of PCR, PCR in Periodontics, Polymorphism
studies in Periodontitis, and molecular techniques in
periodontology. Out of 248 searched articles, 88 articles
describing PCR process and its relation to periodontology
were used to prepare a concise review. The aim of this review
is to discuss the principles, advantages, applications, and
limitations of PCR in the field of periodontology with their
future perspectives.
HISTORY OF POLYMERASE CHAIN REACTION
The field of human genetics started on when DNA was first
isolated by Johann Friedrich Miescher in 1869.[6] Watson and
Crick in 1953 described the double helix structure of DNA.[6]
In 1975, Southern blotting technology was used for genetic
analysis. Its adaptation RFLP was developed in 1980 by Ray
White.[7]
One of the most important revolutionary techniques in
molecular biology, the PCR, was introduced by Mullis in the
1983, and he won the Noble prize in Chemistry in 1993 for its
discovery. They developed it as a rapid and 2 times sensitive
procedure than standard Southern blotting for the detection
of the sickle cell mutation which is the first application of PCR
in the field of medicine.[8] This molecular technique, invented
three decades ago, now has revolutionized various fields. In
dentistry, as early as 1992, PCR was used to identify DNA
from human tooth pulp tissue for use in forensic dentistry.[9]
PCR was utilized for the identification of periodontal pathogen
Porphyromonas gingivalis (Pg) in oral plaque samples in 1993.[10]
Various derivatives of conventional PCR including nested
PCR, multiplex‑PCR, reverse transcriptase PCR (RT‑PCR),
allele‑specific PCR, and quantitative PCR (Q‑PCR) or real‑time
PCR subsequently evolved playing a significant role in the field
of periodontology.[11‑15]
In 2005, open‑ended PCRs were used for genome mapping of
the entire bacterial spectrum in the plaque sample.[16] Later,
the Human Oral Microbiome Database and CORE database to
catalogue the entire bacterial species found in the oral cavity
were developed.[17] Recently, PCR was used in DNA microarray
analysis for the rapid semiquantitative determination of about
10 periodontal pathogens.[18]
PRINCIPLES OF POLYMERASE CHAIN
REACTION
PCR, an in vitro technique, allows amplification and study of
genes and their RNA transcripts obtained from various tissue
Journal of Indian Society of Periodontology ‑ Vol 20, Issue 2, Mar-Apr 2016 129
sources including peripheral blood, skin, saliva, gingival
crevicular fluid, semen, and hair.[19,20] Each assay requires the
presence of template DNA, primers, nucleotides, and DNA
polymerase.
Template DNA is the known target sequence that needs
to be amplified, and it ranges from 100 to 1000 base pairs
in length. Primers are short, single‑stranded sequences of
nucleic acid (oligonucleotides) selected to specifically anneal
to a particular nucleic acid target.[21] Primer pairs containing
forward and reverse primer, each 16–20 base pairs in length
are used.[22] DNA polymerase is the DNA replicating key
enzyme that links individual nucleotides together to form the
PCR product and hence to amplify target sequences of DNA.
The nucleic acid is first extracted from the clinical sample by
heat, chemical, or enzymatic methods. Once extracted, target
nucleic acid is added to the reaction mix containing primers,
components to optimize polymerase activity (i.e., buffer,
cation [MgCl2], salts, and deoxynucleotides) and enzymes in
a test tube or 96‑well plate and then placed in a thermal cycler
that allows repeated cycles of DNA amplification to occur in
the following three basic steps [Figure 1].
1. DNA denaturation – Separation of the double DNA strands
into two single strands is accomplished by heating to 94°C
2. Primary annealing – At 50–58°C, when the primer pair is
mixed with the denatured target DNA, forward primer
anneals to a specific site at one end of the target sequence
of one target strand, and the reverse primer anneals to a
specific site at the opposite end of the other complementary
target strand
3. Extension of the primed DNA sequence – The enzyme
DNA polymerase synthesizes new complementary strands
by the extension of primers at 72°C.[22] Taq polymerase is
commonly used because of its ability to function efficiently
at elevated temperatures.
Automated programmable thermal cyclers carry the PCR
mixture through each reaction step at the precise temperature
and for an optimal duration.
In general, the process is repeated 30 times. At the end of
30 cycles, the reaction mixture contains about 230 molecules
of the desired product.[22] Once amplification reaction has
occurred, a variety of manual and automated methods are
available to detect the amplified product known as amplicon,
of which the simplest is to identify the product by size after
migration through electrophoresis on an agarose gel or
polyacrylamide gel stained with ethidium bromide. Products
appear as a single band matching to the size of the amplified
sequence and fluoresces when illuminated by ultraviolet
light.[21]
TYPES OF POLYMERASE CHAIN REACTION
Quantitative polymerase chain reaction
Is an approach where the accumulation of amplicon is
monitored, as it is generated by the labeling of primers,
oligonucleotide probes, or amplicons with molecules capable
of fluorosing.[21] The fluorescent probes can be those that
involve the nonspecific binding of a fluorescent dye to double
stranded DNA (e.g., SYBER® Green I) or that bind specifically
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Maheaswari, et al.: PCR: A molecular diagnostic tool in periodontology

PRINCIPLES OF PCR

Cycle 1

Target sequence
3’
5’
Template DNA (double-stranded)

Denaturation 5’ 3’

Template DNA (single-stranded)

Primers bind to single-stranded

Annealing Forward Primer Reverse Primer template DNA

New DNA
Extension DNA polymerase adds nucleotides to the 3’
New DNA end of each primer

Template DNA

New DNA

2ndcycle produces
8 copies
3rdcycle produces 16 copies
Exponential
amplification

35th cycle produces 236 copies

Figure 1: Principle of polymerase chain reaction

to the target of interest (e.g., TaqMan®). These probes produce
a change in fluorescent signal following their direct interaction
with or hybridization to the amplicon which is measured by the
optical system to capture fluorescence and computer software
capable of receiving and processing the data. Fluorescence
values are recorded during each cycle and represent the amount
of amplified product.[23,24]
Nested polymerase chain reaction
Involves the sequential use of two primer sets; the first set is
used to amplify a target sequence and the amplicon obtained
is then used as the target sequence for a second amplification
using primers internal to those of the first amplicon.[21]
Real‑time polymerase chain reaction
Amplifies an RNA target. It involves two steps, first RNA
is reverse transcribed into cDNA using an RT and then the
resulting cDNA is used as templates for subsequent PCR
amplification using primers specific for one or more genes.
Multiplex polymerase chain reaction
Uses multiple primer sets within a single PCR mixture to
produce amplicons of varying sizes that are specific to different
DNA sequences. Thus, it has the ability to search for different
targets, organisms or genes using one reaction, avoiding the
use of multiple reaction vessels and minimizing the volume
of the specimen required.[21]
Allele‑specific polymerase chain reaction
Is a diagnostic or cloning technique to identify or utilize
single‑nucleotide polymorphisms (SNPs). It uses primers
whose 3’ ends encompass the SNP and will only anneal
to sequences that match it perfectly, a single mismatch
being sufficient to prevent hybridization under appropriate
conditions.
Colony polymerase chain reaction
Is a technique in which the samples for PCR are taken using
a sterile pipette from the bacterial colonies for bacterial
identification by 16S rRNA gene sequencing.[25]
Hot start polymerase chain reaction
Improves specificity and DNA yield of PCR technique by
reducing nonspecific amplification in the initial set up stage
of the PCR and inhibiting the activity polymerase at ambient
temperature.
Digital polymerase chain reaction
Limits dilution of template targets. It separates individual
nucleic acid samples within a single specimen into separate

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Maheaswari, et al.: PCR: A molecular diagnostic tool in periodontology
regions or droplets and quantifies rare initial nucleic acid
targets, important in areas such as cancer and prenatal
diagnostics.
Polymerase chain reaction‑cloning‑sequencing method
Is a type of open‑ended PCR in which 16S rRNA genes are
amplified directly from samples and amplicons obtained are
then cloned and sequenced by means of the traditional Sanger
method.[26]
ADVANTAGES OF POLYMERASE CHAIN
REACTION
The ease of quantification, greater sensitivity, rapid analysis,
precision, reproducibility, quality control, and least contamination
are the main advantages of PCR. [27] It also allows precise
identification of bacterial strains with divergent phenotype.
A large number of samples can be measured at 1 time. As cell
viability is not a deterrent to PCR technique, it is advantageous
in the study of strictly anaerobic infections, in which cell death
could occur during sampling and transportation.
As PCR allows several million times amplifications of DNA
or RNA, it is possible to use as few as 1–100 cells, and 0.1 µl of
blood or cells scraped from buccal mucosa for analysis; exhibits
excellent detection limits.[28]
Q‑PCR has the ability to quantify the actual number of targets
present in the clinical specimen. Multiplex PCR has the ability
to search for different organisms or genes in one reaction.[21]
Nested PCR facilitates the detection of bacterial DNA present
at very low levels. RT‑PCR is a sensitive method for detection
of viruses and mRNA expression levels.[21,29] Colony PCR was
used for bacterial identification from bacterial colonies.
APPLICATIONS OF POLYMERASE CHAIN
REACTION
Detection and characterization of microorganisms in the
various medical fields of bacteriology, mycology, parasitology,
virology, and dentistry has been revolutionized by the PCR
technique.[24] The clinician and the researcher use the PCR
technique for detecting microorganisms, diagnosing diseases,
cloning and sequencing genes, and carrying out quantitative
and genomic studies in a very rapid and sensitive manner. PCR
has widespread application in various areas including genetic
analysis, medical applications, and in research.
The ability to quantify “infectious burden” using Q‑PCR has
tremendous implications for studying and understanding the
disease state (e.g. AIDS), prognosis of certain infections, and
effectiveness of antimicrobial therapy. Genotyping allows
the study of bacteria such as Mycobacterium tuberculosis (Mt).
Thus, early recognition and optimized treatment are favored
for public health.[30]
As clinically important viruses have genomes composed
of RNA rather than DNA  (e.g.,  human immunodeficiency
virus [HIV], hepatitis B virus), the ability to amplify RNA
using RT‑PCR facilitates laboratory‑based diagnostic testing
to these infectious agents to a greater extent.[21] Identification
of criminals has been made possible by PCR assay in forensic
Journal of Indian Society of Periodontology ‑ Vol 20, Issue 2, Mar-Apr 2016 131
medicine. It is a sensitive test for tissue typing and plays an
essential role in organ transplantation.[31]
The presence of genetic disease mutation can be detected in
samples by PCR. Mutations in oncogenes and tumor suppressor
genes are studied by PCR‑based tests, and the results can be
used to customize the therapy.
IN DENTISTRY
PCR plays an important role in various fields of dentistry.
The subgingival plaque, saliva, mouthwash, blood, gingival
tissue, and buccal mucosa scraping are used in the PCR
to identify microorganisms, genetic polymorphisms, and
mRNA gene expression of various inflammatory mediators
in dentistry.[20,28,32‑35] The knowledge of the ecology of the oral
cavity has been well‑understood using PCR studies.[36]
Epidemiological studies based on the microbiology of dental
diseases, genetic polymorphisms, and their relation to systemic
diseases can be established.
Dental caries pathogens can be identified by PCR, and it also
explains the progress of dental caries.[37] The microorganisms
responsible for endodontic infections can be identified.[38,39]
Genetic markers for oral cancers are identified by the PCR
technique, and they are used in diagnosing and predicting the
outcome and response to treatment.[40]
APPLICATIONS IN PERIODONTOLOGY
Identification of microbial pathogens
The PCR technique is a more accurate, sensitive, and rapid
technique for the detection, identification, and quantification
of periodontal bacteria.[5,12,41]
Q‑PCR or real‑time PCR with species‑specific primers provide
accurate quantification of individual microbial species and total
bacterial count in dental plaque samples.[15] This precise and
sensitive method serves as a useful tool for studies on etiology
of periodontal diseases.
Various putative perio‑pathogens such as Pg, Aggregatibacter
actinomycetecomitans  (Aa), Tannerella forsythia  (Tf), Prevotella
intermedia  (Pi), Prevotella nigrescens, Parvimonas micra  (Pm),
Eubacteria, Campylobacter rectus (Cr), Capnocytophaga sputigena,
Capnocytophaga ochracea, and Capnocytophaga gingivalis have
been detected in subgingival plaque samples.[15,20,42‑45] Pg and Aa
showed similar counts in aggressive periodontitis patients and
controls, but only Aa was found to be related to the disease.[46]
It is also used to identify Mt in gingival enlargement and
osteomyelitis. [47,48] Certain new microbial species like
Methanobrevibacter oralis identified in periodontal diseases using
PCR have not yet been cultivated.[45] Recently, open‑ended
PCR/sequencing techniques are used to detect Gram‑positive
organisms Peptostreptococcus and Filifactor, genera Megasphaera
and Desulfobulbus, species or phylotypes of Atopobium,
Campylobacter, Catonella, Deferribacteres, Dialister, Eubacterium,
Selenomonas, Streptococcus, Tannerella, and Treponema which are
elevated in periodontal disease.[16]
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Maheaswari, et al.: PCR: A molecular diagnostic tool in periodontology
PCR is used for research purposes to determine the prevalence
of herpes simplex virus, human papillomavirus, HIV, human
cytomegalovirus, and Epstein‑Barr virus Type I and II
(1 and 2) in the gingival crevicular fluid of the individuals
with various forms of periodontal disease.[13,49,50] It was found
using hot start PCR that herpes virus might cause direct
damage or impair the resistance of the periodontium to permit
subgingival overgrowth of pathogenic bacteria in aggressive
periodontitis.[51]
The microbial levels can be assessed following various
treatment modalities and thus, can be an indicator for efficacy
of treatment in chronic and aggressive periodontitis.[52‑56] The
negative influence of alcohol consumption on microbiological
parameters were studied by real‑time PCR.[57]
It is also used to study the association of the systemic diseases
such as coronary heart disease, pregnancy complications,
diabetes, chronic kidney disease, osteoporosis, and
respiratory disease with periodontitis by identifying the
periodontal pathogen levels in various tissue samples such as
subgingival plaque, thrombi, carotid endarterectomy, coronary
artherosclerotic plaque, aortic valves, placenta, maxillary sinus
tissue/wash samples.[34,50,58‑65]
Diagnostic tests such as the MicroDent® Test, ParoCheck® kits,
MyPerioPath® Test and oral DNA® using multiplex PCR
scheme are commercially available to evaluate the microbiota in
subgingival plaque samples and they give crucial information
for a prevention strategy for healthy patients and treatment
plans for “at risk” patients.[17]
Polymerase chain reaction as a diagnostic tool in
peri‑implantitis
Periodontal pathogens Aa, Pg, Pi, Td, and Tf have been detected
in the foci of peri‑implantitis using PCR.[66] The fungal organisms
including Candida species were identified at peri‑implantitis
and healthy implant sites, and they co‑colonized with Pm
and Tf.[67] The uncultured phyla Chloroflexi, Synergistetes,
Tenericutes and the organisms Pm, Pseudoramibacter alactolyticus,
Peptostreptococcus stomatis, and Solobacterium moorei associated
with peri‑implantitis were also identified.[68]
This technique also plays a role in detecting bacteria causing
periimplantitis before implant placement to prevent the risk
of periimplantitis.[69]
Q‑PCR has detected opportunistic pathogens such as E. faecalis
in peri‑implant environment of diseased implants suggesting
removal of prosthesis and routine decontamination of implant
surface and implant abutment connection.[70]
The success of dental implants was mainly associated with a
negative TGP (Genetic Test for Periodontitis) which determines
polymorphisms of − 889 IL1A gene and + 3953 IL1B gene using
PCR whereas no success was related to a positive result.[71]
Immune and inflammatory markers identification
Amidst a deregulated oral environment, the subgingival
biofilm triggers the release of pro‑inflammatory cytokines
and host‑derived enzymes causing tissue breakdown.
PCR has become the mainstay in protein detection in
132 Journal of Indian Society of Periodontology ‑ Vol 20, Issue 2, Mar-Apr 2016
Periodontics, with special importance to microbial antigens,
extracellular matrix proteins, and cytokines detection. The
genetic expression of Pg virulence factors was studied using
Q‑PCR.[72] mRNA expression of adhesion molecule (ICAM‑1) in
periodontopathogen Eikenella corrodens (Ec) infected epithelial
cells were determined using real‑time PCR, and it was found to
increase after exposure to N‑acetyl‑D‑galactosamine adherence
lectin of Ec.[73]
Using semiquantitative PCR gene expression of receptor
activator of NF‑KB ligand (RANKL) to osteoprotegerin (OPG)
ratio was found to be increased in periodontitis.[74] Using
Q‑PCR expression of matrix metalloproteinases and RANKL
was found to be correlated with expression of interleukin‑1β,
TNF‑α, IF‑gamma, intense inflammatory reaction and alveolar
bone loss but IL‑4, IL‑10, TIMPs, and OPG expression reduced
the cellular infiltration and alveolar bone loss.[33]
Smoking was associated with the mRNA expression of IL‑1
β using real‑time PCR in chronic periodontitis patients.[75]
The expression of specific micro RNA species in periodontitis
targeting and modulating cytokine mRNA using quantitative
micro RNA PCR assay which provides insights to modify
periodontal inflammation.[76] Quantitative mRNA expression
of various growth factors; receptors toll‑like receptors (TLRs),
NOD2 and NALP3; signaling mediators CD14, MYD88, and
TIR-domain-containing adapter-inducing interferon-beta were
also determined by RT‑PCR.[53,77]
Genetic polymorphism studies
The individual’s susceptibility to periodontitis is attributed
to genetic factors. [78] The correlation of known genetic
polymorphisms with phenotypes for certain patient groups
currently appear to provide the most promising application
of genetic determinants in treating periodontitis.
Genetic polymorphisms affect periodontal disease with a number
of SNPs occurring in the gene coding for cytokines, receptors,
and immune cells are associated with severity and susceptibility
of periodontitis. PCR was used to identify a modified gene on
chromosome 11 which caused a decrease in cathepsin C activity
and resulted in Papillon–Lefevre syndrome.[79]
PCR has been used in linkage and segregation analysis of
genetic studies in periodontal disease. Several studies have
been conducted using PCR exploring the role of IL‑1 gene
polymorphism as a severity factor in periodontal diseases in
various population and ethnic groups.[80‑82]
TLR‑4 gene polymorphism was found to be associated with
chronic periodontitis, while TLR‑9 was not associated.[83‑86]
Polymorphisms in Fc gamma receptor gene and MPO‑463G/A
gene were studied using allele‑specific and RT‑PCR,
respectively, which were found to be related with aggressive
periodontitis.[87,88] Various other polymorphisms including
IL‑10 gene, chemokine ligand (CCL5 and CCR5) gene, and
OPG gene have been associated with periodontitis using PCR
amplification.[89‑92]
Limitations of polymerase chain reaction
The enormous cost of the very accurate PCR technique is a
deterrent to its widespread application in routine diagnostic
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Maheaswari, et al.: PCR: A molecular diagnostic tool in periodontology
procedures.[24] High level of expertise is required to process
samples and to carry out data analysis. The specificity of
amplified PCR product could be altered by nonspecific binding
of primers to the similar sequences of the template DNA. The
DNA polymerase used in the PCR reaction is prone to errors
which can lead to mutations in the fragment generated.
In the quantitative real‑time PCR, the fluorescent signal
cannot discriminate specific versus nonspecific amplified
products. In multiplex PCR mixing different primers can
cause some interference in amplification.[21] A high number
of false negative results has been reported when nested PCR
was used for identifying DNA of periodontal pathogens, and
it is also capable of contaminating other reaction vials.[21,36]
The 16 S rRNA PCR‑based method is not able to distinguish
between closely related and also highly recombinant species,
for example, Neisseria and certain Streptococci.
Future perspectives
Identification of microbial pathogens associated with the
etiology of periodontitis is the first step toward the development
of effective periodontal therapeutic approach. PCR may soon
become the ideal detection method for periodontal pathogens
owing to its inherent capacity of sensitivity and specificity. Test
for diseases of the oral cavity may likely combine inherited
polymorphisms with oral microbial profiles and might
also include assays of gene expression and proteomic data
measured in saliva or other oral tissues.
CONCLUSION
The PCR is a revolutionary watershed in scientific and medical
fields and has now become a standard diagnostic and research
tool in periodontology. Understanding the pathogenesis
involved in the onset, progression and resolution of the
periodontal diseases could greatly help in establishing the
effective ways for prevention and treatment besides decreasing
the risk factor for relevant systemic conditions. The future of
PCR is promising in producing greater insight starting from
identification of periodontal pathogens to effective therapeutic
approach.
Acknowledgement
Authors acknowledge the immense help received from
the authors whose articles are cited and included in
references of this manuscript. The authors are also grateful
to authors/editors/publishers of all those articles, journals,
and books from where the literature for this article has been
reviewed and discussed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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