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70]

Original Article

Detection of Antibodies against Prevotella Intermedia in

Patients with Chronic Periodontitis and Periodontally Healthy
Individuals
P. T. Dixitraj, Aarati Nayak, Shruti Bansal, Kishore Bhat
Department of Periodontology, Maratha Mandal’s Nathajirao G Halgekar Institute of Dental Science’s and Research Center, Rajiv Gandhi University of Health Sciences
Belgaum, Karnataka, India

Abstract
Background: Periodontitis, an inflammatory disease of multifactorial etiology, has bacteria playing an essential role in its pathogenesis.
Prevotella intermedia plays an important role in disease initiation and progression. Objectives: The objective was to detect immunoglobulin
G (IgG) antibodies against P. intermedia in blood of periodontally healthy individuals and patients with chronic periodontitis and compare
their levels. Materials and Methodology: A total of 72 subjects were included, 36 subjects in the healthy group and 36 subjects in the chronic
periodontitis group. Subgingival plaque sample and blood sample were obtained from each study subject. Samples were processed in the
Department of Microbiology and Immunology. P. intermedia were confirmed using the culture method and serum IgG levels were assessed
using ELISA (enzyme‑linked immunosorbent assay) technique. Comparison between healthy and chronic periodontitis groups was done using
independent t‑test. Results: IgG levels against P. intermedia were more in the chronic periodontitis group compared to the healthy group, and
the difference was statistically significant. Interpretations and Conclusions: Increased levels of IgG antibodies against P. intermedia are
associated with periodontal disease. This elevated antibody activity might help to neutralize the effects of the bacterium. IgG antibody level
against P. intermedia is a promising indicator in the serological diagnosis of periodontal disease. In chronic periodontitis, the antibody titer
in the patient’s serum against P. intermedia is raised and could be used as a diagnostic aid.

Keywords: ELISA, Prevotella intermedia, periodontal disease, serum immunoglobulin G

Submitted: 27‑May‑2020;  Accepted: 11-Jan-2021;  Published: 14-May-2021

Introduction found in both periodontally healthy and diseased subjects[8]

Periodontitis, an inflammatory disease of multifactorial
etiology, has bacteria playing an essential role in its
pathogenesis. The bacteria studied, comprise predominantly of
Gram‑negative anaerobic rods.[1] Among them, Porphyromonas
gingivalis, Prevotella intermedia, Fusobacterium nucleatum,
Bacteroides spp., and Selenomonas spp. have been reported
as associated with chronic periodontitis.
In the oral cavity, along with other pathogens P. intermedia
(formerly known as Bacteroides intermedius)[2] plays an
important role in the onset and subsequent development
of the polymicrobial periodontal diseases.[3] They are strict
oral anaerobes and found in various niches and are seen in
nonoral and oral infections. Oral infections include chronic
periodontitis,[4] aggressive periodontitis,[5] puberty associated
gingivitis,[6] and ulcerative gingivitis.[7] P. intermedia has been
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and studies[9] have shown that colonization of P. intermedia
is more in periodontally diseased sites than in periodontally
healthy sites.
The host immune response to bacterial infection in periodontal
disease has been exclusively studied earlier. In periodontal
disease, the antibody levels to several bacteria are elevated
and have been hypothesized that failure of the host to mount
an effective immune response to periodontal pathogens may be
an important mechanism in the pathogenesis of periodontitis.[10]
Address for correspondence: Dr. P. T. Dixitraj,
Deepam, TC 6/897, VARA 696, Arappura Gardens, Vattiyoorkavu P.O,
Thiruvananthapuram, ‑ 695 013, Kerala, India.
E‑mail: drdixitraj@gmail.com
This is an open access journal, and articles are distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit
is given and the new creations are licensed under the identical terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

How to cite this article: Dixitraj PT, Nayak A, Bansal S, Bhat K.

DOI: Detection of antibodies against Prevotella Intermedia in patients with
10.4103/dmr.dmr_27_20 chronic periodontitis and periodontally healthy individuals. Dent Med Res
2021;9:45-50.

© 2021 Dentistry and Medical Research | Published by Wolters Kluwer - Medknow 45

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Dixitraj, et al.: Detection of antibodies against Prevotella intermedia in patients with chronic periodontitis and periodontally healthy individuals
Immunoglobulin G (IgG), the most abundant type of antibody,
is found in all body fluids. The fundamental role of IgG is
activating the humoral immune response, the complement
system, and phagocytosis of microorganisms. IgG reacts
with macrophages, neutrophils, and natural killer cells and
can activate the complement system[11] and has a protective
role in the pathogenesis of disease. In chronic periodontitis,
antibodies are produced against various periodontopathogens
and they activate cells of the immune system. Studies on
various periodontopathogens and their major antigens have
proved that in general, mostly IgG antibody titers are involved
in investigations of humoral immune reaction.[12]
The humoral immune response, in which IgG and IgA
antibodies are produced, is considered to have a protective
role in the pathogenesis of periodontal disease,[13] but the
mechanisms are not fully understood. Failure of the host to
mount an effective immune response to periodontal pathogens
may be an important mechanism in the pathogenesis of
periodontitis.[14]
Even though P. intermedia has been regarded as a major
pathogen contributing to periodontitis, less research has been
done on this particular organism compared to other organisms.
Very few studies have examined the immune responses in
chronic periodontitis to the P. intermedia and the antibody
levels in serum against these organisms in health. We were
therefore prompted to take up a study which aimed at detecting
and comparing the antibody levels against P. intermedia in
patients with chronic periodontitis and periodontally healthy
individuals.
Materials and Methodology
This study included 36 periodontally healthy subjects and
36 patients with chronic periodontitis from both sexes. The
criteria of the patients selected for the periodontally healthy
group had the absence of gingival inflammation, absence
of bleeding on probing, probing depth  ≤3 mm, no clinical
attachment loss and for chronic periodontitis group had the
presence of gingival inflammation, presence of bleeding
on probing, probing depth  ≥5 mm, and clinical attachment
loss >3 mm. Patients on any antibiotic therapy and periodontal
treatment up to 3 months before this study were excluded.
Patients with any systemic diseases or conditions, pregnant,
lactating women, smokers, and patients below 30 years of age
were excluded from the study. Written informed consent was
obtained from each subject enrolled in the study. The ethical
clearance for the study was obtained from the Institutional
Ethics Committee. All microbiological and immunological
procedures were carried out in the laboratory of the Department
of Molecular Biology and Immunology at our institute.
A pooled subgingival plaque sample was collected from each
subject. Randomly selected sites were isolated with sterile
cotton rolls and areas were air‑dried to prevent contamination.
In periodontally healthy subjects, subgingival plaque
samples were collected from the gingival sulcus. In chronic
46
periodontitis subjects, after, supragingival plaque and calculus
were removed carefully, a sterile curette was inserted into the
selected site and the subgingival plaque sample was obtained
by moving the curette along the root surface coronally. Plaque
samples were immediately transferred in a RTF. About 10 ml
of venous blood was collected from the patient. Blood samples
were allowed to clot for 30  min at room temperature. The
samples were centrifuged at 3000 RPM for 15 min. Then, the
serum samples were removed and kept in append of tubes.
These append of tubes were stored at –80ºc until laboratory
analysis.[15]
Culturing technique using Kanamycin Blood Agar as anaerobic
selective medium was used and gram staining and sugar
fermentation tests were performed to confirm the organism.[16]
ELISA procedure
The protein estimation of the antigen was done using Lowry’s
method[17] and the antigen concentration obtained was 120 µg/ml
using a biophotometer. This antigen was diluted in 1:6 ratio
to obtain a concentration of 20 µg/ml and was then mixed
with coating buffer to prepare coating solution. A polystyrene
microtiter plate was used for coating antigen. Hundred microliters
of coating solution was added to each well. Then, the plate was
covered with adhesive and kept at 4°C overnight.   The coating
solution was removed after incubation and wash buffer was used
to clean the wells. Then, 200 µl blocking buffer was added to
block interference from unwanted antigens and was incubated
for 2 h at room temperature. After incubation, the plates were
washed with PBS. The serum sample collected was diluted in
1:100 ratio with PBS and 100 µl of this was added to the wells
and kept for 1 h at room temperature. After 1 h, the wells were
washed three times with PBS. Hundred microliters of conjugate
(goat antihuman IgG HRP diluted with blocking buffer in a ratio
1:5000) was added and kept for 1 h at room temperature. After
incubation, the wells were washed three times with PBS. Hundred
microliters of the substrate (tetramethylbenzidine diluted with
distilled water in ratio 1:20) was added and kept for half an hour.
After half an hour, 100 µl of stop solution was added and the
reaction was stopped. Readings were recorded at 450 nm with
BIORAD I‑mark microplate reader.[18]
Statistical analysis
Software   Statistical Program for Social Science 9 (Spss Inc,
Chicago, USA) was used for data analysis. Independent t‑test
was used to compare IgG levels against P. intermedia in the
study groups (healthy and chronic periodontitis).
Results
Table 1 illustrates the age and sex of subjects of both healthy
and chronic periodontitis group.
Table 2 illustrates the IgG values (relative units/ml) of samples
analyzed by the ELISA method of both healthy and chronic
periodontitis groups.
Table 3 and Graph 1 show the distribution of samples in healthy
and chronic periodontitis groups with respect to age. The mean age
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Dixitraj, et al.: Detection of antibodies against Prevotella intermedia in patients with chronic periodontitis and periodontally healthy individuals

Table 1: Age and sex of the study population Table 2: Enzyme‑linked immunosorbent assay results
Healthy (H) CP Healthy (H) CP
Sample Age Sex Sample Age Sex Sample IgG values Sample IgG values
H1 32 Male CP 1 36 Female (relative units/ml) (relative units/ml)
H2 30 Male CP 2 53 Male H1 8.5 CP1 32.5
H3 31 Male CP 3 56 Female H2 4.5 CP 2 29
H4 31 Female CP 4 31 Female H3 4 CP 3 24
H5 32 Female CP 5 50 Female H4 5 CP 4 2
H6 30 Male CP 6 60 Male H5 7 CP 5 28.5
H7 32 Male CP 7 40 Female H6 10 CP 6 19.5
H8 30 Male CP 8 52 Male H7 7.5 CP 7 3.5
H9 42 Female CP 9 32 Male H8 7.5 CP 8 7
H 10 33 Male CP 10 65 Female H9 8 CP 9 39
H 11 38 Female CP 11 54 Female H 10 9 CP 10 28
H 12 30 Female CP 12 32 Female H 11 7 CP 11 27
H 13 30 Female CP 13 41 Female H 12 8.5 CP 12 20
H 14 35 Female CP 14 30 Female H 13 9.5 CP 13 37.5
H 15 35 Female CP 15 33 Female H 14 8 CP 14 6
H 16 30 Male CP 16 32 Female H 15 9 CP 15 31
H 17 32 Male CP 17 65 Male H 16 14.5 CP 16 4.5
H 18 31 Male CP 18 40 Female H 17 10 CP 17 35
H 19 30 Male CP 19 35 Female H 18 10 CP 18 36.5
H 20 32 Male CP 20 40 Female H 19 7 CP 19 46.5
H 21 38 Male CP 21 48 Female H 20 11 CP 20 42
H 22 33 Male CP 22 56 Female H 21 13 CP 21 38
H 23 34 Male CP 23 52 Male H 22 9.5 CP 22 30
H 24 57 Male CP 24 32 Male H 23 7.5 CP 23 6
H 25 36 Male CP 25 42 Male H 24 9.5 CP 24 50.5
H 26 36 Male CP 26 61 Male H 25 8 CP 25 28.5
H 27 33 Male CP 27 46 Male H 26 8 CP 26 34.5
H 28 33 Male CP 28 38 Male H 27 16 CP 27 30.5
H 29 53 Male CP 29 42 Female H 28 9 CP 28 39
H 30 41 Female CP 30 78 Female H 29 9.5 CP 29 44
H 31 48 Male CP 31 30 Female H 30 7.5 CP 30 48
H 32 36 Female CP 32 48 Female H 31 13 CP 31 44
H 33 60 Female CP 33 49 Female H 32 16.5 CP 32 27.5
H 34 43 Male CP 34 35 Male H 33 7.5 CP 33 27
H 35 34 Female CP 35 40 Female H 34 9 CP 34 9
H 36 48 Female CP 36 45 Female H 35 8.5 CP 35 47.5
CP=Chronic periodontitis H 36 4 CP 36 29
IgG=Immunoglobulin G; CP=Chronic periodontitis
of the healthy group (±standard deviation) was 36.36 ± 7.86. The
mean age of the chronic periodontitis group was 44.97 ± 11.77. 12 were male and 24 were female, i.e., 33.33% of the chronic
77.78% of subjects in the healthy group were in the age group periodontitis patients were male and 66.67% were female.
of 30–39 years; 13.89% of subjects in the healthy group were in
Table 5 and Graph 3 show the comparison of healthy and chronic
the age group of 40–49 years; 8.33% of subjects in the healthy
periodontitis groups with IgG levels (relative units/ml) against
group were in the age group >50 years; 33.33% of subjects in the
P. intermedia by independent t‑test. The mean IgG value (±SD)
chronic periodontitis group were in the age group of 30–39 years;
33.33% of subjects in the chronic periodontitis group were in the against P. intermedia in the healthy group was 8.93 ± 2.88 and
age group of 30–39 years; and 33.33% of subjects in the chronic in the chronic periodontitis group was 28.67 ± 13.85. P value of
periodontitis group were in the age group >50 years. 0.0001 was obtained, which implies that the results are statistically
significant (P < 0.05 ‑ results are statistically significant).
Table 4 and Graph 2 show the distribution of males and females
in healthy and chronic periodontitis groups. Of the total 36
subjects in the healthy group, 23 were male and 13 were female, Discussion
i.e., 63.89% of the healthy patients were male and 36.11% were P. intermedia has been isolated frequently from odontogenic
female. Of the total 36 subjects in the chronic periodontitis, abscesses, saliva, the tongue, and both healthy and diseased

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Dixitraj, et al.: Detection of antibodies against Prevotella intermedia in patients with chronic periodontitis and periodontally healthy individuals

Table 3: Distribution of samples in healthy and chronic

periodontitis groups with respect to age
Age groups Healthy (%) CP (%) Total (%)
30‑39 years 28 (77.78) 12 (33.33) 40 (55.56)
40‑49 years 5 (13.89) 12 (33.33) 17 (23.61)
50+ years 3 (8.33) 12 (33.33) 15 (20.83)
Total 36 (100.00) 36 (100.00) 72 (100.00)
Mean age 36.36 44.97 40.67
SD age 7.86 11.77 10.84
CP=Chronic periodontitis; SD=Standard deviation

Table 4: Distribution of males and females in healthy and Graph 1: Distribution of samples in healthy and chronic periodontitis
chronic periodontitis groups groups with respect to age. X axis: Age group, Y axis: Percentage
Gender Healthy (%) CP (%) Total (%) distribution of samples in healthy and chronic periodontitis groups with
Male 23 (63.89) 12 (33.33) 35 (48.61) respect to age
Female 13 (36.11) 24 (66.67) 37 (51.39)
Total 36 (100.00) 36 (100.00) 72 (100.00)
CP=Chronic periodontitis

Table 5: Comparison of healthy and chronic periodontitis

groups with immunoglobulin G levels (relative units/ml)
against Prevotella intermedia by independent t‑test
Group n Mean±SD SE t P
Healthy group 36 8.93±2.88 0.48 −8.3727 0.0001*
Chronic 36 28.67±13.85 2.31
periodontitis group
*P<0.05 implies that results are statistically significant. SD=Standard
deviation; SE: Standard error
Graph 2: Distribution of males and females in healthy and chronic
periodontitis groups. X axis: Sex, Y axis: Percentage distribution of males
subgingival sites. Although its precise role in the infectious
and females in healthy and chronic periodontitis groups
process remains unknown, it is becoming increasingly clear
that P. intermedia is one of a group of microorganisms that
cause periodontal disease.[19]
Maeda et  al.[20] studied the incidence of black‑pigmented
rods  (BPRs), especially P. intermedia and P. nigrescens, in
periodontal health and disease. Microbiological specimens
were collected from subgingival crevice or periodontal pocket
by paper point. BPR’s appeared in 71.1% of healthy subjects
and 87.8% in active sites of periodontitis patients, although
healthy sites of the periodontitis group showed lesser BPR’s
than healthy subjects. The results of our study indicate that
P. intermedia is present in both healthy and diseased sites. Our
study results are in agreement with Maeda et al. Graph 3: Comparison of healthy and chronic periodontitis groups with
immunoglobulin G levels (relative units/ml) against Prevotella intermedia
In a study by Schenck in 1985, ELISA was used to assess
[21]

IgG, IgA, and IgM serum antibodies against lipopolysaccharide

from Bacteroides gingivalis in periodontal health and disease.
They found that patients with periodontitis had significantly
higher levels of specific antibodies than patients with healthy
gingiva. In the current study, the mean IgG value (±SD) against
P. intermedia in the healthy group was 8.93 ± 2.88 (relative
units/ml) and in the chronic periodontitis group was
28.67 ± 13.85 (relative units/ml). Although similar findings
were observed in our study using ELISA, the organisms
were different. Our study results suggest that IgG levels are
increased during disease, which can be attributed to changes
in the immunoregulatory mechanism.
Hamlet et al. in 2001[22] studied the natural distribution of the
three putative periodontopathogens P. gingivalis, P. intermedia,
and A. actinomycetemcomitans in an Australian population and
the relationship between these organisms, pocket depths, and
supragingival plaque scores. Subjects entered into the study

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Dixitraj, et al.: Detection of antibodies against Prevotella intermedia in patients with chronic periodontitis and periodontally healthy individuals
were in good health and had at least 16 uncrowned teeth.
The subgingival plaque was collected from the shallowest
and deepest probing site in each sextant of the dentition.
In total, 6030 subgingival plaque samples were collected
from 504 subjects. The subject’s ages ranged from 17 to
64  years with a mean age of 38.3  ±  10.8  years. An ELISA
utilizing pathogen‑specific monoclonal antibodies was used
to quantitate bacterial numbers. A. actinomycetemcomitans
was the most frequently detected organism followed by
P. gingivalis and P. intermedia. A. actinomycetemcomitans
presence was overrepresented in the youngest age group
but under‑represented in the older age groups. Conversely,
P. gingivalis and P. intermedia presence was under‑represented
in the youngest age group but over‑represented in the older
age groups. The bacterial presence was strongly associated
with pocket depth for both A. actinomycetemcomitans and
P. gingivalis. In our study, samples were taken from patients
with 30  years and above. The mean age  (±SD) of subjects
were 36.36 ± 7.86 and 44.97 ± 11.77 in healthy and chronic
periodontitis groups, respectively, for our study. All samples
showed the presence of P. intermedia irrespective of the age
in both the study groups. Although the results are similar, a
direct comparative assessment is difficult since study groups
were of different age groups. Also, in our research, we used
in‑house indirect ELISA to detect the antibodies.
Haffajee et  al. in 1995 [23] conducted a study to group
periodontitis subjects according to their elevated serum
antibody levels to specific subgingival species. A total of 119
subjects with evidence of prior periodontal destruction were
included. Serum samples were obtained from each subject at
each visit and the level of antibody was determined by ELISA
to 12 subgingival species. Subgingival plaque samples were
taken and 14 different subgingival species were determined.
Subjects were grouped by cluster analysis of their elevated
antibody levels. Subjects in different cluster groups differed
with respect to age, number of active sites, levels of gingivitis,
prior periodontal destruction, and levels of 11 of 14 microbial
species tested. Subjects with multiple elevated antibody levels
had significantly more active sites. The study concluded that
in chronic periodontitis, the serum antibody levels of different
microorganisms will be elevated. Our study showed similar
results where the serum antibody levels were increased in
chronic periodontitis. Even though our study had a remarkable
similarity with this study, it was confined to the fact that the
samples were collected at the initial visit only, and IgG levels
in the serum were assessed only at the initial visit.
Danielsen et al. in 1993[24] conducted an experimental gingivitis
study in twenty‑eight young, healthy adults in which blood and
clinical recordings were obtained at baseline; after a 4‑week
period of thorough oral hygiene; after a subsequent 3‑week
period of plaque accumulation; and after another 2  weeks
of thorough oral hygiene. Serum IgG antibodies against
whole cells of P. gingivalis, P. intermedia, F. nucleatum,
and S. sanguis were determined using enzyme‑linked
immunosorbent assay. Mean serum IgG antibody levels to
Dentistry and Medical Research  ¦  Volume 9  ¦  Issue 1  ¦  January-June 2021
P. intermedia, F. nucleatum and S. sanguis remained essentially
constant during the experiment, whereas the IgG antibodies to
P. gingivalis declined during the initial period of oral hygiene
and the subsequent period of plaque accumulation to an
average of 84.5% of the baseline value. This reduction could
be attributed to the people who developed marked gingival
inflammation during the period of plaque accumulation,
indicating that the systemic host response may be associated
with local tissue responses to variations in oral hygiene.
These people were, however, also characterized by higher
initial serum IgG responses to P. gingivalis than people who
developed less pronounced gingival inflammation during the
experiment. The variability and individuality noted in the host
response to potential pathogens have important implications
for attempts to use such measures for establishing a diagnosis
or prognosis for the individual patient. The objective of our
current study was only to assess pretreatment antibody levels
against P. intermedia in both healthy subjects and subjects
with chronic periodontitis.
Albandar et al., 2001[10] studied the associations between
serum antibody levels to periodontal pathogens and early‑onset
periodontitis  (EOP). The association between serum IgG,
IgA, and IgM antibodies to 6 periodontal microorganisms
and clinical subtypes of varying severity of EOP was studied
by using ELISA. The study was done on 159  samples
aged 19–25  years and included 97  cases with EOP and 62
controls with no clinical signs of EOP. Serum levels of
A. actinomycetemcomitans, P. gingivalis, P. intermedia,
C. rectus, E. corrodens, and F. nucleatum were assessed.
Serum levels of IgG and IgA antibody reactive to P. gingivalis,
A. actinomycetemcomitans, and P. intermedia were significantly
higher in generalized EOP cases compared to healthy controls.
IgM antibody levels did not show any significant associations
with EOP for any of the 6 bacterial species tested. There were
no significant differences in antibody levels between controls
and the 13 subjects who were classified with localized EOP.
The study concluded that the antibodies to P. gingivalis,
P. intermedia, and A. actinomycetemcomitans may play a
significant role in the pathogenesis of EOP. In the current study,
only IgG levels were assessed against P. intermedia in chronic
periodontitis patients and found that the IgG levels increase
during disease than in health.
In the current study, when the quantification of IgG
antibodies against P. intermedia was done, it ranged from
2 to 50.5 relative units/ml in the periodontitis group. Even
though many patients had elevated antibody levels, out of
the 36 samples, 7 samples showed values corresponding to
those of healthy subjects. The low values suggest that though
some of the patients were infected with P. intermedia, they
were not producing high amounts of antibodies against the
organism. Perhaps antibody production was kept down by
immunoregulation in some of the patients. Hence, difference
in the individual host immune response, extent, and duration
of the infection could be the factors responsible for observed
lack of correlation.
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Dixitraj, et al.: Detection of antibodies against Prevotella intermedia in patients with chronic periodontitis and periodontally healthy individuals
Conclusions
In our present study, IgG antibodies against P. intermedia were
exhibited more in the chronic periodontitis group compared
to the healthy group, and the difference was statistically
significant. The various studies discussed here point toward
varying data. This difference can be attributed to multiple
factors such as immunoregulation, demographic, ethnicity,
behavioral, oral, and general health‑related characteristics
and distribution of the organism. Future studies on IgG
levels to periodontopathogens during disease initiation,
progression, and also the IgG levels before and after treatment
and their comparison with healthy individuals can enlighten
immunoregulation mechanisms in patients with chronic
periodontitis. Long‑term follow‑up randomized clinical trial
is essential to be able to convincingly predict the effect of
periodontal treatment on IgG levels and hence the remission
of the disease process. The variation in the IgG levels after
treatment if any, could point toward the possibility of using
IgG levels against periodontopathogens in order to assess the
disease activity. Having said this, it still could help furthering
research on this subject.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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Dentistry and Medical Research  ¦  Volume 9  ¦  Issue 1  ¦  January-June 2021