PadoTest

To determine the pathogenicity in periodontitis.

The PadoTest® is the microbiological test that recognises key periodontopathogenic germs including the Aa serotypes and recommends targeted measures for more successful treatment. Dentists and dental hygienists throughout Europe have been using the PadoTest® successfully for years.

Every PadoTest® analysis includes the determination of the PadoSero serotype. PadoSero is the microbiological test that determines the virolence of Aggregatibacter actinomycetemcomitans (Aa) via its serotypes and supports the choice of antibiotics.

Bacteria detection with the PadoTest® is essential for:

• the concerted choice of therapy
• the systematic medication without overtreatment with antibiotics
• the quality check after a treatment - proof of efficiency
• the long-term monitoring of treated cases
• the differential diagnosis

Periodontitis Overview

Periodontitis is an infectious disease of the periodontium that is triggered by bacteria and intensified by immune reactions. The PadoTest® is used to determine the presence of periodontopathogenic germs and classify them into three degrees of severity of periodontitis (type 1 to 3).

This classification allows targeted treatment to be initiated, as the PadoTest® provides information on individual measures, including any antibiotics that may be required.

Examined periodontopathogenic bacteria:

Aggregatibacter actinomycetemcomitans

Nomenclature

Aggregatibacter actinomycetemcomitans (Aa) (formerly Actinobacillus actinomycetemcomitans)

Characteristics

Gram-negative, facultative anaerobe, 7 serotypes with different leukotoxin expression (serotype b with high incidence in localized aggressive periodontitis).

Pathogenicity

Highly pathogenic

Virulence factors

• Leukotoxin A
• Chemotaxis inhibitory factor
• Fibroblast inhibition
• Bone resorbing toxin
• Collagenase
• Lipopolysaccharide endotoxin

Occurrence

In case of localized aggressive and chronic periodontitis. The virulence factors promote colonization and establishment of the germ in the oro-pharyngeal area.

• can be a trigger for rheumatoid arthritis
• possible cause for endocarditis

Treatment

Antibiotic of choice is amoxicillin. Cannot be definitively eliminated with scaling/root planing.

Aggregatibacter actinomycetemcomitans - serotypes a - f

Nomenclature

Aggregatibacter actinomycetemcomitans (Aa) - serotypes a -f

Characteristics

6 serotypes with different leukotoxin expression (serotype b with high incidence in localized aggressive periodontitis).

Pathogenicity

non-virulent (serotype a) to highly virulent (serotype b with JP2)

Virulence factors

Leukotoxin expression

Occurrence

In case of localized aggressive and chronic periodontitis. The virulence factors promote colonization and establishment of the germ in the oro-pharyngeal area.

• can be a trigger for rheumatoid arthritis
• possible cause for endocarditis

Treatment

Antibiotic of choice is amoxicillin. Cannot be definitively eliminated with scaling/root planing.

Filifactor alocis

Nomenclature

Filifactor alocis (Fa)

Characteristics

gram-positive anaerobes, extremely difficult to cultivate

Pathogenicity

Highly pathogenic

Virulence factors

15 different proteases, microbial surface components that recognize the adhesive matrix (MSCRAMMs), F. alocis complement inhibitor (FACIN).

Occurrence

Occurs in subgingival samples in chronic periodontitis (CP) and generalized aggressive periodontitis (GAP) and is associated with supporting tissue loss. Fa is a cause of chronic infection and induces the production of proinflammatory cytokines that lead to apoptosis of gingival epithelial cells. In comparison with the representatives Pg, Td, Tf, described in the literature as "red complex", which are associated to the highest degree with periodontal diseases, Fa revealed the third highest prevalence in a group of CAP patients and the second highest prevalence in that of CP patients. Fa is primarily located in the regions of the biofilm that originated from the middle or even apical part of the pocket.

Fa is always intimately intertwined with other periodontal bacteria and exhibits a symbiotic relationship with Pg, for example, which can result in a structural increase of the biofilm.

Treatment

Antibiotic of choice: metronidazole

Porphyromonas gingivalis

Nomenclature

Porphyromonas gingivalis (Pg)

Characteristics

gram-negative strict anaerobe

Pathogenicity

highly pathogenic

Virulence factors

Membrane-associated proteases that, for example, cleave fibrinogen, leading to bleeding on probing (BOP), release haemin and iron, and at the same time serve as a food source for further proliferation of the germ. Lipopolysaccharides, exopolysaccharides, OMP (Outer membrane Proteins), collagenase, trypsin-like protease, gelatinase, aminopeptidase.

Occurrence

The germ is not part of the "normal" oral flora; the immune system is not able to completely control an infection. It colonizes the periodontium more evenly than A. actinomycemtemcomitans, which tends to occur at individual sites.

Treatment

Can usually be removed with root planing. If it is still detected after this treatment, reintervention with curettage or chriurgy is indicated. If Pg and Aa are present in larger amounts, antibiotics must be prescribed in addition to scaling/root planing. The antibiotics of choice are metronidazole or ornidazole + amoxicillin.

Prevotella intermedia

Nomenclature

Prevotella intermedia (Pi)

Characteristics

gram-negative obligate anaerobes

Pathogenicity

highly pathogenic

Virulence factors

• Exopolysaccharides (EPS)
• Cysteine protease (Interpain A)

Occurrence

Is detected as a (co-)pathogen of mostly mixed dentoalveolar infections. Is also referred to as an early marker germ, which creates the anaerobic environment necessary for the colonization of the main periodontal germs by metabolizing the residual sugars in the sulcus or in the periodontal pocket that forms. Pi uses steroid hormones as growth factors, so it might be more prevalent among pregnant women.

Treatment

Pi cannot be treated with scaling/root planing if the bacterial count is elevated. Nitromimidazole preparations (e.g. metronidazole) are the antibiotics of choice. Penicillinase-related penicillin resistance is known in sporadic cases; apart from this, anaerobic ß-lactam antibiotics (e.g. penicillin G, ampicillin, amoxicillin) can be effectively used. The efficacy of clindamycin (resistances) and tetracyclines is different; aminoglycosides are always ineffective.

Tannerella forsythia

Nomenclature

Tannerella forsythia (Tf)

Characteristics

anaerobic strict gram-negative

Pathogenicity

highly pathogenic

Virulence factors

3 proteolytic enzymes: cysteine protease (PrtH), carilysin (structurally comparable to human matrix metalloproteases), mirolase (calcium-dependent serine protease).

Occurrence

Characteristic of severe bone defects. In "active" bags in significantly higher numbers than in "inactive" bags. Also known in cases of recurrent periodontitis. Often associated with refractory periodontal disease. There is a close relationship of co-occurrence with Treponema denticola and Porphyromonas gingivalis.

Treatment

can usually be removed with root planing. The antibiotics of choice are metronidazole or ornidazole, if explicitly necessary (especially in the case of severe inflammatory symptoms).

Treponema denticola

Nomenclature

Treponema denticola (Td)

Characteristics

short, strictly anaerobic gram-negative spirochete

Pathogenicity

highly pathogenic

Virulence factors

tissue-destroying proteases, hyaluronidases, phosphatases and phopholipases. Stimulates formation of IL-1 alpha and TNF- alpha.

Occurrence

is associated with periodontal destruction (advanced periodontitis), necrotizing ulcerative gingivitis/periodontitis.

Treatment

is useful as a marker in the evaluation of treatment success (scaling/root planing) in therapy-refractory pockets. As antibiotic of choice, if required, metronidazole or ornidazole.

Detection and Analysis Method

For detection and quantification, the PadoTest® uses a special multiplex real-time PCR (polymerase chain reaction). The high precision of this form of analysis provides an image of the examined key germs in the gingival pocket. In terms of price, the PadoTest® is extremely attractive and can be used very flexibly due to the possibility of multi-site or single-site tests.

The practitioner recognizes the damage pattern, the PadoTest® determines the pathogenicity of the bacterial load and recommends the therapeutic measures!