Impact of Malocclusions on Periodontopathogenic Bacterial Load and Progression of Periodontal Disease: A Quantitative Analysis

Abstract

(1) Periodontal disease (PD) is a globally prevalent chronic inflammatory condition, exacerbated by the dysbiosis of the oral microbiota. This study aims to evaluate the bacterial load of specific periodontopathogenic bacteria in patients with malocclusions (MAL) compared to those without. (2) Methods: Conducted at the "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, this pilot study involved two groups: patients with MAL and PD, and patients with PD but without MAL. We included 20 patients: 10 with MAL (9 with crowding and 1 with an open bite) and 10 without MAL. Gingival crevicular fluid was collected for bacterial DNA extraction and quantified bacterial load using real-time PCR, focusing on 12 periodontopathogenic bacteria across different complexity classes. (3) Results: The study identified significantly higher concentrations of Treponema denticola (p = 0.023, median = 4.32, IQR = 2.76-5.53 vs. median = 1.93, IQR = 0-3.19), Tannerella forsythia (p = 0.020, mean = 6.04 ± 0.72 vs. mean = 4.4 ± 1.89) and Porphyromonas gingivalis (p = 0.002, median = 5.64, IQR = 4.94-5.98 vs. median = 2.48, IQR = 0-4.05) in patients with MAL compared to those without. This suggests that MAL contributes to an environment conducive to the proliferation of specific pathogens, potentially accelerating PD progression. Additionally, Eikenella corrodens (p = 0.040, mean = 4.55 ± 1.02 vs. mean = 3.23 ± 1.56), Campylobacter rectus (p < 0.001, mean = 4.2 ± 0.56 vs. mean = 1.8 ± 1.51), Prevotella intermedia (p = 0.043, median = 5.04, IQR = 0-5.49 vs. median = 0, IQR = 0-3.39), Capnocytophaga sputigena (p = 0.011, median = 5.91, IQR = 5.47-6.17 vs. median = 4.63, IQR = 3.83-5.64), and Capnocytophaga gingivalis (p = 0.007, median = 5.87, IQR = 5.34-6.03 vs. median = 4.4, IQR = 3.5-5.71) also showed elevated concentrations, indicating the broad impacts of MAL on oral microbial profiles. (4) Conclusions: The findings demonstrate a significant relationship between MAL and increased bacterial loads, underscoring the need for its integration in managing PD. Future research should expand demographic diversity and employ longitudinal designs to better understand the causative mechanisms at play.

Keywords: bacterial quantification; malocclusions; periodontal disease; periodontopathogenic bacteria; real-time PCR.

Figure 1

Comparison of isolated high pathogenic bacterial cultures concentrations according to the existence of malocclusions. The figure illustrates that patients with malocclusions have a significantly higher concentration of Treponema denticola, Tannerella forsythia, and Porphyromonas gingivalis compared to patients without malocclusions. Legend: Aa (Aggregatibacter actinomycetemcomitans)—represented by blue bars; Td (Treponema denticola)—represented by red bars; Tf (Tannerella forsythia)—represented by green bars; Pg (Porphyromonas gingivalis)—represented by orange bars; malocclusions (MAL). Box-Plot Components: median (black line inside the box)—indicates the median bacterial concentration for each group; interquartile range (IQR)—the box spans from the 25th percentile (Q1) to the 75th percentile (Q3), representing the middle 50% of the data; whiskers—extend to the smallest and largest values within 1.5 times the IQR from Q1 and Q3, respectively; circles—represent mild outliers, defined as values that fall between 1.5 and 3 times the IQR from the quartiles; asterisks—represent extreme outliers, defined as values that fall beyond three times the IQR from the quartiles. Key observations: Patients with MAL have significantly higher concentrations of Td (p = 0.023), Tf (p = 0.020) and Pg (p = 0.002). These differences are statistically significant.

Figure 2

Comparison of isolated moderate pathogenic bacterial cultures concentrations according to the existence of malocclusions. The figure illustrates that patients with malocclusions have significantly higher concentrations of Eikenella corrodens, Campylobacter rectus, and Prevotella intermedia compared to patients without malocclusions. Legend: Ec (Eikenella corrodens)—represented by blue bars; Cr (Campylobacter rectus)—represented by red bars; Pi (Prevotella intermedia)—represented by green bars; Fnp (Fusobacterium nucleatum): represented by orange bars; Pn (Prevotella nigrescens)—represented by yellow bars; malocclusions (MAL). The Box-Plot components for Figure 2 are similar to those described for Figure 1. Box-Plot components: median (black line inside the box)—indicates the median bacterial concentration for each group; interquartile range (IQR)—the box spans from the 25th percentile (Q1) to the 75th percentile (Q3), representing the middle 50% of the data; whiskers—extend to the smallest and largest values within 1.5 times the IQR from Q1 and Q3, respectively; circles—represent mild outliers, defined as values that fall between 1.5 and 3 times the IQR from the quartiles; asterisks—represent extreme outliers, defined as values that fall beyond 3 times the IQR from the quartiles. Key observations: Patients with MAL have significantly higher concentrations of Ec (p = 0.040), Cr (p < 0.001) and Pi (p = 0.043). These differences are statistically significant.

Figure 3

Comparison of the isolated low pathogenic bacterial cultures concentrations according to the existence of malocclusions. The figure illustrates that patients with malocclusions have significantly higher concentrations of Capnocytophaga sputigena and Capnocytophaga gingivalis compared to patients without MAL. Legend: Co (Capnocytophaga ochracea)—represented by blue bars; Cs (Capnocytophaga sputigena)—represented by red bars; Cg (Capnocytophaga gingivalis)—represented by green bars; malocclusions (MAL). Box-Plot components: median (black line inside the box)—indicates the median bacterial concentration for each group; interquartile range (IQR)—the box spans from the 25th percentile (Q1) to the 75th percentile (Q3), representing the middle 50% of the data; whiskers—extend to the smallest and largest values within 1.5 times the IQR from Q1 and Q3, respectively; circles—represent mild outliers, defined as values that fall between 1.5 and 3 times the IQR from the quartiles.; asterisks—represent extreme outliers, defined as values that fall beyond 3 times the IQR from the quartiles. Key observations: Patients with MAL have significantly higher concentrations of Cs (p = 0.011) and Cg (p = 0.007). These differences are statistically significant.