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RESEARCH REPORT |
1 Department of Orthodontic and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078, USA;
2 Center for Statistical Consultation and Research, University of Michigan; and
3 Dept. of Biologic & Materials Sciences, Division of Prosthodontics, University of Michigan
* corresponding author, wloesche{at}umich.edu
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMATERIALS & METHODSRESULTSDISCUSSIONREFERENCES |
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KEY WORDS: BANA test • children • transmission
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMATERIALS & METHODSRESULTSDISCUSSIONREFERENCES |
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Tests capable of detecting various oral species have been developed, but DNA probes, immunological reagents, and bacterial culturing are laboratory-based and are not appropriate for chair-side use. Toward this end, there is need for a test that could be used reliably in routine clinical examinations to identify the presence of bacteria associated with periodontal diseases. The BANA (N-benzoyl-DL-arginine-2-naphthylamide) test detects a trypsin-like enzyme that is present in Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythensis. The BANA test had 92% sensitivity and 70% specificity when compared with DNA probes and polyclonal immunological reagents (Loesche et al., 1992).
Watson et al.(1991) showed that 56% of 157 children were positive for BANA-positive species in one or more of 4 samples of plaque, indicating that young children are colonized by P. gingivalis, T. denticola, and T. forsythensis. Children whose parents were colonized by BANA-positive bacteria were 9.8 times more likely to be colonized by BANA-positive species than were children whose parents were BANA-test-negative. Children whose parents had clinical evidence of periodontitis were 12 times more likely to be colonized by BANA-positive species. These data are compatible with the hypothesis that children may acquire the BANA-positive species from their parents, especially if the parent has periodontitis.
The purpose of our study was to obtain information regarding the prevalence of BANA-positive species in young children and their parents, by seeking evidence of the potential transmission of periodontal pathogens between parents and their children.
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MATERIALS & METHODS |
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TOPABSTRACTINTRODUCTIONMATERIALS & METHODSRESULTSDISCUSSIONREFERENCES |
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Experimental Protocol
The parent who accompanied the child was asked to provide information about him/herself and the child, including birth date, gender, and age. Parents completed a questionnaire, with help provided if they had difficulties answering questions. The child was given a dental examination, including ascertainment of DMF score, caries status (caries-free, pit and fissure decay, moderate occlusal caries, proximal caries, rampant caries), and oral hygiene. Additional measurements were:
BANA Test
The toothpick with adherent plaque was wiped onto the lower strip of the BANA card. A separate toothpick was used for each plaque sample. After all tooth sites had been sampled, the upper strip was lightly moistened with distilled water by means of a cotton swab. The BANA card was folded at the perforation mark, so that the lower and upper strips met. The card was placed in an incubator at 55°C for 5 min. The BANA card was removed, and the lower portion was discarded in a manner appropriate for contaminated material. The color on the upper strip was recorded, by the consensus of two different examiners, as ‘no blue’ (negative), a ‘faint blue’ (weakly positive), or a ‘distinct blue’ (positive). The inter-examiner agreement was 96.7%. For statistical analysis, weakly positive and positive results were recorded as positive.
Statistical Analysis
SPSS 10.1 for Windows was used for statistical analysis. Frequency tables were generated for each categorical variable, and descriptive statistics were obtained for continuous variables. Chi-square tests were performed to assess the significance of the relationship of BANA test results to each of the categorical variables. Independent-samples t tests were performed to determine if there was a difference in the means of continuous variables for BANA-positive and BANA-negative patients. A stepwise logistic regression analysis was performed to determine the association between the various independent variables and the BANA-positive status of the child.
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RESULTS |
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TOPABSTRACTINTRODUCTIONMATERIALS & METHODSRESULTSDISCUSSIONREFERENCES |
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Eighty-four (56%) of the children tested BANA-negative for all 4 plaque samples, and 66 (44%) tested positive and/or weakly positive in one or more of the samples (Table 1
). Among the BANA-positive children, 23 had one positive sample, 28 had 2 positive samples, 13 had 3 positive samples, and two had 4 positive samples. Children with BANA-positive samples tended to have lower DMF scores compared with children with negative BANA samples, and those with a higher number of positive samples tended to be older (Table 1).
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). Twenty-four percent of the children aged 3–5 yrs had BANA-positive samples, compared with 56.5% of the children aged 6 to 10 yrs (p < 0.001) (Table 2).
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).
Seventy of the 140 caregivers tested BANA-positive and/or weakly positive in one or more of the quadrants. Eighty-four percent of children whose caregivers were BANA-positive were also BANA-positive, whereas only 7% of children whose caregivers were BANA-negative were BANA-positive (p < 0.001). Sixty-three percent of the children aged 3–5 yrs and 92% of the children aged 6–10 yrs, whose caregivers were BANA-positive, were also BANA-positive (Table 3).
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35 yrs old had BANA-positive scores, while only 26% of children who had younger caregivers had BANA-positive scores (p < 0.001).
We performed a stepwise logistic regression analysis to determine the association between various independent variables and BANA-positive results in the children. Each variable that was found to have a significant relationship to BANA-positive test results was included in the analysis. At each step, the most significant variables were entered into the model. At step one of the model, children with a BANA-positive caregiver had 69 times greater odds of a BANA-positive sample than did children with a BANA-negative caregiver. When the mean PBS and the age of the child were added to the model, they were also significant, and the model R2 increased to 0.85 (Table 4). Other predictor variables—such as caregiver’s age, family members with history of periodontal disease, occlusal development stage, and treatment status, which were significantly associated with the child’s BANA-positive results in the bivariate models (Table 2)—were not significant.
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMATERIALS & METHODSRESULTSDISCUSSIONREFERENCES |
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The present study and that by Watson et al.(1991) showed that 44% and 56%, respectively, of the children had at least one BANA-positive plaque sample. BANA-positive plaque samples were more frequently encountered in older children with a mixed dentition, compared with younger children with a primary dentition. This could reflect that, with increasing age, there is more time for children’s mouths to be colonized from outside sources. Another explanation could be that the micro-environment at interproximal sites in the mixed dentition, such as bleeding during eruption, promotes colonization of BANA-positive species from sites such as the tongue and the primary dentition. In this regard, the BANA species have nutrient requirements for host molecules, such as hemin, progesterone, ceruloplasmin, and acetyl muramic acid, among others (Loesche, 1968; Kornman and Loesche, 1982; Suzuki and Loesche, 1989). The eruption of the permanent teeth increases the number of interproximal sites that provide an ideal environment for anaerobic bacteria.
There was no correlation between BANA scores and PI or brushing habits. The mean value of the PBS was significantly correlated with the presence of BANA-positive plaques (Table 2), as has been found in adults (Kazor et al., 1999).
The vertical transmission of periodontal microflora from mother to child has been reported (Könönen et al., 1992b; Matto et al., 1998). The present study found that children whose parents were colonized by BANA-positive bacteria were significantly more likely to have a positive BANA reaction. Also, children with BANA-positive plaques were more likely to have caregivers or family members who were older and had a history of periodontal disease (P < 0.001).
It is possible that a multi-factor risk model could be designed, like the early childhood caries risk model, to provide some benefit in the recognition and management of aggressive periodontitis. A limitation with the present concept(s) of the etiology of periodontal disease is the difficulty in explaining to young patients or parents why they are more or less at risk based solely on their level of oral hygiene. But an aggressive periodontitis risk model could be used to explain how an anaerobic infection could cause periodontal disease in either the child or the parent (Albandar, 2000; Albandar and Tineco, 2002).
An anaerobic periodontal infection risk model can be proposed from the present study. The BANA reaction of caregivers was the strongest predictor of BANA-positive plaque samples in the children. If the caregiver was BANA-positive, the odds of the child also being BANA-positive was 35 times more than for a child with a BANA-negative caregiver, after adjustment for the child’s age and PBS. The R2 of the model indicated that 85% of the variability was accounted for (Table 4). Use of this model could aid in identifying children who are at risk for periodontal disease and exclude those who are at low risk. A likely scenario would be to BANA-test children whose parents indicate a history of periodontal disease. If the child is BANA-positive, then his age and PBS could be used to estimate risk based on data provided in Table 4.
Oral health risk assessment of this nature should focus efforts toward those children who have the greatest needs, thereby saving time and reducing expenditures. However, children in the present study were selected from patients with high caries scores and some behavioral issues. Therefore, a larger randomly selected population needs to be sampled for the results to be applicable to the general population. A long-term follow-up for those children who had the BANA reactions would be necessary to determine whether the risk indicators identified would predict which children are more likely to develop aggressive periodontitis. Longitudinal studies in adults showed that the presence of P. gingivalis, T. forsythensis, and BANA-positive plaque samples was a risk factor for periodontal disease (Beck et al., 1990; Grossi et al., 1994; Elter et al., 1999).
An unexpected dividend from the present findings could be the observation that children who were BANA-positive always had a mother who was BANA-positive. Recent reports (Jeffcoat et al., 2001; Lopez et al., 2002) indicated a significant association between preterm and low-birthweight infants, and mothers with periodontal disease. Pediatric dentists who identify children with positive BANA results could ask the child’s mother about her periodontal and pregnancy status. If the particular mother was pregnant, the dentist could recommend a periodontal examination.
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ACKNOWLEDGMENTS |
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Received January 13, 2005; Last revision August 17, 2005; Accepted October 12, 2005
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REFERENCES |
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This article has been cited by other articles:
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  Y. Lee, W.-S. S. Tchaou, K. B. Welch, and W. J. Loesche The transmission of BANA-positive periodontal bacterial species from caregivers to children. J Am Dent Assoc, November 1, 2006; 137(11): 1539 - 1546. [Abstract] [Full Text] [PDF]
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