Advs Exp. Medicine, Biology - Neuroscience and Respiration (2015) 8: 25–30 DOI 10.1007/5584_2014_42 # Springer International Publishing Switzerland 2014 Published online: 25 September 2014
Influence of Denture Plaque Biofilm on Oral Mucosal Membrane in Patients with Chronic Obstructive Pulmonary Disease D. Przybyłowska, E. Mierzwin´ska-Nastalska, R. Rubinsztajn, R. Chazan, D. Rolski, and E. Swoboda-Kopec´ Abstract
Patients with chronic obstructive pulmonary disease (COPD) have the lower airways colonized with pathogenic bacteria in a stable period of the disease and during exacerbations. The etiology of bacterial exacerbations of COPD depends on the underlying disease, the frequency of exacerbations and antibiotic therapy. Microorganisms can be aspirated off the denture plaque biofilm into the lower respiratory tract and could reduce the patient’s immunity and cause pneumonia. COPD patients, who are using acrylic dentures in oral cavity, are exposed to denture stomatitis and oral candidiasis. The aim of this study was to establish the composition of denture plaque biofilm and its impact on the oral mucosa in COPD patients. The study included patients in a stable phase of COPD using removable denture and the control group included healthy wearer’s appliances. Examinations concerned the oral mucosal membrane and the hygienic condition of prosthetic restorations. Microbiological examinations were performed by taking a direct swab from the surface of acrylic dentures. Seventeen bacterial and fungal strains were isolated from denture plaque of COPD patients, which could be a reservoir of pathogens in the upper and lower airways. The results showed a greater frequency of prosthetic stomatitis complicated by mucosal infections among COPD patients compared to healthy subjects. Keywords
Candida albicans • COPD • Denture stomatitis • Oral hygiene • Respiratory pathogens
D. Przybyłowska (*), E. Mierzwin´ska-Nastalska, and D. Rolski Department of Prosthodontics, Warsaw Medical University, 59 Nowogrodzka St., Warsaw 02-005, Poland e-mail: [email protected] R. Rubinsztajn and R. Chazan Department of Internal Medicine, Pulmonology and Allergology, Medical University of Warsaw, Poland
E. Swoboda-Kopec´ Department of Dental Microbiology, Medical University of Warsaw, Poland 25
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D. Przybyłowska et al.
Introduction
Chronic obstructive pulmonary disease (COPD) is one of major diseases where oral bacteria bear significant degree of responsibility for exacerbations. International studies showed that poor oral hygiene has an influence on pneumonia infections. A substantial part of nosocomial pneumonias start with the aspiration of oral bacteria from the mouth or nasopharynx to the lower respiratory tract (Paju and Scannapieco 2007). Respiratory tract pathogens, such as Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis and others, and also Candida spp. fungi, leading a saprophytic existence in the mucosa, are responsible for over 50 % of exacerbations of COPD (Sethi 2004). Those microorganisms exist in the form of organized structures forming an ecological niche called biofilm. The pathogenicity of a microorganism is reflected in its capacity to form biofilm, which directly affects oral tissues and the lower respiratory tract (Scannapieco 2006). The presence of bacteria in the airways of patients with COPD implies a breach of host defense mechanisms, which sets up a vicious cycle of epithelial cell damage and impaired mucociliary clearance (Sethi et al. 2009). There is increased submucosal vascular leakage and inflammatory cell infiltration, thereby developing dysfunction of host defenses and bacterial adherence and growth. Microorganisms might cause antigen release, including endotoxins, lipoproteins, peptidoglycans and other molecules, which increases inflammatory reactions in the respiratory tract and elsewhere. Removable acrylic dentures in the mouth create favorable conditions to promote bacterial and fungal microflora colonization. Denture biofilm is a mix of fungal and bacterial biofilm where complex interactions occur between C. albicans and other oral microorganisms. COPD patients are saddled with high risk of bacterial and fungal infections, particularly Candida spp. A chronic local oral inflammation, while wearing dentures, and systemic inflammation impede the mucociliary clearance of patients.
Molecular studies of sputum isolates during exacerbations of COPD have shown the presence of fresh bacterial strains. Their finding in the sputum sample depends largely on the way the forced expiratory volume in 1 s (FEV1) measurement is performed (Liu et al. 2012). Long-term inhaled glucocorticoid therapy, and the frequent necessity of including systemic glucocorticoids and antibiotics in case of disease exacerbation, influences the immune system. Inhalation chemotherapy and home oxygen therapy alter the environmental conditions in the mouth, causing dryness which obstructs saliva flow and impedes its antiseptic properties. It is important to investigate the prevalence of prosthetic stomatitis with yeast-like fungus infections in these patients, which may cause the development of systemic candidiasis. Interdisciplinary studies of the relationship between oral hygiene, dental restorations and general condition of patients with COPD may enable more control over the course of the disease and reduce the medical expenses.
2
Methods
The study was performed with approval of a local Ethics Committee of Warsaw Medical University in Poland and was performed in accord with Declaration of Helsinki for Human Research. A group of 37 denture wearers who were hospitalized COPD patients in a stable phase of disease participated in this study. The control group included 14 healthy users of prosthetic appliances. The COPD group consisted of 11 women and 26 men (age range: 53–88 years, mean age: 70 8.2 years). The inclusion criteria were the absence of active oral disease and no history of antibiotic therapy within the previous 8 weeks. All COPD patients were clinically diagnosed and the disease was confirmed by lung function examination. Lung function was measured using spirometry (Lung Test 1000; MES, Cracow, Poland). Airway obstruction was defined by post-bronchodilator FEV1/FVC
Influence of Denture Plaque Biofilm on Oral Mucosal Membrane in Patients with Chronic Obstructive Pulmonary Disease D. Przybyłowska, E. Mierzwin´ska-Nastalska, R. Rubinsztajn, R. Chazan, D. Rolski, and E. Swoboda-Kopec´ Abstract
Patients with chronic obstructive pulmonary disease (COPD) have the lower airways colonized with pathogenic bacteria in a stable period of the disease and during exacerbations. The etiology of bacterial exacerbations of COPD depends on the underlying disease, the frequency of exacerbations and antibiotic therapy. Microorganisms can be aspirated off the denture plaque biofilm into the lower respiratory tract and could reduce the patient’s immunity and cause pneumonia. COPD patients, who are using acrylic dentures in oral cavity, are exposed to denture stomatitis and oral candidiasis. The aim of this study was to establish the composition of denture plaque biofilm and its impact on the oral mucosa in COPD patients. The study included patients in a stable phase of COPD using removable denture and the control group included healthy wearer’s appliances. Examinations concerned the oral mucosal membrane and the hygienic condition of prosthetic restorations. Microbiological examinations were performed by taking a direct swab from the surface of acrylic dentures. Seventeen bacterial and fungal strains were isolated from denture plaque of COPD patients, which could be a reservoir of pathogens in the upper and lower airways. The results showed a greater frequency of prosthetic stomatitis complicated by mucosal infections among COPD patients compared to healthy subjects. Keywords
Candida albicans • COPD • Denture stomatitis • Oral hygiene • Respiratory pathogens
D. Przybyłowska (*), E. Mierzwin´ska-Nastalska, and D. Rolski Department of Prosthodontics, Warsaw Medical University, 59 Nowogrodzka St., Warsaw 02-005, Poland e-mail: [email protected] R. Rubinsztajn and R. Chazan Department of Internal Medicine, Pulmonology and Allergology, Medical University of Warsaw, Poland
E. Swoboda-Kopec´ Department of Dental Microbiology, Medical University of Warsaw, Poland 25
26
1
D. Przybyłowska et al.
Introduction
Chronic obstructive pulmonary disease (COPD) is one of major diseases where oral bacteria bear significant degree of responsibility for exacerbations. International studies showed that poor oral hygiene has an influence on pneumonia infections. A substantial part of nosocomial pneumonias start with the aspiration of oral bacteria from the mouth or nasopharynx to the lower respiratory tract (Paju and Scannapieco 2007). Respiratory tract pathogens, such as Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis and others, and also Candida spp. fungi, leading a saprophytic existence in the mucosa, are responsible for over 50 % of exacerbations of COPD (Sethi 2004). Those microorganisms exist in the form of organized structures forming an ecological niche called biofilm. The pathogenicity of a microorganism is reflected in its capacity to form biofilm, which directly affects oral tissues and the lower respiratory tract (Scannapieco 2006). The presence of bacteria in the airways of patients with COPD implies a breach of host defense mechanisms, which sets up a vicious cycle of epithelial cell damage and impaired mucociliary clearance (Sethi et al. 2009). There is increased submucosal vascular leakage and inflammatory cell infiltration, thereby developing dysfunction of host defenses and bacterial adherence and growth. Microorganisms might cause antigen release, including endotoxins, lipoproteins, peptidoglycans and other molecules, which increases inflammatory reactions in the respiratory tract and elsewhere. Removable acrylic dentures in the mouth create favorable conditions to promote bacterial and fungal microflora colonization. Denture biofilm is a mix of fungal and bacterial biofilm where complex interactions occur between C. albicans and other oral microorganisms. COPD patients are saddled with high risk of bacterial and fungal infections, particularly Candida spp. A chronic local oral inflammation, while wearing dentures, and systemic inflammation impede the mucociliary clearance of patients.
Molecular studies of sputum isolates during exacerbations of COPD have shown the presence of fresh bacterial strains. Their finding in the sputum sample depends largely on the way the forced expiratory volume in 1 s (FEV1) measurement is performed (Liu et al. 2012). Long-term inhaled glucocorticoid therapy, and the frequent necessity of including systemic glucocorticoids and antibiotics in case of disease exacerbation, influences the immune system. Inhalation chemotherapy and home oxygen therapy alter the environmental conditions in the mouth, causing dryness which obstructs saliva flow and impedes its antiseptic properties. It is important to investigate the prevalence of prosthetic stomatitis with yeast-like fungus infections in these patients, which may cause the development of systemic candidiasis. Interdisciplinary studies of the relationship between oral hygiene, dental restorations and general condition of patients with COPD may enable more control over the course of the disease and reduce the medical expenses.
2
Methods
The study was performed with approval of a local Ethics Committee of Warsaw Medical University in Poland and was performed in accord with Declaration of Helsinki for Human Research. A group of 37 denture wearers who were hospitalized COPD patients in a stable phase of disease participated in this study. The control group included 14 healthy users of prosthetic appliances. The COPD group consisted of 11 women and 26 men (age range: 53–88 years, mean age: 70 8.2 years). The inclusion criteria were the absence of active oral disease and no history of antibiotic therapy within the previous 8 weeks. All COPD patients were clinically diagnosed and the disease was confirmed by lung function examination. Lung function was measured using spirometry (Lung Test 1000; MES, Cracow, Poland). Airway obstruction was defined by post-bronchodilator FEV1/FVC
