Department of OdontologyUme University 2013

Exotoxins of Aggregatibacter

actinomycetemcomitans and periodontal attachment

loss in adolescentsCarola Hglund berg

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Carola Hglund berg

Department of Odontology Ume University, Sweden Ume 2013

Copyright Carola Hglund berg New Series No. 131 ISBN 978-91-7459-787-5 ISSN: 0345-7532 Printed by: Print & Media Ume, Sweden 2013

To my beloved children Jonas and Minna!

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ABSTRACT.................................................................................................. iii ABBREVIATIONS ......................................................................................... v ORIGINAL PAPERS ..................................................................................... vii INTRODUCTION .......................................................................................... 1

Periodontal disease ....................................................................................2 Epidemiology of periodontal diseases ...........................................................5 Aetiology and pathogenesis of periodontal disease ....................................... 10 Aggregatibacter actinomycetemcomitans .................................................... 16 Exotoxins of A. actinomycetemcomitans ..................................................... 21

AIMS ......................................................................................................... 29 METHODS.................................................................................................. 30

Study design ........................................................................................... 30 Study population ..................................................................................... 31 Questionnaire .......................................................................................... 32 Clinical measurements ............................................................................. 32 Outcome measures .................................................................................. 33 Statistics ................................................................................................ 33 Microbial detection methods of A. actinomycetemcomitans ........................... 35 Experimental studies (Papers III and IV) .................................................... 37 Genetic characterization of A. actinomycetmcomitans isolates ....................... 38 Detection of biological and cytotoxic effects ................................................ 40 Haemolytic activity .................................................................................. 43

RESULTS AND DISCUSSION ...................................................................... 45 Main findings ........................................................................................... 45 Methodological considerations ................................................................... 45 Papers I and II ........................................................................................ 48 Paper III ................................................................................................. 53 Paper IV ................................................................................................. 56

CLINICAL IMPLICATIONS ......................................................................... 64 CONCLUSIONS .......................................................................................... 67 ACKNOWLEDGEMENTS .............................................................................. 68 REFERENCES ............................................................................................. 71

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