J Clin Periodontol 2005; 32: 1213–1218 doi: 10.1111/j.1600-051X.2005.00839.

x Copyright r Blackwell Munksgaard 2005

Adriana Jaramillo1,2, Roger Mauricio

Clinical and microbiological Arce1,2, David Herrera3, Marisol
Betancourth1,4, Javier Enrique
Botero1,2 and Adolfo Contreras1,2
characterization of periodontal 1
Periodontal Medicine Group, Universidad
del Valle, Cali, Colombia; 2School of

abscesses Dentistry, Universidad del Valle, Cali,

Colombia; 3Section of Graduate
Periodontology, Faculty of Odontology,
University of Complutense, Madrid, Spain;
4
School of Bacteriology, Universidad del
Jaramillo A, Arce RM, Herrera D, Betancourth M, Botero JE, Contreras A. Clinical Valle, Cali, Colombia
and microbiological characterization of periodontal abscesses. J Clin Periodontol
2005; 32: 1213–1218. doi: 10.1111/j.1600-051X.2005.00839.x. r Blackwell
Munksgaard, 2005.

Abstract
Background/Aim: The knowledge of clinical features, microbial composition and
susceptibility to antimicrobials of periodontal abscesses has recently improved. This
descriptive clinical and microbiological study provides more information on the
characteristics of periodontal abscesses.
Materials and Methods: Clinical parameters and subgingival samples were
examined from 54 subjects presenting 60 periodontal abscesses. Samples were
cultured for anaerobic and facultative bacteria, and data were expressed as frequency
detection and mean proportion of isolation for microorganisms. Selected isolates of
Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Prevotella
intermedia/nigrescens were used to test susceptibility to amoxicillin, azithromycin,
tetracycline and metronidazole. Statistical descriptive analysis was conducted.
Results: Most periodontal abscesses were present in patients with ongoing Chronic
Periodontitis. Bleeding on probing, tumefaction and suppuration were present in almost
all abscesses. Affected teeth were lower anterior teeth, upper anterior teeth and lower
molars. The subgingival microbiota was composed of periodontal pathogens such as
Fusobacterium spp. (75%), P. intermedia/nigrescens (60%), P. gingivalis (51%) and A.
actinomycetemcomitans (30%). Some periodontopathogens showed antimicrobial
resistance to tetracycline, metronidazole and amoxicillin, but not to azithromycin. Key words: aggressive periodontitis;
antimicrobial sensitivity; chronic periodontitis;
Conclusions: Periodontal abscesses showed typical clinical features associated with
microbiota composition; periodontal abscess;
untreated periodontitis, and the organisms identified were important periodontopathic periodontopathic bacteria
bacteria. Rationale use of antibiotic adjunctive therapy in abscess treatment should be
taken into account. Accepted for publication 18 July 2005

A periodontal abscess is defined as a abscess can also be associated to perio- with bleeding on probing (BOP), sup-
localized purulent infection affecting dontal trauma in patients without perio- puration and periodontal pocketing
the tissues surrounding a periodontal dontitis (Kareha et al. 1981). Clinical (Herrera et al. 2000a). The subgingival
pocket that can lead to the destruction reports showed that the presence of microbiota shows a composition that
of supporting structures (Meng 1999). periodontal abscesses was related to resembles that of periodontitis (Herrera
Recently, the scientific information tooth loss in a group of patients with et al. 2000b), indicating its relationship
regarding periodontal abscesses has chronic periodontitis (McLeod et al. with the acute inflammatory process.
improved. Different aetiologies have 1997), suggesting that the control of The treatment for periodontal
been proposed, some of them related to acute infections is relevant for the main- abscesses includes drainage through
the exacerbation of a non-treated perio- tenance of periodontal health. the pocket or an incision, debridement,
dontitis, to periodontal treatment (occlu- Patients with a history of periodontitis irrigation with saline solution, surgery
sion of the gingival margin after and concomitant treatment tend to have or tooth extraction. The administration
mechanical therapy) (Dello Russo 1985) a higher frequency of periodontal of systemic antibiotics can serve as an
and to antibiotic use in untreated perio- abscesses (Herrera et al. 2000c). Clini- adjunct to mechanical therapy, and the
dontitis (Helovuo et al. 1993). Periodontal cally, the tissues appear edematized recommended drugs have been tetracy-
1213
1214 Jaramillo et al.

cline (Hafstrom et al. 1994), penicillin containing VMGA III transport med- examined after 96 h of incubation. The
(Genco 1991), metronidazole (Smith & ium. The samples were analysed using reading at the intersection of the bacter-
Davies 1986), amoxicillin/clavulanate microbial culture techniques for the ial zone of inhibition and the E-strip
and azythromicin (Herrera et al. 2000b). presence of periodontopathic and super- represented the minimal inhibitory con-
The purpose of this study was to infecting bacteria according to previous centration (MIC) of the organism. The
describe the clinical and microbiological reports (Slots 1986). Briefly, most sam- breakpoints used for interpretation were
characteristics of periodontal abscesses. ples were processed within 24 h, with a as follows: amoxicillin, azithromycin
maximum of 48 h at room temperature and tetracycline 44 mg/ml, for metroni-
(251C) and incubated in CO2 and anae- dazole 48 mg/ml (Andres et al. 1998,
Materials and Methods robic culture systems. Brucella blood Luong et al. 2001, NCCLS 2001, de
agar medium was incubated at 351C in Sousa et al. 2003, Jacinto et al. 2003).
Fifty-four patients attending the dental an anaerobic jar for 10 days. The TSBV
clinics of the University of Valle (Cali, medium was incubated in 10% CO2 at
Colombia) from November 2002 to Jan- 371C for 4 days. Presumptive identifica- Statistical analysis
uary 2005 were invited to participate tion was performed according to the
in the study. Subjects who presented one Descriptive analyses were carried out
methods described (Slots & Reynolds (mean, standard deviation, frequency
or more periodontal abscesses were 1982, Slots 1986, Rams et al. 1992) and
included. A periodontal abscess was of detection) for clinical and microbio-
using a commercial identification logical parameters. All data were
defined as an acute localized infection micromethod system (RapID ANA
adjacent to a periodontal pocket. Nega- analysed with statistical software
II, Remel, Norcross, GA, USA) for (GraphPad Prism version 4.00 for Win-
tive pulp testing, consumption of Actinobacillus actinomycetemcomitans,
antibiotics in the past 3 months and dows, GraphPad Software, San Diego,
Porphyromonas gingivalis, Prevotella CA, USA).
non-controlled systemic diseases were intermedia/nigrescens, Tannerella for-
used as exclusion criteria. An informed sythia, Campylobacter spp., Euba-
written consent was obtained in each cterium spp., Fusobacterium spp.,
case, previously approved by the Ethics Peptostreptococcus micros, Eikenella Results
Committee on Human Research, at the corrodens, and Dialister pneumosintes.
University of Valle, Faculty of Health. A group of 54 subjects (mean age 48.3
Total viable counts (TVC) were defined years old) were included for analysis
as the total number of colony-forming (Table 1). In most cases, patients suf-
Clinical examination units obtained on non-selective media fered from chronic periodontitis (87%)
plates. Species found on selective media and, to a lesser degree, aggressive perio-
A periodontal chart was completed for were enumerated and their percentage of dontitis (9.3%).
each patient recording the following TVC was calculated. Special attention Table 2 depicts the clinical charac-
parameters: BOP, pain, redness, tume- was paid to the growth of Gram-nega- teristics of periodontal abscesses. Perio-
faction and suppuration as positive or tive enteric rods and yeasts on TSBV dontal abscesses were localized purulent
negative. Probing depth (PD) was and Brucella agar. Gram-negative accumulations accompanied by redness,
recorded using a marked periodontal enteric rods were sub-cultured and col- inflammation and periodontal destruc-
probe (UNC-15, Hu-Friedy, Chicago, ony purified on MacConkey and Cetri- tion (Fig. 1a, b). BOP was detected in all
IL, USA). Increased tooth mobility mide agar plates (Scharlau, Barcelona, lesions, while redness, tumefaction and
was assessed using an ordinal score: 1 Spain) and identified using a standar- suppuration were present in 93.3%, 95%
s
– horizontal displacement of 1 mm, 2 – dized biochemical test (API 20E , bio- and 93.3% of the cases, respectively.
horizontal displacement 41 mm and 3 – Merieux Inc., Marcy l’Etoile, France). An increased probing pocket depth
horizontal and vertical displacement (9.3  2.5 mm) was the most frequent
41 mm. Bone loss was evaluated in characteristic, followed by radiographic
Antimicrobial susceptibility
dental radiographs and classified as: bone loss and increased tooth mobility.
slight – one-third of the root length, Selected colonies of P. gingivalis, This is of importance considering that
moderate – two-thirds of root length A. actinomycetemcomitans and P. inter-
and severe – 4 two-thirds of root media/nigrescens from pure cultures
length. Other information regarding were used to test their susceptibility to
periodontal and dental history was col- Table 1. Demographic description and perio-
amoxicillin, azithromycin, stetracycline dontal diagnosis of the study sample
lected for analysis. and metronidazole (E-test , AB Bio-
disk, Solna, Sweden). Briefly, viable Frequency,
colonies were homogenized in 0.85% n(%)
Microbiological analysis
saline, and the turbidity was adjusted to Subjects 54
Subgingival microbial samples were MacFarland 1.0 standard (3  108 CFU/ Gender F 5 29
taken from the periodontal pocket asso- ml). Using a sterile glass rod, 0.1 ml of Age, mean  SD 48.3  15.5
ciated to the abscess. Before sampling, the inoculums was spread over Brucella Periodontal diagnosis, n (%)
supragingival plaque was removed from blood agar plates (BD, Sparks, MD, Chronic periodontitis 47 (87)
the tooth with a sterile gauze and iso- USA) and dried for 15 min. at room Aggressive periodontitis 5 (9.3)
lated with cotton rolls. Three sterile temperature. E-test strips were gently Periodontal health 2 (3.7)
Diabetes, n (%) 2 (3.5)
paper points were inserted into the bot- placed onto the agar surface and incu-
Current smoker, n (%) 6 (11.1)
tom of the periodontal pocket for 15 s, bated under anaerobic conditions for 4
and were pooled in screw cap vials days. The elliptic zone of inhibition was SD, standard deviation.
 Characterization of periodontal abscesses 1215

Table 2. Clinical description of periodontal abscesses general, the subgingival microbiota in

n periodontal abscesses was mainly com-
Clinical parameter Frequency (n 5 60), n(%)
posed of microorganisms related to
BOP 60 (100) periodontal disease. Superinfecting bac-
PD (mm  SD) 9.3  2.5 teria (Gram-negative enteric rods) were
Redness 56 (93.3) the sixth most prevalent group of organ-
Tumefaction 57 (95) isms (13 cases, 21.7%) and the isolated
Suppuration 56 (93.3) organisms were Enterobacter aerogenes
Mobility
(3.3%), Pseudomonas spp. (3.3%),
1 30 (50)
2 17 (28.3) Klebsiella pneumoniae (1.7%), Acineto-
3 13 (21.6) bacter lwofii (1.7%), A. baumanii
Radiographic bone loss (1.7%), E. agglomerans (1.7%), and
Slight 4 (6.6) unidentified non-fermenter Gram-nega-
Moderate 19 (31.6) tive rods (8.3%).
Severe 37 (61.6) Susceptibility to antimicrobials of
Radiographic absence of periodontal ligament space 54 (90) selected isolates of periodontopathic
Pain 41 (68.3)
bacteria is depicted in Table 4. We found
Dental extrusion 14 (23.3)
History of periodontitis 52 (86.6) intermediate resistance for tetracycline
History of past periodontal treatment 7 (11.6) in two of 14 isolates of P. intermedia/
Periodontitis-related abscess 49 (81.6) nigrescens. Three of four isolates of
Periodontal treatment-related abscess 4 (6.6) A. actinomycetemcomitans and one of
Trauma-related abscess 3 (5) 11 of P. gingivalis were resistant to
n
As described in ‘‘Materials and Methods’’.
metronidazole. One isolate of A. actino-
BOP, bleeding on probing; PD, probing depth. mycetemcomitans and two of P. inter-
media/nigrescens were resistant to
amoxicillin. None of the bacteria tested
13.4% presented resistance to azithromycin.
1.6%

Upper molar
Upper bicuspid
41.6% Upper anterior
Discussion
20%
Lower molar In this study, most periodontal abscesses
Lower bicuspid
were found to be related with a previous
18.4% Lower anterior
5% history of periodontal disease, sug-
gesting that it could be considered
Lower anterior teeth were most affected by abscesses as a complication of periodontitis, as
followed by upper anterior and lower molar teeth.
reported by others (McLeod et al. 1997,
Fig. 2. Frequency distribution (%) of Herrera et al. 2000a). In a small propor-
abscesses according to teeth. tion of cases (6.6%), abscesses were
found to be a complication of perio-
dontal therapy. Most likely, the presence
reported discomfort related to pain and occlusion of periodontal pockets
(68.3%) and dental extrusion (23.3%). because of periodontal instrumentation
The frequency distribution of could explain the development of these
abscesses is displayed in Fig. 2. Lower lesions.
anterior teeth were most affected Interestingly, the most common
(41.6%), followed by upper anterior group of teeth affected by periodontal
teeth (20%) and lower molars (18.4%). abscess in this study population was
Fig. 1. (a) Clinical appearance of perio- The composition of the subgingival lower incisors. In contrast, Herrera
dontal abscess affecting the lower second microbiota in periodontal abscesses is et al. (2000a) found the molar group to
right molar. The site shows localized puru- presented in Fig. 3 and Table 3. While be the most affected.
lent accumulation, redness, bleeding on Fusobacterium spp. had a frequency The microbiota of periodontal abscesses
probing and suppuration. (b) Radiographic detection of 75%, P. gingivalis and has been characterized by the presence
aspect of periodontal abscess affecting the T. forsythia were detected in 51.7% of periodontal pathogens present in
first upper right molar. Notice severe perio-
dontal destruction and the involvement of and 15% of the cases, respectively. chronic and aggressive periodontitis. In
the furcation area. The presence of other black-pigmented this study, Fusobacterium spp., P. inter-
microorganisms (P. intermedia/nigres- media/nigrescens and P. gingivalis were
cens, 60%) was also frequent. This is found to be the most prevalent micro-
81.6% of the analysed abscesses had a supported by the fact that the percentage organisms associated with periodontal
history of past periodontitis or ongoing of this microorganism in the cultivable abscesses. This is in agreement with
periodontal destruction. Abscesses result- microbiota (8.46%) was the highest. The previous reports (Newman & Sims
ing from periodontal treatment were recovery of A. actinomycetemcomitans 1979, van Winkelhoff et al. 1985,
found in 6.6% of the cases. Patients (30%) was lower than P. gingivalis. In Topoll et al. 1990). Other microorgan-
1216 Jaramillo et al.

100 lower prevalence of this organism

90 (25%), and Herrera et al. (2000a) did
80 75 not find any presence of A. actinomyce-
temcomitans in periodontal abscesses.
Frequency (%)

70
60 We also found a lower prevalence of
60 51.7
50 Micromonas micros (3.3%) than that
40 reported by Herrera et al. (2000a) of
30 70.6%. Differences of prevalence also
30 21.7 23.3
15 occurred with Campylobacter rectus,
20 12.3
6.7 8.3 which was found in 11.7% of cases, in
10 3.3
contrast to Herrera et al. (2000a) (4.2%)
0
and Häfstrom et al. (1994) (80%). Dif-
s

ds

ns

ns

is

p
ro

te

en
ferences in the composition of subgin-
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sp

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al
th

ro

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ita
in
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iv
er

sy

sc
m

m
.m

os

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ng
gival microbiota between people of
ct

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iu
fo

co
m
M

ba

te

gi
co
er

ig

r
T.

te
eu

em
En

P.

/n
diverse geographical locations could
ct

lo

E.

ac
n

ba

py

ia
et
.p

ob
ed
partly explain these findings.
am

yc
Eu
D

s
m
om

Fu
C

r
The presence of enteric and non-

te
tin

in
ac

P.
fermenter Gram-Negative rods in perio-
A.

dontal abscesses has not been previously

Microorganisms
reported. Considering that this group of
Fig. 3. Frequency isolation (%) of periodontopathic microorganisms in periodontal microorganisms has previously been
abscesses. proposed as possible superinfecting
agents in periodontal diseases (Slots et
al. 1988, 1990b, Rams et al. 1990,
Table 3. Percentage of cultivable microbiota in periodontal abscesses Dahlen & Wikstrom 1995, Sedgley
et al. 1996, 1997, Barbosa et al. 2001)
Microorganismn Periodontal abscesses
(n 5 60), %  SD and the fact that they have important
virulence factors that facilitate tissue
Prevotella intermedia/nigrescens 8.46  16.50 invasion (Slots et al. 1990a, Sedgley &
Fusobacterium spp. 3.65  4.40 Samaranayake 1994), we suggest that
Porphyromonas gingivalis 3.34  5.37 they could have a potential role in the
Gram-negative enteric rods 2.46  9.05 rapid tissue destruction observed in
Eikenella corrodens 0.96  3.08
periodontal abscesses.
Tannerella forsythia 0.61  1.83
Campylobacter spp. 0.33  1.06 D. pneumosintes, another recently
Eubacterium spp. 0.16  0.71 suspected periodontopathogen (Contreras
Dialister pneumosintes 0.09  0.34 et al. 2000, Ghayoumi et al. 2002), was
Actinobacillus actinomycetemcomitans 0.09  0.26 found in low proportions and represents
Micromonas micros 0.08  0.42 a new finding in periodontal abscesses.
n
The percentage of the cultivable microbiota was calculated on the basis of the total colony count
Regarding the relative proportions of
(TCC) obtained on non-selective Brucella blood agar plates. cultivable microbiota of each microor-
ganism, the highest proportion was
found for P. intermedia/nigrescens
Table 4. Antimicrobial susceptibility of selected periodontopathic isolates from periodontal (8.46%), in contrast with Herrera et al.
abscesses (2000a), who found higher relative pro-
Antimicrobialn Actinobacillus Porphyromonas Prevotella intermedia/ portions for P. gingivalis (13.6%).
actinomy- gingivalis nigrescens (n 5 14) In vitro susceptibility of bacteria
cetemcomitans (n 5 11) associated with the aetiology of odonto-
(n 5 4) genic infections has been previously
evaluated. Luong et al. (2001) reported
susceptible resistant susceptible resistant susceptible intermediate resistant resistance of P. intermedia and
Tetracycline 4 0 11 0 12 2 0 P. nigrescens to amoxicillin and tetra-
Metronidazole 1 3 10 1 14 0 0 cycline, and to metronidazole (Jacinto
Azithromycin 4 0 11 0 14 0 0 et al. 2003). We found a variable pro-
Amoxicillin 3 1 11 0 11 1 2 portion of isolates of P. intermedia/
n s nigrescens, A. actinomycetemcomitans
Antimicrobial susceptibility was assesed using the E-test . See ‘‘Materials and Methods’’.
and P. gingivalis resistant to amoxicil-
lin, metronidazole and tetracycline, but
isms have been isolated from perio- lower frequency, to differences in the these isolates were not resistant to azi-
dontal abscesses. In a previous report populations or to the longer time of thromycin (Table 4). This could be
(Herrera et al. 2000b), a higher preva- incubation used in that report (14 days). explained by the fact that azithromycin
lence of T. forsythia was found (66.7%) A. actinomycetemcomitans was found is not frequently used in the treatment of
than that in the present study (15%). in 30% of the cases in this study. In dental and medical infections. However,
This difference could be attributed to its contrast, Häfstrom et al. (1994) found a results regarding antimicrobial suscept-
 Characterization of periodontal abscesses 1217

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countries. Previous studies comparing Andres, M. T., Chung, W. O., Roberts, M. C. & analysis of infected root canals from sympto-
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and Dutch patients) with different levels
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higher level of resistance for the popula- and Chemotherapy 42, 3022–3023. Kareha, M. J., Rosenberg, E. S. & DeHaven, H.
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consumption (Spanish sample), both in a Cai, S. (2001) Subgingival occurrence and management of a periodontal abscess with
full-sample evaluation (van Winkelhoff antimicrobial susceptibility of enteric rods an intrabony defect. Journal of Clinical
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teria (Herrera et al. 2000d). Moreover, a Immunology 16, 306–310. ibilities of Eikenella corrodens, Prevotella
Contreras, A., Doan, N., Chen, C., Rusitanonta, intermedia, and Prevotella nigrescens clini-
recently published study comparing
T., Flynn, M. J. & Slots, J. (2000) Importance cal isolates to amoxicillin and tetracycline.
antimicrobial profiles of periodontal Antimicrobial Agents and Chemotherapy 45,
of Dialister pneumosintes in human perio-
pathogens by E-test, from periodontitis dontitis. Oral Microbiology and Immunology 3253–3255.
patients between these two European 15, 269–272. McLeod, D. E., Lainson, P. A. & Spivey, J. D.
populations, found higher levels of Dahlen, G. & Wikstrom, M. (1995) Occurrence (1997) Tooth loss due to periodontal abscess:
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cing the appearance of resistant strains canals associated with periapical abscesses. periodontal abscess. Journal of Perio-
associated with periodontal diseases in Oral Surgery Oral Medicine Oral Pathology dontology 50, 350–354.
our population. Our results also support Oral Radiology and Endodontics 96, 332–339. Rams, T. E., Babalola, O. O. & Slots, J. (1990)
the notion that the use of antibiotics Genco, R. J. (1991) Using antimicrobial agents Subgingival occurrence of enteric rods,
to manage periodontal diseases. Journal of yeasts and staphylococci after systemic dox-
must be based on susceptibility testing,
American Dental Association 122, 30–38. ycycline therapy. Oral Microbiology and
instead of a unique protocol of adjunc- Ghayoumi, N., Chen, C. & Slots, J. (2002) Immunology 5, 166–168.
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Conclusions Hafstrom, C. A., Wikstrom, M. B., Renvert, S. nology 7, 249–252.
The periodontal abscess depicts typical N. & Dahlen, G. G. (1994) Effect of treat- Sedgley, C. M., Chu, C. S., Lo, E. C. &
features, and in this study was asso- ment on some periodontopathogens and their Samaranayake, L. P. (1996) The oral preva-
ciated with untreated chronic perio- antibody levels in periodontal abscesses. lence of aerobic and facultatively anaerobic
Journal of Periodontology 65, 1022–1028. gram-negative rods and yeasts in semi-
dontitis. The more prevalent organisms recluse human vegetarians. Archives of Oral
Helovuo, H., Hakkarainen, K. & Paunio, K.
cultured from periodontal abscesses (1993) Changes in the prevalence of subgin- Biology 41, 307–309.
were Fusobacterium spp., P. inter- gival enteric rods, staphylococci and yeasts Sedgley, C. M. & Samaranayake, L. P. (1994)
media/nigrescens, P. gingivalis and A. after treatment with penicillin and erythro- The oral prevalence of aerobic and faculta-
actinomycetemcomitans. However, the mycin. Oral Microbiology and Immunology tively anaerobic gram-negative rods and
presence of Gram-negative enteric rods 8, 75–79. yeasts in Hong Kong Chinese. Archives of
may be of clinical importance. Herrera, D., Roldan, S., Gonzalez, I. & Sanz, M. Oral Biology 39, 459–466.
(2000a) The periodontal abscess (I). Clinical Sedgley, C. M., Samaranayake, L. P., Chan, J. C.
and microbiological findings. Journal of & Wei, S. H. (1997) A 4-year longitudinal study
Acknowledgements Clinical Periodontology 27, 387–394. of the oral prevalence of enteric gram-negative
Herrera, D., Roldan, S., O’Connor, A. & Sanz, rods and yeasts in Chinese children. Oral
The authors are grateful to the Univer- M. (2000b) The periodontal abscess (II). Microbiology and Immunology 12, 183–188.
sity Complutense, Spain, especially Short-term clinical and microbiological effi- Slots, J. (1986) Rapid identification of impor-
Mariano Sanz, Itziar Gonzalez and cacy of 2 systemic antibiotic regimes. Jour- tant periodontal microorganisms by cultiva-
Ana O’Connor for the calibration of nal of Clinical Periodontology 27, 395–404. tion. Oral Microbiology and Immunology 1,
microbiological resistance techniques. Herrera, D., Roldan, S. & Sanz, M. (2000c) The 48–57.
The authors are also grateful to Senobia periodontal abscess: a review. Journal of Slots, J., Feik, D. & Rams, T. E. (1990a) Age
Buritica for her laboratory assistance, Clinical Periodontology 27, 377–386. and sex relationships of superinfecting micro-
Herrera, D., van Winkelhoff, A. J., Dellemijn- organisms in periodontitis patients. Oral
and Nathaly Vásquez for her collabora-
Kippuw, N., Winkel, E. G. & Sanz, M. Microbiology and Immunology 5, 305–308.
tion. This study was supported by the (2000d) B-lactamase producing bacteria in Slots, J., Feik, D. & Rams, T. E. (1990b) In vitro
Grant No. 1106-04-11996 from the the subgingival microflora of adult patients antimicrobial sensitivity of enteric rods and
Colombian Institute for Science and with periodontitis. A comparison between pseudomonads from advanced adult perio-
Technology Development – COLCIEN- Spain and The Netherlands. Journal of Clin- dontitis. Oral Microbiology and Immunology
CIAS and the University of Valle. ical Periodontology 27, 520–525. 5, 298–301.
1218 Jaramillo et al.

Slots, J., Rams, T. E. & Listgarten, M. A. (1988) systemic antibiotic therapy. Journal of Clin- van Winkelhoff, A. J., Herrera, D., Oteo, A. &
Yeasts, enteric rods and pseudomonads in the ical Periodontology 17, 268–272. Sanz, M. (2005) Antimicrobial profiles of perio-
subgingival flora of severe adult perio- van Winkelhoff, A. J., Carlee, A. W. & de, G. J. dontal pathogens isolates from periodontitis
dontitis. Oral Microbiology and Immunology (1985) Bacteroides endodontalis and other patients in the Netherlands and Spain. Journal
3, 47–52. black-pigmented Bacteroides species in of Clinical Periodontology 32, 893–898.
Slots, J. & Reynolds, H. S. (1982) Long-wave odontogenic abscesses. Infection and Immu-
nity 49, 494–497.
UV light fluorescence for identification of
van Winkelhoff, A. J., Gonzales, D. H., Winkel, Address:
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Clinical Relevance of a localized infection with an infection and to reduce inflammation

Information regarding periodontal inflammatory response. The micro- by means of mechanical debride-
abscesses is still limited. Our data biology was composed of periodon- ment. The use of antibiotics should
support a periodontal disease aetiol- topathic bacteria and other be rationalized to avoid microbial
ogy that could lead to further attach- superinfecting organisms. Taking resistance.
ment loss and tooth loss. The clinical these findings in perspective, treat-
manifestation of abscesses was that ment should be intended to control