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Open Access Highly Accessed Research article

The vaginal microflora in relation to gingivitis

Rutger Persson123*, Jane Hitti4, Rita Verhelst5, Mario Vaneechoutte5, Rigmor Persson13, Regula Hirschi1, Marianne Weibel1, Marilynn Rothen6, Marleen Temmerman7, Kathleen Paul4 and David Eschenbach4

Author Affiliations

1 Department of Periodontology, Div of Oral Microbiology, University of Berne, Berne, Switzerland

2 Department of Periodontics, University of Washington, Seattle, WA, USA

3 Department of Oral Medicine, University of Washington, Seattle, WA, USA

4 Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA

5 Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium

6 Regional Clinical Dental Research Center (RCDRC), University of Washington, Seattle, WA, USA

7 Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

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BMC Infectious Diseases 2009, 9:6  doi:10.1186/1471-2334-9-6

Published: 22 January 2009

Abstract

Background

Gingivitis has been linked to adverse pregnancy outcome (APO). Bacterial vaginosis (BV) has been associated with APO. We assessed if bacterial counts in BV is associated with gingivitis suggesting a systemic infectious susceptibilty.

Methods

Vaginal samples were collected from 180 women (mean age 29.4 years, SD ± 6.8, range: 18 to 46), and at least six months after delivery, and assessed by semi-quantitative DNA-DNA checkerboard hybridization assay (74 bacterial species). BV was defined by Gram stain (Nugent criteria). Gingivitis was defined as bleeding on probing at ≥ 20% of tooth sites.

Results

A Nugent score of 0–3 (normal vaginal microflora) was found in 83 women (46.1%), and a score of > 7 (BV) in 49 women (27.2%). Gingivitis was diagnosed in 114 women (63.3%). Women with a diagnosis of BV were more likely to have gingivitis (p = 0.01). Independent of gingival conditions, vaginal bacterial counts were higher (p < 0.001) for 38/74 species in BV+ in comparison to BV- women. Counts of four lactobacilli species were higher in BV- women (p < 0.001). Independent of BV diagnosis, women with gingivitis had higher counts of Prevotella bivia (p < 0.001), and Prevotella disiens (p < 0.001). P. bivia, P. disiens, M. curtisii and M. mulieris (all at the p < 0.01 level) were found at higher levels in the BV+/G+ group than in the BV+/G- group. The sum of bacterial load (74 species) was higher in the BV+/G+ group than in the BV+/G- group (p < 0.05). The highest odds ratio for the presence of bacteria in vaginal samples (> 1.0 × 104 cells) and a diagnosis of gingivitis was 3.9 for P. bivia (95% CI 1.5–5.7, p < 0.001) and 3.6 for P. disiens (95%CI: 1.8–7.5, p < 0.001), and a diagnosis of BV for P. bivia (odds ratio: 5.3, 95%CI: 2.6 to 10.4, p < 0.001) and P. disiens (odds ratio: 4.4, 95% CI: 2.2 to 8.8, p < 0.001).

Conclusion

Higher vaginal bacterial counts can be found in women with BV and gingivitis in comparison to women with BV but not gingivitis. P. bivia and P. disiens may be of specific significance in a relationship between vaginal and gingival infections.