Title The Current Evidence Is Inconclusive In Identifying Herpes Virus Infection As A Determinant For The Pathogenesis Of Chronic Periodontitis
Clinical Question In patients with periodontal disease, does infection with a virus of the Herpesviridae family play a role in the progressive tissue destruction characteristic of the disease?
Clinical Bottom Line Analysis of samples from periodontal lesions has demonstrated the presence of herpes virus and at higher level in chronic periodontitis than in healthy tissues. However, it has not been convincingly demonstrated that viruses of the Herpesviridae family play a role in the etiology or pathogenesis of periodontal disease. Results from several case-control studies using similar study designs have reported. Yet, these studies have provided contradictory conclusions on this topic. Some results point to statistically significant differences in the frequencies of herpes virus infection in periodontitis patients whereas other studies did not find such a difference.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
19811582Nibali/2009100 Patients with clinical attachment loss and deep probing depths, in various states of periodontal disease, with no systemic disease. 40 healthy controls.Case-control
Key resultsUsing PCR and IgG-serology, presence of virus was detected in subgingival plaque of periodontitis patients at a rate not significantly dissimilar to that of healthy controls. Results were reported for HCMV (p = 0.227 by IgG serology; no comparison reported for PCR) and EBV (p = 0.467 by PCR; p = 0.343 by IgG serology).
19053922Imbronito/200890 Patients in various states of periodontal disease with high probing depth and attachment loss. 30 healthy controls.Case-control
Key resultsHSV-1, HCMV and EBV were identified in subgingival plaque using nested PCR technique. EBV-1 and HSV-1 were detected at significantly higher frequencies (p < 0.005 and p < 0.005 respectively) in chronic periodontitis patients than in control patients. Detection of HCMV did not differ significantly between the test and control groups (p = 0.42).
Evidence Search Herpes and Chronic Periodontitis
Comments on
The Evidence
Nibali, et. al., used a standardized method to gather samples from a large and diverse patient group. The data were compared using Chi-square, Fisher’s exact test and ANOVA. Their findings did not demonstrate a correlation between the presence of herpes virus (HCMV, EBV or VZV) and the several phenotypes of periodontal disease measured in their sample population, including chronic periodontitis and aggressive periodontitis. Their findings thus seem to contradict that literature which supports the notion of Herpes virus as a possible etiologic factor in periodontitis. In comparison, Imbronito, et. al., gathered samples from similar patient groups as Nibali et al., but differing mainly in the age distribution between grou ps. Their data were also analyzed using Chi-square and ANOVA and the results supported the body of evidence suggesting a link between Herpes virus and periodontitis.
Applicability The current evidence is not conclusive as to the link between Herpes virus and chronic periodontitis. The evidence does not yet warrant further investigations on the effects of palliative treatments for herpes infection on the progression of chronic periodontal disease. The clinical implications of herpes infection status relative to the prognosis of periodontal disease is yet undetermined and questionable as it remains to determined whether herpetic infections are primary or secondary to periodontal inflammation.
Specialty (Oral Medicine/Pathology/Radiology) (General Dentistry) (Periodontics) (Dental Hygiene)
Keywords Herpes, virus, periodontitis, periodontal disease, HSV-1, EBV-1, HCMV
ID# 2401
Date of submission 02/28/2013
E-mail meiersk@livemail.uthscsa.edu
Author Steven Meier
Co-author(s) e-mail
Faculty mentor Bjorn Steffensen, DDS
Faculty mentor e-mail steffenseb@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available