This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. While most periodontal patients can be treated successfully by some combination of patient education, scaling, surgery, and antibiotic therapy, some patients contunue to break down which is extremely frustrating and disturbing for both patients and dentists. We define this group as having refractory periodontal disease. We believe that understanding refractory periodontitis is the most significant problem currently facing periodontal research because of the impact that eliminating treatment failure would have on the delivery and cost of periodontal care. The biologic basis for refractory periodontal diseases is poorly understood, but we hypothesize that it is due to infection with specific bacterial species (possibly newly recognized or 'unticultivable') or bacterial complexes in a host that may be subtly immuno-compromised. Furthermore, the presence of herpes viruses may contribute to the pathogenesis of the disease. The long-term goals for the level, to diagnose, and to develop effective therapies for prevention and treatment of refractory periodontal disease. Currently about 10 to 15% of periodontitis patients fail to respond well to conventional therapy and are deemed refractory. The goals of this proposal are to examine the hypothesis that refractory disease is distinct from non-refractory periodontal disease population based upon analyses of microbial and host factors.
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