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Sammanfattning

Periodontitis is presumably caused by bacterial infection, but it has recently been shown that affected tissue often contains cytomegalovirus (CMV) and Epstein-Barr virus (EBV). The present work was initiated to evaluate the role of these viruses in the pathogenesis of persistent apical periodontitis and «refractory» marginal periodontitis. CMV and EBV were quantified using real time PCR. A possible association with relevant bacteria was examined with DNA-DNA hybridization. Of the apical periodontitis samples, 50 % contained EBV, while none contained CMV. Of the marginal periodontitis samples, 40 % were positive for EBV and 12 % for CMV. EBV was only detected in 1 out of 15 healthy periodontium samples. In most cases the viral load was close to the detection limit, but one patient had 100X more virus than the patient with the second highest titer. This patient was given antiviral treatment (500 mg of valaciklovir in the form of Valtrex® taken orally twice daily for a period of 10 days). The antiviral treatment decreased the presence of EBV to the detection limit, and the periodontal condition improved dramatically. One year after treatment, the condition was still stable. The patient had previously gone through a prolonged period of conventional periodontal therapy without success. The case suggests that virus screening and subsequent antiviral therapy may be useful as an adjunct to conventional periodontal therapy in«refractory» marginal peridontitis.

MeSH