Acute periodontal lesions generally respond to conventional therapy. In AIDS patients, however, further deterioration is the usual consequence. Candida albicans(CA) lesions of the oral mucosa have been observed in 88% of AIDS patients; 59% of male homosexual and IV drug abuser oral candidiasis patients subsequently developed AIDS. Indeed HIV may be hard to find in AIDS patients in whom CA lesions are very prominent.

Rapid reproducible silver stains have been developed in our laboratories to detect Gram-negative bacteria, fungi and protozoa. They demonstrate these microorganisms by the microwave-accelerated metallization of the aldehydes produced in their surface carbohydrates or lipopolysaccharides after periodic acid oxidation (Giammara and Hanker, US Patent No. 4,690,901, 1987; Sigma Diagnostics Kit No. HT-100). We thought that these stains might be useful to demonstrate by microscopy the large numbers of CA which culture studies had suggested were present in subgingival plaque at atypical periodontal disease sites of AIDS patients. Direct staining of plaque smears and their evaluation under the light microscope could be done in much less time than that required for culture. Any equivocal microorganisms could be positively identified as CA by immediate examination of the slide or coverslip by scanning electron microscopy. Although our PATS reaction was more valuable for identifying Gram-negative bacteria especially spirochetes and for studying substructure of CA and their epiphytic interactions with bacteria, the SIGMA DIAGNOSTICS Silver Stain HT-100 was much easier to use for rating CA concentration in disease sites. This test was applied to subgingival plaque smears from 28 periodontal disease sites of 22 HIV-seronegative patients and 45 sites of 12 HIV-seropositive patients. After staining, the smears were examined and scored (Davenport Index). None of the 12 HIVseropositive patients but 15 of the 22 HIV-seronegative patients had a score of zero at all sites. The score ranged from 0 (no CA) to 3 (large numbers of CA in all fields). In the seropositive patients the median score was 2 while in the seronegative group it was 0.

The much higher scores obtained in specimens from periodontal disease sites of the AIDS patients suggest that this simple rapid test might be valuable for screening individuals and indicating those requiring further testing or monitoring for AIDS.

Infrabony defects of 230 periodontal patients have been treated surgically by implantation. These lesions of alveolar bone, up to nineteen per patient, generally displayed pocket depths of at least 8mm and were associated with teeth showing pronounced mobility. Approximately 50% of these teeth could have ordinarily been condemned to extraction. In this study, scaling, root planing, and polishing were performed and patients were instructed in oral hygiene measures prior to surgical implantation. A 1:1 mixture of dense sintered hydroxylapatite(HA) particles (OrthoMatrix HA-500) with plaster of Paris (USG Medical Grade Calcium Sulfate Hemihydrate B, containing 0.85% K2SO4) was moistened with a minimum amount of saline. The mixture was then implanted into the dried defect. After setting, the operative site was closed with silk sutures. The plaster bound the HA particles in the defects and prevented particle straying which frequently occurs when they are implanted with saline alone or with other vehicles. There was an almost immediate and sustained diminution in tooth mobility at most implantation sites. Good retention of particles was seen on physical and radiographic examination of most defects for the length of the study (5 years). Overall, there was a marked reduction in pocket depth and improvement in tissue tone and texture. Less than 1% of the teeth at the implantation sites have been lost. No significant inflammation has been observed. Increased radiopacity and resistance to probing suggest bone formation in some implanted defects. Implantation of periodontal osseous defects with the biocompatible HA/plaster composite appears to result in the clinical cessation of progressive periodontal disease.