Comparing the Optical Densities of Oral Bacteria Growth in Humans, Felines and Canines Mychal Hendrickson Saint Martins University Senior Seminar Spring 2006 Dr. Margaret Olney and Dr. Mary Jo Hartman 1 Table of Contents Introduction…………………………………………………..pg. 1-7 Specific Goals………………………………………………..pg. 7 Proposed Research………………………………………….. pg. 8-10 Consent Form………………………………………………..pg. 11-13 Flow Chart…………………………………………………...pg. 14 Budget………………………………………………………..pg.15 Literature Cited………………………………………………pg. 16 2 Abstract In this study I hypothesized that humans would have the greatest amount of oral bacteria growth compared with cats and dogs. Oral samples were collected from 30 cats, 30 dogs, and 30 humans. Bacterial samples were obtained from a combination of the right and left upper canine teeth. These samples were placed in sterile nutrient broth and were incubated at 37C. The optical densities were measured after 24-and 48-hours of incubation. After the 24- hour incubation, all three species’ oral bacteria growth was the same. It was found that dogs have the highest amount of oral bacteria growth, after 48hour incubation period, when compared to cats and humans (F=2.03, d.f.=2, p=0.014). Introduction Many people in the United States of America have cats or dogs as pets. Many of these pet owners express their love for their pets in similar ways as they would towards another human, with affection. Some pet owners even let their cat or dog lick them on the face or hand. It is a personal preference whether a pet is allowed to kiss its owner. Some people find it dirty and say that a pet’s mouth is full of bacteria that have the potential to make them ill. Others believe that pets’ mouths are clean enough and that the benefits of affection outweigh any risks. Since both cats and dogs lick themselves to groom, there may be a meaningful amount of bacteria in the oral cavities of these animals. However, research suggests that a human bite is more dangerous to a human than a cat or dog bite (Allaker et al. 1997). Does being affectionate with our pets increase the possibility of illnesses in humans, or are we humans exposing our pets to health risks? Approximately 500 bacterial species are located within the human oral cavity (Bachrach et al., 2003). These bacteria attach to the surface of teeth in a specific order. 3 On the tooth’s surface are glycoproteins that are known as the acquired pellicle, as described by Tannock (1995). Tannock describes the acquired pellicle as having a negative charge, which attracts positively charged ions. The positively charged ions act as a cloud and surround the acquired pellicle. These positively charged ions then attract the negatively charged bacteria. Since the acquired pellicle has a negative charge and the bacteria have a negative charge, they repel each other. The bacteria produce an extracellular structure that can attach to the tooth’s surface (Tannock, 1995). These attachments then become more permanent with the help of proline rich proteins. Tannock (1995) suggests that the proline rich proteins allow for the attachment of primary colonizers, which then produce receptors to which the late colonizers attach. These layers of bacteria are known as plaque. Cats, dogs, and humans all require regular dental hygiene, either home brushing or a professional cleaning to remove plaque from the tooth’s surface. By understanding the relationships between the amount of oral bacteria and species, safe and appropriate methods of affection expression may be determined. This would provide a safe environment for both humans and their pets. Kroes et al. (1999) examined the bacterial diversity in the human oral cavity. By using the definition of a phylotype differing by <1%, it was possible for Kroes et al. to identify 59 different phylotypes. Phylotype is a commonly used term when classifying and identifying bacteria. Despite the word’s popularity, it lacks a specific definition, but for general practice it refers to the bacteria species differing by 1%. Through direct 16S rDNA sequencing, Kroes et al, were able to identify 28 separate phylotypes. Within these 28 phylotypes, five separate divisions were seen that had not previously been identified. 4 These unidentified phylotypes were then assigned numbers for identification purposes and were then compared to known phylotypes in the clone libraries. The phylotype A-35 was 89.0% similar to its closest relative, which was a ruminal bacteria species. Phylotype A-36 was 89.4% similar to another ruminal bacteria species. Phylotypes A-38 and A-39 were 98% identical to each other and 93% identical to their closest relative, Schwartiza succinivorans, which was isolated from the rumen of cows. Phylotype A-44 was identical to a bacterial species that had been isolated from abscesses. The phylotypes A-33, A-34, A-72 and C-73 are all relatives of the Eubacteriumi saburreum. Phylotype A-63 was most similar to Weeksella zoohelcum, which had been found in the canine upper respiratory tract and has been cultured from human dog bite wounds. While the study by Kroes et al. (1999) only dealt with the human oral cavity, it showed the complexity and abundance of the microflora within the mouth. Kroes et al. used the definition of a phylotype differing by >1%, rather then differing by 1%. This difference of the definition resulted in many phylotypes that had previously not been identified. This study also showed the relationship between bacteria and the species of the host. Kroes et al. concluded that different host species have different locations of the same or similar bacteria. This was observed in the phylotype A-63. In humans this phylotype was found in the oral cavity, but in canines it was found in the upper respiratory tract. It is determined that the location of the bacteria depends on the host species and that different host species have the same or similar bacteria present. Allaker et al. (1997) explored the oral microflora of canines in reference to the bacteria found in bite wounds. The canine population used for this study included dogs with no current oral health problems. For part one of the study, a sample size of 30 dogs 5 was used. Part two of the study used a sample size of 34 dogs. It was found that, as the age of the dog increased, so did the level of plaque. As the amount of plaque increased, the amount of bacteria also increased. It was found that 44% of the dogs had Porphyromonas intermedia present and 68% had Porphyromonas gingivalis present. Allaker et al. (1997) concluded that P. gingivalis and P. intermedia are the main causes of periodontal disease in both humans and canines. The percentage of Eikenella corrodens in the canine mouth was 5%, but in the human mouth it was 10-20%. E. corrodens was an important phylotype because of its potential to be a pathogen in dog bite wounds found on humans. The higher percentage of E. corrodens in humans than in dogs showed that a human bite can be more severe than a canine bite (Allaker et al. 1997). This leads to a consensus that the human oral cavity has more bacteria with the potential to cause illness. Harvey et al. (1995) compared the subgingival bacteria found in felines and canines. All of the 49 dogs and 40 cats that were tested had moderate to severe gingivitis. The most abundant bacteria found were Actinomyces species (sp), Viridans Streptococci, Staphylococcus sp., Fusobacterium sp., Porphyomonas gingivalis, and Peptostreptococcus micros. There were a total of 272 feline isolates and 344 canine isolates. Staphylococcus and Streptococcus sp. were the most abundant gram-positive aerobes in both feline and canine samples. Unidentified gram-negative species were reported at a level of 10% in canines and 9% in felines. Pasteurella multocida were found in both, at levels of 2% for canines and 5% for felines. The most common grampositive anaerobe identified was Peptostreptococcus sp., which was seen at a level of 3% 6 in canines and 2% in felines. Of the gram-negative anaerobes, the highest number seen were Porphyromonas or Prevotella sp. at 17% in canines and 15% in felines. Overall, Harvey et al. (1995) concluded that feline and canine oral floras were very similar. Some of the organisms of the human oral flora are different than those found in the feline and canine oral flora. An example of this was the Prophyromonas gingivalis. In felines and canines, P. gingivalis was catalase-positive, but in humans it is catalase-negative. This is due to a difference in the pH level of the oral cavities (Harvey et al, 1995). The pH in the human oral cavity is 6.5-7, while in the feline and canine oral cavities; it is 7.5-8 (Harvey et al, 1995). A study by Elliott et al. (2005) explored the microbiota in the canine oral cavity and compared it to the human oral cavity. This study showed that there was a considerable difference between the bacteria found in the canine and human oral cavities. The study took samples from the dental plaque of nine dogs and from the saliva of five dogs. From these samples, a total of 339 bacterial isolates were found. Of these 339, there were 84 separate phylotypes and 37 individual species that could be identified. They found that only 28% of the phylotypes were indigenous to the oral microbiota of humans. The 37 identified species, not including Staphylococcus, all were found in samples from the plaque, but only 10 identified species were found from samples of the saliva (Elliot et al., 2005). The only bacteria Elliot et al. (2005) were able to find in both the plaque and saliva at >5% were species of Actinomyces. Actinomyces sp. composed 11.6% of the plaque and 25.5% of the saliva. Granulicatella sp. composed 16.5% and Streptococcus sp. composed 18.2% of the bacteria found in the saliva. In the plaque, 7 Porphyromonas sp. made up 20% and Neisseria species made up 10.3% of the total bacteria found. Through comparative 16S rRNA gene sequencing, Elliot et al. (2005) determined that the bacteria found in canine and human oral cavities differed by 7%. These results support those of a previous study (Harvey al., 1995) that found bacteria isolated from cats and dogs differ from the bacteria found in humans. Species that are found in dogs are not likely to be found in humans. Elliot et al. (2005) stated that similar species are present, but there are considerable differences in the primary role of bacteria in each host. An example of this is members of the Streptococcus genus; in human plaque S. sanguis is present, but in canine plaque S. suis is present. It is believed that different species of bacteria have different roles in the human and canine oral cavities. In the human oral cavity, Streptococcus is a primary colonizer, but in the canine oral cavity, Granulicatella sp. play the role of primary colonizers. The Granulicatella and Streptococci sp. are closely related. Another difference between the canine and human oral cavities was the presences of Fusobacterium sp. Fusobacterium sp. were found in human plaque, but were not found in canine plaque. A close relative to the Fusobacterium, Filifacter sp., were detected in canine plaque. The study by Goldstein et al. (1978) examined the bacteria present in human and animal bites. Bite wounds were divided into 3 groups: 1) human bite; actual bite (HB) and CFI (is a laceration over the third and fourth knuckle joints, usually occurring from punching someone in the mouth, with a clenched fist), 2) dog bite (DB), and 3) other bite (OB). A total of 73 people with bite wounds were examined. The total of human bites received were 34; 18 were HB and 16 were CFI. Thirty-nine people had animal bites, 26 8 were DB and 13 were other bites (including 4 cat, 4 squirrel, 3 rodent, and 2 rattlesnake). Six of the people (3 DB, 2 OB, and 1 HB) had neither anaerobic nor aerobic bacteria isolated from their wounds (Goldstein et al., 1978). Thirty-four people (13 DB, 7 CFI, 8 HB, and 6 OB) had only aerobic bacteria isolated from the wounds (Goldstein et al, 1978). Goldstein et al., (1978) reported that S. aureus was the most frequent isolate. S. aureus was found in 62-80% of the bite wounds and was most associated with infection from human bites. Goldstein et al. (1978) suggested that the human oral cavity had more bacteria than a canine oral cavity. This conclusion was based upon the percentage of bites that bacteria were isolated from. From the CFI bite wounds, 56% were infected with bacteria. Fifty percent of the HB bite wounds were infected with bacteria and 38% of the DB wounds were infected with bacteria. The highest percentage of bacteria of bite wounds infected with bacteria was found to be from a type of human bite. Previous studies have focused mainly on the specific types of bacteria in the oral cavities of cats, dogs, and humans, rather than on which species has the highest amount of oral bacteria. Based on the findings of the previously mentioned studies, I hypothesized that humans would have more bacteria growth cultivated from their oral cavities than felines or canines. My research quantified the amount of oral bacteria growth from each of three host species: cats, dogs and humans. Methods Preparation of nutrient broth: The first step was to prepare the nutrient broth tubes. Nutrient broth (Ward’s) was prepared in liter quantities. For each 1-liter of nutrient broth prepared, 8 grams of 9 powered nutrient broth was added to 1-liter of distilled water. The powered nutrient broth was dissolved in the water with a stir bar. Next, 10 ml of nutrient broth solution was added to each of the 90 test tubes. These tubes were loosely capped and autoclaved for 15 minutes at 121C at 15 psi, using a Tuttnauer 2540E autoclave. Immediately after autoclaving, the caps were tightened on the tubes to prevent contamination, and the tubes were stored at 4C until use. Subject Recruitment: There were a total of 90 participants that met the criteria of not having received a professional dental cleaning two days prior to participation in the study (Stanley and Reysenbach, 2002). Participation was on a volunteer basis and required signing a consent form. Two different consent forms were used, one for the humans (Appendix 1) and one for the cats and dogs (Appendix 2). Subjects were recruited from the Saint Martin’s community and the surrounding areas of Pierce and Thurston counties. These participants were divided into 3 groups: humans, canines and felines. Obtaining samples: One oral sample was obtained from 30 humans, 30 canines and 30 felines, for a total of 90 samples. When samples were collected, the investigator wore latex gloves to avoid the unwanted transfer of bacteria between subject and investigator. The samples were obtained through oral swabbing in two different locations of the mouth. The two locations for swabbing were the outside surfaces of both the right and left maxillary canine teeth (Harvey et al., 1995), (Fig. 1). 10 Figure 3. The right and left maxillary canine teeth that samples were obtained from. These two locations provided the most bacteria and easiest access (Jones Animal Hospital, personal communication, 2003). To ensure sample sizes were the same, each sterile, cotton swab was used to obtain a sample using the same method. First, the right maxillary canine tooth was swabbed quickly in 5 complete circles across the surface of the tooth. The cotton swab was rotated and used to immediately wipe the left maxillary canine tooth in 5 complete circles across the width of the tooth and was placed in a sterilized tube of broth. Before obtaining the samples from humans, the subjects rinsed their mouths for 30 seconds with water (Hitch et al., 2004). This was done to reduce the chance of contamination from tooth brushing and food particles. After waiting 2 minutes, to ensure the bacteria had recolonized on the tooth’s surface (Stanley and Reysenbach, 2002), the tooth was swabbed using the procedure described above. The canine and feline samples were obtained from the same locations in the mouth and in the same manner as the human samples. The only exception was that I rinsed the tooths’ surfaces, since a dog and cat cannot do this alone. I used a needle-less syringe and rinsed both teeth with 3 cc of water. In order to have cooperation from the animal when obtaining the sample, specific holds were used to prevent the cat or dog from scratching or biting me. These two holds were not harmful for the animal. They 11 only prevented movements of their heads and mouths. The cat was held by the scruff of the neck, while lying on its side with the back legs held to prevent the cat from scratching (Jones Animal Hospital, personal communication, 2003). The dog was held with one arm around the neck of the dog, holding the head close to the body of the holder (Jones Animal Hospital, personal communication, 2003). I wore long sleeves, pants and latex gloves. Transportation of samples: First, I prepared empty sterilized test tubes. This was done in a similar manner as the broth tube preparation. One hundred loosely capped, empty test tubes were autoclaved at 15 minutes at 121C at 15 psi. Immediately after being removed from the autoclave, the caps were tightened to ensure sterilization until use. These empty sterilized tubes were used to transport the feline and canine samples back to the lab. In order to control the premature growth of bacteria, the swab was placed in the empty sterilized tube and stored on a shelf in a cooler while being transported back to the lab (for no longer than 4 hours before incubation). The shelf in the cooler ensured that the samples would not freeze, but would maintain a temperature of 11C to avoid unwanted bacteria growth. Upon returning to the lab, the swab from each tube was then placed into a sterilized nutrient broth tube and then incubated. Incubation and optical density: Each test tube containing a sample was loosely capped and incubated for 24 and 48 hours at 37 C. Both the 24 and 48 hour time periods were used to show the growth of bacteria over time. This allowed for bacteria growth in a similar environment to where it was cultivated. The Spectronic 20D+ spectrophotometer was set to measure the optical 12 density at the standard wavelength of 686 nm for each of the broth tubes (Allaker et al., 1997). The spectrophotometer was cleaned by using distilled water and a lint free tissue. The machine was zeroed and blanked using sterile nutrient broth without a swab. Each sample was transferred into a disposable cuvette (Sargent Welch) and then placed into the spectrophotometer. The optical densities were measured for each sample. Data analysis compared the data of the three groups using a one-way analysis of variance test (ANOVA). If there was a significant difference at =0.05, a Tukey’s test (Minitab®, 2005), to compare each group to each other. Results The collected oral samples were incubated at 37C and the optical densities were recorded measuring the absorbance after both 24-hour and 48-hour incubations. The samples from the 24-hour time period were low, < 0.015 absorbance (Fig. 1). The samples from the 24-hour time period were analyzed using a one-way ANOVA (Minitab). The ANOVA showed that there was no significant difference between the oral bacteria growth in cats, dogs, and humans after 24 hours of growth (F= 2.03, d.f= 2, p= 0.138), (Fig.1). 0.16 0.14 absorbance 0.12 0.1 0.08 0.06 0.04 0.02 0 cat Dog Species 13 Human Figure 1. The means of oral bacteria growth in 30 cats, 30 dogs, and 30 humans after 24-hour incubation time period, measured the absorbance (shown on the y-axis) with the spectrophotometer. The x-axis represents the host species of oral bacteria. Error bars represent one standard deviation The 48- hour time period, had bacteria growth ranging from 0.3 to 0.5. The samples of the 48- hour time period were analyzed using a one-way ANOVA test (Minitab®, 2005). This ANOVA showed that there was a significant difference between the oral bacteria of cats, dogs, and humans (F=2.03, d.f.=2, p=0.014), (Fig. 2). 0.6 0.5 Absorbance 0.4 0.3 0.2 0.1 0 cat Dog Human Species Figure 2. The means of oral bacteria growth in 30 cats, 30 dogs, and 30 humans after 48-hour incubation time period, measured by the absorbance with the spectrophotometer. Error bars represent one standard deviation. The Y-axis (absorbance) ranges from zero to 0.60. The x-axis represents the host species of oral bacteria. A Tukeys multiple comparisons test compared the groups to each other and showed a difference at a confidence level of 98.06%. This showed that the difference was between the dogs and the humans. The dogs had the highest amount of oral bacteria growth, when compared to humans (Fig. 2). The cats’ oral bacteria growth was not significantly different from the humans or dogs oral bacteria growth. Discussion Results included both the 24-hour and 48-hour optical density measurements of absorbance from swabs of oral cavities of 30 dogs, 30 cats and 30 humans. At the 2414 hour time period, there was no significant difference between the three groups. The 48hour time period showed that the amount growth from samples from the dogs’ oral cavity was statistically greater than the amount found in humans (P= 0.014). This failed to support my hypothesis that humans would have more oral bacteria growth cultivated from their oral cavity than felines or canines. Within the 24-hour incubation period, bacteria growth occurs in all three species and ranges in growth from 0.02 to 0.14. All three species had low bacteria growth after the 24- hour incubation period. The 48-hour incubation period showed that all three species had bacteria growth. The bacteria growth ranged in absorbance from 0.3 (humans) to 0.5 (dogs). Having completed the experiment, I have determined that I would change the method of obtaining the samples. Rather than using only plaque samples, I would use a combination of plaque and saliva to better represent the oral bacteria population. This is because of the small surface area of the cat’s teeth, which provided fewer bacteria than a tooth with a larger surface area. Additional studies could include growing the oral bacteria on agar plates and then counting the colonies of bacteria growth. Another change I would make to the methods is more precise incubation periods. The incubation period was not exactly 24 and 48 hours, but rather 24 4 hours and 484 hours. This is because of the availability of the spectrophotometer and lab room. My data collection began using the digital spectrophotometer and to maintain consistency, all data collections were obtained from this spectrophotometer. Many of my colleagues were also using this spectrophotometer and sharing had to occur, which allowed for nonprecise incubation times. The open hours of the lab room also effected the incubation 15 time periods, some samples would not reach the full 24 or 48-hour incubation time before the lab closed and therefore data collection was done prematurely. I noticed that the incubator was constantly being opened, due to the high number of people using it. From frequent opening, the incubator may not have maintained a temperature of 37C, which may have lowered the amount of bacteria growth, therefore affecting my data. The last change I would make involves the blanking of the spectrophotometer. For the blank, I used sterile nutrient broth. This is a potential source of error, because there was not a sterile swab within the sterile nutrient broth tube used for blanking the spectrophotometer. If there had been, it could have controlled for the possibility of contamination from swab fibers and ensured that the absorbance measured only the absorbance of bacteria (Steve Parish, personal communication, 2007). My study compared the oral bacteria growth in cats, dogs, and humans and is just a step in the direction of gaining knowledge of safe affection expression between humans and their pets. In order to fully understand what appropriate is, many further studies are needed. Acknowledgements I would like to thank Dr. Mary Jo Hartman and Dr. Margaret Olney for their consent support and help throughout this experiment. I would also like to thank Cheryl Guglielmo for her assistance in the lab. I would like to thank Jeremy Boje and my colleagues for assisting me in the lab room during weekend hours. (Appendix 1) Consent to Act as a Human Subject in an Experimental Study Description: The purpose of this research is to compare the quantities of oral bacteria found in humans, dogs, and cats. Two samples from each participant will be taken. The participants will include 50 humans, 50 16 cats, and 50 dogs. The duration of participation is approximately 10 minutes on one day. It will then be determined who has the most bacteria located in the mouth. Risks and Benefits: There is minimal risk to you. As the investigator, I will follow proper microbiological safety procedures to prevent the transfer of bacteria between the subjects and the investigator. This will be done with the use of latex gloves, a lab coat, safety goggles, sterilized swabs and proper hand washing techniques. Alternative Treatments: There are no alternative treatments in this study. New Information: New information gained during the time the research is in progress and which is relevant to participation will be provided. Cost and Payments: There are no costs or payments associated with participation in this study. All costs not related to the research will be charged to me just as though I were not part of this study. Confidentiality: This research is strictly for educational purposes and complete confidentiality will be maintained. After signing the consent form, the samples obtained from you, will be assigned a number and further reference to the samples will be made using this number. The signed consent forms will be stored in a locked file in the Vice President of Academic Affairs Office at Saint Martins University. Right to Refuse or to End Participation: I understand that I can choose to end my participation in this study, at any time without further consequences to myself. Voluntary Consent: I certify that I have read and understand the above statements. My signature below represents my voluntary participation in this study. I will be given a copy of this consent form. If I have any questions about the research, I can contact Mychal Hendrickson. Any questions concerning my rights as a participant, will be answered by the Office of the Vice President for Academic Affairs (360-438-4310). __________ Date _________________________________________________ Subject Signature Witness Investigator’s Certification: I certify that I have explained to the above individual the purpose of the experiment along with having witnessed the above signature. ___________ Date ___________________________________________________ Investigator (Appendix 2) Consent to Act as an Animal Subject in an Experimental Study Description: 17 The purpose of this research is to compare the quantities of oral bacteria found in humans, dogs, and cats. Two samples from each participant will be taken. The participants will include 50 humans, 50 cats, and 50 dogs. The duration of participation is approximately 10 minutes on one day. It will then be determined who has the most bacteria located in the mouth. Risks and Benefits: There is minimal risk to your pet. As the investigator, I will follow proper microbiological safety procedures to prevent the transfer of bacteria between the subjects and the investigator. This will be done with the use of latex gloves, a lab coat, safety goggles, sterilized swabs and proper hand washing techniques. Alternative Treatments: There are no alternative treatments in this study. New Information: New information gained during the time the research is in progress and which is relevant to participation will be provided. Cost and Payments: There are no costs or payments associated with participation in this study. All costs not related to the research will be charged to me just as though I were not part of this study. Confidentiality: This research is strictly for educational purposes and complete confidentiality will be maintained. After signing the consent form, the samples obtained from your pet, will be assigned a number and further reference to the samples will be made using this number. The signed consent forms will be stored in a locked file in the Vice President of Academic Affairs Office at Saint Martins University. *********************************************************************** Right to Refuse or to End Participation: I understand that I can choose to end my pet’s participation in this study, at any time without further consequences to myself or my pet. Voluntary Consent: I certify that I have read and understand the above statements. My signature below represents my voluntary participation in this study. I will be given a copy of this consent form. If I have any questions about the research, I can contact Mychal Hendrickson. Any questions concerning my rights as a participant, will be answered by the Office of the Vice President for Academic Affairs (360-438-4310). __________ Date ________________________________________ Owner’s Signature Pet’s Name _________________________________ Witness Investigator’s Certification: I certify that I have explained to the above individual the purpose of the experiment along with having witnessed the above signature. ___________ Date ___________________________________________________ Investigator Literature Cited Allaker, R., Young, K., Langloris, T., Rosayro, R., Hardie, J. 1997. Dental plaque of the dog with reference to fastidious and anaerobic bacteria associated with bites. Journal of Veterinary Dentistry. 14:127-130. 18 Elliott, R., Wilson, M., Buckley, C., Spratt, D. 2005. Cultivable oral microbiota of domestic dogs. J. Clinical Microbiology. 11: 5470-5476. Goldstein, E., Citron, D., Wield, B., Blachman, U., Sutter, V., Miller, T., Finegold, S. 1978. Bacteriology of human and animal bite wounds. Journal of Clinical Microbiology. 8: 667-672. Harvey, C., Thornsberry. C., Miller, B. 1995. Subgingival bacteria-comparison of culture results in dogs and cats with gingivitis. Journal of Veterinary Dentistry. 12: 147150. Hitch, G., Pratten, J., Taylor, P. 2004. Isolation of bacteriophages from the oral cavity. Letters in Applied Microbiology. 39:215-219. Kroes, I., Lepp, P., Relman, D. 1999. Bacterial diversity within the human subgingival crevice. Proceedings of the National Academy of Sciences of the United States of America. 96:14547-14552. Minitab Release 14.20.2005. Minitab Inc. Stanley, J., Reysenbach, A. 2002. Biodiversity of microbial life. Ajoln Wiley and Sons, Inc., New York, pp.317-318. Tannock, G. 1995. Normal Microflora: an Introduction to Microbes Inhabiting the Human Body. Chapman and Hall, London, pp. 51-54. 19