For information about OMTS Laboratory services and fees, microbial sampling and shipping instructions, and obtaining a free test sampling kit, please contact Jacqueline Sautter at telephone: (215) 707-4237 or by fax: (215) 707-4223.
Laboratory Director/Clinical Consultant
Thomas E. Rams, DDS, MHS, PhD
Professor, Department of Periodontology and Oral Implantology (School of Dentistry)
Professor, Department of Microbiology and Immunology (School of Medicine)
Tribute to Dr. Paul H. Keyes (1917-2017)
Dr. Paul H. Keyes, a legendary figure in dental research, passed away Tuesday morning, February 7, 2017 after extended illnesses. He was 99 years, 9 months old.
Paul Keyes was a pioneer in dental research who had a distinguished career at the National Institute of Dental Research, National Institutes of Health, in Bethesda, Maryland during 1954-1981. He helped advance dentistry by pursuing new research paradigms in dental caries and non-surgical anti-infective periodontal therapy that were professionally unpopular and scientifically scorned when first proposed, but eventually found to be groundbreaking.
Among these, Dr. Keyes laid the scientific foundation for the concept that dental caries and periodontitis result from growth of bacterial populations on teeth that differ markedly from those found in dental health. He pioneered use of Syrian hamsters at the University of Rochester in the early 1940s as the first reliable animal model system to study the etiology and prevention of dental caries and periodontal diseases, a research tool that was previously unavailable. In dental caries research, Dr. Keyes and his co-authors were the first to document the etiologic role and infectious transmission of mutans streptococci in the pathogenesis of dental caries (1960), the first to associate Actinomyces viscosus with root caries (1964), and the first to use customized vinyl trays with fluoride gels he developed to prevent dental caries (1964).
Interestingly, a 1967 clinical trial conducted by Harold Englander, Paul Keyes and others published in the Journal of the American Dental Association (75: 638-644, 1967) demonstrated an 80% decrease in caries increment among Cheektowaga, NY schoolchildren following daily self-applications of fluoride gels with custom vinyl trays, which ranks unparalleled to the present day in the dental research literature as the single most effective caries prevention methodology.
In 1977, Paul Keyes and Robert Fitzgerald were presented with the inaugural Caries Research Award by the International Association for Dental Research for their outstanding lifetime accomplishments in dental caries research, which were later described as initiating a “revolution” in dental research (Tanzer JM: Dental caries is a transmissible infectious disease: the Keyes and Fitzgerald revolution. Journal of Dental Research
74: 1536-1542, 1995). (http://journals.sagepub.com/doi/pdf/10.1177/00220345950740090601
In periodontal research, Paul Keyes and his co-authors were the first to demonstrate in a prospective animal study the essential role of dental plaque in the clinical transition from periodontal health to experimental periodontitis (1946), the first to prospectively document infectious transmission and microbial specificity in the etiology of experimental periodontitis (1964), the first to conduct a double-blind clinical trial of systemic tetracycline in human periodontitis therapy (1983), the first to comparatively study the microbiology of peri-implantitis and clinically-healthy dental implants (1984), among the first to document the ultrastructural effects of inorganic salts on periodontal microorganisms (1984), and among the first to conduct clinical research on anti-infective approaches to non-surgical treatment of human periodontitis (1975). The wide use today of sodium bicarbonate (baking soda) in toothpastes and home oral hygiene regimens is largely attributable to Dr. Keyes. He was an early proponent of using clinical diagnostic microbiology as a guide in periodontal treatment planning, and for monitoring the efficacy of periodontal therapy – ideas upon which the Oral Microbiology Testing Service (OMTS) Laboratory at Temple University was founded and continues to pursue.
Paul Keyes was arguably the most well-known and controversial dentist of his time among the dental profession and lay public, particularly during the late 1970s-1990 time period as a result of his advocacy of non-surgical anti-infective periodontal therapy (known as the Keyes technique). Interviews of Dr. Keyes appeared in major newspapers, national magazines, and on CBS television at the time of his retirement from the National Institutes of Health. Highly disputed at that time, today there is widespread use of locally and systemically-administered antimicrobial agents in non-surgical treatment of severe periodontitis, and increased microbiological testing of patients.
Dr. Keyes was associated with Temple University Kornberg School of Dentistry in two ways.
First, he held an unpaid adjunctive faculty appointment and periodically gave lectures at the dental school as a Clinical Professor of Periodontology from 1996 until several years ago.
Second, the Paul H. Keyes Term Professorship in Periodontology was established at Temple University Kornberg School of Dentistry and externally funded by a former patient of Dr. Keyes (the late Claire Friedlander) and her family foundation from July 1, 2003 until June 30, 2013. The Keyes Professorship was at the time one of only five named professorships specific to periodontology among dental schools in the United States.
I had the privilege of working with Paul Keyes during his last years at the National Institutes of Health, co-authoring 22 peer-reviewed journal articles with him, and holding the Paul H. Keyes Term Professorship in Periodontology during its existence at Temple University during 2003-2013.
That a number of Paul Keyes’ pioneering research discoveries remain consequential and part of dental education and clinical practice today is a tribute to his intellectual prowess, personal tenacity, and the scientific virtue of his approaches to unraveling unknown aspects of dental caries and periodontal disease, the two major oral diseases that afflict humanity.
Rest in peace, my friend and mentor Paul Keyes.
Thomas Rams, DDS, MHS, PhD
OMTS Laboratory Director
February 8, 2017
Building 600, Room 365-A
The OMTS Laboratory facilities are inspected and licensed by the Pennsylvania Department of Health for high-complexity bacteriological analysis - Clinical Laboratory Permit No. 021872 - in meeting the same proficiency and quality control standards required of hospital medical microbiology laboratories, and is CLIA-registered at a federal level - CLIA Certificate No. 39D0707385 - with the United States Department of Health and Human Services.
The mission of the OMTS Laboratory at the Temple University Maurice H. Kornberg School of Dentistry is to provide excellence and innovation in diagnostic clinical periodontal and peri-implant microbiology for patients, clinicians, and the dental profession. To meet these objectives, the OMTS Laboratory’s primary goals are to:
provide commercial diagnostic periodontal and peri-implant microbiology analysis services on a fee-for-service basis to private practicing periodontists and general dentists in the United States and elsewhere, and to various dental school clinical programs intramural and extramural to Temple University.
conduct and publish oral microbiology research on human periodontal diseases and infectious peri-implant complications.
contribute to Temple University Kornberg School of Dentistry educational programs and patient care services.
serve as the primary service and academic base within the Kornberg School of Dentistry and Temple University for laboratory expertise on the core discipline of clinical periodontal and peri-implant microbiology.
The OMTS Laboratory quantitatively cultures major putative periodontal and peri-implant bacterial pathogens from submitted clinical dental plaque specimens. Organisms routinely examined for by culture include the following:
Aggregatibacter (Actinobacillus) actinomycetemcomitans
Prevotella intermedia group species
Parvimonas micra (Peptostreptococcus micros)
gram-negative enteric rods/psuedomonads
Staphylococcus aureus and other staphylococci
Candida species (yeasts)
In vitro antibiotic resistance screening is performed on isolated organisms using therapeutic non-susceptible breakpoint levels of amoxicillin (8 μg/ml), metronidazole (16 μg/ml), clindamycin (4 μg/ml), and doxycycline (4 μg/ml). For clinical specimens where elevated proportions of gram-negative enteric rods/pseudomonads are recovered, in vitro antibiotic resistance testing to ciprofloxacin is performed. The OMTS Laboratory is the only nationally-based diagnostic periodontal microbiology testing service in the United States to routinely carry out antibiotic resistance testing on clinical isolates of periodontal and peri-implant bacterial pathogens.
For selected clinical specimens by request, direct phase-contrast microscopic morphotypes are enumerated, and reported as the proportional detection of spirochetes, motile rods, non-motile rods, and cocci in the sample. The resulting bacterial analysis provides the treating clinician with guidance in selection of the most appropriate anti-infective therapeutic regimens for patients, help in evaluating the efficacy of periodontal treatments in resolving pathogenic plaque infections, and aid in assessing risk of progressive or recurrent periodontitis disease-activity.
OMTS Laboratory microbiological analysis of subgingival dental plaque specimens is most indicated when a poor clinical treatment response is seen on periodontitis patients 1-3 months following conventional mechanical non-surgical and/or surgical periodontal therapy. Such microbiological culture testing may identify levels of persistent subgingival periodontal pathogens recalcitrant to local forms of periodontal therapy, and their in vitro antibiotic resistance patterns, to aid clinicians in selection of possible adjunctive systemic antimicrobial drug regimens. Periodontitis patients with a history of recurrent destructive disease activity, and/or presenting with specific microbiological profiles (i.e., A. actinomycetemcomitans and other gingival tissue-colonizing pathogens), and/or scheduled for dental implant placement or regenerative forms of periodontal surgery, along with peri-dental implant lesions of suspected infectious etiology (peri-implantitis), may also benefit from OMTS Laboratory microbiological testing.
The OMTS Laboratory was originally established in 1982 as the world's first clinical periodontal microbiology laboratory by Drs. Benjamin F. Hammond and D. Walter Cohen at the University of Pennsylvania prior to its move to the Medical College of Pennsylvania (now Drexel University College of Medicine) in 1991, and its transfer to Temple University in 1997. Dr. Rams has served as the OMTS Laboratory Director since 1995.
Thomas E. Rams, DDS, MHS, PhD, OMTS Laboratory Director/Clinical Consultant
Jacqueline Sautter, AAS, MLT(ASCP), OMTS Laboratory Technician & Clinical Periodontal Microbiologist
Rams TE, Listgarten MA, Slots J. Radiographic alveolar bone morphology and progressive periodontitis. Journal of Periodontology (accepted for publication, in press)
Rams TE, Loesche WJ. Relationship between Periodontal Screening and Recording index scores and need for periodontal access surgery. Journal of Periodontology 88: 1042-1050, 2017
Rams TE, van Winkelhoff AJ. Introduction to clinical microbiology for the general dentist. Dental Clinics of North America 61: 179-197, 2017
Rams TE, Sautter JD, Getreu A, van Winkelhoff AJ. Phenotypic identification of Porphyromonas gingivalis validated with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Microbial Pathogenesis 94: 112-116, 2016
van Winkelhoff AJ, Rurenga P, Wekema-Mulder GJ, Singadji ZM, Rams TE. Non-oral gram-negative facultative rods in chronic periodontitis microbiota. Microbial Pathogenesis 94: 117-122, 2016
Keyes PH, Rams TE. Dental calculus arrest of dental caries. Journal of Oral Biology 3(1): 4, 2016 (http://www.avensonline.org/wp-content/uploads/JOBY-2377-987X-03-0017.pdf)
Keyes PH, Rams TE. Subgingival microbial and inflammatory cell morphotypes associated with chronic periodontitis progression in treated adults. Journal of the International Academy of Periodontology 17: 49-57, 2015
Rams TE, Hawley CE, Whitaker EJ, Degener JE, van Winkelhoff AJ. Centipeda periodontii in human periodontitis. Odontology 103: 286-291, 2015
Rams TE, Feik D, Mortensen, JE, Degener JE, van Winkelhoff AJ. Antibiotic susceptibility of periodontal Streptococcus constellatus and Streptococcus intermedius clinical isolates. Journal of Periodontology 85: 1792-1798, 2014
Rams TE, Degener JE, van Winkelhoff AJ. Antibiotic resistance in human chronic periodontitis microbiota. Journal of Periodontology 85: 160-169, 2014
Rams TE, Degener JE, van Winkelhoff AJ. Antibiotic resistance in human peri-implantitis microbiota. Clinical Oral Implants Research 25: 82-90, 2014
Page LR, Rams TE. Subgingival root brushing in deep human periodontal pockets. Journal of the International Academy of Periodontology 15: 55-63, 2013
Rams TE, Degener JE, van Winkehoff AJ. Prevalence of ß-lactamase-producing bacteria in human periodontitis. Journal of Periodontal Research 48: 493-499, 2013
Rams TE, Feik D, Mortensen JE, Degener JE, van Winkelhoff AJ. Antibiotic susceptibility of periodontal Enterococcus faecalis. Journal of Periodontology 84: 1026-1033, 2013
Rams TE, Balkin BE, Roberts TW, Molzan AK. Microbiological aspects of human mandibular subperiosteal dental implants. Journal of Oral Implantology 39: 714-722, 2013
Khocht A, Yaskell T, Janal M, Turner BF, Rams TE, Haffajee AD, Socransky SS. Subgingival microbiota in adult Down syndrome periodontitis. Journal of Periodontal Research 47: 500-507, 2012
Rams TE, Dujardin S, Sautter JD, Degener JE, van Winkelhoff AJ. Spiramycin resistance in human periodontitis microbiota. Anaerobe 17: 201-205, 2011
Rams TE, Listgarten MA, Slots J. Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis subgingival presence, species-specific serum immunoglobulin G antibody levels, and periodontitis recurrence. Journal of Periodontal Research 41: 228-234, 2006
van Winkelhoff AJ, Rams TE, Slots J. Systemic antibiotic therapy in periodontics. Periodontology 2000 10: 45-78, 1996
Rams TE, Listgarten MA, Slots J. Utility of 5 major putative periodontal pathogens and selected clinical parameters to predict periodontal breakdown in patients on maintenance care. Journal of Clinical Periodontology 23: 346-354, 1996
Keyes PH, Rams TE. Organized spirochetal behavior in human subgingival plaques - a virulence factor in periodontal infections? International Academy of Periodontology Newsletter 3 (1-4): 1-5, 1993
Keyes PH, Rams TE, Jordan HV. Influence of diet and spiramycin on Actinomyces viscosus-associated experimental periodontitis. International Academy of Periodontology Newsletter 2(1): 5-11, 1992
Rams TE, Feik D, Young V, Hammond BF, Slots J. Enterococci in human periodontitis. Oral Microbiology and Immunology 7: 249-252, 1992
Rams TE, Feik D, Listgarten MA, Slots J. Peptostreptococcus micros in human periodontitis. Oral Microbiology and Immunology 7: 1-6, 1992
Rams TE, Andriolo M, Feik D, Abel SN, McGivern TM, Slots J. Microbiological study of HIV-related periodontitis. Journal of Periodontology 62: 74-81, 1991
Slots J, Rams TE. Antibiotics in periodontal therapy: advantages and disadvantages. Journal of Clinical Periodontology 17: 479-493, 1990
Rams TE, Feik D, Slots J. Staphylococci in human periodontal diseases. Oral Microbiology and Immunology 5: 29-32, 1990
Slots J, Feik D, Rams TE. Prevalence and antimicrobial susceptibility of Enterobacteriaceae, Pseudomonadaceae and Acinetobacter in human periodontitis. Oral Microbiology and Immunology 5: 149-154, 1990
Slots J, Rams TE, Listgarten MA. Yeasts, enteric rods and pseudomonads in the subgingival flora of severe adult periodontitis. Oral Microbiology and Immunology 3: 47-52, 1988
Rams TE, Keyes PH, Wright WE, Howard SA. Long-term effects of microbiologically modulated periodontal therapy on advanced adult periodontitis. Journal of the American Dental Association 111: 429-441, 1985
Rams TE, Roberts TW, Tatum H, Keyes PH. The subgingival microbial flora associated with human dental implants. Journal of Prosthetic Dentistry 51: 529-537, 1984
Keyes PH, Rams TE. A rationale for management of periodontal diseases: rapid identification of microbial "therapeutic targets" with phase-contrast microscopy. Journal of the American Dental Association 106: 803-812, 1983