Effect of Chronic Periodontitis on Serum and Gingival Crevicular Fluid Oxidant and Antioxidant Status in Patients With Familial Mediterranean Fever Before and After Periodontal Treatment

Background: The aim of this study is to investigate the impact of periodontal status on oxidant/antioxidant status in patients with chronic periodontitis (CP) who experienced familial Mediterranean fever (FMF) and their response to non‐surgical periodontal therapy. Methods: Data were obtained from 13 patients with FMF with generalized CP (FMF‐CP), 15 systemically healthy patients with generalized CP, 15 systemically and periodontal healthy controls (HCs), and 14 periodontally healthy patients with FMF (FMF‐HC). Each participant's total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) in their gingival crevicular fluid (GCF) and serum were recorded. Probing depth, clinical attachment level, and gingival and plaque indices in each participant were also measured. The GCF and clinical parameters at baseline and 6 weeks after periodontal treatment were recorded. Results: The study showed statistically significant improvement of clinical parameters in both FMF‐CP and CP groups after periodontal treatment. The baseline GCF‐TOS and OSI levels were significantly higher in the CP group compared with the FMF‐CP group (P <0.05). After periodontal treatment, the GCF‐TOS levels were significantly reduced in members of the FMF‐CP group (P <0.05). The GCF‐TAS levels in members of the FMF‐CP group were significantly higher than those of members of the HC group at baseline (P <0.05). Serum‐TAS levels in the FMF‐CP group were significantly higher than those in the CP and HC groups at baseline (P <0.05). The GCF‐TOS level in the FMF‐CP group was significantly higher than that in the FMF‐HC group at baseline and 6 weeks. However, there were no significant differences in the serum‐TOS and serum‐OSI levels of those in the FMF‐CP and CP groups at baseline and 6 weeks (P >0.05). Conclusion: The results of the present study show that patients with FMF‐CP displayed reduced oxidative stress and increased antioxidant status compared with those in the CP and HC groups.     

Effect of scaling and root planing on interleukin-1β, interleukin-8 and MMP-8 levels in gingival crevicular fluid from chronic periodontitis patients

Konopka ?, Pietrzak A, Brzezińska‐B?aszczyk E. Effect of scaling and root planing on interleukin‐1β, interleukin‐8 and MMP‐8 levels in gingival crevicular fluid from chronic periodontitis patients. J Periodont Res 2012; 47: 681–688. © 2012 John Wiley & Sons A/S Background and Objective: There are few data concerning the effect of scaling and root planing on the levels of immune and inflammatory mediators in gingival crevicular fluid from patients with chronic periodontitis. Therefore, in this study the influence of scaling and root planing was determined on amounts of interleukin (IL)‐1β, IL‐8 and MMP‐8 in gingival crevicular fluid from patients with chronic periodontitis, in relation to clinical parameters. Material and Methods: A total of 51 patients were enrolled in this study. The study population consisted of 30 patients with generalized advanced chronic periodontitis, while 21 periodontally healthy subjects were recruited for the control group. The clinical parameters included approximal plaque index, gingival index, pocket depth and clinical attachment loss. The amounts of IL‐1β, IL‐8 and MMP‐8 in gingival crevicular fluid were measured by ELISA. Periodontal parameters as well as gingival crevicular fluid humoral factor amounts were evaluated in the control group and in chronic periodontitis patients at baseline and at 1 and 4 wk after scaling and root planing treatment. Results: At baseline, there were significant differences between control subjects and chronic periodontitis patients in terms of clinical attachment loss, pocket depth, gingival index (p < 0.001) and approximal plaque index (p < 0.01). The amounts of IL‐1β, MMP‐8 (p < 0.001) and IL‐8 (p < 0.01) in gingival crevicular fluid were significantly lower in healthy subjects than in chronic periodontitis patients. Scaling and root planing led to improvement in all examined clinical parameters, apart from clinical attachment loss. Periodontal treatment also resulted in a significant decrease in the amounts of IL‐1β, IL‐8 and MMP‐8 in comparison to baseline, especially 4 wk after scaling and root planing (p < 0.001); however, the amounts of these humoral factors were still higher than those in control group. Conclusion: Our observations indicated that short‐term nonsurgical therapy resulted in a significant improvement in periodontal indices and in a marked decrease of IL‐1β, IL‐8 and MMP‐8 gingival crevicular fluid levels. Nevertheless, no significant correlations were found between clinical parameters and amounts of humoral factors after therapy.     

Effect of nonsurgical periodontal therapy on serum and gingival crevicular fluid cytokine levels during pregnancy and postpartum

Background and Objective: A low‐grade systemic inflammatory status originating from periodontal infection has been proposed to explain the association between periodontal disease and systemic conditions, including adverse obstetric outcomes. The aim of this study was to evaluate the effect of periodontal therapy during pregnancy on the gingival crevicular fluid and serum levels of six cytokines associated with periodontal disease and preterm birth. Material and Methods: A subsample of 60 women (18–35 years of age) up to 20 gestational weeks, previously enrolled in a larger randomized clinical trial, was recruited for the present study. Participants were randomly allocated to receive either comprehensive nonsurgical periodontal therapy before 24 gestational weeks (n = 30, test group) or only one appointment for supragingival calculus removal (n = 30, control group). Clinical data, and samples of blood and gingival crevicular fluid, were collected at baseline, at 26–28 gestational weeks and 30 d after delivery. The levels of interleukin (IL)‐1β, IL‐6, IL‐8, IL‐10, IL‐12p70 and tumor necrosis factor‐α were analyzed by flow cytometry. Results: After treatment, a major reduction in periodontal inflammation was observed in the test group, with bleeding on probing decreasing from 49.62% of sites to 11.66% of sites (p < 0.001). Periodontal therapy significantly reduced the levels of IL‐1β and IL‐8 in gingival crevicular fluid (p < 0.001). However, no significant effect of therapy was observed on serum cytokine levels. After delivery, the levels of IL‐1β in the gingival crevicular fluid of the test group were significantly lower than were those in the control group (p < 0.001), but there were no significant differences between test and control groups regarding serum cytokine levels. Conclusion: Although periodontal therapy during pregnancy successfully reduced periodontal inflammation and gingival crevicular fluid cytokine levels, it did not have a significant impact on serum biomarkers.     

Interleukin‐1 β, interleukin‐12 and interleukin‐18 levels in gingival fluid and serum of patients with gingivitis and periodontitis

Introduction: Cytokines are of major importance in periodontal disease progression. Interleukin‐12 (IL‐12) stimulates interferon‐γ production by T helper type 1 (Th1) cells while IL‐18 induces Th1 responses when present with IL‐12 but Th2 responses in the absence of IL‐12. IL‐1β has been correlated with periodontal disease destruction. This study determined the local concentrations of these cytokines in sites of gingivitis and periodontitis. Methods: Gingival crevicular fluid was collected from two sites in each of 10 gingivitis patients and from two gingivitis sites and two periodontitis sites from each of 10 periodontitis patients. Serum samples were also collected. IL‐1β, biologically active IL‐12 p70, the IL‐12 p40 subunit and IL‐18 concentrations were determined by enzyme‐linked immunoabsorbent assay. Results: IL‐1β and IL‐18 concentrations were higher in the gingival crevicular fluid from periodontitis patients than in that from gingivitis patients; IL‐18 concentrations were higher than those of IL‐1β. Very little IL‐12, either p40 or p70, was detected in the gingival crevicular fluid samples. In the serum, very low levels of cytokines were found. The level of serum IL‐12 p40, however, was higher than in the fluid from periodontitis sites of periodontitis patients. Conclusion: The local production of IL‐1β and IL‐18 in the gingival crevicular fluid increased with increasing inflammation and IL‐18 was the predominant cytokine at both gingivitis and periodontitis sites. Very little IL‐12 was detected with levels decreasing with increasing inflammation. These results suggest that there is an association between severity of periodontal disease and levels of IL‐1, IL‐12 and IL‐18.     

A multiplex immunoassay demonstrates reductions in gingival crevicular fluid cytokines following initial periodontal therapy

Thunell DH, Tymkiw KD, Johnson GK, Joly S, Burnell KK, Cavanaugh JE, Brogden KA, Guthmiller JM. A multiplex immunoassay demonstrates reductions in gingival crevicular fluid cytokines following initial periodontal therapy. J Periodont Res 2009; doi: 10.1111/j.1600‐0765.2009.01204.x. © 2009 John Wiley & Sons A/S Background and Objective: Cytokines and chemokines play an important role in the pathogenesis of periodontal diseases. The objective of this study was to quantitatively assess the effect of initial periodontal therapy on gingival crevicular fluid levels of a comprehensive panel of cytokines and chemokines, including several less extensively studied mediators. Material and Methods: Clinical examinations were performed and gingival crevicular fluid samples obtained from six subjects with generalized severe chronic periodontitis prior to initial periodontal therapy and at re‐evaluation (6–8 weeks). Four diseased and two healthy sites were sampled in each subject. Twenty‐two gingival crevicular fluid mediators were examined using a multiplex antibody capture and detection platform. Statistical analyses were performed by fitting mixed effects linear models to log‐transformed gingival crevicular fluid values. Results: Gingival crevicular fluid interleukin (IL)‐1α and IL‐1β were the only cytokines to differ in initially diseased vs. initially healthy sites. Following initial therapy, 13 of the 16 detectable cytokines and chemokines decreased significantly in diseased sites, including IL‐1α, IL‐1β, IL‐2, IL‐3, IL‐6, IL‐7, IL‐8, IL‐12 (p40), CCL5/regulated on activation, normally T cell expressed and secreted (RANTES), eotaxin, macrophage chemotactic protein‐1, macrophage inflammatory protein‐1α and interferon‐γ. At healthy sites, only three of the 16 mediators were significantly altered following therapy. Conclusion: This is the first study, to our knowledge, to evaluate such an extensive panel of gingival crevicular fluid mediators within the same sample prior to and following initial therapy. The results confirm that periodontal therapy effectively reduces pro‐inflammatory cytokines and chemokines, including less well‐described mediators that may be important in initiation and progression of periodontitis. The multiplex assay will prove useful for future gingival crevicular fluid studies.     

Expression of cytokines in the gingival crevicular fluid and serum from patients with inflammatory bowel disease and untreated chronic periodontitis

Figueredo CM, Brito F, Barros FC, Menegat JSB, Pedreira RR, Fischer RG, Gustafsson A. Expression of cytokines in the gingival crevicular fluid and serum from patients with inflammatory bowel disease and untreated chronic periodontitis. J Periodont Res 2011; 46: 141–146.© 2010 John Wiley & Sons A/S Background and Objective: Previous studies have reported an increased prevalence/severity of chronic periodontitis in patients with inflammatory bowel disease. However, the pathogenesis of periodontal lesions in such patients has not been characterized. The aim of this pilot study was to characterize the pattern of expression of cytokines in the gingival crevicular fluid and serum from patients with untreated chronic periodontitis and Crohn’s disease, ulcerative colitis and systemically healthy controls. Material and Methods: Fifteen patients with Crohn’s disease, 15 patients with ulcerative colitis and 15 controls participated in the study. All subjects had been diagnosed with untreated chronic periodontitis. The clinical parameters evaluated were clinical attachment loss, bleeding on probing and percentage of plaque. The gingival crevicular fluid was sampled from four shallow and four deep periodontal sites of each patient. The concentrations of the cytokines interleukin (IL)‐1β, IL‐4, IL‐6, IL‐10, IL‐12p40, IL‐12p70, interferon‐γ and tumor necrosis factor‐α were measured using a commercially available Lincoplex kit and the concentration of IL‐18 was measured using an ELISA. Results: Multiple comparisons analysis showed that clinical attachment loss, bleeding on probing, percentage of plaque and volume of gingival crevicular fluid were similar across the groups. The concentration of IL‐4 in the gingival crevicular fluid differed significantly between groups in shallow sites (p = 0.046), with higher values found for the controls. In serum, the concentration of IL‐18 was also significantly different between groups, with lower values found for controls (p = 0.018). Conclusion: This study showed a higher concentration of IL‐18 in serum, but not in the gingival crevicular fluid, from periodontitis patients with Crohn’s disease or ulcerative colitis compared with controls. The expression of cytokines was similar in the gingival crevicular fluid from patients with untreated chronic periodontitis who also had Crohn’s disease or ulcerative colitis and in systemically healthy controls with untreated chronic periodontitis.     

Lipid peroxidation levels, total oxidant status and superoxide dismutase in serum, saliva and gingival crevicular fluid in chronic periodontitis patients before and after periodontal therapy

Background:  Recent data have demonstrated increased lipid peroxidation (LPO) levels and oxidative stress in periodontitis. Malondialdehyde (MDA) and superoxide dismutase (SOD) are both increased during oxidative stress. Furthermore, this study examined SOD concentration, total oxidative status (TOS) and MDA levels in periodontal patients and investigated the longitudinal effect of periodontal therapy on the index levels of chronic periodontitis (CP) patients.
Methods:  Serum, saliva and gingival crevicular fluid (GCF) samples were obtained from 48 CP patients and 35 healthy control subjects prior to, as well as after 16 weeks following non-surgical post-periodontal therapy. MDA, TOS and SOD and clinical parameters were determined pre- and post-therapy.
Results:  The levels of TOS and SOD values were significantly higher in the CP group than in the control group (p < 0.05), but only MDA in GCF. Post-periodontal therapy, serum, saliva and GCF TOS and SOD levels significantly decreased compared to basal levels (p < 0.05), but only MDA in GCF.
Conclusions:  LPO was higher in the periodontal region, with TOS and SOD increasing both locally and peripherally. Non-surgical therapy can restore and control the subject antioxidant capacity by locally and systemically modifying the levels of MDA, TOS and SOD.     

Combined photodynamic and low‐level laser therapies as an adjunct to nonsurgical treatment of chronic periodontitis

Lui J, Corbet EF, Jin L. Combined photodynamic and low‐level laser therapies as an adjunct to nonsurgical treatment of chronic periodontitis. J Periodont Res 2011; 46: 89–96. © 2010 John Wiley & Sons A/S Background and Objective: In recent years, there has been a growing interest in the use of dental lasers for treatment of periodontal diseases. The purpose of this short‐term clinical trial was to evaluate the effects of a combination of photodynamic therapy with low‐level laser therapy as an adjunct to nonsurgical treatment of chronic periodontitis. Material and Methods: Twenty‐four nonsmoking adults with untreated chronic periodontitis were randomly assigned in a split‐mouth design to receive scaling and root debridement with or without one course of adjunctive photodynamic therapy and low‐level laser therapy within 5 d. Plaque, bleeding on probing, probing depth and gingival recession were recorded at baseline, 1 and 3 mo after the treatment. Gingival crevicular fluid was collected for assay of interleukin‐1β levels at baseline, 1 wk and 1 mo. Results: The test teeth achieved greater reductions in the percentage of sites with bleeding on probing and in mean probing depth at 1 mo compared with the control teeth (p < 0.05). A significant decrease in gingival crevicular fluid volume was observed in both groups at 1 wk (p < 0.001), with a further decrease at 1 mo in the test sites (p < 0.05). The test sites showed a greater reduction of interleukin‐1β levels in gingival crevicular fluid at 1 wk than the control sites (p < 0.05). No significant differences in periodontal parameters were found between the test and control teeth at 3 mo. Conclusions: The present study suggests that a combined course of photodynamic therapy with low‐level laser therapy could be a beneficial adjunct to nonsurgical treatment of chronic periodontitis on a short‐term basis. Further studies are required to assess the long‐term effectiveness of the combination of photodynamic therapy with low‐level laser therapy as an adjunct in nonsurgical treatment of periodontitis.     

Longitudinal study of volatile fatty acids in the gingival crevicular fluid of patients with periodontitis before and after nonsurgical therapy

Qiqiang L, Huanxin M, Xuejun G. Longitudinal study of volatile fatty acids in the gingival crevicular fluid of patients with periodontitis before and after nonsurgical therapy. J Periodont Res 2012; 47: 740–749. © 2012 John Wiley & Sons A/S Background and Objective: Short‐chain fatty acids (SCFAs) are important metabolic products of subgingival organisms and their concentrations are associated with the status of inflammation. The purpose of this study was to observe and analyze the change in concentration of SCFAs in the gingival crevicular fluid of patients with chronic periodontitis before and after periodontal treatment. Material and Methods: Gingival crevicular fluid samples were taken from 21 patients with chronic periodontitis before periodontal treatment and 2 wk, and 2, 4 and 6 mo after treatment. The concentrations of six different SCFAs in the gingival crevicular fluid were measured using high‐performance capillary electrophoresis. The presence of porphyromonas gingivalis in the same pretreatment gingival crevicular fluid samples used to measure SCFAs was analyzed using PCR amplification. Results: Two weeks after periodontal treatment, the concentrations of lactic acid, propionic acid, butyric acid and isovaleric acid in the gingival crevicular fluid of patients with chronic periodontitis had decreased to the levels found in the healthy control group. However, the concentration of formic acid had increased. Statistically significant differences were found in the levels of these SCFAs before and after treatment. In the longitudinal observation, the concentrations of butyric acid and isovaleric acid in the gingival crevicular fluid had increased to a high level 2 mo after treatment. At the last two study time‐points (4 and 6 mo after treatment), butyric acid and isovaleric acid were still present at a high level and showed a tendency to continue to increase. In contrast, the concentration of formic acid in gingival crevicular fluid showed a gradual decrease over the study period. Conclusions: The concentration of formic acid in the gingival crevicular fluid has an inverse relationship with the severity of periodontitis, whereas the increased concentrations of butyric and isovelaric acids during the long‐term observation period after therapy may indicate the status of recolonization of periodontal pathogens and reflect the subgingival ecology. These two fatty acids could be used as indicators for the development and progression of periodontitis.     

Effect of periodontal treatment on IL-1beta, IL-1ra, and IL-10 levels in gingival crevicular fluid in patients with aggressive periodontitis

Aim: The aim of this study was to examine the effect of phase I periodontal treatment on the levels of interleukin (IL)‐1β, IL‐1ra, and IL‐10 in gingival crevicular fluid (GCF) in patients with generalized aggressive periodontitis (G‐AgP). Material and Methods: Data were obtained from 15 patients with aggressive periodontitis and 15 healthy controls. GCF was collected from at least four pre‐selected sites (one shallow, at least two moderate, or at least one deep pockets) in patients with G‐AgP. In the healthy group, GCF samples were collected from one site. The cytokine levels were determined by an enzyme‐linked immunosorbent assay. Probing depth, clinical attachment level (CAL), gingival and plaque indices, and bleeding on probing were measured. The GCF sampling and clinical measurements were recorded at baseline and 6 weeks later after periodontal treatment. Results: IL‐1β levels were significantly higher at the moderate and deep pocket sites compared with the shallow sites (p<0.05). After periodontal therapy, IL‐1β levels were significantly reduced in the moderate and deep pocket sites (p<0.05). IL‐1ra levels at baseline of the moderate and deep pocket sites were significantly lower than the control sites (p<0.05). IL‐10 levels were similar in all pockets and did not change after periodontal therapy. Conclusions: The periodontal treatment improves the clinical parameters in G‐AgP, and this improvement is evident in deep pocket sites for pocket depth and CAL values. These results confirm that IL‐1β is effective for evaluating the periodontal inflammation and can thus be used as a laboratory tool for assessing the activity of periodontal disease.     

Gingival crevicular fluid and plasma levels of neuropeptide Substance-P in periodontal health, disease and after nonsurgical therapy

Background and Objective: The level of Substance‐P in gingival crevicular fluid has been found to correlate with clinical measures of periodontal disease. The present study was designed to assess the relationship between clinical parameters and levels of Substance‐P in the gingival crevicular fluid from inflamed gingiva, periodontitis sites and after treatment of periodontitis sites, and to correlate them to the Substance‐P levels of plasma. Material and Methods: Thirty, age‐ and gender‐matched subjects were divided into three groups (healthy, gingivitis and chronic periodontitis) based on modified gingival index scores and clinical attachment loss. A fourth group consisted of 10 subjects from the periodontitis group, 6–8 wk after initial therapy. Plasma and gingival crevicular fluid samples were collected and quantified for Substance‐P using an enzyme immunoassay. Results: The mean concentration of Substance‐P, both in gingival crevicular fluid and plasma, was observed to be highest in the periodontitis group (45.13 pg/mL in gingival crevicular fluid and 67.8 pg/mL in plasma) and lowest in the healthy group (6.07 pg/mL in gingival crevicular fluid and below the detection level in plasma). The mean Substance‐P concentration in the gingivitis group (11.42 pg/mL in gingival crevicular fluid and 38.8 pg/mL in plasma) and in the after‐treatment group (7.58 pg/mL in gingival crevicular fluid and 39.7 pg/mL in plasma) lay between the highest and lowest values. In all groups the gingival crevicular fluid levels showed a statistically significant positive correlation with that of plasma and clinical attachment loss. Conclusion: Substance‐P levels were highest in the gingival crevicular fluid from sites with periodontal destruction; however, periodontal treatment resulted in the reduction of Substance‐P levels. Gingival crevicular fluid and plasma Substance‐P levels showed a positive correlation in all of the groups.     

Effect of azithromycin, as an adjunct to nonsurgical periodontal treatment, on microbiological parameters and gingival crevicular fluid biomarkers in generalized aggressive periodontitis

Emingil G, Han B, Özdemir G, Tervahartiala T, Vural C, Atilla G, Baylas H, Sorsa T. The effect of azithromycin, as an adjunct to nonsurgical periodontal treatment, on microbiological parameters and gingival crevicular fluid biomarkers in generalized aggressive periodontitis. J Periodont Res 2012; 47: 729–739. © 2012 John Wiley & Sons A/S Background and Objective: To study the effectiveness of azithromycin in combination with nonsurgical periodontal therapy on clinical and microbiological parameters, and on the MMP‐8 and TIMP‐1 levels in gingival crevicular fluid, over a 6‐mo time‐period in patients with generalized aggressive periodontitis. Material and Methods: Thirty‐two patients with generalized aggressive periodontitis were included in this randomized, double‐blind, placebo‐controlled, parallel‐arm study. They were randomly assigned to azithromycin or placebo groups (500 mg once daily for 3 d). Probing depth, clinical attachment levels, presence of bleeding on probing and plaque were recorded. Gingival crevicular fluid samples were obtained from one single‐rooted tooth, while microbiological samples were obtained from two single‐rooted teeth, all with a probing depth of ≥ 6 mm. Microbiological parameters were analyzed by quantitative real‐time PCR for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium nucleatum, Prevotella intermedia and total bacteria. Gingival crevicular fluid biomarkers were determined by immunofluorometric assay and ELISA. Results: All clinical parameters improved, and microbiological parameters and gingival crevicular fluid MMP‐8 levels significantly decreased, over the 6‐mo period (p < 0.05); both groups demonstrated similar improvements. The azithromycin group presented a higher percentage of deep pockets resolved (probing depth reduction of ≥ 3 mm from baseline) compared with the placebo group at 1 mo (p < 0.05). Conclusion: Adjunctive azithromycin therapy provides no additional benefit over nonsurgical periodontal treatment on clinical parameters, microbiological parameters and gingival crevicular fluid biochemical markers investigated in patients with generalized aggressive periodontitis.     

Salivary interleukin-1β levels in patients with chronic periodontitis before and after periodontal phase I therapy and healthy controls: a case-control study

Background: The role of interleukin (IL)‐1β in periodontal disease pathogenesis is well researched. This study aimed to assess and compare the salivary IL‐1β levels in patients with chronic periodontitis before and after periodontal phase I therapy and periodontally healthy controls. Further, relationships between IL‐1β levels and various clinical parameters were explored. Methods: Twenty‐eight patients with moderate‐to‐severe generalized chronic periodontitis and 24 age‐, race‐, and ethnicity‐matched controls participated in this study. Saliva samples were obtained from all patients. The clinical parameters recorded were clinical attachment loss (AL), probing depth, bleeding on probing, periodontal index, and gingival index. Clinical evaluation and sample collection were repeated 1 month after periodontal phase I therapy in patients with periodontitis. IL‐1β levels were assessed using enzyme‐linked immunosorbent assay. Results: Mean IL‐1β levels in patients with periodontitis at baseline (1,312.75 pg/mL) were significantly higher (P <0.0001; eight‐fold) than in controls (161.51 pg/mL). Although treatment in patients with periodontitis resulted in significant reduction in IL‐1β levels (mean: 674.34 pg/mL; P = 0.001), they remained significantly higher (P <0.0001; four‐fold) than control levels. There were significant correlations between IL‐1β levels and all clinical parameters (P <0.01) except percentage sites with clinical AL >2 mm (P >0.05). Conclusions: The data indicate that IL‐1β levels are raised in the saliva of patients with chronic periodontitis, which are reduced after phase I therapy, suggesting a close association between salivary IL‐1β and periodontitis. Additional longitudinal studies are needed to validate salivary IL‐1β as a marker for periodontal disease.     

Lipid peroxidation levels and total oxidant status in serum, saliva and gingival crevicular fluid in patients with chronic periodontitis

OBJECTIVES: Increased levels of reactive oxygen species lead to oxidative stress. Recent data suggest increased lipid peroxidation (LPO) levels and oxidative stress in periodontitis. Malondialdehyde (MDA), a significant LPO product, increases in oxidative stress. In this study, MDA levels and total oxidant status (TOS) in serum, saliva and gingival crevicular fluid (GCF) were investigated in patients with chronic periodontitis (CP). MATERIALS AND METHODS: Thirty-six CP patients and 28 periodontally healthy controls were included in the study. Following clinical measurements and samplings, MDA and TOS levels were measured by high-performance liquid chromatography and a novel automatic colorimetric method, respectively. RESULTS: While the saliva and GCF MDA levels, and serum, saliva and GCF TOS values were significantly higher in the CP group than the control group (p<0.05), no significant difference in serum MDA levels was found (p>0.05). Strong positive correlations were observed between periodontal parameters and MDA and TOS levels (p<0.05). CONCLUSIONS: The results revealed that LPO significantly increased locally in the periodontal pocket/oral environment, while TOS displayed both systemic and local increases in periodontitis. The findings suggest that increased LPO and TOS may play an important role in the pathology of periodontitis, and are closely related to the clinical periodontal status.     

Progressive periodontal disease has a simultaneous incremental elevation of gingival crevicular fluid and serum CRP levels

Aim: Increased C‐reactive protein levels have been found in all active inflammations, including periodontitis. This study aims to assess the C‐reactive protein levels in periodontal disease progression. Methods: Forty‐five patients were divided into the following three groups (n = 15) based on gingival index, probing pocket depth, and clinical attachment level: healthy (group I), gingivitis (group II), and chronic periodontitis (group III). Gingival crevicular fluid and serum samples were quantified for C‐reactive protein using enzyme‐linked immunosorbent assay. Results: The mean C‐reactive protein concentration in gingival crevicular fluid and serum was found to be highest in group III (1233.33 ng/mL for gingival crevicular fluid, 5483.33 ng/mL for serum), and least in group I (60 ng/mL and 413 ng/mL for gingival crevicular fluid and serum, respectively) The mean C‐reactive protein concentration in group II (453.33 ng/mL for gingival crevicular fluid and 3565.33 ng/mL for serum) was found to be intermediate. Conclusions: C‐reactive protein levels in gingival crevicular fluid and serum increased proportionately with the severity of periodontal disease. They correlated positively with clinical parameters, including gingival index, probing pocket depth, and clinical attachment level. Thus, it can be considered as a periodontal inflammatory biomarker and deserves further consideration.     

Alcohol Consumption and Periodontitis: Quantification of Periodontal Pathogens and Cytokines

Background: There are few studies on periodontal status related to microbiologic and immunologic profiles among individuals not or occasionally using alcohol and those with alcohol dependence. The aim of this study is to determine the effect of alcohol consumption on the levels of subgingival periodontal pathogens and proinflammatory cytokines (interleukin [IL]‐1β and tumor necrosis factor [TNF]‐α) in the gingival fluid among individuals with and without periodontitis. Methods: This observational analytic study includes 88 volunteers allocated in four groups (n = 22): individuals with alcohol dependence and periodontitis (ADP), individuals with alcohol dependence and without periodontitis (ADNP), individuals not or occasionally using alcohol with periodontitis (NAP), and individuals not or occasionally using alcohol without periodontitis (NANP). Levels of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Eikenella corrodens, and Fusobacterium nucleatum were determined by real‐time polymerase chain reaction on the basis of the subgingival biofilm, and IL‐1β and TNF‐α were quantified by enzyme‐linked immunosorbent assay in gingival fluid samples. Results: Individuals with alcohol dependence showed worse periodontal status and higher levels of P. intermedia, E. corrodens, F. nucleatum, and IL‐1β than non‐users. No significant correlations between TNF‐α and bacterial levels were observed. However, in the ADP group, higher levels of E. corrodens were correlated with higher levels of IL‐1β. Conclusion: A negative influence of alcohol consumption was observed on clinical and microbiologic periodontal parameters, as well as a slight influence on immunologic parameters, signaling the need for additional studies.     

Detection of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor 2(PAI-2) in gingival crevicular fluid from healthy, gingivitis and periodontitis patients

Background: The regulation of plasminogen activation is a key element in controlling proteolytic events in the extracellular matrix. Our previous studies had demonstrated that in inflamed gingival tissues, tissue‐type plasminogen activator (t‐PA) is significantly increased in the extracellular matrix of the connective tissue and that interleukin 1β (IL‐1β) can up regulate the level of t‐PA and plasminogen activator inhibitor‐2 (PAI‐2) synthesis by human gingival fibroblasts. Method: In the present study, the levels of t‐PA and PAI‐2 in gingival crevicular fluid (GCF) were measured from healthy, gingivitis and periodontitis sites and compared before and after periodontal treatment. Crevicular fluid from106 periodontal sites in 33 patients were collected. 24 sites from 11 periodontitis patients received periodontal treatment after the first sample collection and post‐treatment samples were collected 14 days after treatment. All samples were analyzed by enzyme‐linked immunosorbent assay (ELISA) for t‐PA and PAI‐2. Results: The results showed that significantly high levels of t‐PA and PAI‐2 in GCF were found in the gingivitis and periodontitis sites. Periodontal treatment led to significant decreases of PAI‐2, but not t‐PA, after 14 days. A significant positive linear correlation was found between t‐PA and PAI‐2 in GCF (r=0.80, p<0.01). In the healthy group, different sites from within the same subject showed little variation of t‐PA and PAI‐2 in GCF. However, the gingivitis and periodontitis sites showed large variation. These results suggest a good correlation between t‐PA and PAI‐2 with the severity of periodontal conditions. Conclusion: This study indicates that t‐PA and PAI‐2 may play a significant rôle in the periodontal tissue destruction and tissue remodeling and that t‐PA and PAI‐2 in GCF may be used as clinical markers to evaluate the periodontal diseases and assess treatment.     

Adjunctive Non‐Surgical Therapy of Inflamed Periodontal Pockets During Maintenance Therapy Using Diode Laser: A Randomized Clinical Trial

Background: Numerous studies have documented the clinical outcomes of laser therapy for untreated periodontitis, but very few have reported on lasers treating inflamed pockets during maintenance therapy. The aim of this study is to compare the effectiveness of scaling and root planing (SRP) plus the adjunctive use of diode laser therapy to SRP alone on changes in the clinical parameters of disease and on the gingival crevicular fluid (GCF) inflammatory mediator interleukin‐1β (IL‐1β) in patients receiving regular periodontal maintenance therapy. Methods: This single‐masked and randomized, controlled, prospective study includes 22 patients receiving regular periodontal maintenance therapy who had one or more periodontal sites with a probing depth (PD) ≥5 mm with bleeding on probing (BOP). Fifty‐six sites were treated with SRP and adjunctive laser therapy (SRP + L). Fifty‐eight sites were treated with SRP alone. Clinical parameters, including PD, clinical attachment level (CAL), and BOP, and GCF IL‐1β levels were measured immediately before treatment (baseline) and 3 months after treatment. Results: Sites treated with SRP + L and SRP alone resulted in statistically significant reductions in PD and BOP and gains in CAL. These changes were not significantly different between the two therapies. Similarly, differences in GCF IL‐1β levels between SRP + L and SRP alone were not statistically significant. Conclusion: In periodontal maintenance patients, SRP + L did not enhance clinical outcomes compared to SRP alone in the treatment of inflamed sites with ≥5 mm PD.     

Diabetes mellitus-associated periodontitis: differences between type 1 and type 2 diabetes mellitus

Aspriello SD, Zizzi A, Tirabassi G, Buldreghini E, Biscotti T, Faloia E, Stramazzotti D, Boscaro M, Piemontese M. Diabetes mellitus‐associated periodontitis: differences between type 1 and type 2 diabetes mellitus. J Periodont Res 2011; 46: 164–169. © 2010 John Wiley & Sons A/S Background and Objective: Although many studies have appeared about diabetes mellitus‐associated periodontitis, few have compared periodontitis inflammatory markers between type 1 (T1DM) and type 2 diabetes mellitus (T2DM), and information regarding this issue is scarce and contradictory. We evaluated the levels of plasma C‐reactive protein and of interleukin‐1β (IL‐1β), interleukin‐6 (IL‐6) and tumour necrosis factor‐α (TNF‐α) in gingival crevicular fluid in two groups of subjects affected by T1DM and T2DM, in order to identify possible differences between the two classes in the inflammatory mechanisms of diabetes mellitus‐associated periodontitis. Material and Methods: Plasma C‐reactive protein and gingival crevicular fluidIL‐1β, IL‐6 and TNF‐α were measured in periodontitis patients affected by type 1 (P‐T1DM, n = 24) and type 2 diabetes mellitus (P‐T2DM, n = 24). Results: Gingival crevicular fluid levels of IL‐1β and TNF‐α in P‐T1DM subjects were significantly higher than in P‐T2DM subjects. In P‐T1DM subjects, we found significant negative correlations between the duration of diabetes mellitus and IL‐1β and between the duration of diabetes mellitus and TNF‐α. Conclusion: This study shows that IL‐1β and TNF‐α levels in periodontitis patients with T1DM are affected by the duration of diabetes mellitus.