Expression of Protease Activated Receptor‐1 in Chronic Periodontitis

Background: Protease activated receptor‐1 (PAR₁) activation by thrombin may play a role in repair and homeostasis of periodontal tissues. The main objective of this study is to investigate PAR₁ expression in patients with periodontitis, before and after non‐surgical periodontal treatment, and to associate its expression with the presence of inflammatory biomarkers and PAR₂ expression. Methods: Gingival crevicular fluid (GCF) samples and clinical parameters, including probing depth, clinical attachment level, bleeding on probing, and gingival and plaque indices, were collected from periodontally healthy individuals and patients with moderate chronic periodontitis (CP) before and 6 weeks after periodontal non‐surgical treatment. PAR₁ and PAR₂ messenger RNA (mRNA) at the GCF were evaluated by quantitative polymerase chain reaction (qPCR). Flow cytometry analysis identified the GCF PAR₁‐expressing cells. GCF inflammatory biomarkers were also determined. Results: Clinical parameters were significantly improved after therapy (P <0.01). The qPCR analysis showed that, before therapy, PAR₁ mRNA levels in CP were similar to controls. Periodontal treatment led to increased PAR₁ expression in CP (P <0.05). PAR₁ expression was inversely correlated to PAR₂ expression and with interleukins 6 and 8, tumor necrosis factor‐α, interferon‐γ, and matrix metalloproteinase‐2 levels. Conclusions: Periodontal treatment results in PAR₁ overexpression in the GCF, and PAR₁ expression is associated with decreased expression of inflammatory biomarkers and inversely correlated to PAR₂ expression in the GCF. Therefore, the data suggest the importance of PAR₁ mediating the known anabolic actions of thrombin in the periodontium.     

Estimation of Pentraxin‐3 Levels in the Gingival Tissues of Chronic and Aggressive Periodontitis Participants: An In Vivo Study

Background: Pentraxins are acute‐phase proteins that belong to a family of evolutionarily conserved proteins, and they are considered markers of inflammation. Pentraxin‐3 (PTX3) is a prototype of the long pentraxin group. It is suggested to play an important role in innate resistance against pathogens, regulation of inflammation, and clearance of apoptotic cells. The aim of this study is to estimate the level of PTX3 in gingival tissues of individuals with chronic (CP) and aggressive (AgP) periodontitis and control participants and further correlate the level of PTX3 with clinical parameters. Methods: The study population consisted of 50 participants ranging in age from 20 to 55 years and attending the outpatient section of Department of Periodontics, Saveetha Dental College and Hospital, Chennai, India. The study groups included the following: 1) group A, patients with generalized CP (n = 20); 2) group B (n = 20), patients with generalized AgP (GAgP); and 3) group C (n = 10), healthy controls. Tissue samples from participants were assayed for PTX3 levels using enzyme‐linked immunosorbent assay. Results: Gingival tissues from patients with GAgP (8.349 ± 5.076 ng/mL) had a higher mean concentration of PTX3 than tissues from patients with generalized CP (5.068 ± 3.274 ng/mL) and controls (0.251 ± 0.277). The PTX3 levels in the gingival tissues correlated positively with clinical parameters in all the groups. Among the parameters, probing depth was the most significant predictor variable associated with PTX3 in cases with periodontitis. Conclusions: PTX3 concentration in gingival tissues of patients with GAgP was higher than in tissues from patients with CP, and the levels correlated positively with clinical parameters. Hence, tissue PTX3 level can be considered a marker of inflammation in periodontal disease.     

Association Between Periodontitis and Gestational Diabetes Mellitus: A Case‐Control Study

Background: Some studies have reported an association between gestational diabetes mellitus (GDM) and periodontitis. The aim of the present study is to analyze this potential association and the influence of risk variables associated with GDM. Methods: This case‐control study includes 360 women, 90 with GDM and 270 controls. Participants received a full‐mouth periodontal examination with a record of bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL). Periodontitis is defined as the presence in ≥4 teeth of ≥1 sites with PD ≥4 mm and CAL ≥3 mm associated with BOP. The influence of risk variables in the occurrence of GDM is tested through univariate analysis and multivariate logistic and multinomial regression. Odds ratio (ORs) and respective confidence intervals (CIs) are calculated and reported. Results: The prevalence of periodontitis was 40% in the case group (GDM) and 46.3% in the control group. There was a lack of association between periodontitis and GDM (OR = 0.74; 95% CI = 0.40 to 1.38). The multivariate final logistic regression model retained the following as significant variables associated with GDM: maternal age (OR = 2.65; 95% CI = 1.97 to 3.56), chronic hypertension (OR = 3.16; 95% CI = 1.35 to 7.42), and body mass index (OR = 1.99; 95% CI = 1.41 to 2.81). Conclusions: A high prevalence of periodontitis was found among cases and controls, with no association between periodontitis and GDM. The present study suggests the need for implementation of health policies directed to the periodontal care of pregnant women.     

Effect of Non‐Surgical Periodontal Therapy on Serum Ferritin Levels: An Interventional Study

Background: Ferritin, an acute‐phase reactant, has been found to be elevated in many chronic inflammation‐related diseases. The aim of the present study is to investigate differences in concentrations of serum ferritin in patients with and without periodontal disease before and after non‐surgical periodontal therapy and correlate these values with clinical variables associated with periodontal disease. Methods: Forty‐two individuals were included in this study, 20 with chronic periodontitis (CP) and 22 classified as periodontally healthy. Serum ferritin concentrations, hemoglobin levels, and periodontal parameters (probing depth [PD], clinical attachment level, gingival index, bleeding on probing, and plaque index) were recorded at baseline and 3 months after non‐surgical periodontal therapy. Results: Patients with CP showed higher concentrations of serum ferritin than periodontally healthy controls (P <0.01). After adjustment for confounders, a positive and significant correlation was observed between serum ferritin levels and the number of sites with PD ≥6 mm at baseline (P <0.01). Regression analyses revealed association between deep pockets and serum ferritin levels at baseline (R² = 0.823). Significant reductions in serum ferritin levels were observed at the 3‐month assessment after periodontal treatment (P <0.01), and the post‐treatment serum ferritin values were comparable to those of controls (P >0.05). Furthermore, the post‐treatment degree of change in the serum ferritin level was positively and significantly associated with improvement in PD (R² = 0.213, P <0.05). Conclusion: Serum ferritin levels are raised in patients with CP and decrease to control levels post‐treatment.     

Resistin Levels in Gingival Crevicular Fluid of Patients With Chronic Periodontitis and Type 2 Diabetes Mellitus

Background: Resistin is associated with local and systemic inflammatory conditions with a direct correlation with type 2 diabetes mellitus (T2DM). The aim of this clinico‐biochemical study is to estimate and compare the levels of resistin in the gingival crevicular fluid (GCF) in health, chronic periodontitis (CP), and T2DM. Methods: Sixty patients (aged >35 years) who participated in this study were divided into four groups of 15 patients each: healthy individuals (group 1), patients with CP (group 2), patients with T2DM (group 3), and patients with T2DM and CP (group 4). The parameters assessed included plaque index (PI), gingival index (GI), probing depth (PD), periodontal index, body mass index, random blood sugar (RBS), and glycated hemoglobin (HbA1c). GCF (4 μL) was collected and analyzed for resistin levels using an enzyme‐linked immunosorbent assay. Results: Resistin was detected in the GCF of all patients. A significant difference was observed in GCF resistin concentrations from group 1 versus group 2 (P = 0.0093), group 3 (P = 0.0341), and group 4 (P = 0.0002); in group 2 versus group 4 (P = 0.0032); and in group 3 versus group 4 (P = 0.0008). When all the samples were analyzed together, GCF resistin levels positively correlated with GI, PD, PI, RBS, and HbA1c and were predictable with PD and HbA1c. Conclusions: Resistin levels are increased in CP and T2DM. Hence, GCF resistin levels may be considered as a potential inflammatory marker for periodontitis with T2DM.     

Association Between Periodontitis and Salivary Nitric Oxide Metabolites Among Community Elderly Koreans

Background: Nitric oxide (NO) is known to play an important role in many biologic systems, although the relationship between NO metabolites and periodontitis remains controversial. Moreover, little evidence of an association between salivary NO (S‐NO) and periodontitis in the general population has been reported. This study aims to investigate the relationship between S‐NO and periodontitis in an elderly Korean population. Methods: A cross‐sectional study was conducted using participants and salivary samples from Sunchang Elderly Cohort Study. The total number of final participants was 242 (91 males and 151 females; 48 to 93 years old). Periodontitis was determined by a clinical attachment loss of >6 mm at six probe points on 12 index teeth. NO was measured in unstimulated saliva via the Griess reaction. Sociodemographic status, general/oral health, and health‐related behaviors were investigated as confounders. Bivariate analysis and multivariable linear regression analyses including confounders were applied. Results: After controlling for age, sex, education, salivary flow rate, number of teeth, smoking status, physical activity, hypertension, and diabetes, three metabolites of S‐NO (total NO, nitrite, and nitrate) were independently associated with the percentage of probe points exhibiting periodontitis. Of these linear associations, total NO was found to have the strongest correlation with periodontitis (partial r = 0.181, P = 0.009). These associations were most pronounced in females (except for nitrate), non‐smokers, those without hypertension, and those without diabetes. Conclusions: Our data suggest that high concentrations of S‐NO are associated with severe periodontitis. Thus, S‐NO may serve as a potential biologic marker for detecting and monitoring periodontitis.     

急、慢性根尖周炎患牙根管内内毒素水平的分析测定

目的　比较急、慢性根尖周炎患牙根管内的内毒素水平并探讨内毒素与患牙尖周瘘管的关系。方法　选择急性根尖周炎、慢性根尖周炎根尖暗影直径<2 mm、根尖暗影直径>2 mm有瘘道和无瘘道的患牙各10例,采用产色基质鲎试剂法检测根管内内毒素含量。结果　慢性根尖周炎根尖暗影<2 mm的患牙,根管内内毒素水平明显低于急性根尖周炎及慢性根尖周炎根尖暗影>2 mm(有或无瘘道)的患牙,其差异有统计学意义(P<0·01)。结论　内毒素可能与尖周炎临床症状及根尖骨吸收程度密切相关。     

Allergic Rhinitis Is Associated With Periodontitis: A Population‐Based Study

Background: Little is known regarding associations of periodontitis with diseases of the nose, one of the structures adjacent to the mouth. This study aims to explore the association between periodontitis and previous allergic rhinitis (AR) using a matched patient–control study design from a population‐based dataset in Taiwan. Methods: Data were sourced from the Longitudinal Health Insurance Database 2000 for 71,182 patients with chronic periodontitis (CP) and 71,182 controls without periodontitis. Generalized linear mixed‐model analyses were used to calculate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for previous AR diagnosis in patients and controls. Results: Significant difference was found in prevalence of prior AR for patients and controls (28.4% versus 24.2%; P <0.001). Generalized linear mixed model suggested that the OR of previous AR for patients was 1.24 (95% CI: 1.22 to 1.27; P <0.001) compared with controls. Adjustments were made for: 1) monthly income; 2) urbanization level; 3) diabetes mellitus; 4) hypertension; 5) coronary heart disease; 6) hyperlipidemia; 7) alcohol abuse; 8) tobacco use disorder; and 9) random effect of geographic region. After adjusting, OR of previous AR diagnosis among patients was 1.21 (95% CI: 1.18 to 1.23; P <0.001) compared with controls. Conclusions: An association between periodontitis and prior AR is demonstrated. It is recommended that physicians be more alert for potential risk of subsequent development of CP in patients with AR.     

Suppuration‐Associated Bacteria in Patients With Chronic and Aggressive Periodontitis

Background: Suppuration (SUP) on probing may be an indication of active periodontal breakdown. The aim of the present study is to analyze which subgingival species are associated with SUP in patients with chronic (CP) and aggressive (AgP) periodontitis. Methods: A total of 156 patients with CP and 66 with AgP were submitted to full‐mouth periodontal examination and subgingival biofilm sampling (14 sites/patient). The counts of 44 bacterial species were determined by checkerboard. Comparisons between groups and sites were analyzed by the Mann‐Whitney and Wilcoxon tests, respectively. Associations between frequency of SUP and bacterial species were analyzed by the Spearman correlation coefficient. Results: The prevalence of SUP in patients with CP was 24.4%, and in patients with AgP it was 30.3%, and the percentage of SUP sites in the groups was 5.72% ± 1.06% and 6.96% ± 1.70%, respectively (P >0.05). SUP sites from patients with CP had significantly higher counts of Veillonella parvula, Dialister pneumosintes, Tannerella forsythia, and Prevotella nigrescens than SUP sites from patients with AgP (P <0.005). Significant positive correlations between high frequency of SUP and high levels of Actinomyces spp, Streptococcus spp., members of the orange complex, Acinetobacter baumannii, and Pseudomonas aeruginosa were observed in patients with CP (P <0.05). In patients with AgP, Actinomyces oris, Propionibacterium acnes, P. aeruginosa, Staphylococcus aureus, and Streptococcus sanguinis were positively associated with SUP, whereas Prevotella intermedia presented a negative association with SUP (P <0.05). Conclusions: SUP sites from patients with CP harbored significantly higher counts of several periodontal species than SUP sites from patients with AgP. Actinomyces spp., Streptococcus spp., members of the orange complex, T. forsythia, and certain non‐oral pathogens were associated with a high number of sites with SUP.     

The Sociodemographic Characteristics,Periodontal Health Status,and Subgingival Microbiota of Patients With Chronic Periodontitis and Type 2 Diabetes Mellitus: A Case‐Control Study in a Chinese Population

Background: In China, chronic periodontitis (CP) is common in patients with type 2 diabetes mellitus (T2DM). The purpose of this study is to identify the sociodemographic characteristics associated with such patients and to assess the periodontal health status and subgingival microbiota of patients with CP and T2DM (T2DMCP) in the Chinese population. Methods: A total of 150 patients with T2DMCP and 306 patients with CP without any systemic disease completed questionnaires, underwent clinical periodontal examinations and participated in diabetes‐related parameter examinations. Subgingival plaques were obtained to determine the prevalence and amounts of selected oral bacterial species using polymerase chain reaction (PCR) and real‐time PCR, respectively. Results: The income level and mean body mass index (BMI) of the patients with T2DMCP were significantly higher than those of the patients with CP. Additionally, the patients with T2DMCP were more likely to be urban residents, and they had significantly more severe periodontitis than did the patients with CP. In the patients with T2DMCP, the prevalence and amounts of Treponema denticola and Tannerella forsythia were significantly higher than those in the patients with CP. Finally, compared with the patients with CP, the patients with T2DMCP had a significantly lower prevalence and amount of Prevotella intermedia. Conclusions: Compared with the patients with CP, the patients with T2DMCP were more likely to be urban residents and generally had higher incomes, higher mean BMI, and poorer periodontal health status. Higher levels of T. denticola and T. forsythia and lower levels of P. intermedia were identified in the subgingival plaque of the patients with T2DMCP.     

Comparative Analysis of Calcium‐Binding Myeloid‐Related Protein‐8/14 in Saliva and Serum of Patients With Periodontitis and Healthy Individuals

Background: This study aims to investigate calcium‐binding myeloid‐related protein (MRP)‐8/14 in the saliva and serum of individuals with periodontitis and periodontally healthy individuals for the assessment of its role in the pathogenesis and clinical diagnosis of periodontitis. Methods: This cross‐sectional study includes 56 patients with periodontitis and 44 periodontally healthy individuals. Saliva and serum were collected for the detection of MRP‐8/14 and calcium levels. Periodontopathic bacteria were determined by polymerase chain reaction in saliva. Correlations between salivary and serum MRP‐8/14 levels and clinical parameters, bacteria, and calcium were analyzed with Pearson correlation in a multiple regression model. MRP‐8/14 levels were documented with receiver operating characteristic (ROC) curves. Results: Compared with healthy individuals, MRP‐8/14 levels were significantly higher in both the saliva and serum of patients with periodontitis, but calcium was increased only in saliva. A high diagnostic potential of salivary MRP‐8/14 was detected for periodontitis (ROC = 0.86). Salivary MRP‐8/14 levels correlated significantly with the presence of the periodontopathogen Treponema denticola, as well as with the clinical parameters of periodontitis. Conclusion: MRP‐8/14 in saliva might be a potential diagnostic parameter for periodontal disease.     

Elevated Cytokine Levels in Gingival Crevicular Fluid of Teeth with Apical Periodontitis

IntroductionBiomarkers assayed from gingival crevicular fluid (GCF) are a potential tool for endodontic diagnosis and for monitoring treatment response. This cross-sectional study measured cytokines in GCF from teeth with apical periodontitis and evaluated their relationship with preoperative pain and other clinical findings.MethodsParticipants presenting for root-end resection surgery due to apical periodontitis diagnosis (n = 56) underwent standardized clinical testing and completed preoperative questionnaires. GCF from diseased and control teeth were collected, processed, and analyzed. Mann-Whitney U and Wilcoxon tests were used to examine the cytokine levels in diseased compared to healthy control teeth. We also assessed the relationship of cytokine levels with clinical findings.ResultsInterleukins (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, interferon-γ, and tumor necrosis factor-⍺ (TNF-⍺) were detected in GCF. TNF-⍺ levels were significantly higher in GCF collected from diseased versus control teeth (P = .02) and increased IL-1β levels in diseased teeth were detected (P = .06). Lower IL-10 levels were observed in teeth with a sinus tract and/or swelling compared to teeth without a sinus tract and/or swelling (P = .08). Cytokine levels did not clearly relate to the presence of pain.ConclusionsElevated levels of proinflammatory cytokines, including TNF-⍺ and IL1- β, were detected in GCF from diseased teeth compared to the healthy controls. Additional studies are needed to further investigate the utility of these biomarkers for objectively evaluating periradicular pathology.     

Whole Salivary Interleukin‐6 and Matrix Metalloproteinase‐8 Levels in Patients With Chronic Periodontitis With and Without Prediabetes

Background: The cytokine profile in unstimulated whole saliva (UWS) of patients with prediabetes and chronic periodontitis (CP) remains uninvestigated. The aim of this study is to assess interleukin (IL)‐6 and matrix metalloproteinase (MMP)‐8 levels in UWS of patients with CP with and without prediabetes. Methods: Eighty‐eight males (aged 39 to 51 years) were divided into three groups: group 1: 28 patients with CP and prediabetes; group 2: 30 patients with CP and without prediabetes; and group 3: 30 controls. Fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels, periodontal parameters (plaque index, bleeding on probing, probing depth, attachment loss, and marginal bone loss), and number of missing teeth were recorded. UWS samples were collected, and UWS flow rate (UWSFR) was measured. IL‐6 and MMP‐8 were measured in UWS using enzyme‐linked immunosorbent assay. P values <0.05 were considered statistically significant. Results: Mean FBG and HbA1c levels were significantly higher in group 1 (119.3 ± 3.1 mg/dL and 6.1% ± 0.2%) than group 2 (80.1 ± 3.5 mg/dL and 4.8% ± 0.5%; P <0.001) and group 3 (75.3 ± 2.2 mg/dL and 4.3% ± 0.2%; P <0.05). UWSFR was significantly higher in groups 2 (0.53 ± 0.1 mL/minute; P <0.05) and 3 (0.51 ± 0.1 mL/minute; P <0.01) than group 1 (0.33 ± 0.05 mL/minute). Periodontal parameters were worse in group 1 (P <0.05) and group 2 (P <0.05) than group 3. There was no difference in periodontal parameters, numbers of missing teeth, or salivary IL‐6 and MMP‐8 levels between patients in groups 1 and 2. Conclusion: Salivary IL‐6 and MMP‐8 levels are elevated in patients with CP with and without prediabetes.     

Locally Delivered 0.5% Azithromycin as an Adjunct to Non‐Surgical Treatment in Patients With Chronic Periodontitis With Type 2 Diabetes: A Randomized Controlled Clinical Trial

Background: Several epidemiologic studies have identified a greater incidence of periodontitis in patients with type 2 diabetes. Recent developments suggest that local delivery of antimicrobials into periodontal pockets improve periodontal health. The present study is designed to investigate the adjunctive effects of subgingivally delivered azithromycin (AZM; 0.5% concentration) as an adjunct to scaling and root planing (SRP) for treating chronic periodontitis in patients with type 2 diabetes. Methods: A total of 63 patients were categorized into two treatment groups: 1) group 1: SRP + placebo gel and 2) group 2: SRP + 0.5% AZM. Clinical parameters were recorded at baseline and 3, 6, and 9 months; they included modified sulcus bleeding index (mSBI), plaque index (PI), probing depth (PD), and clinical attachment level (CAL). Results: Both therapies resulted in significant improvements. Using a patient‐based analysis, patients in group 2 treated with SRP + 0.5% AZM showed enhanced reductions in PI, GI, mSBI, and PD and gains in CAL (P <0.05) over 9 months compared with group 1. Conclusion: Although both treatment strategies seem to benefit the patients, the adjunctive use of 0.5% AZM as a controlled drug delivery system enhances the clinical outcome.     

Efficacy of Locally Delivered 1.2% Rosuvastatin Gel To Non‐Surgical Treatment of Patients With Chronic Periodontitis: A Randomized,Placebo‐Controlled Clinical Trial

Background : Chronic periodontitis (CP) is an inflammatory condition affecting tooth‐supporting tissues and alveolar bone that surround the tooth, leading to formation of a deepened gingival sulcus that is highly prone to pathologic changes and, ultimately, bone resorption and tooth loss. In the literature, several pharmacologic agents have been administered via local delivery routes directly into diseased sites, affirming improvement in periodontal status. Therefore, this study aims to determine the clinical effectiveness of subgingivally delivered 1.2% rosuvastatin (RSV) gel incorporated into a methylcellulose vehicle for its controlled release into intrabony defect (IBD) sites as an adjunct to scaling and root planing (SRP) for treatment of patients with CP. Methods: Sixty‐five patients were categorized into two treatment groups: group 1, SRP plus 1.2 mg RSV; group 2, SRP plus placebo. Clinical parameters, including modified sulcus bleeding index (mSBI), probing depth (PD), and clinical attachment level (CAL), were recorded at baseline (before SRP) and at 1, 3, 4, and 6 months. Radiologic assessment of IBD fill was analyzed at baseline and after 6 months using software. Results: There was significant improvement in both study groups. At 6 months, there was a greater decrease in mSBI scores in group 1 (3.71 ± 0.24) compared to group 2 (1.48 ± 0.33). The mean decrease in PD from baseline to 6 months was 4.04 ± 0.34 and 1.31 ± 0.24 mm in groups 1 and 2, respectively. Mean CAL gain from baseline to 6 months was 4.2 ± 0.17 and 1.4 ± 0.15 mm in groups 1 and 2, respectively. In group 1, there was a greater decrease in mean IBD (2.23 ± 0.32 mm, 48.58%) compared to group 2 (0.46 ± 0.02 mm, 10.02%). All patients tolerated the drug without any adverse reaction. Conclusion: Rosuvastatin in situ gel (1.2%), when delivered locally into IBD/pocket sites, showed a greater reduction than placebo in PD and gingival index, along with increased gain in CAL.     

Validation of Periodontitis Screening Model Using Sociodemographic,Systemic, and Molecular Information in a Korean Population

Background: This study aims to evaluate and validate a periodontitis screening model that includes sociodemographic, metabolic syndrome (MetS), and molecular information, including gingival crevicular fluid (GCF), matrix metalloproteinase (MMP), and blood cytokines. Methods: The authors selected 506 participants from the Shiwha‐Banwol cohort: 322 participants from the 2005 cohort for deriving the screening model and 184 participants from the 2007 cohort for its validation. Periodontitis was assessed by dentists using the community periodontal index. Interleukin (IL)‐6, IL‐8, and tumor necrosis factor‐α in blood and MMP‐8, ‐9, and ‐13 in GCF were assayed using enzyme‐linked immunosorbent assay. MetS was assessed by physicians using physical examination and blood laboratory data. Information about age, sex, income, smoking, and drinking was obtained by interview. Logistic regression analysis was applied to finalize the best‐fitting model and validate the model using sensitivity, specificity, and c‐statistics. Results: The derived model for periodontitis screening had a sensitivity of 0.73, specificity of 0.85, and c‐statistic of 0.86 (P <0.001); those of the validated model were 0.64, 0.91, and 0.83 (P <0.001), respectively. Conclusions: The model that included age, sex, income, smoking, drinking, and blood and GCF biomarkers could be useful in screening for periodontitis. A future prospective study is indicated for evaluating this model's ability to predict the occurrence of periodontitis.