High serum procalcitonin levels in patients with periodontitis and chronic migraine

1 Background

To evaluate the contribution of chronic periodontitis (CP) to serum procalcitonin (proCT) levels in chronic migraine (CM) patients in a cross‐sectional study.

2 Methods

We included 138 subjects divided into 4 groups based on clinical features of CM and periodontal parameters: systemically and periodontally healthy individuals (n = 37), systemically healthy and CP patients (n = 19), CM and periodontally healthy patients (n = 34), and CM+CP patients (n = 48). Demographic, neurological, clinical data as well as full‐mouth periodontal records were obtained. ProCT and high sensitive C‐reactive protein (hs‐CRP) serum levels were determined from blood samples taken during migraine interictal period.

3 Results

Patients from the CP+CM group (0.056±0.006 ng/mL) had significantly higher serum proCT levels in comparison with the systemically and periodontally healthy group (0.029±0.019 ng/mL), CM group (0.041±0.002 ng/mL), or CP group (0.034±0.014 ng/mL) (p < 0.001). There were no significant differences in hs‐CRP between groups (p = 0.081). Multiple linear regression analysis showed that CP was associated with increased proCT levels in CM patients (R² = 0.293, p < 0.001).

4 Conclusions

CP independently contributes to elevated serum proCT levels in CM patients. These findings suggest that CP could play a role in migraine chronification.     

Specific antibodies against Actinobacillus actinomycetemcomitans in serum and saliva of patients with advanced periodontitis

The aim of the present study was to discover any possible correlation between specific antibodies against Actinobacillus actinomycetemcomitans (A.a.) in serum and saliva. The test group consisted of 38 patients aged 31–68 yr (mean 49) with advanced periodontitis. Twenty-nine subjects aged 23–67 yr, without periodontal destruction, formed a control group with a reference level of specific salivary antibodies against A.a. A subgingival plaque sample for culturing A.a. , a specimen of stimulated whole saliva, and a sample of venous blood were taken from each subject of the test group. Specific IgG and IgA antibodies against A.a. were determined from serum and stimulated whole saliva by means of the ELISA test. Fifteen of the patients (39%) had cultivable A.a. Six of the 15 A.a. culture-positive patients and one of the 29 reference subjects exhibited very high antibody titers against A.a. in saliva. Specific IgG and IgA antibodies in saliva correlated highly significantly with the corresponding antibody values in serum among the patients in the test group. It was concluded that among patients with severe adult periodontitis, the less invasive saliva sample has a diagnostic value equal to that of the serum sample concerning specific antibodies against A.a.     

Detection of periodontopathic bacteria and an oxidative stress marker in saliva from periodontitis patients

We assessed the salivary levels of periodontopathic bacteria and 8-hydroxydeoxyguanosine (8-OHdG) in patients with periodontitis. The salivary levels of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia (formerly Bacteroides forsythus) were assessed using real-time polymerase chain reaction. The 8-OHdG levels were determined using an enzyme-linked immunosorbent assay. The salivary levels of 8-OHdG, P. gingivalis, and T. forsythia in the periodontitis patients were significantly higher than those in healthy subjects. By contrast, the A. actinomycetemcomitans level in healthy subjects was higher than that in periodontitis patients. 8-OHdG was significantly correlated with P. gingivalis. Statistically significant decreases in the levels of P. gingivalis, probing depth, bleeding on probing, and 8-OHdG were observed after initial periodontal treatment. These results suggest that the 8-OHdG levels in saliva reflect the load of periodontal pathogens. 8-OHdG could be a useful biomarker for assessing periodontal status accurately, and for evaluating the efficacy of periodontal treatment.     

Age-related changes in immunoglobulin isotypes in whole and parotid saliva and serum in healthy individuals

Mucosal Infections account for the majority of infections seen in elderly people, but little is known of whether mucosal immunity decrease with age. The objective of this study was to investigate the effect of age on the levels of salivary and serum immunoglobulins and the salivary immunoglobulin secretion rates in a healthy adult population. Healthy subjects (116 total) were divided into the following age groups: 20–39; 40–59; 60–79 and >80 years. Unstimulated (resting) whole and stimulated parotid saliva and serum were collected from all participants. Salivary and serum immunoglobulins were quantified by enzyme-linked immunosorbent capture assays. The levels of serum immunoglobulin G (IgG) and IgM were significantly reduced in the oldest age group, whereas no significant reduction in the level of IgA with age was observed. The IgG and IgA levels in whole saliva increased significantly in the oldest age group D, but no changes were detected in IgM levels. No significant changes in any immunoglobulin levels with age were found in parotid saliva. However, significant reductions in the secretion rates of IgA and IgM, but not IgG, in whole saliva were detected in the oldest age group. No significant changes in the secretion rates in parotid saliva were found with age. Our results demonstrate a decline in immunoglobulin secretion rates in saliva and in circulating immunoglobulin concentrations with increased age, which may contribute to the increased susceptibility of elderly individuals to infectious diseases.     

Assessing the levels of immunoglobulins in the saliva of diabetic individuals with periodontitis using checkerboard immunodetection

BACKGROUND: Current methods for determining salivary antibodies are cumbersome for large-scale screenings. OBJECTIVES: To test checkerboard immunodetection for monitoring salivary antibodies and to profile them in diabetic individuals with periodontitis. METHODS: Salivary anti-Porphyromonas gingivalis, anti-Actinobacillus actinomycetemcomitans and total IgA levels of 10 individuals were compared using checkerboard immunoblotting and enzyme-linked immunosorbent assay (ELISA). RESULTS: Close correlation between both methods was found in anti-P. gingivalis IgA and total IgA, but not in anti-A. actinomycetemcomitans IgA, because of high background levels in ELISA. Thereafter, checkerboard immunodetection was used to compare salivary antibodies of 20 adult type II diabetic with 32 non-diabetic individuals with (n=22) or without (n=10) periodontitis. Patients with periodontitis (regardless of their diabetic condition) expressed increased levels of total IgA in both whole and parotid saliva, but reduced levels of anti-A. actinomycetemcomitans IgA in whole saliva. Consequently, the proportion of anti-A. actinomycetemcomitans IgA in the total IgA was lower in saliva of patients with periodontitis compared with healthy controls. CONCLUSIONS: Checkerboard immunodetection was reliable and economical for screening saliva samples for multiple antibody reactions. Our results support previous reports which suggested that patients with periodontitis are able to secrete high levels of salivary Ig, but are hampered in targeting their salivary response toward A. actinomycetemcomitans.     

Salivary cytokine levels in subjects with chronic periodontitis and in periodontally healthy individuals: a cross-sectional study

Background and Objective: Saliva has been proposed as a noninvasive diagnostic fluid that could be used in the diagnosis of oral and systemic diseases. The levels of salivary biomarkers, such as cytokines, could potentially be used as a surrogate to distinguish periodontally healthy individuals from subjects with periodontitis. Therefore, the goal of the present investigation was to determine if the levels of 10 different cytokines in saliva differed between a group of periodontally healthy individuals and a group of subjects with periodontitis. Correlations between the concentrations of these 10 cytokines and clinical parameters of periodontal disease were also examined. Material and Methods: In this cross‐sectional study, 74 subjects with chronic periodontitis and 44 periodontally healthy individuals were periodontally examined and had the levels of granulocyte–macrophage colony‐stimulating factor, interleukin‐1β, interleukin‐2, interleukin‐4, interleukin‐5, interleukin‐6, interleukin‐8, interleukin‐10, interferon‐γ and tumor necrosis factor‐α measured in whole saliva using a multiplexed bead immunoassay (Luminex). Significance of statistical differences in the levels of salivary cytokines between groups was determined using nonparametric analysis of covariance, adjusting for age and smoking status. The Spearman rank correlation coefficient was used to explore associations between the mean levels of salivary cytokines and mean clinical parameters. Results: There were no statistically significant differences between groups for any of the cytokines. There were weak, statistically significant positive associations between salivary interleukin‐8 and pocket depth (r_s = 0.2, p < 0.05) and bleeding on probing (r_s = 0.2, p < 0.05), and weak negative correlations between salivary interleukin‐10 and attachment level (r_s = ?0.2, p < 0.05) and bleeding on probing (r_s = ?0.3, p < 0.001). Conclusion: Mean salivary levels of granulocyte–macrophage colony‐stimulating factor, interleukin‐1β, interleukin‐2, interleukin‐4, interleukin‐5, interleukin‐6, interleukin‐8, interleukin‐10, interferon‐γ and tumor necrosis factor‐α could not discriminate between periodontal health and disease.     

The relationship of stress and anxiety with chronic periodontitis

AIM: This case-control study investigates the relationship of stress and anxiety with periodontal clinical characteristics. METHOD: Seventy-nine selected patients (mean age 46.8+/-8 years) were assigned to three groups in accordance with their levels of probing pocket depth (PPD): control group (PPD< or =3 mm, n=22), test group 1 (at least four sites with PPD > or =4 mm and < or =6 mm, n=27) and test group 2 (at least four sites with PPD >6 mm, n=30). An inclusion criterion of the study required that patients presented a plaque index (PI) with a value equal to or larger than 2 in at least 50% of dental surfaces. All subjects were submitted to stress and anxiety evaluations. Stress was measured by the Stress Symptom Inventory (SSI) and the Social Readjustment Rating Scale (SRRS), while the State-Trait Anxiety Inventory (STAI) was used to assess anxiety. Clinical measures such as PI, gingival index (GI), PPD and clinical attachment level (CAL) were collected. Patient's medical history and socioeconomic data were also recorded. RESULTS: The mean clinical measures (PI, GI, PPD and CAL) obtained for the three groups, were: control group, 1.56+/-0.32, 0.68+/-0.49, 1.72+/-0.54 and 2.04+/-0.64 mm; group 1, 1.56+/-0.39, 1.13+/-0.58, 2.67+/-0.67 and 3.10+/-0.76 mm, group 2, 1.65+/-0.37, 1.54+/-0.46, 4.14+/-1.23 and 5.01+/-1.60 mm. The three groups did not differ with respect to percentage of clinical stress, scores of the SRRS, trait and state anxiety. Frequency of moderate CAL (4-6 mm) and moderate PPD (4-6 mm) were found to be significantly associated with higher trait anxiety scores after adjusting for socioeconomic data and cigarette consumption (p<0.05). CONCLUSIONS: Based on the obtained results, individuals with high levels of trait anxiety appeared to be more prone to periodontal disease.     

The effects of periodontal therapy on serum and salivary leptin levels in chronic periodontitis patients with normal body mass index

Abstract

Summary. Leptin concentrations are altered in favour of pro health after periodontal therapy. Background. Leptin, a non-glycosylated peptide hormone, not only maintains fat stores, but is also an integral part of host defense repertoire. Leptin levels have been found to be altered in an array of inflammatory diseases including chronic periodontitis (CP), but the role of non-surgical periodontal therapy (NSPT) in altering the leptin concentrations in saliva and serum of CP patients is yet to be ascertained. The aim of the present study is to quantify leptin levels in CP patients having normal body mass index (BMI) pre-therapy as compared to periodontally healthy controls and to address whether successful NSPT alters leptin concentration in serum and saliva. Materials and methods. Twenty-two saliva (modified draining method) and serum samples (by venipuncture) were collected from CP patients with normal BMI (n = 22), before and at 4 and 12 weeks after completion of NSPT, and periodontally healthy, age- and gender-matched controls (n = 22). Leptin levels were estimated using enzyme linked immunosorbent assay kits. Results. At baseline, CP patients had significantly different periodontal clinical parameters and the leptin concentrations in saliva of CP patients were found to be significantly lower than periodontally healthy volunteers (4710.10 ± 1133.21 vs 8721.10 ± 1019.58 pg/ml) (p < 0.05), whereas in serum the leptin concentrations were significantly higher than healthy controls (10749 ± 2062.24 vs 8085.00 ± 2859.68 pg/ml). Significant improvement in periodontal parameters, serum and salivary leptin levels were observed in CP patients at 4 and 12 weeks post-therapy (p < 0.01). Conclusion. Altered concentrations of leptin in serum and saliva are observed in CP patients which can be restored in favor of health after periodontal therapy.     

慢性牙周炎和慢性阻塞性肺疾病急性加重患者血清PCT水平及其与疾病关系探讨

目的 通过比较慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease,AECOPD）患者和稳定期患者的牙周、肺功能状况及血清降钙素原（serum procalcitonin,PCT）水平,探究AECOPD和牙周炎的内在联系。方法 选择AECOPD、慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）稳定期共90例患者为研究对象,根据患者的牙周炎分期分为8组：AECOPD伴Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期牙周炎和COPD稳定期伴Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期牙周炎。对各组患者的一般信息、牙周袋探诊深度（pocket probing depth,PPD）、临床附着丧失（clinical attachment loss,CAL）、菌斑指数（plaque index,PLI）、龈沟出血指数（sulcus bleeding index,SBI）、第1秒用力呼气容积占用力肺活量百分比（percentage of 1 second expiratory volume to forced vital capacity,FEV1/FVC%）、第1秒用力呼气的容积占预计值的百分比（percentage of the estimated volume of forced exhalation in the first second,FEV1%pred）以及血清降钙素原水平进行统计分析。结果 AECOPD和稳定期患者年龄、性别、BMI、吸烟状况均无统计学意义（P>0.05）;AECOPD患者Ⅲ期、Ⅳ期牙周炎比例明显高于稳定期患者（P＜0.05）;Ⅰ期牙周炎患者中AECOPD组PPD、SBI显著高于稳定期组;Ⅱ期牙周炎患者中AECOPD组PPD、CAL显著高于稳定期组;Ⅲ期牙周炎患者中AECOPD组SBI、CAL显著高于稳定期组;Ⅳ期牙周炎患者中AECOPD组PLI、CAL显著高于稳定期组（P＜0.05）。AECOPD及稳定期患者随着牙周炎严重程度增加,FEV1/FVC%、FEV1%pred依次降低（P＜0.01）。AECOPD组患者血清中不同牙周状况下PCT水平均显著高于稳定期组患者（P＜0.01）;血清中的PCT水平与PPD（r=0.60,P＜0.01）、CAL（r=0.58,P＜0.01）、SBI（r=0.31,P=0.03）成显著正相关,与FEV1/FVC%（r=-0.79,P＜0.01）、FEV1%pred（r=-0.80,P＜0.01）成显著负相关。结论 本研究结果提示牙周炎与AECOPD可能存在相互促进作用,血清PCT可能在一定程度上反映COPD患者牙周炎严重程度及急性加重风险。     

Prevalence of yeasts in saliva and root canals of teeth associated with apical periodontitis

AIMS: To determine: (i) the relative prevalence and diversity of yeasts in salivary and root canal samples from the same patients; and (ii) the clinical factors associated with their presence in saliva and root canals. METHODOLOGY: Sixty root canal samples from teeth associated apical periodontitis and the corresponding whole unstimulated saliva samples were obtained from 55 patients. The medical history including antibiotic therapy and clinical/radiographic data on the teeth were recorded. The samples were serially diluted and cultured on yeast & fungi-selective sabouraud dextrose agar. Isolates were characterized and speciated by the germ tube formation test, hyphal morphology and a commercial biochemical test kit (Rapid ID32C(R) system). RESULTS: Twenty-three yeast isolates were recovered from 19 saliva samples and eight isolates from six root canal samples. Candida albicans (17/23 & 3/8) and Rodotorula mucilaginosa (2/23 & 4/8) were the most prevalent isolates from saliva and root canal samples. It was significantly (13.8 times) more probable that yeasts would be recovered from root canals when they were also present in the saliva (P = 0.021). The effect of coronal restoration leakage (P = 0.08) and previous root canal treatment (P = 0.123) were equivocal. The history of antibiotic therapy had no association with the presence of yeasts in saliva (OR = 1.1). CONCLUSIONS: Yeasts occurred relatively infrequently (10%) in root canals. Their presence in root canals was significantly associated with their presence in saliva. The role of yeasts in the initiation and perpetuation of periapical disease remains to be determined.     

Relationship between herpesviruses and periodontopathogens in patients with HIV and periodontitis

Background: The purpose of the present study is to verify a possible association between herpesviruses and periodontal pathogens in individuals with human immunodeficiency virus (HIV) and periodontitis. Methods: Twenty‐seven patients with HIV and chronic periodontitis and 23 patients with HIV and gingivitis were included in the study. Probing depth, clinical attachment loss, gingival index, and plaque index were recorded. Blood, saliva, and subgingival plaque were processed for viral and bacterial identification. Bacteria were identified by 16S rRNA‐based polymerase chain reaction and viruses by the nested polymerase chain reaction. Results: For the chronic periodontitis group, Epstein‐Barr (EBV)‐1 (70.4%) and Tannerella forsythia (Tf) (51.8%) presented higher detection in subgingival plaque and saliva (81.5% and 40.7%, respectively) than in blood (22% and 0%, respectively) (P <0.005 and P <0.0001, respectively). Porphyromonas gingivalis (Pg) was more frequent in subgingival plaque (77.7%; P <0.0001). In the gingivitis group, Pg and human cytomegalovirus (HCMV) presented higher frequency in subgingival plaque (95.6% and 91.3%, respectively; P <0.0001 and P = 0.004). Tf and EBV‐1 were detected more frequently in subgingival plaque (47.8% and 78.3%, respectively) and saliva (52.2% and 52.2%, respectively; P = 0.004 and P <0.005) than in blood. EBV‐1, EBV‐1–HCMV, and presence of different viruses presented an association with periodontitis in saliva. Conclusions: No association was detected for herpesviruses and periodontal pathogens in patients who are HIV‐positive with periodontitis. EBV‐1 and coinfection (EBV‐1–HCMV) were associated with patients who are HIV‐positive with periodontitis.     

Azithromycin as an adjunctive treatment of aggressive periodontitis: 12-months randomized clinical trial

Aim: To assess the effect of systemic azithromycin as a supplement to scaling and root planing (SRP) in the treatment of aggressive periodontitis (AgP).
Material and Methods: Twenty-four individuals (13–26 years old) underwent a plaque control program, and then were treated with SRP. Subjects were assigned randomly into two groups; the test group used 500 mg azithromycin once a day for 3 days, whereas the control group used a placebo. Clinical variables were assessed at baseline, 3, 6, 9, and 12 months. The periodontal status at baseline and 12 months was compared using the Wald test, and adjusting for the effect of clustering of teeth within subjects.
Results: There were no significant differences in visible plaque, gingival bleeding, and supragingival calculus between groups throughout the study. Periodontal probing depth (PPD) and clinical attachment level improved significantly from baseline to 12 months in both groups, with the test group showing significantly more reduction in mean PPD compared with controls (2.88 mm versus 1.85 mm, respectively, p =0.025). Subjects administering azithromycin showed a higher percentage of teeth with attachment gain 1 mm (81.34 versus 63.63, p =0.037), whereas the controls had higher percentage of teeth with attachment loss 1 mm (11.57 versus 2.24, p =0.015).
Conclusions: The adjunctive use of azithromycin has the potential to improve periodontal health of young patients with AgP.