Is the severity of periodontitis related to gingival crevicular fluid and serum high-sensitivity C-reactive protein concentrations?

BACKGROUND: Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth supporting tissues leading to tooth loss. Periodontal diseases are associated with an increase in CRP (C-reactive protein) levels. Release of the cytokines such as prostaglandin-E2 (PGE2), and interleukin-1-beta (IL-1ß) from the periodontal lesion, stimulate hepatocytes and circulating leukocytes to produce CRP. The purpose of this cross-sectional study was to evaluate serum levels of hs-CRP (high sensitive C-reactive protein) and gingival crevicular fluid (GCF) levels of hs-CRP, PGE2, and IL-1ß in patients with varying degrees of periodontal disease. METHODS: A total of 60 (30 mild and 30 severe) chronic periodontitis patients were included in this study. GCF and serum samples were collected and whole-mouth clinical periodontal measurements were recorded. GCF levels of hs-CRP, PGE2, IL-1ß, and serum levels of hs-CRP were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Serum hs-CRP levels were measured by latex-enhanced immunoturbidimetric assay. Correlation analyses were performed between the sampled site PD, CAL, and the biomarkers. RESULTS: The groups were similar with regard to age, gender, and number of teeth. All periodontal clinical parameters were increased in the severe periodontitis group. GCF IL-1ß and PGE2 levels were significantly higher in the severe periodontitis group than in the mild periodontitis group (p = 0.04). Serum and GCF levels of hs-CRP were not significantly different between severe and mild cases. There was no significant correlation between serum and GCF levels of CRP. GCF IL-1ß levels were positively correlated with the PD of the sampled site (r = 0.52, p = 0.003). CONCLUSIONS: IL-1ß in GCF could be a marker of disease severity and activity. Neither serum nor GCF levels of hs-CRP differed with disease severity. Serum hs-CRP levels did not reflect GCF levels in periodontitis patients. Local and systemic involvement of CRP in periodontal disease remains to be determined.

Increased proliferation and decreased membrane permeability as defense mechanisms of Fusobacterium nucleatum against human neutrophilic peptide-1.

Human neutrophilic peptides (HNPs) constitute a class of host defense molecules, which contribute to the non-oxidative killing of bacteria and other microorganisms. Since the adaptability is crucial to bacterial survival in changing environments, it is of interest to know how Fusobacterium nucleatum, the major bridge organism connecting early and late colonizers in dental biofilms, defends itself against HNPs. This study aimed to examine the planktonic growth, membrane permeability, and biofilm formation characteristics as defense mechanisms of F. nucleatum against HNP-1. In all experiments, the type strain of F. nucleatum (ssp. nucleatum ATCC 25586) and two clinical strains (ssp. nucleatum AHN 9508 and ssp. polymorphum AHN 9910) were used. Planktonic growth (measured in colony forming units), capsular polysaccharide production (visualized by Ziehl-Neelsen stain), membrane permeability (demonstrated as N-phenyl-1-naphthylamine uptake), biofilm formation, and established biofilm development (measured as total mass and polysaccharide levels) were analyzed in the presence of 0 µg/ml (control), 1 µg/ml, 5 µg/ml, and 10 µg/ml of HNP-1. Planktonic growth of the strains AHN 9508 and ATCC 25586 were significantly (p<0.05) increased in the presence of HNP-1, while their membrane permeability decreased (p<0.005) in the planktonic form. HNP-1 decreased the biofilm formation of the strains ATCC 25586 and AHN 9910, whereas it increased the growth of the strain AHN 9508 in established biofilms. Capsule formation and polysaccharide production were not observed in any strain. We conclude that the inhibition of the membrane permeability and the increase in planktonic and established biofilm growth could act as bacterial defense mechanisms against neutrophilic defensins. In addition, this strain-dependent survival ability against HNP-1 may explain the variation in the virulence of different F. nucleatum strains.

The association between periodontal disease and chronic obstructive pulmonary disease: a case control study.

INTRODUCTION: Although there are studies evaluating the effects of periodontal health on chronic obstructive pulmonary disease (COPD), the effects of COPD - a systemic disease, on periodontal tissue is unknown. The aim of this study is to evaluate the effects of COPD on periodontal tissues by comparing COPD patients and controls. METHODS: Fifty-two COPD patients and 38 non-COPD controls were included in this case-control study. Number of teeth, plaque index (PI), gingival index (GI), bleeding on probing, clinical attachment level and probing depth were included in the periodontal examination. In addition to clinical evaluations, gingival crevicular fluid (GCF) levels of high-sensitive C-reactive protein (hs-CRP), interleukin-1 beta (IL-lb) and prostaglandin-E2 (PGE2), and serum hs-CRP levels were measured in COPD patients and the controls. RESULTS: The number of teeth was significantly lower while PI and GI were significantly higher in COPD patients when compared to the controls. As well as serum hs-CRP levels, the GCF levels of hs-CRP, IL-1b and PGE2 were significantly higher in COPD patients than the controls. CONCLUSION: Our results demonstrated that COPD may be associated with periodontal disease as manifested by lower number of teeth and higher levels of inflammatory mediators especially CRP in GCF. This finding may be a reflection of systemic effects of COPD on periodontal tissues. Poor oral health behavior of COPD patients have to be considered in larger size group studies in the future.

Evaluation of blood cell attachment on Er: YAG laser applied root surface using scanning electron microscopy.

BACKGROUND: Periodontal regeneration is dependent on the uninterrupted adhesion, maturation and absorption of fibrin clots to a periodontally compromised root surface. The modification of the root surface with different agents has been used for better fibrin clot formation and blood cell attachment. It is known that Er:YAG laser application on dentin removes the smear layer succesfully. AIM: The aim of this study is to observe blood cell attachment and fibrin network formation following ER:YAG laser irradiation on periodontally compromised root surfaces in comparison to chemical root conditioning techniques in vitro. MATERIALS AND METHODS: 40 dentin blocks prepared from freshly extracted periodontally compromised hopeless teeth. Specimens were divided in 5 groups; those applied with PBS, EDTA, Citric acid and Er:YAG. They were further divided into two groups: those which had received these applications, and the control group. The specimens were evaluated with scanning electron microscope and micrographs were taken. Smear layer and blood cell attachment scoring was performed. RESULTS: In the Er:YAG laser applied group, smear layer were totally removed. In the blood applied specimens, better fibrin clot formation and blood cell attachment were observed in the Er:YAG group. In the group that had been applied with citric acid, the smear layer was also removed. The smear layer could not be fully removed in the EDTA group. CONCLUSION: Er:YAG laser application on the root dentin seems to form a suitable surface for fibrin clot formation and blood cell attachment. Further clinical studies to support these results are necessitated.

Oral status and Candida colonization in patients with Sjögren's Syndrome.

OBJECTIVE: To determine the oral status, salivary flow rate, Candida carriage in saliva, and prevalence of Candida albicans colonization in several areas of the mouth in patients with primary and secondary Sjögren's syndrome as opposed to those of healthy subjects. STUDY DESIGN: Thirty-seven patients with Sjögren's syndrome (SS), [14 patients with primary SS (SS-1) and 23 patients with secondary SS (SS-2)], along with 37 healthy controls were examined in regard to number of teeth, pro-bing pocket depth (PPD), approximal plaque index (API), bleeding on probing (BOP), presence of prosthetic appliances and smoking habits. Salivary flow rate (SFR), Candida carriage in saliva, presence of Candida albicans colonization on buccal, angular, palatal and sulcular areas, on dentures and on the tongue's dorsal surface were determined. Statistical analyses were performed using the 2-tailed Fisher exact and Kruskal-Wallis test. RESULTS: No statistically significant difference was found between SS-1 and SS-2 groups based on the parameters analysed. Statistically significant differences were observed between patients with SS and healthy subjects in terms of SFR, oral signs and symptoms, API, BOP, C. albicans colonization on tongue and buccal area, and Candida carriage in saliva. In the gingival crevicular fluid positive C. albicans colonization was found in only one subject of SS subgroup. CONCLUSIONS: SS patients carry a higher risk of having periodontitis and are more predisposed to develop candidiasis. C. albicans is scarcely detected in gingival crevicular fluid despite high scores on C. albicans colonization in different areas of the oral cavity in SS patients.

Periodontal treatment outcomes in post menopausal women receiving hormone replacement therapy.

PURPOSE: To evaluate the effect of hormone replacement therapy(HRT) on periodontal treatment outcomes in a group of postmenopausal women with periodontitis. MATERIALS AND METHODS: 23 post-menopausal chronic periodontitis patients were included in this study. The test group(n=11) consisted of women who started HRT with this study and received conjugated estrogen and medroxyprogesteron. The control group(n=12) was women not taking any HRT or supplement therapy. Study groups received the same periodontal treatment. All subjects examiend by recording the following: plaque index (PI), sulcus bleeding index (SBI), periodontal pocket depth (PD) and relative attachment level (RAL) from 6 sites in each tooth. Measurements were recorded at the baseline, 1 month, 3 months, and 6 months following periodontal treatment. Serum estrogene level and bone mineral density was recorded at baseline and 6 months following periodontal treatment. RESULTS: The GI change was greater in the control group. There wasn't significant difference by means of PD, the attachment gain was significantly greater in the HRT receiving group. CONCLUSION: HRT seems to have a positive effect on periodontal treatment outcomes.

The effects of periodontal therapy on intracrevicular prostaglandin E2 concentrations and clinical parameters in pregnancy.

BACKGROUND: The increase in circulating levels of progesterone during pregnancy stimulates production of prostaglandins, especially prostaglandin E2, possibly resulting in pregnancy gingivitis. The purpose of this study is to evaluate the influence of prostaglandin E2 concentrations on gingival tissues in pregnancy and to assess its relationship to clinical parameters. METHODS: This study evaluates the effects of periodontal treatment on clinical indices including plaque index, gingival index, probing depth, and gingival crevicular fluid prostaglandin E2 levels of 22 pregnant women in their first, second, and third trimesters. Initial periodontal therapy consisting of scaling, root planing, and oral hygiene instruction was performed at the beginning of the first trimester and repeated each trimester. Prostaglandin E2 concentrations in gingival crevicular fluid were determined using a commercially available enzyme immunoassay kit. The statistical tests used were paired sample test and correlation analysis. RESULTS: The results of the study show that periodontal therapy has resulted in an improvement in clinical parameters (P<0.05). There is also a statistically significant decrease in levels of prostaglandin E2 at the second and third trimesters following periodontal therapy (P <0.001). The correlation between prostaglandin E2 concentrations and clinical parameters is found to be non-significant (P >0.05). CONCLUSIONS: Our data indicate that levels of prostaglandin E2 in gingival crevicular fluid may be used as a marker of gingival inflammation in order to determine the effects of periodontal therapy in pregnancy. Periodontal therapy that is performed throughout the entire pregnancy period may help prevent the threat of pregnancy gingivitis.

The effect of sociocultural status on periodontal conditions in pregnancy.

BACKGROUND: The effects of sociocultural status on periodontal conditions in pregnant women have been reported by a number of researchers and there have been speculations about the effects of hormonal changes, patients' systemic health, and socio-cultural characteristics on periodontal health during pregnancy. METHODS: This study evaluates the periodontal condition of 61 pregnant women at their first, second, and third trimesters, and the relation between the demographic (age, professional level, education) and clinical variables (previous periodontal care, frequency of tooth brushing). The clinical indices, including plaque index, gingival index, and probing depth measurements were repeated at the first, second, and third trimesters. The statistical tests used were stepwise analysis and paired sample test. RESULTS: The results of the study showed that the plaque index, gingival index, and probing depth scores increased gradually in the first, second, and third trimesters, although oral hygiene instructions were given to the entire study population. The level of statistical significance was established at P <0.05. When the clinical parameters and demographic variables were compared, only educational level and periodontal care seemed to be statistically significant (P<0.05). CONCLUSIONS: Our clinical index scores were related to the educational level of the study population. When the educational level of the study group decreased, the plaque, gingival index, and probing depth scores contrarily increased. Also non-attendance for previous periodontal care increased the scores of plaque index and probing depth. In view of the results of our study, it might be suggested that simple preventive oral hygiene programs may help maintain healthy gingiva during pregnancy.

Arteriovenous malformation of the mandible: a case report.

Arteriovenous malformations (AVMs) are an abnormal collection of blood vessels. They are extremely rare congenital or acquired abnormalities in the structure of blood vessels. These malformations have been associated with severe hemorrhage resulting in significant morbidity and mortality. Gingival bleeding seems to be a common symptom of most documented cases of AVM, and radiographs most often appear normal. A 12-year-old girl who was first examined by a general dentist for occasional bleeding associated with the right mandibular teeth was referred to the University of Istanbul, Faculty of Dentistry. During the suturing process to stop the leakage around the mandibular right first molar, uncontrollable hemorrhage began. Magnetic resonance imaging and angiogram revealed the AVM of the right mandibular body. After embolization with an injection of a mixture of cyanoacrylate and lipiodol, the tooth was extracted and initial periodontal therapy performed. The patient has maintained a satisfactory gingival and oral condition since the completion of dental treatment and establishment of oral hygiene. Clinicians should be aware of these lesions and the impact they can have on routine procedures. Proper recognition and therapeutic intervention can help to avoid serious complications and potentially tragic outcomes.

Detection of implant crevicular fluid prostaglandin E2 levels for the assessment of peri-implant health: a pilot study.

Inflammatory changes in the peri-implant tissues may lead to peri-implantitis and bone loss. Prostaglandin E2 has been shown to have proinflammatory effects on peri-implant tissues, including mediation of bone resorption. The aim of this study was to assess prostaglandin E2 levels in implant crevicular fluid and the possibility of using this method in diagnosing peri-implant mucositis. Twenty-four dental implants with 3 mm or greater probing depths comprised the test group and another 24 implants with probing depths less than 3 mm served as the control group. Plaque index (PI), gingival index (GI), and probing pocket depths (PPD) were recorded. Implant crevicular fluid was obtained by collection onto periopapers. Then, prostaglandin E2 levels were evaluated using a commercially available enzyme immuno-assay kit. PI, GI, PPD, and implant crevicular fluid (ICF) levels of prostaglandin E2 were found to be statistically significantly higher in the test group (P < 0.05). In the test group, gingival index and probing depths were found to be statistically significantly related with ICF prostaglandin E2 levels (P < 0.05). In the control group, there was no statistically significant positive correlation between clinical parameters and ICF prostaglandin E2 levels (P > 0.05). It may be speculated that biochemical tests, such as the detection of prostaglandin E2 levels in the crevicular fluid are useful diagnostic methods for the maintenance of functional dental implants.