A 3-Year-Old With Gingival Hemorrhage and Musculoskeletal Pain.

A 3-year-old had spontaneous gingival hemorrhage and bilateral limb weakness with inability to bear weight. He had no preceding oral trauma or recent infection, took no regular medications, and had no recent use of aspirin or nonsteroidal anti-inflammatory drugs; his diet was limited to primarily chicken nuggets and milk. What is the diagnosis and what would you do next?

Gingival crevicular blood as a source to screen for diabetes control in a dental office setting.

UNLABELLED: screen for diabetes control, this study compared glycosylated hemoglobin (HbAlc) levels found in GCB and serum. Methods: Patients diagnosed (n= 29), with diabetes received a venipuncture on the finger and serum blood (METHODS) obtained was tested for HbAlc status chair-side. GCB (test) was collected at site(s) with evidence of bleeding after probing and the HbAlc value was determined in the same manner as with the serum blood. Results: There was a significant correlation between serum blood and GCB using the HbAlc test. The Pearson RESULTS: tion was 0.98 (P< 0.0001). The Altman-Bland bias was -0.21 (P= 0.0095), indicating that on average, the GCB method slightly underestimated the venipuncture serum (control) method for determining HbA1c values. The Altman-Bland 95% agreement interval ranged from -1.02 to 0.6. Furthermore, the HbAlc values were independent of the gingival sites used for collection with intra-patient GCB values exhibiting a correlation value between sites of 0.91 (P< 0.0001).

Periodontal status and serum biomarkers levels in haemodialysis patients.

AIM: To investigate the association between periodontal status and serum biomarkers levels in haemodialysis patients. METHODS: This cross-sectional study included 96 haemodialysis patients. The periodontal evaluation was realized using clinical attachment level (CAL), probing depth (PD), gingival bleeding index (GBI), visible plaque index (VPI) and gingival index (GI). Biochemical and haematological data - serum albumin, phosphorus, creatinine, transferrin, ferritin, iron, alkaline phosphatase, calcium, potassium and haemoglobin - were collected from the medical records. The subject was diagnosed with periodontitis if he/she had at least two inter-proximal sites in different teeth with CAL ≥4 mm and/or at least two inter-proximal sites in separate teeth with PD ≥5 mm. RESULTS: The study population consisted of 45 men and 51 women, with mean time under haemodialysis of 45.6 ± 33.1 months. Periodontitis was observed in 59.4% of the subjects. The periodontitis group had albumin (p = 0.021) and phosphorus (p = 0.024) serum levels lower than the no periodontitis group. Thus, there was a positive association of periodontitis with hypoalbuminaemia (OR = 9.10, p = 0.006) and a negative association with hyperphosphataemia (OR = 0.21, p = 0.010). CONCLUSIONS: These findings suggest that periodontitis is associated with albumin and phosphorus serum levels in haemodialysis patients.

Can gingival crevicular blood be relied upon for assessment of blood glucose level?

UNLABELLED: Diabetes mellitus (DM) is undiagnosed in approximately half of the patients actually suffering from the disease. In addition, the prevalence of DM is more than twice as high as in patients with periodontitis when compared to periodontally healthy subjects. Thus, a high number of patients with periodontitis may have undiagnosed DM. The purpose of the present study was to evaluate whether blood oozing from a gingival crevice during routine periodontal examination can be used for determining glucose levels. MATERIALS AND METHODS: Observational cross-sectional studies were carried out in 75 patients (43 males and 32 females) with chronic periodontitis who were divided into two groups: Group I and Group II, respectively. Blood oozing from the gingival crevices of anterior teeth following periodontal probing was collected with the stick of glucose self-monitoring device, and the blood glucose levels were measured. At the same time, finger-prick blood was taken for glucometric analysis and subsequent readings were recorded. RESULTS: The patient's blood glucose values ranged from 74 to 256 mg/dl. The comparison between gingival crevicular blood and finger-prick blood showed a very strong correlation, with a t value of 3.97 (at P value = 0.001). CONCLUSIONS: The data from this study has shown that GCB collected during diagnostic periodontal examination can be an excellent source of blood for glucometric analysis.

Elevation of vitamin D-binding protein levels in the plasma of patients with generalized aggressive periodontitis.

BACKGROUND AND OBJECTIVE: Vitamin D-binding protein (DBP) is a multifunctional and highly expressed plasma protein. Among its diverse roles, including those in the immune and inflammatory responses, it is the primary carrier of vitamin D, which has been implicated in periodontitis. We hypothesized that there is a correlation between systemic DBP levels and generalized aggressive periodontitis (GAgP). MATERIAL AND METHODS: Forty-four patients with GAgP and 32 healthy controls were recruited. Clinical parameters were examined, including the mean bleeding index, probing depth, attachment loss and percentage of severely affected sites. Blood chemistry analyses were performed for each subject. Plasma levels of DBP, interleukin-6 (IL-6) and procalcitonin (PCT) were measured using ELISAs, and plasma levels of 25-hydroxy-vitamin D(3) (25(OH)D(3)) were detected using a radioimmunoassay. RESULTS: Significantly higher levels of plasma DBP, IL-6, PCT and 25(OH)D(3), as well as leukocyte counts, neutrophil counts and neutrophil percentages were found in patients with GAgP compared with healthy controls (p < 0.05 for all). Multiple linear regression analysis showed that the plasma DBP levels were significantly correlated with GAgP, plasma PCT levels and smoking status (p < 0.05 for all). In the GAgP group, the plasma DBP levels in smokers were significantly higher than those in nonsmokers (p < 0.001). CONCLUSION: Elevated plasma vitamin DBP levels are associated with GAgP.

Serum osteoprotegerin and periodontal destruction in subjects with type 1 diabetes mellitus.

AIM: Besides their role in bone metabolism, receptor activator of nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) are also known to be associated with inflammation. We explored associations between the extent/severity of periodontitis and circulating levels of sRANKL and OPG and their ratio using a cross-sectional study design. SUBJECTS & METHODS: The extent of periodontal inflammation and tissue destruction and the serum levels of sRANKL (pg/ml) and OPG (pg/ml) were determined in 80 subjects with type 1 diabetes mellitus (T1DM). Plaque-, age-, gender-, smoking-, HbA1c- and body mass index-adjusted associations between periodontal parameters and serum sRANKL, OPG and their ratio were studied using multiple linear regression analysis. RESULTS: Adjusted regression analyses of all the subjects indicated a significant positive association between AL ≥ 4 mm and severity of periodontitis and the level of serum OPG. A major drop in the strength and statistical significance of the above association was observed when the analyses included only non-smokers. Serum sRANKL level and sRANKL/OPG ratio were not associated with periodontitis. CONCLUSION: Our observations suggest that serum OPG may be an indicator of periodontal tissue destruction in T1DM.

Serum cytokine levels and periodontal parameters in ankylosing spondylitis.

BACKGROUND AND OBJECTIVE: Multiple studies support the role of periodontal disease in contributing to the chronic systemic inflammatory burden in a variety of diseases, including ankylosing spondylitis (AS), in the progression which the inflammatory process plays an important role. We assume that patients with AS are more likely to have periodontal disease than healthy individuals. The aim of this study was to determine the possible relationship between inflammatory periodontal diseases and AS by evaluating clinical periodontal parameters and serum cytokine levels. MATERIAL AND METHODS: Forty-eight adults with AS (35 women and 13 men; age range 18-56 years; mean age 34.27 years) and 48 age- and sex-matched systemically healthy control subjects participated in the study. The clinical periodontal parameters, venous blood and Bath Ankylosing Spondylitis Disease Activity Score were obtained, and serum C-reactive protein, tumour necrosis factor-α and interleukin-6 (IL-6) levels were evaluated. RESULTS: There was statistically no significant difference in the frequency of periodontitis between AS patients and the control group. Furthermore, there was no significant difference in probing depth, clinical attachment level and plaque index, and the only significant clinical difference between groups was in levels of bleeding on probing (p < 0.001). Serum concentrations of IL-6, tumour necrosis factor-α and C-reactive protein in the AS group were significantly higher than those in the control group (p < 0.001). In the AS group, there was a correlation between serum IL-6 levels and clinical attachment level (p < 0.001). CONCLUSION: The results of present study suggest that bleeding on probing was the only different periodontal parameter between the AS and the control group, and the periodontal status of patients with AS may be affected by IL-6 levels.

Smoking influences salivary histamine levels in periodontal disease.

OBJECTIVES: Histamine, a potent vasoactive amine, is increased in saliva of periodontitis patients. The present study aimed to further investigate the diagnostic potential of histamine for periodontal disease and assessed smoking, a major risk factor of periodontitis, as a possible influencing factor. METHODS: Salivary and serum samples of 106 participants (60 periodontitis patients, 46 controls) were collected. Salivary histamine was determined by a commercially available ELISA kit, and serum C-reactive protein was measured by a routine laboratory test. Cigarettes per day and packyears were assessed as smoking exposure parameters. RESULTS: Statistically significantly increased levels of salivary histamine and serum C-reactive protein were detected between the patient and control group (P = 0.022 and P = 0.001). Salivary histamine levels were significantly higher in smoking compared with non-smoking patients (P < 0.001), and salivary histamine as well as serum C-reactive protein correlated significantly positively with smoking exposure parameters (P < 0.05). CONCLUSIONS: Smoking, an established and common risk factor of periodontitis, was assessed as a possible influencing factor for salivary histamine. Most interestingly, salivary histamine differed highly significantly between smoking and non-smoking periodontitis patients. Our results suggest a possible involvement of histamine in tobacco-exacerbated periodontal disease, but do not suggest salivary histamine as a reliable diagnostic marker for periodontitis.

Proinflammatory cytokine levels in hyperlipidemic patients with periodontitis after periodontal treatment.

OBJECTIVE: The aim of this study was to evaluate the effects of periodontal treatment on serum and gingival crevicular fluid (GCF) proinflammatory cytokine levels in hyperlipidemic patients with periodontitis. MATERIALS AND METHODS: Fifty-two patients with hyperlipidemia and periodontitis and 28 systemically healthy controls with periodontitis (C) were included in the study. Hyperlipidemic groups were divided into two groups as suggested diet (HD) and prescribed statin (HS). The clinical periodontal parameters, fasting venous blood, and GCF samples were obtained, and serum tumor necrosis factor-alpha (TNF-α), interleukin (IL) 1-beta, and IL-6 levels were evaluated at baseline and at 3 months follow-up (3MFU) after the completion of the non-surgical periodontal treatment that included scaling and root planning. RESULTS: Percentage of bleeding on probing was significantly higher in the HS group than both the HD and C groups. In the HD and HS groups, there were significant decreases in serum IL-6 and GCF TNF-α levels between the 3MFU and baseline. A significant decrease was also found in GCF IL-6 at the end of the study period in the HS group. CONCLUSION: The combination of the periodontal therapy and antilipemic treatment may provide beneficial effects on the metabolic and inflammatory control of hyperlipidemia.

Reduced platelet aggregation in a boy with scurvy.

Pediatric scurvy is a rare condition characterized by perifollicular petechiae and bruising, hemorrhagic gingivitis and musculoskeletal symptoms, all assumed to be predominantly related to abnormal collagen structure. We report on a 9-year-old autistic boy with vitamin C deficiency due to a highly limited food range presenting with multiple petechiae, gum bleeding and debilitating bone pain, in whom platelet aggregometry revealed a distinctly reduced thrombocyte aggregation, normalizing after vitamin C supplementation. This observation indicates that platelet dysfunction may additionally contribute to the hemorrhagic diathesis in scurvy, and demonstrates that ascorbic acid deficiency should be considered in children with an otherwise unexplained acquired thrombocytopathy.

Hematological features in adolescents with periodontitis.

The aim of this study was to assess whether adolescent cases of periodontitis present with different hemogram findings than control subjects. This case-control study comprised 87 adolescent cases presenting with clinical attachment loss ≥3 mm in at least two teeth and 73 control subjects. Blood samples were obtained by venipuncture and analyzed in an Abbott Cell-Dyn 3,500 hematology analyzer for values of white blood cells and red blood cells, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, red-cell distribution width, platelets, and mean platelet volume. Hematocrit values were obtained using volume fractions read from capillary tubes. The associations between log-transformed hemogram variables with each of the three exposure variables "case status" (yes/no), a "high percent sites with PD ≥4 mm" (yes/no), and a "high percent sites with BOP" (yes/no) were investigated using multivariate linear regression analyses. Periodontitis cases presented with 5% higher values for the mean platelet volume than did controls. Subjects with a high percent sites with probing depth ≥4 mm had eosinophil counts that were on average 27% lower than among subjects with fewer deepened pockets. They also had 7% higher values for the mean platelet volume than did persons with less pocketing. Eosinophil counts and mean platelet volumes may be associated with the parameters of periodontitis in adolescents. While standard hematological testing did not show abnormalities in adolescents with periodontitis compared to healthy controls, eosinophil counts and mean platelet volumes may reflect periodontal inflammation.

The gingiva contains leptin and leptin receptor in health and disease.

The presence of leptin (OB) and soluble OB receptor (s-OB-R) in gingival tissue extract and gingival crevicular fluid has led the studies investigating the relationship between OB and periodontal diseases. This study aims to investigate the levels of OB and s-OB-R in serum and their presence in gingiva of healthy controls (HC), gingivitis (G), aggressive periodontitis (AP), and chronic periodontitis (CP) patients; and whether correlations exist between clinical and serum parameters, OB and s-OB-R. Seventy-seven subjects [HC (n = 20), G (n = 20), CP (n = 21), and AP (n = 16)] were included in this study. After the clinical periodontal parameter recordings and venous blood sampling, gingival tissues obtained. Serum parameters' levels determined with enzyme linked immune sorbent assay; and OB and OB-R in gingiva immunohistochemically. No significant differences were observed regarding the serum parameters [high sensitivity C-reactive protein (hs-CRP), lipids, OB, and s-OB-R] when the groups were compared (P > 0.0125). The serum OB has positive correlations with hs-CRP in the G group (P < 0.05), and s-OB-R has presented significant negative correlations with BOP in HC group (P < 0.05), with hs-CRP in G (P < 0.05) and AP groups (P < 0.05). The positive correlations were observed between the serum OB and HDL and body mass index in the CP group (P < 0.05). In all of the tissue samples of all groups, there was positive OB and OB-R immunoreactivity in the gingival epithelium. The gingival tissues contain both OB and OB-R. The serum levels of OB and s-OB-R do not vary between patients and with different periodontal conditions.

C-reactive protein as a marker of periodontal disease.

Periodontal subgingival pathogens affect local and systemic immune and inflammatory response and cause the release of cytokines; this results in periodontal destruction and initiation of an acute phase systemic inflammatory response characterized by the release of C-reactive proteins (CRP). This study set out to evaluate the serum concentration of CRP that can be used as a marker of periodontal disease as well as a risk indicator for cardiovascular disease. Based on their periodontal status, 45 patients were divided into three groups. The following clinical parameters were recorded: plaque index, gingival index, bleeding index, probing pocket depth, and clinical attachment levels. Scoring was done on six tooth surfaces for all teeth. For the CRP assessment, blood samples were collected from subjects at the time of clinical examination. The results indicated an increase in serum CRP levels in patients with generalized aggressive periodontitis and chronic periodontitis as compared to controls.

Systemic endotoxin levels in chronic indolent periodontal infections.

BACKGROUND AND OBJECTIVE: Periodontal disease has been linked with an increased risk of various systemic diseases. A plausible biologic explanation for this link includes the opportunity for oral pathogens to translocate to the circulation as a result of breakdown in integrity of the oral epithelium. This study refined a methodology used to detect endotoxin activity in the serum of subjects with indolent periodontal infections. MATERIAL AND METHODS: The QCL Kinetic Chromogenic Assay (Cambrex) is a kinetic measure of endotoxin activity. Sera from 211 pregnant women with periodontitis enrolled in the Obstetrics and Periodontal Therapy Trial were used to develop the assay further and to evaluate the detection of endotoxin activity that might accompany a low-level bacteremia in chronic periodontitis. RESULTS: We optimized the system to increase the sensitivity and reproducibility of the assay. The refined system was able to detect endotoxin activity in serum at > 0.0125 EU/mL. At baseline (13-16 wk of gestation), 35.5% of the women were positive for endotoxin activity (1.62 +/- 2.21; range: 0.38-15 EU/mL). CONCLUSION: This report describes a sensitive measure of endotoxin activity in serum. The procedure allowed us to document levels of this microbial virulence factor in serum of individuals with indolent infections such as periodontal disease.

Platelet-activating factor levels of serum and gingival crevicular fluid in nonsmoking patients with periodontitis and/or coronary heart disease.

The purpose of the present study was to investigate systemic and local levels of platelet-activating factor (PAF), a potent proinflammatory mediator implicated in cardiovascular pathophysiology in adult nonsmoking patients with periodontitis with or without coronary heart disease (CHD). Eighty-seven volunteers, 25 periodontitis patients, 19 periodontitis with CHD patients, 19 CHD patients, and 24 healthy controls were included, and periodontal conditions were assessed. Gingival crevicular fluid (GCF) and venous blood were collected, and PAF levels were measured by enzyme-linked immunosorbent assay. PAF levels in serum (303.3 ± 204 pg/ml) and in GCF (26.3 ± 6 pg/µl) of the periodontitis group with CHD, the periodontitis group (serum, 302.4 ± 241 pg/ml and GCF, 26.3 ± 8 pg/µl) and the CHD group (serum, 284.7 ± 192 pg/ml and GCF, 20.8 ± 6 pg/µl) were significantly higher than the healthy control group (serum, 65.4 ± 35 pg/ml and GCF, 7.7 ± 3 pg/µl; p < 0.05). In summary, the present study could demonstrate that in patients with periodontitis, the inflammatory mediator PAF is released into serum at least in the same range as for patients with coronary heart disease. However, no additive effects were seen when both conditions were present.

Increased levels of circulating endothelial progenitor cells in subjects with moderate to severe chronic periodontitis.

AIM: Emerging evidence shows that periodontal disease is associated with endothelial dysfunction. The purpose of this study was to determine the association between chronic periodontitis (CP) and circulating endothelial progenitor cells (EPC). MATERIALS AND METHODS: Eighty-six non-smoking subjects (36 males and 50 females, aged 35-80 years) were recruited, including 23 subjects with no or mild CP and 63 subjects with moderate to severe CP. The levels of circulating EPC were quantitatively determined by fluorescence-activated cell analysis, including CD34+/kinase insert domain-containing receptor (KDR)+ (more mature EPC) and CD133+/KDR+ (less mature EPC). Periodontal conditions, the intima-media thickness of carotid arteries and circulating biomarkers were examined. RESULTS: Subjects with moderate to severe CP exhibited an increased risk of high EPC count, compared with those with no or mild CP: CD34+/KDR+ EPC [odds ratio (OR)=9.5, 95% confidence interval (95% CI) 1.5-61.0, p=0.018; CD133+/KDR+ EPC, OR=4.6, 95% CI 1.1-19.5, p=0.039]. C-reactive protein was significantly associated with high CD34+/KDR+ EPC count and age was inversely related with high EPC count. Age, gender and CD34+/KDR+ EPC were independent variables of increased carotid intima-media thickness (p<0.05). CONCLUSION: This study shows for the first time that moderate to severe CP is associated with an increased level of circulating EPC.

The potential use of gingival crevicular blood for measuring glucose to screen for diabetes: an examination based on characteristics of the blood collection site.

BACKGROUND: This study examined conditions under which gingival crevicular blood (GCB) could be used to obtain a useful glucose reading to screen for undiagnosed diabetes during routine dental visits. METHODS: GCB and capillary finger-stick blood (CFB) glucose readings obtained with a glucometer were compared for 46 patients recruited from an urban university dental clinic. Study participants were divided into two groups based on probing depth or bleeding on probing (BOP) at the site of collection of the GCB sample. Group 1 participants had blood collected from sites with adequate BOP to obtain a sample without touching the tooth or gingival margin, whereas group 2 participants had blood collected from sites with little or no bleeding. For each group, Pearson correlations were calculated for glucose readings obtained using GCB and CFB samples, and the limits of agreement between the two samples were examined. RESULTS: For group 1 participants, correlations between CFB and GCB glucose readings were high (0.89), and the limits of agreement were acceptable (-27.1 to 29.7). By contrast, for participants in group 2, correlations between the glucose readings were lower (0.78), and limits of agreement were much broader (-25.1 to 80.5). CONCLUSION: GCB samples were suitable to screen for diabetes in persons with sufficient BOP to obtain a sample without touching the tooth or gingival margin (i.e., in patients having the basic clinical signs of gingivitis or periodontal disease).

Short-term effects of non-surgical periodontal treatment on plasma level of reactive oxygen metabolites in patients with chronic periodontitis.

BACKGROUND: Elevated levels of blood reactive oxygen species (ROS) are associated with the severity of periodontitis. Therefore, improvement of periodontitis may result in a decrease in blood ROS. However, it is unclear how periodontal treatment affects blood ROS. Recently, reactive oxygen metabolites (ROMs) were recognized as a useful measure of blood ROS. The aim of this longitudinal study was to investigate the effect of non-surgical periodontal treatment on plasma ROMs in patients with chronic periodontitis. METHODS: Nineteen subjects with chronic periodontitis (mean age: 46.8 years) were monitored at baseline (prior to scaling and root planing) and 1 and 2 months after therapy. Dental health parameters were evaluated, and plasma was obtained at these time points from patients and controls (19 subjects without periodontitis; mean age: 45.3 years). The plasma ROM level was determined using a spectrophotometric technique. RESULTS: At baseline, patients with chronic periodontitis had higher plasma ROM level (441.8 +/- 71.1 Carratelli units) than the control subjects (324.4 +/- 34.0 Carratelli units; P <0.01). Probing depth, clinical attachment level, and bleeding on probing in patients with chronic periodontitis showed a significant improvement 2 months after non-surgical periodontal treatment, and this was accompanied by a significant reduction in plasma ROM level (P <0.01). CONCLUSIONS: In patients with chronic periodontitis, non-surgical periodontal treatment was effective at improving clinical parameters and reducing plasma ROMs. The improvement in chronic periodontitis by non-surgical periodontal treatment might offer clinical benefits by decreasing blood ROS.

Total antioxidant capacity and superoxide dismutase activity levels in serum and gingival crevicular fluid in pregnant women with chronic periodontitis.

BACKGROUND: There is evidence of reduced antioxidant (AO) defense in periodontitis and pregnancy and adverse interactions between periodontitis and pregnancy. METHODS: In this study, serum and gingival crevicular fluid (GCF) total AO capacity (TAOC) and superoxide dismutase (SOD) enzyme concentrations in pregnant patients with chronic periodontitis (CP) were compared to those in non-pregnant patients. Periodontal examinations were performed and GCF/serum samples were obtained from 33 pregnant patients with CP (PCP), 18 pregnant patients with gingivitis (PG), and 21 periodontally healthy pregnant controls (P-controls), monitored in the first and third trimesters; 27 non-pregnant women with CP; and 25 non-pregnant control women. The concentrations of TAOC (automated measurement method) and SOD (spectrophotometric method) were determined. RESULTS: Periodontal parameters were higher in pregnant patients versus non-pregnant patients and in the CP group compared to controls, whereas TAOC and SOD concentrations were lower (P <0.05). All parameters, except plaque index, increased in pregnant subjects in the third trimester compared to the first trimester, whereas TAOC and SOD levels decreased (P <0.05). Periodontal parameters were highest and TAOC and SOD levels were lowest in the PCP group in the third trimester (P <0.05). CONCLUSIONS: Systemic and local GCF AO levels decreased in pregnancy and periodontitis, and AO defense reached the lowest levels in the last phase of pregnancy, whereas periodontal status deteriorated. These results suggest that reduced AO capacity may be associated with adverse periodontitis-pregnancy interactions, and each situation can be a provocative risk factor for the other.

Short-term effects of an anti-inflammatory treatment on clinical parameters and serum levels of C-reactive protein and proinflammatory cytokines in subjects with periodontitis.

BACKGROUND: Periodontal disease is the most common multifactorial disease, afflicting a very large proportion of the adult population. Periodontal disease secondarily causes increases in the serum levels of C-reactive protein (CRP) and other markers of inflammation. An increased level of CRP reflects an increased risk for cardiovascular disease. The aim of the current randomized clinical trial was to evaluate the short-term effect of a combination of dipyridamole and prednisolone (CRx-102) on the levels of high-sensitivity (hs)-CRP, proinflammatory markers in blood, and clinical signs of periodontal disease. METHODS: Fifty-seven patients with >/=10 pockets with probing depths >/=5 mm were randomized into two groups in this masked single-center placebo-controlled study: CRx-102 (n = 28) and placebo (n = 29). hs-CRP levels, inflammatory markers (interleukin [IL]-6, -1beta, -8, and -12, tumor necrosis factor-alpha, and interferon-gamma [IFN-gamma]), bleeding on probing (BOP), and changes in probing depths were evaluated. The subjects received mechanical non-surgical therapy after 42 days, and the study was completed after 49 days. RESULTS: At day 42, the differences in the hs-CRP, IFN-gamma, and IL-6 levels between the two groups were statistically significant (P <0.05), whereas no difference was found for the other inflammatory markers. There was no change in probing depth or BOP between the two groups. CONCLUSION: The administration of CRx-102 resulted in significant decreases in hs-CRP, IFN-gamma, and IL-6, but it did not significantly change BOP or probing depths.