Association of interleukin-1 beta (+3954) gene polymorphism and gingival crevicular fluid levels in patients with aggressive and chronic periodontitis.

BACKGROUND AND OBJECTIVE: The immune mechanisms and genetic variations that regulate genetic expression, production and biological activity of IL-1beta, are thought to play an important role in the pathogenesis of periodontal disease. The aims of the present study were to analyse interleukin (IL)-1beta (+3954) genotype and allele frequency in both chronic and aggressive periodontitis patients, and also to investigate whether this polymorphism is associated with gingival crevicular fluid (GCF) IL-1beta levels, periodontal disease severity and clinical parameters in subjects of Turkish origin. METHODS: A total of 147 individuals were enrolled in the study including 56 aggressive periodontitis (AP), 44 chronic periodontitis (CP) patients and 47 healthy controls (C). Single nucleotide polymorphism at IL-1beta (+3954) is analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). GCF samples were analyzed for IL-1beta, using enzyme linked immunosorbent assay (ELISA). RESULTS: The distribution of genotypes and allele frequencies for IL-1beta (+3954) were similar among the groups, in spite of a trend toward a higher frequency of allele 2 in the patient groups. The genotype distribution and allele frequencies were also not different after stratification of subjects according to the clinical attachment level (CAL < 4 mm and CAL > 4mm). No differences were found between the GCF IL-1beta levels of the different genotypes. Allele 2 was associated with increased bleeding on probing (BOP) sites in chronic periodontitis patients. CONCLUSION: The results of this study do not support that genetic polymorphism in the IL-1beta (+3954) could be identified as a susceptibility or severity factor in aggressive periodontitis, in the present population. The association of allele 2 frequency and higher percentage of BOP sites in chronic periodontitis suggest that IL-1beta (+3954) potentially play a significant but not major role in the clinical outcome.

The effect of bleaching systems on the gingiva and the levels of IL-1ß and IL-10 in gingival crevicular fluid.

OBJECTIVE: This study aimed to evaluate the color change and clinical periodontal parameters and to analyze the interleukin­1 beta (IL-1ß) and interleukin-10 (IL-10) levels in gingival crevicular fluid (GCF) of patients treated with different bleaching systems. MATERIALS AND METHODS: According to pre-established criteria, 30 healthy volunteers were selected and randomly divided into three groups (n=10): G1, home bleaching (Opalescence 35% Carbamide Peroxide, CP); G2, chemically activated office bleaching (Opalescence Xtra Boost 38% Hydrogen Peroxide, HP); G3, light-activated office bleaching (Opalescence Xtra 35% HP). Treatments were applied according to the manufacturer's recommendations. After shade evaluation, clinical periodontal parameters were evaluated as follows: gingival index (GI), plaque index (PI), and bleeding on probing (BOP). GCF were collected from six maxillary sites per patient at baseline (T0), one day (T1) after bleaching treatments, and 15 days (T2) after bleaching treatments and analyzed for IL-1ß and IL-10 by enzyme-linked immunosorbent assay. Data were subjected to statistical analysis (p<0.05). RESULTS: Spectrophotometer readings exhibited significant differences among the groups (p<0.05). The ΔE values (color change) of G3 were statistically higher than the other groups (p<0.05). The PI of G3 after 15 days was significantly higher than the PI of G2 after 15 days (p<0.05). The GI of G2 was lower than that of G1 and G3 before bleaching (p<0.05). According to BOP, no significant differences were found among the groups at any time intervals (p>0.05). In G3, the total amount of IL-1ß after 15 days was higher than the amount before bleaching (p<0.05). The IL-10 total amount and concentration levels did not exhibit any significant differences among the groups or by time (p>0.05). CONCLUSION: Home and chemically activated bleaching systems could be considered as safer in tooth whitening and maintaining gingival health when compared with a light-activated bleaching system, which might lead to increased proinflammatory cytokine (IL-1ß).

The impact of the IL-11:IL-17 ratio on the chronic periodontitis pathogenesis: a preliminary report.

OBJECTIVE: An imbalance in the pro- and anti-inflammatory cytokines may be responsible for periodontal breakdown through immune responses. This study aimed to determine the total amount, concentration and ratio of interleukin (IL)-11 and IL-17 in gingival crevicular fluid (GCF) of chronic periodontitis (CP) patients. MATERIALS AND METHODS: Forty CP patients and 20 healthy controls (C) were included. The CP group was divided into two subgroups in line with the probing depth (PD) in GCF-sampling sites (CPa: PD >or= 5 mm, CPb: PD

Interleukin-1 beta levels in gingival crevicular fluid in type 2 diabetes mellitus and adult periodontitis.

Interleukin-1 beta (IL-1beta) is a potent bone-resorptive cytokine that also mediates soft-tissue destruction by stimulating prostaglandin production and inducing collagenase and other protease activity. The literature suggests that this substance may be an important mediator of attachment loss in human periodontitis, and indicates that IL-1beta may be useful for locating sites of periodontal disease activity. There is some evidence that IL-1beta is produced by cells of the periodontium, and that it can be detected in gingival crevicular fluid (GCF). Many factors are known to contribute to the destruction of periodontal tissue. One of the most important is immune deficiency in diabetes. The aim of this study was to measure and compare the concentration of IL-1beta in the GCF of patients with non-insulin-dependent diabetes mellitus (Type 2 DM), otherwise healthy adults with periodontitis, and individuals with no periodontal disease in order to assess whether diabetes alters IL-1beta levels. We also examined relationships between GCF levels and the clinical parameters of pocket depth, plaque index, and bleeding index in each group. Seventeen patients with Type 2 DM, 17 adult periodontitis patients (AP), and 17 healthy controls were selected. The levels of IL-1beta in the GCF were quantified by ELISA. The mean IL-1beta concentrations in the Type 2 DM, AP, and control groups were 200.1 +/- 65.34 pg/microl, 131.35 +/- 67.66 pg/microl, and 80.0 +/- 36.08 pg/microl, respectively. The levels in the diabetic patients were significantly higher than those in the AP and control subjects. There were no significant correlations between IL-1beta level and any of the clinical data parameters for each group. We believe that the macrophages may over produce IL-beta in Type 2 DM and increased IL-1beta levels in diabetic patients could be linked to altered immune function.

Relationship between interleukin-6 levels in gingival crevicular fluid and periodontal status in patients with rheumatoid arthritis and adult periodontitis.

BACKGROUND: The aim of this study was to determine and compare interleukin-6 (IL-6) levels in gingival crevicular fluid (GCF) and clinical periodontal findings in patients with rheumatoid arthritis (RA) and adult periodontitis (AP). METHODS: A total of 45 patients divided into 3 groups (15 patients with RA and AP, 15 patients with AP, and 15 periodontally healthy subjects) were included in this study. Plaque index (PI), gingival index (GI), sulcus bleeding index (SBI), probing depth (PD), and attachment level (AL) values for each patient were recorded. Enzyme-linked immunosorbent assay for quantitative detection of IL-6 in each GCF sample was employed. RESULTS: No significant difference could be detected between the RA and AP groups in the mean clinical parameter data except PI. Although the mean GCF IL-6 level in the RA group was the highest, no significant difference could be found among the groups. There was only a strong negative correlation between GCF IL-6 levels and GI scores in the RA group. CONCLUSIONS: In the patients with RA, despite increased local tissue destruction potential due to autoimmunity and higher PI levels than in the AP patients, our findings suggest that medication including corticosteroid and non-steroidal anti-inflammatory drugs may decrease gingival inflammation, but the synthesis and degradation of IL-6 in gingival tissue of RA patients may be different. To our knowledge, this study is the first report determining GCF IL-6 levels in RA patients.

Destructive membranous periodontal disease (Ligneous periodontitis).

Generalized membranous gingival enlargement due to accumulation of amyloid or fibrin-like material is a rare, destructive and poorly defined disease entity. Some patients also show extraoral manifestations. The lesion is an involvement of periodontal tissues caused by the same process as ligneous conjunctivitis. In this report, 3 new cases, two of whom are siblings, are presented. Defective fibrinolysis and abnormal wound healing seem to be the main pathogenetic mechanism of this unusual disease, which should be evaluated systemically considering other mucosal involvement.

The correlation of gingival crevicular fluid interleukin-8 levels and periodontal status in localized juvenile periodontitis.

Localized juvenile periodontitis (LJP) is an early-onset periodontal disease characterized by progressive bone loss involving the permanent first molar and incisor teeth. Approximately 70% to 75% of LJP patients have impaired neutrophil chemotaxis towards a number of chemoattractants including N-formyl-methionyl-leucyl-phenyl-alanine, complement fragment C5a, leukotriene B4, and interleukin 8 (IL-8). The aim of the present study was to observe the role of IL-8 in the pathogenesis of LJP. Fourteen individuals who were systemically and periodontally healthy and 24 systemically healthy individuals diagnosed with LJP (based on the results of clinical periodontal assessments and radiographic examination) were recruited for this study. Gingival crevicular fluid (GCF) samples were obtained from anterior teeth in each subject before treatment. After evaluation of GCF amount from paper strips, enzyme-linked immunoabsorbent assay was employed to determine the amount of IL-8 in GCF. The amount and concentration of IL-8 measured was 894.5 +/- 435 pg, and 445.3 +/- 468 pg/microl for the experimental group and 747.3 +/- 543 pg and 684.7 +/- 548 pg/microl, for the control group. The correlation among the levels of cytokine and clinical parameters was assessed. It was observed that the concentration of IL-8 demonstrated a negative correlation with gingival index in the LJP group. In addition, no significant correlation was found among the total amount and concentration of IL-8, GCF volume, and clinical parameters in the control group. IL-8 is thought to enhance host defense mechanisms against gram-negative bacteria, thus providing protection against periodontal infections. Our data demonstrate that, when both the total amount and concentration of IL-8 are taken into consideration, no significant difference between LJP and healthy subjects is shown. This may indicate a less active IL-8 production compared with healthy subjects in spite of the dense Gram bacterial stimulation in LJP.

A case of chronic severe neutropenia: oral findings and consequences of short-term granulocyte colony-stimulating factor treatment.

Neutropenia is an absolute decrease in the number of circulating neutrophils in the blood which results in susceptibility to severe pyogenic infections. Various oral findings such as periodontitis, alveolar bone loss and ulceration may be seen in neutropenic patients. A case is presented of a 6 year old girl with chronic, probably congenital, severe neutropenia with frequent respiratory tract infections, recurrent oral ulcerations and significant periodontal break-down resembling prepubertal periodontitis. She was given granulocyte-colony stimulating factor (G-CSF) treatment which resulted in an increase in granulocyte count within two weeks and resolution of the neutropenic ulceration. It is suggested that G-CSF together with dental care regimens is a promising treatment model in chronic severe neutropenia cases presenting with oral manifestations.

Motor, sensory and functional recovery in patients with spinal cord lesions.

The aim of this study is to evaluate the sensory, motor and functional improvement in patients with a Spinal Cord Lesion (SCL) by recording at admission, discharge and at 12 months after discharge. Fifty-five patients (29 with paraplegia and 26 with tetraplegia) admitted to our departments of Physical Medicine and Rehabilitation between December 1992-1995. Three patients were excluded as they did not give their consent. Each patient was evaluated at admission, before discharge and at 12 months after discharge. Motor status was evaluated by the motor score (MS), sensory status by the light touch score (LTS), and functional status by the Functional Independence Measure (FIM) score. Each patient was asked to complete a patient questionnaire which was developed according to the standards of the American Spinal Injury Association (ASIA) scale. Twelve patients (10 with paraplegia and two with tetraplegia) were evaluated at 12 months after discharge. Paired samples t-test was used for statistical analysis. The mean age of the patients group was 36.42 +/- 17.70 years, the mean duration of inpatient rehabilitation was 93.87 +/- 44.95 days. The SCL was due to trauma in 45 patients, 86.50% of the cases and was complete in nine patients (17.30%) and incomplete in 19 (36.53%) with paraplegia. Six tetraplegic patients (11.53%) had complete and 18 had (34.61%) incomplete lesions. The evaluation of MS, LTS and FIM scores at admission and discharge showed significant improvement in the MS and LTS in all of the patients with incomplete lesions (P < 0.001). FIM scores showed significant improvement only in those with complete or incomplete paraplegia (P < 0.05). At 12 months follow-up there was no significant change in the MS and the LTS whereas a significant change was noted in the FIM scores (P < 0.05) in 10 paraplegic patients. In summary, the results of this study indicate that rehabilitation was effective in our SCL series although the significant gain may also be attributed to the fact that 71.1% of the study group had incomplete neurological lesions.

Diagnosis, physiology, pathology and rehabilitation of traumatic brain injuries.

Accumulating clinical and experimental studies continue to elucidate and further define the significance of intra- and extra-cranial factors which determine outcome of traumatic brain injury. These factors include severity of injury, age of the patient, presence or absence of premorbid brain insults, and associated pathophysiological events such as anoxia, respiratory arrest, hemorrage, edema, contrecoup and Wallerian degeneration. Following resolution of acute temporary symptoms, delayed complications include seizures, neurotic and psychotic disorders, earlier onset of stroke, earlier senescence, increased suicide risk, reduced life expectancy, progressive intellectual deterioration and development of symptoms comprising the post-traumatic syndrome. In spite of these diverse initial and later pathological sequelae, the reserve capacities of the brain for establishment of compensatory mechanisms can provide bases for a remarkable degree of spontaneous cerebral reorganization and recovery. The accumulating findings in patients with traumatic brain injuries reflect principles and factors underlying the organization, disorganization and reorganization of human brain function.

Reciprocal neurological developments of twins discordant for hydrocephalus.

Studies of 10 sets of twins discordant for hydrocephalus in early life revealed striking differences in degree and nature of development of verbal vs. non-verbal cognitive functions, birth order, and hand and eye preference. Despite similar (four dizygotic pairs) or identical (six monozygotic pairs) genetic endowment and grossly similar intra- and extra-uterine environmental and socio-economic influences, the consistency of the differences between the hydrocephalic children and their seemingly normal twins indicate systematic differences in pre-, peri- and/or early postnatal organization and development of hemispheric function. Follow-up studies also documented development of above-average intelligence, despite drastically reduced cerebral mantle size in hydrocephalus of early onset. The atypical patterns of development of the non-hydrocephalic twins also confirm previously described qualifications reported in studies of the significance of genetic vs. environmental factors in twins.

Diaschisis, site, time and other factors in raven performances of adults with focal cerebral lesions.

Analyses of Raven matrices performances by 35 patients with acute and 22 with chronic focal lesions restricted to the anterior or posterior regions of the left or right hemispheres illustrate the importance of controlling for diaschisis, specific site, time, age and other factors determining neuropsychological performances. These findings have important practical and theoretical implications with respect to the elucidation of principles underlying organization, disorganization and reorganization of human brain functions. They also suggest that many of the previous controversial and conflicting reports may be reconciled when these and other significant underlying factors are accounted for. Finally, they confirm Jackson's earlier observations of the critical role of the right posterior lobe in "visuopsychic" non verbal mental processes.

Translation of Broca's 1865 report. Localization of speech in the third left frontal convolution.

Modern texts continue to cite Broca's 1861 study of a single patient, Tan, as the first definitive localization of a cerebral function, specifically, articulate speech. We describe the development of Broca's theory from his initial support in 1861 for Bouillaud's view that speech is localized in both frontal lobes to his description in 1865 of a center for articulate speech in the third left frontal convolution. We have translated Broca's 1865 French report. Despite the revival of "classical" anatomically based concepts of discrete aphasic syndromes, numerous clinicoanatomical correlation studies have failed to confirm the specific language impairment described by Broca. Broca's own descriptions of language development in the third right frontal convolution following left hemisphere damage also raise questions about the validity of theories of brain-behavior relationships based on punctate localization of specific mental functions.