Clinical and Microbiological Effects of Weekly Supragingival Irrigation with Aerosolized 0.5% Hydrogen Peroxide and Formation of Cavitation Bubbles in Gingival Tissues after This Irrigation: A Six-Month Randomized Clinical Trial.

INTRODUCTION: The study investigated the effect of weekly supragingival irrigation with aerosolized 0.5% hydrogen peroxide (H2O2) solution as a maintenance periodontal therapy on clinical and microbiological parameters in patients with chronic periodontitis. The other purpose was to investigate whether cavitation bubbles can penetrate not only into periodontitis-damaged tissues but also into ex vivo porcine healthy periodontal tissues. MATERIALS AND METHODS: The study included 35 systemically healthy patients with chronic periodontitis (CP). After nonsurgical periodontal debridement (NSPD), all patients were randomized into two groups: the Control group (NSDP alone, n = 18) and the Test group (NSDP plus supragingival irrigation, n = 17). Clinical (Approximal Plaque Index (API), Bleeding Index (BI), and Modified Gingival Index (MGI)) and microbiological (Polymerase Chain Reaction technology (using a micro-IDent® kit)) measurements were performed at the initial time point, 3 months, and 6 months after NSPD. The impact of supragingival irrigation on diseased gingival tissues of CP patients (n = 5) and on ex vivo porcine healthy gingival tissue samples (n = 3) was evaluated to estimate morphological changes in healthy and diseased gingival tissues. RESULTS: Morphological data revealed that supragingival irrigation caused the formation of cavitation bubbles in diseased gingival tissue of CP patients and in healthy porcine gingival tissues. The decrease in API, BI, and MGI scores after 6 months in the Test group significantly (p ≤ 0.01, p ≤ 0.05, and p ≤ 0.01, respectively) exceeded that in the Control group. Test group patients demonstrated a decrease in periodontal sites showing Pocket Probing Depth > 4 mm and, after 6 months, a statistically significant decrease in the proportion of periopathogenic bacteria. CONCLUSION: The effectiveness of mechanical periodontal treatment combined with weekly supragingival irrigation with aerosolized 0.5% H2O2 solution on clinical and microbiological parameters of periodontal tissues of periodontitis patients is reliably higher than that of mechanical periodontal debridement alone. It has been found that cavitation bubbles as a result of irrigation with the aerosolized 0.5% hydrogen peroxide solution can form not only in periodontal tissues of periodontitis patients but also in ex vivo porcine healthy gingival tissues.

Effect of Supragingival Irrigation with Aerosolized 0.5% Hydrogen Peroxide on Clinical Periodontal Parameters, Markers of Systemic Inflammation, and Morphology of Gingival Tissues in Patients with Periodontitis.

BACKGROUND Various studies have shown that non-surgical periodontal treatment is correlated with reduction in clinical parameters and plasma levels of inflammatory markers. The aim of this study was to evaluate the effect of long-term weekly supragingival irrigations with aerosolized 0.5% hydrogen peroxide as maintenance therapy followed by non-surgical periodontal treatment on clinical parameters, plasma levels of inflammatory markers, and morphological changes in gingival tissues of patients with periodontitis. MATERIAL AND METHODS In total, 43 patients with chronic periodontitis were randomly allocated to long-term maintenance therapy. The patients' periodontal status was assessed using clinical parameters of approximal plaque index, modified gingival index, bleeding index, pocket probing depth, and plasma levels of inflammatory markers (high-sensitivity C-reactive protein and white blood cell count) at baseline and after 1, 2, and 3 years. The morphological status of gingival tissues (immediately after supragingival irrigation) was assessed microscopically. RESULTS Complete data were obtained on 34 patients. A highly statistically significant and consistent reduction was observed in all long-term clinical parameters and plasma levels of inflammatory markers. Morphological data showed abundant spherical bubbles in gingival tissues. CONCLUSIONS 1. The present study showed that non-surgical periodontal treatment with long-term weekly supragingival irrigations with aerosolized 0.5% hydrogen peroxide improved clinical periodontal status and plasma levels of inflammatory markers and may be a promising method in periodontology. 2. We found that supragingival irrigation with aerosolized 0.5% hydrogen peroxide created large numbers of spherical bubbles in gingival tissues.

Total antioxidant capacity of venous blood, blood plasma, and serum of patients with periodontitis, and the effect of Traumeel S on these characteristics.

INTRODUCTION: Periodontal diseases are among the most common chronic infections in humans. Chronic low-level bacteremia and a septicemic inflammatory response have been suggested as a pathogenetic link between periodontal disease and atherosclerosis, diabetes and other systemic diseases. All this significantly increases the relevance of the search for the means for treatment and prevention of periodontal diseases. The aim of the present study was to evaluate blood count and the antioxidant capacity of venous blood, blood plasma, and serum in patients with periodontitis and control subjects with healthy periodontal tissues, and to investigate the effect of the homeopathic medication Traumeel S on the antioxidant capacity of venous blood, plasma, and serum. MATERIAL AND METHODS: The study was performed using venous blood of 21 individuals with chronic periodontitis and 22 healthy subjects. Reduction properties of venous blood, blood plasma, and serum were investigated using the method of reduction of nitroblue tetrazolium, proposed by Demehin et al. RESULTS: The data showed that there was no significant difference in venous blood hemoglobin levels or erythrocyte counts between the groups, while significantly higher leukocyte counts were observed in the periodontitis group (P<0.05). The antioxidant capacity of blood plasma was significantly higher in the periodontitis group than it was in the controls (P<0.05). Meanwhile, the antioxidant capacity of serum was significantly lower in the periodontitis group as compared with controls (P<0.05). The preparation Traumeel S had no effect on the antioxidant capacity of venous blood or blood plasma in the studied groups. CONCLUSIONS: Compared to healthy individuals, the antioxidant capacity of blood plasma in patients with periodontitis was higher, while the antioxidant capacity of serum was lower. The homeopathic medication Traumeel S had no effect on the antioxidant capacity of venous blood, blood plasma, or serum. Our findings concerning the elevated leukocyte counts in venous blood of patients with periodontitis confirm the presumption that periodontal diseases cause low-grade systemic inflammation induced by the host response to periodontal bacteria.

Inhibition of peripheral blood neutrophil oxidative burst in periodontitis patients with a homeopathic medication Traumeel S.

BACKGROUND: The anti-inflammatory effects of a homeopathic remedy, Traumeel S, have been observed in experimental and clinical studies; however, its antioxidant properties have not been elucidated. The aim of the present study was to evaluate the antioxidant effects of Traumeel S on peripheral blood neutrophils in patients with periodontitis. MATERIAL/METHODS: The study was performed using venous blood of 22 individuals with chronic periodontitis and 21 healthy subjects. The antioxidant effects of Traumeel S on the production of reactive oxygen species by unstimulated and stimulated with unopsonized E. coli neutrophils were investigated using luminol- and lucigenin-dependent chemiluminescence (CL). RESULTS: Polymorphonuclear leukocytes of periodontitis patients produced higher levels (p<0.01) of light output of lucigenin-dependent chemiluminescence and significantly reduced (p<0.01) light output of luminol-dependent chemiluminescence than analogous cells of healthy subjects. Highly diluted (10⁻4 of the stem solution) Traumeel S significantly (by approximately 50%) reduced superoxide-induced oxidation of lucigenin by unstimulated and stimulated with unopsonized E. coli polymorphonuclear leukocytes of periodontitis patients and had a tendency to intensify luminol-dependent chemiluminescence. Preincubation of the unstimulated and stimulated with unopsonized E. coli polymorphonuclear leukocytes of healthy subjects with Traumeel S exerts no inhibitory action on the luminol- and lucigenin-dependent chemiluminescence of the above-mentioned cells. CONCLUSIONS: This study indicates that Traumeel S may significantly reduce production of superoxide anion by unstimulated and stimulated peripheral blood polymorphonuclear neutrophils of periodontitis patients.

Effect of Perilla frutescens aqueous extract on free radical production by human neutrophil leukocytes.

OBJECTIVE: The present study was intended to evaluate the antioxidant properties of aqueous extract of the Perilla frutescens (L.) Britton. MATERIAL AND METHODS: The antioxidant properties of Perilla frutescens were analyzed employing neutrophil leukocytes stimulated by the nonopsonized Escherichia coli. The neutrophil leukocytes were affected by adding an aqueous extract of Perilla. The generation of the reactive oxygen species by neutrophil leukocytes was investigated using assessment of luminol- and lucigenin-dependent chemiluminescence. RESULTS: We found out that the treatment of neutrophil leukocytes with the Perilla aqueous extract inhibited the release of reactive oxygen species, measured as luminol- and lucigenin-dependent chemiluminescence, by about 30% and more than 90%, respectively. CONCLUSION: The results of this study show that the aqueous extract of the Perilla frutescens inhibits significantly free radical production by neutrophil leukocytes, which was especially obvious when the lucigenin-dependent chemiluminescence assessment method was applied.

The reduction of nitroblue tetrazolium by total blood in periodontitis patients and the aged.

UNLABELLED: Experimental data have demonstrated that impaired antioxidant capacity is associated with increased levels of reactive oxygen species (ROS) production. ROS can cause inactivation of critical enzymes and induce denaturation that renders proteins nonfunctional. Total blood is continuously exposed to oxidative stress. The aim of the current study was to investigate the reduction of nitroblue tetrazolium (NBT) by the total blood in persons with periodontitis and aged subjects. MATERIALS AND METHODS: The reduction of NBT in the total blood was measured according to a previously described procedure (Demehin et al., 2001), with modifications. Eight mL of venous blood were taken by venipuncture in the morning before meals and in portions of 2 mL placed into 4 plastic test tubes. Blood clotting was controlled with heparin (20 units/mL). Then the test tubes with blood were placed in the thermostat at the temperature of 37 degrees C and kept for 5 min. Next, NBT, the final concentration of which ranged to 1 x 10(-4), was added to the blood in the test tubes, which were kept for 20 min at the temperature of 37 degrees C. On completion of incubation, the tubes were centrifuged for 5 min at 2000 x g to sediment any cells. The supernatant was decanted into fresh test tubes, and the absorbance of NBT in the samples was measured spectrophotometrically at wave length of 570 nm at 25 degrees C. RESULTS: Total blood antioxidant capacity in the patients with periodontitis and aged subjects was significantly lower (p<0.01 and p<0.05, respectively) than in the control subjects. In conclusion, the present study raise the necessity to search for causative agents of enhanced oxidative stress in patients with periodontitis and aged subjects and thus find the methods to diminish them.

Oxidative function of neutrophils in periodontitis patients with type 1 diabetes mellitus.

BACKGROUND: The involvement of reactive oxygen species in periodontal diseases is unclear. The aim of the present study was to explore the oxidative function of neutrophilic leukocytes of the peripheral venous blood in patients with severe periodontitis and type 1 diabetes mellitus and in the control subjects with healthy periodontal tissues and without systemic diseases. MATERIALS AND METHODS: The leukocytes for the present investigation were obtained from peripheral venous blood of 38 patients with severe periodontitis and type 1 diabetes mellitus and 27 control subjects. The maximal luminol-dependent chemiluminescence and peak time values of neutrophils stimulated with non-opsonized Escherichia coli ATCC 25922 and Staphylococcus aureus 256 were measured. RESULTS: The maximal luminol-dependent chemiluminescence of neutrophils in patients with severe periodontitis, stimulated with non-opsonized Escherichia coli and Staphylococcus aureus, is mainly lower than that in the control group subjects (p < 0.001). Luminol-dependent chemiluminescence of neutrophils reached its maximal value at the same time in both the diseased and the healthy patients. CONCLUSION: In periodontitis, local non-opsonized bacteria might stimulate neutrophilic leukocytes to release oxygen species. However, these cells in patients with periodontitis are characterized by a lower intensity of luminol-dependent chemiluminescence (p < 0.001) compared to analogous findings in people with healthy periodontal tissues. This might indicate insufficient microbicidal activity of these cells in patients with periodontitis.

Generation of superoxide anion by peripheral blood leukocytes in periodontitis patients with type 1 diabetes mellitus.

UNLABELLED: The involvement of reactive oxygen species in periodontal diseases is unclear. The aim of present study was to explore oxidative function of neutrophil leukocytes of patients with severe periodontitis who have type 1 diabetes mellitus, and control subjects with healthy periodontal tissues and without systemic diseases. MATERIALS AND METHODS: The leukocytes for present investigation were obtained from peripheral venous blood of 38 patients with severe periodontitis who have type 1 diabetes mellitus and 27 control subjects. The maximal lucigenin-dependent chemiluminescence and peak time values of neutrophils stimulated with non-opsonized Escherichia coli ATCC 25922 and Staphylococcus aureus 256 were measured. RESULTS: The maximal lucigenin-dependent chemiluminescence of neutrophils of patients with severe periodontitis stimulated with non-opsonized E. coli and S. aureus was much higher than that in control subjects (p<0.001). In both affected and healthy patients, chemiluminescence of neutrophil leukocytes reached its peak value at similar time. The maximum value of chemiluminescence of leukocytes stimulated with non-opsonized E. coli in both studied groups was reached statistically significantly earlier than when stimulating with non-opsonized S. aureus bacteria (p<0.001). CONCLUSION: In periodontitis, local non-opsonized bacteria might stimulate neutrophil leukocytes to release reactive oxygen species, which can cause inflammation and destruction of periodontal tissue.

Effect of bacterial stimulants on release of reactive oxygen metabolites from peripheral blood neutrophils in periodontitis.

UNLABELLED: The aim of the present investigation was to explore the oxidative activity of peripheral blood polymorphonuclear neutrophils of periodontitis patients and of healthy subjects stimulated with non-opsonized E. coli and lipopolysaccharide of E. coli. MATERIAL AND METHODS: The leukocytes for this study were obtained from peripheral venous blood of 22 parodontitis patients and 16 healthy subjects. Oxidative activity of peripheral blood polymorphonuclear neutrophils was measured by method of the luminol-dependent chemiluminescence. RESULTS: The luminol-dependent chemiluminescence of stimulated neutrophils of periodontitis patients with non-opsonized E. coli increased less significantly (p<0.001) as compared to analogous chemiluminescence of control subjects (147126+/-8386 cpm and 189247+/-9134 cpm, respectively). However, the luminol-dependent chemiluminescence of stimulated neutrophils of periodontitis patients with lipopolysaccharide was five times higher than that of the subjects with intact periodontal tissues and comprised 13261+/-1251 cpm and 2627+/-638 cpm, respectively. CONCLUSIONS: Our study results show a complex dependence of oxidative function of peripheral polymorphonuclear neutrophils of periodontitis patients upon the nature of stimulants. Therefore further attempts should be made to evaluate its significance in the etiopathogenesis of periodontal tissue diseases of inflammatory origin.