Effect of non-surgical periodontal therapy on CD14 + CD16+ monocyte counts in peripheral blood samples: a clinical interventional study.

Monocytes and their macrophage progeny are thought to be involved in tissue and alveolar bone destruction in periodontal disease. It has been documented that the proportion of (CD14 + CD16+) non-classical monocytes in the blood are elevated in chronic periodontitis;A total of 20 chronic generalized periodontitis patients who were otherwise healthy, were recruited for this study. At baseline and 3 weeks after non-surgical periodontal treatment, peripheral blood was obtained to assess the levels of C-reactive protein (CRP) and the proportion of monocyte subsets. Monocyte subsets were assessed using flow cytometry;The mean percentage of CD14 + CD16+ non-classical monocytes in the peripheral blood sample at baseline was 13.95 + 2.09, that reduced to 8.94 + 1.23 3 weeks after non-surgical treatment. A distinct significant reduction in the percentage of non-classical monocytes and a concomitant increase in classical monocytes were observed following periodontal treatment compared to baseline. There was a significant reduction in the all the periodontal parameters and CRP levels 3 weeks post non-surgical periodontal treatment. A positive correlation between CRP and percentage of non-classical monocytes was also observed; Periodontal treatment potentially modulates the host response effectively.

Efficacy of chlorhexidine/herbal formulation for microbial reduction in aerosol generated following ultrasonic scaling - A double-blinded randomized controlled trial.

Background: Ultrasonic scaling is a potential source of aerosol contamination in dental clinics. The two primary sources of microbial load in aerosols are from the oral cavity and dental unit water line. Literature evidence suggest that the use of preprocedural mouth rinse reduce the bacterial load in aerosol generated during ultrasonic scaling. Aim: The aim of the study is to assess the comparative efficacy of reduction in viable bacteria in the aerosol at patient's chest area, doctor's mask area and two feet beside the patient following use of chlorhexidine/herbal formulation diluted in the water source by a randomized controlled clinical trial. Materials and Methods: Forty-five subjects (with chronic gingivitis) were matched for age, gender, and gingival index score. The subjects were randomized and received ultrasonic scaling with distilled water (control)/chlorhexidine (tTest)/herbal formulation (test). Aerosol produced during scaling was collected at patient's chest area, doctor's mask area, two feet beside the patient on blood agar plates, which were incubated at 37°C for 48 h and total colony forming units (CFUs) were counted. Results: A significant reduction in the total CFUs' counts was observed at all the three sites sampled in test groups (chlorhexidine group and herbal formulation group) as compared to control (P < 0.01). Conclusion: The addition of antiseptic agents to the water source contributed to a significant reduction of the cultivable microbial counts in the aerosol and hence can be used to reduce the risk of cross-infection during ultrasonic scaling.

Proinflammatory (CD14+CD16++) monocytes in type 2 diabetes mellitus patients with/without chronic periodontitis.

BACKGROUND: Until date, the proportion of nonclassic monocytes in type 2 diabetic mellitus patients with and without chronic periodontitis has not been evaluated based on glycemic control. The objective of this study was to compare the proportion of CD14+CD16++ monocytes in type 2 diabetic patients with and without chronic periodontitis. MATERIALS AND METHODS: In this cross sectional study A total of sixty individuals with type 2 diabetes mellitus (n = 15/group) were recruited. Individuals were grouped based on glycosylated hemoglobin A (HbA 1c) values and the presence of chronic periodontitis; Group 1 (diabetes mellitus with good glycemic control), Group 2 (diabetes mellitus with poor glycemic control), Group 3 (diabetic mellitus with chronic periodontitis and good glycemic control), Group 4 (diabetic mellitus with chronic periodontitis and poor glycemic control). Fluorochrome-conjugated monoclonal antibodies against CD14, CD16, and human leukocyte antigen-antigen D related was used to analyze the proportion of nonclassic monocytes by flow cytometry. One-way ANOVA with Tukey's post-hoc test was used to assess the significant differences in monocyte subpopulations. The Pearson's correlation test was used to assess the relationship between hemoglobin A1c values and percentage of nonclassical monocytes. In both the above statistical tools, the value of P < 0.05 is considered as significant level. RESULTS: Group 4 had the highest percentage of CD14+CD16++ monocytes 14.67% + 4.70%, followed by Group 3-9.73% + 0.60%, Group 2-9.32% + 2.03% and Group 1-5.92% + 0.63% (P < 0.001). Further, a statistically significant positive correlation between HbA (1c) levels and the proportion of CD14+CD16++ monocytes was observed. CONCLUSION: In the present study, we observed type 2 diabetes mellitus patients with poor glycemic control and chronic periodontitis showed more than two-fold increase in the proportion of nonclassic monocytes compared to type 2 diabetes mellitus patients with good glycemic control.

Human umbilical cord tissue stem cells and neuronal lineages in an injectable caffeic acid-bioconjugated gelatin hydrogel for transplantation.

Present-day scaffolds are useful in cell therapy to a reasonable extent, but in pursuit of improvising the scaffold to improve the outcome, we tested a new injectable caffeic acid-bioconjugated gelatin hydrogel scaffold (CBGH; with tunable stiffness -10%). Two-dimensional (2D) form of human umbilical cord tissue-derived mesenchymal stem cells (HUCMSCs) culture performed based on our previously reported methods and characterized by using multipotent and pluripotent analysis. In addition, neurogenesis was induced in the presence of retinoic acid or neural growth factor or epidermal growth factor categorized by neuronal markers. The viability, proliferation rate, and vascular endothelial growth factor expression of HUCMSCs increased significantly in the CBGH scaffold. In addition, there was an increase in CD90 and TRA-1-81 phenotypic expressions and SOX-2, MAP-2, TAU, NeuN, and NF, which confirmed the neurogenesis of encapsulated HUCMSCs. Topographical elucidation by scanning electron microscopy data showed that the HUCMSCs proliferated and migrated inside the construct. Hematoxylin and eosin staining demonstrated a more viable structural pattern and cresyl violet staining showed the Nissl synthesis, confirming the presence of functional neurons in the encapsulated form. The molecular-level analysis further substantiated that HUCMSCs cultured in CBGH expressed significantly greater upregulation of stemness, neuronal genes, and protein expression compared with the adherent culture. Correspondingly, this is the first time that we have measured the fluorescence intensity variation of the HUCMSCs-stained cell segmentation process using customized MATLAB code execution to reduce the background noise and autofluorescence. We conclude that this novel CBGH scaffold increases the viability, proliferation, stemness, and also neuronal transdifferentiation of HUCMSCs in a three-dimensional culture than the 2D plastic adherent culture.

Cyclosporine-A induces endoplasmic reticulum stress in human gingival fibroblasts - An in vitro study.

Drug induced gingival overgrowth is one of the side effects affecting the gingiva due to administration of certain systemic drugs. Cyclosporine A is one such drug which is commonly used in organ transplant conditions. The resultant overgrowth is fibrotic and extensive in nature which could impair patient esthetics and masticatory function. Endoplasmic reticulum stress is a recently identified phenomenon implicated in other fibrotic pathologies such as lung and renal fibrosis. In fact, endoplasmic reticulum stress has been known to play an important role in cyclosporine A induced renal fibrosis. Thus in this study, we sought to identify it's role in drug induced gingival overgrowth.

Thermoreversible in situ gel for subgingival delivery of simvastatin for treatment of periodontal disease.

OBJECTIVE: The aim of this in vitro study was to formulate an in situ thermoreversible injectable gel with poloxamer (PM) and methylcellulose (MC) to deliver simvastatin (SMV) in a controlled manner. SUBJECTS AND METHODS: Preformulation studies (Fourier transform infrared and differential scanning calorimetry) to assess the interaction between SMV and MC and PM were performed before gel formulation. Keeping the concentration of SMV at 2.2%, the concentration of PM and MC was altered to formulate in situ thermosensitive gel at 37°C. Rheological studies were carried to analyze the physical property of the various formulations. Drug release profile and stability studies were done for the selected formulation. The in vitro drug release profile was carried out for using open end tube method and ultraviolet spectroscopy. RESULTS: The preformulation studies showed that there is no interaction between the polymer and drug based on the rheological studies of different formulation, the formulation. F8 gels at 37°C and attains a viscosity of 4150 cps. CONCLUSIONS: PM 25% and MC 5% formed an ideal thermosensitive injectable gel at 37°C for subgingival delivery of SMV and also show controlled drug release for the period of 10 days in vitro.

Association of microRNA-125a and microRNA-499a polymorphisms in chronic periodontitis in a sample south Indian population: A hospital-based genetic association study.

Periodontitis is a chronic inflammatory disease, caused by interaction between periodontopathic bacteria and the host immune response. MicroRNAs are small, single-stranded molecules, which play a key role in the regulation of diverse biological processes. Dysregulation of microRNAs function can lead to several diseases such as autoimmune and chronic inflammatory diseases. The objective of the study was to determine the association between selected single nucleotide polymorphisms in miR-125a, miR-499 and LIN28 homology A with chronic periodontitis susceptibility in a sample population from south India. Genotyping of the single nucleotide polymorphisms in miR-125a (rs41275794, rs12976445, rs10404453 and rs12975333), miR-499 (rs3746444) and LIN28 homolog A (rs3811463) was performed in DNA from288 controls (individuals with healthy gingiva) and 262 cases (chronic periodontitis patients) by direct dye-terminator sequencing. Disease association analysis revealed a significant association of the variant alleles of the miR-499a polymorphism (rs3746444) in chronic periodontitis [OR=2.07; 95%CI (1.35-3.17)]. The risk associated C-allele frequency was found to be higher in chronic periodontitis subjects as compared to that of healthy individuals. Similar results were also observed in the dominant model [OR=2.42; 95% CI (1.67-3.51)]. The recessive model for miR-125a polymorphism (rs12976445) was also found to be statistically significant with OR=1.54 and 95% CI (1.03-2.30). The haplotype "GCGGCA" was found to be higher in chronic periodontitis subjects than in healthy individuals. Pairwise linkage disequilibrium analysis exhibited that the polymorphisms, rs41275794 and rs12976445 in miR-125a, were in strong linkage equilibrium (D'=0.97). Epistatic interaction by multifactorial dimensionality reduction analysis revealed that the genotypes of the polymorphisms of miR-125a (rs41275794, rs12976445, rs10404453), miR-499a (rs3746444) and LIN28 (rs3811463) were interacting significantly [OR=2.54 (1.65-3.92)], thereby contributing to the risk of chronic periodontitis.

Cyclosporine-A induces endoplasmic reticulum stress and influences pro-apoptotic factors in human gingival fibroblasts.

Cyclosporine-A (CsA) induces gingival overgrowth. Cyclosporine's anti-apoptotic activity in human gingival fibroblast is due to desensitization of mitochondrial permeability transition pore (MPTP) and augmentation of anti-apoptotic, Bcl2. Alternative mechanisms of apoptosis exist involving enzymes like calcium-dependent Calpain and signaling events related to apoptosis, like Glycogen synthase kinase 3ß (GSK3ß) and protein kinase A (PKA). Cyclosporine-A in renal tubular cells induces endoplasmic reticulum stress (ER stress) which has not been explored in gingival overgrowth. Hence, this study was carried out to assess the influence of Cyclosporine-on ER stress and on the alternate anti-apoptotic mechanisms. Human gingival fibroblasts were treated with CsA, and expression of ER stress markers, such as binding immunoglobulin protein and CCAAT/enhancer-binding protein homologous protein (CHOP), MPTP, and expression of Calpain & GSK3ß /PKA were estimated. The results showed CsA-added fibroblast significantly increasing the expression of Endoplasmic reticulum stress markers. Contrary to usual ER stress outcome of apoptosis, we observed Cyclosporine's anti-apoptotic action in spite of augmented ER stress markers. We conclude that CsA's independent action on different organelles may alter the conventional outcome of ER stress.

Clinical Relevance of Cytokines Gene Polymorphisms and Protein Levels in Gingival Cervical Fluid from Chronic Periodontitis Patients.

BACKGROUND: Cytokines are suggested to play a role in periodontitis. OBJECTIVES: To determine and compare the levels of Interleukin-1 beta (IL-1ß) and Tumor necrosis factor alpha (TNF-α) in gingival crevicular fluid (GCF) samples amongst healthy individuals and those with chronic periodontitis. Further to compare the GCF cytokine levels in three genotype classes defined by the respective gene polymorphisms. METHODS: The study was conducted on 41 chronic periodontitis patients and 40 healthy volunteers. IL-1ß and TNF-α were quantified in GCF by cytometric bead array. DNA was extracted from peripheral blood samples and genotyping of IL1B +3954C/T (rs1143634) IL1B -511G/A (rs16944), TNFA -1031T/C (rs1799964) and TNFA -863C/A (rs1800630) polymorphisms were performed using Sanger sequencing and Taqman SNP genotyping assays methods. RESULTS: Both IL-1ß and TNF-α levels were significantly higher in chronic periodontitis group compared to the controls. IL-1ß and TNF-α levels did not significantly differ in genotype classes of the respective polymorphism (IL1B -511G/A, TNFA -1031T/C and TNFA -863C/A). However, individuals with CT genotype of IL1B +3954C/T showed higher levels of IL-1ß in the gingival crevicular fluid (ANOVA p<0.05). CONCLUSION: The results of this study revealed the presence of higher levels of IL-1ß and TNF-α in subjects with periodontitis and genetic control of IL-1ß levels in our samples of Indians.

Effect of Cyclosporin A and Angiotensin II on cytosolic calcium levels in primary human gingival fibroblasts.

BACKGROUND: To evaluate the effect of Cyclosporin A (CsA) and angiotensin II (Ang II) on cytosolic calcium levels in cultured human gingival fibroblasts (HGFs). MATERIALS AND METHODS: Healthy gingival samples from six volunteers were obtained, and primary HGFs were cultured. Cell viability and proliferation assay were performed to identify the ideal concentrations of CsA and Ang II. Cytosolic calcium levels in cultured gingival fibroblasts treated with CsA and Ang II were studied using colorimetric assay, confocal and fluorescence imaging. Statistical analyses were done using SPSS software and GraphPad Prism. RESULTS: Higher levels of cytosolic levels were evident in cells treated with CsA and Ang II when compared to control group and was statistically significant (P < 0.05) in both colorimetric assay and confocal imaging. Fluorescent images of the cultured HGFs revealed the same. CONCLUSION: Thus calcium being a key player in major cellular functions, plays a major role in the pathogenesis of drug-induced gingival overgrowth.

Immunohistochemical Localization of Epithelial Mesenchymal Transition Markers in Cyclosporine A Induced Gingival Overgrowth.

INTRODUCTION: Cyclosporine, an immunosuppressive agent used in the management of renal transplant patients is known to produce Drug Induced Gingival Overgrowth (DIGO) as a side effect. Several mechanisms have been elucidated to understand the pathogenesis of DIGO. Recently, epithelial mesenchymal transition has been proposed as a mechanism underlying fibrosis of various organs. AIM: The aim of the study was to investigate if Epithelial Mesenchymal Transition (EMT) operates in Cyclosporine induced gingival overgrowth. MATERIALS AND METHODS: The study involved obtaining gingival tissue samples from healthy individuals (n=17) and subjects who exhibited cyclosporine induced gingival overgrowth (n=18). Presence and distribution of E-Cadherin, S100 A4 and alpha smooth muscle actin (α-SMA) was assessed using immunohistochemistry and cell types involved in their expression were determined. The number of α- SMA positive fibroblasts were counted in the samples. RESULTS: In control group, there was no loss of E-Cadherin and a pronounced staining was seen in the all layers of the epithelium in all the samples analysed (100%). S100 A4 staining was noted in langerhans cells, fibroblasts, endothelial cells and endothelial lined blood capillaries in Connective Tissue (CT) of all the samples (100%) while α - SMA staining was seen only on the endothelial lined blood capillaries in all the samples (100%). However in DIGO, there was positive staining of E-Cadherin only in the basal and suprabasal layers of the epithelium in all the samples (100%). Moreover there was focal loss of E-Cadherin in the epithelium in eight out of 18 samples (44%). A break in the continuity of the basement membrane was noted in three out of 18 samples (16%) on H & E staining. CONCLUSION: Based on the analysis of differential staining of the markers, it can be concluded that EMT could be one of the mechanistic pathways underlying the pathogenesis of DIGO.

Natural T Regulatory Cells (n Treg) in the Peripheral Blood of Healthy Subjects and Subjects with Chronic Periodontitis - A Pilot Study.

INTRODUCTION: The T cells play a central role in the aetiopathogenesis of periodontal disease. Natural T regulatory cells (nTreg) are the key stone immunoregulatory elements having an anergic phenotype and play an important role in the suppression of exaggerated immune responses thereby maintaining homeostasis. There are increasing evidences for the role of nTreg in the periodontal disease pathogenesis. AIM: To identify the proportion of natural T regulatory cells in the peripheral blood of periodontally healthy subjects and subjects with chronic periodontitis. MATERIALS AND METHODS: A total of 15 subjects (7 with healthy gingiva and 8 with chronic periodontitis) were recruited for this pilot study. Baseline periodontal parameters were recorded and 5 ml of peripheral blood was collected. The samples from both the groups were analysed for the relative proportion of nTreg (identified by the expression CD45RB+CD4+CD25+FOXP3+) using flow cytometry. RESULTS: The mean percentages of the CD45RB+CD4+CD25+ cells expressing FOXP3 in control and chronic periodontitis group were found to be 14.75±5.04 and 43.13±11.17 respectively. The mean proportion of nTreg were compared between the control and chronic periodontitis sample using Mann-Whitney Test and was found to be statistically significant with (p<0.001). CONCLUSION: A higher proportion of nTreg in the peripheral blood sample of chronic periodontitis subjects were observed as compared to that of healthy individuals.

Polymorphic Regions in Fc Gamma Receptor and Tumor Necrosis Factor-α Genes and Susceptibility to Chronic Periodontitis in a Cohort From South India.

BACKGROUND: Polymorphisms in the immunoglobulin G Fc receptor II (FcGR) and tumor necrosis factor-α (TNFA) genes are known to influence pathogenesis and severity of several inflammatory conditions. Association of FcGR and TNFA gene polymorphisms with chronic periodontitis (CP) susceptibility has been found to be diverse among different ethnic populations. Objectives of the present study are to determine association of functional single nucleotide polymorphisms (SNPs) in FcGR and TNF-α genes with CP susceptibility in a cohort from South India. METHODS: Polymorphisms of: 1) FCGR2A 131His/Arg (rs1801274); 2) FCGR2B 232Ile/Thr (rs1050501); 3) TNFA -1031T/C (rs1799964); and 4) TNFA -863C/A (rs1800630) were analyzed among patients with healthy gingiva (n = 176) and patients with CP (n = 177). Genotyping was performed using allele-specific real-time polymerase chain reaction assay. Association between CP and SNPs was examined by multivariable logistic regression analysis with adjustment for: 1) age; 2) sex; and 3) oral hygiene index (OHI). Epistatic interaction between FcGR polymorphisms and interleukin 1B (IL1B) +3954C/T (rs1143634) was assessed using multifactorial dimensionality reduction analysis. RESULTS: Among four SNPs analyzed, only FCGR2A 131His/Arg showed significant association with CP in a dominant model (odds ratio: 1.6; 95% confidence interval: 1.028 to 2.530). This significance disappeared after correcting for multiple comparisons using Bonferroni analysis, or after adjusting for age, sex, and OHI. A significant redundant interaction between IL1B +3954 C/T and FCGR2A 131His/Arg was observed. CONCLUSION: Study results suggest the variant form of the SNP in FCGR2A 131His/Arg, FCGR2B 232Ile/Thr, TNFA -1031T/C, and TNFA -863C/A are not associated with CP susceptibility in the selected cohort from South India.

Differentiation of human gingival mesenchymal stem cells into neuronal lineages in 3D bioconjugated injectable protein hydrogel construct for the management of neuronal disorder.

The success of regeneration attempt is based on an ideal combination of stem cells, scaffolding and growth factors. Tissue constructs help to maintain stem cells in a required area for a desired time. There is a need for easily obtainable cells, potentially autologous stem cells and a biologically acceptable scaffold for use in humans in different difficult situations. This study aims to address these issues utilizing a unique combination of stem cells from gingiva and a hydrogel scaffold, based on a natural product for regenerative application. Human gingival mesenchymal stem cells (HGMSCs) were, with due induction, differentiated to neuronal lineages to overcome the problems associated with birth tissue-related stem cells. The differentiation potential of neuronal lineages was confirmed with suitable specific markers. The properties of mesenchymal stem cells in encapsulated form were observed to be similar to free cells. The encapsulated cells (3D) were then subjected to differentiation into neuronal lineages with suitable inducers, and the morphology and gene expression of transient cells were analyzed. HGMSCs was differentiated into neuronal lineages as both free and encapsulated forms without any significant differences. The presence of Nissl bodies and the neurite outgrowth confirm the differentiation. The advantages of this new combination appear to make it a promising tissue construct for translational application.

Reconstruction of interdental papilla using autogenous bone and connective tissue grafts.

Previous studies have reported the management of Class I and II papillary defects, but knowledge on Class III defects, estimated to have a poor periodontal prognosis, remains minimal. In this case report, a Class III papillary defect reconstruction was attempted mainly since the patient reported with difficulty in phonetics. In Stage I, autogenous bone graft from the maxillary tuberosity and subepithelial connective tissue graft was augmented to decrease the distance between the interdental bone crest and contact point, simultaneously achieving a switch in the periodontal biotype. In Stage II, subepithelial connective tissue graft was augmented to achieve papillary fill. To avoid manual errors associated with quantifying the posttreatment outcomes, image data processing ImageJ software was used to assess the length, perimeter, and surface area of papillary loss using the preoperative images.

Evaluation of antimicrobial properties of bioactive glass used in regenerative periodontal therapy.

CONTEXT: Bone grafting materials which have an inherent anti-microbial property against initial colonizers of plaque bacteria would be useful in regenerative periodontal surgical procedures. AIMS: This study was performed to analyze the antibacterial property of a Perioglas™ against a common oral commensal Streptococcus salivarius (early colonizer). SETTINGS AND DESIGN: In vitro observational study. MATERIALS AND METHODS: Perioglas™ (in various concentrations) was assessed for its antibacterial property against the ATCC 13419 strain of S. salivarius. The anti-microbial activity was analyzed in terms of reduction in colony-forming units in culture plates and smear following a 24 h incubation at 37°C. STATISTICAL ANALYSIS USED: Observational study - No statistical analysis applicable. RESULTS: The bioactive glass (BAG) exerted an antibacterial effect against the S. salivarius in the suspending media and smear. The antibacterial activity of BAG increased in proportion with its concentration. CONCLUSIONS: Perioglas™ demonstrated a considerable antibacterial effect against S. salivarius at 50 mg/mL concentration.

Angiotensin II Levels in Gingival Tissues from Healthy Individuals, Patients with Nifedipine Induced Gingival Overgrowth and Non Responders on Nifedipine.

CONTEXT: The Renin Angiotensin system has been implicated in the pathogenesis of Drug Induced Gingival Overgrowth (DIGO), a fibrotic condition, caused by Phenytoin, Nifedipine and Cyclosporine. AIM: This study quantified Angiotensin II levels in gingival tissue samples obtained from healthy individuals, patients on Nifedipine manifesting/not manifesting drug induced gingival overgrowth. MATERIALS AND METHODS: Gingival tissue samples were obtained from healthy individuals (n=24), patients on nifidipine manifesting gingival overgrowth (n= 18) and patients on nifidipine not manifesting gingival overgrowth (n=8). Angiotensin II levels were estimated in the samples using a commercially available ELISA kit. RESULTS: Angiotensin II levels were significantly elevated in patients on Nifedipine manifesting gingival overgrowth compared to the other 2 groups (p<0.01). CONCLUSION: The results of the study give an insight into the role played by Angiotensin II in the pathogenesis of drug induced gingival overgrowth.

Relationship between depression and chronic periodontitis.

BACKGROUND: Periodontitis is a chronic, multifactorial, polymicrobial disease causing inflammation in the supporting structures of the teeth. There is a plethora of nonoral risk factors which can be quoted to aid in the development of chronic periodontitis. According to WHO, depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt, disturbed sleep or appetite, low energy and poor concentration. Depression is associated with negligent oral health care and another mechanism proposed disturbance in the hypothalamic-pituitary axis system and hypothalamic-pituitary-thyroid system, which can affect the periodontal status by affecting the immune system. AIM: The aim of this study was to assess the association between periodontal clinical parameters and depression rating. MATERIALS AND METHODS: The study design is a case-control study with 35 patients each in case and control group. The periodontal parameters taken for measurement were probing depth and clinical attachment loss. Depression was calculated using Beck's depression scale. STATISTICAL ANALYSIS: The statistical analysis was performed by means of SPSS software (SPSS Inc., Chicago, IL, USA; version 17.0 under windows 2000). Student's t-test was used to determine the relationship between the clinical periodontal parameters and depression. RESULTS: Self-reported scoring of depression by using Beck's depression inventory has shown that periodontal patients had a significantly higher total depression score than normal controls. CONCLUSION: This study reveals that there is a direct correlation between the severity of periodontal disease and the severity of depression in patients.

The epigenetic paradigm in periodontitis pathogenesis.

Epigenome refers to "epi" meaning outside the "genome." Epigenetics is the field of study of the epigenome. Epigenetic modifications include changes in the promoter CpG Islands, modifications of histone protein structure, posttranslational repression by micro-RNA which contributes to the alteration of gene expression. Epigenetics provides an understanding of the role of gene-environment interactions on disease phenotype especially in complex multifactorial diseases. Periodontitis is a chronic inflammatory disorder that affects the supporting structures of the tooth. The role of the genome (in terms of genetic polymorphisms) in periodontitis pathogenesis has been examined in numerous studies, and chronic periodontitis has been established as a polygenic disorder. The potential role of epigenetic modifications in the various facets of pathogenesis of periodontitis is discussed in this paper based on the available literature.

Gingival, plasma and salivary levels of melatonin in periodontally healthy individuals and chronic periodontitis patients: a pilot study.

INTRODUCTION: Periodontal disease is an inflammatory condition affecting tooth supporting structures in which dysregulated immune response and oxidative stress mediate tissue destruction. Melatonin, the pineal gland hormone is a regulator of circadian rhythm, an antioxidant and an immunomodulator. Previous studies have shown lowered melatonin levels in saliva, plasma and gingival crevicular fluid (GCF) of patients with periodontal disease. Till date no study has assessed the melatonin levels in gingival tissues. MATERIALS AND METHODS: Five healthy individuals and 15 chronic periodontitis patients were recruited for this pilot study. 5ml of whole saliva, 2 ml peripheral blood and gingival tissue samples were obtained from each individual at 8.00 am in fasting state. Melatonin assay was performed with a commercially available ELISA kit. Statistical analysis was done to assess the difference in mean melatonin levels among the groups. RESULTS: No statistically significant difference was found in mean melatonin levels between healthy individuals and chronic periodontitis patients in saliva (p=.266) and plasma (p=.933) samples, whereas in gingival tissue samples (p=.015), the melatonin levels were significantly lowered in chronic periodontitis patients compared to healthy individuals. CONCLUSION: This study demonstrates the presence of melatonin in gingival tissue. Furthermore, melatonin levels are lowered in gingival tissues of chronic periodontitis patients.