Amitha Ramesh

Estimation of nitric oxide as an inflammatory marker in periodontitis

Nitric oxide (NO) is not only important in host defense and homeostasis but it is also regarded as harmful and has been implicated in the pathogenesis of a wide variety of inflammatory and autoimmune diseases. The presence of NO in periodontal disease may reflect the participation of an additional mediator of bone resorption responsible for disease progression. The aim of this study was to assess the level of NO in serum in chronic periodontitis, and correlate these levels with the severity of periodontal disease. Sixty subjects participated in the study and were divided into two groups. NO levels were assayed by measuring the accumulation of stable oxidative metabolite, nitrite with Griess reaction. Results showed subjects with periodontitis had significantly high nitrite in serum than healthy subjects. NO production is increased in periodontal disease, this will enable us to understand its role in disease progression and selective inhibition of NO may be of therapeutic utility in limiting the progression of periodontitis.

Periodontal disease in pregnancy is a risk factor for preeclampsia

Many recent studies have evaluated the relation between periodontitis and pregnancy complications. This study aimed to examine the association between preeclampsia and periodontitis in Indian women. A total of 130 pregnant women were enrolled between 26–32 weeks of gestation. Oral health examinations were performed at recruitment and again within 48 hours of delivery to determine the presence and/or progression of periodontitis in all subjects. Pocket depth, clinical attachment loss (CAL), and gingival index were measured in all subjects. There was significant (p < 0.05) difference between the preeclampsia and normotensive groups in the distribution of periodontitis both at recruitment and after delivery. Multiple logistic regression demonstrated that periodontitis both at enrolment (OR = 5.78, 95% CI 2.41–13.89) as well as within 48 hours of delivery (OR = 20.15, 95% CI 4.55–89.29), may be associated with an increased risk of preeclampsia.

Correlation between leptin and the health of the gingiva: a predictor of medical risk.

CONTEXT Over the past decade, a growing body of scientific evidence has suggested an exquisite association between oral infection and systemic diseases (e.g. atherosclerosis, cardiovascular diseases, premature or low birth weight babies, pulmonary diseases, etc.) and also between systemic diseases (e.g. arthritis, diabetes, HIV infection and osteoporosis) and oral and craniofacial diseases and disorders. Leptin is a hormone secreted by the adipocytes in varying quantities and regulates the body weight. The present study was undertaken in the context of knowing the role of leptin in the inflammatory process occurring in the gingiva as the disease progressed from gingivitis to periodontitis. AIMS The present study was done to correlate the concentrations of leptin and interleukin (IL)-6 within the gingiva in healthy, gingivitis and periodontitis groups of patients and to correlate gingival leptin and IL-6 concentrations with plasma leptin and IL-6 concentrations in the healthy, gingivitis and periodontitis groups of patients. SETTINGS AND DESIGN This was a cross-sectional study and was carried out on the patients from the out-patient department of Periodontics in A B Shetty Memorial Institute of Dental Sciences. PATIENTS AND METHODS Seventy-five patients in the age group of 18-60 years were selected and grouped based on the gingival index (Loe and Sillness) and their clinical attachment levels into healthy, gingivitis and periodontitis groups. Leptin and IL-6 levels were estimated within gingiva and the plasma of each subject using an enzyme-linked immunosorbent assay kit. The results of this study were tabulated and subjected to statistical analysis. Mean and the standard deviation were calculated using analysis of variance Fishers F-test and then the results were subjected to Tukeys Honest significance difference method for multiple comparison among the three groups. Correlation among the three groups was estimated using Pearsons correlation analysis. RESULTS Results showed a statistically significant decrease in the concentration of gingival leptin and a statistically significant increase in the concentration of plasma leptin as the gingival disease progressed. CONCLUSION It was concluded that as the gingival disease progressed, the gingival leptin concentration decreased, whereas the plasma leptin concentration increased, indicating a possible correlation between leptin concentration in the gingiva and the risk of developing systemic disease like the cardiovascular disease.

A comparative evaluation of antioxidant enzymes and selenium in the serum of periodontitis patients with diabetes mellitus type 2

Context: Chronic periodontitis is an inflammatory disease with an aberrant response characterized by exaggerated inflammation, involving the release of excess proteolytic enzymes and reactive oxygen species (ROS). Diabetes mellitus is a group of complex multisystem metabolic disorders characterized by a relative or absolute insufficiency of insulin secretion and or concomitant resistance to the metabolic action of insulin on target tissues. Increased production of ROS necessitates elevated requirements for the nutrients involved in antioxidant defenses: Selenium, zinc, and copper. Inflammatory states promote a decrease in the amount of systemic glutathione levels. Catalase is a central antioxidant enzyme constituting the primary defense against oxidative stress. Aims: This study has been designed to evaluate the comparison of glutathione, catalase, and selenium levels in the serum of diabetes mellitus type 2 patients and healthy individuals with and without periodontal disease. Settings and Design: This study is a case control study. Materials and Methods: The study was designed as a case - control study comprising of 150 subjects, inclusive of both sexes and were divided into three groups of 50 patients each. Group I: 50 subjects with type 2 diabetes mellitus and chronic periodontitis. Group II: 50 subjects who are systemically healthy with the chronic periodontitis. Group III: 50 subjects who are systemically healthy and not suffering from Periodontitis: Serum samples were taken for estimation of glutathione, catalase, and selenium from all groups, and Subjected to biochemical analysis after which atomic absorption spectrophotometry method was used to obtain their levels in serum. Statistical Analysis Used: ANOVA and Tukey HSD. Results: The serum levels of glutathione in diabetic patients with periodontitis were significantly lower with a mean of 61.36 + 8.054 when compared to healthy individuals with and without periodontitis with a mean of 56.93 + 6.874 and 90.36 + 6.564 respectively (P ≤ 0.005). The serum levels of catalase were significantly lower in diabetic patients with periodontitis with a mean of 19.30 + 7.355 when compared to healthy individuals with and without periodontitis with a mean of 20.71 + 6.472 and 36.09 + 5.108 respectively (P ≤ 0.005). The serum levels of selenium were significantly lower in diabetic patients with periodontitis with a mean of 81.41 + 55.419 when compared to healthy individuals with and without periodontitis with a mean of 161.44 + 84.787 and 193.84 + 66.713 respectively (P ≤ 0.005). Conclusions: The findings from the study suggest that the levels of glutathione, catalase, and selenium are significantly lower in diabetic patients with periodontitis and also in healthy individuals with periodontitis, but are highest in healthy controls, showing that the serum levels are inversely proportional to inflammation and tissue destruction.

Association of salivary calcium, phosphate, pH and flow rate on oral health: A study on 90 subjects

Background and Objectives: This study was designed to compare inorganic salivary calcium, phosphate, flow rate and pH of un-stimulated saliva and oral hygiene of healthy subjects, patients with periodontitis and dental caries and to correlate salivary calcium level with the number of intact teeth. Materials and Methods: The present study consisted of 90 patients aged between 18 and 55 years and were divided into three groups, periodontitis, dental caries and controls. Oral hygiene index-simplified, probing pocket depth, clinical attachment level and number of teeth present, teeth with active carious lesions were recorded. Salivary flow rate and pH was recorded and subjected to biochemical investigation. Estimation of inorganic calcium and phosphate was performed by colorimetric method. Results: Results showed statistically significant increase in salivary inorganic calcium and phosphate levels, poor oral hygiene status, pH and salivary flow rate in patients with periodontitis when compared with dental caries group and controls. Interpretation and Conclusion: Individuals who have increased salivary inorganic calcium, phosphate, pH, flow rate and maintain poor oral hygiene could be at a higher risk for developing periodontitis and may have less dental caries and more number of intact teeth.

Evaluation of plasma C-reactive protein levels in pregnant women with and without periodontal disease: A comparative study.

Background and Objectives: Circulating C-reactive protein (CRP) levels are a marker of systemic inflammation and are associated with periodontal disease, a chronic bacterial infection associated with elevation of proinflammatory cytokines and prostaglandins. CRP has been associated with adverse pregnancy outcomes, including preterm delivery, preeclampsia, and intrauterine growth restriction. Furthermore, periodontal disease has been associated with increased risk of preterm low birth weight, low birth weight, and preterm birth. The present study was conducted to assess plasma CRP levels in pregnant women with and without periodontal disease; to evaluate the effect of periodontal therapy on the incidence of preterm delivery; and to compare the incidence of preterm delivery in pregnant women with and without periodontal disease. Materials and Methods: A total of 90 pregnant women aged between 18-35 years with gestational age between 12-28 weeks were recruited and divided into three equal groups (control group, study group, treatment group) of 30 each. Blood samples were taken for estimation of C-reactive protein levels from all groups at 12-20 weeks of gestation, determined using ultrasensitive turbidimetric immunoassay (QUANTIA-CRP US). The treatment group comprised plaque control, scaling, and root planning and daily rinsing with 0.2% chlorhexidine mouth before 28 weeks of gestation. Results: The mean value of C-reactive protein levels in subjects with periodontal disease was higher compared to control group i.e., 1.20 ± 0.247 mg/dl and 1.22 ± 0.250 mg/dl, respectively, compared to 0.713 ± 0.139 mg/ dl (P = 0.001). The mean value of CRP levels before treatment was greater than the mean value after treatment i.e., 1.22 ± 0.25 compared to 0.84 ± 0.189 (P < 0.001). The incidence of preterm delivery (< 37 weeks) was 31.7% in the periodontal disease group (study group) compared to 8.3% in the control group (P = 0.001). The incidence of preterm delivery in the treatment group was 15.0% compared to 31.7% in the nontreatment group (study group). Conclusion: The findings from the study suggest that periodontal disease in pregnant women is associated with increased C- reactive protein levels in early pregnancy, incidence of preterm delivery is higher in pregnant women with periodontal disease compared to healthy controls, periodontal therapy during pregnancy reduces plasma CRP levels and there is decrease in incidence of preterm delivery after periodontal therapy.

Alveolar bone mass in pre- and postmenopausal women with serum calcium as a marker: A comparative study

CONTEXT In most women bone mass reaches its peak in the third decade of life and declines thereafter with the onset of menopause and might lead to osteoporosis. Osteoporosis may result in reduced jaw bone mass and alterations of the mandibular structure. Qualitative and quantitative indices have been used for panoramic radiographs to assess the alveolar bone quality. AIMS The purpose of this study was to compare the alveolar bone quality of premenopausal and postmenopausal women using the panoramic mandibular index (PMI). This study also aimed to estimate the levels of serum calcium in premenopausal and postmenopausal women. SETTINGS AND DESIGN Single centre case control study. MATERIALS AND METHODS A total of 30 patients were divided into three groups of ten each - the healthy group, control group, and study group. Alveolar bone mass was evaluated by the PMI. Serum calcium was also assessed for all the patients. STATISTICAL ANALYSIS USED The results obtained were subjected to statistical analysis by one-way analysis of variance using Statistical Software SPSS version 17, Tukey test for comparision, Pearsons correlation coefficient was employed. RESULTS Premenopausal women had the highest values for alveolar cortical bone mass as recorded by the PMI, followed by postmenopausal women with a healthy periodontium. The lowest values were recorded in the group of postmenopausal women with chronic generalized periodontitis. Similar results were found for serum calcium values. CONCLUSION Postmenopausal women exhibit a reduced alveolar bone mass and lowered levels of serum total calcium with the increasing age. These changes may be useful indicators for low skeletal bone mineral density or osteoporosis.

Papillary thyroid carcinoma in a thyroglossal cyst.

The incidence of Papillary Thyroid Carcinoma in a Thyroglossal Cyst is rare. Only about 160 cases have been reported in the last 85 years. We report a case of Thyroglossal Cyst who underwent Sistrunk ’s Operation. The Cyst was reported to contain a focus of papillary thyroid carcinoma. In the absence of metastases in thyroid gland and neck nodes, only thyroid suppression with Thyroxine was given. After I year of follow-up there are no metastases. The importance of Sistrunk’s operation lies not only in complete removal of Thyroglossal Cyst but also in management of small foci of Papillary thyroid Carcinoma.

Evaluation of the association between chronic periodontitis and acute coronary syndrome: A case control study

Background: The periodontal tissues mount an immune inflammatory response to bacteria and their products and the systemic challenge with these agents also induce a major vascular response. Although many studies have found a correlation between chronic periodontitis and cardiovascular diseases, the role of infection in acute coronary syndrome is disputed. The aim of this study is to investigate whether there is an association between chronic periodontitis and acute coronary syndrome. Materials and Methods: A total of 30 patients, ages ranging from 30 –80. 15 patients from A. B. Shetty Memorial Institute of Dental Sciences and 15 patients admitted to Coronary Care Unit of Justice K. S. Hegde Charitable Hospital Deralakatte Mangalore were included in the study. Variables age more than 40 and gender were also analyzed. Results: Of the 30 patients analyzed in this study, periodontitis was recognized in 11 patients of the acute coronary syndrome group and 10 patients in the healthy group. Fishers exact test yielded a p value of 0.4539 with an odds ratio of 0.727(95% confidence interval 0.151 to 3.493). Conclusion: No significant association was found between periodontal disease and acute coronary syndrome. Periodontitis may contribute to cardiovascular disease and stroke in susceptible subjects. Properly powered longitudinal case control and intervention trials are needed to identify how periodontitis and periodontal interventions may have an impact on cardiovascular diseases.

A Comparative Assessment of Serum Vitamin C and Serum Lead Among Periodontitis and Diabetic Patient

Abstract Background and Aims: Pre and post-operative nutritional status are not often tested on a consistent basis when patients are analyzed and diagnosed with Type 2 Diabetes Mellitus (T2DM) or have chronic periodontitis. Thus, this study pursues to evaluate the predictive value of serum vitamin C and lead levels in this population at baseline and after periodontal treatment. Materials and Methods: In an interventional study setting we enrolled 120 subjects which were later categorized into four sub-groups: set 1 – individuals with chronic periodontitis, set 2 – individuals with T2DM, set 3 – individuals with T2DM and chronic periodontitis respectively set 4 - healthy individuals as control group. Scaling and root planing was performed only to individuals with periodontitis and T2DM. At baseline and 21 days after periodontitis treatment blood was obtained from the subjects and analysis of serum vitamin C and serum lead was done and data obtained was statisticaly analysed. Results: ANOVA test showed baseline values of both the parameters to be statistically significant different between groups and within groups (p<0.001). Alteration was seen in the parameters postoperatively regarding serum vitamin C was increased and lead level decreased; paired t-test showed statistically significant difference (p<0.001). Conclusion: Serum Vitamin C can be considered a key biomarker. Increased lead level can be a risk factor for commencement and progression of T2DM and chronic periodontitis.