Biju Thomas

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.

Estimation of Levels of Salivary Mucin, Amylase and Total Protein in Gingivitis and Chronic Periodontitis Patients

BACKGROUND Periodontal diseases are a group of inflammatory conditions resulting from interaction between a pathogenic bacterial biofilm and susceptible hosts inflammatory response eventually leading to the destruction of periodontal structures and subsequent tooth loss. Hence, investigation of salivary proteins in individuals with periodontal diseases may be useful to enhance the knowledge of their roles in these diseases. MATERIALS AND METHODS This case-control study was conducted at A.B. Shetty Memorial Institute of Dental Sciences, Mangalore. The study comprised of 90 patients of age between 25-60 years who were clinically examined and divided into three groups of 30 each: namely clinically healthy, gingivitis and chronic periodontitis. These were classified according to the values of gingival index score, clinical attachment loss and probing pocket depth. Unstimulated saliva was collected and salivary mucin, amylase and total protein levels were determined. STATISTICAL ANALYSIS RESULTS obtained were tabulated and statistically analyzed using ANOVA test and Karl pearsons correlation test. RESULTS The results of the study showed an increased concentration of salivary mucin, amylase and total protein in gingivitis patients and increased levels of amylase and total protein in saliva of chronic periodontitis patients compared to healthy individuals which were statistically significant. A decrease in mucin concentration was observed in the periodontitis group compared to gingivitis group. A positive correlation was present between salivary mucin, amylase and total protein levels in the three groups. CONCLUSION Salivary mucin, amylase and total protein may serve as an important biochemical parameter of inflammation of the periodontium. Also, it can be hypothesized that various enzyme inhibitors might be useful as a part of host modulation therapy in the treatment of periodontal diseases.

Comparative evaluation of micronutrient status in the serum of diabetes mellitus patients and healthy individuals with periodontitis

Background: Periodontal diseases are microbial induced chronic inflammatory conditions characterized by infiltration of leukocytes, loss of connective tissue, alveolar bone resorption, and formation of periodontal pockets. In response to periodontal pathogens, the leukocytes (PMN) elaborate destructive oxidants, proteinases and other factors. The balance between these factors, the antioxidants and endogenously synthesized antiproteinases determine the extent of periodontal damage. Diabetes mellitus is a metabolic disorder. Most of the complications of diabetes are due to hyperglycemia. Persons with diabetes are at a greater risk for periodontal disease Malnutrition is characterized by marked tissue depletion of antioxidant nutrients and impaired acute phase protein response to infections resulting in impaired healing. Diabetes mellitus also alters the micronutrient levels. Malnutrition is characterized by marked tissue depletion of antioxidant nutrients and impaired acute phase protein response to infections resulting in impaired healing. Malnutrition, which usually involves concomitant deficiencies of several essential macro and micro nutrients, therefore, has the potential to adversely influence the prognosis of periodontal infections. Objectives:This study has been conducted to evaluate and compare the serum levels of vitamin C, zinc and copper in diabetic and healthy individuals with periodontitis. Materials and Methods: In this case control study 60 subjects inclusive of both sexes were selected and divided into 3 groups of 20 each. Group 1 comprised of 20 subjects with type 2 diabetes mellitus and periodontal disease, Group 2 comprised of 20 healthy subjects with periodontal disease. And Group 3 comprised of 20 healthy subjects without periodontal disease. Venous blood samples were collected and centrifuged at 3000rpm for 15 minutes and the superanatant serum is collected to measure the vitamin C, zinc and copper levels. The vitamin C levels of clinical samples were measured using spectrophotometric quantitation (dinitrophenyl hydrazine method) and zinc and copper levels were measured using atomic absorption spectrophotometry. Results: The results showed that the levels of vitamin C and zinc decreased and copper levels increased in diabetic patients with periodontits compared to healthy individuals with periodontitis. Conclusion: It may be reasonable to suggest vitamin and/or mineral supplements for patients whose nutrition might be inadequate. Future research should focus on an evaluation of which nutrients may help to prevent the onset and progression of periodontal 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.

Serum levels of antioxidants and superoxide dismutase in periodontitis patients with diabetes type 2

Aims and Objectives: The present study was designed to estimate and compare the superoxide dismutase and total antioxidant capacity levels in the serum of diabetes mellitus - Type 2 patients and healthy individuals with and without periodontal disease. Materials and Methods: The study was designed as a case-control study comprising of 150 subjects, inclusive of both genders in the age group of 35-65 years. They were divided into three groups of 50 patients each. Patients were categorized into diabetic with chronic periodontitis (DM-CP) and systemically healthy groups with and without periodontitis. Serum samples were collected and sent for biochemical analysis to estimate the total antioxidant capacity (TAOC) and superoxide dismutase (SOD) levels. Results obtained were then statistically analysed using ANOVA test. Results: The results showed a higher level of serum TAOC in the systemically healthy group without periodontitis (PH) compared to the other groups. The P value was found to be <0.05. The SOD levels were found to be highest in the DM-CP group. Conclusion: The results of this study indicate that serum TAOC were found to be highest in the PH group and lowest in the systemically healthy with chronic periodontitis (CP). The serum SOD levels were found to be highest in the DM-CP group. The increased levels of SOD seen in DM patients may be a result of a protective and adaptive mechanism against the oxidative stress developing in the tissue.

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 micronutrient (zinc, copper and iron) levels in periodontitis patients with and without diabetes mellitus type 2: a biochemical study.

CONTEXT Periodontal tissue destruction is caused by an inappropriate host response to microorganisms. Diabetes is a metabolic disease and most of its complications are due to hyperglycemia. Periodontitis is considered as its sixth complication. Micronutrients such as zinc, copper and iron are essential for human health. There is accumulating evidence that the metabolism of several trace elements is altered in diabetes mellitus and that these nutrients might have specific roles in the pathogenesis and progress of this disease and its complication. An association between micronutrients and periodontitis has also been suggested by preliminary studies. However, till date there is a lack of relevant clinical data. AIM This study was designed to estimate and compare the serum levels of zinc, copper and iron in diabetes mellitus type 2 patients and healthy individuals with and without periodontitis. SETTING AND DESIGN Single centre case-control study. SUBJECTS AND MATERIALS This study included 150 subjects, 50 in each group. Group 1 comprised of 50 subject with diabetes mellitus type 2 and periodontitis. Group 2 comprised of 50 subjects with chronic periodontitis and Group 3 comprised of 50 control subjects. Atomic absorption spectrophotometry method was used to measure clinical level of zinc and copper in serum. Estimation of serum iron levels was done by bathophenanthroline method. STATISTICAL ANALYSIS The results obtained were tabulated and subjected to statistical analysis by analysis of variance and Tukey multiple comparison tests using statistical software SPSS version 17. RESULTS The results showed that the serum levels of zinc decreased and serum levels of iron and copper increased in diabetes patients with periodontitis compared to healthy individuals with and without periodontitis. CONCLUSION Imbalance of Zinc, copper and iron levels in the serum can predispose an individual to the risk of developing periodontitis.

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.