C. M. S. Figueredo

Increased Interleukin-1β Concentration in Gingival Crevicular Fluid as a Characteristic of Periodontitis

BACKGROUND The levels of interleukin-1β (IL-1β) have been reported to be higher in sites with periodontitis than in healthy controls. This may be the result of a more severe inflammation and/or constitutional differences in IL-1β production. Our aim was to test the hypothesis that the level of IL-1β in gingival crevicular fluid (GCF) is a characteristic trait of periodontitis, regardless of the degree of tissue destruction. As a secondary aim, we investigated the correlation between IL-1β and neutrophil elastase. An untreated population was used. METHODS GCF samples from inflamed sites in 13 patients with gingivitis (GG), and from inflamed sites with shallow (GP) and deep (PP) pockets in 18 patients with periodontitis were collected. Interleukin-1β, elastase-α-1-antitrypsin complex (E-A1AT), α-1-antitrypsin (A1AT), and α-2-macroglobulin (A2MG) were measured with ELISA. Elastase activity was measured with a specific substrate. RESULTS The concentration of IL-1β was significantly higher in PP than in GG, but no significant differences were detected between PP and GP. A weak positive correlation between the elastase activity and IL-1β was also observed. The elastase activity had a tendency to be higher in PP, although no significant difference was found among the 3 groups. The concentrations of E-A1AT, A1AT, and A2MG were similar in the 3 types of sites. CONCLUSIONS The levels of IL-1β in GCF were increased in samples from periodontitis patients, regardless of the severity of disease at the sampled site, suggesting that the levels of IL-1β are typical of a given patient. J Periodontol 1999;70:1457-1463.

Effect of periodontal treatment on metabolic control, systemic inflammation and cytokines in patients with type 2 diabetes.

OBJECTIVE The aim of this study was to investigate the effect of periodontal therapy on the circulating concentration of high-sensitivity capsule-reactive protein (hs-CRP), fibrinogen (FIB), interleukin (IL)-4, IL-6, IL-8, IL-10 and tumour necrosis factor-alpha (TNF-alpha) and on the metabolic control in type 2 diabetes mellitus (T2DM) patients. MATERIAL AND METHODS Twenty-three T2DM patients with chronic periodontitis were enrolled in this study. Periodontal clinical parameters, namely visible plaque index, gingival bleeding index, bleeding on probing, probing depth and clinical attachment levels, were evaluated. Blood samples for plasma were collected and assessed for the levels of hs-CRP, FIB, IL-4, IL-6, IL-8, IL-10 and TNF-alpha. The glycated haemoglobin (HbA(1c)) and fasting plasma glucose were also measured. All parameters were evaluated before and 3 months after non-surgical periodontal therapy. RESULTS All clinical parameters were significantly improved 3 months after the periodontal therapy. A univariate comparison showed a tendency towards a decrease of the measured biomarkers, most pronounced for TNF-alpha and FIB, after therapy. Periodontal treatment also reduced HbA(1c) and hs-CRP levels, albeit not significantly. CONCLUSIONS The clinically successful non-surgical periodontal therapy tended to reduce systemic inflammation and the concentration of some circulating cytokines.

Prevalence of periodontitis and DMFT index in patients with Crohn's disease and ulcerative colitis

AIM To compare the prevalence of periodontal disease and the decayed, missing and filled teeth (DMFT) index in patients with Crohns disease (CD) and ulcerative colitis (UC) with those without these diseases. MATERIAL AND METHODS Ninety-nine CD (39.0 SD+/-12.9 years), 80 UC (43.3 SD+/-13.2) and 74 healthy controls (40.3 SD+/-12.9) were compared for DMFT index and presence of periodontitis. Probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), plaque and DMFT index were measured on all subjects. The presence of periodontitis was defined as having CAL > or =3 mm in at least four sites in different teeth. RESULTS Significantly more patients with UC (90.0%; p<0.001) and CD (81.8%; p=0.03) had periodontitis than controls (67.6%). Among smokers, UC patients had significantly more periodontitis. CD had a greater mean DMFT score (18.7 versus 13.9; p=0.031) compared with controls and UC had greater median PPD (2.2 versus 1.7 mm; p<0.0001) than controls. Among non-smokers, CD (2.4 mm; p<0.0001) and UC showed deeper pockets (2.3 mm; p<0.0001) compared with controls (1.5 mm). UC had a greater mean DMFT score (15.3 versus 12.1; p=0.037) compared with controls. CONCLUSIONS CD and UC patients had higher DMFT and prevalence of periodontitis than controls, but smoking was an effect modifier.

Immunologic and Microbiologic Profiles of Chronic and Aggressive Periodontitis Subjects

BACKGROUND This study determines the gingival crevicular fluid (GCF) levels of interleukin (IL)-1 beta, IL-2, IL-4, IL-8, interferon (IFN)-gamma and elastase activity in inflamed shallow and deep periodontal sites from patients with generalized chronic (GCP) and generalized aggressive periodontitis (GAgP), and to compare them to shallow sites from subjects with gingivitis. A secondary aim analyzes the microbiologic profile of these subjects. METHODS Cross-sectional clinical data were obtained from 20 GCP, 17 GAgP, and 10 gingivitis subjects. GCF samples were collected with paper strips and the levels of IL-1 beta, IL-2, IL-4, IL-8, and IFN-gamma were measured using a multiplexed bead immunoassay. Elastase activity was assessed by an enzymatic assay. Subgingival plaque samples were analyzed using checkerboard DNA-DNA hybridization. Significance of differences among groups for immunologic and microbiologic data was examined using Kruskal-Wallis adjusting for multiple comparisons. RESULTS Mean clinical parameters and GCF volumes were higher in patients with GCP and GAgP compared to the gingivitis group. Higher levels of IL-1 beta and higher elastase activity were found in deep sites compared to shallow sites in both periodontitis groups (P <0.05). The microbiologic data showed significantly higher levels of the red complex species in patients with GCP and GAgP compared to gingivitis (P <0.05). There were no statistically significant differences in levels of GCF biomarkers and in levels of subgingival bacterial species between subjects with GCP and GAgP. CONCLUSION There were no statistically significant differences in the measured immunologic and microbiologic parameters between subjects with GCP and GAgP.

The Short-Term Effectiveness of Non-Surgical Treatment in Reducing Levels of Interleukin-1β and Proteases in Gingival Crevicular Fluid From Patients With Type 2 Diabetes Mellitus and Chronic Periodontitis

BACKGROUND This study aimed to compare the effectiveness of non-surgical periodontal treatment in improving periodontal status and reducing gingival crevicular fluid (GCF) levels of interleukin (IL)-1β and IL-18, elastase activity, and matrix metalloproteinase (MMP)--8 and --9 in periodontitis patients with and without type 2 diabetes mellitus (T2DM). METHODS Twenty-three patients with T2DM (diabetes group) and 26 systemically healthy subjects (control group) with chronic periodontitis participated in this study. The clinical examination included visible plaque index, gingival bleeding index, probing depth, clinical attachment level, and bleeding on probing. GCF samples were collected from five or six deep sites to evaluate the levels of IL-1β and -18, elastase, and MMP-8 and -9. Shallow sites were analyzed for IL-1β and elastase. The glycemic control was analyzed by the concentration of glycated hemoglobin (HbA1c). The subjects received non-surgical periodontal treatment and were reexamined 90 days later. RESULTS All clinical parameters showed a significant improvement after treatment, which was accompanied by a significant reduction in IL-1β, elastase activity, and MMP-8 and -9 levels in deep sites. The shallow sites also showed significant reductions in IL-1β and elastase activity levels. Treatment did not significantly reduce HbA1c concentrations in patients with T2DM. CONCLUSIONS Non-surgical periodontal treatment was effective in reducing the levels of IL-1β, elastase activity, and MMP-8 and -9 in GCF from diabetes and control groups. Patients with T2DM showed less reduction only in elastase activity in shallow sites compared to controls. This reduction was associated with improvement of the clinical periodontal status.

Effect of Non-Surgical Treatment on Chronic and Aggressive Periodontitis: Clinical, Immunologic, and Microbiologic Findings

BACKGROUND Our goal was to examine differences in clinical, microbiologic, and immunologic responses to non-surgical mechanical therapy in patients with generalized chronic periodontitis (GCP) and generalized aggressive periodontitis (GAgP). METHODS Twenty patients with GCP and 14 patients with GAgP were evaluated. Clinical data, gingival crevicular fluid (GCF), and subgingival plaque samples were collected at baseline and 3 months after non-surgical periodontal treatment. Levels of 40 subgingival species were measured using checkerboard DNA-DNA hybridization. GCF interleukin (IL)-1β, -4, and -8 and interferon-γ (IFN-γ) were analyzed using a multiplexed bead immunoassay, and elastase activity was measured using an enzymatic assay. The significance of changes with time was examined using the Wilcoxon rank sum test. Changes in clinical, microbiologic, and immunologic parameters after therapy were compared between groups using the Mann-Whitney U test. RESULTS After periodontal therapy, we found significant improvements for all clinical parameters in both groups. We also observed significant reductions in elastase activity in shallow and deep sites from the GAgP group and in deep sites from the GCP group. Microbiologic data showed significant reductions in proportions of orange and red complexes and an increase in proportions of Actinomyces species in both clinical groups. When the clinical, microbiologic, and immunologic responses after therapy were compared between groups, only minor differences were found. CONCLUSION This study fails to show any significant differences between severe forms of GCP and GAgP in response to non-surgical periodontal treatment.

Increased interleukin‐18 in gingival crevicular fluid from periodontitis patients

INTRODUCTION This study aimed to measure the levels of interleukin-18 (IL-18) in inflamed shallow sites and inflamed deep sites in patients with periodontitis and to compare the data with results from inflamed shallow sites in patients with gingivitis. A secondary aim was to examine the composition of the subgingival microbiota in the sampled sites. METHODS Gingival crevicular fluid was collected from five gingivitis sites and five periodontitis sites from 18 patients with chronic periodontitis, and from five gingivitis sites from 15 patients with gingivitis. Samples from each site category were pooled and IL-18 levels were measured using an enzyme-linked immunosorbent assay. The subgingival microbiota was analyzed by checkerboard DNA-DNA hybridization. RESULTS All clinical parameters and gingival crevicular fluid volumes were higher in periodontitis sites compared with gingivitis sites from patients with periodontitis and gingivitis. The total amount of IL-18 was higher in periodontitis sites than gingivitis sites in both periodontitis (P = 0.018) and gingivitis (P = 0.002) patients and was higher in gingivitis sites from periodontitis patients than in those from gingivitis patients (P = 0.015). There were higher levels of Tannerella forsythia, Porphyromonas gingivalis, and Treponema denticola (red complex species) in periodontitis sites compared with gingivitis sites in both the periodontitis and gingivitis patients (P < 0.001). CONCLUSION Levels of IL-18 were higher in patients with chronic periodontitis compared with patients with gingivitis, even at sites with similar pocket depths. The presence of similar levels of red complex species in gingivitis sites from periodontitis patients and from gingivitis patients suggested that the higher levels of IL-18 were not associated with a different microbial challenge.

Expression of cytokines in the gingival crevicular fluid and serum from patients with inflammatory bowel disease and untreated chronic periodontitis

BACKGROUND AND OBJECTIVE Previous studies have reported an increased prevalence/severity of chronic periodontitis in patients with inflammatory bowel disease. However, the pathogenesis of periodontal lesions in such patients has not been characterized. The aim of this pilot study was to characterize the pattern of expression of cytokines in the gingival crevicular fluid and serum from patients with untreated chronic periodontitis and Crohns disease, ulcerative colitis and systemically healthy controls. MATERIAL AND METHODS Fifteen patients with Crohns disease, 15 patients with ulcerative colitis and 15 controls participated in the study. All subjects had been diagnosed with untreated chronic periodontitis. The clinical parameters evaluated were clinical attachment loss, bleeding on probing and percentage of plaque. The gingival crevicular fluid was sampled from four shallow and four deep periodontal sites of each patient. The concentrations of the cytokines interleukin (IL)-1β, IL-4, IL-6, IL-10, IL-12p40, IL-12p70, interferon-γ and tumor necrosis factor-α were measured using a commercially available Lincoplex kit and the concentration of IL-18 was measured using an ELISA. RESULTS Multiple comparisons analysis showed that clinical attachment loss, bleeding on probing, percentage of plaque and volume of gingival crevicular fluid were similar across the groups. The concentration of IL-4 in the gingival crevicular fluid differed significantly between groups in shallow sites (p = 0.046), with higher values found for the controls. In serum, the concentration of IL-18 was also significantly different between groups, with lower values found for controls (p = 0.018). CONCLUSION This study showed a higher concentration of IL-18 in serum, but not in the gingival crevicular fluid, from periodontitis patients with Crohns disease or ulcerative colitis compared with controls. The expression of cytokines was similar in the gingival crevicular fluid from patients with untreated chronic periodontitis who also had Crohns disease or ulcerative colitis and in systemically healthy controls with untreated chronic periodontitis.

Serum Levels of Long-Chain Polyunsaturated Fatty Acids in Patients With Periodontal Disease

BACKGROUND Long-chain polyunsaturated fatty acids omega-3 and omega-6 (LC-PUFA n-3 and n-6) can function as important inflammatory modulators and also have a strong effect in the proresolving inflammatory processes. The aim of the authors is to analyze the serum levels of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and arachidonic acid (AA) in patients with generalized chronic periodontitis (GCP) and compare these results with serum levels of patients with gingivitis only. METHODS Twenty-one patients with untreated GCP (mean age: 46.0 ± 8.8 years) and 16 patients with gingivitis only (mean age: 31.5 ± 7.5 years) were investigated. The clinical examination included probing depth (PD), clinical attachment level, bleeding on probing, and plaque index. Blood samples were analyzed for the presence of DHA, EPA, DPA, and AA using gas chromatography. RESULTS Significantly higher levels of DHA, DPA, EPA, and AA were observed in patients with GCP when compared with patients with gingivitis (P = 0.007, P = 0.004, P = 0.033, and P = 0.001, respectively). The differences were still significant even after the adjustments for age and sex. The PD showed a significant positive correlation with DHA (r = 0.5; P = 0.003), DPA (r = 0.6; P <0.001), and AA (r = 0.6; P <0.001). CONCLUSION The present findings suggest that serum levels of LC-PUFA n-3 and n-6 may be affected by the severity of periodontal disease.

Alterações da articulação temporomandibular e suas repercussões orofaciais em pacientes portadores de artrite idiopática juvenil

Patients with juvenile idiopathic arthritis (JIA) can have alterations in bone metabolism and skeletal growth, as well as damage to the temporomandibular joint (TMJ), which can generate extra and/or intraoral alterations, resulting in craniofacial disorders. Our goal is to carry out a review of the literature on orofacial alterations in patients with JIA. Among the orofacial disorders in patients with JIA, alterations in mandibular growth, caused by dysfunctions in the TMJ region, seem highly prevalent in these patients. The most often found alterations are: retrognathia, micrognathia, anterior open bite, dental crowding, facial asymmetry and mouth opening limitation. Thus, the rheumatologist becomes a key agent in the early detection of these disorders, helping with patient referral to a dentist. The diagnosis, in turn, should be performed by the orthodontist, using clinical examination and imaging methods, allowing early treatment and a favorable prognosis. TMJ disorders should be treated by a multidisciplinary team, including pharmacological treatment for pain control and dental care through functional appliance and/or orthodontic therapy, physical therapy and sometimes, speech therapy. We conclude that among the orofacial disorders in patients with JIA, alterations in mandibular growth generated by dysfunctions in the TMJ region seem highly prevalent. Such dysfunctions can cause mainly open bite, mandibular retrusion, micrognathia, dental crowding and facial asymmetry. The rheumatologist can detect these alterations at an early stage, with immediate patient referral to a team that should preferably be a multidisciplinary one, consisting of an orthodontist, physical therapist and speech therapist, to reduce future occlusal and mandibular growth complications.