Kemal Üstün

Effects of periodontal therapy on disease activity and systemic inflammation in rheumatoid arthritis patients

OBJECTIVE This observational prospective cohort study aimed to evaluate the effects of non-surgical periodontal treatment on clinical periodontal measurements and systemic inflammatory mediator levels in low or moderate to highly active rheumatoid arthritis (RA) patients with chronic periodontitis. SUBJECTS AND METHODS Rheumatoid arthritis activity was assessed with disease activity score test (DAS28). Thirty patients with RA with moderate to high disease activity (DAS28 ≥ 3.2) and chronic periodontitis (MHDA group) and thirty patients with RA with low disease activity (DAS28 < 3.2) and chronic periodontitis (LDA group) were enrolled in the study. The patients were monitored at the beginning and 3 months after undergoing periodontal therapy. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-α) levels in serum, DAS28 and periodontal parameters were evaluated. RESULTS Erythrocyte sedimentation rate, CRP, TNF-α levels in serum, DAS28 and periodontal parameters exhibited similar and significant reduction 3 months after the non-surgical periodontal treatment. CONCLUSION Non-surgical periodontal treatment may prove beneficial in reducing RA severity as measured by ESR, CRP, TNF-α levels in serum and DAS28 in low or moderate to highly active RA patients with chronic periodontitis.

Effect of chronic periodontitis on oxidative status in patients with rheumatoid arthritis.

BACKGROUND Rheumatoid arthritis (RA) and chronic periodontitis (CP) are the most common chronic inflammatory diseases and have remarkable similar pathologies. The aim of this study is to investigate the impact of periodontal status on oxidative stress in patients with RA by evaluating serum oxidative parameters and prolidase levels. METHODS For this cross-sectional comparative study, the following four groups were composed of 20 individuals each (80 individuals total): 1) RA with CP (RA-CP group); 2) RA but periodontally healthy (RA-C group); 3) systemically healthy with CP (CP group); and 4) systemically and periodontally healthy (C group). Demographic, periodontal, rheumatological, and serum oxidative parameters as determined by serum total antioxidant status, total oxidant status, oxidative stress index (OSI), lipid hydroperoxide levels, paraoxonase, arylesterase, and ceruloplasmin activity, prolidase level, and total sulfhydryl groups were evaluated. RESULTS The OSI values of the RA-CP group were statistically significantly higher than those of the C group (P <0.05). The prolidase levels of the RA-C, RA-CP groups and the CP group were statistically higher than those of the C group (P = 0.001, P = 0.007, and P = 0.001, respectively). CONCLUSIONS Although CP and RA each increase oxidative stress, in a small sample size these effects are only significant when both CP and RA are combined relative to neither exposure. In addition, increased prolidase levels in patients with RA and CP may be related to increased oxidative tissue damage.

Radio‐protective effects of Nigella sativa oil on oxidative stress in tongue tissue of rats

OBJECTIVE The aim of this study was to evaluate the effects of Nigella sativa (N.S.) oil against radiation-induced oxidative stress in the rat tongue. MATERIAL AND METHODS Thirty-two Sprague-Dawley rats were randomly divided into four equal groups. Group 1 [control group(C)] did not receive N.S. oil or irradiation. Group 2 [sham control group(CN)] did not receive N.S. oil or irradiation but received 1-ml saline orally, plus sham irradiation. Group 3 [irradiation group(R)] received irradiation, plus 1-ml saline orally. Group 4 [irradiation plus N.S. oil group(RN)] received irradiation plus 1 g kg(-1) per day of N.S. oil orally for 10 days. The animals were euthanized on day 10, and tongue tissues were collected for evaluating biochemical oxidative parameters. RESULTS The oxidative stress index, total oxidant status and lipid hydroperoxides levels in the R group were statistically higher than those in the C, CN and RN groups. The paraoxonase levels in the R group were statistically lower than those in the C, CN and RN groups. No statistically significant differences were detected between any of the groups, in terms of total antioxidant status and the arylesterase, ceruloplasmin and total sulfhydryl group levels. CONCLUSION Nigella sativa (N.S.) oil may be a beneficial agent in protecting against ionizing radiation-related tissue injury.

Serum cytokine levels and periodontal parameters in ankylosing spondylitis.

BACKGROUND AND OBJECTIVE Multiple studies support the role of periodontal disease in contributing to the chronic systemic inflammatory burden in a variety of diseases, including ankylosing spondylitis (AS), in the progression which the inflammatory process plays an important role. We assume that patients with AS are more likely to have periodontal disease than healthy individuals. The aim of this study was to determine the possible relationship between inflammatory periodontal diseases and AS by evaluating clinical periodontal parameters and serum cytokine levels. MATERIAL AND METHODS Forty-eight adults with AS (35 women and 13 men; age range 18-56 years; mean age 34.27 years) and 48 age- and sex-matched systemically healthy control subjects participated in the study. The clinical periodontal parameters, venous blood and Bath Ankylosing Spondylitis Disease Activity Score were obtained, and serum C-reactive protein, tumour necrosis factor-α and interleukin-6 (IL-6) levels were evaluated. RESULTS There was statistically no significant difference in the frequency of periodontitis between AS patients and the control group. Furthermore, there was no significant difference in probing depth, clinical attachment level and plaque index, and the only significant clinical difference between groups was in levels of bleeding on probing (p < 0.001). Serum concentrations of IL-6, tumour necrosis factor-α and C-reactive protein in the AS group were significantly higher than those in the control group (p < 0.001). In the AS group, there was a correlation between serum IL-6 levels and clinical attachment level (p < 0.001). CONCLUSION The results of present study suggest that bleeding on probing was the only different periodontal parameter between the AS and the control group, and the periodontal status of patients with AS may be affected by IL-6 levels.

Protective effects of ginkgo biloba extract on ligature-induced periodontitis in rats

OBJECTIVE The aim of this study was to test the hypothesis that the systemic administration of extract of Ginkgo biloba (EGb) would prevent excessive tissue destruction in ligature-induced periodontitis in a rat model. MATERIALS AND METHODS Thirty-two male Wistar albino rats were used in the current study. The rats were randomly divided into four groups of eight rats each: (1) non-ligated treatment (NL) group, (2) ligature-only (LO) group, (3) ligature plus GB28 (28 mg/kg, daily for 11 days) group and (4) ligature plus GB56 (56 mg/kg, daily for 11 days) group. RESULTS Measurement of alveolar bone loss in the mandibular molar tooth revealed significantly lower bone loss values in the LO group compared to groups NL, GB28 and GB56 (p < 0.05). CONCLUSION The present results are the first data which suggests that host response in periodontitis can be modified by EGb administration. EGb minimized progression of periodontal disease.

Effects of Low-Level Laser Therapy as an Adjunct to Standard Therapy in Acute Pericoronitis, and its Impact on Oral Health-Related Quality of Life

OBJECTIVE The purpose of this study was to evaluate the effect of low-level laser therapy (LLLT) as an adjunct to standard therapy in acute pericoronitis. METHODS Eighty acute pericoronitis patients were randomly assigned to one of four LLLT groups: (neodymium:yttrium-aluminum garnet [Nd:YAG] 1064-nm: n=20, 8 J/cm2, 0.25 W, 10 Hz, 10 sec; 808-nm diode: n=20, 8 J/cm2, 0.25 W, continuous mode, 10 sec; 660-nm diode: n=20, 8 J/cm2, 0.04 W, continuous mode, 60 sec; or a placebo laser control group: n=20). After standard treatment, LLLT or a placebo laser were applied to the treatment area at a distance of 1 cm from the buccal site. Interincisal opening, pain perception, and oral health-related quality of life (OHRQoL) were evaluated at baseline, 24 h, and 7 days after laser application. The data were analyzed by the one-way ANOVA test. RESULTS We found that the trismus and the OHRQoL in the Nd:YAG and the 808-nm diode groups were significantly improved when compared with the 660-nm diode and control groups at 24 h (p<0.05). No statistically significant differences were detected on day 7 among the groups with regard to any of the parameters evaluated. CONCLUSIONS The results demonstrate that both the 1064-nm Nd:YAG and the 808-nm diode lasers were effective in improving trismus and OHRQoL in acute pericoronitis. Taking into account the limitations of this study, we conclude that the 1064-nm Nd:YAG laser has biostimulatory effects and improves OHRQoL, making it suitable for LLLT.

Relationship between periodontal destruction and gene mutations in patients with familial Mediterranean fever

Recent studies have shown that genetic factors involved in the host responses might determine the disease severity for both familial Mediterranean fever (FMF) and periodontitis. The present study aimed to investigate the relationship of FMF with periodontitis and to search for the potential association between periodontitis and MEFV gene missense variations in patients with FMF. The study consisted of 97 FMF patients and 34 healthy volunteers. FMF patients were classified according to the kind of MEFV gene mutation: (1) patients with homozygous M694V gene mutation, (2) patients with heterozygous M694V gene mutation, and (3) patients with MEFV gene different mutations. Gingival Index (GI), Plaque Index (PI), probing pocket depth (PD), and clinical attachment level (CAL) were measured in all participants. The results of multivariate logistic regression showed a highly significant association between homozygous M694V gene mutation and periodontitis in FMF patients (p < 0.05). After adjusting for potential confounders (smoking, body weight, age, and gender), FMF patients with homozygous M694V gene mutation were 3.51 (1.08–11.45) times more likely to present periodontitis than the other FMF patients. These results indicate that the presence of homozygous M694V gene mutation seems to increase the risk for periodontitis in FMF patients.

Effect of Chronic Periodontitis on Oxidative Status in Patients With Psoriasis and Psoriatic Arthritis

BACKGROUND Psoriasis (PS), psoriatic arthritis (PsA), and chronic periodontitis (CP) are the most common chronic inflammatory diseases and have remarkable pathologic similarities. The aim of this study is to investigate the effect of periodontal inflammation on oxidative stress in patients with PS and PsA by evaluating serum total antioxidant status, total oxidant status, oxidative stress index, levels of lipid hydroperoxides, and the activities of paraoxonase, arylesterase, and ceruloplasmin. Also measured were the levels of prolidase and total sulfhydryl groups. METHODS A total of 120 participants were divided into six groups of 20 participants: 1) PS with CP (PS-CP); 2) PS-periodontally healthy (PS-C); 3) PsA with CP (PsA-CP); 4) PsA-periodontally healthy (PsA-C); 5) systemically healthy with CP (CP); and 6) both systemically and periodontally healthy (C). Demographic, periodontal, and serum oxidative parameters were evaluated. RESULTS Oxidative stress index values of PS-C, PS-CP, PsA-C, and PsA-CP groups were approximately twice as high as those of C and CP groups, and there were no differences between any of the PS (PS-C and PS-CP), and PsA (PsA-C and PsA-CP) groups. Total antioxidant status levels of the C group were higher by 27% compared with those of the PS-C and the PsA-CP groups (P <0.05). Total oxidant status levels of both PsA-C and PsA-CP groups were approximately twice as high as those of the C (P <0.05) and CP (P <0.05, P <0.001 respectively) groups. CONCLUSIONS The contribution of CP on systemic oxidative levels in patients with PS and PsA or systemically healthy individuals seems limited. PS and PsA did not show any additional detrimental effect on clinical parameters in patients with CP.

Immunohistochemical Analysis of CD45RO+ T Cells and Vascular Endothelial Growth Factor Expression in Cyclosporin A–Induced Rat Gingival Tissue

BACKGROUND The aim of this study is to evaluate CD4(+), CD8(+), and CD45RO(+) T cells, and vascular endothelial growth factor (VEGF) expression in cyclosporin A (CsA)-induced rat overgrown gingival tissue during an 8-week period. METHODS Sixty male Sprague-Dawley rats weighing 200 to 250 g were used in this study. Mandibular first molars were ligated with 3-0 silk suture. The rats received daily doses of 0.09% NaCl (control group) or 10 mg/kg body weight of CsA (test group) by intraperitoneal injections. Five rats from the control group and 10 rats from the test group were sacrificed at each experimental period (2, 4, 6, and 8 weeks after the beginning of CsA treatment). The specimens were examined immunohistochemically. RESULTS CD4(+), CD8(+), and CD45RO(+) T cells, and VEGF expression were more prevalent in the CsA-treated group than in the control group (P <0.05). VEGF was significantly correlated with CD4(+) T cells, CD4(+)/CD8(+) ratio, and CD45RO(+) cells (P <0.05). CONCLUSION Based on our findings, we conclude that VEGF, a major regulator of angiogenesis, and CD4(+), CD8(+), and CD45RO(+) memory T cells play a key role in CsA-induced gingival overgrowth.

Relationship between alexithymia and chronic periodontitis

Objective: The aim of this study was to investigate the potential relationship between alexithymia and chronic periodontitis. Materials and Methods: A case–control study of 222 male and female subjects aged 21–63 years was conducted. The participants were divided into a chronic periodontitis group (n = 114) and a control group (n = 108) with no history of periodontitis. The Toronto Alexithymia Scale (TAS-20) was used to evaluate alexithymia status of the subjects. Clinical data were collected on parameters such as the plaque index, bleeding on probing, probing depth, and the clinical attachment level (CAL). Socioeconomic data on the patients were also recorded. Results: Chronic periodontitis group showed higher frequency in alexithymic patients as compared to control group. The proportion of high dental anxiety did not differ between the groups. The total TAS-20 score was statistically significantly higher in male subjects than in female subjects (P < 0.05). The bivariate analyses of the psychometric measures and the periodontal parameters revealed positive correlations with the severity of periodontal disease/CAL and the total TAS-20 score (P < 0.05). Conclusion: The results of the current study suggest that alexithymia is a possible risk factor for chronic periodontitis. Further research is needed to identify the underlying mechanism.