Ricardo Guimarães Fischer

Periodontal Therapy Reduces Plasma Levels of Interleukin-6, C-Reactive Protein, and Fibrinogen in Patients With Severe Periodontitis and Refractory Arterial Hypertension

BACKGROUND Recent epidemiologic studies suggest that inflammation is the link between periodontal diseases and cardiovascular complications. This study aimed to evaluate the effects of non-surgical periodontal treatment on plasma levels of inflammatory markers (interleukin [IL]-6, C-reactive protein [CRP], and fibrinogen) in patients with severe periodontitis and refractory arterial hypertension. METHODS Twenty-two patients were examined and randomly divided into two groups. The test group was composed of 11 patients (mean age, 48.9 +/- 3.9 years) who received periodontal treatment, whereas the control group had 11 patients (mean age, 49.7 +/- 6.0 years) whose treatment was delayed for 3 months. Demographic and clinical periodontal data were collected, and blood tests were performed to measure the levels of IL-6, CRP, and fibrinogen at baseline and 3 months later. RESULTS The clinical results showed that the mean percentages of sites with bleeding on probing, probing depth (PD) 4 to 5 mm, PD > or =6 mm, clinical attachment loss (CAL) 4 to 5 mm, and CAL > or =6 mm were significantly reduced in the test group 3 months after periodontal treatment. There were no significant differences between the data at baseline and 3 months in the control group. Periodontal treatment significantly reduced the blood levels of fibrinogen, CRP, and IL-6 in the test group. CONCLUSION Non-surgical periodontal therapy was effective in improving periodontal clinical data and in reducing the plasma levels of IL-6, CRP, and fibrinogen in hypertensive patients with severe periodontitis.

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.

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.

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.

Extent and severity of chronic periodontitis in chronic kidney disease patients

UNLABELLED BACKGROUND AND OBJECTVE: Chronic inflammatory diseases have been investigated as a possible source of inflammation in chronic kidney disease patients; however, there is a shortage of information about the prevalence of periodontitis in such individuals. Therefore, the aim of this cross-sectional study was to determine the extent and severity of periodontitis in chronic kidney disease patients undergoing the following three different treatment modalities: predialysis; continuous ambulatory peritoneal dialysis (CAPD); and hemodialysis (HD); and to compare the findings with those from systemically healthy individuals. MATERIAL AND METHODS Forty CAPD patients (mean age 52±12 years), 40 HD patients (mean age 50±10 years), 51 predialysis patients (mean age 54±11 years) and 67 healthy individuals (mean age 50±7 years) were examined. The periodontal examination included probing pocket depth, clinical attachment loss, bleeding on probing and presence of plaque. Patients with at least four sites with clinical attachment loss ≥6 mm were considered to have severe chronic periodontitis, and those with at least 30% of sites with clinical attachment loss ≥4 mm were considered to have generalized chronic periodontitis. RESULTS Predialysis and HD patients had significantly more sites with clinical attachment loss ≥6 mm than healthy individuals. The CAPD patients had similar periodontal condition to healthy subjects. There were significantly more cases of severe chronic periodontitis in predialysis and HD patients. CONCLUSION Predialysis and HD are associated with a higher prevalence of severe periodontitis compared with healthy individuals and CAPD patients.

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.

Subgingival microflora in inflammatory bowel disease patients with untreated periodontitis.

Objective To analyze the subgingival microflora composition of inflammatory bowel disease (IBD) patients with untreated chronic periodontitis and compare them with systemically healthy controls also having untreated chronic periodontitis. Method Thirty IBD patients [15 with Crohn’s disease (CD) and 15 with ulcerative colitis (UC)] and 15 control individuals participated in the study. All patients had been diagnosed with untreated chronic periodontitis. From every patient, subgingival plaque was collected from four gingivitis and four periodontitis sites with paper points. Samples from the same category (gingivitis or periodontitis) in each patient were pooled together and stored at −70°C until analysis using a checkerboard DNA–DNA hybridization technique for 74 bacterial species. Results Multiple-comparison analysis showed that the groups differed in bacterial counts for Bacteroides ureolyticus, Campylobacter gracilis, Parvimonas micra, Prevotella melaninogenica, Peptostreptococcus anaerobius, Staphylococcus aureus, Streptococcus anginosus, Streptococcus intermedius, Streptococcus mitis, Streptococcus mutans, and Treponema denticola (P<0.001). CD patients had significantly higher levels of these bacteria than UC patients either in gingivitis or in periodontitis sites (P<0.05). CD patients harbored higher levels of P. melaninogenica, S. aureus, S. anginosus, and S. mutans compared with controls both at gingivitis and at periodontitis sites (P<0.05). UC patients harbored higher levels of S. aureus (P=0.01) and P. anaerobius (P=0.05) than controls only in gingivitis sites. Conclusion Our study showed that even with similar clinical periodontal parameters, IBD patients harbor higher levels of bacteria that are related to opportunistic infections in inflamed subgingival sites that might be harmful for the crucial microbe–host interaction.

Presence of Helicobacter pylori in supragingival dental plaque of individuals with periodontal disease and upper gastric diseases

BACKGROUND Helicobacter pylori is a Gram-negative microorganism which is able to colonize the gastric mucosa and is associated with peptic ulcer, gastric carcinoma, and gastric mucosa-associated lymphoid tissue lymphoma. Several studies have detected this bacterium in the oral cavity, suggesting it as a potential reservoir. The aim of this study was to investigate the presence of H. pylori in the oral cavity of individuals with periodontal disease and gastric diseases. METHODS 115 individuals, with mean age 49.6 (±5.8) years, were divided in 4 groups: (A) with gastric diseases and periodontal disease; (B) with gastric diseases and no periodontal disease; (C) without gastric diseases and without periodontal disease, (D) without gastric diseases and with periodontal disease. Supra and subgingival plaque samples were collected from posterior teeth of the individuals with sterile paper points, and prepared for Polymerase Chain Reaction analysis. Fishers exact test was used for detecting statistical differences between groups (p<0.05). RESULTS H. pylori was detected in supragingival plaque of 9/36 (25%) of group A, 1/31 (0.3%) of group B, 0 (0%) of group C and 3/36 (8.3%) of group D. No subgingival samples were positive for H. pylori. There was a statistically higher prevalence of H. pylori in groups A and D when compared to B and C (p<0.05). CONCLUSION H. pylori was detected in the supragingival plaque, but not in the subgingival plaque, of individuals with periodontal disease and upper gastric diseases. There was an association between the supragingival colonization of H. pylori and oral hygiene parameters such as the presence of plaque and gingival bleeding.

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.