Host mediators in gingival crevicular fluid: implications for the pathogenesis of periodontal disease

The relationship of beta-glucuronidase activity in crevicular fluid to clinical parameters of periodontal disease. Findings from a multicenter study

Previous reports have suggested that persistently elevated levels of the acidic glycohydrolase beta-glucuronidase (beta G) in gingival crevicular fluid (GCF) can identify patients with chronic adult periodontitis who are at risk for future probing attachment loss (PAL). To comprehensively study beta G activity in GCF, a multicenter trial examining the relationship of the enzyme in GCF to traditional clinical parameters of periodontal disease and PAL was conducted. In this report, the baseline data was used to evaluate the relationship of beta G activity in GCF to traditional parameters of periodontal disease. The study group included 130 patients who had been treated for periodontal disease and were on a regular recall schedule, and 10 patients with chronic adult periodontitis who had never received treatment. Upon entering the longitudinal trial, the patients were examined, and a standardized 30-s GCF sample was collected from the mesiobuccal crevice of all study teeth. As a control, GCF samples and clinical data were collected from 62 patients with a healthy periodontium or mild inflammatory gingivitis without loss of probing attachment. At baseline, beta G activity for the periodontitis patients ranged from 0 to 1704 Units (U), with a median of 32 U. beta G could not be detected in 0.2% of samples (activity < or = 2.0 U). The 90% cumulative relative frequency was 139 U. For the healthy/gingivitis subjects beta G activity ranged from 0 to 504 U, with a median of 22 U. Enzyme was not detectable in 0.4% of samples. Only 0.9% of samples contained greater than 139 U. beta G activity in GCF was not related to gender or age. For the periodontitis patients, elevated enzyme activity (> or = 140 U) was most often associated with molar teeth, followed by maxillary bicuspids. Maxillary central incisors, and mandibular central and lateral incisors displayed the lowest frequency of elevated enzyme activity. The relationship of beta G activity to the traditional parameters of probing depth and bleeding on probing was assessed. For shallow sites (1.0-1.5 mm, 2.0-2.5 mm probing depth), the large majority of GCF samples contained low enzyme activity (90% of samples < 50 U). Descriptive indicators demonstrated a trend of increased beta G activity with increased probing depth. The median beta G activity shifted from 15 U for the shallowest sites (1.0-1.5 mm) to 127 U for the deepest sites (5-8 mm). However, this was due to a broadening of the distribution rather than representing a shift in the distribution profile.(ABSTRACT TRUNCATED AT 400 WORDS)

Histological evaluation of interleukin-1 beta and collagen in gingival tissue from untreated adult periodontitis

Interleukin-1 beta (IL-1 beta) may be related to the pathological processes associated with periodontitis, primarily due to its ability to induce collagenase, increase neutrophil chemotaxis, and stimulate bone resorption. This study was designed to histologically quantitate IL-1 beta positive cells from various histologic fields in untreated gingivitis/early periodontitis (G/EP) versus moderate/severe periodontitis (M/SP) gingival tissues, and associate these with collagen loss. Two gingival biopsies from 8 patients were collected, one from a G/EP site and one from a M/SP site. Mouse monoclonal antibodies in combination with an avidin-biotin-peroxidase system were used to stain for IL-1 beta, while the van Gieson method was used to stain for collagen in serial sections. Collagen loss in G/EP (35%) and M/SP (52%) fields was consistent with gingivitis and periodontitis, respectively. IL-1 beta positive cells in combined coronal/sulcular (Co/Su) and apical/sulcular (Ap/Su) fields (nearest the bacterial insult) were significantly more numerous compared to combined coronal/middle (Co/Mi) and apical/middle (Ap/Mi) fields (p < 0.05). While numbers and percentages of IL-1 beta positive cells were generally higher in M/SP biopsies, differences were not significant. Further, there was no correlation between the number of IL-1 beta positive cells and percent collagen loss. However, a significant correlation between IL-1 beta positive cells and corresponding gingival crevicular fluid IL-1 beta concentrations was noted (r = 0.65, p = 0.01). Through the use of immunohistochemistry, this study demonstrated that the presence of IL-1 beta + cells does not appear to have a direct association with collagen loss.

Current status of tests for periodontal disease

The methods applied to the diagnosis of periodontal disease are changing. Historically, static clinical and radiographic parameters have formed the basis of the periodontal evaluation. As the limitations of these traditional procedures became clear, several new techniques have been proposed as diagnostic tests for periodontal disease. These tests are based on improved understanding of the pathogenesis of periodontal disease, and can be considered in three categories: assessment of physical changes in the periodontium, the bacterial infection, and the host response to the infection. Several technical questions must be addressed before these tests can be widely utilized. These specific concerns include such matters as the information available from the tests (e.g., Does the test provide a measure of disease severity or identify the site, region, or patient experiencing active disease?), the most appropriate test configurations, the statistical analysis of data from trials examining the accuracy of the tests, and selection of patients who would benefit from these procedures. Last, several important practical issues must be examined before these tests can be expected to gain widespread acceptance. These include familiarization of dental practitioners with the use of diagnostic tests and the medical laboratory, the role of regulatory agencies in determining the claims made by these tests, and the medical/dental insurance benefits provided for these services.

DNA probe and enzyme analysis in periodontal diagnostics

Recent research in periodontology has indicated that a finite number of bacterial species are associated with periodontal disease. This has generated the hypothesis that periodontal disease is essentially an infection due to one or more of the putative periodontopathogens; i.e., the specific plaque hypothesis (SPH). This microbial specificity paradigm has already changed the way researchers and some clinicians view periodontal disease. The clinician must heed several cautions signs, however, if he is to use the SPH to provide treatment options that could enhance the delivery of care. There are several diagnostic technologies that can be used to detect and semi-quantitate those bacterial species that have been identified as periodontopathogens. This paper discusses diagnostic tests based upon the detection in plaque of DNA segments or enzyme activity(ies) that are unique for one or more of the suspected periodontopathogens.