Effect of periodontal therapy on salivary enzymatic activity

Salivary β-glucosidase as a direct factor influencing the occurrence of halitosis

β-Glucosidases are enzymes present in all living organisms, playing a pivotal role in diverse biological processes. These enzymes cleave β-glycosidic bonds between carbohydrates, or between a carbohydrate and a non-carbohydrate moiety, which may result in the liberation of volatile aglycones. Released compounds execute diverse physiological roles, while the industry takes advantage of exogenously added β-glucosidases for aroma enrichment during food and beverage production. β-Glucosidase enzymatic activity has been reported in human saliva and given the fact that these enzymes are involved in aroma release, we investigated here the correlation between β-glucosidase activity in human saliva and the occurrence of halitosis. Measurement of salivary enzyme activity of 48 volunteers was performed using p-nitrophenyl-β-d-glucopyranoside as substrate. Each volunteer was clinically evaluated by a dental surgeon and clinical and laboratorial data were statistically analyzed. Gas-chromatography of saliva headspace allowed the analysis of the direct role of exogenous β-glucosidase on aromatic /volatile profile of saliva samples. The data demonstrated a positive correlation between halitosis and enzymatic activity, suggesting that the enzyme exerts a direct role in the occurrence of bad breath. Gas-chromatography analysis demonstrated that exogenously added enzyme led to the alteration of volatile organic content, confirming a direct contribution of β-glucosidase activity on saliva volatile compounds release. Although halitosis is a multifactorial condition, the complete understanding of all governing factors may allow the development of more effective treatment strategies. Such studies may pave the way to the use of β-glucosidase inhibitors for halitosis clinical management.

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β-Glucosidases are capable of altering the aromatic profile of saliva.

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Increased salivary β-glucosidase is associated with halitosis.

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Increased salivary β-glucosidase is associated with dental biofilm.

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Salivary β-glucosidases are produced by oral microrganisms.

Salivary enzymes as diagnostic markers for detection of gingival/periodontal disease and their correlation with the severity of the disease

Context:

Host responses to periodontal disease include the production of different enzymes released by stromal, epithelial or inflammatory cells. Important enzymes associated with cell injury and cell death are aspartate aminotransferase, alanine aminotransferase (AST, ALT), alkaline phosphatase, acidic phosphatase (ALP, ACP), and gama glutamyl transferase (GGT). Changes in enzymatic activity reflect metabolic changes in the gingiva and periodontium, in the inflammation.

Aims:

In this article we examined the activity of AST, ALT, GGT, ALP, and ACP in the saliva from patients with periodontal disease, before and after periodontal treatment (experimental group — 20 gingivitis patients and 20 periodontitis patients), and in the saliva from healthy subjects (control group — 20 samples).

Settings and Design:

Periodontal disease was determined based on the clinical parameters (gingival index (GI), probing depth (PD), and clinical attachment loss (CAL)). Patients with periodontal disease were under conventional periodontal treatment.

Materials and Methods:

The stimulated saliva of the patient was collected in a sterile test tube and analyzed using the Automatic Analyzer.

Results:

The obtained results showed statistically significant increased activity of AST, ALT, GGT, ALP, and ACP in the saliva from patients with periodontal disease, in relation to the control group. A significant reduction in the enzyme levels was seen after conventional periodontal therapy.

Conclusions:

Based on these results, it can be assumed that the salivary enzymes (AST, ALT, GGT, ALP, and ACP) can be considered as biochemical markers for evaluating the diagnosis and prognosis of the functional condition of periodontal tissues in disease and health, and in the evaluation of the therapy effects in periodontal disease.

Salivary Biomarkers: A Periodontal Overview

The current clinical diagnostic criterias which were introduced almost half a century ago continue to function as the basis of oral diagnosis in today's clinical practice. Evolvement with time is now brought us to the era of biomarkers. It's a new paradigm for periodontal diagnosis which is of immense benefit in managing periodontitis patients. Biomarkers are tell – tale molecules that can be used to monitor health status, disease onset, treatment response and outcome.

These biomarkers can be obtained from blood components such as: serum or plasma. However because of it's being an invasive procedure other body fluids such as saliva and GCF are being considered for potential source of biomarkers. The simple and non-invasive nature of saliva collection and its high sensitivity assay development has led to the salivary biomarkers being a promising future for periodontal diagnosis.

Evaluating the levels of salivary alkaline and acid phosphatase activities as biochemical markers for periodontal disease: A case series

BACKGROUND

The purpose of this study was to determine the salivary levels of alkaline phosphatase (ALP) and acid phosphatase (ACP) activities in patients with periodontal disease and to evaluate the use of these enzymes as biochemical markers for periodontal tissue damage.

MATERIALS AND METHODS

In this prospective analytical study, we examined the activities of salivary ALP and ACP in patients with periodontal disease, before and after periodontal treatment. The experimental groups consisted of 20 gingivitis patients and 20 periodontitis patients and the control group had healthy subjects (20 samples). The stimulated saliva of the patient was collected in a sterile test tube and analyzed using Hitachi's Diagnostic Automatic Analyser. Periodontal disease was determined based on clinical parameters such as gingival index, probing depth and clinical attachment loss. Patients with periodontal disease were under conventional periodontal treatment. The statistical analysis applied was Student's t-test. Probabilities less than 0.05 (P < 0.05) were considered significant.

RESULTS

The obtained results showed statistically significant increased activities of ALP and ACP in saliva from patients with periodontal disease in relation to control group. A significant reduction in the enzyme levels was seen after conventional periodontal therapy.

CONCLUSIONS

Based on these results, salivary ALP and ACP can be considered to be the biomarkers for evaluating periodontal tissue damage.

Respiratory disease and the role of oral bacteria

The relationship between oral health and systemic conditions, including the association between poor oral hygiene, periodontal disease, and respiratory disease, has been increasingly debated over recent decades. A considerable number of hypotheses have sought to explain the possible role of oral bacteria in the pathogenesis of respiratory diseases, and some clinical and epidemiological studies have found results favoring such an association. This review discusses the effect of oral bacteria on respiratory disease, briefly introduces the putative biological mechanisms involved, and the main factors that could contribute to this relationship. It also describes the role of oral care for individuals who are vulnerable to respiratory infections.

alpha-Galactosidase activity in human saliva

OBJECTIVE

The purpose of this study was to investigate whether alpha-galactosidase activity is present in whole and glandular saliva and whether alpha-galactosidase activity depends on blood type and secretor status.

DESIGN

For the first experiments, 30 healthy participants (15 men, 15 women; mean age, 24.2+/-1.5 years) who were 10 A, 10 B, and 10 O blood type subjects were included. alpha-Galactosidase activity in unstimulated whole saliva (UWS) was assayed by using 4-methylumbelliferyl-alpha-d-galactopyranoside as a substrate. Total protein concentration was determined by bicinchoninic acid assay. The secretor status of the blood group antigens was determined by immunoblotting. alpha-Galactosidase activity in UWS according to gender, blood type, secretor status, sample clarification, and buffer was investigated. Daily variations of alpha-galactosidase activity and alpha-galactosidase isozyme activity were also investigated. For the second experiments, 10 healthy blood type B participants (5 men, 5 women; mean age, 27.0+/-2.7 years) were enrolled. alpha-Galactosidase activity in whole and glandular saliva was investigated.

RESULTS

alpha-Galactosidase activity was detected in UWS and was mainly isozyme A activity. There was no difference in alpha-galactosidase activity according to gender, blood type, and secretor status. alpha-Galactosidase activity in UWS was higher in unclarified samples than in clarified ones and showed wide daily variations. alpha-Galactosidase activity in whole saliva was significantly higher than that in glandular saliva.

CONCLUSIONS

alpha-Galactosidase activity which is mainly isozyme A activity was detected in human whole and glandular saliva. alpha-Galactosidase activity in UWS did not differ according to blood type and secretor status.

Candidate salivary biomarkers associated with alveolar bone loss: cross-sectional and in vitro studies

This cross-sectional study evaluated the association between radiographic evidence of alveolar bone loss and the concentration of host-derived bone resorptive factors (interleukin-1 beta, tumor necrosis factor-alpha, interleukin-6, prostaglandin-E2), and markers of bone turnover [pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), osteocalcin, osteonectin] in stimulated human whole saliva collected from 110 untreated dental patients. Alveolar bone loss scores for each patient were derived from radiographic examination. Variables positively associated with increased bone loss score were: age, current smoking, use of bisphosphonate drugs, and salivary interleukin-1beta levels above the median. Salivary osteonectin levels above the median were associated with a decreased bone loss score. Additional in vitro studies were carried out to determine the fate of interleukin-1beta, interleukin-6 and tumor necrosis factor-alpha added to whole and parotid saliva. All cytokines added to saliva were detected in significantly lower concentrations than when added to buffer alone. Protease inhibitors added to saliva did not prevent the reduction in detection of biomarkers. Variation in time of incubation, repeated cycles of freezing and thawing, or exposure to dimethylsulfoxide did not appreciably affect the measurement of cytokines in saliva. These results suggest that detection of biomarkers by conventional immunoassays may underestimate the actual quantity of molecules in saliva.

Salivary enzyme levels after scaling and interleukin-1 genotypes in Japanese patients with chronic periodontitis

BACKGROUND

Saliva has been used as a diagnostic fluid in medicine and dentistry. It is easy to collect using non-invasive methods. The intracellular enzymes present in saliva have been studied as markers of periodontal disease. The purpose of this study was to determine the salivary enzyme levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) after scaling and to clarify the influence of interleukin (IL)-1 genotypes on these enzyme levels.

METHODS

Forty-nine Japanese patients with chronic periodontitis (24 men and 25 women; mean age: 55.1 years) were enrolled in this study. Measurements of clinical parameters including probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) and collections of stimulated whole mixed saliva were performed at baseline and 4 weeks after scaling. After evaluation of salivary AST, ALT, and LDH levels, DNA was extracted from various cells in whole saliva. IL-1A+4845 G/T genotype was determined by polymerase chain reaction amplification, followed by enzyme digestion and electrophoresis. Statistical analysis was performed by the Wilcoxon signed-rank and Mann-Whitney U tests. A significant difference was set at P <0.05.

RESULTS

Mean PD, CAL, and BOP values significantly decreased after scaling (mean +/- SE: 3.2 +/- 0.1 mm to 2.6 +/- 0.1 mm in PD; 3.9 +/- 0.2 mm to 3.3 +/- 0.2 mm in CAL; and 41% +/- 4% to 18% +/- 3% in BOP) (P <0.001). The values of AST, ALT, and LDH were 77.0 +/- 7.5, 43.9 +/- 5.5, and 753.4 +/- 96.5 (units per liter [U/l]) at baseline, and significantly decreased to 55.5 +/- 6.5, 30.0 +/- 5.5, and 394.7 +/- 34.0 (U/l) after scaling, respectively (P = 0.01, P = 0.006, and P <0.001). The carriage rate of the IL-1A+4845 allele 2 was 24.5%. No difference was noted in the decrease in PD, CAL, and BOP after scaling between the carriers (N = 12) and non-carriers (N = 37) of IL-1A+4845 allele 2. However, the IL-1A allele 2 non-carriers displayed a significant decrease in salivary AST and ALT levels (P <0.001), in contrast to the carriers who did not show any changes in the salivary levels of the enzymes after scaling.

CONCLUSIONS

These results documented that salivary AST, ALT, and LDH levels reflect inflammation and destruction of periodontal tissue, suggesting clinically useful markers following periodontal therapy. In addition, although IL-1A+4845 alleles may not influence clinical parameters, they may influence post-scaling values of salivary AST and ALT.

Saliva of patients with Type 1 diabetes: effect of smoking on activity of lysosomal exoglycosidases

OBJECTIVE

The aim of our study was to evaluate the influence of smoking on the activity of N-acetyl-beta-hexosaminidase (HEX), its isoenzymes A (HEX-A) and B (HEX-B) and beta-galactosidase (GAL), in the saliva of patients with Type 1 diabetes.

METHODS

In the supernatant HEX and its isoenzymes A and B, and beta-galactosidase were determined by the method of Chatteriee et al in modification of Zwierz et al (mKat kg(-1) of protein). Protein was determined by the Lowry et al method (mg ml(-1)).

RESULTS

The results presented here suggest that diabetes and smoking modify activity of HEX and its isoenzymes, but only combination of diabetes and smoking give a significant increase in the specific activity of HEX and its isoenzymes.

CONCLUSIONS

Type 1 diabetes slightly changes the composition of saliva. Smoking cigarettes significantly modifies the composition and properties of saliva in healthy individuals and patients with Type 1 diabetes.

Diagnostic biomarkers for oral and periodontal diseases

This article provides an overview of periodontal disease diagnosis that uses clinical parameters and biomarkers of the disease process.This article discusses the use of biomarkers of disease that can be identified at the tissue, cellular, and molecular levels and that are measurable in oral fluids such as saliva and gingival crevicular fluid. Biomarkers identified from these biologic fluids include microbial, host response, and connective tissue-related molecules that can target specific pathways of local alveolar bone resorption. Future prospects for oral fluid-based diagnostics that use micro-array and microfluidic technologies are presented.

Levels of aspartate aminotransferase (AST) in saliva of patients with different periodontal conditions

OBJECTIVES

The purpose of this study was to evaluate the relationship between aspartate aminotransferase (AST) levels in saliva measured by Reflotron trade mark System of Diagnosis and periodontal condition indicated by Community Periodontal Index of Treatment Needs (CPITN).

MATERIAL AND METHODS

Fifteen patients were assigned to one of four groups C0, C1, C3 and C4, based on their largest CPITN code among the examined sites, totaling 60 participants. About 1.0 ml of non-stimulated saliva was collected from the individuals after a mouth rinse with water. Biochemical analyses of saliva samples were carried out using the proposed system in order to quantify their AST concentration.

RESULTS

There were no significant differences between levels (U/ml) of AST (median; interquartile range) from groups C0 (30.9; 14.7-41.7), C1 (30.3; 19.5-39.4) and C3 (35.1; 27.0-63.5). However, group C4 (106.2; 84.4-129.7) differed statistically from the others (p<0.001) and presented AST levels as high as 284.2 U/ml. Gingival bleeding and suppuration were observed in three individuals with concentrations higher than 125.0 U/ml.

CONCLUSION

Levels of AST in saliva from patients presenting CPITN code 4 were higher than from patients coded lower and could be detected by the evaluated diagnostic system. Periodontal destruction such as periodontal pockets, gingival bleeding and suppuration seems to be related to higher AST levels in saliva.

Beta-glucuronidase activity in saliva: relationship to clinical periodontal parameters

BACKGROUND

Beta-glucuronidase (betaG) in gingival crevicular fluid (GCF), a marker of neutrophil influx into the crevicular environment, has previously been shown to be correlated with periodontal clinical parameters at individual sites (probing depth and clinical attachment level). Furthermore, elevated levels of betaG were found to be a risk factor for periodontal attachment loss. Analysis of betaG in saliva may be a measure of crevicular neutrophil influx for the whole mouth. The purpose of this cross-sectional study was to evaluate the relationship between betaG activity in saliva and periodontal clinical parameters in subjects demonstrating various levels of periodontal disease.

METHODS

The study population consisted of 380 subjects (108 males and 272 females). A sample of unstimulated whole saliva and a venous blood sample were obtained from each subject, and a periodontal examination, which included measurement of probing depth (PD), attachment level (AL), and gingival index (GI) was performed. The unmodified saliva samples were frozen at -20 degrees C and analyzed for betaG activity. The blood samples were analyzed for number of white blood cells, neutrophils, monocytes, lymphocytes, and platelets. Statistical analysis was conducted to determine the association between salivary betaG activity and the whole-mouth clinical periodontal parameters, complete blood count, smoking status, and age.

RESULTS

Highly significant correlations between salivary betaG activity and mean probing depth (MPD), mean gingival index (MGI), and the number of sites with probing depth > or = 5 mm were found. When subjects were divided into tertiles based on their MPD and MGI, elevated salivary betaG activity was detected in subjects in the 2 upper tertiles. Logistic regression modeling was used to determine which of the clinical or laboratory parameters were able to identify patients with at least 4 sites with PD > or = 5 mm. Salivary betaG activity > or = 100 produced an odds ratio (OR) of 3.77. In comparison, current and former smokers had an OR of 3.15 and 2.29, respectively. CONLCUSIONS: The results suggest that a significant association exists between periodontal clinical parameters and salivary betaG activity. Due to the non-invasive and simple nature of saliva collection, this association should be studied to determine its usefulness as a screening test for periodontitis, and a means of monitoring the response to treatment.

Relation of dental composite formulations to their degradation and the release of hydrolyzed polymeric-resin-derived products

This article reviews the principal modes of dental composite material degradation and relates them to the specific components of the composites themselves. Particular emphasis is placed on the selection of the monomer resins, the filler content, and the degree of monomer conversion after the clinical materials are cured. Loss of mechanical function and leaching of components from the composites are briefly described, while a more detailed description is provided of studies that have considered the chemical breakdown of materials by agents that are present in the oral cavity, or model the latter. Specific attention will be given to the hydrolysis process of monomer and composite components, i.e., the scission of condensation-type bonds (esters, ethers, amides, etc.) that make up the monomer resins, following reaction of the resins with water and salivary enzymes. A synopsis of enzyme types and their sources is outlined, along with a description of the work that supports their ability to attack and degrade specific types of monomer systems. The methods for the study of biodegradation effects are compared in terms of sensitivity and the information that they provide. The impact of biodegradation on the ultimate biocompatibility of current materials is discussed from the perspective of what is known to date and what remains to be studied. The findings of the past decade clearly indicate that there are many reasons to probe the issue of biochemical stability of composite resins in the oral cavity. The challenge will now be to have both industry and government agencies take a pro-active approach to fund research in this area, with the expectation that these studies will lead to a more concise definition of biocompatibility issues related to dental composites. In addition, the acquired information from such studies will generate the development of alternate polymeric chemistries and composite formulations that will require further investigation for use as the next generation of restorative materials with enhanced biostability.

Systemic diseases caused by oral infection

Recently, it has been recognized that oral infection, especially periodontitis, may affect the course and pathogenesis of a number of systemic diseases, such as cardiovascular disease, bacterial pneumonia, diabetes mellitus, and low birth weight. The purpose of this review is to evaluate the current status of oral infections, especially periodontitis, as a causal factor for systemic diseases. Three mechanisms or pathways linking oral infections to secondary systemic effects have been proposed: (i) metastatic spread of infection from the oral cavity as a result of transient bacteremia, (ii) metastatic injury from the effects of circulating oral microbial toxins, and (iii) metastatic inflammation caused by immunological injury induced by oral microorganisms. Periodontitis as a major oral infection may affect the host's susceptibility to systemic disease in three ways: by shared risk factors; subgingival biofilms acting as reservoirs of gram-negative bacteria; and the periodontium acting as a reservoir of inflammatory mediators. Proposed evidence and mechanisms of the above odontogenic systemic diseases are given.

Systemic diseases caused by oral infection

Recently, it has been recognized that oral infection, especially periodontitis, may affect the course and pathogenesis of a number of systemic diseases, such as cardiovascular disease, bacterial pneumonia, diabetes mellitus, and low birth weight. The purpose of this review is to evaluate the current status of oral infections, especially periodontitis, as a causal factor for systemic diseases. Three mechanisms or pathways linking oral infections to secondary systemic effects have been proposed: (i) metastatic spread of infection from the oral cavity as a result of transient bacteremia, (ii) metastatic injury from the effects of circulating oral microbial toxins, and (iii) metastatic inflammation caused by immunological injury induced by oral microorganisms. Periodontitis as a major oral infection may affect the host's susceptibility to systemic disease in three ways: by shared risk factors; subgingival biofilms acting as reservoirs of gram-negative bacteria; and the periodontium acting as a reservoir of inflammatory mediators. Proposed evidence and mechanisms of the above odontogenic systemic diseases are given.

Association of periodontal infections with atherosclerotic and pulmonary diseases

Chronic infections may influence the severity and/or course of a number of systemic diseases. Periodontal diseases are localized chronic inflammatory conditions of the gingiva and underlying bone and connective tissues induced by bacteria and bacterial products of dental plaque. This paper will discuss the evidence for the role of periodontal disease in the pathogenesis of 2 important systemic diseases, atherosclerosis and pulmonary infections. Both epidemiological and laboratory studies are reviewed to assess the biological basis for the association of periodontal infections and these important diseases. Several potential mechanisms by which periodontal diseases may influence these conditions are also discussed.

Effect of filler content on the profile of released biodegradation products in micro-filled bis-GMA/TEGDMA dental composite resins

This study assesses the effect of the filler content, in a micro-filled composite (0.04 microm), on the liberation of biodegradation products derived from two model composite systems. The materials were based on bis-phenyl glycidyl dimethacrylate (bis-GMA) and triethylenene glycol dimethacrylate (TEGDMA) monomers. The composites were produced using silica filler concentrations of 20 and 40%) by weight. Samples were incubated with either cholesterol esterase (CE) or phosphate buffer solutions (PBS) for 8, 16 and 32 days. Products were isolated by high-performance liquid chromatography (HPLC) and identified by mass spectrometry. The identified products included TEGDMA, 2,2-bis[4(2,3-hydroxypropoxy)-phenyl]propane (bis-HPPP) and triethylene glycol methacrylate (TEGMA). Bis-HPPP was only produced in the presence of enzyme. The amount of isolated TEGMA, in both composite systems, was shown to be significantly higher for materials incubated with enzyme than their buffer counterparts (P < 0.05). Between 0 and 8 days incubation with enzyme, significantly higher amounts of Bis-HPPP and TEGMA were generated with the lower filler model material (composite-20) than the higher filled composite (composite-40), while the opposite effect was observed between 8 and 16 days. The data indicate that biodegradation product release profiles are dependent on the filler/resin ratios, and suggests that this parameter should be considered when assessing product release for biocompatibility issues pertaining to dental composite systems.

Biodegradation of commercial dental composites by cholesterol esterase

The research literature suggests that current dental polymeric composites are not chemically inert at the material/biological interface. Several studies have investigated the process of "biodegradation" on dental composites in the presence of enzymes, by monitoring changes in weight loss and surface hardness properties. However, it is hypothesized that these methods can provide an erroneous measure of biochemically induced degradation, since they are less sensitive to molecular events and lack the ability to provide chemical information. Knowledge of the latter is important because it relates to the biological significance of biodegradation, i.e., the identification and quantification of released compounds that may be capable of influencing cell, bacteria, or enzyme function. It was the objective of this study to compare three methods (weight loss, surface micro-hardness, and liquid chromatography combined with mass spectrometry) for their ability to measure the effect of enzyme-induced biodegradation on three commercial composite resin materials. The enzyme was cholesterol esterase, and the composites were Silux Plus XL, Z100 A2 (3M), and TPH XL (L.D. Caulk). Biodegradation was readily detected by liquid chromatography, and its sensitivity was shown to be substantially greater than that of weight loss or surface hardness measurements, although surface hardness measurements did show some agreement with liquid chromatography data. The data also indicated that the levels and distribution of released degradation products can vary substantially from one product to the next, and that this merits further investigation if the potential impact of different commercial restorative materials on cell and bacteria function is to be assessed.

Role of oral bacteria in respiratory infection

An association between oral conditions such as periodontal disease and several respiratory conditions has been noted. For example, recent evidence has suggested a central role for the oral cavity in the process of respiratory infection. Oral periodontopathic bacteria can be aspirated into the lung to cause aspiration pneumonia. The teeth may also serve as a reservoir for respiratory pathogen colonization and subsequent nosocomial pneumonia. Typical respiratory pathogens have been shown to colonize the dental plaque of hospitalized intensive care and nursing home patients. Once established in the mouth, these pathogens may be aspirated into the lung to cause infection. Other epidemiologic studies have noted a relationship between poor oral hygiene or periodontal bone loss and chronic obstructive pulmonary disease. Several mechanisms are proposed to explain the potential role of oral bacteria in the pathogenesis of respiratory infection: 1. aspiration of oral pathogens (such as Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, etc.) into the lung to cause infection; 2. periodontal disease-associated enzymes in saliva may modify mucosal surfaces to promote adhesion and colonization by respiratory pathogens, which are then aspirated into the lung; 3. periodontal disease-associated enzymes may destroy salivary pellicles on pathogenic bacteria to hinder their clearance from the mucosal surface; and 4. cytokines originating from periodontal tissues may alter respiratory epithelium to promote infection by respiratory pathogens.

Analysis of gingival crevicular fluid intracytoplasmic enzyme activity in patients with adult periodontitis and rapidly progressive periodontitis. A longitudinal study model with periodontal treatment

In the present study, the activity of 3 functionally related enzymes, creatine kinase (CK), lactate dehydrogenase (LDH), and aspartate aminotransferase (AST) levels in the rest and flow gingival crevicular fluid (rGCF, fGCF) from patients with rapidly progressive periodontitis (RPP) and adult periodontitis (AP) were determined before and after periodontal treatment, including maintenance. When rGCF and fGCF mean enzyme levels were compared, rGCF was found to contain approximately twice as much enzyme levels than fGCF throughout the study. The findings of the present study revealed that both the rGCF and fGCF samples also contained higher CK, LDH, and AST levels than serum samples. Baseline clinical parameters and GCF enzyme levels presented a significant decline throughout the non-surgical and surgical treatment phases in both patient groups, with surgical treatment being more effective. Despite clinical stability, in the AP group levels of LDH and AST showed a tendency to increase in the third month, while enzyme levels still continued to decrease in the RPP group, who received additional antibiotics during the surgical phase. These findings suggest that GCF intracytoplasmic enzyme profile is related with periodontal status and successful periodontal treatment, in addition to clinical improvement, has a significant effect on this profile. Analysis of biochemical events, more specifically intracytoplasmic enzyme levels in GCF, are likely to offer a sensitive measure of periodontal pathology which may help in overcoming the existing limitations of clinical parameters. For this purpose, analysis of rGCF intracytoplasmic enzymes seems to be more beneficial.

Relationships between periodontal disease and bacterial pneumonia

Bacterial pneumonia is a prevalent and costly infection that is a significant cause of morbidity and mortality in patients of all ages. The continuing emergence of antibiotic-resistant bacteria (e.g., penicillin-resistant pneumococci) suggests that bacterial pneumonia will assume increasing importance in the coming years. Thus, knowledge of the pathogenesis of, and risk factors for, bacterial pneumonia is critical to the development of strategies for prevention and treatment of these infections. Bacterial pneumonia in adults is the result of aspiration of oropharyngeal flora into the lower respiratory tract and failure of host defense mechanisms to eliminate the contaminating bacteria, which multiply in the lung and cause infection. It is recognized that community-acquired pneumonia and lung abscesses can be the result of infection by anaerobic bacteria; dental plaque would seem to be a logical source of these bacteria, especially in patients with periodontal disease. It is also possible that patients with high risk for pneumonia, such as hospitalized patients and nursing home residents, are likely to pay less attention to personal hygiene than healthy patients. One important dimension of this personal neglect may be diminished attention to oral hygiene. Poor oral hygiene and periodontal disease may promote oropharyngeal colonization by potential respiratory pathogens (PRPs) including Enterobacteriaceae (Klebsiella pneumoniae, Escherichia coli, Enterobacter species, etc.), Pseudomonas aeruginosa, and Staphylococcus aureus. This paper provides the rationale for the development of this hypothesis especially as it pertains to mechanically ventilated intensive care unit patients and nursing home residents, two patient groups with a high risk for bacterial pneumonia.

Value of some laboratory and clinical measurements in the treatment plan for advanced periodontitis

In our previous study, we reported that only 13 of 46 adult patients with advanced periodontitis responded well to initial non-surgical periodontal therapy. In the present follow-up study, the remaining 33 patients were randomly treated further using either modified Widman flap surgery or systemic metronidazole. The patients responding unsatisfactorily to this 2nd treatment phase, received supplementary systemic chemotherapy or surgery, respectively. By using this study design, we determined which baseline clinical variables and/or laboratory findings predicted the treatment outcome in these study patients. Clinical variables included the assessment of bleeding, suppuration, probing pocket depth, furcation lesions, relative attachment level and radiographic infrabony defects. Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were cultured from subgingival plaque samples. The specific IgG and IgA antibody levels against 5 serotypes of A. actinomycetemcomitans were determined in serum and saliva. Elastase-like, trypsin-like and general protease activities were assessed from saliva. The bivariate statistical analyses showed that the most pronounced difference between the patients responding well to initial non-surgical therapy (group MC, n = 13), to either supplementary surgery or chemotherapy (group FT1, n = 11), or those responding to the complex therapy (group FT2, n = 17), was the prior extent of periodontal destruction expressed as the proportion of > or = 6 mm deep periodontal pockets. When multiple linear regression was used to investigate the influence of clinical and laboratory findings on the variation of treatment response between the 3 groups, the most significant explanatory factor was the simultaneous presence of subgingival A. actinomycetemcomitans and multiple deep periodontal pockets. None of the immunological or biochemical variables used had any further influence in the model. Pretreatment microbiological examination, especially for the detection of A. actinomycetemcomitans, seems to be a valuable laboratory screening method for identifying complex treatment need in adult patients with advanced periodontitis. However, the evaluation of the extent and pattern of periodontal breakdown remains crucial for choosing the treatment strategy including surgery and/or chemotherapy in A. actinomycetemcomitans-infected adult periodontitis patients.

The effect of non-surgical periodontal and adjunctive minocycline-HCL treatments on the activity of salivary proteases

The purpose of this investigation was to evaluate the effect of non-surgical periodontal treatment and adjunctive systemic minocycline therapy on the level of neutral protease activity in whole saliva of adults with periodontitis. A test group of 21 adult patients with moderate to severe periodontitis was compared to a control group of 5 adults with healthy periodontium. Four test groups were examined: 1) scaling and root planing (SRP), probing depth = 4 to 5 mm; 2) SRP, PD > or = 6 mm; 3) SRP and adjunctive systemic minocycline therapy, PD = 4 to 5 mm; 4) SRP and adjunctive systemic minocycline therapy, PD > or = 6 mm. Clinical parameters and levels of neutral protease in whole saliva were assessed at baseline and on the sixth week after the non-surgical periodontal treatment. Neutral protease activity was measured by spectrofluorimetric method. Statistical tests of Mann-Whitney and Spearman Rank correlation coefficient were used in the evaluation of the mean values of measurements. The mean values of protease activity were significantly higher in the test groups than in the control group at baseline. Six weeks after non-surgical therapy, patients with 4 to 5 mm probing depth had approximate values of protease activity comparable to the control group. Hence it can be argued that these patients did not need minocycline HCL as an adjunctive therapy. However, non-surgical therapy had limited effects on both clinical parameters and enzyme activities for subjects with > or = 6 mm probing depth; on the other hand, gingival inflammation and enzyme activities were reduced significantly by the usage of minocycline as adjunctive therapy in these patients. According to our results, neutral protease activity in saliva is related to probing depth and gingival bleeding index, and not related to age and epithelial cell number. For these reasons, systemic minocycline therapy might be useful as an adjunct to non-surgical therapy in the presence of deep pockets, especially for reinfected cases. Further investigations are needed to confirm this suggestion.

Oral fluid elastase as an indicator of periodontal health

The study was designed to find out whether oral elastase activity could be used as a simple biochemical indicator of periodontal health. Both stimulated whole saliva and water rinse samples were collected from subjects with different degrees of adult periodontitis, gingivitis or healthy periodontium. In both sample types, elastase was mostly bound to insoluble fraction and preferred valine containing synthetic substrate, similar to neutrophil elastase. The elastase measurement required very little manipulation or time and its reproducibility was found to be good. The elastase levels were found to be negligible in edentulous subjects and usually very low in subjects with healthy periodontium. In about 85% of periodontitis cases having at least 1 deep periodontal pocket ( > or = 6 mm), clearly elevated elastases levels were detected in both the saliva and r rinse samples. In advanced periodontitis cases, the colour reaction took place in 0.5 to 2 h. In localized periodontitis cases, 2- to 18-h incubations were required for positive reaction. There was a good correlation between the elastase activity and the number of deep periodontal pockets and the average community periodontal index of the subjects. Elastase activity was not a good indicator of gingivitis. About 45% of gingivitis cases were positive with the elastase test, and the enzyme values were not significantly increased in experimental gingivitis. In a longitudinal study on advanced periodontitis cases, elastase levels dropped dramatically as a result of clinically successful therapy, close to the values of healthy subjects. The oral elastase test could serve as a valuable adjunct in periodontal screening and assessment of treatment efficacy.

Saliva-bacterium interactions in oral microbial ecology

Saliva is thought to have a significant impact on the colonization of microorganisms in the oral cavity. Salivary components may participate in this process by one of four general mechanisms: binding to microorganisms to facilitate their clearance from the oral cavity, serving as receptors in oral pellicles for microbial adhesion to host surfaces, inhibiting microbial growth or mediating microbial killing, and serving as microbial nutritional substrates. This article reviews information pertinent to the molecular interaction of salivary components with bacteria (primarily the oral streptococci and Actinomyces) and explores the implications of these interactions for oral bacterial colonization and dental plaque formation. Knowledge of the molecular mechanisms controlling bacterial colonization of the oral cavity may suggest methods to prevent not only dental plaque formation but also serious medical infections that may follow microbial colonization of the oral cavity.

The effect of treatment on the activity of salivary proteases and glycosidases in adults with advanced periodontitis

Enzyme activity in whole saliva of trypsin-like protease, elastase-like protease, general protease, and three glycosidases was measured by colorimetric assays, using synthetic substrates. A study group of 24 adults with advanced periodontitis was compared to a control group of 25 subjects with healthy periodontium. Clinical parameters and levels of enzyme activity were assessed at baseline, after non-surgical periodontal therapy (at 8 months), following the maintenance phase or periodontal surgery (at 15 months), and after the maintenance phase with or without systemic chemotherapy (at 20 months). The mean values of the proteolytic enzymatic activity and the activity of two glycosidases in whole saliva were significantly higher in the study group than in the control group at baseline. After the initial treatment phase at 8 months, all three proteases were reduced significantly, but the glycosidases were still high. After all treatment phases at 20 months, the activity of both the proteases and glycosidases approximated the values of the healthy group. In the saliva samples collected prior to treatment and following non-surgical periodontal therapy, the activity of salivary elastase correlated significantly with the number of deep gingival pockets (PD > or = 6 mm) and with either gingival index (GI) or the percentage of bleeding sites (BOP%). The enzyme activity in whole saliva appears to reflect the status of periodontal health. Salivary elastase shows good potential to serve as a novel adjunct to detect destructive periodontal inflammation and to follow periodontal healing after treatment.

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.

Cathepsin B/L-, elastase-, tryptase-, trypsin- and dipeptidyl peptidase IV-like activities in gingival crevicular fluid. A comparison of levels before and after basic periodontal treatment of chronic periodontitis patients

20 chronic periodontitis patients were given a full periodontal examination, including measurements of probing depth, clinical attachment loss, gingival index, bleeding index and plaque index. At a second visit, gingival crevicular fluid (GCF) was collected from the deepest accessible probing site of each tooth. The patients then received scaling, root planing and other appropriate nonsurgical treatment. GCF was collected from the same sites as sampled pretreatment and clinical parameters were measured again. Cathepsin B/L-, elastase-, tryptase-, trypsin-, and dipeptidyl peptidase IV-like activities in GCF samples were determined by fluorimetric assay with peptidyl derivatives of 7-amino-4-trifluoromethyl coumarin. Following treatment, there were reductions in all clinical parameters and all protease activities. Most were statistically significant both on a patient level using average patient values and on a site level using either individual patient or pooled patient data. As in previous pre-treatment comparisons, post-treatment protease levels correlated positively and significantly with the corresponding clinical parameters at patient and site levels. The reductions and correlations were more marked for total enzyme activities than concentrations. GCF protease levels appear to reflect the clinical status of periodontal lesions and may thus be of value in monitoring disease activity.

The effect of periodontal therapy on salivary pseudocholinesterase activity

The effects of different stages of periodontal therapy on salivary pseudocholinesterase (PCE) activity in patients with periodontitis were determined by use of a spectrophotometric method. The mean PCE activity in whole saliva was 17.95 U/L in the pre-treatment phase, 4.67 U/L after scaling and oral hygiene instructions, and 1.93 U/L following surgical procedures. It was observed that the mean salivary PCE activity in patients with periodontitis showed a tendency to decrease in both phases of treatment, and PCE levels at the end of periodontal therapy were similar to those of healthy subjects.

Arginine catabolism by strains of oral streptococci

Arginine catabolism via the arginine deiminase pathway was found in Streptococcus sanguis 903. Citrulline and ornithine were released from resting cells incubated with arginine, arginine-containing peptides, or saliva. Maximum arginine catabolism by resting cells of S. sanguis 903 was found in the pH range 7-8 and at 45-48 degrees C. Arginine deiminase activity was found in the cytoplasm and in the cell-wall extract of this strain, while ornithine carbamoyltransferase activity was found in the cytoplasm and in extracts of cell walls and cytoplasmic membranes. Streptococcus mutans GS-5 and Streptococcus sobrinus strains OMZ 176 and 6715 could release arginine from salivary peptides but were incapable of significant arginine catabolism.

Accessible sialic acid content of oral epithelial cells from healthy and gingivitis subjects

The purpose of the present study was to determine if there were differences in the quantity of accessible sialic acid on superficial epithelial cells collected from different areas of the mouth, and from healthy subjects with good oral hygiene, as compared to subjects with gingivitis. Superficial epithelial cells were collected by gently scraping the tongue dorsum, hard palate, free gingiva and buccal epithelium. The cells were washed and treated with clostridial neuraminidase to release accessible sialic acid; this was quantitated using a fluorometric assay. Buccal cells released an average of 62.6 ng sialic acid per 10,000 cells, which was nearly 3-fold more than cells from the hard palate (24.1 ng), free gingiva (21.9 ng), or tongue (15.4 ng). Buccal and free gingival cells collected from 5 healthy subjects had significantly higher levels of accessible sialic acid on their surface than cells collected from 5 subjects with gingivitis. These differences were significant at the p less than 0.001 and p less than 0.01 levels, respectively. The data obtained suggest that the oral hygiene status of an individual can influence the quantity of accessible sialic acid residues on oral epithelium; this would be expected to influence the attachment and colonization of bacteria which bind to sialic acid-containing receptors.

Selective modulation of bacterial attachment to oral epithelial cells by enzyme activities associated with poor oral hygiene

The present investigation explored the hypothesis that elevated levels of certain enzymes in the gingival crevicular environment of individuals with poor oral hygiene and/or gingival inflammation may modify the surfaces of epithelial cells and thereby modulate the types of bacteria which attach and colonize. Buccal epithelial cells treated with neuraminidase and certain proteases were used as a model for study. Bacteria studied included Streptococcus sanguis and Streptococcus mitis which have been associated with gingival health, Actinomyces species which are increased in plaque associated with developing gingivitis, and Bacteroides gingivalis, Bacteroides intermedius, and Actinobacillus actinomycetemcomitans which are associated with destructive periodontal diseases. Treatment of epithelial cells with the enzymes studied produced selective effects on their receptivity for bacteria. Neuraminidase treatment of epithelial cells greatly reduced the attachment of all strains of S. sanguis and S. mitis studied. In contrast, the number of Actinomyces viscosus, A. naeslundii and A. israelii cells which attached was significantly increased. Neuraminidase treatment also appeared to enhance attachment of B. intermedius and B. gingivalis. Treatment of buccal cells with trypsin, chymotrypsin or papain also selectively affected bacterial attachment. Such protease treatment greatly reduced the numbers of streptococci and A. viscosus cells which attached, while the numbers of B. gingivalis and B. intermedius were significantly increased. Treatment of epithelial cells with preparations of lysosomal enzymes derived from human PMNs produced similar selective effects. The changes in bacterial adhesion observed by the enzyme treatments studied are consistent with the shifts in the composition of the gingival crevice flora which occur when oral hygiene is terminated and gingivitis develops.

Salivary collagenase. Origin, characteristics and relationship to periodontal health

Saliva collected from subjects with healthy and with diseased periodontium was assayed for collagenase activity by incubation at 25 degrees C with soluble type I, II or III collagen. The degradation products were analyzed by separation in SDS-polyacrylamide gel electrophoresis followed either by protein staining or by exposure of the dried gel to X-ray film in the case of radioactively labeled type I collagen. Collagenase of vertebrate type was detected in the whole saliva of all subjects but not in parotid, sublingual or submandibular fluids. Most of the collagenase was in the soluble fraction of saliva that also contained factors which both activated and inhibited the enzyme. The salivary collagenase resembled the collagenase of human PMNs and gingival sulcular fluid in its molecular size of 70,000 daltons, in its activation by gold thioglucose and in its tendency to degrade types I and II collagens over type III collagen. Before periodontal treatment, the saliva of periodontitis patients had significantly higher collagenase than after treatment. In periodontitis, collagenase existed mainly in the active form, while in the healthy mouths most of the enzyme was latent but could be activated by sulfhydryl reagents or proteolytically with trypsin, and chymotrypsin but not by human plasma kallikrein or plasmin. In some of the samples from untreated periodontitis patients bacterial collagenase may have been present in small quantities. Most of the collagenase in the saliva from all subjects appeared to originate from PMNs entering the oral cavity through the gingival sulcus.

Determination of pseudocholinesterase activity in the gingival crevicular fluid, saliva, and serum from patients with juvenile periodontitis and rapidly progressive periodontitis

By use of a spectrophotometric method, pseudocholinesterase (PCE) activities were determined in gingival crevicular fluid (GCF), saliva, and serum from patients with juvenile periodontitis (JP) and rapidly progressive periodontitis (RPP) and from controls. The PCE activity in the GCF samples was 181 +/- 48 U/L in the JP group, 588 +/- 135 U/L in the RPP group, and 88.5 +/- 29.1 U/L in the control group. Saliva PCE activity levels were 9.1 +/- 1.7 U/L in the JP group, 21.8 +/- 4.5 U/L in the RPP group, and 12.7 +/- 0.8 U/L in the control group. GCF contained a higher PCE activity than saliva but a lower one than that of serum. The RPP group had a significantly higher PCE activity in both the GCF and saliva samples. No significant differences could be found regarding serum enzyme levels. Also, no significant correlations were present between biochemical values and the severity of periodontal disease. GCF may be an important source for the PCE content of saliva. It is suggested that the increased PCE activity seen in RPP patients might be caused by either the direct production of esterases by bacteria or the induction of esterases during periodontal destruction.

Detection of high-risk groups and individuals for periodontal diseases: laboratory markers from analysis of saliva

The use of saliva as a source of components that may identify subjects at risk of developing destructive periodontitis, or provide markers of disease potential or activity, has been reviewed. It was concluded that bacteria, their constituents or products are unlikely to be rewarding and that host-derived salivary factors such as enzymes cannot identify risk, as deficiency states for these do not exist. Secretory IgA, plasma IgA and IgG isotype levels and specific antibodies may be associated with risk, but probably only if levels fall below those which are protective or a specific antibody response is absent. More work is needed to distinguish between monomeric and dimeric IgA antibodies and to identify IgG antibodies in longitudinal clinical studies. In general, although saliva may prove to be useful as a source of indicators of current disease activity or as a means of assessing responses to treatment, it is unlikely to provide evidence for the existence of risk factors.

Trypsin-like activity in subgingival plaque. A diagnostic marker for spirochetes and periodontal disease?

Taxonomic screening of subgingival plaque organisms with various enzyme assays have shown that Treponema denticola, Bacteroides gingivalis and an unspeciated Capnocytophaga species possess a trypsin-like enzyme (TLE) that can be detected by the hydrolysis of N-benzoyl-DL-arginine-2-naphthylamide (BANA). As these organisms can be considered to be periodontopathic, it was of interest to determine whether this BANA hydrolyzing enzyme could be detected directly in subgingival plaque samples. Subgingival plaque samples were collected from single sites of known pocket depth, and after dispersal by vortexing, aliquots were incubated overnight with BANA and were counted microscopically. The color reactions were developed with fast garnet, read by the eye and classified as positive (red to red-orange), negative (yellow) and questionable. In the BANA-positive plaques, the spirochetes averaged 43% of the microscopic count, whereas in the BANA negative plaques the spirochetes averaged 8% of the microscopic count. The average pocket depth of BANA-positive plaques was 6.7 mm, whereas the average pocket depth of BANA-negative plaques was 4.5 mm. When both of these parameters were combined, the presence of a positive BANA reaction was usually indicative of subgingival plaques containing greater than 34% spirochetes removed from sites that had probing depths of 7 mm or more. Seventy-one per cent of the plaques removed from untreated periodontal patients were BANA-positive, while only 8% of the plaques removed from successfully treated patients seen at maintenance recall visits were BANA-positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Arylaminopeptidase activities of oral bacteria

Protease and peptidase enzymes are thought to play a role in the virulence of many oral organisms, especially those associated with periodontal diseases. In order to evaluate the peptidases of periodontopathogens, we compared the arylaminopeptidase activities of Bacteroides gingivalis with those of other oral and non-oral bacteria. Sixty-three bacterial strains representing the prominent cultivable organisms in human periodontal pockets were tested, including representatives of the black-pigmented Bacteroides, Actinobacillus, Actinomyces, Campylobacter, Capnocytophaga, Eikenella, Fusobacterium, Haemophilus, Lactobacillus, Streptococcus, and Veillonella species. Each micro-organism was examined for its ability to hydrolyze 18 synthetic substrates of beta-naphthylamide derivatives of amino acids, dipeptides, and tripeptides. Quantitation of the enzyme activity was accomplished by colorimetric measurement of the amounts of released beta-naphthylamines. N-CBz-glycyl-glycyl-L-arginine-beta-naphthylamide was readily cleaved by B. gingivalis, but slightly or not at all by the other oral strains tested. L-arginine-beta-naphthylamide was cleaved by B. gingivalis, Capnocytophaga species, and Streptococcus species, but not readily by the other Bacteroides strains. Some dipeptide substrates tested, such as glycyl-L-arginine- and glycyl-L-proline-beta-naphthylamide, were strongly cleaved by B. gingivalis and weakly cleaved by other Bacteroides strains. Since high levels of N-CBz-glycyl-glycyl-L-arginyl-aminopeptidase activity are characteristic of B. gingivalis, its measurement may be valuable in the identification of this organism in clinical samples as an aid in diagnosis and monitoring of periodontal infections. Furthermore, this and other aminopeptidases produced by B. gingivalis and other oral organisms may play a role in the tissue destruction seen in periodontal disease.