Assessment of Salivary and Serum Antioxidant Vitamins and Lipid Peroxidation in Patients with Recurrent Aphthous Ulceration

Assessment of differences in stress markers of edentulous patients rehabilitated with complete dentures

Background

Biomarkers can aid in determining the success of complete denture. Fewer studies evaluated the biomarkers in edentulous patients. This can aid in planning of better qualitative care for edentulous patients. The study compared the quantities of nitric oxide (NO), salivary alpha amylase (SAA) and thiobarbituric acid reactive substances (TBARS) before and after denture insertion in complete denture patients.

Methods

The study involved 25 edentulous patients. The saliva samples were obtained from patients prior, 1 h, and 1 week after denture insertion. Standardized procedure was followed in sample management, transportation and storing. The investigations varied with the biomarkers. SAA was estimated by enzymatic assay. TBARS by lipid peroxidation and NO was assessed by Griess reaction. The obtained data were tabled and statistically analyzed.

Results

The results displayed variation in the level of markers between before and after denture insertion. The mean levels of SAA decreased from 8.26 ± 1.32 nm/ml to 3.44 ± 1.25 nm/ml in following denture insertion. The mean of TBARS and NO increased after denture insertion to 14.33 ± 4.72 nm/ml and NO 22.92 ± 5.79 ng/ml. The results were statistically significant with p < 0.05.

Conclusion

The study concluded that denture insertion decreased the levels of psychological stress marker (SAA) and increased the Oxidative stress marker (TBARS, NO).

Systemic and local effect of oxidative stress on recurrent aphthous stomatitis: systematic review

Recurrent aphthous stomatitis (RAS) is a chronic and recurrent inflammatory disease of the mouth. It is characterised by the appearance of painful ulcers in the oral mucosa. RAS is believed to be a multifactorial disease with genetic predisposition, environmental factors and alterations in the immune system. Oxidative stress, caused by an imbalance between free radicals and the antioxidant system, also appears to be involved in the pathogenesis of RAS. Several risk factors, such as smoking, iron and vitamin deficiency and anxiety, may contribute to the development of the disease. Understanding the underlying mechanisms may help in the prevention and treatment of RAS. We searched PubMed, Scopus and Web of Science databases for articles on oxidative stress in patients with RAS from 2000 to 2023. Studies analysing oxidant and antioxidant levels in the blood and saliva of RAS patients and healthy controls were selected. Of 170 potentially eligible articles, 24 met the inclusion criteria: 11 studies on blood samples, 6 on salivary samples and 7 on both blood and salivary samples. Multiple oxidative and antioxidant markers were assessed in blood and saliva samples. Overall, statistically significant differences were found between RAS patients and healthy controls for most markers. In addition, increased oxidative DNA damage was observed in patients with RAS. Patients with RAS show elevated levels of oxidative stress compared to healthy controls, with a significant increase in oxidative markers and a significant decrease in antioxidant defences in saliva and blood samples.

Systematic review and meta-analysis of oxidative stress and antioxidant markers in recurrent aphthous stomatitis

BACKGROUND

We performed this systematic review and meta-analysis to synthesize all studies that reported the level of oxidative and antioxidative markers in recurrent aphthous stomatitis (RAS) patients compared to controls.

METHODS

We registered our study in PROSPERO (CRD42023431310). PubMed, ProQuest, Scopus, EMBASE, Google Scholar, and Web of Science were searched to find relevant publications up to June 5, 2023. The standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. We included 30 articles after multiple stags of screening.

RESULTS

We found that erythrocyte superoxide dismutase and Glutathione peroxidase activity were significantly lower in patients with RAS compared to healthy controls (SMD = - 1.00, 95%CI = -1.79 to -0.21, p = 0.013, and SMD = - 1.90, 95%CI = -3.43 to -0.38, p = 0.01, Respectively). However, there was not any difference between patients with RAS and healthy controls in erythrocyte Catalase (SMD = - 0.71, 95%CI = -1.56-0.14, p = 0.10). The total antioxidant status (TAS) level, in serum was significantly lower in patients than healthy controls (SMD = - 0.98, 95%CI = -1.57 to -0.39, p = 0.001). In addition, RAS patients had higher levels of serum Malondialdehyde (MDA), Serum total oxidant status, and serum oxidative stress index than healthy controls (SMD = 2.11, 95%CI = 1.43-2.79, p < 0.001, SMD = 1.53, 95%CI = 0.34-2.72, p = 0.01, and SMD = 1.25, 95%CI = 0.25-2.25, p = 0.014, Respectively); However, salivary MDA and TAS, and serum uric acid, vitamin E and C, and reduced glutathione levels of patients with RAS were not different from that of healthy controls.

CONCLUSIONS

The relationship between oxidative stress and RAS is well established in this meta-analysis. Although the molecular processes underlying the etiology of this pathology remain unknown, evidence indicating oxidative stress has a significant role in the pathogenesis of RAS has been revealed.

Salivary malondialdehyde in oral submucous fibrosis - A marker for oxidative damage

BACKGROUND

Oral submucous fibrosis (OSMF) is a potentially malignant disorder of oral mucosa and its malignant transformation rate accounts to about 7%-13%. Oxidative damage and lipid peroxidation plays an important role in OSMF. Lipid peroxidation has not been widely investigated in OSMF patients with respect to clinical staging and histopathological grading. As human saliva is a diagnostic fluid which can be obtained in a noninvasive procedure as compared to the blood for serum analysis, the present study was aimed at evaluating the salivary malondialdehyde (MDA) levels in OSMF and comparison with respect to clinical staging and histopathological grading.

AIM

This study aims to evaluate salivary MDA levels in OSMF and compare the levels with respect to clinical and histopathological grading systems.

MATERIALS AND METHODS

Forty cases of clinically diagnosed and histopathologically proven cases of OSMF were included for the purpose of this study. As controls 40 age-matched individuals without any systemic disease were selected. Unstimulated whole saliva was collected from each individual, centrifuged and frozen at - 20°C until analysis. Lipid peroxidation products MDA were analyzed by thiobarbituric acid reaction.

RESULTS

Salivary MDA levels were significantly increased in OSMF patients compared to controls. The progressively increased salivary MDA levels showed a positive correlation with the clinical stages and histopathological grades of OSMF and the results were statistically significant.

CONCLUSION

The increased salivary MDA levels in OSMF patients compared to the control group suggests an increased oxidative stress levels in the potentially malignant disorders such as OSMF. The mean salivary MDA levels were increased significantly as the clinical stage and histopathological grade of OSMF advances, suggesting MDA to be used as a reliable biochemical marker and also a prognostic marker to assess the extent of oxidative damage in OSMF.

Do Heavy Metals Accumulated in Saliva Involve in the Etiopathogenesis of Recurrent Aphthous Stomatitis?

Recurrent aphthous stomatitis (RAS) is one of the most common diseases of oral mucosa characterized by recurrent painful ulcers. Although many factors have been implicated in its etiology, they are not fully identified. To investigate the involvement of heavy metals accumulated in saliva in the etiopathogenesis of RAS. This is a prospective, comparative, and controlled clinical study investigating the relationship between heavy metal exposure and RAS. The study consisted of 75 patients with idiopathic RAS who presented to our clinic with recurrent oral wound complaints and 74 healthy volunteers. All subjects were interviewed regarding age, acute or chronic diseases, dietary habits, and possible chemical exposure. Lead (Pb), cadmium (Cd), mercury (Hg), copper (Cu), and manganese (Mn) was measured in saliva by inductively coupled plasma-mass spectrometer (ICP-MS). Significance was considered at p < 0.05. Salivary levels of Pb (15.2 ± 1.1 vs. 7.6 ± 9.9 μg/l; p < 0.003), Hg (0.50 ± 0.60 vs. 0.13 ± 0.30 μg/l; p < 0.001; p < 0.001), Cd (0.11 ± 0.14 vs. 0.06 ± 0.13 μg/l; p < 0.021), and Cu (34.9 ± 22.5 vs. 21.6 ± 21.9 μg/l; p < 0.001) were significantly higher in the patient group than that in the control group. There was no significant difference between Mn levels (57.9 ± 41.6 μg/l). Higher heavy metal content of saliva in the patients with RAS may induce apoptosis and ulcer in oral mucosa cells through triggering release of reactive oxygen species resulting from oxidative stress resulting DNA damage.

Saliva for Assessing Vitamin A Status in Extremely Preterm Infants: A Diagnostic Study

BACKGROUND

Salivary measurement of hormones and vitamins is gaining prominence as a minimally invasive procedure with the negligible potential for harm. We aimed to assess the utility of saliva for assessing vitamin A status in extremely preterm infants.

METHODS

Paired saliva and blood samples were collected at 4 weeks of age from infants born <28 weeks of gestation using a proprietary polymer swab. Plasma retinol was measured using high-performance liquid chromatography, and salivary retinol was measured using enzyme-linked immunosorbent assay.

RESULTS

Thirty infants were recruited with a median (IQR) gestation and birth weight of 26.2 weeks (24.8-27.2) and 865 g (718-1,002), respectively. An adequate volume of saliva (>50 µL) was obtained in 68%. There was no significant correlation (Spearman's correlation coefficient = 0.16, p = 0.3) between individual plasma and salivary retinol levels. Bland-Altman analysis showed wide limits of agreement (-113 to +119%) between individual plasma and salivary retinol levels.

CONCLUSION

Individual vitamin A status cannot be determined reliably from saliva in extremely preterm infants using current collection materials and analysis techniques.

The effects of pomegranate peel extract on recurrent aphthous stomatitis

As high as 20% of the population is thought to have recurrent aphthous stomatitis (RAS), hence, finding new therapeutic agents may be needed. Pomegranate (Punica granatum), has been extensively used in the folk medicine of many cultures, as it possesses antioxidant, anti-inflammatory and anti-bacterial properties. In this study, it is hypothesized that a topical form of pomegranate peel extract (PPE) may shorten the duration, accelerate the healing and reduce the pain of RAS patients. The presented randomized, double-blind study was conducted on 56 patients. Herein, 28 patients were advised to apply PPE gel, and the other 28 patients were given placebo gel, twice daily for one week. Efficacy evaluations were made at days 0 (before using the gel), 3, 5 and 7. The mean values of ulcer size, pain and healing duration of ulcers were compared in both groups. PPE gel was significantly effective in reducing the pain (p<0.001), ulcer size (p<0.001), and healing duration of ulcers (p<0.001) over a period of one week. PPE in the form of oral gel can be used in the management of aphthous ulcers.

Evaluation of Salivary Lipid Peroxidation End Product Level in Dental Caries

BACKGROUND

Tissue destruction can be measured by the level of lipid peroxidation (LP) end products. Since free radicals are very reactive with low survival time, the level of free radicals and oxidative stress activity are measured indirectly by tissue damage end product assessment, i.e. Malondialdehyde (MDA) that is a final end product of LP.

OBJECTIVE

The aim of this study was to evaluate salivary MDA level as an indicator of oxidative stress; in caries-active and caries-free students.

METHODS

A total of 100 male and female students, 15-17 years of age, participated in this casecontrol study. Five mL of whole saliva was obtained. Salivary MDA level was measured spectrophotometrically. Statistical comparisons were performed with Student's t-test, using SPSS 13.

RESULTS

Salivary MDA level was significantly higher in the caries-active group compared to the control caries-free group. MDA was also slightly lower in males.

CONCLUSION

Higher MDA level might indicate caries-induced oxidative stress. In this study there was a relationship between salivary MDA level and dental caries. Therefore oxidative stress suppression might prevent caries initiation and progression.

Evaluation and Comparison of Total Antioxidant Capacity of Saliva Between Patients with Recurrent Aphthous Stomatitis and Healthy Subjects

Background & Objectives:

Recurrent Aphthous Stomatitis (RAS) is one of the most common chronic ulcerative lesions of the oral mucosa and its development may be associated with oxidative stress. The aim of this study was to evaluate salivary Total Antioxidant Capacity (TAC) in patients with minor RAS.

Materials & Methods:

In this case-control study, 27 patients with minor RAS and 28 age- and sex-matched controls without RAS were enrolled. TAC was measured in unstimulated saliva for patients (during active lesion phase and after healing) and controls by immunologic assay. Data were analyzed by SPSS 18 using paired and unpaired t-tests (P<0.05).

Results:

Salivary TAC levels of patients presented a significant increase from active lesion phase (0.26±0.16) to healing time (0.43±0.41); (P=0.034). There was no significant difference in the level of salivary TAC between patients during active lesion phase and controls (0.24±0.13); (P=0.641).

Conclusion:

Increasing level of salivary TAC may be involved in remission of RAS lesions, suggesting its evaluation in future studies.

Salivary and Serum Antioxidant and Oxidative Stress Markers in Dental Caries

Dental caries is the most common, chronic, noncommunicable, preventable oral disease worldwide. Oxidation may play an important role in dental caries initiation and progression. Antioxidants in body fluids protect cells. The aim of this study was to evaluate salivary and serum total antioxidant capacity (TAC) and malondialdehyde (MDA) levels in dental caries. A total of 118 healthy caries-free and caries-active male and female students participated. Caries was detected clinically. Unstimulated whole-saliva samples and blood samples were obtained. Sialochemical analysis was carried out by spectrophotometric assay. Data were analyzed with the Student t test using STATA 11. Salivary and serum TAC levels in the case and control groups did not show any significant differences. Mean salivary MDA levels in the case and control groups were 0.71 ± 0.1 and 0.35 ± 0.06 nmol/mL, respectively. The results showed significantly higher levels of salivary and serum MDA in the case group compared to the healthy control group. The oxidative stress marker was significantly higher in the caries group compared to the healthy control group. Antioxidants were not significantly different between the two groups. MDA can be produced by dental caries, resulting in a decrease in antioxidant levels, causing disease progression. Further studies are necessary to determine whether MDA is the cause or effect of the disease.

Enteral vitamin A for reducing severity of bronchopulmonary dysplasia in extremely preterm infants: a randomised controlled trial

Background

Intramuscular vitamin A supplementation decreases the risk of bronchopulmonary dysplasia (BPD) in very-low-birth-weight preterm infants without significant adverse effects. However, intramuscular vitamin A supplementation is not widely accepted because of the discomfort and risk of trauma associated with repeated injections. Enteral vitamin A supplementation has not been studied adequately in the clinical trials. Enterally administered water-soluble vitamin A is absorbed better than the fat-soluble form. We hypothesised that enteral administration of a water-soluble vitamin A preparation will decrease severity of BPD compared with a control group receiving placebo.

Methods

We plan a double-blind randomised placebo-controlled trial at a tertiary neonatal-perinatal intensive care unit. Eligibility criteria include infants born at less than 28 weeks’ gestational age and less than 72 h of life. Infants with major congenital gastrointestinal or respiratory tract abnormalities will be excluded. After parental consent, infants will be randomized to receive either enteral water-soluble vitamin A (5000 IU once a day) or placebo. The intervention will be started within 24 h of introduction of feeds and continued until 34 weeks’ post-menstrual age (PMA).

The primary outcome is severity of BPD at 36 weeks’ PMA. Severity of BPD will be assessed objectively from the right-shift of the peripheral oxyhaemoglobin saturation versus partial pressure of inspired oxygen (SpO₂-PiO₂) curve. We require 188 infants for 80% power and 5% significance level based on an expected 20% decrease in the right shift of the SpO₂-PiO₂ curve in the vitamin A group (primary outcome) compared with control group at 36 weeks’ PMA, and a 20% attrition rate.

Secondary outcomes will be plasma and salivary concentrations of vitamin A on day 28 of the trial (first 30 infants), lung and diaphragm function, clinical outcomes at 36 week’ PMA or before discharge/death, and safety of vitamin A.

Discussion

BPD poses a significant economic burden on the health-care system. If our study shows that enteral supplementation of water-soluble vitamin A is safe and effective for decreasing the severity of BPD, it will provide the opportunity to further evaluate a simple, globally acceptable preventive therapy for BPD.

Trial registration

ANZCTR; ACTRN12616000408482 (30th March 2016).

Electronic supplementary material

The online version of this article (10.1186/s12887-017-0958-x) contains supplementary material, which is available to authorized users.

Relative Efficacy of Quercetin Compared with Benzydamine Hydrochloride in Minor Aphthae: A Prospective, Parallel, Double Blind, Active Control, Preliminary Study

BACKGROUND AND OBJECTIVES

Recurrent aphthous stomatitis is an inflammatory condition present since ancient era wherein numerous treatment modalities have been tried. But complete eradication of the disease has not been possible and hence newer agents are being introduced. One such agent is a flavonoid named quercetin with proven antioxidant, anti-inflammatory, and ulcer healing properties.

METHODS

40 patients with minor aphthous ulcers were divided equally into two groups: A and B. Group A patients were advised to apply quercetin gel and Group B patients were advised to take benzydamine hydrochloride mouth wash. Clinical evaluation including assessment of ulcer size and pain score and questionnaire about the acceptability of both the drugs in terms of taste and ease of application was carried out. Each criterion was compared and statistically analyzed.

RESULTS

There was statistically significant reduction in the mean score of pain sensation and ulcer area in both the groups. Quercetin showed statistically highly significant ulcer size reduction as compared to benzydamine hydrochloride.

CONCLUSION

From the present study, it is evident that quercetin is safe, well tolerated, and effective therapy which promotes complete ulcer healing in a short duration of time.

Salivary changes in oral mucosal diseases

Saliva is a unique biological fluid that can be easily collected and analyzed with low cost and low morbidity. Therefore, there is a growing attention for using salivary biomarkers in the diagnosis and monitoring of disease progress and response to treatment. Salivary changes have been described in relation to oral mucosal diseases. This article discusses the causes and consequences of salivary hypofunction and presents a review of the literature related to changes in salivary parameters in various oral mucosal diseases and in systemic diseases with possible oral mucosal involvement.

Use of Saliva Biomarkers to Monitor Efficacy of Vitamin C in Exercise-Induced Oxidative Stress

Saliva is easily obtainable for medical research and requires little effort or training for collection. Because saliva contains a variety of biological compounds, including vitamin C, malondialdehyde, amylase, and proteomes, it has been successfully used as a biospecimen for the reflection of health status. A popular topic of discussion in medical research is the potential association between oxidative stress and negative outcomes. Systemic biomarkers that represent oxidative stress can be found in saliva. It is unclear, however, if saliva is an accurate biospecimen as is blood and/or plasma. Exercise can induce oxidative stress, resulting in a trend of antioxidant supplementation to combat its assumed detriments. Vitamin C is a popular antioxidant supplement in the realm of sports and exercise. One potential avenue for evaluating exercise induced oxidative stress is through assessment of biomarkers like vitamin C and malondialdehyde in saliva. At present, limited research has been done in this area. The current state of research involving exercise-induced oxidative stress, salivary biomarkers, and vitamin C supplementation is reviewed in this article.

Assessment of serum malondialdehyde, uric acid, and vitamins C and E levels in patients with recurrent aphthous stomatitis

Background/purpose

Recurrent aphthous stomatitis (RAS) is a common oral mucosal disease. Recently, oxidative stress has been thought to play a major role in the etiopathogenesis of RAS. The aim of this investigation was to compare the serum levels of an important oxidant agent [malondialdehyde (MDA)] and nonenzymatic antioxidants [uric acid (UA) and vitamins C and E] in patients with RAS versus healthy individuals.

Materials and methods

Ninety-seven patients with idiopathic minor RAS and 97 race-, age-, and sex-matched healthy individuals were included in this study. All these individuals were allocated to three groups: RAS patients in the active stage (Group A); the same RAS patients in Group A in the remission stage (Group B); and healthy individuals without RAS (Group C). The serum levels of MDA, UA, and vitamins C and E were measured by the spectrophotometric method. Independent sample t test and paired t test were performed for statistical evaluation.

Results

Serum MDA level of Group A was significantly higher than that of Group B (P = 0.040) or Group C (P = 0.011), whereas the serum level of vitamin E was significantly decreased in Group A as compared with Group B (P = 0.012) or Group C (P = 0.001). No statistically significant differences were found between Group B and Group C in terms of MDA, UA, and vitamins C and E serum levels (P > 0.05).

Conclusion

With the double-faced character of oxidant/antioxidant, UA and vitamin C may not play a crucial role in the pathogenesis of RAS. However, MDA and vitamin E can be used as indicators for RAS.

Vitamin C: the known and the unknown and Goldilocks

Vitamin C (Ascorbic Acid), the antiscorbutic vitamin, cannot be synthesized by humans and other primates, and has to be obtained from diet. Ascorbic acid is an electron donor and acts as a cofactor for fifteen mammalian enzymes. Two sodium-dependent transporters are specific for ascorbic acid, and its oxidation product dehydroascorbic acid is transported by glucose transporters. Ascorbic acid is differentially accumulated by most tissues and body fluids. Plasma and tissue vitamin C concentrations are dependent on amount consumed, bioavailability, renal excretion, and utilization. To be biologically meaningful or to be clinically relevant, in vitro and in vivo studies of vitamin C actions have to take into account physiologic concentrations of the vitamin. In this paper, we review vitamin C physiology; the many phenomena involving vitamin C where new knowledge has accrued or where understanding remains limited; raise questions about the vitamin that remain to be answered; and explore lines of investigations that are likely to be fruitful.

Salivary biomarkers of oxidative stress: A critical review

Human saliva is an increasingly attractive medium for biomarker discovery due to its amenability to noninvasive and repeated sampling, ease of collection and processing, and suitability for single analyte or metabolomic measurements. Salivary biomarkers of oxidative stress reflect local and systemic pathologies and may inform on the diagnosis, prognosis, and therapeutic responsiveness of numerous human diseases. However, for many of the disorders investigated, data reporting on alterations in salivary redox homeostasis are often highly conflicted across studies. We surveyed the available biomedical literature on this topic and noted significant discrepancies in the study designs, target populations, and operating procedures which likely contribute to the discordant data sets reported. Based on these observations, guidelines are provided to minimize interlaboratory variability in redox biomarker discovery based on human saliva.

Association between individual response to food taste and gastroesophageal symptoms

OBJECTIVE

Taste is an important element in food preferences. Gastroesophageal reflux disease (GERD) is related to lifestyles including eating habits. We aimed to investigate the relationship between responses to specific tastes and GERD.

METHODS

Altogether 280 patients including 170 men with a mean age of 58.6 years were included in the study to determine the relationship between their liking for specific tastes and GERD using a new self-administered questionnaire (responses to various tastes and participants' sensitivity to taste and hot food and on the frequency of stomatitis). Another self-administrated questionnaire was administrated for a diagnosis of GERD (the frequency scale for the symptoms of GERD cut-off score of 10). Furthermore, 142 of 280 patients who had received esophagogastroduodenoscopy (EGD) were investigated on the association between endoscopic esophagitis and their favorite tastes.

RESULTS

In the association analyses between responses to specific tastes and GERD, the group liking salty food and the group with a high frequency of stomatitis had a significantly higher incidence of GERD (salty food: odds ratio [OR] 2.059, 95% confidence interval [CI] 1.215-3.488, P = 0.0073; stomatitis: OR 2.861, 95% CI 1.558-5.253, P = 0.0007, respectively). In association analyses with endoscopic esophagitis, the groups liking salty and sour food had a significantly higher incidence rate of endoscopic esophagitis (salty: OR 2.718, 95% CI 1.330-5.555, P = 0.0061; sour: OR 3.267, 95% CI 1.491-7.160, P = 0.0031, respectively).

CONCLUSIONS

Sensitivity and response to specific food taste were associated with GERD. The results of a preference to hot or salty food and endoscopic esophagitis suggest that physical stimuli are important for esophageal injuries.

Anti-inflammatory effects of zinc in PMA-treated human gingival fibroblast cells

OBJECTIVES

Abnormal cellular immune response has been considered to be responsible for oral lesions in recurrent aphthous stomatitis. Zinc has been known to be an essential nutrient metal that is necessary for a broad range of biological activities including antioxidant, immune mediator, and anti-inflammatory drugs in oral mucosal disease. The objective of this study was to investigate the effects of zinc in a phorbol-12-myristate-13-acetate (PMA)-treated inflammatory model on human gingival fibroblast cells (hGFs).

STUDY DESIGN

Cells were pre-treated with zinc chloride, followed by PMA in hGFs. The effects were assessed on cell viability, cyclooxygenease-1,2(COX-1,2) protein expression, PGE2 release, ROS production and cytokine release, Results: The effects were assessed on cell viability, COX1/2 protein expression, PGE2 release, ROS production, cytokine release. The results showed that, in the presence of PMA, zinc treatment leads to reduce the production of ROS, which results in decrease of COX-2 expression and PGE2 release.

CONCLUSIONS

Thus, we suggest that zinc treatment leads to the mitigation of oral inflammation and may prove to be an alternative treatment for recurrent aphthous stomatitis.

Assessment of serum enzymatic antioxidant levels in patients with recurrent aphthous stomatitis: a case control study

Background and Aim. Recurrent aphthous stomatitis (RAS) is a common oral mucosal disorder characterized by recurrent, painful oral aphthae. Despite extensive research, the exact etiology of RAS remains elusive. Recently oxidant-antioxidant imbalance of the body has been implicated in the pathogenesis of recurrent aphthous stomatitis. Thus, the aim of the study was to evaluate the enzymatic antioxidant levels in patients with recurrent aphthous stomatitis. Materials and Methods. The serum levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) were measured in 30 patients with recurrent aphthous stomatitis and compared to the control group, which included 30 healthy subjects. Student's t-test was performed for statistical evaluation. Results. The mean levels of superoxide dismutase (130.2 ± 15.94 U/mL) and glutathione peroxidase (3527.93 ± 488.32 U/L) were found to be significantly lower in study group as compared to control group (211.9 ± 20.93 U/mL, 8860.93 ± 1105.31 U/L, resp.) (P = 0.000) while level of catalase in study group was significantly higher when compared to control group (10981.00 ± 1018.07 U/mL versus 9764.00 ± 1621.19 U/mL) (P = 0.000). Conclusion. Enzymatic antioxidant system is impaired in recurrent aphthous stomatitis patients and seems to play a crucial role in its pathogenesis.

Relationship of salivary cortisol and anxiety in recurrent aphthous stomatitis

BACKGROUND AND OBJECTIVES

Recurrent aphthous stomatitis (RAS) is one of the most frequently encountered oral mucosal disorders. Despite extensive amount of research, the etiology of RAS remains unclear. Psychological-emotional factors were considered as one of the major predisposing factors. The aim of the study was to assess the levels of anxiety and salivary cortisol levels in patients with RAS and also to determine the association and relationship of salivary cortisol levels to variations of stress.

MATERIALS AND METHODS

A total of 30 patients suffering with RAS, along with the same number of age and sex matched healthy controls were included in the study. Saliva was collected from all the subjects at 9.00 am to avoid diurnal variations of cortisol levels. Salivary cortisol levels were measured by competitive enzyme linked immunosorbent assay. Anxiety levels of both groups were measured by using Hamilton's anxiety scale. Student's t-test was used to compare the anxiety and salivary cortisol levels between both groups.

RESULTS

The mean salivary cortisol level of the RAS group showed a very highly significant difference (P = 0.000) from the controls. The mean anxiety scores of the RAS group showed a very highly significant difference (P = 0.000) from the controls. The values of Pearson correlation coefficient between anxiety and salivary cortisol was 0.980 and one with a P value of 0.000 showing that there is a highly positive correlation between anxiety and salivary cortisol.

CONCLUSION

Results suggest that anxiety may be involved in the pathogenesis of RAS. Thus besides traditional treatment of RAS patients, our findings suggest that psychological support is also needed.

The Serum and salivary level of malondialdehyde, vitamins A, E, and C in patient with recurrent aphthous stomatitis

Background:

Oral recurrent aphthous stomatitis (RAS) is a chronic inflammatory disease affected oral mucosa which has afflicted about 20% of the society. Etiology of this disease is unknown. Three main factors influencing aphthous stomatitis are genetic, hematologic, and immunologic factors. Another proposed factor that may be considered in etiology of aphthous ulcer is oxidant, anti-oxidant imbalance in the body. The purpose of this study was the evaluation of lipid peroxide enzyme as an important oxidant agent and anti-oxidant vitamins in the saliva and serum of the patients suffering from RAS and compare it to healthy people.

Materials and Methods:

In this cross-sectional, descriptive – analytical study, 25 patients suffering from RAS were compared to 24 healthy individuals. Applying enzyme-linked immunosorbent assay method, the amount of malondialdehyde (MDA) as well as Vitamins A, E, and C were measured in the saliva and serum of two groups. The results were analyzed by Statistical Package for the Social Sciences (SPSS) software version (11.5), t-test and χ².

Results:

No significant difference was detected between salivary and serum levels of antioxidant vitamins (A, E, and C) and MDA in both experimental groups (P > 0.05).

Conclusion:

According to the results of this study, RAS is not associated with oxidant–antioxidant imbalance in the body. However, it seems quite necessary to carry out more studies in this area.

Antioxidants and biomarkers of oxidative damage in the saliva of patients with Down's syndrome

BACKGROUND

The aim of this study was to investigate enzymatic and non-enzymatic antioxidant systems and levels of biomarker levels of oxidative damage in the saliva of patients with Down's syndrome (DS).

METHODS

Saliva samples were collected from 30 patients with DS and control group (age: 14-24 years). Subsequently, the concentrations of superoxide dismutase, concentration of malondialdehyde, carbonylated proteins, uric acid, vitamin C and total protein, peroxidase activity and total antioxidant capacity were analyzed.

RESULTS

Patients with DS presented significantly higher concentrations of superoxide dismutase, higher levels of malondialdehyde and salivary total protein content than controls (p<0.05). Conversely, no difference in carbonylated proteins or antioxidants (uric acid, vitamin C, peroxidase, and total antioxidant capacity) was observed between DS patients and controls (p>0.05).

CONCLUSION

Patients with DS are more vulnerable to oxidative stress in saliva as indicated by the significant increase in malondialdehyde and superoxide dismutase concentrations found in this study.

Oxidative stress and cellular immunity in patients with recurrent aphthous ulcers

Recurrent aphthous ulcer (RAU) is an inflammatory condition of the oral mucosa characterized by painful, well-circumscribed, single or multiple round or ovoid ulcerations. The exact etiologic factor(s) of these ulcerations are not yet understood. The objective of this study was to evaluate inflammatory processes and free radical metabolism of 25 patients with RAUs compared to 25 healthy controls. The levels of malondialdehyde (MDA) and glutathione (GSH) were determined by high-performance liquid chromatography. Tumor necrosis factor-alpha (TNF-α), interleukin-2 (IL-2), IL-10, and IL-12 were determined by ELISA. Nitric oxide (NO), myeloperoxidase (MPO), total antioxidant status (TAS), and total oxidant status (TOS) levels were measured spectroscopically in serum. The levels of MDA, GSH, TNF-α, IL-2, IL-12, MPO, and TOS, and oxidative stress index (OSI) were higher, and the levels of NO, IL-10, and TAS were lower in patients with RAU than in controls. Statistical analysis showed that GSH, TNF-α, IL-2, IL-10, and OSI differed significantly in patients with RAU compared to controls. These parameters have important roles in oxidant/antioxidant defense.

Copper/zinc and copper/selenium ratios, and oxidative stress as biochemical markers in recurrent aphthous stomatitis

PROJECT

Recurrent aphthous stomatitis (RAS) is a common oral mucosal disorder characterized by recurrent, painful oral aphthae, and oxidative stress presumably contributes to its pathogenesis. The aim of this study is to scrutinize the relationship between oxidative stress and serum trace elements (copper, Cu; zinc, Zn; selenium, Se), and to evaluate the ratios of Cu/Zn and Cu/Se in this disorder.

PROCEDURE

Patients with RAS (n = 33) and age- and sex-matched healthy control subjects (n = 30) were enrolled in this study. Malondialdehyde (MDA) concentrations in plasma and the activities of superoxide dismutase (SOD1; CuZnSOD), glutathione peroxidase (GPx) and catalase (CAT) in erythrocyte were determined as spectrophotometric. Also, the levels of Se, Zn and Cu in serum were determined on flame and furnace atomic absorption spectrophotometer using Zeeman background correction.

RESULTS AND CONCLUSIONS

Oxidative stress was confirmed by the significant elevation in plasma MDA, and by the significant decrease in CAT, SOD1, and GPx (p < 0.05). When compared to controls, Zn and Se levels were significantly lower in patients, whereas Cu levels was higher in RAS patients than those in controls (p < 0.05). In addition, the correlation results of this study were firstly shown that there were significant and positive correlations between Se-CAT, Se-GPx, and Cu-MDA parameters, but negative correlations between Se-Cu, Se-MDA, Cu-CAT, Cu-SOD1 and Cu-GPx parameters in RAS patients. Furthermore, the ratios of Cu/Zn and Cu/Se were significantly higher in the patients than the control subjects (p < 0.05). Our results indicated that lipid peroxidation associated with the imbalance of the trace elements seems to play a crucial role in the pathogenesis of RAS. Furthermore, the serum Cu/Zn and Cu/Se ratios may be used as biochemical markers in these patients.

Assessment of the serum paraoxonase activity and oxidant/antioxidant status in patients with recurrent aphthous stomatitis

OBJECTIVES

Several studies have indicated that recurrent aphthous stomatitis (RAS) is associated with oxidative stress. The aim of this study was to investigate serum paraoxonase (PON) activity and oxidant/antioxidant status in patients with RAS.

DESIGN AND METHODS

Thirty-one patients with RAS and 31 healthy controls were enrolled. Serum PON1 and arylesterase activities, total antioxidant capacity, total oxidant status, and oxidative stress index were determined.

RESULTS

Serum total antioxidant capacity levels, PON1, and arylesterase activities were significantly lower in RAS than controls (P < 0.001), while total oxidant status levels and oxidative stress index were significantly higher (P < 0.001). PON1 activity had a significant correlation with high-density lipoprotein cholesterol only (r = 0.482, P < 0.05), while there were no correlations with other lipids (P > 0.05) in patients with RAS.

CONCLUSIONS

Our results indicate that RAS is associated with decreased PON1 activity and increased oxidative stress that plays a crucial role in the pathogenesis of RAS. Further studies on a larger number of patients are needed to verify these results.

Vitamin E supplementation, superoxide dismutase status, and outcome of scaling and root planing in patients with chronic periodontitis: a randomized clinical trial

BACKGROUND

This study investigates the levels of superoxide dismutase (SOD) activity in serum and saliva of patients with chronic periodontitis (CP). In addition, the outcome of scaling and root planing (SRP) with and without vitamin E supplementation is evaluated in terms of changes in periodontal parameters and SOD activity in patients with CP.

METHODS

Serum and salivary SOD activity in 38 patients with CP were compared with those of 22 systemically and periodontally healthy individuals (control group). At periodontal examination, serum and saliva samples were obtained. Patients with CP were randomly divided into treatment groups 1 (TG-1) and 2 (TG-2). SRP was performed for both groups, and TG-2 also received 200 mg (300 IU) vitamin E every other day. Periodontal parameters and SOD activity were evaluated after 3 months. SOD activity was determined using an SOD assay and enzyme-linked immunosorbent assay reader at 450 nm.

RESULTS

SOD activity in both serum (P <0.05) and saliva (P <0.001) was lower in patients with CP compared with controls. After 3 months of follow-up, SOD activity improved in both treatment groups; however, the improvement in TG-2 was higher than in TG-1, along with more improvement in periodontal parameters. Serum SOD levels in TG-2 increased even above the level of the control group.

CONCLUSIONS

Systemic and local SOD levels are lowered in CP. Adjunctive vitamin E supplementation improves periodontal healing as well as antioxidant defense.

Salivary markers of oxidative stress in patients with oral premalignant lesions

The aetiology of oral premalignant lesions is unknown. Oxidative stress is associated with inflammation and cancerogenesis. The aim of our study was to compare salivary markers of oxidative and carbonyl stress in patients with oral premalignant lesions and age-matched healthy controls. Unstimulated saliva samples were collected from 16 patients with oral premalignant lesions (leukoplakia, lichen planus, erythroplakia) and 16 age-matched healthy controls. Biochemical analysis included measurement of thiobarbituric acid reacting substances (TBARS), advanced oxidation protein products (AOPP), advanced glycation endproducts (AGEs) and total antioxidant capacity (TAC). Salivary RNA was analyzed using real time PCR. Salivary TBARS and AGEs were significantly higher in patients than in controls. No differences were found in AOPP. TAC and expression of superoxide dismutase were lower in patients than in age-matched controls. Other analyzed transcripts (vascular endothelial growth factor, sialotransferase, neuraminidase) did not differ between patients and the control group. Markers of lipoperoxidation and carbonyl stress were increased in patients with oral premalignant lesions. Decreased antioxidant status potentially due to decreased expression of antioxidant enzymes might be responsible for these findings. Our results might point to the aetiology or pathogenesis of oral premalignant lesions as well as to the mechanism of transition to oral carcinoma.

Oxidant/antioxidant status in recurrent aphthous stomatitis

OBJECTIVE

Recurrent aphthous stomatitis (RAS) is a common oral mucosal disorder characterized by recurrent, painful oral aphthae, and oxidative stress presumably contributes to its pathogenesis. The study was performed to evaluate the involvement of oxidant toxicity in this disorder.

METHODS

Patients with RAS (n = 26) and age- and sex-matched healthy control subjects (n = 20) were included in this study. Following an overnight fast, blood specimens were obtained. Plasma malondialdehyde concentrations and erythrocytes glutathione peroxidase activities were determined. Also, plasma vitamin E and selenium levels were detected. Mann-Whitney U-test was performed for statistical evaluation.

RESULTS

Oxidative stress was confirmed by the significant elevation in plasma malondialdehyde levels and by the significant decrease in glutathione peroxidase activities, vitamin E and selenium levels (P < 0.001).

CONCLUSIONS

Our results indicated that lipid peroxidation and the inadequacy of the defense system seem to play a crucial role in the pathogenesis of recurrent aphthous stomatitis.

Effect of sample storage on stability of salivary glutathione, lipid peroxidation levels, and tissue factor activity

Saliva samples are often required to be stored for longer periods of time either because of the project protocol or because of lack of funding for analysis. The effects of 6 months storage (fresh, 30, 60, 90 120, 150, and 180 d) on the stability of salivary reduced glutathione (GSH), lipid peroxidation (LPO) and 90 days of storage (fresh, 15, 30, 60, and 90 d) on the stability of salivary tissue factor (TF) activity and the stability of saliva imprint samples at -20 degrees C were evaluated in this study. Salivary GSH, malondialdehyde (MDA) levels as an index of LPO, and TF activities were determined using the methods of Beutler, Yagi, and Quick, respectively. Saliva imprint samples were stained with Giemsa and microscopically examined. Salivary GSH levels and TF activities decreased, whereas MDA levels increased significantly after 6 months of storage at -20 degrees C. Leucocyte, epithelium and bacterium cell counts did not significantly change at the end of 90 d of storage. Saliva samples may be stored up to 1 month at -20 degrees C for LPO assay. For cytological examinations, saliva samples may be stored for 90 d at -20 degrees C. Further studies are needed to determine the stability of salivary GSH, and salivary TF activity stored less than 30 days at -20 degrees C. On the other hand, if saliva samples are required to be stored, to avoid the changes because of different storage periods, we recommend that they must be stored under the same circumstances and in the same time period.