Saliva: A diagnostic biomarker of periodontal diseases

Assessment of Saliva Oxidative Stress Biomarkers and Gingival Health Status in a Sample of High-Functioning Autistic Children in Erbil City

Introduction Autism spectrum disorder (ASD) is a complicated disorder that affects communication, social interaction, and behavior. Several investigations have documented increased oxidative stress and damage in individuals with ASD compared with neurotypical controls. Saliva can be used as a non-invasive technique to assess oxidative stress biomarkers. This study aimed to explore the association between oxidative stress and oral health in a sample of high-functioning children with autism in Erbil City. Methods We conducted a case-control study with 96 participants aged 5-12 years, which included 48 children with ASD and 48 healthy controls. Stimulated saliva samples were collected and centrifuged. Oxidative stress biomarkers (malondialdehyde [MDA], glutathione [GSH], and uric acid) and gingival/plaque indices were also measured. Data were analyzed using SPSS, with significance set at p≤0.05. Results The data showed no significant differences between the ASD and control groups in the gingival index, salivary malondialdehyde, glutathione, or uric acid levels. However, the control group had a significantly higher mean plaque index than the ASD group (P = 0.003). Conclusion Sample size and confounding variables may influence the absence of significant differences in gingival index and salivary oxidative stress biomarkers between groups. The higher plaque index in controls aligns with plaque gingivitis. Age differences could impact oral health interpretations. Further research is needed to understand significant factors and the clinical significance of these findings in pediatric ASD populations. Most autistic children were from educated families and had good oral hygiene in addition to special care by the staff of the center.

Intelligent salivary biosensors for periodontitis: in vitro simulation of oral oxidative stress conditions

ASTRACT

One of the most common oral diseases affecting millions of people worldwide is periodontitis. Usually, proteins in body fluids are used as biomarkers of diseases. This study focused on hydrogen peroxide, lipopolysaccharide (LPS), and lactic acid as salivary non-protein biomarkers for oxidative stress conditions of periodontitis. Electrochemical analysis of artificial saliva was done using Gamry with increasing hydrogen peroxide, bLPS, and lactic acid concentrations. Electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) were conducted. From EIS data, change in capacitance and CV plot area were calculated for each test condition. Hydrogen peroxide groups had a decrease in CV area and an increase in percentage change in capacitance, lipopolysaccharide groups had a decrease in CV area and a decrease in percentage change in capacitance, and lactic acid groups had an increase of CV area and an increase in percentage change in capacitance with increasing concentrations. These data showed a unique combination of electrochemical properties for the three biomarkers. Scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS) employed to observe the change in the electrode surface and elemental composition data present on the sensor surface also showed a unique trend of elemental weight percentages. Machine learning models using hydrogen peroxide, LPS, and lactic acid electrochemical data were applied for the prediction of risk levels of periodontitis. The detection of hydrogen peroxide, LPS, and lactic acid by electrochemical biosensors indicates the potential to use these molecules as electrochemical biomarkers and use the data for ML-driven prediction tool for the periodontitis risk levels.

Innovations in Screening and Diagnosis of Periodontal Disease in Tobacco Users: A Review

Tobacco use is a significant risk factor for periodontal disease, a chronic inflammatory condition affecting the supporting structures of the teeth. Early detection and intervention are crucial for preventing the progression of periodontal disease and its associated complications. This review paper explores recent innovations in the screening and diagnosis of periodontal disease, with a focus on advancements in technology and methodologies for assessing periodontal health in tobacco users. By examining the latest research findings and technological developments, this paper aims to highlight the potential of novel approaches to improve the early detection and management of periodontal disease in this high-risk population. In addition, it discusses the challenges and opportunities associated with implementing these innovations in clinical practice and public health settings.

Comparative evaluation of salivary, serum, and GCF alkaline phosphatase levels in chronic periodontitis patients before and after nonsurgical periodontal therapy: A clinico-biochemical study

Background

Chronic periodontitis is a multifactorial disease that causes the supporting tissues around the teeth to become inflamed and destroyed, which further causes tooth mobility and eventual tooth loss. The enzyme alkaline phosphatase (ALP), which is involved in bone resorption and gingival inflammation, is an important biomarker. The current study's objective is to compare the serum, gingival crevicular fluid (GCF), and salivary levels of ALP in individuals with chronic periodontitis before and after nonsurgical periodontal therapy.

Materials and Methods

On the basis of clinical and radiographic examinations, 72 participants were split into two groups: Group I (healthy individuals) and Group II (chronic periodontitis patients). All patients who were in an aseptic condition had their serum, GCF, and unstimulated saliva taken, and samples were then tested for ALP levels using ALP kit.

Results

The difference in salivary, serum, and GCF ALP levels between the control group (23.44 ± 4.76, 58.88 ± 8.29, and 776.76 ± 121.91) and the study group (105.66 ± 16.33, 102.38 ± 4.43, and 1,825.77 ± 275.12) was found to be statistically significant with P < 0.001. The difference in salivary, serum, and GCF ALP levels from baseline (105.66 ± 16.33, 102.38 ± 4.43, and 1,825.77 ± 275.12) to postoperative (49.54 ± 5.69, 83.46 ± 4.22, and 1,148.38 ± 129.01) was found to be statistically significant with P < 0.001. The results demonstrated that patients with chronic periodontitis have considerably higher levels of serum, GCF, and salivary ALP than healthy individuals.

Conclusion

Salivary and GCF ALP can thus be used as a key inflammatory diagnostic biomarker in periodontal diseases.

Recent advances in nanomaterial-based biosensor for periodontitis detection

Periodontitis, a chronic inflammatory condition caused by bacteria, often causes gradual destruction of the components that support teeth, such as the alveolar bone, cementum, periodontal ligament, and gingiva. This ultimately results in teeth becoming loose and eventually falling out. Timely identification has a crucial role in preventing and controlling its progression. Clinical measures are used to diagnose periodontitis. However, now, there is a hunt for alternative diagnostic and monitoring methods due to the progress of technology. Various biomarkers have been assessed using multiple bodily fluids as sample sources. Furthermore, conventional periodontal categorization factors do not provide significant insights into the present disease activity, severity and amount of tissue damage, future development, and responsiveness to treatment. In recent times, there has been a growing utilization of nanoparticle (NP)-based detection strategies to create quick and efficient detection assays. Every single one of these platforms leverages the distinct characteristics of NPs to identify periodontitis. Plasmonic NPs include metal NPs, quantum dots (QDs), carbon base NPs, and nanozymes, exceptionally potent light absorbers and scatterers. These find application in labeling, surface-enhanced spectroscopy, and color-changing sensors. Fluorescent NPs function as photostable and sensitive instruments capable of labeling various biological targets. This article presents a comprehensive summary of the latest developments in the effective utilization of various NPs to detect periodontitis.

Periodontitis Continuum: Antecedents, Triggers, Mediators, and Treatment Strategies

Periodontitis (PD) is a chronic inflammatory disease of the periodontium characterized by the formation of gingival pockets and gingival recession. The local inflammatory environment can lead to the destruction of the extracellular matrix and subsequent bone loss. The pathophysiology of PD involves interactions between genetic predisposition, lifestyle, environmental factors, the oral microbiota condition, systemic health disorders, innate and adaptive immune responses, and various host defenses. The review highlighted the importance of the oral cavity condition in systemic health. Thus, a correlation between harmful oral microbiota and cardiovascular disease (CVD)/diabetes/ arthritis, etc, progressions through inflammation and bacterial translocation was highlighted. Antecedents increase an individual's risk of developing PD, trigger initiate microbe-host immunologic responses, and mediators sustain inflammatory interactions. Generally, this review explores the antecedents, triggers, and mediators along the pathophysiological continuum of PD. An analysis of modern approaches to treating periodontitis, including antibiotics for systemic and local use, was carried out. The potential role of natural ingredients such as herbal extracts, phytoconstituents, propolis, and probiotics in preventing and treating PD was highlighted.

Comparative evaluation of mucin and total protein in periodontal disease before and after nonsurgical periodontal therapy

Background

Periodontal ailments cause a quantum leap in the biomarker profile of the saliva. This profile is, in fact, the epiphany of the scale and extent of the disease. Both gingivitis and periodontitis are chronic inflammatory diseases with a step-grade progression. The study aimed to determine the response of the host in these conditions by analyzing concentrations of salivary mucin and total protein activity, before and after nonsurgical periodontal therapy (NSPT).

Materials and Methods

Sixty adult subjects were clinically examined and divided into three groups (n = 20) according to the clinical assessment and categorized as Group I (healthy), Group II (gingivitis), and Group III (chronic periodontitis). Whole saliva was collected, and salivary mucin and total protein levels were quantitatively measured at baseline in all the groups and additionally after NSPT in Groups II and III.

Results

Levels of mucin and total protein increased in patients with gingivitis and periodontitis. There was a slight decline in mucin levels in periodontitis patients in comparison with the gingivitis group. A positive correlation was found between the respective clinical parameters of both the groups along with their levels of salivary mucin and total protein. It indicated that the response of salivary glands to increase their protective potential caused the change among the groups.

Conclusion

Periodontal diseases induce an increase in the levels of mucins and proteins, which is believed as the action of the salivary glands to protect the oral cavity and put off the chaos caused by the microorganisms.

Salivary Biomarkers in Periodontitis: A Scoping Review

Periodontal disease is a prevalent and potentially impactful oral health condition, ranging from gingivitis to severe periodontitis. Early detection and precise management are crucial in modern dentistry due to its prevalence and potential systemic health implications. Traditional clinical assessments and radiographic imaging have been the primary diagnostic tools. However, recent advances in oral diagnostics have introduced the concept of non-invasive, easily accessible salivary biomarkers. This review explores the evolving landscape of salivary biomarkers associated with periodontal disease, offering a comprehensive analysis of recent studies. It delves into the key findings, clinical significance, and potential impact of these biomarkers in revolutionizing periodontal disease diagnostics and treatment monitoring. The study emphasizes their diagnostic and prognostic capabilities, including their ability to assess disease severity, correlate with clinical parameters, aid in early detection, and enhance personalized treatment planning. As the field of oral diagnostics continues to advance, understanding the role of salivary biomarkers in periodontal disease management holds the promise of improving precision and effectiveness in oral healthcare. This review underscores the potential for salivary biomarkers to become integral components of routine periodontal care, offering a minimally invasive and patient-centered approach to oral health management.

Biomarkers for diagnosis of stage III, grade C with molar incisor pattern periodontitis in children and young adults: a systematic review and meta-analysis

AIM

To explore the existing salivary, gingival crevicular fluid (GCF), blood, and serum biomarkers associated with grade C molar-incisor pattern (C/MIP) periodontitis in systemically healthy children and young adults.

MATERIALS AND METHODS

Cross-sectional, case-control, and cohort studies on stage III grade C periodontitis or former equivalent diagnosis with analysis of molecular biomarkers in saliva, GCF, blood, or serum were retrieved from six databases and screened based on the eligibility criteria. The risk of bias in included studies was evaluated. Meta-analysis was planned for biomarkers assessed using the same detection methods and sample type in at least two papers.

RESULTS

Out of 5621 studies identified at initial screening, 28 papers were included in the qualitative analysis of which 2 were eligible for meta-analysis for IgG in serum samples. Eighty-seven biomarkers were assessed with the majority being higher in cases than in controls. Only the meta-analysis of total serum IgG with low heterogeneity value revealed a significant increase in its levels in C/MIPs compared to controls (standardised mean difference: 1.08; 95% CI: 0.76, 1.40).

CONCLUSION

There is a paucity of data on biomarkers associated with molar-incisor pattern periodontitis. Although serum IgG levels are raised, other more specific biomarkers in saliva, GCF, and blood/serum may be promising but require further investigation.

Comparative clinical evaluation of a local drug delivery of cranberry and garcinia fruit gel with tetracycline fibers for amelioration of periodontitis: A split mouth study

Background

The present study formulates and evaluates a polyberry gel comprising extracts of cranberry (Vaccinium macrocarpon) and brindle berry (Garcinia cambogia) in patients suffering from chronic periodontitis.

Materials and Methods

The polyberry gel was evaluated for various physicochemical parameters, in vitro permeability and stability, and the active phytoconstituents were quantified by High-performance thin layer chromatography (HPTLC). Total phenolic content, total antioxidants, and ascorbic acid were estimated in the two extracts by in vitro assays. Patients suffering from chronic periodontitis with probing pocket depth (PPD) up to 5 mm were divided into 3 groups of 21 patients each and treated with scaling and root planing (SRP) or SRP followed by subgingival placement of polyberry gel or tetracycline fibers (standard). Plaque Index (PI), Gingival Index (GI), PPD, Clinical Attachment Level (CAL), and the salivary aspartate aminotransferase (AST) and C-reactive protein (CRP) levels were recorded at baseline and after 1 month.

Results

A significant (P < 0.01) reduction in the periodontic disease parameters was observed in the standard and gel-treated groups between their baseline and 1-month time-interval readings. The polyberry gel treatment significantly (P < 0.05 for AST and P < 0.01 for the rest) attenuated the periodontitis-elevated PI, GI PPD, CAL, AST and CRP levels when compared with SRP at the end of the study and was comparable with tetracycline.

Conclusion

The amelioration of periodontitis and gingival inflammation may be attributed to the potent antioxidant activity of the polyphenolic phytoconstituents of the gel. The polyberry gel may thus be used as a safe adjunct to SRP/tetracycline in chronic periodontitis.

Efficacy of nonsurgical periodontal therapy affecting salivary biomarkers in non-diabetic and type 2 diabetic periodontitis patients. An observational study

Objectives

To assess the effects of non-surgical periodontal therapy on salivary biomarkers in non-diabetic and type 2 diabetic periodontitis patients and to investigate if saliva may be used to monitor glucose levels in type 2 diabetes.

Material and methods

250 participants with chronic generalized periodontitis aged 35-70 years were divided into two groups: test group with type 2 diabetes (125 subjects with 64 males & 61 females) and control group with non-diabetic (125 subjects with 83 males & 42 females). Participants received non-surgical periodontal treatment. Pre-NSPT and 6-week post-NSPT saliva glucose, amylase, total protein, and C-reactive protein (CRP) levels were measured. Intergroup correlations were assessed using Karl Pearson's correlation coefficient and paired t-test.

Results

Non-surgical periodontal therapy significantly decreased CRP (p < 0.05) in diabetics and non-diabetics. CRP mean values changes from baseline 1.79 to post op 1.5 and baseline 1.5 to post-op 1.24 in males and females of test group, respectively. In control group males and females, mean values change from baseline 1.48 to post-op 1.42 and 1.499 to 1.40. Other parameters Glucose, amylase & total protein showed improvement in the level, but statistically non-significant (p > 0.05). Salivary glucose levels corresponded favorably with HbA1C levels.

Conclusion

In individuals with type 2 diabetes and non-diabetic generalized chronic periodontitis, non-surgical periodontal therapy may play a role in lowering the level of significant salivary biomarkers. Saliva can be utilized as a non-invasive approach for monitoring glucose levels in people with type 2 diabetes and chronic periodontitis.

Salivary leukocyte esterase activity by SillHa is a risk indicator of periodontal disease

BACKGROUND

There is increasing evidence that diagnostic salivary tests measuring inflammatory biomarkers are being developed to assess inflammatory status for early detection, prevention, and progression of periodontal disease. Therefore, the aim of the present study was to investigate and identify the salivary biomarker that can predict the inflammatory status of periodontal disease.

METHODS

A total of 36 patients (28 women and 8 men) with an average age of 57 years were investigated. Unstimulated saliva was collected from the recruited subjects and analyzed using SillHa, a saliva-testing device that measures bacteria count, saliva buffer capacity, acidity, leukocyte esterase, protein, and ammonia. Periodontal parameters were then obtained by clinical examination and initial periodontal therapy was performed. Data obtained with SillHa were compared with clinical periodontal parameters at baseline, re-examination (three months from baseline), and final examination (six months from re-examination).

RESULTS

Leukocyte esterase activity in saliva measured by SillHa; BOP and PCR measured by clinical examination showed a significant difference between baseline and final examination and between re-examination and final examination. Patients in the lower median group (group 1) had a significant difference in leukocyte esterase activity between baseline and final examination and re-examination and final examination. In addition, patients in Group 1 had significantly lower BOP between baseline and final examination. While patients in the higher median group (group 2) showed a modest decrease in leukocyte esterase activity, which was significant only between baseline and final examination, no significant changes were observed concerning BOP. Furthermore, the associated systemic disease was observed in 30% and 81.2% of group 1 and 2 patients, respectively.

CONCLUSION

The results suggest that leukocyte esterase activity in saliva measured by SillHa could serve as a reliable diagnostic marker for monitoring inflammatory status in periodontal disease.

Effect of Salivary Exosomal miR-25-3p on Periodontitis With Insulin Resistance

Periodontitis is caused by an oral microbial dysbiosis-mediated imbalance of the local immune microenvironment, which is promoted by insulin resistance and obesity. The prevalence and severity of periodontitis is higher in patients with type 2 diabetes than in healthy individuals, possibly because of differences in immune responses. The level of glycemic control also affects the saliva profile, which may further promote periodontal disease in diabetes patients. Therefore, we compared the salivary exosomal miRNA profiles of patients with type 2 diabetes with those of healthy individuals, and we found that exosomal miR-25-3p in saliva is significantly enriched (by approximately 2-fold, p < 0.01) in obese patients with type 2 diabetes. We also identified CD69 mRNA as a miR-25-3p target that regulates both activation of γδ T cells and the inflammatory response. Knockdown of CD69 increased (by approximately 2-fold) interleukin-17A production of γδ T cells in vitro. To evaluate the role of exosomal miRNA on progression of periodontitis, we analyzed regional immune cells in both periodontal tissues and lymph nodes from mice with periodontitis. We found that diet-induced obesity increased the population of infiltrating pro-inflammatory immune cells in the gingiva and regional lymph nodes of these mice. Treatment with miR-25-3p inhibitors prevented the local in vivo inflammatory response in mice with periodontitis and diet-induced obesity. Finally, we showed that suppression of interleukin 17-mediated local inflammation by a miR-25-3p inhibitor alleviated (by approximately 34%) ligature-induced periodontal alveolar bone loss in mice. Taken together, these data suggest that exosomal miR-25-3p in saliva contributes to development and progression of diabetes-associated periodontitis. Discovery of additional miR-25-3p targets may provide critical insights into developing drugs to treat periodontitis by regulating γδ T cell-mediated local inflammation.

The Expression of miR-23a and miR-146a in the Saliva of Patients with Periodontitis and Its Clinical Significance

Background

This study is aimed at exploring the significance of the expression of miR-23a and miR-146a in patients with periodontitis and their correlations with inflammatory factors.

Methods

A total of 120 patients with chronic periodontitis admitted to the department of stomatology in Yantai Yuhuangding Hospital from August 2017 to December 2018 were enrolled as a study group, and 80 healthy volunteers in physical examination during the same period were enrolled as a control group. The expression of miR-23a, miR-146a, interleukin-1β (IL-1β), interleukin-6 (IL-6), and interleukin-17 (IL-17) in the saliva of people in the two groups was determined using the quantitative real-time polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA).

Results

The study group showed significantly higher relative expression of saliva miR-23a and miR-146a than the control group. The area under the curve (AUC) of saliva miR-23a and miR-146a for diagnosing periodontitis was 0.857 and 0.886, respectively. The expression of saliva miR-23a and miR-146a increased with the deterioration of periodontitis in the patients. After basic treatment, the study group showed significantly decreased expression of saliva miR-23a and miR-146a. Patients in the study group showed significantly higher levels of saliva IL-1β, IL-6, and IL-17 than those in the control group, and their saliva miR-23a and miR-146a were positively correlated with their saliva IL-1β, IL-6, and IL-17, respectively.

Conclusion

Saliva miR-23a and miR-146a can be used as biomarkers for the diagnosis and assessment of periodontitis, and they may have regulatory relationships with IL-1β, IL-6, and IL-17.

miR-205 and HMGB1 expressions in chronic periodontitis patients and their associations with the inflammatory factors

OBJECTIVE

This paper sets out to investigate the miR-205 and HMGB1 expressions in chronic periodontitis (PO) patients and their associations with the inflammatory factors.

METHODS

From February 2016 to May 2018, 68 PO patients treated in our hospital were recruited for the study and placed in a patient group (PG), and 60 healthy volunteers were also recruited and placed in a healthy group (HG). Serum samples were collected from both groups for the identification of miR-205 using qPCR, as well as to determine the HMGB1 and inflammatory factor (IL-1β, IL-6, TNF-α) expression levels using ELISA. The correlations of the miR-205 and HMGB1 expression levels with the periodontal clinical indicators and the inflammatory factors were analyzed using a correlation analysis.

RESULTS

In comparison with the HG expression, the serum miR-205 expression was lower, and the HMGB1 was elevated in PG (P < 0.05). An ROC curve analysis showed that the areas under the curve (AUCs) of the serum miR-205 and HMGB1 expressions in diagnosing PO were 0.936 and 0.955 respectively. However, the serum miR-205 expression in PG increased while the HMGB1 expression decreased post treatment (P < 0.05). A correlation analysis revealed an inverse association between the serum miR-205 expression levels and the periodontal clinical indicators [bleeding index (BI), probing depth (PD), plaque index (PLI), and attachment loss (AL)], and the inflammatory factors [interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α)], but there was a positive association between the HMGB1 expression level and these parameters.

CONCLUSIONS

miR-205 and HMGB1 are closely related to the progression of PO, and may be candidate biomarkers for the diagnosis and treatment of PO.

Polyamine biomarkers as indicators of human disease

The significant increase of periodontitis, chronic kidney disease (CKD), Alzheimer's disease and cancer can be attributed to an ageing population. Each disease produces a range of biomarkers that can be indicative of disease onset and progression. Biomarkers are defined as cellular (intra/extracellular components and whole cells), biochemical (metabolites, ions and toxins) or molecular (nucleic acids, proteins and lipids) alterations which are measurable in biological media such as human tissues, cells or fluids. An interesting group of biomarkers that merit further investigation are the polyamines. Polyamines are a group of molecules consisting of cadaverine, putrescine, spermine and spermidine and have been implicated in the development of a range of systemic diseases, in part due to their production in periodontitis. Cadaverine and putrescine within the periodontal environment have demonstrated cell signalling interfering abilities, by way of leukocyte migration disruption. The polyamines spermine and spermidine in tumour cells have been shown to inhibit cellular apoptosis, effectively prolonging tumorigenesis and continuation of cancer within the host. Polyamine degradation products such as acrolein have been shown to exacerbate renal damage in CKD patients. Thus, the use of such molecules has merit to be utilized in the early indication of such diseases in patients.

Bifidobacterium animalis subsp lactis HN019 presents antimicrobial potential against periodontopathogens and modulates the immunological response of oral mucosa in periodontitis patients

Objective

To evaluate the effects of Bifidobacterium animalis subsp. lactis HN019 (HN019) on clinical periodontal parameters (plaque accumulation and gingival bleeding), on immunocompetence of gingival tissues [expression of beta-defensin (BD)-3, toll-like receptor 4 (TLR4), cluster of differentiation(CD)-57 and CD-4], and on immunological properties of saliva (IgA levels) in non-surgical periodontal therapy in generalized chronic periodontitis (GCP) patients. Adhesion to buccal epithelial cells (BEC) and the antimicrobial properties of HN019 were also investigated.

Materials and methods

Thirty patients were recruited and monitored clinically at baseline (before scaling and root planing—SRP) and after 30 and 90 days. Patients were randomly assigned to Test (SRP+Probiotic, n = 15) or Control (SRP+Placebo, n = 15) group. Probiotic lozenges were used for 30 days. Gingival tissues and saliva were immunologically analyzed. The adhesion of HN019 with or without Porphyromonas gingivalis in BEC and its antimicrobial properties were investigated in in vitro assays. Data were statistically analyzed (p<0.05).

Results

Test group presented lower plaque index (30 days) and lower marginal gingival bleeding (90 days) when compared with Control group. Higher BD-3, TLR4 and CD-4 expressions were observed in gingival tissues in Test group than in Control group. HN019 reduced the adhesion of P. gingivalis to BEC and showed antimicrobial potential against periodontopathogens.

Conclusion

Immunological and antimicrobial properties of B. lactis HN019 make it a potential probiotic to be used in non-surgical periodontal therapy of patients with GCP.

Clinical relevance

B. lactis HN019 may be a potential probiotic to improve the effects of non-surgical periodontal therapy.

Name of the registry and registration number (ClinicalTrials.gov): “Effects of probiotic therapy in the treatment of periodontitis”—NCT03408548.

A Mediterranean Diet Intervention Reduces the Levels of Salivary Periodontopathogenic Bacteria in Overweight and Obese Subjects

The human oral cavity is a complex ecosystem, and the alterations in salivary microbial communities are associated with both oral and nonoral diseases. The Mediterranean diet (MD) is a healthy dietary pattern useful for both prevention and treatment of several diseases. To further explore the effects of the MD on human health, in this study, we investigated the changes in the salivary microbial communities in overweight/obese subjects after an individually tailored MD-based nutritional intervention. Healthy overweight and obese subjects were randomized between two intervention groups. The MD group (Med-D group) increased their MD adherence during 8 weeks of intervention while the control diet (control-D) group did not change their dietary habits. The salivary microbiota was assessed at baseline and after 4 and 8 weeks of intervention. Despite no observed changes in the overall salivary microbiota composition, we found a significant decrease in the relative abundances of species-level operational taxonomic units annotated as Porphyromonas gingivalis, Prevotella intermedia, and Treponema denticola in the Med-D group compared to that in the control-D group after 8 weeks of intervention, which are known to be associated with periodontal disease. Such variations were significantly linked to dietary variables such as MD adherence rates and intakes of animal versus vegetable proteins. In addition, increased levels of Streptococcus cristatus were observed in the Med-D group, which has been reported as an antagonistic taxon inhibiting P. gingivalis gene expression. Our findings suggest that an MD-based nutritional intervention may be implicated in reducing periodontal bacteria, and an MD may be a dietary strategy supportive of oral homeostasis.IMPORTANCE Changes in dietary behavior with increased adherence to a Mediterranean diet can determine a reduction of periodontopathogenic bacterial abundances in the saliva of overweight subjects with cardiometabolic risk due to an unhealthy lifestyle, without any change in individual energy intake, nutrient intake, and physical activity.

Caries Increment and Salivary Microbiome during University Life: A Prospective Cohort Study

The purpose of this 3-year prospective cohort study was to explore the relationship between an increase in dental caries and oral microbiome among Japanese university students. We analyzed 487 students who volunteered to receive oral examinations and answer baseline (2013) and follow-up (2016) questionnaires. Of these students, salivary samples were randomly collected from 55 students at follow-up and analyzed using next-generation sequencing. Students were divided into two groups: increased group (Δdecayed, missing, and filled teeth (ΔDMFT) score increased during the 3-year period) and non-increased group (ΔDMFT did not increase). Thirteen phyla, 21 classes, 32 orders, 48 families, 72 genera, and 156 species were identified. Microbial diversity in the increased group (n = 14) was similar to that in the non-increased group (n = 41). Relative abundances of the family Prevotellaceae (p = 0.007) and genera Alloprevotella (p = 0.007) and Dialister (p = 0.039) were enriched in the increased group compared with the non-increased group. Some bacterial taxonomic clades were differentially present between the two groups. These results may contribute to the development of new dental caries prevention strategies, including the development of detection kits and enlightenment activities for these bacteria.

Estimation and correlation of salivary calcium, phosphorous, alkaline phosphatase, pH, white spot lesions, and oral hygiene status among orthodontic patients

Introduction:

The initial carious lesions are the so-called “white spot” lesions (WSLs), which implies that there is a subsurface area with most of the mineral loss beneath a relatively intact enamel surface. It is common in patients who are taking orthodontic treatment. Salivary reservoir of calcium and phosphorous counteracts the demineralization and encourages re-mineralization providing protection against caries challenge. This study was aimed to estimate and correlate the oral hygiene status, WSLs and salivary calcium, phosphorus, alkaline phosphatase (ALP), and pH in patients undergoing fixed orthodontic therapy.

Materials and Methods:

All clinical and biochemical parameters were recorded in 27 patients before starting orthodontic treatment and at 6 months of orthodontic treatment. The salivary calcium, phosphorous, ALP, and pH were determined by Arsenazo III method, Molybdate – UV and the International Federation of Clinical Chemistry method, respectively. International caries detection and assessment system index for WSL, orthodontic plaque index, bleeding on probing, and gingival index were recorded. Shapiro–Wilk's test and Wilcoxon test were applied to the data collected for statistical analysis.

Results:

There was a statistically significant increase with ALP levels, orthodontic plaque index score, gingival index score, and bleeding on probing index score. A statistically significant reduction was seen with respect to levels of calcium and pH.

Conclusion:

Maxillary canines and lateral incisors were the most affected teeth with WSLs (78.84%). There is a need for more stringent prevention programs and oral hygiene practices prior to initiation of orthodontic treatment and also during orthodontic treatment.

Evaluation of salivary calcium, phosphorus and alkaline phosphatase concentrations before and after the first phase of periodontal treatment in patients with chronic periodontitis

Background

Evaluation of salivary biomarkers is a non-invasive, convenient, and economical method for diagnosing many diseases. Evidence shows that salivary biomarkers and periodontal disease might be correlated. This study was conducted to evaluate phase I periodontal therapy's effect on salivary concentrations of calcium, phosphorous, and alkaline phosphatase (ALP).

Methods

In this descriptive, analytical study, 16 patients were selected from those referred to the Department of Oral Medicine, Faculty of Dentistry, Isfahan University of Medical Sciences, using convenience sampling. Salivary samples were collected using the drooling method. The salivary concentrations of calcium, phosphorous, and ALP were measured immediately after saliva collection, before the first phase of periodontal therapy and one month later, using a colorimetric assay. The data were analyzed with SPSS using paired t-test. P<0.05 was considered statistically significant.

Results

The salivary concentrations of calcium, phosphorous, and ALP were 6.68, 20.57, and 48.31 mg/dL, respectively, before and 7.15, 22.51, and 40.37 mg/dL, respectively, after phase I periodontal therapy. There were no significant differences between the salivary levels of calcium, phosphorous, and ALP before and after phase I periodontal therapy (P>0.05).

Conclusion

This study revealed that the salivary concentrations of calcium, phosphorous, and ALP remained relatively unchanged after phase I periodontal therapy.

Interleukin-21 and its association with chronic periodontitis

Context:

Interleukin-21 (IL-21) is a pleiotropic cytokine, well documented to contribute to the development of Th17 cells which have been shown to play an important role in the pathogenesis of periodontitis. Periodontal disease is a chronic infection of tooth-supporting tissue.

Aim:

This study evaluates the saliva and serum levels of IL-21 in patients with chronic periodontitis and periodontally healthy individuals.

Settings and Design:

The present study was carried out in the Department of Microbiology in association with Department of Oral Medicine and Radiology, Maratha Mandal's N.G.H Institute of Dental Sciences and Research Centre, Belgavi, Karnataka.

Materials and Methods:

Fifty samples of each group were included in the present study. The levels of IL-21 were assessed using a commercially available enzyme-linked immunosorbent assay (ELISA) kit and the results were expressed as pg/mL.

Statistical Analysis Used:

Statistical analysis was performed using SPSS 17.0 software. Data were expressed as mean ± standard deviation and interquartile ranges and comparison of controls and cases by Mann–Whitney test.

Results:

Serum and salivary levels of IL-21 were significantly higher in chronic periodontitis group than in controls (P < 0.001). Clinical periodontal parameters correlated positively with serum IL-21 levels.

Conclusions:

IL-21 is highly expressed in patients with chronic periodontitis and correlated well with clinical parameters of periodontal destruction. Therefore, IL-21 appears to play a role in tissue destruction and can be used as diagnostic biomarker in chronic periodontitis. Saliva can be considered to be a useful alternative to serum as a diagnostic sample.

Citizen science charts two major "stomatotypes" in the oral microbiome of adolescents and reveals links with habits and drinking water composition

BACKGROUND

The oral cavity comprises a rich and diverse microbiome, which plays important roles in health and disease. Previous studies have mostly focused on adult populations or in very young children, whereas the adolescent oral microbiome remains poorly studied. Here, we used a citizen science approach and 16S profiling to assess the oral microbiome of 1500 adolescents around Spain and its relationships with lifestyle, diet, hygiene, and socioeconomic and environmental parameters.

RESULTS

Our results provide a detailed snapshot of the adolescent oral microbiome and how it varies with lifestyle and other factors. In addition to hygiene and dietary habits, we found that the composition of tap water was related to important changes in the abundance of several bacterial genera. This points to an important role of drinking water in shaping the oral microbiota, which has been so far poorly explored. Overall, the microbiome samples of our study can be clustered into two broad compositional patterns (stomatotypes), driven mostly by Neisseria and Prevotella, respectively. These patterns show striking similarities with those found in unrelated populations.

CONCLUSIONS

We hypothesize that these stomatotypes represent two possible global optimal equilibria in the oral microbiome that reflect underlying constraints of the human oral niche. As such, they should be found across a variety of geographical regions, lifestyles, and ages.

Salivary arginase activity after mechanical-chemical therapy

Abstract Introduction Salivary components can be used as biomarkers for diagnosing and monitoring oral diseases. There is evidence that one potential biomarker, arginase, is associated with the inflammatory processes of periodontal disease, and its enzymatic activity is reduced according to the improvement in the clinical parameters after treatment. Objective The present study aimed to evaluate the salivary arginase activity in gingivitis and periodontitis patients treated with full-mouth mechanical procedures combined with the adjunctive use of essential oils or chlorhexidine mouthwash, respectively. Material and method Twenty-six gingivitis and 16 periodontitis patients received complete periodontal examinations at the baseline and 3 months after therapy, in which the periodontal probing depth, clinical attachment loss, plaque index, and gingival index measurements were taken. At these same appointments, the salivary total protein level and salivary arginase activity were also established via spectrophotometry. Result There were improvements in all of the clinical parameters (p < 0.05) evaluated from the baseline to 3 months in both groups. In addition, the salivary arginase activity and total protein levels were reduced after the gingivitis treatment. Conclusion Similar to the clinical results, both therapeutic protocols positively affected the salivary arginase activity; however, further studies are necessary to clarify its potential as a salivary biomarker for periodontal monitoring.

The association between receptor activator of nuclear factor kappa-β ligand and clinical attachment level among waterpipe smoker

BACKGROUND

Higher levels of receptor activator of nuclear factor kappa-β ligand, i.e., RANKL, were reported among periodontitis patients compared with their healthy peers. This study aimed to measure the salivary level of RANKL among waterpipe smokers and to find the possible correlation between salivary level of RANKL and clinical periodontal parameters.

MATERIALS AND METHODS

This study is a cross-sectional study involving 89 (49 waterpipe smokers and 40 nonsmokers) participants. The whole unstimulated saliva samples were collected for quantitative determination of RNAKL using a human RANKL enzyme-linked immunosorbent assay kit. Plaque index, gingival index, bleeding on probing, periodontal pocket depth (PPD), and clinical attachment level (CAL) were recorded for each participant. Mann-Whitney U-test was used to detect any difference between groups at P < 0.05. Spearman correlation coefficient test was used to test the association between variables. Linear regression was used to investigate the cause-and-effect relationship between the associated variables.

RESULTS

In a comparison, RANKL, PPD, and CAL showed statistical differences (P < 0.05) between waterpipe smokers and nonsmokers. RANKL was found to be positively associated with CAL, and approximately 62.8% of CAL in this study sample could be explained by RANKL. The regression equation was CAL = 1.744 + 0.004 (RANKL).

CONCLUSIONS

The salivary level of RANKL was positively related to CAL in this study sample.

Point of Care- A Novel Approach to Periodontal Diagnosis-A Review

Periodontal disease, one of the prevalent oral diseases, is characterized by gingival inflammation and periodontal tissue destruction. Diagnosing this disease is challenging to the clinicians as the disease process is discontinuous and shows periods of exacerbation and remission. Traditional diagnostic methods basically tells about the past tissue destruction so new diagnostic methods are required which is able to detect the active state of the disease, determine the future progression and also estimates the response to the therapy, thereby helping in the better clinical management of the patient. Both saliva and Gingival crevicular fluid (GCF) are believed to be reliable medium to detect the biomarkers which plays a pivotal role in measuring the disease activity. Keeping these observations in mind rapid chairside tests are developed to diagnose periodontal disease called as Point of Care (POC) diagnostics which simplifies diagnosis and helps in improving the prognosis. This review article highlights about the biomarkers used in the diagnosis and throws light on the various available point of care diagnostic devices.

Plasmonic Hepatitis B Biosensor for the Analysis of Clinical Saliva

A biosensor for the detection of hepatitis B antibodies in clinical saliva was developed. Compared to conventional analysis of blood serum, it offers the advantage of noninvasive collection of samples. Detection of biomarkers in saliva imposes two major challenges associated with the low analyte concentration and increased surface fouling. The detection of minute amounts of hepatitis B antibodies was performed by plasmonically amplified fluorescence sandwich immunoassay. To have access to specific detection, we prevented the nonspecific adsorption of biomolecules present in saliva by brushes of poly[(N-(2-hydroxypropyl) methacrylamide)-co-(carboxybetaine methacrylamide)] grafted from the gold sensor surface and post modified with hepatitis B surface antigen. Obtained results were validated against the response measured with ELISA at a certified laboratory using serum from the same patients.

Estimation and Comparison of Salivary Calcium, Phosphorous, Alkaline Phosphatase and pH Levels in Periodontal Health and Disease: A Cross-sectional Biochemical Study

INTRODUCTION

In oral diagnostics there is a great challenge to determine biomarkers for screening and evaluating the disease activity. Biomarkers can also serve as a useful tool to measure the efficacy of the therapy.

AIM

To evaluate and compare the levels of salivary calcium, phosphorous, alkaline phosphatase and pH levels in periodontally healthy subjects and patients with gingivitis and periodontitis.

MATERIALS AND METHODS

The present study consisted of 150 subjects aged between 20-45 years who were divided into three groups; periodontally healthy, gingivitis and chronic periodontitis. Prior to the clinical examination the demographic details, relevant information of the subject, gingival index, plaque index, Oral Hygiene Index (OHI) and pH were recorded. Biochemical assay of saliva i.e., inorganic calcium, phosphorous and alkaline phosphatase were estimated by colorimetric method. ANOVA and Tukey's test were applied for statistical analysis.

RESULTS

The mean levels of biomarkers studied were; inorganic calcium (12.55μg/dl), phosphorous (14.50μg/dl), alkaline phosphatase (49.62μg/dl) and pH (11.65). There was a gradual increase in these levels as the condition progressed from health to gingivitis or periodontitis which was statistically significant at p<0.001.

CONCLUSION

Based on these results, it can be concluded that, the biomarkers like salivary calcium, phosphorous, alkaline phosphatase and pH can be considered for evaluating the diagnosis and prognosis of periodontal tissues in disease and health.

Saliva: A Cutting Edge in Diagnostic Procedures

The ability to monitor the health and disease status of the patient through saliva is a highly desirable goal for the health professionals. Considering the microconcentration of salivary constituents, saliva is explored to be diagnostic tool as it also meets the demands for an inexpensive, noninvasive and easy to use screening method. The incorporation of salivary diagnostics into clinical practice is gaining reality and will be of diagnostic value in the prospective future. The investigative use of saliva is not being applied only in dental health but also in various other systemic disorders. The advent of molecular techniques is gaining attention and this has triggered its application as a specific and sensitive biomarker in proteomics, genomics, and transcriptomics. This review discusses the basics of salivary diagnostics, expectoration techniques, and its application in various local and systemic disorders.

Estimation and correlation of salivary thiocyanate levels in healthy and different forms of tobacco users having chronic periodontitis: A cross-sectional biochemical study

BACKGROUND

Periodontitis is a common inflammatory disease with complex and multi-factorial origin. Tobacco usage has shown its adverse effect on periodontal health. Various components within saliva not only protect the integrity of oral tissues, but also provide clues to local and systemic diseases and conditions. Salivary thiocyanate (SCN) has been shown to be a chemical indicator in smokers and smokeless tobacco users. Noninvasive nature of salivary testing has made it an attractive and effective alternative to blood and urine testing. Limited studies are there comparing and correlating the salivary SCN levels in smokers with chronic periodontitis (CP). However, no studies show correlation of salivary SCN among gutka chewers with CP.

AIMS AND OBJECTIVES

The objective of the following study is to estimate, compare, and correlate the SCN levels in periodontally healthy, CP, smokers with CP and gutka chewers with CP subjects.

MATERIALS AND METHODS

Study includes 120 subjects with age 18-55 years, categorized as periodonally healthy (n = 30), CP (n = 30), smokers (n = 30), and gutka chewers (n = 30) with CP. Required clinical parameters such as gingival index, probing depth and clinical attachment loss were recorded and salivary SCN levels were estimated through ultraviolet-spectrophotometer.

RESULTS

Mean salivary SCN level were shown to be higher among smokers and gutka chewers with CP as compared to healthy and CP alone.

CONCLUSION

The present study exhibited the significant increase in salivary SCN levels among smokers and gutka chewers when compared to others, concluding that the analysis of salivary SCN levels could be used as an adjunctive means of diagnosis.

Mucin levels in saliva of adolescents with dental caries

Background

Human saliva, a complex secretion that contains a mixture of inorganic and organic molecules, plays an essential role in the maintenance of oral health. Mucins are the major macromolecular component of the secretion and are considered the first line of defense for epithelial tissues. The aim of this study was to compare levels of mucins (MUC5B, MUC7, and MUC1) in saliva of young subjects with dental caries.

Material/Methods

All patients had DMF (decay/missing/filled) higher than value 0. Eight subjects with DMF=3 (control group) and 27 adolescents with DMF >11 (research group) were recruited for this study. Clinical evaluation procedures were oral examination, including tooth, periodontal, oral mucosal status, and collection of saliva samples. Saliva was collected for mucin assay. Enzyme-linked immunosorbent assay was used to quantitate MUC5B, MUC7, and MUC1.

Results

Our results indicate that adolescents with very high intensity of dental caries disease had increased levels of MUC1 and MUC5B. The membrane mucin MUC1 protein levels in the group with DMF>11 (research group) were higher compared to the group with DMF=3 (control group), and the increase was statistically significant (p=0.011). Similarly, secreted mucin MUC5B protein levels were higher (p=0.06) in the group with DMF>11 (research group). Although MUC7 protein levels were slightly reduced in symptomatic subjects, the decrease was statistically insignificant (p=0.918).

Conclusions

Our data suggest links between the production of mucins, especially MUC1 and MUC5B in saliva, and dental caries disease.

Residual Salivary Secretion Ability May Be a Useful Marker for Differential Diagnosis in Autoimmune Diseases

Background. We have elucidated decreased resting salivary flow in approximately 60% of patients with autoimmune diseases not complicated by Sjögren syndrome (SjS). In this study, salivary stimulation tests using capsaicin were performed to examine residual salivary secretion ability in patients with autoimmune diseases. Materials and Methods. Fifty-eight patients were divided into three groups: patients with primary or secondary SjS (SjS group), patients with systemic sclerosis not complicated by SjS (SSc group), and patients with other autoimmune diseases (non-SjS/non-SSc group). Simple filter paper and filter paper containing capsaicin were used to evaluate salivary flow rates. Results. Resting salivary flow rates were significantly lower in the SjS and SSc groups than in the non-SjS/non-SSc group but did not differ significantly between the SjS and SSc groups. Capsaicin-stimulated salivary flow rates were significantly lower in the SjS and SSc groups than in the non-SjS/non-SSc group, but not significantly different between the SjS and SSc groups. In the non-SjS/non-SSc group, salivary flow rates increased after capsaicin stimulation to the threshold level for determination of salivary gland dysfunction, whereas no improvement was observed in the SjS and SSc groups. Conclusion. Residual salivary secretion ability may be a useful marker for differential diagnosis in autoimmune diseases.

Periodontal proteomics: wonders never cease!

Proteins are vital parts of living organisms, as they are integral components of the physiological metabolic pathways of cells. Periodontal tissues comprise multicompartmental groups of interacting cells and matrices that provide continuous support, attachment, proprioception, and physical protection for the teeth. The proteome map, that is, complete catalogue of the matrix and cellular proteins expressed in alveolar bone, cementum, periodontal ligament, and gingiva, is to be explored for more in-depth understanding of periodontium. The ongoing research to understand the signalling pathways that allow cells to divide, differentiate, and die in controlled manner has brought us to the era of proteomics. Proteomics is defined as the study of all proteins including their relative abundance, distribution, posttranslational modifications, functions, and interactions with other macromolecules, in a given cell or organism within a given environment and at a specific stage in the cell cycle. Its application to periodontal science can be used to monitor health status, disease onset, treatment response, and outcome. Proteomics can offer answers to critical, unresolved questions such as the biological basis for the heterogeneity in gingival, alveolar bone, and cemental cell populations.

Melatonin levels in periodontal health and disease

BACKGROUND AND OBJECTIVE

The aim of this study was to measure melatonin levels in the gingival crevicular fluid and saliva of subjects with healthy periodontal tissues, plaque-induced gingival inflammation, chronic periodontitis and aggressive periodontitis.

MATERIAL AND METHODS

A total of 70 subjects were examined and assigned to four groups: healthy periodontium (10 subjects); plaque-induced gingival inflammation (20 subjects); chronic periodontitis (20 subjects); and aggressive periodontitis (20 subjects). Gingival crevicular fluid and saliva samples were collected from each subject and analyzed using ELISAs.

RESULTS

The melatonin levels in both gingival crevicular fluid and saliva were lower in patients with chronic periodontitis (10.4 and 12.8 pg/mL, respectively) and aggressive periodontitis (8.4 and 8.8 pg/mL, respectively) than in patients with gingivitis (13.9 and 17.6 pg/mL, respectively) and in healthy subjects (16.6 and 22.9 pg/mL, respectively). The mean melatonin levels in both gingival crevicular fluid and saliva were statistically significantly higher in healthy patients compared with patients with chronic periodontitis and aggressive periodontitis; however, there was no significant difference in the plaque-induced gingival inflammation between the study groups.

CONCLUSIONS

The melatonin levels in gingival crevicular fluid and saliva are decreased in diseased periodontal tissues, especially periodontitis. The melatonin level was lowest in the aggressive periodontitis group.