Evaluation of salivary biomarkers of periodontitis among smokers and nonsmokers: A novel study

Can the salivary urea and stimulated saliva concentration be a marker of periodontal diseases in opioid users? A case-control study

Introduction

& Aim: Microbial plaque is the primary cause of periodontal diseases, and smoking and opioid addiction can accelerate microbial plaque formation and disease progression. Adequate saliva flow and salivary urea concentration are important parameters for a healthy periodontium. In this study, the relationship between Periodontal Diseases and the History of opioid addiction was investigated by measuring the Salivary Urea and Stimulated Saliva Concentration.

Materials & methods

This case-control study was conducted on 240 patients (120 cases and 120 controls) in 2021 referred to addiction treatment centers and the dental clinic in Iran, Birjand. The control and case groups were matched in terms of age. Demographic, base data, and clinical examination results were collected by a checklist. Data were analyzed using SPSS 19 and one-way ANOVA and chi-square tests. P-value <0.05 was considered as the significance level.

Results

Periodontitis severity was significantly higher in the case group than in the control group (P-value = 0/000). Salivary urea concentration significantly increased in both case and control groups with an increase in periodontitis severity (P-value = 0/003 in the case group and P-value = 0/000 in the control group), but there was no significant relationship between the stimulated saliva flow rate and the severity of periodontitis in these two groups (P-value>0.05).

Conclusion

Following the use of opioids, the flow of saliva decreases, and with the exacerbation of the periodontal disease, the concentration of urea in saliva increases. Therefore, it seems that the analysis of saliva parameters, including urea concentration, can be useful for the diagnosis of periodontal disease, and saliva urea concentration is not directly related to opioid use.

Neopterin, the Cell-Mediated Immune Response Biomarker, in Inflammatory Periodontal Diseases: A Narrative Review of a More than Fifty Years Old Biomarker

Neopterin is a biomarker of the activation of cellular immunity. The purpose of this review is to summarise neopterin metabolism, methods of its detection, and its role in inflammation, focusing on periodontal inflammatory diseases. This derivative of guanosine is a non-enzymatic product of 7,8-dihydroneopterin oxidation caused by free radicals which protect activated macrophages from oxidative stress. Various methods, usually based on enzyme-linked immunosorbent essay, high-performance liquid chromatography, or radioimmunoassay were developed for the isolation of neopterin. A wide spectrum of diseases and conditions are known to affect neopterin levels, including cardiovascular, bacterial, viral, and degenerative diseases, as well as malignant tumours. Neopterin levels were found to increase in subjects with periodontitis, especially when the oral fluid and gingival crevicular fluid were evaluated. These findings confirm the role of activated macrophages and cellular immunity in periodontal inflammatory diseases. The gingival crevicular fluid and the oral fluid appear to be the most valuable biologic fluids for the evaluation of neopterin levels in periodontitis. For gingival crevicular fluid, neopterin can be determined as the concentration or the so-called total amount. Nonsurgical periodontal treatment was associated with a decrease in neopterin levels, but an increase was also reported, suggesting the possible role of macrophages in the resolution of the periodontal lesion.

Diagnostic and Prognostic Markers of Periodontal Disease

Aim of the study: The aim of this study is to determine the values of salivary enzyme biomarkers (alkaline phosphatase - ALP, aspartate aminotransferase - AST and lactate dehydrogenase - LDH) in subjects with healthy and diseased periodontium and to investigate the possibility of using these salivary enzymes as diagnostic and prognostic markers. Methods: We collected saliva with the spitting method from all examinees in the morning, using the recommendations provided by Navazesh. The values of the enzymes in saliva were determined spectro-photometrically, with the following methods: ALP-IFCC, AST-IFCC, LDH-PYRUVATE. IGI Silness-Löe was used to determine the presence of gingival inflammation, and to determine the presence of clinically manifest periodontitis, we determined the clinical loss of periodontal attachment with a graduated periodontal probe. For statistical purposes, we used the method of ANOVA Chi Square and Student's t-test. Results: The difference in the average salivary AST and LDH values between the first and the second group, as well between the first and third group is statistically significant (p < 0.000). The difference in the average salivary AST and LDH values between the examinees with gingivitis and the examinees with clinically manifest periodontal disease is statistically insignificant (p < 0.485101 for AST, p < 0.816665 for LDH). The difference in the average salivary levels of ALP between the three groups is statistically significant (p < 0.000). Conclusion: The salivary levels of AST, LDH, and ALP can be used as diagnostic markers, while ALP can also be used as a prognostic marker for periodontal disease.

Estimation and Correlation of Serum Albumin and Serum Alkaline Phosphatase Levels Between Smokers and Non-smokers With Generalized Chronic Periodontitis

Background Periodontal disease is a chronic low-grade inflammatory disease triggered by periodontal microbial interaction present in the dysbiotic biofilm and the host's immune response further leads to the destruction of the supporting periodontal apparatus, which may, in turn, lead to tooth loss. Smoking is an environmental risk factor for periodontitis, and it enhances the secretion of various enzymes from host cells, which results in the initiation and progression of periodontal disease. The albumin concentration is related to nutrition and inflammation. Alkaline phosphatase (ALP), an enzyme found in various cells of the periodontium, is considered to cause the destruction of the periodontium. The study aimed to compare the serum albumin and serum ALP levels in smokers and non-smokers with generalized chronic periodontitis. Materials and methods The cross-sectional study included a total of 60 subjects. Subjects were divided into two groups, which included non-smokers with generalized chronic periodontitis (NS+P) and smokers with generalized chronic periodontitis (S+P). Clinical parameters analyzed were plaque index, gingival index, probing pocket depth, and clinical attachment level. The serum ALP and albumin levels were analyzed using a fully automated analyzer. Results The serum ALP levels were higher in the S+P group compared to the NS+P group. Conversely, the serum albumin levels were lower in the S+P group compared to the NS+P group. Conclusion There was a significant correlation of increased serum ALP levels and decreased serum albumin levels in the S+P group compared to the NS+P group.