Association between periodontitis and serum c-reactive protein levels

Relationship between C-reactive protein level and periodontitis and systemic diseases

BACKGROUND

Periodontitis affects systemic disease risk, although the relationship thereof in the context of different C-reactive protein (CRP) levels is not clear. This study investigated the association of periodontitis with systemic diseases according to high-sensitivity CRP (hs-CRP) level and sought to identify the risk of systemic diseases in patients with periodontitis.

METHODS

We used data from the seventh (2016-2018) Korea National Health and Nutrition Examination Survey. In a total of 16,489 subjects, the hs-CRP group was classified into the hs-CRP low-risk group and the hs-CRP high-risk group. Propensity score matching (PSM) is used for 1:1 matching of confounding variables (e.g., age, gender, income, and education) between hs-CRP low-risk and hs-CRP at-risk groups to analyze the final 5316 subjects. The association between general characteristics and prevalence of systemic diseases was analyzed using descriptive statistics and the chi-squared test. The associations between hs-CRP level and systemic and periodontitis were analyzed using logistic regression analyses.

RESULTS

Within the hs-CRP group, the presence of periodontitis was associated with a significantly increased prevalence of hypertension, diabetes mellitus, and stroke. In the hs-CRP risk group, periodontitis significantly increased the risk of hypertension and diabetes mellitus by 2.1 and 2.4 times, respectively.

CONCLUSIONS

The presence of periodontitis significantly increases the prevalence of systemic diseases and more so in individuals with higher hs-CRP levels. This indicates the significance of maintaining oral health in reducing the risk of systemic diseases.

The evaluation of salivary leucine-rich alpha-2 glycoprotein (LRG) and C-reactive protein (CRP) in humans with periodontal health or periodontal disease

OBJECTIVE

The purpose of the present research is to evaluate the salivary levels of leucine-rich alpha-2 glycoprotein (LRG) and C-reactive protein (CRP) in periodontal health and disease (gingivitis and stage III periodontitis) and also to compare the discriminative efficiencies of both biomarkers in periodontal disease.

BACKGROUND

LRG is a new acute-phase protein whose functions are still being investigated. LRG and CRP are both biomarkers that are increased by inflammation. No clinical study has yet investigated the comparison of the level of LRG and CRP in periodontal health, gingivitis and periodontitis in saliva samples.

METHODS

A total of 60 individuals, including 20 periodontally healthy (control group/group C), 20 with gingivitis (group G), and 20 with Stage III periodontitis (group P), who were systemically healthy and non-smokers, participated in this study. Periodontal charts were used for recording clinical periodontal parameters and saliva LRG and CRP levels were measured by ELISA. Analyzing the area under the curve (AUC) was performed by the receiver-operating characteristics curve.

RESULTS

Salivary levels of LRG and CRP were significantly higher in disease groups than in group C (p < .05). Positive statistically significant correlations were observed between both biomarkers and clinical parameters (p < .05). There was also a strong positive correlation between two biomarkers (p < .05). In distinguishing periodontal disease from periodontal health, LRG (AUC = 0.833) and CRP (AUC = 0.826) were found to have similar accuracy (p = .923).

CONCLUSION

LRG and CRP may be useful and similarly effective biomarkers in the diagnosis of periodontal diseases based on the findings of this study.

Can delta neutrophil index values predict the success of periodontal treatment in patients with periodontitis?

OBJECTIVES

The aim of this study was to evaluate the effect of delta neutrophil index (DNI) on non-surgical periodontal therapy (NSPT), whose role has been documented in the pathogenesis and follow-up of periodontal disease.

METHODS AND MATERIALS

The study included 35 patients with stage 3, grade A periodontitis (test group) and 35 patients without periodontal disease (control group). Initially, periodontal parameters were recorded and blood samples were taken from all patients. For patients with periodontitis, periodontal parameter measurements and blood sample analyses were repeated 3 months after NSPT.

RESULTS

After NSPT, DNI, CRP (C-reactive protein), neutrophil count, WBC (white blood cell), and neutrophil-lymphocyte ratio (NLR) values decreased in the test group, but did not reach a statistically significant level (p > 0.05). When the inflammatory variables were examined, significantly higher CRP, IG (immature granulocytes), DNI, neutrophil count, and WBC were observed in the test group compared to the control group (p < 0.05). In the test group, periodontal parameters were lower 3 months after NSPT than at baseline (p < 0.05).

CONCLUSION

Consistent with previous findings in the literature, the patients with periodontitis were determined to have higher levels of DNI, CRP, neutrophils, and WBC, compared to the individuals without periodontitis. Although a decrease was seen in DNI after NSPT, this was not at a significant level.

CLINICAL RELEVANCE

DNI is a guide in the evaluation of inflammation at the onset of periodontal disease, but studies with a larger number of cases are needed to use these parameters in the evaluation of treatment success.

TRIAL REGISTRATION

This study was retrospectively registered on December 27, 2022, with the number NCT05666622 at http://www.

CLINICALTRIALS

gov .

Adjunctive systemic antibiotic effect on periodontal state, salivary enzyme activity, and glycemia imbalance in type-2 diabetics after non-surgical periodontal management

AIM

The current study aimed at analyzing the effect of non-surgical periodontal treatment accompanied by systemic antibiotics on salivary enzyme activities, periodontal parameters, and glycemic control in type-2 diabetic (T2D) patients with chronic periodontitis.

METHODS

The study included 125 type-2 diabetic patients with chronic periodontitis who had good glycemic control (T2Dc), 125 type-2 diabetics who had bad glycemic control (T2Dpc). The 125 T2Dpc were divided randomly into two groups. The first one enrolled 63 T2Dpc and received a non-surgical periodontal treatment (T2Dpc + NST). The second group enrolled 62 T2Dpc and received the non-surgical treatment accompanied by systemic antibiotics (T2Dpc+NST+A). HbA1c, periodontal indices, and salivary enzyme activities were assessed for all groups. The Glycated hemoglobin (HbA1c) was assessed. The Salivary alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransaminase (ALT), lactate dehydrogenase (LDH), and creatine kinase (CK) activities were measured.

RESULTS

The T2Dpc were characterized by the highest probing depth (PPD) and clinical attachment loss (CAL) periodontal scores, as well as ALP, AST, and ALT enzymatic activities. However, BOP did not differ significantly between T2Dc and T2Dpc. Whereas the rest of clinical parameters PI, GI, and OHI-S did not significantly differ between groups. The Pearson's analysis revealed three correlations between ALP-PPD, ALP-CAL, and ALP-BOP (bleeding on probing) in both T2Dc and T2Dpc (P < 0.05). Interestingly, a significant decrease in periodontal indices, salivary enzyme activities, and HbA1c was recorded in T2Dpc+NST+A group.

CONCLUSION

The increase in ALP, AST, and ALT activities reflects the impact of uncontrolled T2D on periodontal tissue alteration. The ALP activity increase was associated with the severity of periodontal status in diabetic patients. In comparison to non-surgical treatment alone, the adjunct use of systemic antibiotics improves periodontal state, enzyme activity, and glycemic control.

Risk factors and immunological biomarkers in denture stomatitis: An observational cross-sectional study

OBJECTIVE

Assess risk factors, local and systemic immunological biomarkers in healthy individuals and with Denture Stomatitis (DS).

DESIGN

For this observational transversal study, 27 participants without DS (Group 0), 24 with moderate DS (Group 1), and 25 with severe DS (Group 2) were assessed for sociodemographic, behavioral, and clinical parameters, microbial load of Candida spp., Staphylococcus spp., Streptococcus mutans, Pseudomonas spp., and enterobacteria, and cytokine and C-reactive protein levels. ANOVA, Fisher's exact, Kruskal-Wallis, Mann-Whitney, Wilcoxon and Pearson's chi-square tests were used for data analysis (α = 0.05).

RESULTS

Group 1 had a significantly higher mean age compared to the other groups (P = 0.018), but no correlation was identified between age and DS (P = 0.830; r = 0.025). No significant differences were found among the groups for other sociodemographic and behavioral characteristics. Group 1 had significantly older upper and lower dentures; however, no correlation was identified between age of upper (P = 0.522; r = 0.075) and lower (P = 0.143; r = 0.195) dentures and DS. The microbial load of Candida albicans on the dentures (P = 0.035) and Candida spp. on the palate (P = 0.008) of the groups 1 and 2 was higher than group 0. Group 1 and 2 had higher Candida spp. counts on denture (P = 0.003) than group 0. There was no difference among groups for bacterial analyzed. Group 1 showed higher and Group 2 intermediate salivary levels of IL-6 compared to Group 0. There was no difference in the C-reactive protein levels among groups.

CONCLUSIONS

Microbial load of Candida spp. is the factor with the strongest relationship with DS, with capacity for local signaling through IL-6.

Can the delta neutrophil ındex be used as a preliminary biomarker ın the evaluation of periodontal disease: a pilot study

OBJECTIVE

Tissue destruction in periodontal diseases is related to inflammatory mediators in the host. However, it is unknown whether a relationship between delta neutrophil index (DNI) and neutrophil-lymphocyte ratio (NLR) in Stage 3 Grade A patients occurs. This cross-sectional study aimed to investigate the relationship between periodontal disease and DNI and NLR.

METHODOLOGY

The study included 74 systemically healthy, non-smoking adults separated into 3 groups. Group 1: 26 subjects with good periodontal health, Group 2: 26 subjects with gingivitis, and Group 3: 22 subjects with Stage 3 Grade A periodontitis. After determining which group the patient will be included in, a clinical periodontal examination was made of each patient and pocket depth (PD), clinical attachment level (CAL), gingival index (GI), bleeding on probing (BOP) and plaque index (PI) parameters were measured. Venous blood samples were taken and examined with an automatic hematology analyzer for DNI, immature granulocytes (IG), NLR, C-reactive protein (CRP), procalcitonin, neutrophil count and lymphocyte count.

RESULTS

DNI, IG, CRP, and neutrophil count were observed to be highest in Group 3, followed by Group 2, and the difference between the groups in these parameters was determined to be statistically significant (p<0.001, p<0.001, p=0.046, p=0.016). DNI, IG, CRP and neutrophil count were observed to be positively correlated with periodontal parameters.

CONCLUSION

The findings of this study support the role of DNI as a new biomarker for periodontal diseases. DNI may better reflect the systemic level of stage 3 grade A periodontitis than traditional inflammatory markers.

Cofilin 2 Acts as an Inflammatory Linker Between Chronic Periodontitis and Alzheimer's Disease in Amyloid Precursor Protein/Presenilin 1 Mice

Increasing evidence has shown a correlation between chronic periodontitis (CP) and Alzheimer’s disease (AD). Nevertheless, there is still a lack of direct evidence, and especially key molecules to connect the two diseases. This study aims to investigate potential protein links between CP and AD within the inflammatory aspect. The hippocampus of CP model mice and controls were collected, and changes in protein expression were evaluated using two-dimensional differential in-gel electrophoresis (2D-DIGE) analysis combined with liquid chromatography tandem mass spectrometry. A total of 15 differentially expressed proteins were identified in CP model mice, as compared with the controls. Among them, S100-A9, transthyretin, Cofilin 2, peroxiredoxin 2, and lipocalin-2 were validated by Western blot according to their dual function both in inflammation and AD. Based on 2D-DIGE analysis, CP animal model had higher levels of S100-A9, Cofilin 2, peroxiredoxin 2, and lipocalin-2 compared to controls. The level of Cofilin 2, one of the well-established proteins in the pathology of AD, was strongly correlated with the time course of CP pathology, indicating a specific molecular correlation between CP and AD. Moreover, the in vivo results showed the level of Cofilin 2 increased significantly along with a prominent increase of the phosphorylation of protein phosphatase 2 (PP2A) and tau protein in the cell lysates of Porphyromonas gingivalis (P.g-LPS)-treated SK-N-SH APPwt cells. Cofilin 2 inhibition resulted in a sharp decrease in PP2A dependent of tau phosphorylation. Furthermore, tumor growth factor (TGF)-β1 was one of the most important inflammatory cytokines for the Pg-LPS-induced Cofilin 2 upregulation in SK-N-SH APPwt cells. These results showed inflammation served as the bond between CP and AD, whereas inflammatory related proteins could be the key linkers between the two diseases. Determining the association between CP and AD at the molecular mechanism will not only hold the direct evidence of the association between the two diseases but also provide a new way of preventing and treating AD: the effective prevention and treatment of CP could serve as a useful method to alleviate the development of AD.

Multimorbid disease trajectories for people with periodontitis

AIM

Periodontitis is a multifactorial condition linked to increased risk of systemic diseases. This study aimed to identify disease trajectories of people with periodontitis using the process mining technique as a heuristic approach.

MATERIALS AND METHODS

A total of 188,863 participants from the UK Biobank cohort were included. Self-reported oral health indicators (bleeding gums, painful gums, loose teeth) were surrogates for periodontitis at baseline. Systemic disease diagnoses and dates formed the process mining event log. Relative risk (RR) of systemic diseases, disease trajectories, and Cox proportional hazard ratio models for mortality were compared to age- and sex-matched controls who did not report a history of periodontitis.

RESULTS

Participants with loose teeth had shorter median time to most systemic diseases, and crude RR was increased for several diseases including cardiovascular disease (crude RR: 1.15, 95% CI: 1.03-1.28), hypertension (crude RR: 1.14, 95% CI: 1.05-1.24), and depression (crude RR: 1.33, 95% CI: 1.09-1.61). Participants with loose teeth had increased RR for 20 disease trajectories, though these were not significant after adjustments. Participants with bleeding/painful gums had similar disease trajectories as those of matched controls.

CONCLUSIONS

Self-reported periodontitis may be associated with early and frequent multimorbidity development, though further evidence is required to confirm this hypothesis. People with periodontitis should be informed of the risks of disease progression and be targeted in prevention initiatives.

Periodontitis and Systemic Disorder-An Overview of Relation and Novel Treatment Modalities

Periodontitis, a major oral disease, affects a vast majority of the population but has been often ignored without realizing its long-fetched effects on overall human health. A realization in recent years of its association with severe diseases such as carditis, low birth weight babies, and preeclampsia has instigated dedicated research in this area. In the arena of periodontal medicines, the studies of past decades suggest a link between human periodontal afflictions and certain systemic disorders such as cardiovascular diseases, diabetes mellitus, respiratory disorders, preterm birth, autoimmune disorders, and cancer. Although, the disease appears as a locoregional infection, the periodontal pathogens, in addition their metabolic products and systemic mediators, receive access to the bloodstream, thereby contributing to the development of systemic disorders. Mechanism-based insights into the disease pathogenesis and association are highly relevant and shall be useful in avoiding any systemic complications. This review presents an update of the mechanisms and relationships between chronic periodontal infection and systemic disorders. Attention is also given to highlighting the incidence in support of this relationship. In addition, an attempt is made to propose the various periodonto-therapeutic tools to apprise the readers about the availability of appropriate treatment for the disease at the earliest stage without allowing it to progress and cause systemic adverse effects.