Effect of systemic control and local treatment on collagenase enzyme activity in gingival crevicular fluid of uncontrolled diabetic patients

Collagenase enzyme activity in periodontal disease have an important role in break down of collagen fibres and continuous loss of attachment. Collagenase activity increased in inflamed gingival and gingival sulcular fluid relative to healthy gingival. The enzyme is present in connective tissue cells and in the specific granules of PMN. Also, gram-ve organisms in the gingival cervic appears to stimulate gingival collagenase production. It has been well documented that incidence and severity of periodontal diseases increased in uncontrolled diabetes, probably through alteration in tissue resistance: Also, diabetes stimulates gingival collagenase production mediated, in part, by the hormonal or metabolic alterations in host tissues and the overgrowth of gram-ve organisms in the gingival crevice. So determination of the relationship between the severity of periodontal disease and crevicular fluid collagenase in uncontrolled diabetic patients may be useful for determination of tissue destruction in those patients. The study was performed on 15 adult male patients having advanced marginal periodontitis and uncontrolled diabetes. Gingival index,plaque index, measurement of the amount of gingival fluid and collagenolytic activity in the gingival fluid were measured. After two weeks of controlling the diabetic state the same parameters were taken and subgingival scaling was done. Tow weeks later the same parameters were retaken. The results revealed that the higher collagenolytic activity was found in gingival fluid of uncontrolled diabetic patients. Two weeks after controlling the diabetic state, collagenase activity had decreased significantly. Further significant decrease was observed when subgingival scaling had been performed. It appears that the dramatically elevated collagenase activity in uncontrolled diabetic patients is clearly originated from both the host cells as a result of the diabetic state, and also, from gram-ve organisms in the gingival sulcus where diabetes favor its colonization. The two sources of collagenase should be considered during management of uncontrolled diabetic patients. Both systemic control of diabetes as well as local treatment by thorough scaling are necessary to eliminate a possible destructive mechanism of the periodontium in diabetic patients

Neutrophil chemotaxis in localized and generalized juvenile periodontitis

The aim of the present investigation was to study the defect of neutrophil chemotaxis in the disease compared individuals. Patients with juvenile periodontitis were grouped into one of the two recognized form of the disease, the localized form and the generalized type. Periodontitis, 17 patients having the generalized form of the disease and 10 healthy individuals were assessed for chemotaxis using a Boyden diffusion chamber. The results showed that neutrophil chemotaxis in juvenile periodontitis, especially the localized form is less than normal individuals. The defect of neutrophils may be related to the high concentration of endotoxins in the disease or due to absence of glycoprotein on the surface membrane which interferes with neutrophil migration. Also, the defect may be genetic or due to presence of lysozymes in a high concentration inhibiting neutrophil chemotaxis by binding the cell wall of neutrophils. The decrease of neutrophil chemotaxis in the localized than the generalized forms of the disease may be related to the difference of pathogenic microorganisms between the two forms of the disease

Effect of subgingival irrigation in the treatment of deep periodontal pockets

The present study was conducted to test the use of irrigation with antiseptics in deep periodontal pockets and to compare between their efficacy. Irrigation with chlorhexidine, betadin, stannous fluoride and saline was done weekly for eight weeks. The effect of these irrigants on deep periodontal pockets was evaluated using plaque index, suppurative index, bleeding index and probing depth. These clinical parameters were measured for irrigation groups and the control before the study and at 4, 8, 12 and 16 weeks. All subjects were subjected to thorough preliminary subgingival curettage only once before the initial irrigation as well as the controls. The results obtained demonstrated that the use of irrigating antiseptics could inhibit or reduce the inflammatory process in the periodontal pocket when used in adjunction to mechanical debridement. Also, no difference could be detected between the irrigation materials used as regard their clinical effect