Obesity as a modifying factor of periodontal therapy outcomes: local and systemic adipocytokines and oxidative stress markers.

OBJECTIVES: Adipocytokines and oxidative stress (OS) are involved in the pathogenesis of both obesity and periodontitis. The aim of this study was to evaluate periodontal therapy outcomes in terms of serum and gingival crevicular fluid (GCF) levels of adipocytokines and OS markers in obese patients with periodontitis, in order to have an insight into the association between obesity and periodontitis. MATERIALS AND METHODS: A total of 39 patients (20 obese, 19 non-obese) with periodontitis were included in this study. Clinical periodontal parameters were assessed; serum and GCF levels of adipocytokines and OS markers were evaluated by ELISA at baseline and 3 months after non-surgical periodontal therapy. RESULTS: Significant improvements in clinical periodontal parameters were observed in both groups at 3 months (p < 0.01). While serum levels of TNF-α, leptin, and total oxidant status (TOS) in the obese group were higher at baseline (p < 0.01), leptin levels remained higher at 3 months despite a significant decrease (p < 0.01). Although NSPT improved GCF levels of total antioxidant status (TAS) and TOS in both groups, they were significantly different between the groups after therapy (p < 0.05). CONCLUSIONS: It seems that leptin, TNF-α, and TOS contribute to systemic inflammatory and oxidative state in patients with obesity. Despite improvements in clinical periodontal parameters, obesity might be a modulating factor in the development and progression of periodontal disease in terms of some adipocytokines and OS markers. CLINICAL RELEVANCE: Since the global burden of both obesity and periodontitis is continuously increasing, the management of these inflammatory diseases has become more important. The current study contributes to our understanding of the role of OS and adipocytokines on the relationship between obesity and periodontitis by response to periodontal treatment.

Methodological evaluation of gingival crevicular fluid volume and neutrophil elastase levels: sequential sampling, length of sampling time and two different sampling methods.

Objectives: The mechanisms underlying the formation and composition of gingival crevicular fluid (GCF) and its flow into and from periodontal pockets are not understood very well. The aim of this study was to evaluate the length of sampling time and sequential sampling of GCF neutrophil elastase (NE) enzyme levels by using intracrevicular and orifice methods.Material and methods: Twenty adults (mean age of 41.8 years, ranged 31-60 years, 18 males and 2 females) with chronic periodontitis were enrolled and all completed the 3-d study. GCF was collected by both intracrevicular and intrasulcular methods, 720 samples of GCF were collected. In first, second and third day, the length of sampling time in seconds (s) and order were '5- 10-30-s'; '10- 30- 5-s' and '30- 5- 10-s,' respectively. GCF elastase levels were determined by hydrolysis of neutrophil specific substrate N-methoxysuccinyl-Ala-Ala-Pro-Val-p-nitroanilide.Results: NE activity (µU) and NE activity/volume (µU/µl) were significantly different for order of sampling (p < .05), but not for the length of sampling time (p>.05).Conclusions: Within the limits of this study, the choice of sampling technique in GCF-profile studies seems to be a critical decision as it has the potential to affect the GCF volume and NE activity.

Evaluation of long-term effects of diode laser application in periodontal treatment of poorly controlled type 2 diabetic patients with chronic periodontitis.

PURPOSE: This study aimed to investigate the effects of diode laser (DL) in addition to non-surgical periodontal treatment on periodontal parameters, systemic inflammatory response and serum haemoglobin A1c (HbA1c ) level in patients with poorly controlled type 2 diabetes mellitus (T2DM) and chronic periodontitis. METHODS: Thirty-seven patients with poorly controlled T2DM and chronic periodontitis completed this study. The patients were divided into two groups. The individuals in the control group received placebo laser treatment in addition to scaling and root planing (SRP). The individuals in the study group received DL (1 watt) in addition to SRP. Clinical index measurements were performed before treatment (T0), 3 months after treatment (T1) and 6 months after treatment (T2). Plaque index, gingival index, bleeding on probing, clinical attachment level and probing depth were measured to determine periodontal status. HbA1c and C-reactive protein (CRP) levels were also analysed using blood samples. RESULTS: In both groups, clinical and laboratory parameters were significantly improved at T1 and T2 compared to baseline (P < 0.05). Gingival index, bleeding on probing and probing depth were more significantly reduced after treatment in the SRP+DL group than in the SRP group (P < 0.05). The serum CRP and HbA1c levels were similar between the groups (P > 0.05). CONCLUSION: The use of DL in addition to SRP in periodontal treatment of T2DM individuals makes positive contribution to the reduction of local inflammation and to periodontal healing. On the other hand, it has no beneficial effects on systemic inflammatory response and glycaemic control.

Apoptosis: an underlying factor for accelerated periodontal disease associated with diabetes in rats.

OBJECTIVES: Diabetes mellitus (DM) is well-established risk factor for periodontal disease. DM can also lead to changes in the number of apoptotic cells in periodontal tissues. The goal of this study was to evaluate apoptosis, depending on DM, in healthy and diseased periodontal soft tissues. MATERIAL AND METHODS: A total of 43 adult male Sprague-Dawley rats were used in this study. Experimental periodontitis was created by placing silk ligatures around the cervices of the first mandibular molars. Experimental diabetes was induced by intraperitoneal injection of the diabetogenic agent streptozotocin (STZ). Following the induction of both experimental diseases, the animals were divided into four groups: (1) The healthy group (H) (n = 10); (2) The diabetes group (D) (n = 10); (3) The periodontitis group (P) (n = 11); and (4) The diabetes and periodontitis group (DP) (n = 12). Apoptotic cells were determined by immunohistochemistry, and the frequency of apoptotic cells was evaluated by apoptotic index score. RESULTS: It was observed that there was less apoptosis in both the epithelial and gingival connective tissue cells of healthy diabetic tissues than in healthy tissues without diabetes. When periodontal disease existed, apoptosis increased in both the epithelial and gingival connective tissues of diabetic and non-diabetic animals. CONCLUSIONS: There may be differences in the apoptotic mechanisms in the periodontal soft tissues of diabetic and non-diabetic animals. CLINICAL RELEVANCE: Apoptosis may be one of the underlying factors in increased risk for periodontal disease that is associated with diabetes.

Immunohistochemical analysis of CD45RO+ T cells and vascular endothelial growth factor expression in cyclosporin A-induced rat gingival tissue.

BACKGROUND: The aim of this study is to evaluate CD4(+), CD8(+), and CD45RO(+) T cells, and vascular endothelial growth factor (VEGF) expression in cyclosporin A (CsA)-induced rat overgrown gingival tissue during an 8-week period. METHODS: Sixty male Sprague-Dawley rats weighing 200 to 250 g were used in this study. Mandibular first molars were ligated with 3-0 silk suture. The rats received daily doses of 0.09% NaCl (control group) or 10 mg/kg body weight of CsA (test group) by intraperitoneal injections. Five rats from the control group and 10 rats from the test group were sacrificed at each experimental period (2, 4, 6, and 8 weeks after the beginning of CsA treatment). The specimens were examined immunohistochemically. RESULTS: CD4(+), CD8(+), and CD45RO(+) T cells, and VEGF expression were more prevalent in the CsA-treated group than in the control group (P <0.05). VEGF was significantly correlated with CD4(+) T cells, CD4(+)/CD8(+) ratio, and CD45RO(+) cells (P <0.05). CONCLUSION: Based on our findings, we conclude that VEGF, a major regulator of angiogenesis, and CD4(+), CD8(+), and CD45RO(+) memory T cells play a key role in CsA-induced gingival overgrowth.

Periodontitis as a risk factor for preterm low birth weight.

PURPOSE: There is growing evidence showing that a number of complex human diseases are caused or are at least influenced by periodontal diseases. Such diseases include cardiovascular diseases, respiratory diseases, diabetes mellitus and osteoporosis. The aim of study was to evaluate periodontal diseases as a risk factor for a preterm low birth weight. MATERIALS AND METHODS: A total of 48 mothers, 20 of who had a preterm low birth weight delivery, were examined in the Clinics of Periodontology, Faculty of Dentistry, Cumhuriyet University. The periodontal exams consisted of a full mouth pocket depth, a Loe and Sillness Gingival index score measurements, and a panoramic radiograph analysis. Information on any other factors that may cause a preterm low birth weight was obtained from the family physician. RESULTS: The study results indicated that periodontitis (OR: 3.6 95% CI: 1.06-12.18) together with bacterial vaginosis (OR: 11.57 95% CI: 1.26-105.7) were independent risk factors of a preterm low birth weight. According to the data obtained from this study, the paternal age, tobacco use and the mothers' height were not significant risk factors for a preterm low birth weight. CONCLUSION: Within the limits of this study, it is concluded that a poor periodontal health status of the mother may be a potential risk factor for a preterm low birth weight.

The effect of endodontic therapy on periapical exudate neutrophil elastase and prostaglandin-E2 levels.

This study aimed to investigate periapical exudate neutrophil elastase (NE) and prostaglandin E2 (PGE2) levels and their relationships with clinical symptoms, and to determine the changes of their levels following first treatment visit. Periapical exudate samples were collected from the canals of 34 nonvital single-rooted teeth at two sequential treatment visits. Periapical exudate NE and PGE2 levels were found to be higher in the presence of clinical symptoms (pus discharge, swelling) (p < 0.05). The canals of teeth with larger periapical radiolucent area (>or=1 cm) contained more PGE2 levels than with smaller ones (<1 cm) (p < 0.05). Periapical exudate NE levels were significantly correlated with PGE2 levels (p < 0.05), and their levels at first treatment visit did not change following root canal therapy (p > 0.05). The periapical exudate NE and PGE2 levels may regulate periapical disease expression, but the results of this study were unable to reveal this association.

Periodontal treatment of two siblings with juvenile hyaline fibromatosis.

BACKGROUND AND AIM: Juvenile hyaline fibromatosis (JHF) is an autosomal recessive disease that presents with multiple subcutaneous nodular tumours, gingival fibromatosis, flexion contractures of the joint and hyaline material accumulation in extracellular area. Recently, the causative gene for JHF, capillary morphogenesis protein 2 (CMG2) was identified. In this case report, periodontal status, treatment and follow-up together with histopathologic evaluation of gingival tissue specimens and mutation screening of two JHF cases are presented. CASE REPORTS: A 10-year-old female (case 1) and her 3-year-old brother (case 2) were first examined in our department with a complaint of gingival hyperplasia in 1991. Symptoms of the disease were detected in two of four siblings in the family. Several gingivectomy operations were carried out over 11 years with hygiene motivation and initial phase therapy. After the last gingivectomy operation in 2002, the patients were reviewed frequently. RESULTS AND CONCLUSIONS: Although there was linear marginal gingival inflammation, no remarkable enlargement was noted at last appointment. Histopathological findings showed increased amounts of subepithelial nodular connective tissue, thinned epithelial mucosa, separated inter-cellular bridges and decreased numbers of connective tissue cells in gingival tissue samples. Electron microscopic examinations supported the histopathological findings. Mutation screening of CMG2 demonstrated that the siblings were homozygous for a pathogenic missense mutation, V386F. Our clinical findings demonstrate that gingivectomy is useful and frequent periodontal visits are important for maintaining oral hygiene and decreasing growth rate of gingiva in JHF.

Periodontal status in two siblings with severe congenital neutropenia: diagnosis and mutational analysis of the cases.

BACKGROUND: Severe congenital neutropenia (SCN), also known as Kostmann syndrome, was originally reported as an autosomal recessive disease of neutrophil production. The disease is characterized by a maturation arrest of neutrophil precursors at the promyelocytic stage of differentiation and by extremely low levels of mature neutrophils in peripheral blood. METHODS: A 6-year-old male presented with a complaint of gingival swelling and bleeding, and swelling at the left side of his face. Upon clinical examination, severe inflammation of all gingival tissues was apparent, and a periapical abscess with mobility was noted on the left mandibular second molar. Medical and dental histories revealed numerous recurrent bacterial infections associated with oral and non-oral tissues. His medical history with recurrent infections led us to evaluate his 3-year-old sister to determine the status of her oral health. Inflammation of her oral tissues and recurrent bacterial infections were apparent. Their consanguineous parents were in good health. To assist in identifying possible systemic diseases underlying the inflammatory situation in the siblings, consultations were requested from the Pediatric Hematology Department at Selcuk University and Pediatric Oncology Department at Gulhane Military Medical Academy. RESULTS: Based on absolute neutrophil count (< or =200/mm(3)) and bone marrow aspiration findings consistent with early maturation arrest in myelopoiesis, the cases were diagnosed as SCN. No chromosomal abnormality was detected upon cytogenetic examination. Sequencing analysis also revealed no mutation in the neutrophil elastase or growth factor independent-1 (GFI-1) genes in these patients. Severe periodontal disease, attachment loss, and mobility for over 50% of the deciduous teeth were noted. Within 6 months, the male sibling lost all of his deciduous teeth due to periapical and periodontal infections. His sister presented with tooth mobility for all mandibular incisors. Monthly visits, including scaling, polishing, and 0.2% chlorhexidine digluconate irrigation were performed to support their oral hygiene and to avoid recurrent oral infections. We have been able to stabilize these patients' periodontal conditions during a 2-year follow-up period. CONCLUSION: This case report emphasizes the role of periodontists and pediatric dentists in the diagnosis of diseases linked with neutrophil and other systemic disorders and highlights the need to optimize the health of oral tissues with regular appointments.

Neutrophil elastase levels in periapical exudates of symptomatic and asymptomatic teeth.

The aim of this study was to determine neutrophil elastase levels (NE) in periapical exudates and to evaluate its relationship with clinical signs and symptoms of endodontically involved teeth. A total of 42 teeth with periapical periodontitis of 37 patients were clinically examined and spontaneous pain, swelling, pain on palpation or percussion, sinus tract formation and pus discharge were recorded. Additionally, periapical lesion size was measured on periapical radiographs. Periapical exudate samples were obtained during routine root canal treatment by using paper points. Enzyme levels were determined by spectrophotometric assays using the NE specific substrate N-methoxysuccinil-Ala-Ala-Pro-Val-p-nitroanilide. The teeth with signs and symptoms showed higher NE levels than the teeth without symptoms (p<0.05). The differences were significant when NE levels were presented as total amounts instead of concentration. This study demonstrated that NE in periapical lesions related with clinical symptoms and total enzyme amount may be more reliable mode of data presentation.

Critical steps in electronic volume quantification of gingival crevicular fluid: the potential impact of evaporation, fluid retention, local conditions and repeated measurements.

BACKGROUND AND OBJECTIVES: Various methodological factors may operate during clinical gingival crevicular fluid (GCF) sampling, volume quantification or subsequent laboratory analysis. For precise volume quantification, specific concern for generation and maintenance of a reliable calibration curve, the potential risk of GCF loss as a result of evaporation or fluid retention on actual volume and the impact of local conditions is needed because each of these factors may act as a source of subsequent volumetric distortions. Thus, the present study aimed to analyse the impact of sample transfer time on the rate of evaporation and the possibility of fluid retention, and the impact of local conditions and number of replicated measurements on the reliability of calibration data. MATERIALS AND METHODS: To analyse evaporative errors, standardized Periopaper strips provided with known test volumes (0.1 microl, 0.2 microl, 0.5 microl and 0.6 microl) were transferred to Periotron 8000 with different time intervals (immediately, 5 s, 30 s and 60 s). For fluid retention, after quantifying the actual volume of the strips provided with known volumes (0.1 microl and 0.6 microl) of two test fluids, a second set of measurements was performed using dry strips. To determine the impact of local conditions (temperature and humidity) and the validity of 3, 5 and 20 replications (0.0-0.6 microl with 0.1- microl increments) on device calibration for 20 degrees C and 25 degrees C, electronic readings were obtained from three devices at three different locations. Differences in volumetric data in each experimental design were statistically analysed. RESULTS: No significant fluid loss was observed within 5 s, but evaporation clearly led to volumetric distortions with extending transfer times (30 s or 60 s) (p < 0.05). Measurable amounts of fluid retention were found for both volumes and both test fluids, but not with identical patterns. Local conditions resulted in unique calibration data for each test volume and for each device. Although a 5 degrees C increase generally provided higher readings, this was not observed for all devices at all volumes. Additional replicates (n = 5 or n = 20) did not seem to add any further reliability to the triplicate scores for the given test volumes. CONCLUSION: The findings of the present study confirm the reliability of triplicate readings, and uniqueness of each device and electronic data and the distinct impact of local environmental conditions on the generation/maintenance of calibration scores for each particular device. Furthermore, they underline time-dependent evaporation and fluid retention as additional technical concerns and once again highlight the importance of methodological standardization of the electronic volume quantification process.

Interleukin-1beta, tumor necrosis factor-alpha levels and neutrophil elastase activity in peri-implant crevicular fluid.

The aim of this study was to determine interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha) levels and neutrophil elastase (NE) activity in peri-implant crevicular fluid (PICF) of smoker and nonsmoker patients, and to investigate their relationships with clinical parameters. A total of 42 endosseous root-form dental implants of 14 patients were clinically examined by modified Plaque index (PI), modified Gingival index (GI) and probing depth (PD). Smoking habits of the patients were recorded. PICF of implants were collected by Periopaper strips and IL-1beta, TNF-alpha levels were determined by enzyme-linked immunosorbent assay (ELISA). NE was analyzed with a neutrophil specific chromogenic substrate, N-methoxysuccinyl-Ala-Ala-Pro-Val-p-nitroanilide. The cytokine and enzyme levels in PICF were expressed as total amount/activity and as concentrations. NE activity in PICF significantly correlated with GI and PD, and IL-1beta levels with GI and PICF volume (P < 0.05). The correlations were stronger when the PICF levels were expressed as total IL-1beta amount and as total NE activity. The implants with inflamed gingiva (GI > 1) had higher levels of IL-1beta and NE activity than implants with noninflamed or slightly inflamed gingiva (GI 3 mm) was greater than the implants with shallow pockets (PD

A rare case of gingival myiasis caused by diptera (Calliphoridae).

Myiasis was first described by Hope in 1840. Since then, many cases of myiasis affecting different human organs have been reported. Oral myiasis is very rare in healthy persons but occurs mainly in the tropics and associated with inadequate public and personal hygiene. In this case report, we present clinical findings gingival myiasis. The patient was 26-year-old farmer and his chief complaint was discomfort and swelling in his maxillary gingiva. The patient's medical and family histories were non-contributory and oral hygiene was not acceptable. The diagnosis was based on the characteristic clinical features and the visual presence of wriggling larvae about 1 cm in size. The larvae were identified as Calliphoridae. Treatment consisted of removal of the maggots from the gingival sulcus, followed by scaling and oral hygiene instruction. One week later, a periodontal flap operation was done. The patient was followed-up for 6 months and healing was uneventful.