Effect of ultrasonic debridement using a chlorhexidine irrigant on circulating levels of lipopolysaccharides and interleukin-6.

AIM: Transient bacteraemia and endotoxaemia, and elevated levels of systemic cytokines have been reported following subgingival debridement. This study aimed to investigate the effect of chlorhexidine (CHX) solution on circulating levels of lipopolysaccharide (LPS) and interleukin-6 (IL-6) when used as an irrigant during ultrasonic debridement in patients with periodontitis. MATERIAL AND METHODS: Eighteen patients with moderate to advanced chronic periodontitis were treated in a split-mouth, crossover, single-masked study. Irrigation with 0.02% CHX solution or water was used during treatment of two ipsilateral quadrants on two separate occasions 7 days apart, randomized as to order. Peripheral blood samples were collected for circulating levels of LPS and IL-6 at baseline, 5 and 120 min. after instrumentation commenced. RESULTS: Median concentrations of LPS were elevated from baseline to 5 min. into treatment with both CHX and control irrigant (p<0.05). Median levels of IL-6 increased with both treatments from baseline to 120 min. (p<0.001): CHX, 0.81-1.85 pg/ml; control, 0.78-1.78 EU/ml. CONCLUSIONS: Ultrasonic instrumentation in patients with moderate to advanced periodontitis increases circulating levels of LPS after 5 min. and IL-6 120 min. after commencement of treatment, and is not affected by using 0.02% CHX as an irrigant instead of water.

Investigation of periodontal destruction patterns in smokers and non-smokers.

BACKGROUND: Previous work has suggested that tobacco smoking has a local as well as a systemic effect on the severity of periodontal disease. OBJECTIVE: To test the hypothesis that smokers have more disease in the upper anterior region. METHODS: A retrospective stratified random sample of 49 non-smokers and 39 heavy smokers (>or=20 cigarettes/day) was obtained from a total of 3678 referred patients with adult periodontitis. Probing depth data were collected from clinical records and radiographic measurements were carried out on existing dental panoramic tomographs to assess the inter-proximal bone levels. RESULTS: The proportion of sites with "bone loss" 4.5 mm or greater was higher in smokers, the greatest difference being observed in upper anterior sites (smokers: 73.3+/-25.5%, non-smokers: 48.3+/-31.2%, p<0.001). A difference was also observed when the number of palatal sites probing 4 mm or greater in the upper anterior region was expressed as a proportion of all such sites in the mouth (smokers: 12.3+/-6.8%, non-smokers: 9.8+/-8.8%; p=0.050). CONCLUSION: The overall pattern of tissue destruction was consistent with a systemic effect of smoking. The suggestion of a marginal local effect of the smoking habit in maxillary anterior palatal sites requires further investigation.

The effect of a commercially available chlorhexidine mouthwash product on human osteoblast cells.

Chlorhexidine mouthwash (CMW) is used for decontamination of tooth, implant or prosthetic surfaces to treat or prevent local infection. A cell culture model was used to investigate cytotoxicity of CMW employing an MTT assay to record cell activity. Human osteoblast-like cells (HOS TE 85) were seeded. Dilutions of CMW (1:1 to 1:128) were made up with culture medium. Positive and negative controls were prepared. Cells were incubated, exposed to CMW, for 5 min to 4 h. Diluted tetrazolium salt solution was added. Plates were incubated for a further 4 h. Medium was removed, dimethylsulphoxide was added, and absorbance at 570nm read. Undiluted CMW caused total cytotoxicity, similar to positive control. Progessive dilution of CMW was associated with elevated cell survival. Cytotoxicity increased with longer time exposures. It was concluded that CMW can be cytotoxic in high concentrations and when applied for long time periods. Work is needed to determine effects on other cell types and clinical significance of these findings.

The short-term effects of treatment of chronic periodontitis on circulating levels of endotoxin, C-reactive protein, tumor necrosis factor-alpha, and interleukin-6.

BACKGROUND: The acute-phase response involves molecules including tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and C-reactive protein (CRP). This study aimed to determine whether subgingival scaling resulted in rapid changes in plasma concentrations of these molecules. METHODS: Twenty-three non-smoking adults with chronic periodontitis received subgingival scaling for 60 minutes. Venous blood samples were taken at 0, 15, 30, 60, and 120 minutes. TNF-alpha and IL-6 were assayed from all samples and CRP from the baseline and final samples. Lipopolysaccharide (LPS) was assayed at 0, 15, and 30 minutes using limulus lysate assay (LAL) and EndoCAb Ig assays. RESULTS: LPS assays were suggestive of a transient low-grade bacteremia, but changes in LPS approaching significance (P=0.061) were seen with LAL only. There was a significant increase in circulating TNF-alpha (P=0.0387) and IL-6 (P<0.0001), and the degree of change in TNF-alpha was correlated with the severity of periodontal breakdown (P=0.001). There was also a significant correlation between levels of IL-6 and TNF-alpha (P<0.001). CONCLUSIONS: Chronic periodontitis patients undergoing an episode of subgingival scaling show a significant elevation in circulating TNF-alpha and IL-6. This may account for anecdotal reports of pyrexia following treatment and may be significant in terms of the relationship between periodontal disease, bacteremia, and cardiovascular disease.