Methodological Considerations in Salivary Proteomics for Periodontal Research-A Review.

The diagnosis and management of periodontal diseases can be enhanced by the identification of biomolecules which can predict disease susceptibility, indicate current disease activity, and monitor response to therapy. Salivary proteomics is a major avenue in the ongoing search for a biomarker in periodontal research. Saliva is a valuable diagnostic vehicle which "mirrors" oral and systemic health and disease. Standardized methods of saliva sampling and processing will increase diagnostic test accuracy and decrease bias in measurements. Prominent databases such as PubMed/Medline, PMC, Scopus, and Google Scholar were searched and literature evidence from January 2000 till September 2022 were studied to identify the methodological considerations employed in salivary proteomics for periodontal research. Evidence and recommendations in this regard were collated into this narrative review. The methods of saliva collection and processing presented in this review will help researchers conduct salivary proteomic studies with standardized protocols.

Evaluation of the effect of scaling and root planing on salivary and serum fetuin-A levels in patients with Stages II and III periodontitis.

BACKGROUND: Fetuin-A has garnered recognition in the etiopathogenesis of several systemic disorders. It has been recently acknowledged as an anti-inflammatory marker for periodontal disease. This study aimed to compare and correlate salivary and serum fetuin-A levels in health and patients with stages II-III periodontitis along with evaluating the effect of non-surgical periodontal therapy (NSPT) on the same. METHODS: Group 1 comprised of 30 healthy subjects. Group 2 embodied 30 patients with stages II-III periodontitis. Clinical periodontal parameters were recorded. Saliva and serum samples were assembled. Periodontitis patients received non-surgical periodontal treatment. They were recalled after 6 months, and collection of samples and recording of clinical parameters were reiterated. Fetuin-A levels were analyzed using ELISA. RESULTS: Salivary and serum fetuin-A levels were significantly lower in periodontitis patients when compared with the healthy subjects (P < 0.001) at baseline. Their concentrations significantly upregulated 6 months after active periodontal therapy (P < 0.001). Salivary fetuin-A levels revealed a significant positive correlation with their serum levels in Group 1 at baseline (P < 0.001). They also displayed a positive correlation in Group 2 at baseline and 6 months post periodontal therapy, nevertheless failed to establish a statistically significant association. CONCLUSION(S): Our study concluded that salivary and serum fetuin-A levels diminished with increasing severity of periodontal inflammation, and NSPT remarkably improved their levels. They also displayed a significant positive correlation in health, and a non-significant, yet positive correlation in patients with periodontitis.

Oral Microbial Shift Following 1-Month Supplementation of Probiotic Chewable Tablets Containing Lactobacillus reuteri UBLRu-87 as an Adjunct to Phase 1 Periodontal Therapy in Chronic Periodontitis Patients: A Randomized Controlled Clinical Trial.

CONTEXT: Although Lactobacilli as a probiotic was established as a treatment for a wide range of systemic infections, its role in periodontitis and oral microbiota is still under investigation. AIMS: The present randomized clinical trial was aimed to evaluate the effects of probiotic chewable tablets containing Lactobacillus reuteri UBLRu-87 along with initial periodontal therapy on clinical parameters and oral microbiota of chronic periodontitis (CP) patients. SETTINGS AND DESIGN: The randomized controlled clinical trial. SUBJECTS AND METHODS: Thirty CP patients were selected who received scaling and root planing (SRP) and were randomly allocated into two treatment groups; Groups A and B. Group A received L. reuteri-containing chewable probiotic tablets. The clinical parameters (plaque index, gingival index, probing pocket depth, clinical attachment level), and microbiological parameters (Porphyromonas gingivalis and L. reuteri levels using real-time polymerase chain reaction) were evaluated at baseline, following treatment at 1 month and 3 months in both groups. STATISTICAL ANALYSIS: Paired t-test and unpaired t-test were used for the statistical analysis. RESULTS: On intergroup analysis, statistically significant improvement in clinical as well as microbiological parameters was observed in Group A (SRP + PROBIOTIC) compared to Group B (SRP ALONE) at all evaluation time points. CONCLUSION: Probiotic chewable tablets containing L. reuteri may be a useful adjunct along with initial periodontal therapy to slow recolonization of periopathogens along with improvement in clinical outcomes of CP. Further long-term trials are necessary to establish the optimal dosage of probiotics.

Objective evaluation of healing and esthetic outcome of root coverage procedure using chorion membrane: a case series.

The ultimate goal of any periodontal plastic surgery aimed to treat gingival recession is predictable recession coverage and esthetic outcome. Due to the post-operative morbidity and discomfort related to subepithelial connective tissue graft, various other methods have been introduced including the use of fetal membranes. The fetal membranes have shown promising results in medicine and recently in the field of regenerative dentistry and could possibly become a viable alternative to autogenous grafts. This article reports a series of cases of Miller's class I gingival recession that were treated by chorion membrane combined with coronally advanced flap and evaluated using objective variables for post-operative healing and esthetics. Nine systemically healthy subjects with ten Miller's class I buccal gingival recession were included in the study. Clinical parameters were recorded at baseline, 3 months and 6 months post-surgery; wound healing index (WHI) was recorded one week post-surgery. At the end of 6 months, the percentage of root coverage and the root coverage esthetic score (RES) were calculated. The results showed statistically significant (p < 0.05) improvement in most of the parameters. The mean percentage of root coverage obtained was 62.20 ± 21.99% ranging from 33.3 to 100%. The WHI showed excellent healing score and RES assessed at the end of six months showed superior esthetic results. The chorion membrane along with coronally advanced flap is a predictable procedure for root coverage with better post surgical healing and superior esthetics.

Identification of a novel salivary biomarker miR-143-3p for periodontal diagnosis: A proof of concept study.

BACKGROUND: Though the use of salivary miRNAs as potential biomarkers has been reported in few diseases/conditions such as rheumatoid arthritis and oral cancer, there are no reported studies on their utility in periodontal diagnostics. Thus, the aim of the present study was to profile salivary miRNAs and identify the most suitable salivary miRNA biomarker in chronic periodontitis. METHODS: In this study, we have explored the potential application of next generation sequencing (NGS) technology for profiling miRNAs in two unstimulated saliva samples collected by passive drool method from a patient diagnosed with generalized chronic periodontitis and a healthy control. Subsequently, the validation of most highly expressed known miRNA in periodontitis was performed in saliva samples collected from an independent set of 16 chronic periodontitis patients and 16 periodontally healthy controls using quantitative real-time PCR (qRT-PCR). Target gene prediction and pathway mapping were performed using bioinformatic tools. RESULTS: NGS analysis identified 40 upregulated and 40 downregulated known miRNAs in chronic periodontitis compared to healthy controls, of which miR-143-3p was the most highly expressed miRNA in periodontitis (Read count - 227630; fold change - 5.82). Validation using qRT-PCR showed significant upregulation of miR-143-3p expression in the test group compared with controls (P < 0.05). K-RAS (V-Ki-ras2 Kirsten rat sarcoma viral oncogene) gene was predicted as the target gene for miR-143-3p in humans. KEGG (Kyoto Encyclopedia of genes and genomes) pathway mapping revealed the involvement of K-RAS in mitogen-activated protein kinases (MAPK) pathway. CONCLUSIONS: The application of NGS for miRNA expression profiling can be considered a valuable tool in detection of novel biomarkers in periodontal diagnostics. Also, the results of the study points to the potential utility of miR143-3p as a novel salivary biomarker for chronic periodontitis.

MIP-1α and MCP-1 as salivary biomarkers in periodontal disease.

AIM: Chemokines released by different host cells when exposed to the components of periodontopathic bacteria induce and maintain an inflammatory response in the periodontium. The aim of the study was to estimate the salivary levels of two chemokines, macrophage inflammatory protein-1 alpha (MIP-1α) and monocyte chemo attractant protein-1 (MCP-1) in health, gingivitis and periodontitis and to evaluate their role as reliable salivary biomarkers in discriminating gingivitis and periodontitis from health. METHODS: A cross sectional study was designed to estimate the levels of MIP-1α and MCP-1 in whole unstimulated saliva from 75 patients who were divided into healthy (Group 1, n = 25), gingivitis (Group 2, n = 25) and chronic generalized periodontitis (Group 3, n = 25). MIP-1α and MCP-1 levels were estimated by using ELISA and were correlated with clinical parameters. ROC curve analysis was done to determine the sensitivity and specificity of these biomarkers in distinguishing periodontal disease from health. RESULTS: Both the biomarkers were detected in all the saliva samples. There was a statistically significant difference in the concentration of both the analytes in Group 3 and Group 2 compared with Group 1 (p < 0.001). ROC curve analysis showed 100% sensitivity and specificity for MIP-1α and MCP-1 in discriminating periodontitis from health. For discriminating gingivitis from health, MIP-1α had a higher sensitivity and specificity (100% & 88% respectively) compared to MCP-1(84.1% & 80% respectively). CONCLUSION: There is a substantial increase in the concentration of both MIP-1α and MCP-1 with increasing severity of periodontal disease. Both the analytes showed promising results as biomarkers for discriminating periodontal disease from health.

Unveiling the role of stress in periodontal etiopathogenesis: an evidence-based review.

Periodontal disease is a multifactorial disease affecting the supporting tissues of the teeth, resulting in progressive attachment loss and bone loss. Periodontal disease is influenced by various systemic, environmental, and psychologic factors that have the potential to alter periodontal tissues and host immune response, resulting in more severe periodontal destruction. Several studies have documented the relationship between psychosocial stress and chronic forms of periodontal disease. Stress impairs periodontal health through changes in behavior and complex interactions among the nervous, endocrine, and immune systems. The influence of stress on periodontal disease is affected by the emotional coping skills of the individual. Psychologic stress and depression may also influence the outcome of periodontal therapy. Stressful life events and coping skills are factors to consider in the risk of periodontal disease destruction and the potential for successful periodontal therapy. Therefore psychosocial stress is considered as an important risk factor for periodontal disease, and emotional stress in periodontitis patients should be diagnosed and treatment should be administered for the proper management and successful outcome of periodontal disease.