Clinical and microbiological efficacy of systemic roxithromycin as an adjunct to non-surgical periodontal therapy in treatment of chronic periodontitis. A randomized, double-blinded, placebo-controlled clinical trial.

PURPOSE: The objective of this randomized clinical trial was to evaluate the clinical and microbiological effects of systemic administration of roxithromycin (RXM) as an adjunct to non-surgical periodontal therapy (NSPT) in the treatment of individuals with moderate to severe chronic periodontitis (CP). METHODS: 70 individuals (38 males and 32 females, aged 25 to 60 years) with moderate to severe CP were randomly allocated into two groups. 35 individuals were allocated to full mouth SRP+RXM while 35 individuals were allocated to SRP+ Placebo group. The clinical parameters evaluated were probing depth (PD), clinical attachment level (CAL), gingival index (GI), plaque index (PI) and % bleeding on probing sites (%BOP) at baseline (B/L), 1-, 3- and 6-month intervals while microbiologic parameters included percentage of sites positive for periodontopathic bacteria A. actinomycetemcomitans, P. gingivalis and T. forsythia at B/L, 3 and 6 months using polymerase chain reaction. RESULTs: Both groups showed improved clinical and microbiologic parameters over 6 months. RXM group showed a statistically significant reduction in mean PD and CAL gain as compared to the placebo group (P < 0.0001). There was reduction in percentage of sites positive for periodontopathic bacteria over the duration of the study in both groups and a statistically significant reduction in the number of sites positive for A. actinomycetemcomitans in RXM group (P < 0.001).

Gingival crevicular fluid and serum levels of resistin in obese and non-obese subjects with and without periodontitis and association with single nucleotide polymorphism at -420.

OBJECTIVE: Resistin is an adipocytokine, which have been studied for its role in insulin resistance and recently in inflammation. The present study was designed to study the gingival crevicular fluid (GCF) and serum levels of resistin in obese and non-obese subjects with and without periodontitis and to further study the association of single-nucleotide polymorphism (SNP) -420 with these levels. MATERIALS AND METHODS: A total of 90 subjects were divided based on gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), body mass index (BMI) and waist circumference (WC) into: Non-obese healthy (Group 1, n = 30, BMI ≤ 22.9 and WC < 90 for male subjects and < 80 for female subjects, PPD ≤ 3 mm, CAL = 0, GI = 0), non-obese periodontitis (Group 2, n = 30, BMI ≤ 22.9 and WC < 90 for male subjects and < 80 for female subjects, PPD ≥ 5 mm, CAL ≥ 3, GI ≥ 1) and obese periodontitis (Group 3, n = 30, BMI ≥ 25.0 and WC ≥ 90 for male subjects and ≥ 80 for female subjects, PPD ≥ 5 mm, CAL ≥ 3, GI ≥ 1). The GCF and serum levels of resistin were quantified using enzyme-linked immunosorbent assay and compared amongst the study groups. Further, the association of the resistin levels with periodontal inflammation and SNP at -420 was studied. RESULTS: The mean resistin levels were highest in Group 3 (14.66 ± 5.93 ng/ml and 9.99 ± 7.22 µg/ml), followed by Group 2 (12.34 ± 4.31 ng/ml and 7.47 ± 3.94 µg/ml) and least in Group 1 (7.09 ± 3.34 ng/ml and 6.05 ± 3.61 µg/ml) in serum and GCF respectively. The levels positively correlated with GI, PPD, CAL, BMI, WC and waist-hip ratio (r < 0.6). The SNP at -420 showed that GG genotype was associated with Group 2 and 3 i.e. periodontitis, while CC genotype was associated with periodontal health. The GG genotype was also associated with high serum resistin levels as compared to CC and CG genotypes. CONCLUSION: Resistin levels increased with periodontal inflammation indicating its possible inflammatory role in periodontitis. GG genotype at -420 is associated with increased serum resistin and with periodontal disease. Thus, further research is needed to study GG genotype and increased serum and GCF resistin levels as putative risk factors for periodontal diseases.

Association of metabolic syndrome and periodontal disease in an Indian population.

BACKGROUND: Metabolic syndrome, the whole of interconnected factors, presents with local manifestation, such as periodontitis, related by a common factor known as oxidative stress. The aim of the present study was to assess the association between metabolic syndrome and periodontal disease in an Indian population. METHODS: Clinical criteria for metabolic syndrome included 1) abdominal obesity; 2) increased triglycerides; 3) decreased high-density lipoprotein cholesterol; 4) hypertension or current use of hypertension medication; and 5) high fasting plasma glucose. Serum C-reactive protein (CRP) levels were also measured. Periodontal parameters including gingival index (GI) average and deepest probing depth (PD) and clinical attachment level (CAL) were recorded on randomly selected quadrants, one maxillary and one mandibular. Based on the presence or absence of metabolic syndrome, individuals were divided into two groups. RESULTS: The periodontal parameters PD, CAL and GI differed significantly between the two groups. The GI values in Group 1 (2.06 ± 0.57) were greater than in Group 2 (1.79 ± 0.66; p = 0.0025). Similarly PD and CAL values in Group 1 (4.58 ± 1.69 and 2.63 ± 1.61 mm) were significantly greater (p < 0.001) than in Group 2 (3.59 ± 1.61 and 1.61 ± 1.40 mm, respectively). Also, three metabolic components and serum CRP correlated with average PD, and the strength of the correlation was medium in Group 1 as compared to Group 2, in which it was weak. CONCLUSION: The association between metabolic syndrome and periodontal disease was significant, and abdominal obesity appeared to be the most important contributing metabolic factor to periodontal disease.

Resistin in serum and gingival crevicular fluid as a marker of periodontal inflammation and its correlation with single-nucleotide polymorphism in human resistin gene at -420.

AIMS: Resistin is an adipocytokine, which have been studied for its role in insulin resistance and recently in inflammation. The aim of the present study is to assess the concentration of resistin in serum and gingival crevicular fluid (GCF) and to compare the levels between subjects with and without periodontitis and type 2 diabetes mellitus (T2DM) and to further correlate the resistin levels with the single-nucleotide polymorphism (SNP) at -420. SETTING AND DESIGNS: A total of 96 subjects (48 males and 48 females) were divided on the basis of gingival index (GI), probing pocket depth (PD), clinical attachment level (CAL) and hemoglobin A1c levels into healthy (group 1, n = 24), uncontrolled-diabetes related periodontitis (group 2, n = 24), controlled-diabetes related periodontitis (group 3, n = 24) and chronic periodontitis without T2DM (group 4, n = 24). MATERIALS AND METHODS: The GCF and serum levels of resistin were quantified using the enzyme-linked immunosorbent assay and compared among the study groups. Further, the association of the resistin levels with periodontal inflammation and SNP at -420 was studied. RESULTS AND CONCLUSION: The resistin levels in GCF and serum from patients with periodontitis or diabetes mellitus related periodontitis (controlled or uncontrolled) were higher than that of healthy subjects and correlated positively with GI. Further, subjects with GG genotype at -420 showed significantly higher GI, PD, CAL as compared with genotype group CC. Resistin was detected in all serum and GCF samples and was significantly higher in periodontitis. Further, GG genotype at -420 was associated significantly with periodontal inflammation and resistin levels.

Effect of nonsurgical periodontal therapy on crevicular fluid and serum glutathione peroxidase levels.

BACKGROUND: Plasma glutathione peroxidase (eGPx) is an important selenium containing antioxidant in human defense against oxidative stress. While crevicular fluid (GCF) eGPx levels and its association with periodontal disease is well documented, there is no data on correlation of GCF and serum eGPx levels in chronic periodontitis. Hence this study was undertaken to further probe into the role of oxidative stress in periodontal diseases and effect of nonsurgical periodontal therapy (NSPT) by correlating GCF and serum levels of eGPx. MATERIALS AND METHODS: Thirty subjects (16-Males and 14-Females; age: 30-38 years) participated in the study. The subjects were divided, based on gingival index, probing pocket depth and clinical attachment level into: Healthy (group-1, n=10), Gingivitis (group-2, n=10) and Periodontitis (group-3, n=10). Chronic periodontitis patients after NSPT constituted group 4. GCF and serum samples collected from each subject were quantified for eGPx levels using Enzyme linked Immunosorbent Assay. RESULTS: The mean eGPx concentrations increased from health (14.01 ng/µl and 78.26 ng/ml) to gingivitis (22.86 ng/µl and 90.44 ng/ml) and then to periodontitis (29.89 ng/µl and 103.43 ng/ml), in GCF and serum respectively. After NSPT, there was statistically significant reduction in eGPx concentration in GCF and serum (19.41 ng/µl and 85.21 ng/ml). Further, all the GCF eGPx values showed a positive correlation to that of serum eGPx level. CONCLUSION: Thus, increased eGPx concentration in GCF can be considered as an indicator of local increase in oxidative stress. While, increase in serum eGPx levels indicates that periodontal disease can also lead to increased oxidative stress at the systemic level.

Association of serum and crevicular visfatin levels in periodontal health and disease with type 2 diabetes mellitus.

BACKGROUND: Levels of visfatin in serum and gingival crevicular fluid (GCF) were explored in patients with periodontal health, periodontal disease with and without type 2 diabetes mellitus (t2 DM) and were found to be elevated with periodontal disease, and were correlated with periodontal clinical parameters. DM and chronic periodontitis (CP) are associated with each other. Adipokines, specifically visfatin, are secreted from adipocytes and are thought to cause insulin resistance. The purpose of this study is to determine the presence of visfatin in serum and GCF in t2 DM among individuals with CP and to find an association, if any. METHODS: Thirty individuals (15 males and 15 females) were selected based on their clinical parameters into three groups: group 1 (10 healthy), group 2 (10 well-controlled t2 DM among individuals with CP), and group 3 (10 individuals with CP and without diabetes). Serum and GCF samples were collected to estimate the levels of visfatin using enzyme linked immunosorbent assay. RESULTS: The mean visfatin concentration increased in both serum and GCF in individuals with t2 DM with CP. Also, it was observed that visfatin in both serum and GCF correlated positively with all the periodontal parameters. CONCLUSIONS: All the samples in each group tested positive for visfatin assay. Serum and GCF visfatin concentration in both t2 DM with CP and individuals with CP and without diabetes correlated positively with all the clinical parameters. Additional large-scale longitudinal studies should be performed to confirm positive correlations.

Gingival crevicular fluid and serum visfatin concentration: their relationship in periodontal health and disease.

BACKGROUND: Visfatin is a pleiotropic mediator that acts as growth factor, cytokine, and enzyme involved in energy including nicotinamide adenine dinucleotide metabolism and was recently demonstrated to exert several proinflammatory functions. The purpose of this study is to determine the presence of visfatin in gingival crevicular fluid (GCF) and serum samples and to find out their association, if any. METHODS: At the beginning of the study, 40 individuals (20 males and 20 females; age range: 23 to 53 years) were selected and divided into three groups based on the gingival index, probing depths, clinical attachment levels, and radiologic parameters (bone loss). Group 1 (10 patients with healthy periodontium; age range: 25-36 years), group 2 (15 patients with gingivitis; age range: 25-36 years), and group 3 (15 patients with chronic periodontitis; age range: 23-53 years) GCF (by microcapillary pipettes) and serum (by venipuncture) samples were collected to estimate levels of visfatin using an enzyme-linked immunosorbent assay kit. RESULTS: Mean visfatin concentrations increased in GCF and serum with the severity of disease from healthy to gingivitis to periodontitis groups and differed significantly (P <0.05). However, it was found that GCF values were higher than serum values. The highest to lowest visfatin concentrations were found in groups 3 through 1, respectively. Visfatin in GCF and serum correlated positively with periodontal parameters in the chronic periodontitis group. CONCLUSIONS: The results suggest that GCF and serum visfatin concentrations increase with the severity of periodontal disease. Hence, visfatin values were considered an inflammatory marker in periodontal disease in GCF and serum. Visfatin also deserves further consideration as a therapeutic target.

Multiple dental anomalies and aggressive periodontitis: a coincidence or an association?

Aggressive periodontitis (AgP) comprises a group of rare, often severe, rapidly progressive forms of periodontitis mostly characterized by an early age of clinical manifestation and a distinctive tendency for cases to aggregate in families. Abnormal dental morphology and position have been associated with severe periodontal diseases. The purpose of this paper is to report a case of multiple dental anomalies associated with AgP. This paper reports a case of unusual association of multiple dental anomalies to AgP. Clinical findings and history led to the diagnosis of localized AgP, and radiologically. It was associated with multiple dental anomalies, especially supernumerary roots. Thus, the present case represents a very interesting demonstration of AgP association with supernumerary roots and the nature of this association merits further investigations.

Crevicular fluid levels of plasma glutathione peroxidase (eGPx) in periodontal health and disease.

BACKGROUND & OBJECTIVES: Reactive oxygen species (ROS) have been implicated in numerous human diseases, including periodontal diseases. Plasma glutathione peroxidase (eGPx) as an important antioxidant, has a protective role against ROS and is an established marker of oxidative stress. The present study evaluated the levels of eGPx in GCF to further probe into the role of oxidants and antioxidants in periodontal disease. METHODS: 60 subjects were divided into three groups consisting of 20 subjects in each group based on gingival index, pocket probing depth, clinical attachment loss and radiological parameters (bone loss): healthy (group 1), gingivitis (group 2) and periodontitis (group 3), whilst, group 3 patients after the treatment constituted group 4. GCF samples were collected from all groups to estimate the levels of eGPx using ELISA. RESULTS: The mean eGPx concentration in GCF were observed to be the highest in group 3 i.e., 30.89+/-4.93 ng/microl and lowest in group 1 i.e., 15.32+/-3.06 ng/microl. The mean eGPx concentration in group 2 (23.77+/-2.91 ng/microl) and group 4 (18.92+/-3.53 ng/microl) fell between the highest and the lowest values. CONCLUSION: This suggests that eGPx levels in GCF increase proportionally with the severity of periodontal diseases. eGPx can be considered as a marker of oxidative stress in periodontal diseases. However, controlled, longitudinal studies with larger samples have to be carried out to confirm this possibility.