The alterations of whole saliva constituents in patients with diabetes mellitus.

The present study was undertaken in order to determine the possible alterations in whole saliva and the periodontal status in patients with diabetes mellitus (DM), and was conducted on 17 patients with DM and 17 systemically and periodontally healthy subjects. When the subjects were evaluated clinically, significantly increased probing depths were noticed in the DM group when compared with the healthy subjects. In whole saliva samples, sodium, potassium, total protein, amylase, thiocyanate, and secretory IgA levels were determined in both groups. Difference between the two groups regarding the mean salivary potassium levels were found to be statistically significant since the mean salivary potassium levels in the DM and the control groups were 2.470 +/- 9.04 mmol/L and 14.30 +/- 8.88 mmol/L, respectively. The mean salivary total protein, amylase and secretory IgA levels in the DM group were 2.41 +/- 1.0 mg/mL, 124.2 +/- 79.7 U/mL and 6.86 +/- 3.50 mg/L, all being significantly higher than the control group. However, no significant differences could be shown for the salivary sodium and thiocyanate levels. Nor was there any difference between non-insulin dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM). The findings of the present study suggest that, besides the clinical examinations, the determination of the possible alterations in the composition of whole saliva might also be helpful in understanding the increased severity of periodontal disease in diabetic patients.

The gingival crevicular fluid interleukin-1 beta and tumour necrosis factor-alpha levels in patients with rapidly progressive periodontitis.

Cytokines are believed to play an important role in the pathogenesis of periodontal diseases. In the present study, gingival crevicular fluid (GCF) levels of two important cytokines, interleukin 1-beta (IL-1 beta) and tumour necrosis factor-alpha (TNF-alpha) and, in addition, serum IL-1 beta levels, were determined in patients with severe and rapid periodontal breakdown by use of ELISA. While IL-1 beta was detected in all of the GCF samples studied, TNF-alpha could only be detected in about half the samples. The mean GCF IL-1 beta level was 38.45 +/- 13.99 pg/mL, and the mean TNF-alpha level was 3.20 +/- 1.39 pg/mL, respectively. The GCF IL-1 beta levels also presented a strong positive correlation with the mean pocket depths. Although weak, both of the cytokines also presented correlations with the presence of bleeding on probing. Additionally GCF samples contained increased IL-1 beta levels when compared with the serum samples suggesting local production mechanisms. The findings of the present study suggest that these cytokines may be involved in the pathogenesis of periodontal diseases (IL-1 beta being more significant), and also may help in defining the active phase of periodontal breakdown.

Oral findings, treatment and follow-up of a case with major aphthous stomatitis (Sutton's disease).

Major aphthous stomatitis (Sutton's disease) is a clinical variant of recurrent aphthous stomatitis, which is noted for its high morbidity. Since the etiology of the disease is not clear, many therapies have been attempted. However, the controversial results hinder the adoption of a single mode of management. We present a 13-year-old boy with Sutton's disease, who was successfully treated with a combination of burst systemic prednisone (1 mg/kg/day for five days, thereafter half dose on alternate days for one week) and topical triamcinolone (four rinses a day). He continued the mouth rinses with the same interval. At the end of the first month, significant healing was observed and gradual tapering was recommended on the condition that the ulcers were well-controlled. The maintenance of steroid rinse once a day provided a symptom-free period of one year. Neither any withdrawal signs nor side affects were observed. Therefore, we think that this regimen should be considered as the treatment of choice in Sutton's disease along with a close follow-up even in childhood.

beta 2-Microglobulin levels in serum and saliva of patients with juvenile periodontitis.

beta 2-Microglobulin (beta 2-m) is a low-molecular-weight protein which has been suggested to play an important role in immune functions. The aim of this study was to determine beta 2-m levels in serum and saliva from patients with juvenile periodontitis (JP) and to compare them with those of periodontally healthy subjects. The study was performed on 11 patients with JP and 10 periodontally healthy controls (C). Clinical measurements were recorded and serum and saliva samples were obtained from the individuals. beta 2-m levels were determined using the ELISA technique. Serum beta 2-m levels were significantly higher in the JP group than in the control group. In saliva, no significant difference in beta 2-m levels between the groups was found. The higher beta 2-m levels in serum in the JP group suggest that beta 2-m may play a role as a systemic factor in the etiology and pathogenesis of JP.

Myeloperoxidase activity in peripheral blood, neutrophil crevicular fluid and whole saliva of patients with periodontal disease.

Mean levels of myeloperoxidase (MPO) activity were determined in samples of gingival crevicular fluid (GCF), whole saliva and peripheral blood neutrophils from patients with rapidly progressive periodontitis (RPP) and adult periodontitis (AP) using a spectrophotometric method. The mean neutrophil MPO activity in the RPP group was 563.1 +/- 137.05 U/l x 10(6)/ml, that in the AP group was 483.3 +/- 88.81 U/l x 10(6)/ml, and that in the control group was 220.6 +/- 26.7 U/l x 10(6)/ml. The mean GCF MPO activity in the RPP group was 15.13 +/- 2.34 U/mg, which was significantly higher than in the other two groups. The mean whole saliva MPO activity in the RPP group was 0.14 +/- 0.04 U/ml, that in the AP group was 0.11 +/- 0.02 U/ml, and that in the control group was 0.05 +/- 0.06 U/ml. MPO activity detected in the samples was significantly increased in the patient groups when compared to the healthy subjects. The highest MPO activity was found in the RPP group. The present findings suggest a relationship between MPO activity and the pattern and severity of periodontal breakdown. Also the increased MPO activity in periodontally diseased patients can be attributed to the increased number of neutrophils, the degranulation of these cells and also their hyperactive state in the presence of chronic antigenic stimulation.

Periodical gingival bleeding as a presenting symptom of periodontitis due to underlying cyclic neutropenia. Case report.

A 13-year-old boy presenting with spontaneous and periodical gingival bleeding accompanied by fever was thoroughly examined in order to determine the underlying aetiology of the gingival bleeding. Following repeated blood tests, the patient was diagnosed as having cyclic neutropenia. Thus, it was suggested, gingival bleeding, especially when spontaneous and periodical, should be carefully investigated to eliminate the possibility of cyclic neutropenia.

Oral-dental findings in a case of Maffucci's syndrome.

A case of Maffucci's syndrome (MS) in a 17-year-old Caucasian female is presented with a thorough intraoral examination. The prominent finding was recurrent gingival hyperplasia affecting both the free and attached gingiva with deep periodontal pockets, tooth mobility, pathological tooth migration, and severe alveolar bone loss. Furthermore, the pattern of alveolar bone destruction, in many ways, resembled that of localized juvenile periodontitis. Although there is always the possibility that these oral features may not be related with the syndrome, we suggest a careful dental and periodontal examination in future cases, which we believe will help develop a better description of oral findings in MS.

Neutrophil chemotaxis and periodontal status in Down's syndrome patients.

Along with clinical parameters, chemotaxis and random migration of neutrophils were evaluated in 15 patients with Down's syndrome (DS) and 15 healthy subjects. Signs of more severe gingival inflammation were present in the DS group. The random migration and chemotaxis of neutrophils were significantly decreased in comparison with the control group. In DS, the pathological status was attributed to these impaired host defense factors besides the existing bacterial plaque.

Immunoglobulin A levels in serum and saliva of patients treated with phenytoin.

A study was conducted to compare IgA levels in serum and saliva obtained from phenytoin-treated epileptic patients (PHT-TEPs) and a control group and to examine the correlation between IgA levels and clinical parameters. Eighteen epileptic patients treated with phenytoin and 18 periodontally healthy individuals with no systemic disease were included in the study. Clinical parameters were recorded, and samples of serum and saliva were obtained from each individual. IgA levels were determined by the radial immunodiffusion technique. Serum IgA levels were significantly lower in PHT-TEPs. No difference was found in salivary IgA levels between the PHT-TEP and control groups. Weak negative correlations were found between serum IgA level and gingival overgrowth index (GOI), and between salivary IgA level and GOI. None of the clinical parameters was significantly correlated with IgA level in the PHT-TEP group.

Oral-dental findings in dyskeratosis congenita.

A 13-yr-old girl with dyskeratosis congenita is presented. Besides oral leukoplakia and nail dystrophies, there was evidence of pancytopenia, growth retardation, alopecia, mental retardation and microcephaly. The oral findings included caries, gingival recession, short-blunted roots, gingival bleeding, tooth mobility and severe alveolar bone loss resembling juvenile periodontitis.

Clinical and immunological characteristics of patients with rheumatoid arthritis and periodontal disease.

Various clinical and immunological parameters were determined in patients with RA and patients with adult periodontitis. There were no significant differences between the two groups with regard to the number of missing teeth, although pocket depths and gingival inflammation scores were significantly increased in the periodontitis group (p less than 0.05). Salivary IgM levels were below the minimum detectable level in both groups, and no significant differences were evident between the two groups with regard to salivary IgG and IgA levels. However, serum IgG, IgA and IgM levels in RA patients were significantly higher than in periodontitis patients (p less than 0.05), indicating enhanced humoral immunity. The present findings suggest that RA patients are not a risk group for advanced periodontal problems in comparison with age- and sex-matched systemically healthy controls.

Prepubertal periodontitis. A case report with an analysis of lymphocyte populations.

An 11-year-old boy with clinical and radiological features of prepubertal periodontitis is presented. He had a history of recurrent upper respiratory tract infections and otitis media. Neutrophil chemotaxis was significantly reduced compared to normal. Total T- and B-lymphocyte numbers were not altered. T-lymphocyte subsets studied with monoclonal antibodies revealed that both T-helper and T-suppressor cell populations were reduced with a normal TH/TS ratio of 1.8. No significant changes were observed in the serum IgG, IgA and IgM values. Serum C3c and C4 levels were found to be elevated. These findings may contribute to the pathogenesis of prepubertal periodontitis.