Yang et alJ Periodontol.2015

PRESENTED BYBIBINA GEORGE

INTRODUCTION

• Periodontitis is one of the most prevalent oral diseases and a major cause of tooth

loss in adults.

• Among many pathogenic factors, plaque is well known to be an initial contributor

to periodontitis.

• Socransky SS et al. detected the subgingival microbiota using checkerboard

DNA-DNA hybridization and observed 5 complexes.

• Red complex:

- Porphyromonas gingivalis (Pg),

- Tannerella forsythia (Tf) and

-Treponema denticola (Td)

BIOMARKERS OF INFLAMMATION 8-OHdG

• Most stable product of ROS

• Marker of mitochondrial DNA

damage caused by premature

oxidation in the gingival tissues of

periodontitis patients

{Canakci CF et al}

IL-17• Proinflammatory cytokine produced by T-

helper 17 cells

• Stimulate various cell types to produce other inflammatory cytokines and chemokines

• Preserves immune homeostasis

• Supports immune responses (Th1) and combines with receptor activator of RANK and RANKL, resulting in osteoclastic bone resorption

AIM

• To investigate the influences of clinical and microbial parameters on

variation of 8-OHdG and IL-17 levels in saliva.

MATERIALS AND METHODS:• SOURCE OF DATA:

Patients who attended the Department of Periodontics, School of

Stomatology, China Medical University .

• Ethical clearance:

Reviewed and approved by Ethics Committee of China Medical University.

• Duration of study: Feb. 2013 – June 2014

SELECTION CRITERIA:INCLUSION CRITERIA• ≥ 20 teeth• PD ≥ 4mm• CAL ≥ 2mm• Radiograph showing > 30 %

bone destruction

EXCLUSION CRITERIA• Habits• Systemic illness• Pregnancy

EXPERIMENTAL DESIGN:Periodontal Examination

• Simplified Oral Hygiene Index (OHS) (Greene and Vermillion)

• Sulcular Bleeding Index (SBI)

• Probing pocket depth (PPD)• Clinical attachment loss

measurements

Clinical Examination

• Measured four sites per tooth:

• Mesio‑buccal• Buccal• Disto‑buccal• lingual

SAMPLE COLLECTION

•DNA Extraction and Real time PCR

96 participants:48 CP + 48 Healthy

SAMPLE COLLECTION

SUBGINGIVAL PLAQUESAMPLE

SALIVA COLLECTION

Sterile Eppendorf tubes

RightQuadrant

LeftQuadrant

MesiolingualMesiobuccal

500 µl phosphate buffered saline

solution

5 ml sterile plastic centrifuge tube

LABStored at -80°C

DNA Extraction Real time - PCR

Saliva Sample ELISA

P. gingivalis

T. forsythia

T. denticola

8- OHdG

IL-17

STATISTICAL ANALYSIS• Software: SPSS 13.0

• Tests:

Students t test

ANOVA

Pearson’s correlation analysis

P value ≤ 0.05

RESULTS:

Comparison of Demographic and Clinical Parameters Between CP and Control Groups at Baseline

Comparison of Salivary 8-OHdG and IL-17 Levels With Clinical and Microbial Parameters at Baseline

Comparison of Clinical and Microbial Parameters Before and After Nonsurgical Treatment

DISCUSSION• Salivary 8-OHdG level in CP group

was higher than that in control group.

• 8-OHdG levels were significantly decreased after treatment at both 1 and 3 months

• Variations in the clinical parameters impacted the variation in the salivary 8-OHdG level, while variations in the microbial parameters affected the variation in the salivary IL-17 level

8OHdGClinical ParametersCP

IL-17Microbial Paramete

rs CP

REVIEW OF LITERATURE:

• Settem RP et al. A bacterial glycan core linked to surface (S)-layer

proteins modulates host immunity through Th17 suppression.

Mucosal Immunol.2013 Mar;6(2):415-26. demonstrated that the surface

glycosylation of T.forsythia acted to ensure its persistence in the host, likely

through the suppression of Th17 responses. In addition, suggested that the

bacterium then induces the Toll-like receptor 2-Th2 inflammatory axis to cause

bone destruction.

• Dede FO et al. 8-hydroxy-deoxyguanosine levels in gingival crevicular fluid

and saliva in patients with chronic periodontitis after initial periodontal

treatment. J Clin Periodontol. 2013 Jun;84(6):821-8. evaluated the effects of

initial periodontal treatment on the gingival crevicular fluid (GCF) and salivary

levels of 8-hydroxy-deoxyguanosine (8-OHdG) as a marker of oxidative

deoxyribonucleic acid (DNA) damage in patients with chronic periodontitis

(CP) and revealed that DNA injury and oxidative stress increased in tissue cells and

especially in periodontal pockets in patients with CP, and the periodontal treatment

resulted in a significant decrease of 8-OHdG levels in the GCF samples.

• Shaker OG et al. IL-17 and IL-11 GCF Levels in Aggressive and Chronic

Periodontitis Patients: Relation to PCR Bacterial Detection.Himdawi.

2012(2012)/174764. evaluated IL-17 and IL-11 in gingival crevicular fluid (GCF) of

generalized chronic periodontitis (GCP) and generalized aggressive periodontitis (GAgP)

patients in relation to periodontopathic bacteria and found that IL-17 level was more in

GCF of GAgP, suggesting a potential role in the aetiopathogenesis, and the decreased ratio

of IL-11/IL-17 might reflect an imbalance between the proinflammatory and anti-

inflammatory cytokines in different periodontal diseases. The high positivity of P.

gingivalis in the dental plaque was associated with significantly increased GCF levels of

IL-17 in GCP and GAgP patients. 

• Ozcaka O et al. Interleukin-17 and interleukin-18 levels in saliva and

plasma of patients with chronic periodontitis. J Periodontol Res.

2011:Oct;46(5):592-8.investigated whether patients with chronic periodontitis

exhibited different salivary and/or plasma concentrations of interleukin (IL)-17 and

IL-18 compared with clinically healthy subjects and found IL-17 level significantly

lower than IL-18 in chronic periodontitis patient but higher than healthy patients .

• Pabon MCM et al.Detection of Treponema denticola in saliva obtained

from patients with various periodontal conditions. Clin Investigations.

March 2008;12(1):73–81. determined the prevalence of T. denticola in saliva

samples from patients with chronic periodontitis, aggressive periodontitis, and healthy

subjects by assessing the  probing depth, clinical attachment loss, and extent of

periodontal breakdown. They concluded that the prevalence of T. denticola in CP

patients was significantly higher than those in healthy and AgP subjects. Furthermore,

all clinical measurements were significantly greater (P < 0.05) for T. denticola-positive

subjects compared to T. denticola-negative subjects.

CONCLUSION• The salivary 8-OHdG and IL-17 levels in CP patients were significantly reduced

after non-surgical treatment.

• Variation in the salivary 8-OHdG level arose due to variations in the PD, CAL and OHI-S.

• However, variation in the salivary IL-17 level was attributed to variations in the PD, subgingival quantity of T. forsythia, and salivary quantities of P. gingivalis, T. forsythia and T.denticola.

• These findings may be of great significance in facilitating the rapid evaluation of clinical periodontal status.

CRITICAL APPRAISAL:

• Title of the article is self explanatory as it defines the necessity of

the study.

• The study does not precisely establish the possible relation between

the periodontal pathogens and 8-OHdG and IL-17.

• Study focuses more on 8-OHdG and IL-17 rather than the

implications of effects of the periodontopathogens.