C – reactive protein in saliva of non-smoking patients with periodontitis (a pilot study)

Introduction: C-reactive Protein (CRP) as an inflammatory biomarker can be easily determined in saliva, but the values of salivary CRP in periodontitis are not well-studied. The aim of this study was to analyze and determine the values of salivary CRP in non-smokers with periodontitis stage 3 or 4 before and after supragingival and subgingival full-mouth periodontal therapy.Methods: Standard periodontal parameters and saliva samples were collected in 12 non-smoking patients. Patients in the test group (n = 6) underwent supragingival and subgingival full-mouth periodontal therapy, and the control group (n = 6) received only supragingival full-mouth therapy. Both groups received the same oral hygiene instructions in addition to therapy. After 3 months, re-registration of periodontal parameters and re-sampling of saliva for analysis of salivary CRP were done for both groups.Results: Statistical analysis revealed large differences in the values of clinical periodontal parameters and CRP levels in the test group after therapy. Values of salivary CRP in the test and control groups were lower 3 months the therapy; however, the results were not statistically significant. The correlation of clinical periodontal parameters and salivary CRP varied in both groups.Conclusion: Our pilot study reveals decreased concentrations of salivary C-reactive protein in non-smoking patients following non-surgical periodontal therapy. Further studies are needed to prove the reliability of salivary CRP as a biomarker for periodontitis

The severity of carotid artery lesions associated with aggressive and chronic periodntitis

Upalna parodontna bolest potvrđena je kao čimbenik rizika za razvoj ateroskleroze. Svrha ovog istraživanja bila je dokazati povezanost parodontnog statusa i elastičnih svojstava arterija kod pacijenata s parodontitisom. U istraživanju je sudjelovalo 128 ispitanika podijeljenih u četiri skupine. Prva pokusna skupina je uključivala 37 pacijenata s kroničnim parodontitisom, a druga pokusna skupina 30 pacijenata s agresivnim parodontitisom. U kontrolnoj skupini za kronični parodontitis bilo je 27 ispitanika, dok je u kontrolnoj skupini za agresivni parodontitis bilo 34 ispitanika. Kontrolne skupine su sačinjavale osobe bez znakova parodontne bolesti. Parodontni status je određen pomoću parodontnih indeksa. U serumu su određeni trigliceridi, HDL kolesterol, LDL kolesterol, ukupni serumski serum kolesterol, visoko osjetljivi C-reaktivni protein (hsCRP) i glukoza. Debljina intime-medije (IMT) i elastična svojstva zajedničke karotidne arterije bilateralno su mjerena pomoću ultrazvuka Aloka ProSound ALPHA 10 s linearnom sondom od 13 MHz. Istraživanjem su dobivene signifikantno veće vrijednosti karotidnih IMT vrijednosti (0,8 mm) kod pacijenata s kroničnim parodontitisom. Nakon uključivanja potencijalnih doprinosnih čimbenika, pokazalo se da je kronični parodontitis statistički značajan prediktor (p=0,004) za karotidne IMT vrijednosti u multivarijantnom modelu. Kod pacijenata s agresivnim parodontitisom uočene su statistički značajne razlike u elastičnim svojstvima arterija (p<0,05), ali bez razlika u IMT vrijednostima. Agresivni parodontitis je bio statistički značajan prediktor za krutost karotidnih arterija u multivarijantnom modelu. Obje skupine s parodontitisom su imale statistički veće hsCRP vrijednosti (2,2 i 1,4 mg/L). Rezultati našeg istraživanja su pokazali da upalna parodontna bolest može utjecati na hemodinamiku karotidnih arterija neovisno o promjenama IMT vrijednosti. Potrebna su daljnja istraživanja elastičnih svojstava arterija kod pacijenata s parodontitisom.Inflammatory periodontal disease is recognized as a risk factor for the development of atherosclerosis. The objective of this study was to demonstrate the relationship between periodontal condition and arterial elastic properties in periodontitis patients. The study was conducted on 128 subjects divided into four groups. The test groups consisted of 37 patients with chronic periodontitis and 30 patients with aggressive periodontitis. There were 27 subjects in the control group for chronic periodontitis, and 34 subjects in the control group for aggressive periodontitis. Both control groups consisted of periodontally healthy volunteers. Periodontal condition was assessed using periodontal indices. Triglycerides, HDL cholesterol, LDL cholesterol, total serum cholesterol, high sensitive C-reactive protein (hsCRP), and glucose levels were quantified in serum. Intima-media thickness (IMT) and arterial elasticity measurements on common carotid artery were performed using Aloka ProSound ALPHA 10 with 13 MHz linear probe. This research revealed significantly higher values of carotid IMT (0,8 mm) in chronic periodontitis patients. Chronic periodontitis was statistically significant predictor (p=0,004) for the carotid IMT in the multivariate model, when potential confounding factors were included. Aggressive periodontitis patients showed statistically significant difference in arterial elasticity indices (p<0,05), but no difference regarding IMT values. Aggressive periodontitis was statistically significant predictor for the carotid stiffness in the multivariate model. Both periodontitis groups had statistically higher levels of hsCRP (2,2 and 1,4 mg/L). Our results demonstrate that inflammatory periodontal disease may affect carotid arterial haemodynamics, regardless alterations of IMT. Future research of arterial elasticity in periodontitis patients is required

The severity of carotid artery lesions associated with aggressive and chronic periodntitis

Upalna parodontna bolest potvrđena je kao čimbenik rizika za razvoj ateroskleroze. Svrha ovog istraživanja bila je dokazati povezanost parodontnog statusa i elastičnih svojstava arterija kod pacijenata s parodontitisom. U istraživanju je sudjelovalo 128 ispitanika podijeljenih u četiri skupine. Prva pokusna skupina je uključivala 37 pacijenata s kroničnim parodontitisom, a druga pokusna skupina 30 pacijenata s agresivnim parodontitisom. U kontrolnoj skupini za kronični parodontitis bilo je 27 ispitanika, dok je u kontrolnoj skupini za agresivni parodontitis bilo 34 ispitanika. Kontrolne skupine su sačinjavale osobe bez znakova parodontne bolesti. Parodontni status je određen pomoću parodontnih indeksa. U serumu su određeni trigliceridi, HDL kolesterol, LDL kolesterol, ukupni serumski serum kolesterol, visoko osjetljivi C-reaktivni protein (hsCRP) i glukoza. Debljina intime-medije (IMT) i elastična svojstva zajedničke karotidne arterije bilateralno su mjerena pomoću ultrazvuka Aloka ProSound ALPHA 10 s linearnom sondom od 13 MHz. Istraživanjem su dobivene signifikantno veće vrijednosti karotidnih IMT vrijednosti (0,8 mm) kod pacijenata s kroničnim parodontitisom. Nakon uključivanja potencijalnih doprinosnih čimbenika, pokazalo se da je kronični parodontitis statistički značajan prediktor (p=0,004) za karotidne IMT vrijednosti u multivarijantnom modelu. Kod pacijenata s agresivnim parodontitisom uočene su statistički značajne razlike u elastičnim svojstvima arterija (p<0,05), ali bez razlika u IMT vrijednostima. Agresivni parodontitis je bio statistički značajan prediktor za krutost karotidnih arterija u multivarijantnom modelu. Obje skupine s parodontitisom su imale statistički veće hsCRP vrijednosti (2,2 i 1,4 mg/L). Rezultati našeg istraživanja su pokazali da upalna parodontna bolest može utjecati na hemodinamiku karotidnih arterija neovisno o promjenama IMT vrijednosti. Potrebna su daljnja istraživanja elastičnih svojstava arterija kod pacijenata s parodontitisom.Inflammatory periodontal disease is recognized as a risk factor for the development of atherosclerosis. The objective of this study was to demonstrate the relationship between periodontal condition and arterial elastic properties in periodontitis patients. The study was conducted on 128 subjects divided into four groups. The test groups consisted of 37 patients with chronic periodontitis and 30 patients with aggressive periodontitis. There were 27 subjects in the control group for chronic periodontitis, and 34 subjects in the control group for aggressive periodontitis. Both control groups consisted of periodontally healthy volunteers. Periodontal condition was assessed using periodontal indices. Triglycerides, HDL cholesterol, LDL cholesterol, total serum cholesterol, high sensitive C-reactive protein (hsCRP), and glucose levels were quantified in serum. Intima-media thickness (IMT) and arterial elasticity measurements on common carotid artery were performed using Aloka ProSound ALPHA 10 with 13 MHz linear probe. This research revealed significantly higher values of carotid IMT (0,8 mm) in chronic periodontitis patients. Chronic periodontitis was statistically significant predictor (p=0,004) for the carotid IMT in the multivariate model, when potential confounding factors were included. Aggressive periodontitis patients showed statistically significant difference in arterial elasticity indices (p<0,05), but no difference regarding IMT values. Aggressive periodontitis was statistically significant predictor for the carotid stiffness in the multivariate model. Both periodontitis groups had statistically higher levels of hsCRP (2,2 and 1,4 mg/L). Our results demonstrate that inflammatory periodontal disease may affect carotid arterial haemodynamics, regardless alterations of IMT. Future research of arterial elasticity in periodontitis patients is required

Parodontne bolesti kao čimbenik rizika

There is an increasing body of evidence in periodontology that speaks in favor of the association between human chronic inflammatory diseases and opportunistic infections. Considering their frequency and microbiological etiology, periodontal diseases, especially severe periodontitis, have become subjects of many studies. Periodontitis is a major infectious threat to the whole organism, since it can affect distant organs and tissues by releasing microbes, their products and mediators of inflammation into the bloodstream. This fact has reduced the boundaries between medicine and dentistry, but the change in thinking has developed an entirely new field of periodontology, also known as “periodontal medicine”. Over the past decade a growing body of scientific evidence shows a strong connection between periodontal disease and systemic conditions and diseases such as atherosclerosis, cardiovascular and cerebrovascular diseases, premature birth, diabetes and respiratory diseases. Most of the research has been focused on the relationship between periodontal disease and atherosclerosis since they have many common, potential pathophysiological mechanisms, including complex etiology, and share many risk factors, especially smoking history. There is data linking periodontitis with an increased risk for atherosclerosis and thromboembolic events. Periodontitis in pregnant women may increase the risk for preterm birth and low birth-weight. The role of diabetes as a risk factor for periodontal disease has been investigated earlier, but a number of studies suggest that there may be a two-way relationship, in accordance with the concept that infection may weaken metabolic control of diabetes. The results of numerous studies and the development of periodontal medicine have led to productive cooperation with colleagues in medicine, and discovered many new evidences that suggest that the oral cavity is an integral part of the human body, and that systemic health must include oral and periodontal health.Sve je više dokaza koje govore u prilog povezanosti kroničnih upalnih bolesti čovjeka s oportunističkim infekcijama u parodontologiji. Parodontne bolesti, posebice uznapredovali parodontitis, postale su predmet mnogobrojnih istraživanja s obzirom na učestalost i mikrobiološku etiologiju. Parodontitis predstavlja veliku infektivnu opasnost za cijeli organizam jer otpuštajući mikroorganizme, njihove produkte te medijatore upale u krvotok može djelovati na udaljene organe i tkiva. Navedena činjenica smanjila je granice između medicine i stomatologije te je promjenom razmišljanja došlo do razvoja potpuno novog područja u parodontologiji koje je nazvano „parodontna medicina“. Tijekom prošlog desetljeća sve veći broj znanstvenih činjenica upućuje na snažnu povezanost parodontnih bolesti i sistemnih stanja i bolesti kao što su: ateroskleroza, kardiovaskularne i cerebrovaskularne bolesti, prijevremeni porođaj, dijabetes i plućne bolesti. Najviše istraživanja bilo je usmjereno na povezanost između parodontitisa i ateroskleroze s obzirom da imaju mnogo zajedničkih, potencijalnih patofizioloških mehanizama, kompleksne su etiologije te dijele brojne rizične faktore, među kojima je najznačajniji status pušača. Pronađeni su dokazi koji povezuju parodontitis s povećanim rizikom za aterosklerozu i tromboemboličkim zbivanjima. Parodontitis trudnica može povećati rizik za prijevremeno rođenje i smanjenu porođajnu težinu djeteta. Uloga dijabetesa kao faktora rizika za parodontitis istražena je ranije, ali određen broj studija ukazuje da možda postoji i dvosmjerni odnos, u skladu s koncepcijom da infekcija može doprinijeti oslabljenoj metaboličkoj kontroli dijabetesa. Rezultati mnogobrojnih studija i razvoj parodontne medicine doveli su do plodonosne suradnje s kolegama u medicini i otkrili mnoga nova saznanja koja potvrđuju da je usna šupljina integralni dio ljudskog tijela te da sistemsko zdravlje mora uključivati oralno i parodontno zdravlje

Periodontal status in nursing home residents in Split-Dalmatia County

Background and Purpose: Poor oral health in elderly people is accompanied by a high proportion of missing teeth, dental cavities, periodontal disease, xerostomia, and the occurrence of oral pre-malignant lesions and cancers. Available evidence suggests that the prevalence of periodontal diseases increases proportionally with age. The purpose of this study was to assess the prevalence and severity of periodontal diseases among nursing home residents in Split-Dalmatia County and to propose a program of public health measures. Materials and Methods: Oral health status was assessed for 114 individuals aged 54–96 years. Prior to the examination, the participants filled out the questionnaire regarding age, gender, education, smoking, alcohol consumption, habits and oral hygiene maintenance. Periodontal condition was assessed using the Community Periodontal Index and clinical attachment level. Results: Statistical analysis of the CPI showed that, for all the sextants, the most numerous group of subjects was the one with excluded sextants. Following those, the most numerous were the sextants with visible deposits of dental calculus. Statistical analysis of the CAL through the sextants showed that the excluded group was the most frequent finding, followed by the group with CAL of 4–5 mm. Conclusions: Older persons often have poor oral health and frequently suffer from periodontal disease. We should encourage preventive examinations performed while the dentists need to put an effort to prevent the progression of periodontal disease and sustain the older people’s quality of life, especially in nursing home residents

Quorum Sensing of Periodontal Pathogens

Pojam quorum sensing označava međustaničnu komunikaciju bakterija kojom koordiniraju gensku ekspresiju populacije sukladno njezinoj gustoći. Bakterije proizvode i ispuštaju u međustanični prostor male molekule, tzv. autoinduktore, čija koncentracija raste s povećanjem populacije. Postizanje koncentracije stimulatornog praga rezultira promjenom u genskoj ekspresiji. Gram-pozitivne i gram-negativne bakterije imaju različite quorum sensing sustave. Najbolje istražen,kanonski sustav jest LuxI/R-tip/acil homoserin laktonom posredovan quorum sensing sustavom gram-negativnih bakterija koje ga koriste uglavnom za komunikaciju unutar svoje vrste. Gram-pozitivne bakterije posjeduju quorum sensing sustav posredovan peptidima. Bakterije mogu komunicirati unutar svoje vrste, ali i s bakterijama drugih vrsta, što im omogućuje autoinduktor- 2 quorum sensing sustav koji se zato i naziva univerzalnim bakterijskim jezikom. Parodontopatogene bakterije imaju AI-2 quorum sensing sustav. Poznato je da njime kontroliraju formaciju biofilmova, unos željeza, odgovor na stres i ekspresiju pojedinih faktora virulencije. Bolje razumijevanje mehanizama bakterijske komunikacije omogućit će utjecanje na quorum sensing inhibitorima u svrhu sprječavanja i kontrole bolesti.The term ‘quorum sensing’ describes intercellular bacterial communication which regulates bacterial gene expression according to population cell density. Bacteria produce and secrete small molecules, named autoinducers, into the intercellular space. The concentration of these molecules increases as a function of population cell density. Once the concentration of the stimulatory threshold is reached, alteration in gene expression occurs. Gram-positive and Gram-negative bacteria possess different types of quorum sensing systems. Canonical LuxI/R-type/acyl homoserine lactone mediated quorum sensing system is the best studied quorum sensing circuit and is described in Gram-negative bacteria which employ it for inter-species communication mostly. Grampositive bacteria possess a peptide-mediated quorum sensing system. Bacteria can communicate within their own species (intra-species) but also between species (inter-species), for which they employ an autoinducer-2 quorum sensing system which is called the universal language of the bacteria. Periodontal pathogenic bacteria possess AI-2 quorum sensing systems. It is known that they use it for regulation of biofilm formation, iron uptake, stress response and virulence factor expression. A better understanding of bacterial communication mechanisms will allow the targeting of quorum sensing with quorum sensing inhibitors to prevent and control disease