{"id":3745,"date":"2015-12-28T11:14:36","date_gmt":"2015-12-28T11:14:36","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=3745"},"modified":"2020-04-25T03:41:56","modified_gmt":"2020-04-25T03:41:56","slug":"prevalence-of-reactive-oxygen-metabolites-levels-in-chronic-periodontitis-with-diabetic-mellitus-and-chronic-periodontitis-patients-in-gcf-plasma-and-saliva-a-biochemical-study","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol8no2\/prevalence-of-reactive-oxygen-metabolites-levels-in-chronic-periodontitis-with-diabetic-mellitus-and-chronic-periodontitis-patients-in-gcf-plasma-and-saliva-a-biochemical-study\/","title":{"rendered":"Prevalence of Reactive Oxygen Metabolites Levels in Chronic Periodontitis with Diabetic Mellitus and Chronic Periodontitis Patients in GCF, Plasma and Saliva \u2013A Biochemical Study"},"content":{"rendered":"<p><strong>Introduction <\/strong><\/p>\n<p>Periodontitis is a term used to describe an inflammatory process, initiated by the plaque biofilm, that lead to loss of periodontal attachment to the root surface and adjacent alveolar bone, and which ultimately results in tooth loss<strong><sup>1<\/sup><\/strong>.The gram negative anaerobes are the primary etiologic agents<strong><sup>2<\/sup><\/strong> but majority of breakdown occurs as a result of inappropriate host response .PMNS are the primary mediators of host response against pathogens and they generate increased levels of Reactive Oxygen Species(ROS)<strong><sup>3<\/sup><\/strong>.<\/p>\n<p>ROS is a term collectively describing the hydroxyl(OH<sup>-)<\/sup>, hydroperoxyl (HOO<sup>-)<\/sup>, nitric oxide( NO<sup>-)<\/sup>, alkoxyl (Ro<sup>&#8211;<\/sup>), singlet oxygen(<sup>1<\/sup>O<sub>2<\/sub>), hypochlorous acid (HOCl) and hydrogen peroxide (H<sub>2<\/sub>O<sub>2<\/sub>)<strong><sup>4<\/sup>. <\/strong>The changes in the host response as a consequence of various diseases can affect the severity and prognosis of periodontitis .One such disease is Diabetes Mellitus\u00a0 (DM),which encompasses a group of metabolic disorders characterized by hyperglycemia secondary to defects in insulin secretion, action (or) both. It has been reported that periodontitis is one of the first clinical manifestation of diabetes<strong><sup>5<\/sup> <\/strong>and is recognised as a common complication in diabetic patients particularly in poorly controlled diabetes <strong><sup>6<\/sup><\/strong>. Diabetes Mellitus may contribute to the destructive aspects of the host response that leads to periodontal disease and other inflammatory conditions through the generation of reactive oxygen species (ROS)<strong><sup>(7-10)<\/sup><\/strong>.Overproduction of ROS is also thought to\u00a0\u00a0 contribute to the severity of the disease,including vascular disease<sup>(11-12)<\/sup>.ROS are unstable , with a short half life , and thus are difficult to detect. Several markers of lipid peroxidation have been studied to monitor the \u00a0ROS production. Hydroperoxides are one of the most studied marker of ROS.<\/p>\n<p>In the present study ROM level is compared among subjects with Chronic periodontitis(CP) and Chronic periodontitis with Diabetes mellitus(CP-DM).<\/p>\n<p><strong>Materials and Methods<\/strong><\/p>\n<p>The study population consisted of 40 subjects belonging to both sexes and all subjects were randomly selected from the outpatient clinic of the Department of Periodontics, Thaimoogambigai Dental college and Hospital, Chennai. Subjects were divided into two groups of 20 subjects each as with Group I- Chronic Periodontitis (CP)and Group II- Chronic Periodontitis with Diabetes\u00a0 Mellitus (CP-DM). The participants were informed about the study and their consent was obtained .The study protocol was approved by the ethical committee of Dr. M.G.R University,Chennai , India, in accordance with the Helsinki Declaration of 1975,as revised in 2000.<\/p>\n<p><strong>Selection criteria<\/strong><\/p>\n<p><strong>Inclusion criteria \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0<\/strong><\/p>\n<p><strong> Chronic Periodontitis<\/strong><\/p>\n<ul>\n<li>Visible plaque<\/li>\n<li>Bleeding on probing<\/li>\n<li>At least four teeth with one or more sites exhibiting probing depth \u2265 4mm.<\/li>\n<li>Clinical attachment level\u00a0 \u22654mm.<\/li>\n<\/ul>\n<p><strong> Diabetic Mellitus with Chronic Periodontitis<\/strong><\/p>\n<ul>\n<li>Known diabetic<\/li>\n<li>Fasting blood glucose level should be \u2265120 mg\/dl<\/li>\n<li>Bleeding on probing<\/li>\n<li>At least four teeth with one or more sites exhibiting probing depth \u2265 4mm.<\/li>\n<li>Clinical attachment level\u00a0 \u22654mm.<\/li>\n<\/ul>\n<p><strong>Exclusion criteria<\/strong><\/p>\n<ol>\n<li>\u2264 15 teeth<\/li>\n<li>Current or previous smokers<\/li>\n<li>Pregnant or lactating women<\/li>\n<li>Presence of any systemic condition apart from Diabetes Mellitus\u00a0 for the DM-CP group.<\/li>\n<li>Subjects under antioxidants (vitamin C, vitamin E and coenzyme Q),antibiotics, or anti-inflammatory drugs in the past 3 months.<\/li>\n<\/ol>\n<p><strong>Collection of GCF<\/strong><\/p>\n<p>Detailed case history, clinical examination and supragingival scaling were done one day before the collection of GCF. On the subsequent day after drying the area with a blast of air, supragingival plaque was removed without touching the marginal gingiva and the GCF was collected. A standardized volume of 1\u00b5l was collected from each site with an extracrevicular approach, using volumetric capillary pipettes that were caliberated from 1-5\u00b5l. The collected GCF was\u00a0\u00a0 transferred immediately to ependorff tubes and stored at -70<sup>\u25e6<\/sup>c until the time of assay.<\/p>\n<p><strong>Collection of Plasma<\/strong><\/p>\n<p>Blood (3 ml) was drawn from the antecubital vein, under aseptic precautions and collected in a colour coded herparinised test tube (green colour) and centrifuged immediately at 3000 xg for 5 minutes.\u00a0 If not immediately assayed plasma aliquots were stored at -80<strong><sup>\u00ba<\/sup><\/strong>c until analysis.<\/p>\n<p><strong>Collection of Saliva: Draining \/ Spitting method<\/strong><\/p>\n<p>The subject is asked to accumulate saliva in the floor of mouth and then spit into a preweighed or graduated test tube.<\/p>\n<p><strong>Laboratory method for detection of ROM<\/strong><\/p>\n<p>The d-ROMs test, developed by world-renowned Italian biochemist is a photometric test for measurement of the concentration of hydroperoxides (ROOH) in biological samples. The presence of ROOH in cells indicates oxidative attack of ROS on various organic substrates such as carbohydrates, lipids, amino acids, proteins, or nucleotides.<\/p>\n<p><strong>Test principle<\/strong><\/p>\n<p>The d-ROMs test uses the principle of Fenton\u2019s reaction: by mixing a biological sample with an acidic buffer (Reagent R1), the newly-created transition metal ion (iron or copper) catalyzes the breakdown of hydroperoxide, generating new radical species such as hydroxyperoxyl (ROO+) and alkoxyl (RO+). By adding a chromogen (N, N-diethyl-paraphenylendiamine, Reagent R2) having the ability to donate an electron and change color when oxidized by free radicals, and using photometric reading available with the FRAS 4 dedicated analytical equipment, it becomes possible to quantify the level of hydroperoxides available in the sample.<\/p>\n<p><strong>Statistical Analysis <\/strong><\/p>\n<p>One way Anova is used to test the significance of the values in Chronic periodontitis(CP) and Chronic periodontitis with Diabetes Mellitus patients(CP-DM) .<\/p>\n<p><strong>Results<\/strong><\/p>\n<p>The mean value of ROM in GCF is 531.590, in plasma it is 565.628 and in saliva is 580.471 in Chronic periodontitis patients. The p value is 0.004.<\/p>\n<p>In CP-DM\u00a0 patients , the mean value of ROM in GCF is 594.275, in plasma it is 630.165 and in saliva it is 635.555 . The p value is 0.007. This is depicted in Table 1.<\/p>\n<p>On comparing\u00a0 the ROM values between groups there was a significant value in GCF(p value is 0.001).The ROM values between Chronic periodontitis(CP) and Chronic periodontitis with Diabetes Mellitus ( CP -DM) in plasma p value is &lt;0.001 which is highly significant . On comparing\u00a0 the ROM values between CP and CP\u00a0\u00a0 -DM in saliva ,the p value is &lt;0.001 which is highly significant.This is depicted in Table 2.<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3751\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_T1-150x150.jpg\" alt=\"Table 1: Comparison of parameters in chronic periodontitis and chronic periodontitis with diabetes .\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_T1-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_T1-256x256.jpg 256w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_T1.jpg 827w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Table 1: Comparison of parameters in chronic periodontitis and chronic periodontitis with diabetes .<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_T1.jpg\" target=\"_blank\">Click here to View\u00a0table<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3752\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_T2-150x150.jpg\" alt=\"Table 2: Comparison of ROM values between groups in GCF, Plasma and Saliva.\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_T2-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_T2-256x256.jpg 256w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_T2.jpg 763w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Table 2: Comparison of ROM values between groups in GCF, Plasma and Saliva.<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_T2.jpg\" target=\"_blank\">Click here to View\u00a0table<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3753\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_fig1-150x150.jpg\" alt=\"Fig. 1. Comparison between groups\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_fig1-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_fig1-256x256.jpg 256w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_fig1.jpg 815w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 1:\u00a0<\/strong><strong>Comparison between groups<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol8_No2_Prev_Shan_fig1.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>Discussion <\/strong><\/p>\n<p>In this study the results demonstrated a significantly lower ROM levels in Chronic periodontitis (CP)when compared with Chronic periodontitis with diabetes mellitus (CP-DM). This was in accordance to the study by Brock et al which showed a reduction in systemic and local antioxidant (AO) defense in periodontitis<sup>13<\/sup>.<\/p>\n<p>This is one of the first study which evaluates the ROM levels in GCF , plasma and saliva in CP-DM and CP patients . In the present study there was a significant difference in GCF ROM level between CP-DM\u00a0\u00a0 and CP (p value 0.001). This may be attributable to the excessive oxygen radical production from antioxidation of glucose <sup>14<\/sup>, glycated proteins and glycation of oxidative enzymes which limit their capacity to detoxify oxygen radicals<sup>15<\/sup>.<\/p>\n<p>In the present study there was a highly significant difference between the ROM levels in plasma\u00a0 in CP-DM\u00a0 and CP patients . This was similar to the study done by Alliny et al 2012<sup>16<\/sup>.The disturbed status in antioxidant mechanism may be explained on the basis of increased ROS production by phagocyte cells in periodontitis. The strongest \u00a0evidence to implicate ROS in the pathological destruction of the connective tissue during periodontal disease arises in considering PMNS infiltration as a key event of the host response against microbial invasion. These\u00a0 infiltration in numbers is likely to lead to an increase in the ROS levels leading to oxidative stress<sup>17<\/sup>.<\/p>\n<p>There was a highly significant difference between the salivary ROM levels in CP-DM and CP patients (p&lt;0.001).Changes in the glucose level have been demonstrated to influence the Cu, Zn-SOD activity .Hyperglycemia induce superoxide\u00a0 formation\u00a0 and overproduction of superoxide also appears to be the central mechanism underlying all the major molecular mechanisms implicated in glucose \u2013mediated vascular damage . This could be the reason for a variety of hyperglycemia-induced phenotypes in the target cells of diabetic complications<sup>18<\/sup> .Decreased SOD( superoxide dismutase)\u00a0 activity and increased number of leukocytes could be attributable to an increase in ROS level, resulting\u00a0 in tissue breakdown. When compared to CP patients, CP-DM patients had increased ROM level. A decrease in the activities of antioxidant enzyme systems in Diabetes Mellitus is linked to the progressive glycation of enzymatic proteins. Approximately 50% of SOD in erythrocytes of patients with Diabetes Mellitus is glycated ,resulting in low activity<sup>19<\/sup>.<\/p>\n<p>In our study ROM levels was compared in GCF, plasma and saliva .There were significant results obtained .Sampling of GCF is time consuming\u00a0 and might only reflect on gingival inflammation at the specific site sampled .Where as there is abundance of saliva and sampling is much \u00a0easier, less costly, and could be better tolerated by the patient and analysis may provide an overall assessment of disease status as opposed to site specific GCF analysis<sup>20<\/sup>.In our study comparable results were obtained in saliva and plasma.<\/p>\n<p>This study has its own limitation ,in that its non-longitudinal design made it difficult to evaluate the effect of periodontal treatment and Diabetes Mellitus control on ROM levels.<\/p>\n<p><strong>Conclusion <\/strong><\/p>\n<p>This study gives convincing support in favour of the etiological role of free radical injury in Chronic periodontitis with Diabetes Mellitus. The compensatory mechanism of antioxidants is collapsed because of excessive production of free radicals during periodontitis and is not able to cope with the increased production of free radicals attributable to Diabetes Mellitus and thereby could worsen the situation.<\/p>\n<p><strong>Bibliography<\/strong><\/p>\n<ol>\n<li>Genco R, Kornman K, Williams R, et al. Consensus report. Periodontal diseases: Pathogenesis and microbial factors. Ann Periodontol 1996;1:926-932.<\/li>\n<li>Haffajee AD, Socransky SS. Microbial etiological agentsof destructive periodontal diseases. Periodontol 2000,1994;5:78-111.<\/li>\n<li>Moseley R, Waddington RJ, Embery G. Degradation of glycosaminoglycans by reactive oxygen species derived from stimulated polymorphonuclear leukocytes.Biochim Biophys Acta 1997;1362:221-231.<\/li>\n<li>Battino M, Bullon P, Wilson M, Newman H. Oxidative injury and inflammatory periodontal diseases: The challenge of anti-oxidants to free radicals and reactive oxygen species. Crit Rev Oral Biol Med 1999;10:458-476.<\/li>\n<li>Lamster IB, Lalla E, Borgnakke WS, Taylor GW. 2008.\u00a0The relationship between oral health and diabetes mellitus.\u00a0J Am Dent Assoc\u00a0139(Suppl):19S\u201324S.<\/li>\n<li>Loe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 1993;16:329-334.<\/li>\n<li>Chapple IL.\u00a0Reactive oxygen species and antioxidants in inflammatory diseases.\u00a0J Clin Periodontol 1997;24:287\u2013296\u00a0.<\/li>\n<li>Panjamurthy K, Manoharan S, Ramachandran CR..Lipid peroxidation and antioxidant status in patients with periodontitis.\u00a0Cell Mol Biol Lett\u00a0.200510; 255\u2013264\u00a0.<\/li>\n<li>Akalin FA, Baltacio\u00f0lu E, Alver A, Karabulut E.Lipid peroxidation levels and total oxidant status in serum, saliva and gingival crevicular fluid in patients with chronic periodontitis.J Clin Periodontol 2007;34:558\u2013565.<\/li>\n<li>Tsai CC, Chen HS, Chen SL, Ho YP, Ho KY, Wu YM, et al. Lipid peroxidation. A possible role in the induction and progression of chronic periodontitis.J Periodontal Res.2005;40:378\u2013384.<\/li>\n<li>Halliwell B.Oral inflammation and reactive species: a missed opportunity?Oral Dis\u00a0 2000.;6:136\u2013137.<\/li>\n<li>Vel\u00e1zquez E, Winocour PH, Kesteven P, Alberti KG, Laker MF. Relation of lipid peroxides to macrovascular disease in type 2 diabetes.Diabet Med1991.;8:752\u2013758.<\/li>\n<li>Brock GR, Butterworth CJ, Matthews JB, Chapple IL. Local and systemic total antioxidant capacity in periodontitis and health.J Clin Periodontol.\u00a02004;31:515\u2013521.<\/li>\n<li>Wolff SP. Diabetes mellitus and free radicals. Free radicals, transition metals and oxidative stress in the aetiology of diabetes mellitus and complications. Br Med Bull 1993;49:642-652.<\/li>\n<li>Giugliano D, Ceriello A, Paolisso G. Diabetes mellitus, hypertension, and cardiovascular disease: Which role for oxidative stress? Metabolism 1995;44:363-368.<\/li>\n<li>Alliny S. Bastos,\u00a0Dana T. Graves,\u00a0Ana Paula de Melo Loureiro,\u00a0Carlos Rossa J\u00fanior. Lipid Peroxidation Is Associated with the Severity of Periodontal Disease and Local Inflammatory Markers in Patients with Type 2 Diabetes. J Clin Endocrinol Metab. 2012 Aug; 97(8): E1353\u2013E1362.<\/li>\n<li>Miyasaki KT, Wilson ME, Brunetti AJ, Genco RJ. Oxidative and non-oxidative killing of Actinobacillusactinomycetemcomitans by human neutrophils.\u00a0Infect Immun.\u00a01986;53:154\u2013160.<\/li>\n<li>Sechi LA, Ceriello A, Griffin CA, Catena C, Amstad P, Schambelan M, et al. Renal antioxidant enzyme mRNA levels are increased in rats with experimental diabetes mellitus.\u00a0Diabetologia.\u00a01997;40:23\u201329.<\/li>\n<li>Arai K, Maguchi S, Fujii S, Ishibashi H, Oikawa K, Taniguchi N. Glycation and inactivation of human Cu-Zn-superoxide dismutase. Identification of the in vitro glycated sites. J Biol Chem 1987;262:16969-16972.<\/li>\n<li>Miller CS, King CP Jr., Langub MC, Kryscio RJ, Thomas MV. Salivary biomarkers of existing periodontal disease:A cross-sectional study. J Am Dent Assoc 2006;137:322-329.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Introduction Periodontitis is a term used to describe an inflammatory  [&#8230;]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-3745","post","type-post","status-publish","format-standard","hentry","category-vol8no2"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/3745","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=3745"}],"version-history":[{"count":4,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/3745\/revisions"}],"predecessor-version":[{"id":32861,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/3745\/revisions\/32861"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=3745"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=3745"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=3745"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}