Periodontal inflamed surface area (PISA) is associated with salivary cytokine compounds Summary Background Periodontal disease (PerioD) is a chronic and complex inflammatory condition that results from the interaction between subgingival dysbiotic bacteria and the host immune response leading to local inflammation. Since periodontal inflammation is characterized by multiple cytokine effects, we investigated whether periodontal inflamed surface area (PISA), a continuous measure of clinical periodontal inflammation, is a predictor of composite indices of salivary cytokines. Methods and findings In a cross-sectional study of 67 healthy, well-educated individuals, we assessed PISA and several cytokines expressed in whole stimulated saliva. Two salivary cytokine indices were constructed using weighted and unweighted approaches based on Principal Component Analysis [referred to as Cytokine Component Index (CCI)] or by averaging the (standardized) level of all cytokines [referred to as Composite Inflammatory Index (CII). ]. In regression analysis, we found that PISA scores were significantly associated with both salivary cytokine constructs (CCI: part R = 0.51, p<0.001; CII: part R = 0.40, p = 0.001) independently of age, sex and BMI, showing that scores summarizing salivary cytokines correlated with the severity of clinical periodontal inflammation. Conclusions Clinical periodontal inflammation may be reflected by a single score encompassing several salivary cytokines. These results are consistent with the complexity of interactions that characterize periodontal disease. Additionally, type I error is likely to be avoided. |
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Researchers at NYU School of Dentistry have developed a unique score to describe the level of cytokines in saliva, and this score is related to the severity of clinical gum inflammation, according to a study published in the journal PLOS ONE .
While more research is needed to test "cytokine scoring ," it could hold promise for measuring how well a patient responds to gum disease treatment, predicting gum disease recurrence, or detecting ongoing inflammation. related to systemic diseases.
"Periodontal inflammation is not only evident on examination, but is reflected in the patient’s saliva," said Angela Kamer, DMD, MS, PhD, associate professor in the Ashman Department of Periodontology and Implantology at NYU Dentistry and lead author of the study. .
Periodontal (or gum) disease is a chronic inflammatory condition that affects approximately half of adults.
Marked by swollen gums, which can bleed and pull away from the tooth, periodontal disease results from the complex interaction between an imbalance of healthy and unhealthy bacteria below the gum line and the immune system’s response. This response produces high levels of cytokines (small proteins that send signals to the immune system) in the inflamed gums, especially pro-inflammatory cytokines such as IL-8, IL-1β, IL-6, and TNFα.
Periodontal disease is also associated with systemic conditions including cardiovascular disease, diabetes, and Alzheimer’s. Scientists believe that gum inflammation contributes to these conditions through both indirect (cytokines that stimulate systemic inflammation) and direct (cytokines that travel to a specific organ such as the heart or brain) pathways, but studying this is difficult. due to the challenge of measuring cytokines in the fluid found deep in the gum pockets.
Fortunately, cytokines are also found in saliva, which is easier to collect. In the study, researchers wanted to know if clinically detected gum inflammation could predict the level of cytokines found in saliva.
"Salivary cytokines are a window into the molecular composition of the oral environment," said Vera Tang, DDS, MS, clinical assistant professor in the Ashman Department of Periodontics and Dental Implantology at NYU Dentistry and first author of the study.
Researchers evaluated the gums and saliva of 67 adults, over the age of 45, who had some degree of periodontal disease but were otherwise healthy. To measure your clinical periodontal inflammation, researchers used a formula called Periodontal Inflamed Surface Area (PISA), which is calculated using measurements of gum pocket depth and bleeding on probing. PISA provides a unique measure of periodontal inflammation; a higher PISA score indicates worse inflammation.
Participants were also asked to spit into sterile tubes to capture saliva samples, which were then analyzed to measure a variety of pro- and anti-inflammatory cytokines: IL-1β, IL-6, IL-8, IL-13, TNF-α and IL-10. Led by statistician Malvin Janal, PhD, the researchers used two different ways (the cytokine component index and the composite inflammatory index) to combine these cytokines into a single score.
They found that PISA scores were significantly associated with new cytokine scores, independent of other factors, such as age, sex, smoking, and body mass index (BMI). The higher the cytokine score, the greater the periodontal inflammation.
"This demonstrates that a single score encompassing several salivary cytokines correlates with the severity of periodontal inflammation," said Leena Palomo, DDS, MSD, professor and chair of the Ashman Department of Periodontics and Dental Implantology at NYU Dentistry, and co-author of the study. .
The researchers caution that more research is needed to validate the cytokine score in patients with different health conditions, as well as those with all levels of periodontal disease, including healthy gums and early-stage gum disease. However, if the cytokine score is validated in larger and more diverse patient populations, it could be used to better understand the progression and recurrence of periodontal disease, as well as the possible connection to other systemic conditions.
“With gum disease treatment, such as scaling and planing, we know that PISA scores go down. “It would be interesting to see if the cytokine score also drops or, if it persists, to investigate what that means,” Kamer added. “Are you detecting an underlying cause, such as ongoing inflammation from a systemic disease? Or if someone has a hyperinflammatory response , which we would know from a high cytokine score, can you predict whether periodontitis will recur or progress in the future? We hope to explore these questions in future research.”
Other authors of the study include Babak Hamidi, DDS, MPH, Cheryl Barber, MS, MPH, and Benjamin Godder, DMD, of NYU Dentistry. This research was funded by the National Institutes of Health (R03-DE023139).
