Periodontal Diseases: Diagnosis

Origin and function of the cellular components in gingival crevice fluid

Periodontal disease is a bacteria-induced chronic inflammatory disease affecting the soft and hard supporting structures encompassing the teeth. When left untreated, the ultimate outcome is alveolar bone loss and exfoliation of the involved teeth. Traditional periodontal diagnostic methods include assessment of clinical parameters and radiographs. Though efficient, these conventional techniques are inherently limited in that only a historical perspective, not current appraisal, of disease status can be determined. Advances in the use of oral fluids as possible biological samples for objective measures of current disease state, treatment monitoring, and prognostic indicators have boosted saliva and other oral-based fluids to the forefront of technology. Oral fluids contain locally and systemically derived mediators of periodontal disease, including microbial, host-response, and bone-specific resorptive markers. Although most biomarkers in oral fluids represent inflammatory mediators, several specific collagen degradation and bone turnover-related molecules have emerged as possible measures of periodontal disease activity. Pyridinoline cross-linked carboxyterminal telopeptide (ICTP), for example, has been highly correlated with clinical features of the disease and decreases in response to intervention therapies, and has been shown to possess predictive properties for possible future disease activity. One foreseeable benefit of an oral fluid-based periodontal diagnostic would be identification of highly susceptible individuals prior to overt disease. Timely detection and diagnosis of disease may significantly affect the clinical management of periodontal patients by offering earlier, less invasive, and more cost-effective treatment therapies.

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Oral Fluid–Based Biomarkers of Alveolar Bone Loss in Periodontitis

It is the purpose of this review to survey the influence of corticosteroids, androgens, oestrogens and progesterone on gingival tissues and to show the relationship of such influences to periodontal disease. The clinical changes seen in plaque-induced gingivitis are accentuated by circulating levels of the above hormones via mechanisms such as partial immune suppression, increased fluid exudation, stimulation of bone resorption and stimulation of fibroblast synthetic activity. High counts of Bacteroides intermedius have been observed in users of oral contraceptives and also in the second trimester of pregnancy, in the absence of overt gingival inflammation. This is due to competition for binding between progesterone and naphthaquinone, which have a structural similarity; and the latter is an essential nutrient for the microbe. Hence high counts of Bacteroides intermedius may be a more sensitive indicator of an altered systemic hormonal condition than the usual clinical parameters. The main hormonal effect accentuates false pocketing, rather than initiating a change in attachment levels, except in cases of progressive periodontal disease associated with plaque induced inflammation and bone loss.

Hormonal influences on gingival tissue: relationship to periodontal disease.

Gingival crevicular fluid is regarded as a promising medium for the detection of markers of periodontal diseases activity. The collection protocols are straight forward and non-invasive and can be performed at specific sites of interest in the periodontium. Because the fluid accumulates at the gingival margin, it will contain potential markers derived not only from the host tissues and serum but also the subgingival microbial plaque, and thus an extremely broad range of candidate molecules may be investigated. However, the ability to successfully describe indicators of current disease activity and predictors of future disease is dependent not only upon the choice of the biochemical marker but also on the accurate description of the health status of the sample sites using currently available clinical and radiographic methods. Areas of study which currently show the most promise involve the analysis of host enzyme activities directed against components of the extracellular matrix, the nature of the glycosaminoglycans released into the sulcus and the concentration in gingival crevicular fluid of certain mediators of the inflammatory process, most notably prostaglandin E2.

I. Ishikawa

Papers

Alkaline phosphatase in human gingival fluid and its relation to periodontitis.

Possible role of lysosomal enzymes in the pathogenesis of periodontitis: a study on cathepsin D in human gingival fluid.

Increase of extracellular cathepsin D activity in gingival washings during experimental gingivitis in man.

Partial purification of a neutral protease from human polymorphonuclear leukocytes and its proteolytic effect on immunoglobulin G