Microbial infections and elevated PGE2 as risk indicators of adult periodontitis.

Abstract

Although numerous factors have been proposed as risk indicators for periodontitis, little research has been undertaken on a broader combination of risk indicators. This study explores a combination of adult periodontitis risk indicators such as socio-economic factors, history of smoking, clinical signs, number of microorganisms, and gingival crevicular fluid prostaglandin E2 (PGE2). The study population included generally healthy individuals whose age ranged from 20 to 50, who received treatment at the Faculty of Dentistry at Chiangmai University. Out of 126 participants, 43 were active periodontitis cases, 38 were non-active periodontitis cases, and 45 were non-periodontitis comparisons. Periodontitis cases were recruited and followed-up every two months until they could be placed in either active or non-active groups. Active cases were identified by a change of clinical attachment loss of 2 mm or more at any site compared to the baseline. Subsequently, the non-periodontitis comparisons were selected to match with active cases regarding age and gender. Clinical measurements including attachment level, periodontal pocket depth, bleeding upon probing, and subgingival calculus were performed on six sites by one examiner. Subgingival plaque and gingival crevicular fluid samples were obtained as pooled samples from mesio-buccal sites of every tooth except the third molar. The presence of three microorganisms (P. gingivalis, A. actinomycetemcomitans, and C. rectus) was determined by digoxigenin-labeled oligonucleotide probes (Boehringer Mannheim) and PGE2 was detected using the Correlate-CLIA kits (Assay Design Inc.). A direct relationship was found between PGE2 and periodontitis after adjusting for age, gender, worst pocket depth, and smoking history. The counts of microorganisms showed an inconclusive relationship with periodontitis. However, a direct relationship between A. actinomycetemcomitans and active peridontitis was shown after adjusting for smoking history and PGE2. Models of risk indicators for periodontitis were constructed using a combination of indicators. These models suggest P. gingivalis and PGE2 serve to distinguish between non-periodontitis and periodontitis, while the levels of A. actinomycetemcomitans serve to distinguish between active and non-active periodontitis after adjusting for other variables. These findings offer a noninvasive means of studying the relationship between microorganisms, smoking habits and PGE2; it may provide a practical diagnostic approach in epidemiological fields.