Correlation Of C - Reactive Protein With The Severity Of Periodontitis
A.S Pavithra1, Arvina Rajasekar2*
1 Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai- 77, India.
2 Senior Lecturer, Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences [SIMATS],
Saveetha University, Chennai- 77, India.
*Corresponding Author
Dr. Arvina Rajasekar,
Senior Lecturer, Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences [SIMATS], Saveetha University, Chennai-
77, India.
Tel: +91 9486442309
E-mail: arvinar.sdc@saveetha.com
Received: September 13, 2021; Accepted: September 22, 2021; Published: September 23, 2021
Citation:A.S Pavithra, Arvina Rajasekar. Correlation Of C - Reactive Protein With The Severity Of Periodontitis. Int J Dentistry Oral Sci. 2021;8(9):4593-4596. doi: dx.doi.org/10.19070/2377-8075-21000935
Copyright: Dr. Arvina Rajasekar©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Introduction: Although periodontitis is a chronic inflammatory disease, some factors of the acute inflammation phase are
involved in this disease among which is the C-Reactive protein (CRP). CRP is one of the diagnostic markers used for the
prediction and early detection of periodontal disease.
Aim: The main aim was to correlate CRP level with severity of periodontitis.
Materials and Methods: The present non-randomized clinical trial was carried out from June 2020 to December 2020 in
the Department of Periodontics, Saveetha Dental College and Hospitals, Chennai, India. A total of 21 patients with mild,
moderate and severe periodontitis were enrolled and were divided into three groups: Group 1 - Mild periodontitis, Group 2 -
Moderate periodontitis and Group 3 - Severe periodontitis with 7 patients in each group. Unstimulated salivary samples were
collected and subjected to latex agglutination assay.
Result: The mean level of C-Reactive protein level in mild periodontitis patients was 2.25±0.50 mg/dl, 0.56±0.78 mg/dl in
moderate periodontitis patients and 4.07±0.67 mg/dl in severe periodontitis patients. We observed a positive correlation that
the CRP level increases as the severity of periodontitis increases.
Conclusion: The present study suggests that levels of CRP increases with severity of periodontitis. Therefore, CRP can be
used as a diagnostic marker for periodontitis.
2.Introduction
3.Materials and Methods
3.Results
4.Discussion
5.Conclusion
5.References
Keywords
C-Reactive Protein; Periodontitis; Biomarker; Innovative; Chronic periodontitis; Gingivitis.
Introduction
Periodontitis is a chronic disease in the oral cavity. It is classified
into three types as mild, moderate and severe. Periodontitis is an
inflammatory condition that affects the teeth's supporting tissues
and is caused by a community of microorganism [1-7]. It causes
the degradation of both soft and hard tissues, resulting in increased
pocket width, clinical attachment loss, recession, mobility,
bone loss, pathologic migration of the teeth, and tooth loss if left
untreated. The apical migration of junctional epithelium, as well
as alveolar bone destruction, are the hallmarks of periodontitis. It
is known to be caused by numerous complex colonies of bacteria
that develop on the tooth surface, causing bone and periodontal
tissue damage. It's an inflammatory reaction that causes tissue to
deteriorate [8-11].
One of the most prevalent disorders of the oral cavity is periodontitis.
Scaling and root planing is one of the most common approaches
for treating periodontitis. Many adjuncts, such as topical
agents, medicinal agents like tetracycline, minocycline, and other
antibiotics, are used to aid in the quicker healing of periodontitis.
[3, 12-17].
The liver produces C-reactive protein (CRP). When the body is
inflamed, the amount of this substance increases. LDL cholesterol
not only coats but also destroys the walls of the arteries [18].
This damage triggers inflammation, which the body attempts to
resolve by dispatching a "response team" of proteins known as
"acute phase reactants," of which CRP is one. Inflammatory factors, such as C-reactive protein, is an acute-phase reactant released
in response to a variety of inflammatory stimuli such as heat, trauma,
infection, and hypoxia. CRP levels are useful in the diagnosis,
control, and treatment of the inflammatory process [19]. Because
of its long plasma half-life, CRP plays an important role in the
innate immune response and is easily assessed (12 to 18 hours).
CRP levels are present in trace quantities in healthy people, with
levels ranging from 0.3 mg/l to 0.3 mg/l. 6–8 CRP levels in the
blood can reach 100 mg/l in the presence of a systemic infection,
making it a useful marker for monitoring the infection's progression
[20]. In humans, CRP is the prototypical acute phase reactant.
In diseases including rheumatoid arthritis and vasculitis, CRP
is used as a control of the inflammatory response [21].
Our team has extensive knowledge and research experience that
has translate into high quality publications [22-41].
Literature evidence reveals only minimal studies have assessed the
correlation of C-Reactive protein in periodontitis patients [42-46].
Therefore, the aim of this article was to assess the correlation of
C-Reactive protein level with the severity of periodontitis among
the patients reported to Saveetha Dental College and Hospitals,
Chennai.
Materials and Methods
Population Selection:
The present non-randomized clinical trial was carried out from
June 2020 to December 2020 in the Department of Periodontics,
Saveetha Dental College and Hospitals, Chennai, India. A total of
21 patients with mild, moderate and severe periodontitis were enrolled.
The ethical clearance was obtained from the Institutional
Ethical Committee and a written informed consent was obtained
from all the study participants. Patients who were systemically
healthy, with presence of atleast 4-20 teeth having clinical attachment
loss were included in the study. Smokers, pregnant or lactating
mothers, patients under long term medications, systemically
compromised patients were excluded from the study.
Study Design:
Patients were assigned to three groups: Group 1 - Mild periodontitis,
Group 2 - Moderate periodontitis and Group 3 - Severe periodontitis
with 7 patients in each group. Severity of periodontitis
was classified based on the amount of clinical attachment loss
(CAL) and was designated as mild (1-2mm CAL), moderate (3-
4mm CAL) and severe (>5mm CAL).
Sample Collection:
Unstimulated salivary samples were collected from each patient
before the procedure in a sterile container and stored under -22
degree celsius.
Latex Agglutination Method:
1ml of saliva sample was diluted with 2ml water in a ratio of 1:2.
In the glass slide 1 drop of CRP latex reagent was added and the
sample was then added. If there was visible agglutination, it was
considered a positive reaction and indicates presence of detectable
level of CRP in test specimens. If there was no visible agglutination,
it was considered a negative reaction and indicates
absence of detectable level of CRP in test specimens.
Statistical Analysis:
The data was analyzed using Statistical Package for Social Sciences
(SPSS Software, Version 23.0). Descriptive and inferential statistics
were done for data summarization and presentation.
Results
In the present study, the mean level of C-Reactive protein level
in mild periodontitis patients was 2.25±0.50 mg/dl, 0.56±0.78
mg/dl in moderate periodontitis patients and 4.07±0.67 mg/dl
in severe periodontitis patients. We observed a positive correlation
that the CRP level increases as the severity of periodontitis
increases. (Table 1 and Figure 1).
Table 1: CRP level in mild moderate and severe periodontitis patient.
Figure 1. Correlation of CRP level with severity of periodontitis.
Discussion
The present study assessed the correlation of C-Reactive protein
level in mild, moderate and severe periodontitis patients.
In the present study, CRP level was high among severe periodontitis
patients followed by moderate and mild periodontitis patients.
Matilla K et al., [42]conducted a study to assess the effect of periodontal
treatment on C-Reactive protein level. It was observed
that the CRP level was high in periodontitis patients and there
was a decrease in CRP level after periodontal therapy. Podzimek
S et al.,[47] compared the systemic levels of CRP in the peripheral
blood samples of patients with chronic and aggressive periodontitis,
gingivitis and observed that CRP levels increased subsequently
with the severity of periodontitis.
In a study by Gomes-Filho IS et al.,[45] it was reported that chronic
periodontitis is associated with elevated plasma CRP levels,
even after controlling for several potential confounders. Similar
results were seen in studies by Noach B et al.,[46]Patil V et al.,
[48] Yamazaki et al.,[49] where CRP levels were high in periodontal
diseased patients initially and were reduced after periodontal
therapy. The result of the present study is in accordance with the
previous studies.
Salzberg T N et al.,[43] conducted a study to determine the relative
level of serum CRP in periodontally healthy subjects and aggressive periodontitis patients and found out that periodontally
healthy subjects had the CRP level within the range of 0.4-0.8
mg/l. Whereas the CRP level was found to be within the range of
1.5-2.8 mg/l in aggressive periodontitis patients. Similarly Gupta
S et al.,[50] evaluated the role of CRP as a diagnostic marker in
chronic periodontitis patients. The authors found out that the
periodontally healthy subjects and periodontally compromised
patients possessed a mean CRP level of 0.252 ± 0.0393 mg/l and
0.106 ± 0.029mg/l respectively.
Dholey M K et al.,[51] estimated the salivary and serum CRP level
in healthy individuals and chronic periodontitis patients. The
mean baseline serum CRP concentrations in healthy individuals
and chronic periodontitis patients were - 4.490 ± 10.223 mg/l,
18.245 ± 25.680 mg/l respectively, The mean baseline salivary
CRP concentrations in healthy individuals and chronic periodontitis
patients were - 4.955 ± 6.803mg/l, 0.4735 ± 8.255mg/l respectively,
The result of the present study is in agreement with the
previous studies as the CRP levels were found to be higher in all
the periodontitis patients.
Even though severe periodontitis patients had higher C-Reactive
protein level than mild and moderate periodontitis, these results
cannot be generalised since this study was conducted among a
small population. Also, more randomized controlled clinical trials
need to be conducted to assess and compare the salivary and serum
CRP levels between periodontally healthy and compromised
patients before and after periodontal therapy to confirm this finding.
Conclusion
Within the limitations, the present study suggests that levels of
CRP increases with severity of periodontitis. Therefore, CRP can
be used as a diagnostic marker for periodontitis.
Acknowledgement
The authors would like to thank the study participants for their
participation and kind cooperation throughout the study.
Source of Funding
The present project was sponsored by
• Saveetha Institute of Medical and Technical Sciences,
• Saveetha Dental College and Hospitals,
• Saveetha University,
• Lakshmi Enterprises,Chennai.
References
-
[1]. S TA, Thanish AS, Rajasekar A, Mathew MG. Assessment of tooth loss in
chronic periodontitis patients with and without diabetes mellitus: A crosssectional
study. Int. j. res. pharm. sci. 2020;11: 1927–31
. [2]. Rajeshwaran N, Rajasekar A, Kaarthikeyan G. Prevalence of Pathologic Migration in Patients with Periodontitis: A Retrospective Analysis. J. Complement. Med. Res. 2020;11(4):172-8.
[3]. Rajeshwaran N, Rajasekar A. Prevalence of Angular Bone Defects in Chronic Periodontitis Patients with and without Systemic Diseases. Indian J. Forensic Med. Toxicol. 2020 Oct 1;14(4).
[4]. B G, Geethika B, Rajasekar A, Chaudary M. Comparison of periodontal status among pregnant and non-pregnant women. Int. j. res. pharm. sci. 2020;11: 1923–6.
[5]. Rajasekar A, Lecturer S, Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, et al. Assessment Of Periodontal Status among Post Menopausal Women: A Retrospective Study. Int. J. Dent. Oral Sci. 2020: 1063–6.
[6]. Sabarathinam J, Rajasekar A, Madhulaxmi M. Prevalence of Furcation Involvement Among Patients with Periodontitis: A Cross Sectional Study. Int. j. res. pharm. sci. 2020;11: 1483–7.
[7]. Kandhan TS, Rajasekar A. Prevalence of Periodontal Diseases Among Patients with And Without Systemic Diseases–A Retrospective Study. J. Complement. Med. Res. 2020;11(4):155-62.
[8]. SHAH P, RAJASEKAR A, CHAUDHARY M. Assessment of Gender Based Difference in Occurrence of Periodontal Diseases: A Retrospective Study. J. contemp. issues bus. gov. 2021 Feb 16;27(2):521-6.
[9]. SHUKRI N, MOHAMED M, SEKAR AR, SUBRAMANIAM AB. Assessment of periodontal health among patients with diabetes mellitus: a retrospective study. J. contemp. issues bus. gov. 2020 Dec 11;26(2):28-34.
[10]. RAJASEKAR A, CHAUDARY M. Prevalence of Periodontal Diseases Among Individuals Above 45 Years: A Retrospective Study. J. contemp. issues bus. gov. 2021 Feb 19;27(2):527-33.
[11]. C C, Cinthura C, Nasim I, Rajasekar A. Association Between Type of Tooth and Number of Walls Present in Teeth Undergoing FRC Post - An Institution Based Retrospective Study. Int. j. res. pharm. sci. 2020;11:123–8.
[12]. Dabholkar CS, Shah M, Kathariya R, Bajaj M, Doshi Y. Comparative Evaluation of Antimicrobial Activity of Pomegranate-Containing Mouthwash Against Oral-Biofilm Forming Organisms: An Invitro Microbial Study. J Clin Diagn Res. 2016 Mar;10(3):ZC65-9.Pubmed PMID: 27135005.
[13]. Garmasheva I, Kovalenko N, Voychuk S, Ostapchuk A, Livins'ka O, Oleschenko L. Lactobacillus species mediated synthesis of silver nanoparticles and their antibacterial activity against opportunistic pathogens in vitro. Bioimpacts. 2016;6(4):219-223.Pubmed PMID: 28265538.
[14]. Mohapatra S, Leelavathi L, Meignana AI, Pradeep KR, Rajeshkumar S. Assessment of Antimicrobial Efficacy of Zinc Oxide Nanoparticles Synthesized Using Clove and Cinnamon Formulation against Oral Pathogens--An In Vitro Study. J. Evol. Med. Dent. Sci. 2020 Jul 20;9(29):2034-40.
[15]. Evaluation of antiplaque and antigingivitis effects of A herbal mouthwash. Int J Pharm Res. 2021 Jan 1;13(01). Available from: http://www.ijpronline. com/ViewArticleDetail.aspx?ID=19227
[16]. Chouksey A, Dilliwal H, Agrawal R, Khashu H. Efficacy of Aloe vera Gel delivered locally as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Periodontitis: A Pilot Study. Int. j. oral care res. 2017;5: 370–5. [17]. .Rajasekar A, Mathew MG. Prevalence of Periodontal Disease among Individuals between 18-30 Years of Age: A Retrospective Study. Ann Med Health Sci Res. 2021 Jun 30.
[18]. Pavithra RS, Varghese S. Gingival tissue level of interleukin-1 in diabetic patient with chronic periodontitis. Res. J. Pharm. Technol. 2017;10(12):4442- 4.
[19]. Herryawan H. Effect of topical application red betel (piper crocatum) leaf gel on clinical attachment level repair patient with chronic periodontitis. J. dentomaxillofacial sci.2017:160.
[20]. Ansar W, Ghosh S. C-reactive protein: A clinical marker in cardiovascular disease. InBiology of C reactive protein in health and disease. 2016: 143- 165.
[21]. Pink I, Raupach D, Fuge J, Vonberg RP, Hoeper MM, Welte T, et al. C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19. Infection. 2021 May 22:1-9.
[22]. Ramesh A, Varghese S, Jayakumar ND, Malaiappan S. Comparative estimation of sulfiredoxin levels between chronic periodontitis and healthy patients - A case-control study. J Periodontol. 2018 Oct;89(10):1241-1248.Pubmed PMID: 30044495.
[23]. Paramasivam A, Priyadharsini JV, Raghunandhakumar S, Elumalai P. A novel COVID-19 and its effects on cardiovascular disease. Hypertens Res. 2020 Jul;43(7):729-30.
[24]. S G, T G, K V, Faleh A A, Sukumaran A, P N S. Development of 3D scaffolds using nanochitosan/silk-fibroin/hyaluronic acid biomaterials for tissue engineering applications. Int J Biol Macromol. 2018 Dec;120(Pt A):876- 885.Pubmed PMID: 30171951.
[25]. Del Fabbro M, Karanxha L, Panda S, Bucchi C, Doraiswamy JN, Sankari M, et al. Autologous platelet concentrates for treating periodontal infrabony defects. Cochrane Database Syst Rev. 2018;11:CD011423.
[26]. Paramasivam A, Vijayashree Priyadharsini J. MitomiRs: new emerging microRNAs in mitochondrial dysfunction and cardiovascular disease. Hypertens Res. 2020 Aug;43(8):851-853.Pubmed PMID: 32152483.
[27]. Jayaseelan VP, Arumugam P. Dissecting the theranostic potential of exosomes in autoimmune disorders. Cell Mol Immunol. 2019 Dec;16(12):935-936. Pubmed PMID: 31619771.
[28]. Vellappally S, Al Kheraif AA, Divakar DD, Basavarajappa S, Anil S, Fouad H. Tooth implant prosthesis using ultra low power and low cost crystalline carbon bio-tooth sensor with hybridized data acquisition algorithm. Comput Commun. 2019 Dec 15;148:176-84.
[29]. Vellappally S, Al Kheraif AA, Anil S, Assery MK, Kumar KA, Divakar DD. Analyzing Relationship between Patient and Doctor in Public Dental Health using Particle Memetic Multivariable Logistic Regression Analysis Approach (MLRA2). J Med Syst. 2018 Aug 29;42(10):183.Pubmed PMID: 30155746.
[30]. Varghese SS, Ramesh A, Veeraiyan DN. Blended Module-Based Teaching in Biostatistics and Research Methodology: A Retrospective Study with Postgraduate Dental Students. J Dent Educ. 2019 Apr;83(4):445-450.Pubmed PMID: 30745352.
[31]. Venkatesan J, Singh SK, Anil S, Kim SK, Shim MS. Preparation, Characterization and Biological Applications of Biosynthesized Silver Nanoparticles with Chitosan-Fucoidan Coating. Molecules. 2018 Jun 12;23(6):1429.Pubmed PMID: 29895803.
[32]. Alsubait SA, Al Ajlan R, Mitwalli H, Aburaisi N, Mahmood A, Muthurangan M, et al. Cytotoxicity of different concentrations of three root canal sealers on human mesenchymal stem cells. Biomolecules 2018; 8 (3): E68. [33]. Venkatesan J, Rekha PD, Anil S, Bhatnagar I, Sudha PN, Dechsakulwatana C, et al. Hydroxyapatite from cuttlefish bone: isolation, characterizations, and applications. Biotechnol Bioprocess Eng. 2018 Aug;23(4):383-93.
[34]. Vellappally S, Al Kheraif AA, Anil S, Wahba AA. IoT medical tooth mounted sensor for monitoring teeth and food level using bacterial optimization along with adaptive deep learning neural network. Measurement. 2019 Mar 1;135:672-7.
[35]. PradeepKumar AR, Shemesh H, Nivedhitha MS, Hashir MMJ, Arockiam S, Uma Maheswari TN, et al. Diagnosis of Vertical Root Fractures by Conebeam Computed Tomography in Root-filled Teeth with Confirmation by Direct Visualization: A Systematic Review and Meta-Analysis. J Endod. 2021 Aug;47(8):1198-1214.Pubmed PMID: 33984375.
[36]. R H, Ramani P, Tilakaratne WM, Sukumaran G, Ramasubramanian A, Krishnan RP. Critical appraisal of different triggering pathways for the pathobiology of pemphigus vulgaris-A review. Oral Dis. 2021 Jun 21. doi: 10.1111/odi.13937.Pubmed PMID: 34152662.
[37]. Ezhilarasan D, Lakshmi T, Subha M, Deepak Nallasamy V, Raghunandhakumar S. The ambiguous role of sirtuins in head and neck squamous cell carcinoma. Oral Dis. 2021 Feb 11.Pubmed PMID: 33570800.
[38]. Sarode SC, Gondivkar S, Sarode GS, Gadbail A, Yuwanati M. Hybrid oral potentially malignant disorder: A neglected fact in oral submucous fibrosis. Oral Oncol. 2021 Oct;121:105390.Pubmed PMID: 34147361.
[39]. Kavarthapu A, Gurumoorthy K. Linking chronic periodontitis and oral cancer: A review. Oral Oncol.. 2021 Jun 16:105375.
[40]. Vellappally S, Al-Kheraif AA, Anil S, Basavarajappa S, Hassanein AS. Maintaining patient oral health by using a xeno-genetic spiking neural network. J. Ambient Intell. Humaniz. Comput. 2018 Dec 14:1-9.
[41]. Aldhuwayhi S, Mallineni SK, Sakhamuri S, Thakare AA, Mallineni S, Sajja R, et al. Covid-19 Knowledge and Perceptions Among Dental Specialists: A Cross-Sectional Online Questionnaire Survey. Risk Manag Healthc Policy. 2021 Jul 7;14:2851-2861.Pubmed PMID: 34262372.
[42]. Mattila K, Vesanen M, Valtonen V, Nieminen M, Palosuo T, Rasi V, et al. Effect of treating periodontitis on C-reactive protein levels: a pilot study. BMC Infect Dis. 2002 Dec 10;2:30.Pubmed PMID: 12475397.
[43]. Salzberg TN, Overstreet BT, Rogers JD, Califano JV, Best AM, Schenkein HA. C-reactive protein levels in patients with aggressive periodontitis. J. Periodontol. 2006 Jun;77(6):933-9.
[44]. Pejcic A, Kesic LJ, Milasin J. C-reactive protein as a systemic marker of inflammation in periodontitis. Eur J Clin Microbiol Infect Dis. 2011 Mar;30(3):407-14.Pubmed PMID: 21057970.
[45]. Gomes-Filho IS, Freitas Coelho JM, da Cruz SS, Passos JS, Teixeira de Freitas CO, Aragăo Farias NS, et al. Chronic periodontitis and C-reactive protein levels. J. Periodontol. 2011 Jul;82(7):969-78.
[46]. Noack B, Genco RJ, Trevisan M, Grossi S, Zambon JJ, De Nardin E. Periodontal infections contribute to elevated systemic C-reactive protein level. J. Periodontol. 2001 Sep;72(9):1221-7.
[47]. Podzimek S, Mysak J, Janatova T, Duskova J. C-Reactive Protein in Peripheral Blood of Patients with Chronic and Aggressive Periodontitis, Gingivitis, and Gingival Recessions. Mediators Inflamm. 2015;2015:564858.Pubmed PMID: 26346216.
[48]. Saon M, Patil DH, Ding T, Kim FY, Torlak M, Ogan K, et al. Level of preoperative CRP as an independent predictor of survival in patients after nephrectomy for renal cell carcinoma: Long-term outcomes. J. Clin. Oncol. 2018;36:687.
[49]. Sato K, Yamazaki K, Kato T, Nakanishi Y, Tsuzuno T, Yokoji-Takeuchi M, et al. Obesity-Related Gut Microbiota Aggravates Alveolar Bone Destruction in Experimental Periodontitis through Elevation of Uric Acid. mBio. 2021 Jun 29;12(3):e0077121.Pubmed PMID: 34061595.
[50]. Gupta S, Suri P, Patil PB, Rajguru JP, Gupta P, Patel N. Comparative evaluation of role of hs C -reactive protein as a diagnostic marker in chronic periodontitis patients. J Family Med Prim Care. 2020 Mar 26;9(3):1340-1347. Pubmed PMID: 32509613.
[51]. Srivastava P, Agarwal BK, Chandel MS. A COMPARATIVE STUDY OF SERUM AND SALIVARY BIOCHEMICAL MARKERS IN DIABETES MELLITUS TYPE II WITH HEALTHY INDIVIDUALS. Int J Med Biomed Sci. 2020;4.
