|Year : 2021 | Volume
| Issue : 1 | Page : 1-4
Estimation of plasma levels of fibrinogen in patients with periodontitis: An intervention study
Sapna Pritesh Ganna1, Rajani Kalla2, Deep Shailesh Shah3, Charchil Narendrakumar Patel4, Mahesh Giradharlal Chavda5, Priteshkumar Sureshchand Ganna6
1 Department of Periodontics, Ahmedabad Dental College and Hospital, Bhadaj, Gujarat, India
2 Department of Prosthodontics, RUHS College of Dental Sciences, Jaipur, Rajasthan, India
3 Department of Oral Medicine and Radiology, Siddhpur Dental College and Hospital, Siddhpur, Dist Patan, Gujarat, India
4 Department of Oral and Maxillofacial Surgery, Siddhpur Dental College and Hospital, Siddhpur, Dist Patan, Gujarat, India
5 Department of Periodontics, Government Dental College and Hospital, Ahmedabad, India
6 Department of Orthodontics and Dentofacial Orthopedics, Siddhpur Dental College and Hospital, Siddhpur, Dist Patan, Gujarat, India
|Date of Submission||30-Oct-2020|
|Date of Acceptance||22-Nov-2020|
|Date of Web Publication||18-Feb-2021|
Dr. Sapna Pritesh Ganna
Department of Periodontics, Ahmedabad Dental College and Hospital, A-1/809, Anand Laxmi Apartment Near Railway Crossing, Behind Shanidev Temple, Shahibaug, Ahmedabad, Gujarat 380004, Tamil Nadu.
Source of Support: None, Conflict of Interest: None
Aims: This study was conducted to investigate the effect of nonsurgical periodontal therapy on plasma levels of fibrinogen in patients with chronic periodontitis and its association. Materials and Methods: Twenty otherwise healthy subjects with chronic periodontitis were recruited for this intervention study. Both clinical parameters and blood were collected at baseline and one month, three months after nonsurgical periodontal therapy (scaling, root planning, and oral hygiene instructions). Periodontal examination included PD, CAL, PI, GI, and blood; these were analyzed to determine plasma fibrinogen. The effect of treatment was assessed by paired t-test; correlation between blood and clinical parameters was assessed by Pearson’s correlation. Results: There was a significant reduction in PD, CAL, PI, and GI at one month and three months after periodontal therapy (P < 0.001); plasma fibrinogen levels significantly decreased at one month and three months after treatment (P < 0.001). Also, a significant correlation was seen between clinical parameters and fibrinogen levels at different intervals of time. Conclusion: In patients with chronic periodontitis, nonsurgical periodontal therapy significantly reduced fibrinogen levels after one month and three months and it may, thus, decrease their risk of coronary heart disease.
Keywords: Cardiovascular disease, chronic periodontitis, fibrinogen
|How to cite this article:|
Ganna SP, Kalla R, Shah DS, Patel CN, Chavda MG, Ganna PS. Estimation of plasma levels of fibrinogen in patients with periodontitis: An intervention study. Int J Oral Care Res 2021;9:1-4
|How to cite this URL:|
Ganna SP, Kalla R, Shah DS, Patel CN, Chavda MG, Ganna PS. Estimation of plasma levels of fibrinogen in patients with periodontitis: An intervention study. Int J Oral Care Res [serial online] 2021 [cited 2021 Jun 17];9:1-4. Available from: https://www.ijocr.org/text.asp?2021/9/1/1/309663
| Introduction|| |
Periodontitis is a chronic, tissue destructive inflammatory state that is predominantly induced by bacterial colonization of the gingival crevice, resulting in tissue destruction around the teeth that is caused by infection and subsequent induction of inflammatory mediators. Oral microbial burden, inflammatory burden, and hemostatic factors have been implicated in the periodontal disease–coronary heart disease association.
As periodontitis is a chronic low-grade inflammatory disease of the tooth-supporting tissues, it may increase blood levels of systemic inflammatory markers, including IL-6, c reactive protein, and fibrinogen.
Intervention studies have shown that periodontal treatment has an effect on serum inflammatory and hematologic markers, thus modifying/reducing the risk for coronary heart diseases (CHD). However, further research is necessary to establish the potential benefit of periodontal therapy on systemic health as it relates to CHD.
Hence, this intervention study was aimed at determining the effect of conventional, mechanical, and nonsurgical periodontal therapy on plasma levels of fibrinogen in patients with chronic periodontitis, at observing changes in clinical periodontal parameters and plasma levels of fibrinogen after periodontal therapy in patients with periodontitis, and at investigating the association between periodontitis and plasma levels of fibrinogen, a risk marker for cardiovascular disease.
| Materials and Methods|| |
Subjects (males and females) clinically diagnosed with generalized moderate-to-severe periodontitis were screened for suitability of the study. Overall, 20 subjects (both males and females) in the age group of 15 to 45 years clinically diagnosed with generalized moderate-to-severe periodontitis were enrolled in the study.
Clinical Periodontal Parameters
- Plaque index
- Gingival index
- Full mouth probing pocket depth
- Full mouth clinical attachment level
Blood samples, that is, 5mL of overnight fasting blood, was drawn after venipuncture from antecubital fossa. Blood samples were obtained at baseline before intervention (i.e. before periodontal therapy) and at one month and three months follow-up evaluations post-periodontal therapy. Overall, 3mL of blood was used for fibrinogen and the other 2mL was used for HDL and LDL.
After recording of baseline clinical parameters and baseline blood sample collection, all subjects received nonsurgical periodontal therapy, which included supra- and subgingival scaling and root planing and oral hygiene instructions.
A 3-mL blood sample was collected from the antecubital vein, and fibrinogen was assayed by using STA-Fib 2 kit.
| Results|| |
Plasma Fibrinogen Levels (mg/dL) at Different Time Intervals
Baseline plasma fibrinogen level mean ± SD was 412.30 ± 54.03 mg/dL. After thorough scaling and root planing at the one-month follow-up, mean ± SD of fibrinogen was 353.85 ± 53.15 mg/dL and at the three-month follow-up it was 345.70 ± 50.83 mg/dL. There was a significant change in fibrinogen level at one month (14% reduction), with a mean difference of 58.450 mg/dL and a t value of 10.902. There was a statistically significant reduction in fibrinogen value when compared with baseline with a P value of <0.001 and at the three-month interval with a mean difference of 66.600 mg/dL (16%) and a t value of 13.561 with a P value of <0.001.
Comparison of Different Clinical Parameters, that is, Probing Depth (mm) and Clinical Attachment Loss (mm) at Different Time Intervals
Mean ± SD of probing depth was 4.32 ± 0.80 mm at baseline, after treatment with mean ± SD of 3.06 ± 0.56 mm (29% reduction), at one month with a mean difference of 1.262 mm and 3.04 ± 0.61 mm (30% reduction), and at three months with a mean difference of 1.280 mm compared with baseline. The intragroup comparison showed that PD was significantly reduced at the one-month and three-month interval after treatment compared with baseline values with a P value of <0.001, with no statistically significant reduction between one-month and three-month PD after treatment with a P value of 0.433 (1% reduction). Clinical attachment loss (CAL) was 4.31 ± 0.78 mm at baseline and 3.26 ± 0.60 mm (24% reduction) at 1 month; and with 1.053 mm mean difference compared to baseline and 3.21 ± 0.59 mm(26%rduction) at 3 months with mean difference of 1.105 following treatment. There was a statistically significant reduction in CAL when compared with baseline after treatment with P < 0.001.
Comparison of Different Clinical Parameters, That Is, Plaque Index and Gingival Index at Different Time Intervals
Plaque index with mean ± SD was 2.08 ± 0.47 at baseline, 0.88 ± 0.13 at one month (58% reduction), with a mean difference of 1.198 compared with baseline, and 0.89 ± 0.14 (57% reduction) at three months, with a mean difference of 1.190 after three months compared with baseline after periodontal therapy. A statistically significant reduction in PI was seen when compared with baseline P < 0.001, but no statistically significant reduction was seen between one month and three months with a P value of 0.451. At baseline, gingival index (GI) with mean ± SD was 2.15 ± 0.40; at one-month interval, GI was 0.90 ± 0.15 (58% reduction) with a mean difference of 1.253; and at three months, GI was 0.88 ± 0.14 (59% reduction) with a mean difference of 1.276 when compared with baseline, which showed a statistically significant (P < 0.001) reduction. Also, between one month and three months, a comparison of GI showed significant GI reduction with a P value of < 0.001.
Comparison of Plasma Levels of HDL (mg/dL), LDL (mg/dL) at Different Time Intervals
The mean ± SD of HDL was 44.40 ± 8.23 mg/dL at baseline, 42.95 ± 7.66 at one month, and 43.10 ± 7.73 at three months after intervention and mean ± SD of LDL, which was 97.90 ± 6.97 mg/dL at baseline, 94.95 ± 6.43 at one month, and 96.25 ± 6.52 at three months, respectively, after periodontal therapy.
[Table 1] displays a statistically significant correlation of fibrinogen with clinical parameters with an r value of 0.609, 0.793, 0.608, and 0.699 for probing depth, CAL, PI, and GI, respectively, with a large correlation with CAL, GI with P < 0.001, three months after intervention.
| Discussion|| |
The results of the current study suggested that plasma levels of fibrinogen in patients with chronic periodontitis showed significant reduction after mechanical nonsurgical periodontal therapy. The results also showed significant improvement in the recorded clinical parameters within three months of the intervention, indicating that this particular treatment of chronic periodontitis had systemic effects.
Periodontal improvement in comparison with baseline values was noted at one month and three months after nonsurgical therapy. PI and GI were found to be significantly reduced after nonsurgical periodontal therapy. The magnitude of PD reduction achieved in the current study was consistent with published outcomes.
Results showed no correlation between levels of HDL, LDL, and fibrinogen and levels of HDL, LDL, and clinical parameters. This was in association with a study done by Lopez et al.
In this study, the overall reduction in fibrinogen level was 16%, which was statistically significant when compared with baseline, three months after periodontal therapy (P < 0.001). These results were consistent with studies done on systemically healthy patients with systemic disease,,,, but no significant changes have been observed in studies where they have evaluated the fibrinogen levels at six weeks and three months after periodontal treatment, which could be because the author had performed the study irrespective of periodontal status.
Untreated periodontal disease might contribute incrementally to the inflammatory burden for many years, but its role and relative contribution within the spectrum of cardiovascular risk is uncertain. It now appears that a relatively simple periodontal treatment, that is, scaling and root planing can have a beneficial systemic effect because it may normalize hematological markers. It could, therefore, be one of the cost-effective public health measures.
| Conclusion|| |
This study supports the hypothesis that the rise in systemic inflammatory markers observed in patients with periodontitis can be reduced by periodontal treatment, thereby reducing the cardiovascular disease risk, and it could therefore be one of the cost-effective public health measures.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Buhlin K, Hultin M, Norderyd O, Persson L, Pockley AG, Rabe P, et al
. Risk factors for atherosclerosis in cases with severe periodontitis. J Clin Periodontol 2009;36:541-9.
Sahingur SE, Sharma A, Genco RJ, De Nardin E Association of increased levels of fibrinogen and the -455G/A fibrinogen gene polymorphism with chronic periodontitis. J Periodontol 2003;74:329-37.
Bokhari SA, Khan AA, Butt AK, Azhar M, Hanif M, Izhar M, et al
. Non-surgical periodontal therapy reduces coronary heart disease risk markers: A randomized controlled trial. J Clin Periodontol 2012;39:1065-74.
Vidal F, Figueredo CM, Cordovil I, Fischer RG Periodontal therapy reduces plasma levels of interleukin-6, C-reactive protein, and fibrinogen in patients with severe periodontitis and refractory arterial hypertension. J Periodontol 2009;80:786-91.
Hussain Bokhari SA, Khan AA, Tatakis DN, Azhar M, Hanif M, Izhar M Non-surgical periodontal therapy lowers serum inflammatory markers: A pilot study. J Periodontol 2009;80: 1574-80.
López NJ, Quintero A, Casanova PA, Ibieta CI, Baelum V, López R Effects of periodontal therapy on systemic markers of inflammation in patients with metabolic syndrome: A controlled clinical trial. J Periodontol 2012;83:267-78.
Taylor B, Tofler G, Morel-Kopp MC, Carey H, Carter T, Elliott M, et al
. The effect of initial treatment of periodontitis on systemic markers of inflammation and cardiovascular risk: A randomized controlled trial. Eur J Oral Sci 2010;118:350-6.
Montebugnoli L, Servidio D, Miaton RA, Prati C, Tricoci P, Melloni C, et al
. Periodontal health improves systemic inflammatory and haemostatic status in subjects with coronary heart disease. J Clin Periodontol 2005;32:188-92.