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Table of Contents
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 40-41

Effect of chronic periodontitis on serum ferritin levels before and after non-surgical periodontal therapy: A review

1 Sri Siddhartha Dental College and Hospital, Tumkur, Karnataka, India
2 Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
3 Azamgarh Dental College Chandeswar, Uttar Pradesh, India
4 Government Dental College, Raipur, Chhattisgarh, India
5 Dental College RIMS, Manipur Health Services, Imphal, India

Date of Submission12-Feb-2021
Date of Acceptance15-Feb-2021
Date of Web Publication29-Mar-2021

Correspondence Address:
Dr. Nikesh Thounaojam
Sri Siddhartha Dental College and Hospital, Tumkur, Karnataka.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/INJO.INJO_11_21

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Various biomarkers in serum/plasma have been evaluated in patients with periodontitis. Ferritin has emerged as a potential diagnostic marker in the assessment of oral and systemic diseases, particularly periodontal diseases. Ferritin concentrations in serum of patients with chronic periodontitis (CP) have not been evaluated, for changes in relation to the effectiveness of periodontal therapy. So the aim of this review is to identify the causal relationship, if any between CP and serum ferritin levels. It was found that serum ferritin level can be used as a biomarker in evaluating the effectiveness of periodontal therapy in CP patients. More interventional studies with higher sample size are required to ascertain the role of serum ferritin levels in evaluating the periodontal health status.

Keywords: Chronic periodontitis, clinical periodontal parameters, ELISA, ferritin, non-surgical periodontal therapy, serum

How to cite this article:
Thounaojam N, Jha R, Chaudhary BN, Pankaj VC, Pankaj SC, Geeta R. Effect of chronic periodontitis on serum ferritin levels before and after non-surgical periodontal therapy: A review. Int J Oral Care Res 2021;9:40-1

How to cite this URL:
Thounaojam N, Jha R, Chaudhary BN, Pankaj VC, Pankaj SC, Geeta R. Effect of chronic periodontitis on serum ferritin levels before and after non-surgical periodontal therapy: A review. Int J Oral Care Res [serial online] 2021 [cited 2021 Aug 6];9:40-1. Available from: https://www.ijocr.org/text.asp?2021/9/1/40/312533

  Introduction Top

Periodontal disease is an inflammatory condition of the tooth supporting tissues, caused by subgingival accumulation of anaerobic Gram-negative bacteria, and is characterized by a progressive breakdown of periodontal tissues. The role of bacteria in the initiation of periodontal disease is primary, while a range of host-related factors such as heredity, diabetes, and smoking influence the clinical presentation and rate of progression of disease.[1] Early diagnosis and treatment play a very important role in the prevention of progressive periodontitis.[2] At present, periodontitis is diagnosed almost entirely on the basis of an array of clinical measurements including probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and radiographic findings. Whereas CAL measurements by periodontal probes and radiographic bone levels provide information about past periodontal tissue breakdown, assessment of disease presence requires additional measurements of BOP and PD.[3] There is a need for development of new diagnostic test that can detect the presence of active periodontal disease, predict future disease progression, and evaluate the response to periodontal therapy, thereby improving the clinical management of periodontal patients.

  Biomarkers Top

Biomarkers, whether produced by normal healthy individuals or in individuals affected by specific systemic diseases, are molecules that could be used to monitor health status, disease onset, treatment response, and outcome. Oral fluid biomarkers related to periodontal disease can be associated with soft tissue inflammation, alveolar bone loss, bacterial products, and antimicrobial proteins.[4],[5]

  Ferritin Top

Ferritin is an acute phase reactant and is elevated in inflammation, autoimmune disorders, chronic infection, and liver disease. Elevated serum ferritin levels are well established in many chronic inflammation-related diseases such as multiple sclerosis and rheumatoid arthritis.[6],[7] Ferritin plays an important role in iron storage and recycling. Ferritin stores iron in a non-toxic and soluble form and releases it in a controlled fashion. Ferritin without the associated iron is known as apoferritin. Apoferritin consists of 24 polypeptide chains of two subunits each, a heavy subunit involved in iron transport and a light subunit responsible for long-term storage of iron in the liver and spleen.[8] Ferritin also plays an important role in host immune response. An increased immune response augments the migration of ferritin from the plasma to within the cells to counter infective agents that attempt to bind iron from the host tissue.[9] Oral infections cause significant increases in systemic inflammatory responses, manifested by the release of acute phase cytokines and acute phase reactants.[10] Elevated serum ferritin levels may be associated with chronic periodontitis (CP), and change in serum ferritin levels may be reflected in response to periodontal therapy.

  CP and Serum Ferritin Levels Top

CP leads to the loss of connective tissue attachment and bone supporting the teeth through accumulation of subgingival anaerobic Gram-negative bacteria. Ferritin is a soluble 450 kDa protein. It is found in all cells of the body but is in high concentration in marrow macrophages, the spleen, and the liver. It provides intracellular storage of bio-available iron in a safe and readily accessible form.[3]Ferritin is found in all the cells of the body and all the tissue fluid.[5],[6] Two key factors that can regulate ferritin expression are iron and proinflammatory cytokines. Oral infections cause significant increase in systemic inflammatory responses, manifested by the release of acute-phase cytokines and acute-phase reactants.[1] CP is an inflammatory disease and rise in serum ferritin levels is concomitant with the degree of inflammation or chronicity of inflammation. The key finding of the majority studies shows significant reduction in serum ferritin levels 1 month after non-surgical periodontal therapy in CP patients. The comparison of periodontal parameters such as plaque index, gingival index, modified sulcular bleeding index, probing pocket depth, and CAL in patients at baseline and 1 month after non-surgical periodontal therapy has been observed to be statistically significant (P ≤ 0.01) by many studies. Changes in the periodontal parameters might be due to reduction in periodontal inflammation after non-surgical periodontal therapy.[7],[8],[9],[10]

  Conclusion Top

In the present review, serum ferritin levels were found to be elevated in the CP patients at baseline when compared with healthy subjects after non-surgical periodontal treatment. Non-surgical periodontal treatment may have an effect on serum ferritin levels. Hence, it can be concluded that these serum ferritin levels may be an important factor in the pathogenesis of the disease. Although causal relationship between serum ferritin and increased susceptibility to periodontitis is not established, it is possible that a failure of adequate host defense to plaque bacteria may be a predisposing factor and may end in periodontal disease, like the acquisition of infection, in general, is dependent on host-related issues of where serum ferritin levels are, but one of the many contributing factors. Hence, evaluating serum ferritin levels is a valuable adjunct to the clinical and radiographical diagnosis of periodontal lesion and predicts the future disease progression and evaluates response to periodontal therapy.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Guo LN, Yang YZ, Feng YZ Serum and salivary ferritin and hepcidin levels in patients with chronic periodontitis and type 2 diabetes mellitus. BMC Oral Health 2018;18:63.  Back to cited text no. 1
Bhavya B, Ashwini S, Shruthi KR Estimation of hemoglobin and serum ferritin concentration from females with chronic periodontitis before and after non-surgical periodontal therapy: An interventional study. IJRSR 2017;8:20276-9.  Back to cited text no. 2
Shirmohamadi A, Chitsazi MT, Faramarzi M, Salari A, Alavi FN, Pashazadeh N Effects of non-surgical periodontal treatment on transferrin serum levels in patients with chronic periodontitis. JODDD 2016;10:169-75.  Back to cited text no. 3
Latha S, Thirugnanamsambandan S, Arun RT, Masthan KMK, Malathi L, Rajesh E Serum ferritin level and red blood cell parameters in healthy controls and chronic periodontitis patients. J Pharm Bioallied Sci 2015;17:154-9.  Back to cited text no. 4
Santosh HN, David CM, Kumar H, Sanjay CJ, Bose A Chronic periodontitis and anemia of chronic disease: An observational study. Arch Orafac Sci 2015;10:57-64.  Back to cited text no. 5
Polepalle T, Moogala S, Boggarapu S, Pesala DS, Palagi FB Acute phase protein and their role in periodontitis: A review. J Clin Diagn Res 2015;9:1-5.  Back to cited text no. 6
Serkan S, Pamuk ON, Pumuk GP, Necati C Correlation between ferritin level and acute phase parmeters in rheumatoid arthritis and systemic lupus erythematosus. Eur J Rheumatol 2015;1:92-5.  Back to cited text no. 7
Tran J, Story C, Moore D, Metz M Unexpected increased ferritin concentration in patients with anorexia nervosa. Ann Clin Biochem 2013;50:504-6.  Back to cited text no. 8
Prakash S, Dhingra K, Priya S Similar hematological and biochemical parameters among periodontitis and control group subjects. Eur J Dent 2012;6:287-94.  Back to cited text no. 9
Da Costa R, Szyper-Kravitz M, Szekanecz Z, Csépány T, Dankó K, Shapira Y, et al. Ferritin and prolactin levels in multiple sclerosis. Isr Med Assoc J 2011;13:91-5.  Back to cited text no. 10


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