Does smoking affect gingival crevicular fluid LL-37 levels following non-surgical periodontal treatment in chronic periodontitis?

The Antimicrobial Peptide LL-37 as a Predictor Biomarker for Periodontitis with the Presence and Absence of Smoking: A Case-Control Study

Background

A major issue is finding a valid biomarker able to diagnose periodontal disease with the presence and absence of risk factors. Indeed, the association between smoking and periodontal diseases and its impact on the manifestation of antimicrobial peptides has been delineated in clinical and epidemiological investigations. The antimicrobial peptide cathelicidin (LL-37) is pivotal in preserving periodontal health.

Objectives

This investigation examines and contrasts the levels of cathelicidin in the saliva of smokers and nonsmokers of periodontitis. The study also seeks to establish this biomarker's diagnostic ability to differentiate between periodontal health and disease.

Materials and Methods

The study involved the collection of unstimulated saliva samples from 160 participants, comprising 80 patients diagnosed with periodontitis (40 of whom were smokers and 40 were nonsmokers) and 80 periodontitis-free individuals (40 smokers and 40 nonsmokers). The clinical periodontal parameters were assessed, including recording the probing pocket depth, the level of clinical attachment, and the percentage of bleeding on probing. Subsequently, enzyme-linked immunosorbent assays were conducted to quantify the protein levels of LL-37 in the saliva samples obtained from the subjects mentioned above.

Results

The highest level of salivary LL-37 was found in the nonsmoker periodontitis (NSP) patients, followed by the group of smoker periodontitis (SP) and then nonsmoker healthy (NSH) group, while the lowest level was found in the healthy smoker (HS) group. At the same time, the LL-37 seems to be a very good biomarker in differentiating periodontal health from disease with the presence and absence of smoking.

Conclusion

Periodontitis results in a significant elevation of salivary LL-37 levels in smoker and nonsmoker patients compared to healthy individuals. These levels are positively correlated with the periodontal parameter and can serve as a valuable diagnostic tool to predict periodontitis, whereas smoking significantly reduces these levels.

The influence of smoking on oral neutrophils and matrix metalloproteinase-8 in periodontitis patients before and after nonsurgical treatment

Objective

To evaluate and compare the oral neutrophil numbers (ONN) in saliva, the level of matrix metalloproteinase-8 (MMP-8) in gingival crevicular fluid (GCF) and the periodontal parameters in smokers versus non-smokers with periodontitis, before and after nonsurgical periodontal treatment (NSPT).

Materials and method

40 chronic periodontitis patients including 20 smokers and 20 non-smokers were enrolled in this quasi-experimental study. All patients were received the NSPT included instructing oral hygiene, scaling and root planing. At baseline (T0) and after NSPT 1 month (T1) and 3 months (T3), all patients were assessed for salivary ONN, GCF MMP-8, and clinical parameters like plaque index (PlI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD) and clinical attachment loss (CAL). The differences between the two groups were analyzed using the independent sample t-test and the Mann-Whitney U test; and the differences between T0, T1 and T3 of each group were analyzed with paired-samples t-test and Wilcoxon signed-rank test. The level of significance was set at 0.05.

Results

The ONN was significantly less in smokers than in non-smokers although there was no significant difference in other parameters between the two groups at baseline (p > 0.05). All clinical periodontal parameters reduced significantly after 1 month and 3 months of NSPT in both groups (p < 0.01). PPD of non-smokers was significantly lower than those of smokers at T1 and T3. ONN and MMP-8 level showed a significant decrease in non-smoking subjects, while there was no significant difference in smoking ones after NSPT (T1 and T3). At 1 month after treatment, ONN tended to reduce in non-smokers whereas to increase in smokers significantly.

Conclusion

Smoking reduced ONN, impaired treatment effect in reducing PPD, and changed the MMP-8 level in gingival crevicular fluid to NSPT.

Trial registration

Identifier NCT04974502 in CLinicalTrials.gov.

Nonsurgical periodontal treatment improved the type 2 diabetes mellitus status in smokers: A randomized controlled trial

AIM

Type 2 diabetes mellitus (T2D) and periodontal disease have bilateral associations. The effect of periodontal treatment on T2D patients who smoke is scarce. This study aimed to assess the effect of nonsurgical periodontal treatment (NSPT) in periodontitis smokers with T2D for a duration of 6 months of follow-up.

MATERIALS AND METHODS

Forty moderate to severe periodontitis smokers with T2D were randomly distributed into two different treatment groups: the test group (NSPT including oral hygiene instructions, scaling and root planing; and 0.05% Chlorhexidine mouthrinse) and the control group (treatment including oral hygiene instructions, supragingival removal of plaque and calculus and 0.05% Chlorhexidine mouthrinse). Periodontal parameters including plaque index (PI), gingival index (GI), bleeding on probing (BOP), periodontal probing depth (PPD) and clinical attachment loss (CAL) were examined. Metabolic parameters, including fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c), and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline and at 1, 3, and 6 months of follow-up.

RESULTS

The test group significantly improved all periodontal parameters and reduced metabolic parameters and hs-CRP, whereas improvements in PI and GI were observed in the control group at 1, 3 and 6 months of follow-up. However, the PPD, CAL, metabolic parameters and hs-CRP increased in the control group at 3 and 6 months of follow-up, but the differences were not significant.

CONCLUSIONS

NSPT improves the periodontal status of smokers with T2D, has a favorable effect on glycemic control and reduces pro-inflammatory mediators, which may limit complications due to T2D in these patients.

Clinical and Biochemical Effects of Smoking on Non-Surgical Periodontal Treatment in Grade III Stage C Periodontitis Patients

Objective: The purpose of this study was to evaluate the effect of smoking on clinical parameters and the serum and saliva levels of RANKL, OPG, and IL-34 in periodontitis stage III grade C (III-C) patients after non-surgical periodontal treatment (NSPT). Methods: A total of 60 subjects, 40 periodontitis-III-C patients (20 smokers and 20 non-smokers) and 20 non-smoker periodontally healthy individuals, were included. All clinical periodontal parameters were recorded, and unstimulated saliva and serum samples were collected from all patients at baseline, but at 1 and 3 months only from periodontitis patients (N=40). Saliva and serum levels of RANKL, OPG, and IL-34 were analyzed by ELISA. Results: At baseline only whole mouth probing depth (PD) and percent of sites with PD>5mm were higher in smokers than non-smoker periodontitis patients (p

Periodontal treatment outcomes in smokers: A narrative review

Smoking is considered as the major environmental risk factor for periodontal diseases. Smokers have a higher risk for severe periodontitis with more periodontal tissue destruction, more gingival recession, and more susceptibility for tooth loss. The aim of this narrative review is to provide up-to-date evidence on the clinical outcomes of periodontal treatment in smokers. Electronic databases were searched for studies that compare the clinical outcomes in smokers and non-smokers following non-surgical and surgical periodontal treatment modalities and also during the supportive periodontal treatment. Clinical studies published before May 2021 were included in the review. Smokers have a higher risk for recurrence of periodontal disease and the response to non-surgical as well as surgical periodontal treatment is not as good as that of non-smokers. Moreover, there is a dose-response effect in the adverse effects of smoking on periodontal health. Compared to non-smokers, smoker patients with periodontitis tend to respond less favorably to non-surgical and surgical periodontal treatment, and exhibit recurrence more frequently during supportive periodontal treatment. Along with the periodontal treatment, smokers may be encouraged to quit. Long follow-up and the communication between the dentist and the patient give a great opportunity for such counseling.

The multifaceted roles of antimicrobial peptides in oral diseases

Antimicrobial peptides are naturally occurring protein molecules with antibacterial, antiviral and/or antifungal activity. Some antimicrobial peptides kill microorganisms through direct binding with negatively charged microbial surfaces. This action disrupts the cytoplasmic membrane and leads to the leakage of the cytoplasm. In addition, they are involved in the innate immune response. Antimicrobial peptides play an important role in oral health, as natural antimicrobial peptides are the first line of host defence in response to microbial infection. The level of natural antimicrobial peptides increases during severe disease conditions and play a role in promoting the healing of oral tissues. However, they are insufficient for eliminating pathogenic micro-organisms. The variability of the oral environment can markedly reduce the effect of natural antimicrobial peptides. Thus, researchers are developing synthetic antimicrobial peptides with promising stability and biocompatibility. Synthetic antimicrobial peptides are a potential alternative to traditional antimicrobial therapy. Pertinent to oral diseases, the deregulation of antimicrobial peptides is involved in the pathogenesis of dental caries, periodontal disease, mucosal disease and oral cancer, where they can kill pathogenic microorganisms, promote tissue healing, serve as biomarkers and inhibit tumor cells. This narrative review provides an overview of the multifaceted roles of antimicrobial peptides in oral diseases.

LL-37 and hBD-2 in the gingival crevicular fluid of smokers and nonsmokers with periodontitis

Abstract Introduction The association between smoking and periodontal diseases has been described in clinical and epidemiological studies. Objective The aim of this study was to compare the LL-37 and human β-defensin-2 (hBD-2) levels in crevicular fluid of patients with generalized periodontitis in smokers (S) and nonsmokers (NS). Material and method A total of 35 patients with generalized periodontitis stages III and IV, 15 NS (11 female, 4 male) and 20 S (7 female and 13 male), were included in the study. The evaluated clinical parameters were bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL). Enzyme-linked immunosorbent assays were performed to quantify the LL-37 and hBD-2 levels in the gingival crevicular fluid of these patients. The results were analyzed statistically with the level of significance set at 5%. Result In relation to periodontal clinical parameters, no statistically significant difference was observed for BOP and PD between groups S and NS. There was a higher CAL in the S group than in the NS group (p = 0.0095). There was no statistically significant difference between the levels of LL-37 and hBD-2 when comparing groups S and NS (p>0.05). Conclusion It was concluded that smokers have a higher clinical attachment loss than nonsmokers, but that smoking did not influence the levels of LL-37 and hBD-2 in the gingival crevicular fluid in periodontitis.

The impact of smoking on non-surgical periodontal therapy: A systematic review and meta-analysis

AIM

Smoking is a risk factor for periodontitis. This study aimed to evaluate the impact of smoking on clinical outcomes of non-surgical periodontal therapy.

MATERIALS AND METHODS

Electronic databases were searched to screen studies published before May 2020. The included studies had to have two groups: smokers (S) and non-smokers (NS) with periodontitis. The outcomes evaluated were differences between groups in probing depth (PD) reduction and clinical attachment level (CAL) gain after non-surgical periodontal therapy. Meta-regressions were conducted to evaluate correlations between outcomes and other contributing factors.

RESULTS

Seventeen studies were included. The post-treatment PD reduction in the S group was smaller than in the NS group (weighted mean difference in PD reduction: -0.33 mm, 95% confidence interval (CI): [-0.49, -0.17], p < .01). The CAL gain in the S group was also smaller than in the NS group (weighted mean difference in CAL gain: -0.20 mm, CI: [-0.39, -0.02], p < .01). Additionally, baseline PD significantly affected the difference in PD reduction between two groups.

CONCLUSIONS

Smoking negatively impacts clinical responses to non-surgical periodontal therapy. Smokers with periodontitis have significantly less PD reduction and CAL gain than non-smokers.

Smoking reduces cathelicidin LL-37 and human neutrophil peptide 1-3 levels in the gingival crevicular fluid of patients with periodontitis

BACKGROUND

Antimicrobial peptides are components of innate immune response that have a key role on susceptibility and resistance of the oral cavity to diseases. This study aimed to investigate the influence of smoking on cathelicidin LL-37 and human neutrophil peptides 1 through 3 (HNP 1-3) levels in the gingival crevicular fluid (GCF) of patients with periodontitis. The relationship between levels of these peptides with the periodontal status and selected inflammatory mediators levels in smokers and non-smokers was also evaluated.

METHODS

Forty patients with periodontitis, 20 smokers and 20 non-smokers were recruited. After a full periodontal clinical assessment, GCF samples were collected from healthy (n = 5) and diseased (n = 5) sites of each patient. Peptides and inflammatory mediators in the GCF were quantitated by sandwich ELISAs and Multiplex assay, respectively.

RESULTS

Diseased sites had significantly (P <0.05) higher levels of LL-37 and lower levels of HNP 1-3 than healthy sites in both smokers and non-smokers. Diseased sites of smokers presented significantly lower levels of LL-37 and HNP 1-3 when compared with diseased sites of non-smokers. Concentration of LL-37 was directly correlated with the presence of proinflammatory mediators matrix metalloproteinase (MMP)-8 and interleukin (IL)-1β and inversely correlated with concentration of IL-10. HNP 1-3 concentration was positively correlated with IL-10 and negatively correlated with concentrations of MMP-8 and IL-1β.

CONCLUSIONS

Smoking was associated with reduced levels of LL-37 and HNP 1-3 in GCF of patients with periodontitis. LL-37 had a distinct expression pattern from HNP 1-3: LL-37 was upregulated in diseased sites, and HNP 1-3 was increased in periodontally healthy sites.1.

Does peri-implant bone loss affect the LL-37 and proteinase 3 levels in peri-implant sulcus fluid?

BACKGROUND

Inactive human cathelicidin antimicrobial peptide is present in neutrophils, and proteinase 3 activates this peptide by producing active LL-37 peptide. LL-37 acts as a defensive peptide in the oral tissues. In the present study, the aim was to evaluate LL-37 and proteinase 3 levels in peri-implant sulcus fluid (PISF) in implants with and without peri-implantitis.

METHODS

Patients who simultaneously had dental implants with peri-implantitis and without peri-implantitis were included in the study. Forty-four samples with peri-implantitis and 34 samples without peri-implantitis from 16 patients were obtained. Intraoral evaluations such as pocket depth, modified sulcus bleeding index, and modified plaque index were noted. Enzyme-linked immunosorbent assay was used for the evaluation of PISF LL-37 and proteinase 3 levels.

RESULTS

PISF volume was significantly increased in the implants with peri-implantitis than those without peri-implantitis (p < 0.05). No difference was present between PISF LL-37 and proteinase 3 total amounts between the implants with and without peri-implantitis (p > 0.05). Pocket depths and PISF LL-37 and proteinase 3 levels were not correlated in the groups (p > 0.05).

CONCLUSIONS

PISF volume might be increased in response to peri-implant bone destruction. However, peri-implant tissue destruction caused by peri-implantitis does not seem to affect PISF LL-37 and proteinase 3 levels.

Salivary LL-37 and periodontal health in children exposed to passive smoking

BACKGROUND

Antimicrobial peptides play an important role in the local defence of oral cavity. Cigarette smoke has detrimental effects on immune defence mechanisms. The effect of passive smoking on salivary LL-37, as an antimicrobial peptide, in children has not yet been reported.

AIM

The aims of this study were to evaluate salivary LL-37 levels in PS-exposed and PS-unexposed children and to investigate the association between salivary LL-37 levels and periodontal clinical parameters.

DESIGN

Unstimulated salivary samples were collected from 180 children (90 PS-exposed [38 girls and 52 boys; mean age: 9.36 ± 1.60 years] and 90 PS-unexposed [43 girls and 47 boys; mean age: 9.02 ± 1.71 years]) in this study. Periodontal clinical parameters, including plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL), were recorded in all children. Salivary cotinine and LL-37 levels were measured by enzyme-linked immunosorbent assay.

RESULTS

PI and GI values in PS-exposed children were significantly higher than those in PS-unexposed children. The mean salivary cotinine concentration was significantly higher in PS-exposed children than in control subjects. The mean salivary LL-37 concentration of PS-exposed children was significantly lower (100.71 ± 72.14 pg/mL) than that of PS-unexposed children (151.84 ± 107.89 pg/mL).

CONCLUSION

Passive smoking could suppress salivary LL-37 concentrations in children.