Salivary IgG and IgA before and after periodontal therapy. A preliminary report

Oral fluid-based biomarkers of alveolar bone loss in periodontitis

Periodontal disease is a bacteria-induced chronic inflammatory disease affecting the soft and hard supporting structures encompassing the teeth. When left untreated, the ultimate outcome is alveolar bone loss and exfoliation of the involved teeth. Traditional periodontal diagnostic methods include assessment of clinical parameters and radiographs. Though efficient, these conventional techniques are inherently limited in that only a historical perspective, not current appraisal, of disease status can be determined. Advances in the use of oral fluids as possible biological samples for objective measures of current disease state, treatment monitoring, and prognostic indicators have boosted saliva and other oral-based fluids to the forefront of technology. Oral fluids contain locally and systemically derived mediators of periodontal disease, including microbial, host-response, and bone-specific resorptive markers. Although most biomarkers in oral fluids represent inflammatory mediators, several specific collagen degradation and bone turnover-related molecules have emerged as possible measures of periodontal disease activity. Pyridinoline cross-linked carboxyterminal telopeptide (ICTP), for example, has been highly correlated with clinical features of the disease and decreases in response to intervention therapies, and has been shown to possess predictive properties for possible future disease activity. One foreseeable benefit of an oral fluid-based periodontal diagnostic would be identification of highly susceptible individuals prior to overt disease. Timely detection and diagnosis of disease may significantly affect the clinical management of periodontal patients by offering earlier, less invasive, and more cost-effective treatment therapies.

Racial differences in salivary sIgA concentrations in postmenopausal women

The purpose of this study was to compare sIgA salivary concentrations between Caucasian and African-American postmenopausal women. The age, height, weight and history of hormone replacement therapy were recorded and the BMI was calculated for each individual. Whole, stimulated saliva was assayed for sIgA and total protein. Logistic regression analysis evaluated the relationships between the outcome variables. Total salivary sIgA and adjusted sIgA (adjusted for protein) concentrations were significantly higher in the African-American women (p<0.01). There were significant statistical correlations between sIgA concentrations and race (p<0.01). Our data suggest that racial differences in salivary sIgA concentrations in elderly women could be an important variable for planning future studies utilizing salivary samples as biological markers.

Periodontal disease diagnosis: current status and future developments

OBJECTIVES

This manuscript attempts to critically review traditional and currently employed methods of periodontal diagnosis, in the light of current knowledge about individual patients and sites at risk of progressive periodontal attachment loss.

DATA SOURCES

Articles published over the last decade from international research journals, have demonstrated that existing methods of periodontal disease diagnosis are seriously deficient with respect to accuracy, their ability to predict ongoing or future disease activity and their ability to determine the current activity status of historically diseased sites.

STUDY SELECTION

Longitudinal studies have questioned the rationale behind traditional treatment regimes and underlined the importance of site-directed therapy to avoid potentially damaging instrumentation of quiescent or healthy sites. The recent explosion in local, less invasive chemotherapies for periodontal disease management has aimed at addressing the site-specific nature of this group of diseases, but the true benefits of such novel therapies cannot be realised until more accurate and specific diagnostic techniques become available.

CONCLUSIONS

The manuscript concludes that the range of clinical information collected by experienced periodontists using currently available technology is probably sufficient to manage mild-to-moderate chronic adult periodontitis. However, those patients at risk from more aggressive attachment loss, and those individuals that appear refractory to traditional therapies, require the development of more accurate diagnostic tests to compliment the revolution in site-specific therapies. A diagnostic model is presented, which attempts to draw together current and future diagnostic methods for managing the majority of periodontal disease types, and it is suggested that current diagnoses should include some assessment of "risk'.

Salivary immunoglobulin concentrations in predentate and edentulous mouths

The concentrations of IgA, IgG and IgM in whole saliva of predentate babies, dentate adults, and edentulous old people, and the salivary IgG concentration of dentate old people, were determined using a solid phase radioimmunoassay. A highly significant difference in IgG concentrations was found between toothless and dentate people. The average IgG concentration in the saliva of edentulous old people was 5.2 mg/1, which was about 20% of that of dentate old people. The salivary IgG content of babies was only 1.7 mg/1, which was in concordance with the low postnatal serum IgG values. The salivary IgA level in this age group was also low. The edentulous old people tended to have decreased IgM values, and the predentate babies tended to have increased IgM values compared with the dentate adults.

Systemic antibody response of clinically characterized patients with antigens of Eubacterium brachy initially and following periodontal therapy

Eubacterium brachy, a gram-positive anaerobic rod, has been implicated by cultural studies to be associated with the microflora of periodontal diseases. Serum samples from 184 clinically characterized patients were evaluated in a standardized enzyme-linked immunosorbent assay (ELISA) for reactivity to E. brachy antigens. Sera from clinically healthy subjects (HS) served as controls. Sera from rapidly progressive periodontitis (RP) patients demonstrated significantly greater reactivity by ELISA than did HS when reactivity with E. brachy antigens was determined (P less than 0.05). Juvenile periodontitis (JP) and adult periodontitis (AP) patients did not differ in reactivity by ELISA from HS (P greater than 0.05). Three to 4 years following successful periodontal therapy, reactivity was not significantly altered in any patient group (P greater than 0.05). The possible significance of these findings and the importance of an extracellular antigen of E. brachy in the immunopathology of periodontal diseases are discussed.

Fluctuations in crevicular and salivary anti-A. viscosus antibody levels in response to treatment of gingivitis

Experimental gingivitis studies support a pathogenic rôle for Actinomyces viscosus because of its numerical predominance in disease-associated plaques. The aims of the present investigation were to quantify specific crevicular IgG against A. viscosus before and after conventional gingivitis treatment and to determine whether salivary IgA and IgG against A. viscosus and A. naeslundii would be affected concomitantly. 6 subjects with generalized gingivitis were selected. Examinations were made before and after treatment and included collection of unstimulated saliva, paraffin-stimulated saliva and crevicular material as well as measurements of clinical parameters. The immunoglobulins were estimated by an ELISA assay using whole bacterial cells as antigen. Crevicular IgG against A. viscosus WVU 627 was demonstrated in pre- and post-treatment samples with a tendency towards increased values in the post-treatment samples. Salivary IgA and IgG against A. viscosus were also demonstrated in pre- and post-treatment samples. There were tendencies towards increased IgA values for paraffin-stimulated saliva and increased IgG values for unstimulated saliva in the post-treatment samples. Salivary IgA and IgG values against A. naeslundii ATCC 12104 were either not detected or barely detectable in both pre- and post-treatment samples. A. naeslundii B 74 IgG values were also rather low. As for A. viscosus WVU 627, anti-B 74 IgA values demonstrated a post-treatment increase for most subjects, especially for unstimulated saliva for which all post-treatment values were elevated. It is interesting to note that saliva samples showed changes similar to crevicular material, considering that salivary IgA is most likely derived from a different source. Together, elevated crevicular and salivary antibody concentrations might account for some of the beneficial effects of periodontal therapy by scaling.

Serum and salivary IgG and IgA response to initial preparation therapy

The purpose of this study was to determine and compare IgG and IgA concentration in both serum and unstimulated whole saliva obtained prior to any therapy and following initial preparation therapy (IPT) in 15 healthy adult dentulous patients, five each of periodontal disease Classes I, II and III. During the first visit before therapy, 10 ml of whole blood and 5 ml of saliva were obtained. Serum protein electrophoresis was conducted to rule out immunoglobulinopathies. Radial cell immunodiffusion endpoint technique was employed on serum and saliva to determine IgG and IgA in mg/dl. Following IPT, achievement of plaque control and 3 weeks after any dental instrumentation, 10 ml of blood and 5 ml of saliva were obtained from each patient and IgG and IgA in mg/dl were determined. The following are trends that were observed: greater decrease in IgG and IgA in serum and saliva following IPT in Class I periodontal patients than in other classes; saliva was a better indicator of local humoral response than serum for this group of patients; the less severe the periodontal involvement, more consistent was the reduction in IgG and IgA following IPT, especially for saliva; IPT elicited a decreased IgG and IgA concentration when local antigenic stimuli were reduced by both patient and dentist.

Salivary immunoglobulins in patients with juvenile periodontitis and their healthy siblings

The concentrations of the salivary immunoglobulins IgA, IgG and IgM were determined with a solid phase radioimmunoassay in the unstimulated whole saliva of 21 patients with juvenile periodontitis (JP), their 27 healthy siblings and 17 healthy age-matched controls. In the JP group the concentrations of IgA were increased, averaging 188 +/- 32.5 (SE) mg/L as compared with the mean of 139 +/- 21.2 mg/L in their healthy siblings and 130 +/- 24.5 mg/L in the controls. An elevation was found in the amount of IgG in the JP patients 45.6 +/- 12.5 mg/L as compared with 18.1 +/- 5.9 mg/L in the siblings and 21.0 +/- 5.6 mg/L in the controls. The mean IgM was 22.5 +/- 5.4 mg/L in the JP group, 13.3 +/- 2.9 mg/L in the siblings and 8.7 +/- 1.6 mg/L in the controls, indicating an increase of IgM in the JP group and the siblings. A significant difference was found in the mean IgM values in the juvenile periodontitis group when compared to the control group. (0.02 greater than P greater than 0.01).