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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 32-34

Effects of chronic periodontitis in serum ferritin levels before and 1 month after nonsurgical periodontal therapy: An intervention study


MDS, Department of Periodontology, Sri Siddhartha Dental College and Hospital, Tumkur, Karnataka, India

Date of Web Publication25-Sep-2019

Correspondence Address:
Dr. N Thounaojam
Department of Periodontology, Sri Siddhartha Medical College and Hospital, Agalakote, Tumkur, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INPC.INPC_29_19

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  Abstract 


Introduction: 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. The aim of the present study is to identify the causal relationship if any between CP and serum ferritin levels.
Materials and Methods: A total of 30 patients in the age group of 25–60 years were recruited from the Outpatient Department of Periodontics, Sri Siddhartha Dental College and Hospital Agalakote, Tumkur. Along with all the clinical parameters, each patient's blood was collected for in vitro assessment of serum ferritin levels at baseline and 1 month after nonsurgical periodontal therapy.
Results: The mean reduction in serum ferritin levels from baseline and 1 month after nonsurgical periodontal treatment in CP patients was statistically highly significant. On comparison between normal healthy individuals, the mean difference in serum ferritin levels in CP patients was statistically highly significant.
Conclusion: With the result obtained, serum ferritin levels can be used as a biomarker in evaluating the effectiveness of periodontal therapy. More interventional studies with larger sample size and long-term studies are needed to evaluate serum ferritin levels can be used as a biomarker for CP patients.

Keywords: Biomarker, chronic periodontitis, interventional studies, nonsurgical periodontal therapy, serum ferritin


How to cite this article:
Thounaojam N. Effects of chronic periodontitis in serum ferritin levels before and 1 month after nonsurgical periodontal therapy: An intervention study. Int J Prev Clin Dent Res 2019;6:32-4

How to cite this URL:
Thounaojam N. Effects of chronic periodontitis in serum ferritin levels before and 1 month after nonsurgical periodontal therapy: An intervention study. Int J Prev Clin Dent Res [serial online] 2019 [cited 2019 Nov 13];6:32-4. Available from: http://www.ijpcdr.org/text.asp?2019/6/2/32/263377




  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. 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.[1] There is a need for the 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. 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. Ferritin also plays an important role in the host immune response. An increased immune response augments the migration of ferritin from the plasma to within the cells to counter infective agents thatattempt to bind iron from the host tissue.[2] Oral infections cause significant increases in systemic inflammatory responses, manifested by the release of acute phase cytokines and acute phase reactants.[3] 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.


  Materials and Methods Top


A total of 30 patients, aged 25–60 years, of both genders reporting to the Outpatient Department of Periodontics, Sri Siddhartha Dental College and Hospital, Agalakote, Tumkur, were enrolled for the study. Participants were selected based on the inclusion and exclusion criteria and Participants were distributed under Group I control (healthy individuals) and Group II experimental (CP patients). Detailed medical and dental case history was taken. Plaque Index (Tureskey et al. modification of Quigley Hein Index 1970), Gingival Index (Loe and Silness 1963), Modified Sulcular Bleeding Index, Probing Pocket Depth, and CALs were recorded. About 1.5 ml of blood was collected from the antecubital fossa by venipuncture at baseline and 1 month after periodontal treatment. The blood sample was allowed to clot at room temperature. After 1 h, serum was separated from blood by centrifuging at 1800 rpm for 5 min and 0.5 ml extracted serum was immediately transferred to vial and each serum vial was given a tracking number and sent to laboratory for analysis. Group II CP (experimental group) patients were evaluated clinically 1 month after nonsurgical periodontal treatment to reassess the periodontal measurements described previously. Clinical examination was carried out by a single examiner.


  Results Top


The present study was an in vivo interventional study conducted to assess the effect of CP on serum ferritin levels before and 1 month after nonsurgical periodontal treatment. The mean difference in serum ferritin levels when compared between control Group I (healthy individuals) (68.49 ng/ml) and experimental Group II CP patients (116.23 ng/ml) at baseline was 47.74 ng/ml which was statistically highly significant (P ≤ 0.001) [Table 1]. The mean difference in serum ferritin levels when compared between control Group I (healthy individuals) (68.49 ng/ml) and experimental Group II (CP) patients (103.65 ng/ml) 1 month after nonsurgical periodontal treatment was 36.16 ng/ml which was statistically highly significant (P ≤ 0.001) [Table 2]. The mean difference in serum ferritin levels when compared between experimental Group II (CP) patients at baseline (116.23 g/dl) and 1 month after nonsurgical periodontal treatment (103.65 g/dl) was 12.58 g/dl which was statistically highly significant.(P ≤ 0.001) [Table 3].
Table 1: Intergroup comparison of serum ferritin levels in Group I (healthy individuals) and Group II (chronic periodontitis) patients at baseline

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Table 2: Intergroup comparison of serum ferritin levels in Group I (healthy individuals) and Group II (chronic periodontitis) patients 1 month after nonsurgical periodontal treatment

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Table 3: Intragroup comparison of serum ferritin levels in Group II (chronic periodontitis) patients at baseline and 1 month after nonsurgical periodontal treatment

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  Discussion Top


In the present study, the mean serum ferritin levels of Group II (CP) patients at baseline were found to be higher than the Group I (healthy individuals). Even though serum ferritin levels in Group II was higher than Group I, the serum ferritin concentration of both Group I and Group II were in normal range (≤200 ng/ml for female and ≤300 ng/ml for male). This could attribute to the fact that CP is an inflammatory disease and rise in serum ferritin levels is concomitant with the degree of inflammation or chronicity of inflammation. Consequently, the present study results were similar to the result obtained by Chakraborty et al., Guo et al., and Santosh et al.[4],[5],[6] where serum ferritin levels were higher in CP patients than healthy individuals but contradictory to those obtained by Ali et al., Latha et al., Prakash et al.[7],[8],[9] The key finding of the present interventional study was statistically significant reduction in serum ferritin levels 1 month after nonsurgical periodontal therapy in CP patients, which is in accordance to the study done by Chakraborty et al. and Bhavya et al.[4],[10] 11 out of 15 (73%) Group II (CP) patients treated by nonsurgical periodontal therapy showed reduction in serum ferritin levels compared to baseline which might be due to the reduction of inflammation or infection. 4 out of 15 (27%) Group II (CP) patients treated by nonsurgical periodontal therapy showed slightly increased levels of serum ferritin levels but were within the normal range which might be due to nonresolving of the inflammation. One of the important remarks about this study is that, serum ferritin levels are determined to evaluate the periodontal health status and its effectiveness in evaluating after periodontal therapy. The results showed that CP patients had an elevated serum ferritin levels compared to healthy individuals. Furthermore, nonsurgical periodontal therapy of CP patients has reduced the serum ferritin levels along with the improvement in periodontal clinical parameters. These findings are similar to the study done by Chakraborty et al. and Bhavya et al.[4],[10]


  Conclusion Top


In the present study, serum ferritin levels were found to be elevated in the CP patients at baseline compared to healthy individuals and 1 month after nonsurgical periodontal treatment. Suggesting nonsurgical periodontal treatment may have an effect on serum ferritin levels. Hence, it can be concluded that this 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 predisposing factor and end in periodontal disease, like the acquisition of infection in general is dependent on host-related issues of where serum ferritin levels is, but one of the many contributing factors.

Financial support and sponsorship

Nil.

Conflicts of interest

There no conflicts of interest.



 
  References Top

1.
Tonetti MS, Claffey N; European Workshop in Periodontology Group C. Advances in the progression of periodontitis and proposal of definitions of a periodontitis case and disease progression for use in risk factor research. Group C consensus report of the 5th European workshop in periodontology. J Clin Periodontol 2005;32 Suppl 6:210-3.  Back to cited text no. 1
    
2.
Chow JK, Werner BG, Ruthazer R, Snydman DR. Increased serum iron levels and infectious complications after liver transplantation. Clin Infect Dis 2010;51:e16-23.  Back to cited text no. 2
    
3.
Becerik S, Öztürk VÖ, Atmaca H, Atilla G, Emingil G. Gingival crevicular fluid and plasma acute-phase cytokine levels in different periodontal diseases. J Periodontol 2012;83:1304-13.  Back to cited text no. 3
    
4.
Chakraborty S, Tewari S, Sharma RK, Narula SC. Effect of non-surgical periodontal therapy on serum ferritin levels: An interventional study. J Periodontol 2014;85:688-96.  Back to cited text no. 4
    
5.
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. 5
    
6.
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. 6
    
7.
Ali CJ, Ahmed MA. Evaluation of serum ferritin, hemoglobin, mean cell volume, mean corpuscular hemoglobin concentration and mean corpuscular hemoglobin levels in blood from patients with different severities of periodontal diseases. Res J Pharm Biol Chem Sci 2018;9:593-600.  Back to cited text no. 7
    
8.
Latha S, Thirugnanamsambandan S, Arun RT, Masthan KM, Malathi L, Rajesh E. Serum ferritin level and red blood cell parameters in healthy controls and chronic periodontitis patients. J Pharm Bioallied Sci 2015;7:S184-9.  Back to cited text no. 8
    
9.
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
    
10.
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. Int J Recent Sci Res 2017;8:20276-9.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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