Effect of nonsurgical periodontal therapy on serum and gingival crevicular fluid cytokine levels during pregnancy and postpartum

Abstract

Background and Objective: A low‐grade systemic inflammatory status originating from periodontal infection has been proposed to explain the association between periodontal disease and systemic conditions, including adverse obstetric outcomes. The aim of this study was to evaluate the effect of periodontal therapy during pregnancy on the gingival crevicular fluid and serum levels of six cytokines associated with periodontal disease and preterm birth. Material and Methods: A subsample of 60 women (18–35 years of age) up to 20 gestational weeks, previously enrolled in a larger randomized clinical trial, was recruited for the present study. Participants were randomly allocated to receive either comprehensive nonsurgical periodontal therapy before 24 gestational weeks (n = 30, test group) or only one appointment for supragingival calculus removal (n = 30, control group). Clinical data, and samples of blood and gingival crevicular fluid, were collected at baseline, at 26–28 gestational weeks and 30 d after delivery. The levels of interleukin (IL)‐1β, IL‐6, IL‐8, IL‐10, IL‐12p70 and tumor necrosis factor‐α were analyzed by flow cytometry. Results: After treatment, a major reduction in periodontal inflammation was observed in the test group, with bleeding on probing decreasing from 49.62% of sites to 11.66% of sites (p < 0.001). Periodontal therapy significantly reduced the levels of IL‐1β and IL‐8 in gingival crevicular fluid (p < 0.001). However, no significant effect of therapy was observed on serum cytokine levels. After delivery, the levels of IL‐1β in the gingival crevicular fluid of the test group were significantly lower than were those in the control group (p < 0.001), but there were no significant differences between test and control groups regarding serum cytokine levels. Conclusion: Although periodontal therapy during pregnancy successfully reduced periodontal inflammation and gingival crevicular fluid cytokine levels, it did not have a significant impact on serum biomarkers.

Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta‐analysis

“…, Fiorini et al. ). These trials reported the effect of PT on pregnancy outcomes and were therefore not related to CVD.…”

Systemic inflammatory burden and local inflammation in periodontitis: What is the link between inflammatory biomarkers in serum and gingival crevicular fluid?

“…However, in a large group of pregnant women, periodontal treatment had no influence on the levels of the selected inflammatory biomarkers (Michalowicz et al, 2009). These findings were further confirmed by many others who did not detect differences in systemic biomarkers before and after treatment (Fiorini et al, 2013;Geisinger et al, 2016). Another systematic review and meta-analysis on the role of C-reactive protein rejected the hypothesis that periodontal treatment can reduce systemic C-reactive protein levels (Ioannidou, Malekzadeh, & Dongari-Bagtzoglou, 2006).…”

Changes in inflammatory mediators in gingival crevicular fluid following periodontal disease treatment in pregnancy: relationship to adverse pregnancy outcome

“…There is ample evidence demonstrating that treatment of periodontal disease improves the inflammatory profile of GCF, decreasing the levels of a variety of cytokines such as IL-1IL-6,IL-8, IL-10, IL-12, IL-17, TNF-chemokines RANTES) and prostaglandins in the affected sites (Gamonal et al 2000, Thunell et al 2010, de Lima Oliveira et al 2012, Gupta et al 2013. Treatment and subsequent reduction in inflammatory mediator levels is also associated with significant improvements in the clinical parameters of the disease, such as probing depths, percentage of bleeding on probing and plaque (Ide et al 2003, Offenbacher et al 2006b, Fiorini et al 2013; however, the effects of pregnancy on GCF inflammatory status in periodontal disease are not known. Pregnancy is a state of selective immune modulation, characterised by a decreased Th1-type response to some antigens and an increased Th2 response to others (Mor et al 2011).…”

“…Hence, the inflammatory profile of GCF in pregnancy and its response to treatment may be atypical and explain the risk of inflammation-associated pregnancy complications such as preterm birth, low birth weight and fetal growth restriction. Only one previous study has been published in this area: Fiorini et al observed major reductions in GCF levels of IL-1β and IL-8 and periodontal inflammation after nonsurgical periodontal therapy during pregnancy, with no significant effect on cytokine levels in the maternal circulation (Fiorini et al 2013). The effects of treatment on pregnancy outcome were not investigated.…”