Resumen de Combining Salivary Pathogen and Serum Antibody Levels Improves Their Diagnostic Ability in Detection of Periodontitis
Background: Initiation and progression of periodontitis correlates with increased quantities of periodontitis-associated bacteria in periodontal biofilms. In the present study, the aim is to measure Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis amounts in saliva and their antibody (immunoglobulin [Ig]A and IgG) levels in serum and evaluate their diagnostic abilities, together or alone, in chronic periodontitis.
Methods: The study population comprised 230 Finnish dentate adults: 84 with generalized chronic periodontitis (GCP), 65 with localized chronic periodontitis (LCP), and 81 controls without periodontitis. General and oral health information was obtained by questionnaires, interviews, and clinical and radiographic examinations. Salivary and serum samples were analyzed by quantitative single copy gene�based real-time polymerase chain reaction and multiserotype enzyme-linked immunosorbent assay, respectively.
Results: Pathogen carriers suffered mostly from GCP and seldom from LCP. A. actinomycetemcomitans and P. gingivalis quantities in saliva were strongly associated with corresponding serum IgA and IgG values (P <0.001) and with severity of disease (P <0.001). P. gingivalis exhibited more straightforward associations among salivary bacterial burdens, corresponding antibody formation, and periodontitis severity than A. actinomycetemcomitans. The combination of information on age, sex, smoking, and P. gingivalis results provided an area under the curve of 0.817 (95% confidence interval 0.76 to 0.87, P <0.001) for GCP.
Conclusion: The combination of saliva P. gingivalis quantity with pathogen-specific host response may be used to diagnose periodontitis with high accuracy.
Periodontitis is an infection-induced inflammatory disease initiated by periodontitis-associated bacteria. Etiologically, the most important periodontal microorganisms are Gram-negative, facultative, or obligatory anaerobic rods. Among them, the two major pathogens, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, are etiologically linked to aggressive or chronic forms of periodontal disease, respectively.1 The presence of these two pathogens in saliva was suggested to be a good indicator of periodontitis, since both of them increase their numbers in the oral cavity together with the initiation and progression of disease and, in addition, frequently are found in low numbers in periodontally healthy individuals.1 Initial tissue response against bacterial challenge includes the release of inflammatory markers from cells of the junctional and sulcular epithelium and from fibroblasts and neutrophils. With the progression of disease, humoral response to increased bacterial challenge by specific antibodies is regulated by activated B-cells.2 To monitor periodontal health status and the onset, progression, and treatment outcome of periodontal diseases through non-invasive means is a desirable goal.3 Saliva, an easily collected and non-invasive specimen, has long been used as a diagnostic fluid in medicine.4 In periodontology, several host- or bacteria-derived markers, such as elevated levels of bacteria, bacterial products, host-originated enzymes, cytokines, and bone turnover biomarkers, have been analyzed in saliva and proposed as candidate diagnostic markers of periodontitis.4 However, there are still many inconsistencies and disagreements in the literature regarding use of salivary markers as periodontitis indicators; these inconsistencies are generally attributed to the heterogeneity of detection techniques, as well as local and systemic factors that may affect the detection level of examined markers in saliva. It was previously proposed that chronic periodontitis, the most prevalent form of destructive periodontal disease, has dynamic states of exacerbation and remission, and that the increase or the decrease in bacterial burden, inflammatory response, and tissue breakdown may not occur simultaneously but consecutively at different sites of periodontal tissues.5 In the present study, it is hypothesized that the simultaneous use of infection- and immune response�related biomarkers improves their diagnostic capabilities, compared with their use individually. Thus, the present aim is to analyze salivary levels of A. actinomycetemcomitans and P. gingivalis and their serum antibodies, alone or together, as markers of periodontitis.
