Cross‐sectional analysis of risk factors for subclinical periodontitis; active matrix metalloproteinase‐8 as a potential indicator in initial periodontitis in adolescents

Abstract

Background The aim of this study was to investigate how different patient‐related risk indicators might be associated with the odds of developing subclinical periodontitis in adolescents. Methods This cross‐sectional study included 252 Finnish individuals aged 15 to 16 years, of whom 141 were boys and 111 girls. A specially trained dentist performed clinical examinations: measurements included periodontal indexes (bleeding on probing, visible plaque index, root calculus, and probing depth, smoking by pack‐years, periodontal bacteria (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, Prevotella nigrescens, and Treponema denticola) and the potential salivary periodontal biomarkers (active matrix metalloproteinase‐8 [aMMP‐8], polymorphonuclear leukocyte elastase [PMN elastase], and total protein, albumin, immunoglobulin A, immunoglobulin G, and immunoglobulin M). Results were analyzed by ordinal logistic regression, one‐way analysis of variance, Fisher exact test, and Kruskal‒Wallis H test. Results The main finding of this study was that subclinical periodontitis in adolescents was statistically significantly associated with elevated salivary aMMP‐8 but not with PMN elastase. Also, adolescents with subclinical periodontitis had statistically significantly higher levels of bleeding on probing, root calculus, and dental plaque than adolescents without subclinical periodontitis. Conclusions We suggest that the main risk factor for subclinical periodontitis in adolescents is the partly calcified, dysbiotic bacterial biofilm, which interacts with the immune defenses of the host; this leads to gingival inflammation and eventually to deepening periodontal pockets. This proinflammatory subclinical periodontitis stage, which represents stage I periodontitis in the new classification, is reflected as elevated salivary aMMP‐8 levels in oral fluids.

Evaluation of Salivary Biomarkers for the Diagnosis of Periodontitis

“…Recent investigations showed MMP-8 to be an indicator especially for early periodontitis [20,21]. In the current study, MMP-8 in the gingivitis and periodontitis groups showed signi cant higher compared to the healthy group, but there was no signi cant difference between periodontitis and gingivitis group.…”

Active Matrix Metalloproteinase-8 Point-of-Care (PoC)/Chairside Mouthrinse Test vs. Bleeding on Probing in Diagnosing Subclinical Periodontitis in Adolescents

“…The aMMP-8 PoC test also has the potential to enhance the periodontal risk assessment of patients. As has been suggested by Heikkinen et al [2], the aMMP-8 PoC test result could be used together with other patient-related risk factor information, e.g., gender, use of tobacco products, as well as oral health habits, such as toothbrushing, to create an even more accurate periodontal disease risk profile for patients. Moreover, Räisänen et al [22] recently reported a strong association between patient’s aMMP-8 PoC test results and his/her periodontal treatment needs (CPITN) among adolescents and adults.…”

“…Activated matrix metalloproteinase-8 (MMP-8) is a major destructive collagenase in periodontitis [1] but, also, a potential biomarker for initial periodontitis/subclinical periodontitis/pre-periodontitis as well as periodontitis [1,2,3,4,5]. According to several studies [1,2,6,7,8,9,10,11], the progression of periodontitis is reflected as an excessive elevation and activation of MMP-8 in oral fluids. This stage can be measured using a point-of-care lateral flow collagenase-2 immunotest [1,12,13,14,15,16,17,18,19,20,21,22,23].…”

Regulation of Salivary Peptidoglycan Recognition Protein 1 in Adolescents

“…Inclusion criteria were adolescents aged 15 to 16 y living in Kotka and without any orthodontic treatment history and mixed dentition. All participants were examined clinically and, based on a questionnaire, details about general health and health habits (e.g., smoking) registered (Heikkinen et al 2008, 2010, 2016, 2018). Those who were smoking daily or weekly were considered current smokers.…”

“…The groups were formed in the following way: healthy group if full-mouth BOP <20 without deep periodontal pockets, gingivitis group if BOP ≥20 without deep periodontal pockets, and subclinical periodontitis group if they had deep periodontal pockets. In the subclinical periodontitis, not all of the clinical or x-ray manifestation symptoms required to diagnose periodontitis are present; mainly gingival bleeding and shallow periodontal pockets exist (Heikkinen, Pakbaznejad, et al 2017; Heikkinen, Raivisto, et al 2017; Heikkinen et al 2018; Räisänen et al 2019). Subclinical periodontitis corresponds to stage I periodontitis, according to the new classification of periodontal diseases (Caton et al 2018).…”