Inflammatory markers in the saliva of cerebral palsy individuals with gingivitis after periodontal treatment

Abstract

The aim of this study was to evaluate the effect of periodontal treatment on the salivary cytokine levels and clinical parameters of individuals with cerebral palsy (CP) with gingivitis. A non-randomized, clinical trial was conducted in individuals diagnosed with spastic CP. Thirty-eight individuals were enrolled in the study and were categorized according to gingival index scores between 0-1 or 2-3, assigned to groups G2 or G1, respectively. Periodontal treatment comprised oral hygiene instructions, conventional mechanical treatment and 0.12% chlorhexidine applied as an adjunct. Clinical parameters and saliva samples were collected at baseline and at the 15-day follow-up visit. Bleeding on probing and periodontal screening and recording were determined. Non-stimulated saliva samples were obtained, and the salivary flow rate, the osmolality and the levels of cytokines IL-1β, IL-6, IL-8, IL-10, TNF-α and IL-12p70 were evaluated by a cytometric bead array. The Wilcoxon test, the Mann-Whitney test, Spearman correlation analysis, Poisson regression analysis and an adjusted analysis were performed (α = 0.05). The groups differed significantly in periodontal clinical parameters at baseline and at follow-up. Salivary flow rate and osmolality were similar in both groups at both timepoints. However, TNF-α and IL-1β levels were higher in G1 than in G2 at baseline. Mechanical treatment resulted in improved clinical parameters for both groups. Furthermore, mechanical treatment resulted in a significant reduction in salivary IL-1β and IL-8 levels for both groups after treatment. Periodontal treatment performed in individuals with CP and gingivitis reduces the levels of TNF-α, IL-1β, IL-6 and IL-8.

The Impact of Oral-Gut Inflammation in Cerebral Palsy

“…However, the degree of mucosal inflammation of constipated CP subjects represented by GB was so high that IL-10 action did not reduce the inflammatory process of dysbiosis (59). Only one study reported the effect of mechanical treatment on gingivitis control measures by cytokines levels, and the results showed that, although reduction of inflammatory process occurs, the levels of IL-1β, IL-6, and IL-8 remain high compared to subjects without CP (8).…”

“…Inflammatory biomarkers can be evaluated both in serum (67) or in saliva (8). Blood collection in subjects with CP is a hard task, because these subjects present sympathetic nervous system predominance (68), resulting in vasoconstriction, and consequently making peripheral venous access more difficult.…”

“…GMFCS is stratified into five levels of body mobility: Level I (walking without limitations), Level II (walking with limitations), Level III (walking using a hand-held mobility device), Level IV (self-mobility with limitations), and Level V (transported in a wheelchair) (6). Our previous studies demonstrated that out of 254 subjects, 50 (19.7%) had GMFCS I, II, or III while 204 (80.3%) presented GMFCS IV or V (7)(8)(9). Notably, epilepsy prevalence increases in spastic CP subjects at the highest GMFCS classifications (IV and V) (10).…”

Clinical and Inflammatory Factors Influencing Constipation and Quality of Life in Cerebral Palsy

“…Inflammatory biomarkers can be evaluated both in serum [49] or in saliva [8]. Blood collection in subjects with CP is a hard task, because these subjects present sympathetic nervous system predominance [50], resulting in vasoconstriction, and consequently making peripheral venous access more difficult.…”

“…GMFCS is stratified into five levels of body mobility: Level I (walks without limitations), Level II (walks with limitations), Level III (walks using a hand-held mobility device), Level IV (self-mobility with limitations) and Level V (transported in a wheelchair) [6]. Our previous studies demonstrated that out of 254 subjects, 50 (19.7%) subjects had GMFCS I, II or III while 204 (80.3%) presented GMFCS IV or V [7][8][9]. These proportion results reflect on the population of this current cohort.…”