Non-Surgical Periodontal Therapy Could Improve the Periodontal Inflammatory Status in Patients with Periodontitis and Chronic Hepatitis C

Abstract

Non-surgical periodontal therapy (NSPT) is the first essential step for the management of any periodontitis patient. This study aims to evaluate the impact of NSPT on pro-inflammatory mediators’ regulation and on clinical parameters in periodontitis patients who suffer from chronic hepatitis C. At baseline, selected patients were clinically evaluated for their periodontal status. A subsequent quantitative assessment of C-reactive protein and pentraxin-3 in samples of gingival fluid was performed by Enzyme-Linked Immunosorbent Assay (ELISA). Afterwards, NSPT was performed. Three months after NSPT, the clinical and ELISA assessments were repeated. The results show an improvement of the clinical parameters in periodontitis patients at the three-month recall. In chronic hepatitis C patients with periodontitis, the gingival fluid levels of pro-inflammatory markers reduced significantly. The targeted markers also expressed significant correlations with the clinical parameters used for the assessment of periodontitis’ severity. The results suggest that, while chronic hepatitis C patients exhibited a more negative periodontal status at baseline as compared to non-hepatitis ones, NSPT is effective in decreasing the local periodontal inflammatory reaction and in proving the periodontal status of this type of patients. Given the limitation of the study, periodontal screening and NSPT should be included in the integrated therapeutical approach of chronic hepatitis C patients, for its impact on the local inflammatory response.

Immunological Insights on Pathogenic Connections between Hepato-Digestive Disorders and Periodontal Conditions

“…PTX, also known as acute-phase proteins (APP), play a key role in the initiation of inflammation, primarily by protecting against pathogenic bacteria via complement activation. This role is supported by the fact that in GCF samples originating from patients diagnosed with periodontitis, PTX3 levels were significantly elevated, as compared to control groups [36,75]. These elevated GCF PTX3 levels also correlated with clinical periodontal parameters, suggesting an early up-regulated synthesis of this mediator by neutrophil cells, in response to periodontal bacterial aggression [36].…”

“…Serum amyloid P and CRP are two minor members of this family. One of the long proteins in this family, plasma pentraxin 3 (PTX3), is detected in significantly higher concentrations in patients with steatohepatitis than in those without [36]. Patients with more severe forms of NAFLD have higher serum concentrations of this protein, and higher levels of this protein are associated with more severe forms of hepatic fibrosis.…”

Periodontitis, Metabolic and Gastrointestinal Tract Diseases: Current Perspectives on Possible Pathogenic Connections

“…This mechanism is also found in degenerative hepatic conditions (as CHC and MAFLD). The inflammatory reaction in both periodontitis and hepatic conditions is driven by the same pro-inflammatory mediators, thus generating the hypothesis that the two type of conditions may share a pathogenic connection [ 54 , 55 ].…”

“…The evaluation of the periodontal and dental status of periodontitis patients with CHC has shown that it was significantly more negatively modified than that of non-CHC periodontitis participants, in terms of tooth loss, number of periodontal pockets, periodontal pocket depth, clinical attachment loss and gingival index [ 55 ]. Furthermore, periodontitis + CHC patients exhibited significantly elevated gingival fluid levels of specifically-hepatic-synthetized enzymes, such as aspartate-aminotransferase and alanine-aminotransferase [ 56 , 57 ].…”

DNA-aptamer-nanographene oxide as a targeted bio-theragnostic system in antimicrobial photodynamic therapy against Porphyromonas gingivalis

“…Pharmacological intervention and surgery are considered the gold standard therapeutic protocol for advanced periodontitis, which may be associated with a high level of displeasure in the patient 3 . Although non-surgical treatment can improve important clinical parameters, microbial pathogens are not significantly reduced and this approach is not also effective in moderate to severe periodontal lesions 4 – 6 . Periodontitis is a polymicrobial disease and Porphyromonas gingivalis , as one of the most common bacterial causes, forms a microbial biofilm in the periodontium and on the teeth through the expression of various virulence factors, which eventually leads to treatment failure 7 .…”