The study investigated the influence of periodontal status and levels of periodontal pathogens on salivary 8-hydroxydeoxyguanosine (8-OHdG) and interleukin 17 (IL-17) levels. The study found that salivary 8-OHdG and IL-17 levels were higher in patients with chronic periodontitis compared to healthy controls and decreased after nonsurgical periodontal treatment. Variations in clinical parameters like probing depth and clinical attachment level impacted 8-OHdG levels, while variations in microbial parameters like levels of Treponema forsythia affected IL-17 levels. The study provides evidence that periodontal status and pathogens influence biomarkers of oxidative stress and inflammation.

1. THE INFLUENCES OF PERIODONTAL
STATUS AND PERIODONTAL PATHOGEN
QUANTITY ON SALIVARY
8-HYDROXYDEOXYGUANOSINE AND
INTERLEUKIN17 LEVELS
Yang et al
J Periodontol.2015
PRESENTED BY
BIBINA GEORGE

2. INTRODUCTION
• Periodontitis is one of the most prevalent oral diseases and a major cause of tooth
loss in adults.
• Among many pathogenic factors, plaque is well known to be an initial contributor
to periodontitis.

3. • Socransky SS et al. detected the subgingival microbiota using checkerboard
DNA-DNA hybridization and observed 5 complexes.
• Red complex:
- Porphyromonas gingivalis (Pg),
- Tannerella forsythia (Tf) and
-Treponema denticola (Td)

4. BIOMARKERS OF INFLAMMATION
8-OHdG
• Most stable product of ROS
• Marker of mitochondrial DNA
damage caused by premature
oxidation in the gingival tissues of
periodontitis patients
{Canakci CF et al}
IL-17
• Proinflammatory cytokine produced by
T-helper 17 cells
• Stimulate various cell types to produce
other inflammatory cytokines and
chemokines
• Preserves immune homeostasis
• Supports immune responses (Th1) and
combines with receptor activator of
RANK and RANKL, resulting in
osteoclastic bone resorption

5. AIM
• To investigate the influences of clinical and microbial parameters on
variation of 8-OHdG and IL-17 levels in saliva.

6. MATERIALS AND METHODS:
• SOURCE OF DATA:
Patients who attended the Department of Periodontics, School of
Stomatology, China Medical University .
• Ethical clearance:
Reviewed and approved by Ethics Committee of China Medical
University.
• Duration of study: Feb. 2013 – June 2014

7. SELECTION CRITERIA:
INCLUSION CRITERIA
• ≥ 20 teeth
• PD ≥ 4mm
• CAL ≥ 2mm
• Radiograph showing > 30 %
bone destruction
EXCLUSION CRITERIA
• Habits
• Systemic illness
• Pregnancy

8. EXPERIMENTAL DESIGN:
Periodontal Examination
• Simplified Oral Hygiene Index
(OHS) (Greene and Vermillion)
• Sulcular Bleeding Index (SBI)
• Probing pocket depth (PPD)
• Clinical attachment loss
measurements
Clinical Examination
• Measured four sites per tooth:
• Mesio-buccal
• Buccal
• Disto-buccal
• lingual
SAMPLE COLLECTION
• DNA Extraction and
Real time PCR
96 participants:
48 CP + 48 Healthy

9. SAMPLE COLLECTION
SUBGINGIVAL PLAQUE
SAMPLE
SALIVA
COLLECTION
Sterile Eppendorf tubes
Right
Quadrant
Left
Quadrant
MesiolingualMesiobuccal
500 µl phosphate
buffered saline
solution
5 ml sterile plastic
centrifuge tube
LAB
Stored at -80°C

10. DNA Extraction Real time - PCR
Saliva Sample ELISA
P. gingivalis
T. forsythia
T. denticola
8- OHdG
IL-17

11. STATISTICAL ANALYSIS
• Software: SPSS 13.0
• Tests:
Students t test
ANOVA
Pearson’s correlation analysis
P value ≤ 0.05

12. RESULTS
:
Comparison of Demographic and Clinical Parameters
Between CP and Control Groups at Baseline

13. Comparison of Salivary 8-OHdG and IL-17 Levels With Clinical
and Microbial Parameters at Baseline

14. Comparison of Clinical and Microbial Parameters Before and
After Nonsurgical Treatment

15. DISCUSSION
• Salivary 8-OHdG level in CP group
was higher than that in control group.
• 8-OHdG levels were significantly
decreased after treatment at both 1 and
3 months
• Variations in the clinical parameters
impacted the variation in the salivary 8-
OHdG level, while variations in the
microbial parameters affected the
variation in the salivary IL-17 level
8OHdG
Clinical
Parameters
CP
IL-17
Microbial
Parameter
CP

16. REVIEW OF LITERATURE:
• Settem RP et al. A bacterial glycan core linked to surface (S)-layer
proteins modulates host immunity through Th17 suppression. Mucosal
Immunol.2013 Mar;6(2):415-26. demonstrated that the surface
glycosylation of T.forsythia acted to ensure its persistence in the host, likely
through the suppression of Th17 responses. In addition, suggested that the
bacterium then induces the Toll-like receptor 2-Th2 inflammatory axis to cause
bone destruction.

17. • Dede FO et al. 8-hydroxy-deoxyguanosine levels in gingival crevicular fluid
and saliva in patients with chronic periodontitis after initial periodontal
treatment. J Clin Periodontol. 2013 Jun;84(6):821-8. evaluated the effects of
initial periodontal treatment on the gingival crevicular fluid (GCF) and
salivary levels of 8-hydroxy-deoxyguanosine (8-OHdG) as a marker of
oxidative deoxyribonucleic acid (DNA) damage in patients with chronic
periodontitis (CP) and revealed that DNA injury and oxidative stress increased in
tissue cells and especially in periodontal pockets in patients with CP, and the
periodontal treatment resulted in a significant decrease of 8-OHdG levels in the GCF
samples.

18. • Shaker OG et al. IL-17 and IL-11 GCF Levels in Aggressive and Chronic
Periodontitis Patients: Relation to PCR Bacterial Detection.Himdawi.
2012(2012)/174764. evaluated IL-17 and IL-11 in gingival crevicular fluid (GCF)
of generalized chronic periodontitis (GCP) and generalized aggressive periodontitis
(GAgP) patients in relation to periodontopathic bacteria and found that IL-17 level
was more in GCF of GAgP, suggesting a potential role in the aetiopathogenesis, and
the decreased ratio of IL-11/IL-17 might reflect an imbalance between the
proinflammatory and anti-inflammatory cytokines in different periodontal diseases.
The high positivity of P. gingivalis in the dental plaque was associated with
significantly increased GCF levels of IL-17 in GCP and GAgP patients.

19. • Ozcaka O et al. Interleukin-17 and interleukin-18 levels in saliva and
plasma of patients with chronic periodontitis. J Periodontol Res.
2011:Oct;46(5):592-8.investigated whether patients with chronic periodontitis
exhibited different salivary and/or plasma concentrations of interleukin (IL)-17 and
IL-18 compared with clinically healthy subjects and found IL-17 level significantly
lower than IL-18 in chronic periodontitis patient but higher than healthy patients .

20. • Pabon MCM et al.Detection of Treponema denticola in saliva obtained
from patients with various periodontal conditions. Clin Investigations.
March 2008;12(1):73–81. determined the prevalence of T. denticola in saliva
samples from patients with chronic periodontitis, aggressive periodontitis, and healthy
subjects by assessing the probing depth, clinical attachment loss, and extent of
periodontal breakdown. They concluded that the prevalence of T. denticola in CP
patients was significantly higher than those in healthy and AgP subjects. Furthermore,
all clinical measurements were significantly greater (P < 0.05) for T. denticola-positive
subjects compared to T. denticola-negative subjects.

21. CONCLUSION
• The salivary 8-OHdG and IL-17 levels in CP patients were significantly reduced
after non-surgical treatment.
• Variation in the salivary 8-OHdG level arose due to variations in the PD, CAL
and OHI-S.
• However, variation in the salivary IL-17 level was attributed to variations in the
PD, subgingival quantity of T. forsythia, and salivary quantities of P. gingivalis,
T. forsythia and T.denticola.
• These findings may be of great significance in facilitating the rapid evaluation
of clinical periodontal status.

22. CRITICAL APPRAISAL:
• Title of the article is self explanatory as it defines the necessity of
the study.
• The study does not precisely establish the possible relation between
the periodontal pathogens and 8-OHdG and IL-17.
• Study focuses more on 8-OHdG and IL-17 rather than the
implications of effects of the periodontopathogens.