Effect of Periodontal Therapy on Salivary Nitric Oxide Levels in Chronic Periodontitis Patients with and without Hypertension
Nitric Oxide(NO) is a multifunctional signaling molecule involved in the maintenance of metabolic, cardiovascular homeostasis and a potent endogenous vasodilator that suppresses the formation of vascular lesions in atherosclerosis. Through nitrate-nitrite reduction and some commensal oral bacteria can supply bioactive NO, which is essential for the endothelial cell function and regulation of arterial BP, it is thought that a decreased quantity of oral nitrate-reducing bacteria and an increased quantity of pathogenic bacteria are responsible for a correlation between oral hygiene and chronic periodontitis and at a later stage cardiovascular diseases(CVD).
To evaluate the effect of periodontal therapy on salivary NO levels in chronic periodontitis (CP) patients and chronic periodontitis patients with hypertension.
Materials and methods:
A total of 60 subjects with age group of 20-55 years male and female subjects, divided into three groups, 20 each. Group I– control (Healthy), group II–CP (chronic periodontitis) and group III–CP with Hypertension. Subjects underwent clinical examination for Plaque Index, Gingival Bleeding Index, Probing Pocket Depth, Clinical Attachment Level using UNC15 probe and Blood pressure measurement using Sphygmomanometer. Salivary nitric oxide concentration detected using human N Strips developed from University of Texas health science. All the parameters were evaluated at baseline and 4weeks after initial periodontal therapy.
Four weeks after initial periodontal therapy both groups II and III exhibited improvement in clinical periodontal parameters (OHI-S, GI, PPD, CAL) and at baseline salivary NO levels were depleted in group III and low in group II, after 4 weeks salivary NO was low and adequate respectively however, statistically significant differences were observed only with OHI-(S) and salivary NO values in both groups II and III (p < 0.05). However, when the post-treatment clinical periodontal parameters and salivary NO level of groups II and III were compared, statistically significant differences (p < 0.05) were observed except for PPD and CAL between the groups.
Study revealed depleted salivary nitric oxide levels in periodontitis with hypertensive group and low levels of nitric oxide levels with chronic periodontitis patients as compared to the control group at baseline and the NO levels were improved after 4 weeks in both the groups II and III improving the blood pressure levels. Salivary Levels NO can be utilized as an indicator for assessment of the periodontitis as well as hypertensive patients. Periodontal therapy is effective in improving salivary levels of NO in both the groups.
A co- relationship exists between periodontal disease and hypertension. NO is found to play a significant role in the pathobiology of both CP and hypertyension. Initial periodontal therapy seems to be beneficial in improving salivary NO levels along with periodontal parameters in CP patients with or without hypertension. However further studies are warranted to enhance our knowledge about the role of NO in periodontal diseases in the course of hypertension.
Hypertension, Periodontal Therapy, Periodontitis, Salivary Nitric oxide.