RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA ANNEXURE II PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION 1 NAME

E AND ADDRESS OF THE Dr. SARUN.E CANDIDATE POST GRAGUATE STUDENT DEPARTMENT OF PERIODONTICS DAYANANDA SAGAR COLLEGE SCIENCES KUMARSWAMI LAYOUT BANGALORE

OF

DENTAL

2 NAME OF THE INSTITUITION

DAYANANDA SCIENCES

SAGAR

COLLEGE

OF

DENTAL

COURSE OF SUBJECT

STUDY

AND MASTER OF DENTAL SURGERY, PERIODONTICS.

! DATE OF ADMISSION TO THE 2! " #$" 2#1# COURSE

$ TITLE OF THE TOPIC

EVALUATION OF GLUTATHIONE LEVEL IN GINGIVAL CREVICULAR FLUID IN PERIODONTAL HEALTH, IN CHRONIC PERIODONTITIS AND IN POST NON SURGICAL PERIODONTAL THERAPY" A CLINICO BIOCHEMICAL STUDY.

%. BRIEF RESUME OF THE INTENDED WORK

%.1 NEED FOR THE STUDY Periodontitis is an inflammatory disease characterized by a non resolving inflammation, generated in response to virulence factors elaborated by periodontal pathogens. Neutrophils are the predominant inflammatory cells within diseased periodontal tissues, and therefore the release of their lysosomal enzymes and the generation of extracellular reactive oxygen species is thought to be a major factor in the etiology of local tissue damage. Oxidative stress is implicated in the pathogenesis of periodontitis and alters the redox balance of the tissues and also the cells of the innate immune system.1 lutathione, present predominantly in gingival creviculr fluid, is reported to be the most lutathione is a non essential

important redox regulator and controls inflammatory process.

tripeptide. !t can be synthesized within the cell" however its constituent amino acids are essential and are obtained through the diet. !t also acts as a neurotransmitter governing neuro# immune# endocrine functions. !t is also important for the preservation and restoration of other antioxidant species. $ !t appears that periodontal redox balance is affected by periodontal inflammation, but can be restored to healthy levels by successful therapy. %e can demonstrate that successful non surgical therapy does not fully restore &'(reduced lutathione) concentration in &&' ratio). 'owever, ingival

crevicular fluid, but does restore the redox balance ( &'* lutathione) , && (oxidized lutathione) and total

&'(reduced ingival

lutathione concentration in

crevicular fluid remains lower than that in healthy patients, implying a reduced buffering capacity against +eactive oxygen species activity in periodontitis patients, even following successful therapy. ,his may constitute a deficiency in innate immunity in periodontitis patients, rendering them more susceptible to oxidative stress and its se-uelae. ,hese findings open up the potential to develop novel therapeutic approaches in the management of periodontitis based up on elevating the &' (reduced

lutathione) buffering capacity within the tissues using various pharmacological interventions.

,hus the purpose of the present study is to evaluate and compare the level of lutathione in gingival crevicular fluid of periodontally healthy controls, chronic periodontitis patients and evaluate the effect of non surgical periodontal therapy. %.2 REVIEW OF LITERATURE . study was conducted to -uantify reduced and oxidized glutathione level in ingival

crevicular fluid of periodontitis patients pre#therapy versus periodontally healthy controls and ascertain whether successful non surgical therapy alters glutathione level. +esults showed successful non surgical therapy did not fully restore &'( reduced lutathione) concentration in ingival

crevicular fluid but did restore the restore the redox balance ( &'* && ratio). 1 . study was conducted to investigate longitudinal changes in ingival crevicular fluid and

plasma total antioxidant capacity following reduction in periodontal inflammation with successful non surgical therapy. ,he result showed that there were no differences in plasma ,otal antioxidant capacity between periodontitis patients and controls at baseline, but ingival crevicular fluid ,otal

antioxidant capacity was lower in chronic periodontitis patients than controls. &uccessful periodontal therapy did not alter plasma ,otal antioxidant capacity but antioxidant capacity increased to control subject level. / . study was conducted to investigate the association between periodontal health and the serum levels of various antioxidants including carotenoids, retinol, and vitamin 0 in a homogenous group of %estern 0uropean men. ,he results showed that low serum levels of a number of carotenoids in particular beta cryptoxanthin and beta carotene were associated with an increased prevalence of periodontitis in that homogenous group of 12#32 yr old %estern 0uropean men. 4 . study was conducted to investigate the role of malondialdehyde level and total oxidant ingival crevicular fluid ,otal

status in serum, saliva, and gingival crevicular fluid in patients with chronic periodontitis. ,he results showed that in saliva and ingival crevicular fluid 5alondialdehyde level and serum and

ingival crevicular fluid total oxidatant status values were significantly higher in chronic periodontitis group than control group. No significant difference in serum 5alondialdehyde level was found.
6

. cross sectional study was conducted to determine both local (saliva and

ingival crevicular

fluid) and peripheral (plasma and serum) antioxidant capacity in periodontal health and disease. ,he mean levels of peripheral 7 salivary ,otal antioxidant capacity were lower in periodontitis and difference was only significant for plasma. ,his study concluded that antioxidant capacity of ingival crevicular fluid is both -uantitatively and -ualitatively distinct from that of saliva, plasma and serum.
1

%. OBJECTIVES OF THE STUDY 1. ,his study focuses to evaluate and compare the levels of glutathione in gingival crevicular fluid of periodontally healthy control, and chronic periodontitis patient8s and / months post non surgical periodontal treatment. $. ,o estimate the redox balance , which can be restored by non surgical periodontal therapy &. MATERIALS AND METHODS 3.1 SOURCE OF THE DATA &tudy will be conducted on both male and female patients who are in the age group of /2#62 years reporting to the 9epartment of Periodontics, 9ayananda sagar college of 9ental &ciences.

&.2 METHOD OF COLLECTION OF DATA ingival crevicular fluid sample will be obtained from $2 patients (12 male and 12 female) with chronic periodontitis and $2 periodontally healthy controls with age and gender matched. :erbal and written informed consent will be obtained from participants. &.1.1 INCLUSION CRITERIA 1) C'()r'* +r',( .2# gingiva should be clinically healthy without bleeding on

probing, no change in color, no evidence of attachment loss, probing depth ; /mm. $) S),/0 +r',(.2# chronic periodontitis patients with at least $ non adjacent < 6mm with bleeding on probing and

sites per -uadrant with probing depth

demonstrated radiographic bone loss in an intraoral periapical radiograph.

&.1.2

EXCLUSION CRITERIA 1) smo=ing habit $) usage of vitamin supplements /) usage of anti#inflammatory or antibiotic medication in past / months 4) any form of systemic diseases 6) oing through pregnancy, lactation or menopause

1) regular usage of mouth wash

&.2.

DURATION OF STUDY

% 1'()23

&.2.!

STUDY DESIGN

>ase control >linico ?iochemical &tudy &.2.$ STUDY MATERIAL ingival crevicular fluid samples will be collected from a mesiobuccal, distolingual sites on each of / teeth (a molar, premolar and canine or incisor) in upper left or in upper right -uadrants, providing six samples. ingival crevicular fluid samples are collected for /2 sec on Periopaper
,5

strips from

$2 patients with chronic periodontitis and $2 matched controls.

&.2.%

STUDY METHOD

ingival crevicular fluid samples from six sites per individuals are pooled and eluted in to 1m5 09,. , 6mg@l cresol red , 2.$5 boric acid in /.6A perchloric acid stabilizing medium(/22 micro litter) to prevent oxidation of labile antioxidant species. &' (reduced lutathione) and &&

(oxidized lutathione) are measured by 'igh performance li-uid chromatography. ,he data gathered from the study will be subjected to appropriate statistical analysis.

STATISTICAL ANALYSIS ,he results will be statistically evaluated by t# test and paired t# test

&. DOES THE STUDY RE4UIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS5 "Y63" ingival crevicular fluid samples collection using Periopaper,5 from $2 chronic perodontitis patients (pre and / months post non nonsurgical periodontal therapy) and $2 healthy controls. Performing non surgical periodontal treatments in $2 chronic periodontitis patients to evaluate the effect of therapy in restoring the redox balance. 9etection of &' (reduced lutathione), &&

(oxidized lutathione) levels using 'igh performance li-uid chromatography.

&.! HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF &. 5 Y63

7.

LIST OF REFERENCES 18 rant 55, ?roc= +, 5atthews B?, >happle !C>. >revicular fluid glutathione levels in

periodontitis and the effect of non surgical therapy .B >lin Periodontol $212" /3"13#$/ 28 !.C.> >happle 7 Bohn ?. 5atthews# the role of reactive oxygen and antioxidant species in periodontal tissue destruction. Periodontology $222" 4/, 112#$/$ 8 >happle !C>, ?roc= !8 +,. 5ilward 5+, .Cing N, 5athews B?# compromised >D total antioxidant capacity in periodontitis" cause or effect. B >lin Periodontol $223" /4*12/#112 erard B. Cinden, Eathy 5 5c clean, Bayne : .%oodside >hris > Patterson, .lun 0vans, Cans Foung and Dran= Eee. .ntioxidants and periodontitis in 12#32 yr old men .B >lin Periodontol $22G"/1*H4/#H4G $8 Derda .lev .=alin, 0sra ?altacioglu, .hmet alver and 0rdem =ara bulut# lipid peroxidation levels and total oxidant status in serum, saliva and gingival crevicular fluid in patients with chronic periodontitis . B >lin Periodontol $223" /4*66H#616 %8 ?roc= &8 +, ?utterworth >B, B.?.5athews 7 !.C.>.>happle. Cocal and systemic total antioxidant capacity in periodontitis and health. B >lin Periodontol $224" /1*616#6$1 ustafsson,.. and .sman,? (1GG1). !ncreased release of free oxygen radicals from peripheral neutrophils in adult periodontitis after Dca# receptor stimulation. B >lin Periodontol $/, /H#44. 78 >happle, !.C.>.(1GG3) +eactive oxygen species and antioxidants in inflammatory diseases. B >lin Periodontol $4, $H3#$G1. 98 5asatoshi ,a=ene, Naoyu=i &agano, !wasa=i, &himizu and Eoichi !to# New biomar=ers evidence of oxidative 9N. damage in whole saliva from clinically healthy and periodontally diseased individuals# B Periodontol. 5ay $22$ 1#8 ?attino, 5.Derreiro, 5.&, allardo, !.,Newman, '.N 7?ullon,P.($22$) ,he antioxidant capacity of saliva. . B >lin Periodontol $22$"$G*1HG#1G4 118 ?altacioglu, 0. .=altn,D..., .lver, .., ?alaban, f., Insal, 5.7Earabulut,0.# total antioxidant capacity and superoxide dismutase activity levels in serum and gingival crevicular fluid in post menopausal women with chronic periodontitis. . B >lin Periodontol $221" //*/H6#/G$

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Dr. SAVITA. A.M. P+OD0&&O+ 7 '0.9

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