Effect of serum ferritin levels in gingivitis and periodontitis patients before and after nonsurgical periodontal therapeutic intervention

Shreya Gajjar Md. Ahsanul Haq Rutvi Shah Kishan Mandani Sudeshna Banerjee Susmita Sinha Mainul Haque Santosh Kumar   

Open Access   

Published:  Jun 09, 2023

DOI: 10.7324/JAPS.2023.147406
Abstract

Periodontitis is an inflammatory disease that takes hold of the supporting structures of teeth. The diagnosis is based on traditional approaches, such as clinical attachment loss and periodontal pocket depths. However, recent advances in dentistry have harnessed biomarkers as an alternative diagnostic aid. Serum ferritin is a biomarker whose blood levels can be exploited to differentiate periodontium in health and disease. This article helps justify the importance of serum ferritin as a potential biomarker for investigating periodontitis after performing nonsurgical periodontal therapy in healthy and chronic periodontitis patients. Venous blood was obtained from individuals with dental biofilm-induced gingivitis and Stage 3 Grade A Periodontitis, and serum ferritin levels and hemoglobin (Hb) levels were measured. Non-surgical periodontal therapy was performed on Stage 3 Grade A Periodontitis. After 3 months, blood was collected again, and serum ferritin levels and Hb levels were assessed. High serum ferritin proportions were observed in an individual suffering from Stage 3 Grade A Periodontitis. However, they declined considerably after 3 months after treatment with non-surgical periodontal therapy. Analysis by the generalized estimating equation method exhibited a significant decrease in Oral Hygiene Simplified Index (β = 2.02, p < 0.001), gingival index (β = 1.11, p < 0.001), probing pocket depth (β = 1.03, p < 0.001), clinical attachment level (β = 3.01, p < 0.001), and serum ferritin (β = 76.9, p < 0.001) in the test group compared to the control group. However, no significant difference was noted in Hb. Nevertheless, no significant changes were noticed in healthy subjects. Serum ferritin is a salient biomarker for the pathogenesis of persistent gum affliction.


Keyword:     Biomarker inflammatory disease hemoglobin surgical therapy medical treatment gum diseases ferrritin


Citation:

Gajjar S, Haq MA, Shah R, Mandani K, Banerjee S, Sinha S, Haque M, Kumar S. Effect of serum ferritin levels in gingivitis and periodontitis patients before and after nonsurgical periodontal therapeutic intervention. J Appl Pharm Sci, 2023. Online First. https://doi.org/10.7324/JAPS.2023.147406

Copyright: © The Author(s). This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Reference

Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. J Res Med Sci, 2014; 19(2):164–74.

Abu-Ashour W, Twells L, Valcour J, Randell A, Donnan J, Howse P, Gamble JM. The association between diabetes mellitus and incident infections: a systematic review and meta-analysis of observational studies. BMJ Open Diabetes Res Care, 2017; 5(1):e000336; https://doi.org/10.1136/bmjdrc-2016-000336

Ali CJ, Ahmed MAA. Evaluation of serum ferritin, hemoglobin, mean cell volume, mean corpuscular hemoglobin concentration, and mean corpuscular hemoglobin levels in blood from patients with different severities of periodontal diseases. Res J Pharm Biol Chem Sci, 2018; 9(1):593–600.

Anumolu VN, Srikanth A, Paidi K. Evaluation of the relation between anemia and periodontitis by estimation of blood parameters: a cross-sectional study. J Indian Soc Periodontol, 2016; 20(3):265–72; https://doi.org/10.4103/0972-124X.176392

Bhavya B, Ashwini S, Shruthi KR. Estimation of hemoglobin and serum ferritin concentration from females with chronic periodontitis before and after non-surgical periodontal therapy: an interventional study. Int J Recent Sci Res, 2017; 8(9):20276–9; https://doi.org/10.24327/ijrsr.2017.0809.0863

Bhuyan R, Bhuyan SK, Mohanty JN, Das S, Juliana N, Juliana IF. Periodontitis and its inflammatory changes linked to various systemic diseases: a review of its underlying mechanisms. Biomedicines, 2022; 10(10):2659; https://doi.org/10.3390/biomedicines10102659

Biomarkers Definitions Working Group. Biomarkers and surrogate endpoints: preferred definitions and conceptual framework. Clin Pharmacol Ther, 2001; 69(3):89–95; https://doi.org/10.1067/mcp.2001.113989

Cekici A, Kantarci A, Hasturk H, Van Dyke TE. Inflammatory and immune pathways in the pathogenesis of periodontal disease. Periodontol 2000, 2014; 64(1):57–80; https://doi.org/10.1111/prd.12002 Chakraborty RK, Burns B. Systemic inflammatory response syndrome. StatPearls, Treasure Island, FL, 2023. Available via https://www.ncbi.nlm.nih.gov/books/NBK547669/ (Accessed 24 March 2023).

Chakraborty S, Tewari S, Sharma RK, Narula SC. Effect of non-surgical periodontal therapy on serum ferritin levels: an interventional study. J Periodontol, 2014; 85(5):688–96; https://doi.org/10.1902/jop.2013.130107

Chiou B, Connor JR. Emerging and dynamic biomedical uses of ferritin. Pharmaceuticals (Basel), 2018; 11(4):124; https://doi.org/10.3390/ph11040124

Chu L, Bramanti TE, Ebersole JL, Holt SC. Hemolytic activity in the periodontopathogen Porphyromonas gingivalis: kinetics of enzyme release and localization. Infect Immun, 1991; 59(6):1932–40; https://doi.org/10.1128/iai.59.6.1932-1940.1991

Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, The National Academies of Sciences, Engineering, and Medicine, Balogh EP, Miller BT, Ball JR, editors. Improving diagnosis in health care. National Academies Press, Washington, DC, 2015. Available via https://www.ncbi.nlm.nih.gov/books/NBK338593/ (Accessed 24 March 2023).

Dev S, Babitt JL. Overview of iron metabolism in health and disease. Hemodial Int, 2017; 21(Suppl 1):S6–20; https://doi.org/10.1111/hdi.12542

Eke PI, Page RC, Wei L, Thornton-Evans G, Genco RJ. Update of the case definitions for population-based surveillance of periodontitis. J Periodontol, 2012; 83(12):1449–54; https://doi.org/10.1902/jop.2012.110664

Ems T, St Lucia K, Huecker MR. Biochemistry, iron absorption. StatPearls, Treasure Island, FL, 2022. Available via https://www.ncbi.nlm.nih.gov/books/NBK448204/ (Accessed 24 March 2023).

Farhana A, Khan YS. Biochemistry, lipopolysaccharide. StatPearls, Treasure Island, FL, 2023. Available via https://www.ncbi.nlm.nih.gov/books/NBK554414/ (Accessed 24 March 2023).

Ganz T, Nemeth E. Iron homeostasis in host defence and inflammation. Nat Rev Immunol, 2015; 15(8):500–10; https://doi.org/10.1038/nri3863

Gehlot M, Sharma R, Tewari S, Kumar D, Gupta A. Effect of orthodontic treatment on periodontal health of periodontally compromised patients. Angle Orthod, 2022; 92(3):324–32; https://doi.org/10.2319/022521-156.1

Gehrer CM, Mitterstiller AM, Grubwieser P, Meyron-Holtz EG, Weiss G, Nairz M. Advances in ferritin physiology and possible implications in bacterial infection. Int J Mol Sci, 2023; 24(5):4659; https://doi.org/10.3390/ijms24054659

Giannobile WV, Beikler T, Kinney JS, Ramseier CA, Morelli T, Wong DT. Saliva as a diagnostic tool for periodontal disease: current state and future directions. Periodontol 2000, 2009; 50:52–64; https://doi.org/10.1111/j.1600-0757.2008.00288.x

Gokhale SR, Sumanth S, Padhye AM. Evaluation of blood parameters in patients with chronic periodontitis for signs of anemia. J Periodontol, 2010; 81(8):1202–6; https://doi.org/10.1902/jop.2010.100079

Gomes FI, Aragão MG, Barbosa FC, Bezerra MM, de Paulo Teixeira Pinto V, Chaves HV. Inflammatory cytokines interleukin-1β and tumour necrosis factor-α—novel biomarkers for the detection of periodontal diseases: a literature review. J Oral Maxillofac Res, 2016; 7(2):e2; https://doi.org/10.5037/jomr.2016.7202

Greene Jc, Vermillion Jr. The simplified oral hygiene index. J Am Dent Assoc, 1964; 68:7–13; https://doi.org/10.14219/jada.archive.1964.0034

Guo LN, Yang YZ, Feng YZ. Serum and salivary ferritin and Hepcidin levels in patients with chronic periodontitis and type 2 diabetes mellitus. BMC Oral Health, 2018; 18(1):63; https://doi.org/10.1186/s12903-018-0524-4

Highfield J. Diagnosis and classification of periodontal disease. Aust Dent J, 2009; 54 Suppl 1:S11–26; https://doi.org/10.1111/j.1834-7819.2009.01140.x

Hiranmayi KV, Sirisha K, Ramoji Rao MV, Sudhakar P. Novel pathogens in periodontal microbiology. J Pharm Bioallied Sci, 2017; 9(3):155–63; https://doi.org/10.4103/jpbs.JPBS_288_16

Hoare A, Soto C, Rojas-Celis V, Bravo D. Chronic inflammation as a link between periodontitis and carcinogenesis. Mediators Inflamm, 2019; 2019:1029857; https://doi.org/10.1155/2019/1029857 Jiang Y, Zhou X, Cheng L, Li M. The impact of smoking on subgingival microflora: from periodontal health to disease. Front Microbiol, 2020; 11:66; https://doi.org/10.3389/fmicb.2020.00066

Joshipura KJ, Muñoz-Torres FJ, Morou-Bermudez E, Patel RP. Over-the-counter mouthwash use and risk of pre-diabetes/diabetes. Nitric Oxide, 2017; 71:14–20; https://doi.org/10.1016/j.niox.2017.09.004

Kadry S, Sleem C, Samad RA. Hemoglobin levels in pregnant women and its outcomes. Biom Biostat Int J, 2018; 7(4):326?36; https://doi.org/10.15406/bbij.2018.07.00226

Kakar A, Blanchard S, Shin D, Maupomé G, Eckert GJ, John V. Periodontal diagnosis and treatment planning—an assessment of the understanding of the new classification system. J Dent Educ, 2022; 86(12):1573–80; https://doi.org/10.1002/jdd.13037

Kanmaz M, Kanmaz B, Buduneli N. Periodontal treatment outcomes in smokers: a narrative review. Tob Induc Dis, 2021; 19:77; https://doi.org/10.18332/tid/142106

Kell DB, Pretorius E. Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells. Metallomics, 2014; 6(4):748–73; https://doi.org/10.1039/c3mt00347g

Kernan KF, Carcillo JA. Hyperferritinemia and inflammation. Int Immunol, 2017; 29(9):401–9; https://doi.org/10.1093/intimm/dxx031

Khashaba O, Alasfar A, Elgendy EA, Mowafey B. Clinical and radiographic diagnostic study of strontium ranelate andmetal-substituted hydroxyapatite bone graft materials in diabetes mellitus with chronic periodontitis. J Adv Periodontol Implant Dent, 2020; 12(2):51–7; https://doi.org/10.34172/japid.2020.015

Kim HN, Kim K, Lee Y. Intra-oral photograph analysis for gingivitis screening in orthodontic patients. Int J Environ Res Public Health, 2023; 20(4):3705; https://doi.org/10.3390/ijerph20043705

Ko TJ, Byrd KM, Kim SA. The chairside periodontal diagnostic toolkit: past, present, and future. Diagnostics (Basel), 2021; 11(6):932; https://doi.org/10.3390/diagnostics11060932

Kolte RA, Kolte AP, Deshpande NM. Assessment and comparison of anemia of chronic disease in healthy subjects and chronic periodontitis patients: a clinical and hematological study. J Indian Soc Periodontol, 2014; 18(2):183–6; https://doi.org/10.4103/0972-124X.131321

Könönen E, Gursoy M, Gursoy UK. Periodontitis: a multifaceted disease of tooth-supporting tissues. J Clin Med, 2019; 8(8):1135; https://doi.org/10.3390/jcm8081135

Kotla NK, Dutta P, Parimi S, Das NK. The role of ferritin in health and disease: recent advances and understandings. Metabolites, 2022; 12(7):609; https://doi.org/10.3390/metabo12070609

Kumar KM, Varghese SS. Views on antioxidant mouthwashes as adjunct in periodontal therapy. Bioinformation, 2020; 16(12):1069-1079; https://doi.org/10.6026/973206300161069

Lang NP, Bartold PM. Periodontal health. J Periodontol, 2018; 89(Suppl 1):S9–16; https://doi.org/10.1002/JPER.16-0517

Lasserre JF, Brecx MC, Toma S. Oral microbes, biofilms and their role in periodontal and peri-implant diseases. Materials (Basel), 2018; 11(10):1802; https://doi.org/10.3390/ma11101802

Latha S, Thirugnanamsambandan S, Arun RT, Masthan KM, Malathi L, Rajesh E. Serum ferritin level and red blood cell parameters in healthy controls and chronic periodontitis patients. J Pharm Bioallied Sci, 2015; 7(Suppl 1):S184–9; https://doi.org/10.4103/0975-7406.155896

Leite FRM, Nascimento GG, Scheutz F, López R. Effect of smoking on periodontitis: a systematic review and meta-regression. Am J Prev Med, 2018; 54(6):831–41; https://doi.org/10.1016/j.amepre.2018.02.014

Listgarten MA. Pathogenesis of periodontitis. J Clin Periodontol, 1986; 13(5):418–30; https://doi.org/10.1111/j.1600-051x.1986.tb01485.x

Löe H. The gingival index, the plaque index, and the retention index systems. J Periodontol, 1967; 38(6):Suppl:610–6; https://doi.org/10.1902/jop.1967.38.6.610

Macfarlane TV, Kawecki MM, Cunningham C, Bovaird I, Morgan R, Rhodes K, Watkins R. Mouthwash use in general population: results from adult dental health survey in Grampian, Scotland. J Oral Maxillofac Res, 2011; 1(4):e2; https://doi.org/10.5037/jomr.2010.1402 Mahroum N, Alghory A, Kiyak Z, Alwani A, Seida R, Alrais M, Shoenfeld Y. Ferritin—from iron, through inflammation and autoimmunity, to COVID-19. J Autoimmun, 2022; 126:102778; https://doi.org/10.1016/j.jaut.2021.102778

Maldonado RF, Sá-Correia I, Valvano MA. Lipopolysaccharide modification in Gram-negative bacteria during chronic infection. FEMS Microbiol Rev, 2016; 40(4):480–93; https://doi.org/10.1093/femsre/fuw007

Marçal FF, Mota de Paulo JP, Barreto LG, de Carvalho Guerra LM, Silva PGB. Effectiveness of orthodontic toothbrush versus conventional toothbrush on plaque and gingival index reduction: a systematic review and meta-analysis. Int J Dent Hyg, 2022; 20(1):87–99; https://doi.org/10.1111/idh.12511

Martínez-García M, Hernández-Lemus E. periodontal inflammation and systemic diseases: an overview. Front Physiol, 2021; 12:709438; https://doi.org/10.3389/fphys.2021.709438

McClanahan SF, Bartizek RD, Biesbrock AR. Identification and consequences of distinct Löe-Silness gingival index examiner styles for the clinical assessment of gingivitis. J Periodontol, 2001; 72(3):383–92; https://doi.org/10.1902/jop.2001.72.3.383

Moreira AC, Mesquita G, Gomes MS. Ferritin: an inflammatory player keeping iron at the core of pathogen-host interactions. Microorganisms, 2020; 8(4):589; https://doi.org/10.3390/microorganisms8040589

Nagendra L, Boro H, Mannar V. Bacterial infections in diabetes. In: Feingold KR, Anawalt B, Blackman MR, et al. (eds.). Endotext, MDText.com, South Dartmouth, MA, 2000. Available via https://www.ncbi.nlm.nih.gov/books/NBK579762/ (Accesssed 24 March 2023).

Naik V, Acharya A, Deshmukh VL, Shetty S, Shirhatti R. Generalized, severe, chronic periodontitis is associated with anemia of chronic disease: a pilot study in urban, Indian males. J Investig Clin Dent, 2010;1(2):139–43; https://doi.org/10.1111/j.2041-1626.2010.00028.x

Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci (Qassim), 2017; 11(2):72–80.

Parihar S, Sharma N K, Bhatnagar A, Kishore D, Parihar AV, Rahman F. Comparison of hematological parameters for signs of anemia among participants with and without chronic periodontitis: a cross-sectional study. J Indian Assoc Public Health Dent, 2019; 17:4–7; https://doi.org/10.4103/jiaphd.jiaphd_49_18

Patel MD, Shakir QJ, Shetty A. Interrelationship between chronic periodontitis and anemia: a 6-month follow-up study. J Indian Soc Periodontol, 2014; 18(1):19–25; https://doi.org/10.4103/0972-124X.128194

Pradeep AR, Anuj S. Anemia of chronic disease and chronic periodontitis: does periodontal therapy have an effect on anemic status? J Periodontol, 2011; 82(3):388–94; https://doi.org/10.1902/jop.2010.100336

Prakash S, Dhingra K, Priya S. Similar hematological and biochemical parameters among periodontitis and control group subjects. Eur J Dent, 2012; 6(3):287–94.

Preshaw PM. Detection and diagnosis of periodontal conditions amenable to prevention. BMC Oral Health, 2015; 15 (Suppl 1):S5; https://doi.org/10.1186/1472-6831-15-S1-S5

Radzki D, Wilhelm-W?glarz M, Pruska K, Kusiak A, Ordyniec-Kwa?nica I. A fresh look at mouthwashes-what is inside and what is it for? Int J Environ Res Public Health, 2022; 19(7):3926; https://doi.org/10.3390/ijerph19073926

Rajendiran M, Trivedi HM, Chen D, Gajendrareddy P, Chen L. Recent development of active ingredients in mouthwashes and toothpastes for periodontal diseases. Molecules, 2021; 26(7):2001; https://doi.org/10.3390/molecules26072001

Ramadan DE, Hariyani N, Indrawati R, Ridwan RD, Diyatri I. Cytokines and chemokines in periodontitis. Eur J Dent, 2020; 14(3):483–95; https://doi.org/10.1055/s-0040-1712718 Sandnes M, Ulvik RJ, Vorland M, Reikvam H. Hyperferritinemia-a clinical overview. J Clin Med, 2021; 10(9):2008; https://doi.org/10.3390/jcm10092008

Shetty MK, Thomas B, Shetty AV. Comparative evaluation of hemoglobin level in anemic patients with chronic periodontitis before and after treatment. J Interdiscip Dentistry, 2014; 4:24–6; https://doi.org/10.4103/2229-5194.135000

Silva H. Tobacco use and periodontal disease-the role of microvascular dysfunction. Biology (Basel), 2021; 10(5):441; https://doi.org/10.3390/biology10050441

Silva N, Abusleme L, Bravo D, Dutzan N, Garcia-Sesnich J, Vernal R, Hernández M, Gamonal J. Host response mechanisms in periodontal diseases. J Appl Oral Sci, 2015; 23(3):329–55; https://doi.org/10.1590/1678-775720140259

Simpson TC, Weldon JC, Worthington HV, Needleman I, Wild SH, Moles DR, Stevenson B, Furness S, Iheozor-Ejiofor Z. Treatment of periodontal disease for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev, 2015; 2015(11):CD004714; https://doi.org/10.1002/14651858.CD004714.pub3

Sosiawan A, Wahjuningrum DA, Setyowati D, Suhartono M, Audrey NW, Mawantari TP, Setiawan F, Pawar AM. The relationship between parents’ oral hygiene knowledge and children with Down Syndrome’s oral hygiene via OHI-S. F1000Res, 2022; 11:374; https://doi.org/10.12688/f1000research.87848.2

Stathopoulou PG, Buduneli N, Kinane DF. Systemic biomarkers for periodontitis. Curr Oral Health Rep, 2015; 2:218–226; https://doi.org/10.1007/s40496-015-0072-9

Sukhbaatar N, Weichhart T. Iron regulation: macrophages in control. Pharmaceuticals (Basel), 2018; 11(4):137; https://doi.org/10.3390/ph11040137

Taba M Jr, Kinney J, Kim AS, Giannobile WV. Diagnostic biomarkers for oral and periodontal diseases. Dent Clin North Am, 2005; 49(3):551–71, vi; https://doi.org/10.1016/j.cden.2005.03.009

Thounaojam N. Effects of chronic periodontitis in serum ferritin levels before and 1 month after nonsurgical periodontal therapy: an intervention study. Int J Prev Clin Dent Res, 2019; 6:32–4; https://doi.org/10.4103/INPC.INPC_29_19

Ward DM, Cloonan SM. Mitochondrial iron in human health and disease. Annu Rev Physiol, 2019; 81:453–82; https://doi.org/10.1146/annurev-physiol-020518-114742

Zhang Y, He J, He B, Huang R, Li M. Effect of tobacco on periodontal disease and oral cancer. Tob Induc Dis, 2019; 17:40; https://doi.org/10.18332/tid/106187

Zhu Y, Dashper SG, Chen YY, Crawford S, Slakeski N, Reynolds EC. Porphyromonas gingivalis and Treponema denticola synergistic polymicrobial biofilm development. PLoS One, 2013; 8(8):e71727; https://doi.org/10.1371/journal.pone.0071727

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