PERIODONTAL STATUS and PERIODONTOPHATIC MICROBIOTA in SYSTEMIC ERYTHEMATOSUS LUPUS
Objectives: To describe the periodontal condition and subgingival microbiota in systemic erythematosus lupus (SLE) outpatients attending at the University Hospital in Cali, Colombia. Methods: We recruited 100 SLE patients and their periodontal status was established according the new Classification Scheme for Periodontal and Peri-implant Diseases and Conditions proposed in the 2017 World Workshop that includes: periodontal health, gingivitis, and periodontitis (stages I, II, III and IV, grade A,B,C). Full mouth examination was performed including six sites per tooth. Clinical parameters including probing depth (PD, mm), clinical attachment level (CAL, mm), bleeding on probing (BOP, %). The degree of gingival inflammation was measured using Löe and Silnes index (1964). A periodontal index classification for Periodontal Inflamed Surface Area (PISA) was calculated for each tooth using periodontal parameters such as CAL and BOP (six aspects), and the global PISA score is obtained by summing up individual PISA scores. A subgingival biofilm sample was taken to determine microbiological profiles. Descriptive statistics and Chi2 - Pearson tests were performed. Results: The average age was 41.08 years (± 13.97), 94 (94%) women and six (6%) men. Clinical periodontal diagnosis distribution was, one female has periodontal health, 14 gingivitis and 85 periodontitis. The most prevalent subgingival microorganisms were Fusobacterium species (90.9%), Prevotella intermedia/nigrescens (60.6%), Campylobacter species (57.6%), Eubacterium species (52.5%), Eikenella corrodens (44.4%), Porphyromonas gingivalis (38.4%), Gram-negative enteric rods (35.4%) for whole population. The ELA anti-LA, ELA anti-SM test were increased in periodontitis. Conclusions: A high prevalence of periodontal disease in SLE is confirmed. Microbial counts of A. actinomycetemcomitans and P. gingivalis, two key oral pathogens and important serologic parameters related to the severity of SLE are increased in gingivitis and in active lupus, respectively. More research is needed to determine if the association between SLE and periodontitis is causal, the diseases are pathogenetically related, and oral health deserves more attention amongst SLE treatment protocols.
Division: Meeting:2021 IADR/AADR/CADR General Session (Virtual Experience) Location: Year: 2021 Final Presentation ID:1397 Abstract Category|Abstract Category(s):Periodontal Research-Diagnosis/Epidemiology
Authors
Medina, Luis Fernando
( Universidad del Valle
, Cali
, Valle del Cauca
, Colombia
)
Cruz-olivo, Edison
( Universidad del Valle
, Cali
, Valle del Cauca
, Colombia
)
Guerrero Loria, Silvia
( Universidad del Valle
, Cali
, Valle del Cauca
, Colombia
)
Alegria, Luisa Fernanda
( Universidad del Valle
, Cali
, Valle del Cauca
, Colombia
)
Salazar, Bernardo
( Universidad del Valle
, Cali
, Valle del Cauca
, Colombia
)
Martinez-cajas, Carlos Humberto
( Universidad del Valle
, Cali
, Valle del Cauca
, Colombia
)
Amaya, Sandra
( Universidad del Valle
, Cali
, Valle del Cauca
, Colombia
)
Contreras, Adolfo
( Universidad del Valle
, Cali
, Valle del Cauca
, Colombia
)
Support Funding Agency/Grant Number: Convocatoria Interna de la Universidad del Valle
Financial Interest Disclosure: NONE
Educational level None Primary school High school Technician University
18 (18) 10 (10) 54 (54) 10 (10) 8 (8)
Social level/status scale 1 to 6 Level/status 1 Level/status 2 Level/status 3
56 (56) 30 (30) 14 (14)
Ethnicity (Self recognition) White Mestizo (brown skin) African-descendant Indigenous
22 (22) 42 (42) 27 (27) 9 (9)
Periodontal status (2017 AAP/EFP definition) Periodontal health Gingivitis Periodontitis Stage I Periodontitis Stage II Periodontitis Stage III Periodontitis Stage IV
1 (1) 14 (14) 25 (25) 31 (31) 20 (20) 9 (9)
Gingival Inflammation (Sillness & Löe ndex) Absence of inflammation Mild inflammation Moderate inflammation Severe inflammation
1 (1) 38 (38) 32 (32) 29 (29)
Table 2. Clinical parameters and periodontal status in SLE
Gingivitis (n=14)
Periodontitis (n=85)
Total (n=99)
X ± SD Me (IQR)
X ± SD Me (IQR)
X ± SD Me (IQR)
p
Tooth loss
1.43±2.47 0(0-3)
5.56±5.74 4(1-9)
4.98±5.58 3(0-8)
0.0028*
BOP sites
31±19.22 27.5(19-39)
37.93±32.72 29(16-45)
36.95±31.19 29(16-44)
0.8056
BOP %
17.21±12.23 14(11-22)
29.51±21.72 25(14-36)
27.77±21.04 22(13-35)
0.0271*
mean PD (mm)
2.14±0.36 2(2-2)
2.54±1.21 2(2-3)
2.48±1.14 2(2-3)
0.0748
CAL (mm)
1.57±0.94 2(1-2)
1.74±1.23 2(1-3)
1.72±1.19 2(1-3)
0.5911
PISA
82.5±59.08 82.5(22-110)
358.78±354.23 240(123-455)
319.71±342.6 207(102-421)
0.0000*
Abbreviations: (BOP) bleeding on probing; (PD) probing depth; (CAL) clinical attachment level; (PISA) Periodontal Inflamed Surface Area; (X) mean; (SD) Standard Deviation; (mm) millimeters; *p < 0.05 statistical significance
Table 3. Periodontopathic species frequency detection according to periodontal status in SLE
Microorganisms
Gingivitis n =14 (14,1%)
Periodontitis n = 85 (85,9%)
Total N=99 (100%)
p
Aggregatibacter actinomycetemcomitans
4 (28,6)
10 (11,8)
14 (14,1)
0.108†
Porphyromonas gingivalis
4 (28,6)
34 (40,0)
38 (38,4)
0.415
Prevotella intermedia/nigrescens
9 (64,3)
51 (60,0)
60 (60,6)
0.761
Tannerella forsythia
4 (28,6)
18 (21,2)
22 (22,2)
0.506†
Campylobacter spp
6 (42,9)
51 (60,0)
57 (57,6)
0.229
Eubacterium spp
6 (42,9)
46 (54,1)
52 (52,5)
0.434
Fusobacterium spp
13 (92,9)
77 (90,6)
90 (90,9)
1.000†
Parvimonas micra
4 (28,6)
25 (29,4)
29 (29,3)
1.000†
Eikenella corrodens
8 (57,1)
36 (42,4)
44 (44,4)
0.302
Dialister pneumosintes
1 (7,1)
25 (29,4)
26 (26,3)
0.105†
Gram-negative Enteric Rods
6 (42,9)
29 (34,1)
35 (35,4)
0.556†
ß-hemolytic streptococci
2 (14,3)
4 (4,7)
6 (6,1)
0.200†
Yeasts
2 (14,3)
17 (20,0)
19 (19,2)
1.000†
† Chi2 test exact (Fisher)
* p<0.05, statistical significance