Periodontal conditions and TNF-α level in gingival crevicular fluid in scleroderma patients

Objectives: Systemic sclerosis (SSc) is a chronic disease with prominent vasculopathy, inflammation, production of auto-antibodies, and tissue fibrosis. Periodontitis is a chronic inflammatory oral condition manifested by microbial infection, inflammation and destruction of the alveolar bone. In both conditions tumor necrosis factor-α (TNF-α) and other pro-inflammatory cytokines play important role in pathogenesis. We assessed the periodontal status in SSc patients and compared these parameters to TNF-α level in gingival crevicular fluid (GCF) of SSc patients and healthy controls.
Methods: Twenty SSc patients and 20 controls underwent full mouth periodontal examination by calibrated exeminers including: probing depth (PD), plaque index (PI), gingival index (GI), bleeding on probing (BOP). GCF samples from each subject were collected and measurement of TNF-α levels were determined using an ELISA method. Analysis of variance (ANOVA) with Scheffe modification was used to test the differences between the clinical periodontal parameters and TNF-α level between the SSc patients and the control group. Mann-Whitney U test was used for analysis of periodontal parameters and SSc clinical features. Pearson correlation coefficient test was used to analyze correlation between TNF-α level in GCF and the various periodontal parameters.
Results: SSc patients had a greater PD (3.74±0.32 mm versus 3.35±0.31 mm, p>0.003), GI (1.53±0.34 versus 1.12±0.54, p>0.049), and non-significantly higher BOP than controls. TNF-α levels in GCF were higher in SSc patients (1.63±0.36 pg/ml versus 1.15±0.34 pg/ml, p=0.001). Periodontitis parameters correlated with several SSc variables, PI, in particular with higher in patients with longer disease duration, sclerodactyly, more severe skin involvement, and SSc activity score.
Conclusions: Patients with SSc have higher indices of periodontal inflammation and higher TNF-α level in GCF than healthy individuals. These changes probably reflect the complexity of factors that influence oral health in SSc. Common pathologic pathways may be responsible for the association between SSc and periodontitis, future studies are necessary in order to evaluate this further.