Citation Information :
Mathew A, MN P, Menon P, Radeideh A, Varma S, Thomas S, Varughese N, Hamed GM. A Clinical Study on the Circadian Rhythm of Salivary Cortisol on Aggressive Periodontitis and Its Correlation with Clinical Parameters using Electrochemiluminescence Immunoassay Method. J Contemp Dent Pract 2019; 20 (4):482-488.
Aim: Periodontal pathologies are gaining importance as there is a clear indication of bi-way control on general homeostasis of an individual. The study of HPA axis in various diseases has proved that there is evident vulnerability existing for any organism when the Cortisol diurnal rhythm is altered. The aim was to compare the diurnal rhythm of salivary cortisol in aggressive periodontitis with control patients. This study also compared various parameters like body mass index (BMI), waist circumference, Hamilton anxiety scale, OHI-S, clinical attachment loss in aggressive periodontitis.
Materials and methods: 30 control patients were compared against 30 aggressive periodontitis patients in Salivary cortisol diurnal rhythm. It was estimated using the electrochemiluminescence (ECL) method on a 3 point analysis—Soon after waking up, 30 minutes after waking up, 1 hour before sleep to see the diurnal variation in aggressive periodontitis patients. The samples were transferred to CABRI labs to be frozen to –20°C. The analysis was done using Cobas e-411 autoanalyzer by Roche, USA.
Results: The average cortisol in aggressive patients was found to be higher compared to control patients and was found to be statistically significant with a p value of 0.012. Control group is moderately skewed left (negative skewness graph) while the aggressive p periodontitis patients showed moderately skewed right (+ve skewness graph).
Conclusion: The cortisol awakening response seen in control patients is not observed in aggressive periodontitis. Instead of giving a surge, the cortisol showed a dip in the first 30 minutes followed by a gradual increase in aggressive periodontitis instead of decline as observed in normal patients.
Clinical significance: The study will focus on the importance of cortisol circadian rhythm on periodontal health allowing the microorganism to create an environment of dysbiosis.
Fives-Taylor P, Hutschins Meyer D, Mintz KP, et al. Virulence factors of Actinobacillusactinomycetemcomitans. Periodontology 2000 1999;20:136-167.
Huang N, Frank C. Gibson. Immuno-pathogenesis of Periodontal Disease: Current and Emerging Paradigms. Curr Oral Health Rep 2014; 1(2):124-132.
Demmer RT, Papapanou PN. Epidemiologic patterns of chronic and aggressive periodontitis. Periodontol 2000;2010:53:28-44.
Smith M, Seymour GJ, Cullinan MP. Histopathological features of chronic and aggressive periodontitis. Periodontology 2000;2010: 53:45-54.
Habib KE, Gold PW, Chrousos GP. Neuroendocrinology of stress. Endocrinol Metab Clin North Am 2001;30:695-728.
Ratka A, Sutanto W, Bloemers M, et al. On the role of brain mineralocorticoid (type I) and glucocorticoid (type II) receptors in neuroendocrine regulation. Neuroendocrinology 1989;50:117-123.
Pruessner JC, Wolf OT, et al. Free cortisol levels after awakening: a reliable biological marker for the assessment of adrenocortical activity. Life Sci 1997; 61(26):2539-2549.
Chida Y, Steptoe A. Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. Biol Psychol 2009; 80(3):265-278.
Fries E, Dettenborn L, et al. The cortisol awakening response (CAR): facts and future directions. Int J Psychophysiol 2009;72(1):67-73.
Hienz SA, Paliwal S, Ivanovski S. Mechanisms of Bone Resorption in Periodontitis. Journal of Immunology Research Volume 2015;2015.
Miller DB, O'Callaghan JP. Neuroendocrine aspects of the response to the stress. Metabolism 2002;51:5-10.
Takada T, Yoshinari N, Suguushi S, et al. Effect of restraint stress on the progression of experimental periodontitis in rats. J Periodontol 2004;75:306-315.
Genco RJ, Ho AW, Kopman J, et al. Models to evaluate the role of stress in periodontal disease. Ann Periodontol 1998;3:288-302.
Elenkov IJ, Papanicolaou DA, Wilder RL, et al. Modulatory effects of glucocorticoids and catecholamines on human interleukin-12 and interleukin-10 production: Clinical implications. Proc Assoc Am Physicians 1996;108:374-381.
Bosnjak A, Plancak D, Curilovic Z. Advances in the relationship between periodontitis and systemic diseases. Acta Stomatol Croat 2001;35(2):267-271.
Geiger AM. Malocclusion as an etiologic factor in periodontal disease: a retrospective essay. Am J Orthod Dentofacial Orthop 2001; 120(2):112-115.
Vettore M, Quintanilha RS, Monteiro da Silva AM, et al. The influence of stress and anxiety on the response of non-surgical periodontal treatment. J Clin Periodontol 2005;32:1226-235.
Miller S. Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry. Psychol Bull 2004;130(4): 601-630.
Mahvash Mousavi Jazi, Association between Psychological Stress and Stimulation of Inflammatory Responses in Periodontal Disease. Dent (Tehran) 2013;10(1):103-111.
Swolin-Eide D, Ohlsson C. Effects of cortisol on the expression of interleukin-6 and interleukin-1 beta in human osteoblast-like cells. 1998;156(1):107-114.
Segal BM, Dwyer BK, Shevach EM. An interleukin (IL)-10/IL-12 immunoregulatory circuit controls susceptibility to autoimmune disease. J Exp Med 1998;187: 537-546.
Hidalgo MM, Avila-Campos MJ, et al. Neutrophil chemotaxis and serum factor modulation in Brazilian periodontitis patients Arch Med Res. 1997 Winter; 28(4):531-535.
Nath SG, Raveendran R. What is there in a name? A literature review on chronic and aggressive periodontitis. J Indian Soc Periodontol. 2011;15(4):318-322.
Gemmell E, Seymour GJ. Immunoregulatory control of Th1/Th2 cytokine profiles in periodontal disease. Periodontoogy 2000 2004; 35:21-41.
Hajishengallis G. Immuno-microbial pathogenesis of periodontitis: Keystones, pathobionts, and the host response. Trends in Immunology 2014;35(1):3-11.
Hoath B, Wiebe C, Garcia Fulle De Owen MI, et al Current status of classification of periodontal disease. Can J Dent Hygen 2016:50(3):140- 144.
Swanson C, Lorentzon M, Conaway HH, et al. Glucocorticoid regulation of osteoclast differentiation and expression of receptor activator of nuclear factor-kappaB (NF-kappaB) ligand, osteoprotegerin, and receptor activator of NF-kappaB in mouse calvarial bones. Endocrinology. 2006 ;147(7):3613-3622.