Scientists have determined the main causes of gingivitisan inflammation of the gums attributed to a bacterial infection that is a leading cause of tooth loss in adults. If left untreated, the bacterial infection can lead to periodontitis, a serious gum disease that damages the soft tissue around the teeth , destroying the bone that supports them.
The new findings came following clinical investigations of saliva samples from 30 people with healthy gums and 30 with gingivitis, reported in the BMC Oral Health magazine.
Determine the main causes of gingivitis
The authors state that, according to their clinical examination, the presence of MIF or macrophage migration inhibitory factor, a protein crucial for the regulation of innate immunity, can be used by dentists as an “effective indicator” of gingivitis.
“During the clinical examination, we recorded three gum health parameters: bleeding on probing (BOP), visible plaque index (VPI), and simplified modified gingival index (SMGI). Then, we used special tests (ELISA) to measure the levels of MAF, MCF and MIF in their saliva sample.”
“Our results showed that MAF levels were similar in both healthy people and patients with gingivitis. However, MCF and MIF levels were significantly higher in those with gingivitis. Interestingly, MIF levels changed at different stages of gum inflammation. So our study suggests that MCF and MIF levels in saliva could be signs of gum inflammation. Furthermore, the level of MIF in saliva can be used as an effective indicator of gingivitis,” says co-author Prof. Sausan Al Kawas from the University of Sharjah in the United Arab Emirates (UAE).
Dr Betul Rahman, also a co-author and associate professor at the College of Dental Medicine at the University of Sharjah, says the study recorded three gum health parameters of participants who took part in the clinical trials.
“We recorded three gum health parameters: bleeding on probing (BOP), visible plaque index (VPI) and simplified modified gingival index (SMGI). Then, we used special tests (ELISA) to measure the levels of MAF, MCF, and MIF in the saliva sample,” adds Dr. Rahman.
The clinical investigations were conducted at University Dental Hospital Sharjah from February 2020 to June 2021. Of the methods used and data collected, the scientists write: “Sixty participants, 30 healthy individuals and 30 patients with gingivitis, ranging in age from 18 and 45 years old”. years, have been enlisted in this research. Before enrolling in the study, participants were provided with verbal and written information and informed consent was obtained from them.
“Sixty saliva samples were collected from periodontally healthy (n = 30) and gingivitis (n = 30) patients. Bleeding on probing (BOP), visible plaque index (VPI), and simplified modified gingival index (SMGI) were recorded through clinical examination analysis.
“Statistical analysis was performed using SPSS (version 28). The mean total score for each biomarker was determined, and descriptive bivariate statistics were conducted to characterize biomarker levels across study groups.”
Dr. Rahman is optimistic about the results. He says: “Our study represents a promising step towards non-invasive diagnostics in oral health. The identification of salivary biomarkers such as MIF could revolutionize the way we detect and manage gingivitis, offering a more precise and timely approach to oral hygiene.”
The study signals new hope on the road to fighting gingivitis, according to Prof. Kawas, who adds: “Understanding the role of macrophage-related chemokines in gingivitis is fundamental. Our findings pave the way for future research and innovations in diagnostics and therapeutic strategies.” for periodontal diseases.”
The study takes on further significance when taking into account the high prevalence of gingivitis and how the most common form of gum inflammation can turn into a chronic disease. Medical literature shows that gingivitis affects 9-17% of children between the ages of 3 and 11, with the rate skyrocketing to 70-90% among adults.
The authors' aim was to investigate whether some substances present in saliva could shed light on the health of the gums. “We focused on three substances present in saliva: macrophage activating factor (MAF), macrophage chemotactic factor (MCF) and macrophage migration inhibitory factor (MIF). We looked at people with healthy gums and those with gum inflammation (gingivitis) to see whether the levels of these substances were linked to the severity of gum disease,” says Prof. Kawas.
For a long time doctors have been looking for a faster, simpler and highly accurate non-invasive test as an indicator (biomarker) of gum disease since current diagnosis methods to show bone loss and thus treat gum disease have been based on items such as bleeding on probing (BOP), plaque scores, clinical attachment loss, probing of pocket depths, and radiographs.
These methods “are time-consuming, expensive, and their accuracy depends on the dentist's skills. Saliva is the best non-invasive body fluid to use for the diagnosis of many diseases of the body and oral cavity. This study could be used to develop such a simple and accurate test using saliva samples to diagnose and follow patients with gum disease.”
The results of the study, according to Prof. Kawas, “could potentially interest various pharmaceutical sectors related to oral health. The identification of salivary biomarkers opens avenues for the development of innovative diagnostic tools and therapeutic interventions, which could attract the interest of dental care providers, diagnostic companies, and pharmaceutical organizations.
“The ultimate goal was to contribute to the development of non-invasive diagnostic tools for the early diagnosis and monitoring of gingivitis, thus improving the precision of preventive and therapeutic interventions in oral health. By identifying reliable salivary biomarkers, we aimed to address the limitations of current diagnostic methods and facilitate early intervention in oral diseases.”
The authors believe their research has significant practical implications for the field of oral health given that current diagnostic methods for gingivitis rely on clinical examinations, which may have limitations in identifying individuals at risk of developing periodontitis.
“Our findings suggest that salivary MIF levels could serve as a potential early diagnostic biomarker for gingivitis. This has practical implications for dentists, as incorporating salivary biomarkers into routine screening could allow for more accurate and timely identification of those at risk. Early diagnosis allows for timely intervention, potentially preventing the progression of gingivitis to more severe periodontal conditions,” adds Dr. Rahman.
Engineers at the University of Cincinnati have developed a new device that can warn consumers about the early risks of tooth decay due to diseases such as gingivitis and periodontitis.
Gingivitis, the earliest form of gum disease, is caused by bacteria. But not just any bacteria.
The problem for researchers was finding a device that could pinpoint the particular type responsible for the disease, said Andrew Steckl, a prominent Ohio scholar and distinguished research professor in UC's College of Engineering and Applied Science.
“It's been a real challenge to get to the point where we can detect this toxin created by the bacteria responsible for gingivitis,” he said.
Steckl and UC senior researcher Daewoo Han collaborated with Sancai Xie, a principal scientist at Procter & Gamble Co., and described their findings in a paper published in Sensors and Diagnostics.
Steckl's research group has explored biosensing for various applications. They studied stress hormones in sweat in collaboration with the Air Force Research Lab at Wright-Patterson Air Force Base. Now they are studying saliva.
“There are good reasons to use saliva,” he said. “It is relatively abundant and easy to obtain through non-invasive methods. And saliva contains many important elements that can serve as indicators of your health.”
Gingivitis bacteria can travel through the bloodstream, leading to cardiovascular disease and other serious health problems, Steckl said. But saliva is a complicated biofluid, Han said.
“We wanted to identify a biomarker in saliva. But saliva is difficult to use,” said Han, the study's lead author.
The researchers pretreated the sample using potato starch to remove a protein called amylase that could interfere with the test results. Their test uses antibodies that react to endotoxins present in bacteria.
Developing a sensor required precise selectivity and sensitivity, Steckl said.
“Daewoo worked very hard on many dead ends before it was successful,” Steckl said. “I tell my students that research is research, research and research until you find the answer.”
At-home health tests have been available for generations for niche uses such as pregnancy detection. But the COVID-19 pandemic has introduced a broad consumer audience to the concept of tracking their health with new technologies.
The home testing industry is expected to generate $45 billion annually by 2031, according to Allied Market Research.
Steckl said he sees a lot of opportunities for new consumer products. “Our results are definitely promising,” Steckl said. “Sometimes it's easy. The majority
part of the time you have to persevere.”
A whole food, plant-based diet reduced gingivitis in a recent randomized trial published in the Journal of Clinical Periodontology.
For the study, 30 patients with gingivitis were randomized into an experimental and control group. The experimental group was switched to a diet low in processed carbohydrates and animal proteins and high in omega-3 fatty acids, vitamin C, vitamin D, antioxidants, plant nitrates and fiber for four weeks. The control group did not change their diet. All participants stopped using dental floss and other tools to clean the spaces between their teeth.
Although no differences were found regarding plaque values, the experimental group experienced a significant reduction in gingival bleeding. They also showed increased vitamin D values and weight loss.
“The study results clearly demonstrate the possibility of naturally reducing gingivitis through an optimized diet that also promotes overall health. According to this, dental teams should address dietary habits and provide appropriate recommendations in the treatment of gingivitis, as it could be a side effect of a pro-inflammatory Western diet,” said lead author Dr Johan Woelber, from the University of Freiburg, Germany.
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