Bahar ALKAYA, Mustafa ÖZCAN, Mehmet Cenk HAYTAÇ, Meltem DEMİRKIRAN, Mehmet BALAL

Multiple skleroz ile periodontal sağlık arasındaki ilişki: klinik- immunolojik çalışma

Amaç: Multiple Sklerozlu hastalarda nörolojik bulguların şiddeti ile periodontal durum arasındaki potansiyel ilişkinin klinik ve enflamatuar belirteçler kullanılarak değerlendirilmesidir. Gereç ve Yöntem: Multiple Skleroz (MS) tanısı konulmuş, 18-69 yaş arası 131 hasta çalışmaya dahil edildi. Çalışma grupları hastalara verilen Genişletilmiş Engellilik Durumu Ölçek skorlarına (EDSS) göre oluşturuldu. Birinci grup EDSS ≤3, ikinci grup ≥3,5 şeklinde planlandı. Ağız içi muayenede cep derinliği (CD), diş eti çekilmesi (DEÇ), gingival indeks (GI), plak indeksi (PI) değerleri kaydedildi. Hastalardan diş eti oluğu sıvısı (DOS) örneği alındı. Elde edilen veriler sonucunda EDSS skorları farklı olan gruplar arasındaki klinik ve immünolojik ölçümlerin karşılaştırılması hedeflendi. Bulgular: Çalışmanın sonucunda EDSS skoru yüksek olan grupta GI, PI, CD, DEÇ ölçümleri EDSS skoru düşük olan gruba göre daha yüksek bulunurken, immünolojik ölçümler arasında fark gözlenmemiştir. Korelasyon, regresyon analizlerinde ise periodontal sağlığın EDSS ve pro-inflamatuar sitokin IL-6 ile ile ilişkili olduğu gözlenmiştir. Sonuç: Çalışmanın sonucuna göre MS hastalarında hastalığın şiddeti arttıkça periodontal klinik durumların da olumsuz yönde etkilendiği görülmüştür. Bu konunun daha iyi anlaşılabilmesi için daha geniş kitlelerde yapılacak immünolojik, genetik, nörolojik çalışmalara ihtiyaç vardır.

The relationship between multiple sclerosis and periodontal health: a clinical-immunological study

Purpose: The aim of this study is to evaluate the potential relationship between the severity of neurological signs and the periodontal condition in patients with multiple sclerosis by using clinical and inflammatory markers. Materials and Methods: 131 patients aged 18-69 who were diagnosed with Multiple sclerosis (MS) were included in the study. The participants were categorized into two groups based on their Expanded Disability Status Scale (EDSS) score: the first group had EDSS score ≤3; and the second group had EDSS score ≥3,5. Neurogical examination was carried out by a neurologist and MS types, EDSS scores were recorded. Detailed periodontal examination including pocket depth (PD), gingival recession (GR), gingival index (GI) and plaque index (PI) were recorded, and gingival fluid (GF) samples were collected. Results: The results showed that the GI, PI, PD, GR were found to be higher in patients with higher EDSS scores compared to patients with lower EDSS score. No significant differences were observed between immunological measurements. The correlation and regression analyzes revealed that periodontal status is associated with EDSS scores and the pro-inflammatory cytokine IL-6 levels. Conclusion: In conclusion; it has been observed that as the severity of the disease increases in MS patients, periodontal clinical conditions are also negatively affected. In order to better understand this subject immunological, genetic, neurological studies should be performed in larger study populations are needed.

Keywords:

Multiple sclerosis, periodontal health, EDSS,

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1. Kes V, Čengić L, Cesarik M, Tomas A, Zavoreo I, Matovina L et al. Quality of life in patients with multiple sclerosis. Acta Clin Croat 2013; 52(1): 107-111.
2. Koutsouraki E, Costa V, Baloyannis S. Epidemiology of multiple sclerosis in Europe: a review. International review of psychiatry 2010; 22(1): 2-13.
3. Marrie R. Environmental risk factors in multiple sclerosis aetiology. The Lancet Neurology 2004; 3(12): 709-718.
4. Kurtzke, J. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS) Neurology 1983; 33(11): 1444-1444.
5. Seymour G, Ford P, Cullinan M, Leishman S, Yamazaki K. Relationship between periodontal infections and systemic disease. Clinical Microbiology and Infection 2007; 13: 3-10.
6. Löe H, Periodontal disease: the sixth complication of diabetes mellitus. Diabetes care 1993; 16(1): 329-334.
7. Pischon N, Heng N,Bernimoulin. Obesity, inflammation, and periodontal disease. Journal of dental research 2007; 86(5): 400-409.
8. Gustavsen M, Celius E, Moen S, Bjølgerud A, Berg-Hansen P, Nygaard G et al. No association between multiple sclerosis and periodontitis after adjusting for smoking habits. European journal of neurology 2015; 22(3): 588-590.
9. Sheu J, Lin H. Association between multiple sclerosis and chronic periodontitis: a population‐based pilot study. European journal of neurology 2013; 20(7): 1053-1059.
10. Göbel, K, Ruck T, Meuth S. Cytokine signaling in multiple sclerosis: Lost in translation. Multiple Sclerosis Journal 2018; 24(4): 432-439.
11. Kappos L, Polman C, Freedman M, Edan G, Hartung H, Miiler D et al.Treatment with interferon beta-1b delays conversion to clinically definite and McDonald MS in patients with clinically isolated syndromes Neurology 2006; 67(7): 1242-1249.
12. Dulamea A, Boscaiu V, Sava M. Disability status and dental pathology in multiple sclerosis patients. Multiple sclerosis and related disorders 2015; 4(6): 567-571.
13. Hatipoglu, H, Kabay C, Hatipoğlu G, Ozden H.Expanded disability status scale-based disability and dental-periodontal conditions in patients with multiple sclerosis. Medical Principles and Practice 2016; 25(1): 49-55.
14. Cannella B, Raine C. The adhesion molecule and cytokine profile of multiple sclerosis lesions. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society 1995; 37(4): 424-435.
15. Ishimi Y, Miyaura C, Jin C, Abe E, Akatsu T. IL-6 is produced by osteoblasts and induces bone resorption. The Journal of Immunology 1990; 145(10): 3297-3303.
16. Mogi M, Otogoto J, Ota N, Inagaki H, Minami M, Kojima K. Interleukin 1β, interleukin 6, β2-microglobulin, and transforming growth factor-α in gingival crevicular fluid from human periodontal disease. Archives of oral biology 1999; 44(6): 535-539.
17. Takahashi K, Takashiba S, Nagai A, Takigawa M, Myoukai F, Kurihara H et al. Assessment of interleukin‐6 in the pathogenesis of periodontal disease. Journal of periodontology 1994; 65(2): 147-153.
18. Johannsen, A, Bjurshammar N, Gustafsson A. The influence of academic stress on gingival inflammation. International journal of dental hygiene 2010; 8(1): 22-27.