Comparative analysis of the potential effect of phase I therapy on gingival crevicular fluid myeloperoxidase levels in non-diabetic and diabetic patients with periodontitis

Hakan Özdemir, Hakan Develioğlu, Nermin Yamalık, Hüseyin Aydın, Kaya Eren
3.069 782


Objectives: To evaluate the effect of periodontal therapy on clinical parameters as well as on myeloperoxidase (MPO) activity in the gingival crevicular fluid (GCF) of patients with type 2 diabetes mellitus and of systemically healthy individuals.

Materials and Methods: 24 type 2 DM patients subjects, and 21 systemically healthy individuals, both groups with chronic periodontitis, and systemically and periodontally healthy individuals were enrolled. Periodontal clinical parameters, namely periodontal probing depth (PD), plaque index (PI), gingival index (GI), clinical attachment level (CAL), and gingival bleeding time index (GBI), as well as GCF MPO activity, were assessed before and 3 months after non-surgical periodontal therapy. GCF enzyme activity was spectrophotometrically analyzed. Possible correlation between clinical periodontal status and MPO activity was also evaluated.

Results: Despite the relatively stable clinical measures and GCF MPO content in the periodontally-healthy subjects, the clinical periodontal status improved, as significant reductions were observed in all of the clinical parameters in periodontitis patients with and without diabetes (p<0.05). GCF MPO activity presented with significant reductions in both of the periodontally-diseased groups after phase I treatment (p<0.05), however it could not reach to the level of periodontal health (p<0.05).

Conclusions: Periodontal inflammation is likely to play the major role in the higher MPO activity observed at diseased sites, while diabetes mellitus do not seem to further increase the production of this enzyme. Periodontal treatment can provide successful improvement in clinical periodontal parameters and reduction in enzyme profile of GCF in diabetics.


Diabetes mellitus; myeloperoxidase; cronic periodontitis; gingival crevicular fluid

Full Text:




Boutros SM. Michalowicz BS, Smith, QT, Aeppli DM . Crevicular fluid enzymes from endosseous dental implants and natural teeth. Int J Oral Maxillofac Implants. 1996;11(3):322-30.

Cao F , Smith QT.Crevicular fluid myeloperoxidase at healthy and periodontitis sites. J Clin Periodontol. 1989;16(1):17-20.

Cutler CW, Machen, RL, Jotwani R, Iacopino AM. Heightened gingival inflammation and attachment loss in type 2 diabetics with hiperlipidemia.J Periodontol. 1999;70(11):1313-21.

Eiserich JP, Hristova M, Cross CE, Jones AD, Freeman BA, Hallival B, et al. Formation of nitric oxide-derived inflammatory oxidants by myeloperoxidase in neutrophils. Nature. 1998;391(6665):393-7.

Eley BM, Cox SW. Advances in periodontal diagnosis.7. Proteolytic and hydrolytic enzymes link with periodontitis. Br Dent J. 1998;184(7):323-8.

Figueredo CM , Gustaffson A.Protease activity in gingival crevicular fluid. Presence of free protease. J Clin Periodontol. 1998;25(4):306-10.

Gursoy UK, Marakoglu I, Ersan S .Periodontal status and cytoplasmic enzyme activities in gingival crevicular fluid of type 2 diabetic and/or obese patients with chronic periodontitis. J Int Acad Periodontol. 2006;8(1): 2-5.

Gonçalves D, Correa FO, Khalil NM, de Faria Oliveira OM, Orrico SR.The effect of non-surgical periodontal therapy on peroxidase activity in diabetic patients: a case-control pilot study.J Clin Periodontol. 2008;35:799-806.

Iacopino AM . Periodontitis and diabetes interrelationships: Role of inflammation. Ann Periodontol. 2001;6(1):125-37.

Karjalainen KM, Knuuttila ML . The onset of diabetes and poor metabolic control increases gingival bleeding in children and adolescents with insulin-dependent diabetes mellitus. J Clin Periodontol. 1996;23(12):1060-7.

Kawamura M, Fukuda S, Kawabata K, Iwamoto Y . Comparison of health behaviour and oral/medical conditions in non-insulin-dependent (Type II) diabetics and non-diabetics. Aust Dent J.1998;43(5):315-20.

Kowolik MJ , Grant M .Myeloperoxidase activity in human gingival crevicular neutrophils. Arch Oral Biol.1983;28(4):293-5.

Lamster IB, Oshrain RL, Fiorello LA, Celenti RS, Gordon, JM . A comparison of 4 methods of data presentation for lysosomal enzyme activity in gingival crevicular fluid. J Clin Periodontol. 1988;15(6):347-52.

Löe H, Sillness J . Periodontal disease in pregnancy.I. Prevalence and severity. Acta Odontol Scand. 1963 Dec;21:533-51.

Nishimura F, Takahashi K, Kurihara M, Takashiba S, Murayama Y. Periodontal disease as a complication of diabetes mellitus. Ann Periodontol. 1998;3(1):20-29.

Nowicki D, Vogel RI., Mekers S, Deasy MJ . The gingival bleeding time index. J Periodontol. 1981;52(5):260-2.

Oliver RC, Tervonen T . Diabetes-A risk factor for periodontitis in adults. J Periodontol. 1994;65(5):530-8.

Over C, Yamalik N, Yavuzyilmaz E, Ersoy F , Eratalay K. Myeloperoxidase activity in peripheral blood, neutrophil crevicular fluid and whole saliva of patients with periodontal disease. J Nihon Univ Sch Dent. 1993;35(4):235-40.

Page RC, Kornman KS. The pathogenesis of human periodontitis: an introduction.Periodontol 2000. 1997;Jun14:9-11.

Rudin HJ , Overdiek HF, Rateitschak KH . Correlation between sulcus rate and clinical and histological inflammation of the marginal gingiva. Hel Odont Acta.1970; 14(1):21-26.

Seppala B, Ainamo J . A site-by-site follow-up study on the effect of controlled versus poorly controlled insulin-dependent diabetes mellitus. J Clin Periodontol. 1994; 21(3):161-5.

Silness J, Löe H . Periodontal disease in pregnancy.II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964 Feb;22:121-35.

Smith QT, Au GS, Freese PL, Osborn JB, Stoltenberg JL . Five parameters of gingival crevicular fluid from eight surfaces in periodontal health and diseases.J Periodontol. 1992;27(5):466-75.

Suzuki K, Ota H, Sasagawa S, Sakatani S, Fujikura T . Assay method for myeloperoxidase in human polymorphonuclear leukocytes.Ann Biochem.1983; 132(2):345-52.

Tözüm, TF, Akman AC, Yamalik N, Tulunoglu IF, Türkyılmaz I, Karabulut E et al. Analysis of the inflammatory process around endosseous dental implants and natural teeth: myeloperoxidase levels and nitric oxide metbolism. Int J Oral Maxillofac Implants. 1993;22(6):969-79.

Verma S , Bhat KM . Diabetes Mellitus-A modifier of periodontal disease expression. J Int Acad Periodontol. 2004;6(1):13-20.

Wei PF, Ho KY, Ho YP, Wu YM., Yang YH , Tsai CC . The investigation of glutathione peroxidase, lactoferrin, myeloperoxidase and interleukin-1 beta in gingival crevicular fluid: Implications for oxidative stress in human periodontal diseases. J Periodontal Res. 2004;39(5):287-93.

Westfelt E, Rylander H, Blohme G, Jonasson P , Lindhe J . The effect of periodontal therapy in diabetics. Results after 5 years. J Clin Periodontol. 1996; 23(2):92-100.

Wolff LF, Smith QT, Synder WK, Bedrick JA, Liljemark WF, Aeppli DA, et al. Relationship between lactate dehydrogenase and myeloperoxidase levels in human gingival crevicular fluid and clinical microbial measurements. J Clin Periodontol. 1988; 15(2):110-5.

Yamalık N, Caglayan F, Kılınç K, Kılınç A , Tümer C . The importance of data presentation regarding gingival crevicular fluid myeloperoxidase and elastase–like activity in periodontal disease and health status. J Periodontol. 2000;71(3):460-7.

Kilpatrick ES. Glycated haemoglobin in the year 2000. J Clin Pathol, 2000;53:335–39.

This work is licensed under a Creative Commons Attribution-Gayriticari-NoDerivs 3.0 Unported Lisansı