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Background
Dental plaque is the major etiological factor associated with the development of gingivitis. Mostly, efficient mechanical plaque control would be enough for the resolution of the gingival inflammation. Antimicrobial mouthrinses as adjuncts to daily plaque control is more beneficial than only brushing when individuals are unable to consistently maintain adequate levels of plaque control using mechanical methods alone. Chlorhexidine (CHX) mouthrinse as antimicrobial agent is considered as the gold standard in preventing the dental plaque formation and gingival inflammation due to its both antiplaque and antigingivitis effects.
Microorganisms of dental plaque stimulate host cells to express their matrix metalloproteinases (MMPs), which is one of the mechanisms leading to periodontal tissue destruction. MMP-8 is expressed by many types of cells and known to be the main host cell-derived collagenase that contributes significantly to tissue destruction and remodeling events in inflammatory periodontal diseases. Significant decreases in gingival crevicular fluid (GCF) MMP-8 levels following periodontal treatment including scaling and root planning have been reported. However, there are limited data related to the MMP-8 levels in gingivitis patients. Emingil et al. demonstrated GCF MMP-8 total amount to be significantly higher in gingivitis patients compared to healthy controls. Atilla et al. found no significant difference in GCF MMP-8 levels between gingivitis and control subjects. Recently, the persistence of MMP-8 at physiologic levels after treatment has been suggested to be involved in the down-regulation of the inflammatory process and the onset of the reparative phase.
MMP activity is regulated by changes in the balance between the expression and synthesis of MMPs and tissue inhibitors of matrix metalloproteinases (TIMPs). TIMP-1 was demonstrated to be the major inhibitor of MMPs in gingival tissues of patients with periodontal disease. The balance between MMPs and TIMPs plays an essential role in maintaining the healthy condition of periodontal tissues, and disturbed balance may cause collagen breakdown and periodontal tissue destruction. It has been demonstrated that periodontal treatment increased TIMP-1 expression and decreased the ratios of MMPs/TIMP-1 in chronic periodontitis. However, previous studies have demonstrated controversial results about TIMP-1 levels in periodontal disease. Both increased and decreased TIMP-1 levels were reported in GCF and gingival tissues of patients with periodontitis.
We have previously showed CHX mouthrinse had limited beneficial effects on clinical periodontal parameters but was not effective on GCF cytokine levels in gingivitis. It has been stated that CHX mouthrinses is very efficient agent in reducing and/or preventing dental plaque and had an additional effect on the degree of inflammation in oral cavity. CHX can inhibit MMPs and prevent oxidative activation of MMPs and oxidative inactivation of α1-antitrypsin. TIMP-1 can also be inactivated by reactive oxygen species. Therefore, we hypothesized that the reduction of dental plaque by CHX mouthrinse might affect the GCF MMP-8 and TIMP-1 levels, which is known to act as crucial mediators in inflammatory process of periodontal diseases. To the best of our knowledge, there is no study investigating the efficacy of CHX mouthrinse in addition to daily plaque control on GCF MMP-8 and TIMP-1 levels in the presence of plaque-associated gingivitis. Therefore, the present study aimed to determine the effect of adjunctive chlorhexidine mouthrinse on GCF MMP-8 and TIMP-1 levels in plaque-associated gingivitis.
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