INFLAMMATORY MEDIATORS OF THE TERMINAL DENTITION IN ADULT AND EARLY-ONSET PERIODONTITIS

Based upon the prosthodontic literature, subjects who are at the trans ition stage between natural dentition and edentulism are called ''term inal dentition'' (TD) cases. The aim of the present cross-sectional in vestigation was to characterize the local and systemic inflammatory re sponses in 2 groups of patients with terminal dentition periodontitis. Eight severe adult periodontitis terminal dentition (AP-TD subjects a nd 8 early onset periodontitis terminal dentition (EOP-TD) subjects we re entered into the study. Our purpose was to measure an extended batt ery of cytokines in the gingival crevicular fluid (GCF) and in lipopol ysaccharide (LPS)-stimulated monocytic culture supernatants as well as gingival mononuclear cell messenger RNA (mRNA) transcripts determined from biopsy samples. Within the GCF there were 3 tiers (levels) of me diators based upon approximate 10-fold differences in concentration. T he highest tier included prostaglandin E-2 (PGE(2)), interleukin-1 bet a (IL-1 beta) and interleukin-2 (IL-2), the intermediate tier included tumor necrosis factor alpha (TNF alpha) and interferon gamma (IFN-gam ma) and at the lowest concentration level were interleukin-4 (IL-4) an d interleukin-6 (IL-6). Thus, the GCF analysis clearly indicated that in both AP-TD and EOP-TD groups the monocytic, i.e. IL-1 beta and PGE( 2) and Th1, i.e. IL-2 and IFN-gamma, inflammatory mediator levels quan titatively dominated over the Th2 mediators, i.e. IL-4 and IL-6. LPS-s timulated monocytic release of IL-1 beta, PGE(2) and TNF alpha was sig nificantly elevated in both AP-TD and EOP-TD groups compared to those of a control group of 21 subjects with moderate to advanced adult peri odontitis. The cytokine mRNA expression of isolated gingival mononucle ar cells showed that in both the AP-TD and the EOP-TD groups Th1 and T h2 cytokines were expressed, with low levels of IL-4 and IL-12. In con clusion, our data suggest that this cross-sectional TD periodontitis m odel may reflect progressive periodontal disease associated with tooth loss. Furthermore. although Th1 cytokine levels in the GCF dominate o ver the Th2 response, monocytic activation provides the main source of proinflammatory mediators. In addition, LPS-stimulated peripheral blo od monocytes demonstrate an upregulated inflammatory mediator secretio n in the terminal dentition.