Effect of smokeless tobacco use on salivary glutathione levels among chronic periodontitis patients before and after nonsurgical periodontal therapy
More details
Hide details
Department of Periodontics, P.M.N.M. Dental College and Hospital, Bagalkot, India
Arati C. Koregol   

Department of Periodontics, P.M.N.M. Dental College and Hospital, Bagalkot, Karnataka 587103, India
Publication date: 2020-03-05
Submission date: 2019-06-06
Final revision date: 2019-11-25
Acceptance date: 2019-12-04
Tob. Prev. Cessation 2020;6(March):15
Smokeless tobacco (SLT) jeopardizes periodontal health and also produces an imbalance between reactive oxygen species (ROS) and antioxidants (AO) such as glutathione. Glutathione is an important redox regulator in saliva and its maintenance is essential for periodontal health. Periodontitis patients have a reduced total AO capacity in whole saliva, and periodontal therapy restores the redox balance. Hence, the purpose of this study was to investigate the effects of smokeless tobacco use on saliva glutathione levels in patients with chronic periodontitis and to evaluate these effects after non-surgical periodontal therapy.

The study included 100 subjects in four groups; healthy, gingivitis, and chronic periodontitis (CP) patients with and without SLT use. Saliva samples were collected, and clinical periodontal parameters were recorded at baseline and at one month after non-surgical periodontal therapy. Glutathione levels were analyzed using spectrophotometry at 412 nm. Statistical analysis was carried out using paired t-test, chi-squared, and analysis of variance (ANOVA).

Mean glutathione values in saliva were found to be lower in periodontitis patients compared to SLT users at baseline and at 1 month post non-surgical periodontal therapy (p<0.001) In addition, non-surgical therapy leads to a highly significant improvement in the glutathione levels in gingivitis, in the CP with and without ST groups (p<0.001).

Successful non-surgical periodontal therapy leads to considerable progress in the redox balance, thus regulating glutathione levels and reducing the effects of SLT on the periodontium. This emphasises the importance of nonsurgical therapy, especially among SLT users.

The authors acknowledge the support of Chandrashekar V M in the biochemical analysis.
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
There was no source of funding for this research.
Not commissioned; externally peer reviewed.
Patel BP, Rawal UM, Shah PM, Prajapati JA, Rawal RM, Dave TK. Study of tobacco habits and alterations in enzymatic antioxidant system in oral cancer. Oncology. 2005;68(4-6):511-519. doi:10.1159/000086995
Bains VK, Bains R. The antioxidant master glutathione and periodontal health. Dent Res J. 2015;12(5):389-405. doi:10.4103/1735-3327.166169
Chapple ILC, Brock G, Eftimiadi C, Matthews JB. Glutathione in gingival crevicular fluid and its relation to local antioxidant capacity in periodontal health and disease. J Clin Pathol: Mol Pathol. 2002;55(6):367-373. doi:10.1136/mp.55.6.367
Trivedi S, Lal N, Mahdi AA, Singh B, Pandey S. Association of salivary lipid peroxidation levels, antioxidant enzymes, and chronic periodontitis. Int J Periodontics Restorative Dent. 2015;35(2):e14-e19. doi:10.11607/prd.2079
Moore S, Calder KA, Miller NJ, Rice Evans CA. Antioxidant activity of saliva and periodontal disease. Free Rad Res. 1994;21(6):417-425. doi:10.3109/10715769409056594
Townsend DM, Tew KD, Tapiero H. The importance of glutathione in human disease. Biomed Pharmacother. 2003;57(3-4):145‑155. doi:10.1016/s0753-3322(03)00043-x
Ongoz Dede F, Bozkurt Dogan S, Balli U, Avci B, Durmuslar MC, Baratzade T. Glutathione levels in plasma, saliva and gingival crevicular fluid after periodontal therapy in obese and normal weight individuals. J Periodont Res. 2016;51(6):726-734. doi:10.1111/jre.12349
American Academy Of Periodontology Task Force Report on the Update to the 1999 Classification Of Periodontal Diseases and Conditions. J Periodontol. 2015;86(7):835-838. doi:10.1902/jop.2015.157001
Use of Smokeless tobacco among adults-United States, 1991. JAMA. 1993;269(23):2971. doi:10.1001/jama.1993.03500230053013
Savita M, Sarun E, Arora S, Krishnan S. Evaluation of glutathione level in gingival crevicular fluid in periodontal health, in chronic periodontitis and after nonsurgical periodontal therapy: A clinicobiochemical study. Contemp Clin Dent. 2015;6(2):206-210. doi:10.4103/0976-237x.156047
Kosoko AM, Olayanju OA, Rahamon SK, Arinola OG. Salivary lipid peroxidation and antioxidant status in nigerian cigarette smokers with or without periodontitis. Asian J Med Health. 2017;3(3):1-9. doi:10.9734/ajmah/2017/30749
Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand. 1963;21(6):533-551. doi:10.3109/00016356309011240
Silness J, Loe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964;22(1):121-135. doi:10.3109/00016356408993968
Muhlemann HR, Son S. Gingival sulcus bleeding - a leading symptom in initial gingivitis. Helv Odontol Acta. 1971;15(2):107-113. PMID:5315729.
Russell AL. A system for classification and scoring for prevalence surveys of periodontal disease. J dent Res. 1956;35(3):350-359. doi:10.1177/00220345560350030401
Sculley DV and Langley-Evans SC. Periodontal disease is associated with lower antioxidant capacity in whole saliva and evidence of increased protein oxidation. Clin Sci. 2003;105(2):167-172. doi:10.1042/cs20030031
Sedlak J, Lindsay RH. “Estimation of total, protein-bound and non-protein sulfhydryl groups in tissue with Ellman’s reagent”. Anal Biochem. 1968;25:192-205. doi:10.1016/0003-2697(68)90092-4
Singh GP, Rizvi I, Gupta V, Bains VK. Influence of smokeless tobacco on periodontal health status in local population of north india: A cross sectional study. Dent Res J. 2011;8(4):211-220. doi:10.4103/1735-3327.86045
Dahiya P, Kamal R, Gupta R, Bhardwaj R, Chaudhary K, Kaur S. Reactive oxygen species in periodontitis. J Indian Soc Periodontol. 2013;17(4):411-416. doi:10.4103/0972-124x.118306
Borges IJ, Moreira EAM, Filho DW, Oliveira TB, Silva MBS, Frode TS. Proinflammatory and oxidative stress markers in patients with periodontal disease. Mediators Inflamm. 2007;2007:1-5. doi:10.1155/2007/45794
Kaufman E, Lamster IB. Analysis of saliva for periodontal diagnosis- A review. J Clin Periodontol 2000;27(7):453-465. doi:10.1034/j.1600-051x.2000.027007453.x
Kinney JS, Morelli T, Brun T, et al. Saliva/pathogen biomarker signatures and periodontal disease progression. J Dent Res. 2011;90(6):752-758. doi:10.1177/0022034511399908
Lieshout E, Peters W. Age and gender dependent levels of glutathione and glutathione s transferase in human lymphocytes. Carcinogenesis. 1998;19(10):1873-1875. doi:10.1093/carcin/19.10.1873
Tinti F, Soory M. Mechanisms for redox actions of nicotine and glutathione in cell culture, relevant to periodontitis. Sci Rep. 2012;2:566. doi:10.1038/srep00566
Karim S, Pratibha PK, Kamath S, et al. Superoxide dismutase enzyme and thiol antioxidants in gingival crevicular fluid and saliva. Dent Res J (Isfahan). 2012;9(3):266-272. PMID:23087730.
Chapple IL. Reactive oxygen species and antioxidants in inflammatory diseases. J Clin Periodontol. 1997;24:287-296. doi:10.1111/j.1600-051x.1997.tb00760.x
Tsai CC, Chen HS, Chen SL, et al. Lipid peroxidation: a possible role in the induction and progression of chronic periodontitis. J Periodontal Res. 2005;40(5):378-384. doi:10.1111/j.1600-0765.2005.00818.x
Barnes VM, Kennedy AD, Panagakos F, et al. Global metabolomic analysis of human saliva and plasma from healthy and diabetic subjects, with and without periodontal disease. PLoS One. 2014;9(8):e105181. doi:10.1371/journal.pone.0105181
Rai B, Jain R, Anand S, Kharb S. Total salivary glutathione levels: Periodontitis in smoker and non-smoker. The Internet Journal of Laboratory Medicine. 2008;3(2):47-49. doi:10.5580/288d
Diab R, Mounayar A, Maalouf E, Chahine R. Beneficial effects of Solanum melongena (Solanaceae) peduncles extracts, in periodontal diseases. J Med Plant Res. 2011;5(11):2309-2315.