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ORIGINAL ARTICLE
Year : 2010  |  Volume : 14  |  Issue : 4  |  Page : 227-230  

Quantitative estimation and correlation of serum albumin levels in clinically healthy subjects and chronic periodontitis patients


Department of Periodontics ,VSPM Dental College and Research Center, Digdoh Hills, Hingna Road, Nagpur - 440019, Maharashtra, India

Date of Submission17-Aug-2010
Date of Acceptance16-Sep-2010
Date of Web Publication19-Feb-2011

Correspondence Address:
Rajashri A Kolte
VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur 440019, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-124X.76923

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   Abstract 

Aim: The aim of this study was to evaluate the relationship between periodontal disease and general health status in adults using the serum albumin concentration. Materials and Methods: A total of 100 patients of both genders with age range of 40 to 70 years were included in the study. Patients were divided into the following two groups: clinically healthy subjects and patients with periodontitis, that is, loss of attachment ≥5 mm. Dental examinations were carried out at baseline and clinical attachment levels were measured at four sites. Serum albumin concentration was estimated by bromocresol green albumin method. Results: The mean serum albumin levels for Group I was 4.47 g/dl with standard deviation (SD) of 0.276 and for Group II, the mean value of serum albumin was 4.61 g/dl with SD of 0.273. Using Student's unpaired 't' test, the difference between the serum albumin levels in Group I and Group II were found to be statistically significant (P=0.020). The mean body mass index values for Group I was 22.63 with a SD of 3.85, whereas the same for Group II was 22.23 with a SD of 4.21, which were on comparison, found to be nonsignificant (P=0.462). Conclusion: The findings of the clinical trial suggest an inverse relationship between the serum albumin concentration and chronic periodontal disease.

Keywords: Adults, general health status, periodontal disease, serum albumin


How to cite this article:
Kolte RA, Kolte AP, Kohad RR. Quantitative estimation and correlation of serum albumin levels in clinically healthy subjects and chronic periodontitis patients. J Indian Soc Periodontol 2010;14:227-30

How to cite this URL:
Kolte RA, Kolte AP, Kohad RR. Quantitative estimation and correlation of serum albumin levels in clinically healthy subjects and chronic periodontitis patients. J Indian Soc Periodontol [serial online] 2010 [cited 2019 Dec 6];14:227-30. Available from: http://www.jisponline.com/text.asp?2010/14/4/227/76923


   Introduction Top


Periodontal infection has been implicated as a risk factor for systemic diseases such as coronary heart disease and diabetes. [1] It has been suggested that impaired dentition status, such as tooth loss owing to periodontal infection, may affect individuals by causing dietary restrictions through difficulty in chewing, possibly compromising their nutritional status and well-being. [2] However, the association between periodontal disease and general health, including nutritional status, in the elderly who may be at a higher risk of developing inflammatory conditions or disorders is still unclear.

Serum albumin level is a practical marker of the general health status as it demonstrates the severity of an underlying disease and mortality in the elderly. [3] Several studies have demonstrated that serum albumin concentrations are associated with general health status among the elderly. [4] Moreover, malnutrition may also be monitored by means of serum albumin concentration. [5] Serum albumin is the main protein synthesized by the liver. Inflammation and malnutrition both reduce albumin concentration by decreasing its rate of synthesis.

On the other hand, periodontitis is defined as an inflammatory condition of the gingival tissues, characterized by loss of attachment (LA) of the periodontal ligament and the bony support of the tooth. [6] Moreover, periodontitis has been implicated as a risk factor for medical diseases such as cardiovascular diseases and diabetes mellitus. [7] In periodontal diseases, bacteria trigger inflammatory host responses that cause destruction of the alveolar bone and periodontal connective tissue. The individual characteristics that diminish the efficiency of host response may include medical factors such as malnutrition, which consistently impairs the innate and adaptive defenses of the host, including phagocytic function, cell-mediated immunity, complement system, secretory antibody, and cytokine production and function. [8]

Consequently, it is very important to study the association between periodontal disease and serum albumin levels, which reflect the general health status in the elderly who may be at a higher risk of developing inflammatory conditions or disorders.

So, the aim of this study was to evaluate the relationship between periodontal disease and general health status in adults using the serum albumin concentration.


   Materials and Methods Top


A total of 100 patients of both genders with age range of 40 to 70 years were included in this study. Patients were selected from the Out Patient Department of Periodontics V.S.P.M.'s Dental College and Research Centre, Nagpur.

Inclusion criteria for this study were Group I (clinically healthy subjects) and Group II (patients with periodontitis, i.e., LA≥5 mm). Hospitalized or institutionalized patients were excluded from the study. A total of 100 patients were selected. Prior to the study, the purpose and design of the study was explained to patients and informed consent was signed by every patient.

The study protocol was approved by Ethics Committee of V.S.P.M's Dental College and Research Centre, Nagpur and all the procedures followed were in accordance with the Helsinki Declaration of 1975 and as revised in 2000.

Dental examinations for number of teeth present, gingival index, plaque index, probing depth, and loss of clinical attachment were assessed at baseline. A personal interview was conducted to obtain the information regarding gender and smoking habit. Anthropometric evaluation which included measurements of weight and height for the calculation of body mass index (BMI) was done. For biochemical tests, 1 ml blood was drawn from antecubital vein and was centrifuged at 2,500 rpm for 10 minutes [Figure 1] and [Figure 2].
Figure 1: Blood being procured from the subjects

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Figure 2: Centrifugal machine

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Biochemical value of serum albumin level was measured by the bromocresol green albumin (BCG) method. Analysis was done by Selectra E Kit (Merck® ) using fully automated biochemical analyzer [Figure 3] and [Figure 4].
Figure 3: Serum albumin kit

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Figure 4: Biochemical analyzer

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The patients were divided into the following two groups:

Group I: Clinically healthy subjects

Group II: Patients with chronic periodontitis with LA≥5 mm.

Clinical attachment level was measured by Hu Friedy William's graduated probe on mesiobuccal, midbuccal, distobuccal, and lingual surfaces of each tooth. Serum level of albumin was measured by the BCG method. Data were analyzed in 100 subjects examined, in whom the levels of serum albumin were evaluated. Students' unpaired 't' test was used for analysis between clinically healthy subjects and chronic periodontitis patients for gingival index, plaque index, BMI, and serum albumin level. A correlation was found in BMI and serum albumin levels in both the groups.


   Results Top


The study consisted of 100 individuals who were equally divided into two groups, one group with clinically healthy gingiva (Group I) and the other group characterized by chronic periodontitis (Group II).

The mean serum albumin levels for Group I was 4.74 g/dl with standard deviation (SD) of 0.276 and ranged between 4.0 and 5.03 g/dl. Similarly, the mean serum albumin level for Group II was 4.61 g/dl with SD of 0.273, which ranged from 3.68 to 5.03 g/dl. On comparison of both the values using the Students' unpaired 't' test, the differences between the serum albumin levels in Group I and Group II were found to be statistically significant (P=0.020).

The gingival index and plaque index which are important indicators as far as periodontal health and chronic periodontitis are concerned showed values which were grossly different between the two groups. The gingival index values in Group I was 0.557 with SD of 0.238 and in Group II was 1.858 with SD of 0.433 (P=0.001) and for plaque index, values for Group I was 0.801 with SD of 0.221 and in Group II was 1.702 with SD of 0.440 (P=0.001).

The mean BMI values for Group I was 21.63 with a SD of 3.85, whereas the same for Group II was 22.23 with a SD of 4.21. On comparison, these were found to be nonsignificant (P=0.462).


   Discussion Top


In this clinical trial, a statistically significant association was observed between the serum albumin levels of clinically healthy subjects and chronic periodontitis patients. In this trial, 50 patients of chronic periodontitis had a periodontal LA which was greater than 5 mm; the results showed an inverse independent relationship between periodontal disease and serum albumin concentrations which were somewhat similar to the findings of study reported by Ogawa et al. However, the age group in our clinical trial ranged between 40 and 70 years of age with an approximate presence of 28 teeth per subject, whereas the one investigated by Ogawa et al. was above 70 years and above with an appropriate presence of 18 teeth per subject. [9]

In elderly individuals, it would seem imperative that the impaired dentition status and a lean lifestyle along with possibility of compromised systemic health status would reflect within the values of serum albumin concentration. Though this is a possibility, it becomes difficult to infer whether serum albumin concentrations are affected by inflammatory component of chronic periodontitis or the compromised nutritional status, owing to the general health status of the individual.

This possibility of general health/nutritional status in any way affecting the serum albumin concentrations was somewhat eliminated in our clinical trial, as the subjects included in our clinical trial were physically fit without any systemic diseases and the mean dentate percentage being 28 teeth per subject. Thus, it would seem legitimate to infer that the lower serum albumin concentrations (4.61 g/dl) were solely affected by the inflammatory component of chronic periodontitis.

Our results are similar to those reported by Yoshihara et al. and substantiate the association between oral health status, in particular periodontal disease and serum albumin concentrations. [10]

There has also been a linkage of serum albumin level and mortality rate. Investigations by Corti et al. have reported graded increase in mortality rate with decreasing albumin levels. [4] However, it seems more evident that serum albumin levels below 4 g/dl have higher mortality rate. Shibata et al. reported significantly different 10-year survival rate with a quartile of serum albumin levels. Therefore, the periodontal disease status has a substantial influence not only on the subject's serum albumin levels but also on general health aspects. [3] The mean serum albumin levels in our trial in chronic periodontitis patients was 4.61 g/dl, which would lead us to assume that the survival rates would be better for the subjects included in the trial.

In a longitudinal study by Iwasaki et al., a significant association was found between the number of periodontal disease events over 4 years and serum albumin levels. [11] Though in our study a correlation between periodontal disease events and serum albumin levels could not be established, the subjects in Group II, that is, chronic periodontitis, exhibited an average of 17.3% of teeth exhibiting LA greater than 5 mm. So, this group of patients does reflect about the severity and extent of periodontal destruction, which at many sites within the oral cavity would represent periodontal disease events.

In view of the above findings of the present study, we cannot confirm a clear cause-effect relationship between serum albumin and periodontal disease at this stage. In order to explore the actual relationship, further prospective studies and clinical trials with larger sample size would be necessary.

In conclusion, the findings of the clinical trial suggest an inverse relationship between the serum albumin concentration and chronic periodontal disease.

 
   References Top

1.Genco RJ, Trevisan M, Wu T, Beck JD. Periodontal disease and risk of coronary heart disease. JAMA 2001;285:40-1.  Back to cited text no. 1
    
2.Chauncey HH, Muench ME, Kapur KK, Wayler AH. The effect of the loss of teeth on diet and nutrition. Int Dental J 1984;34:98-104.  Back to cited text no. 2
    
3.Shibata H, Haga H, Ueno M, Hagai H, Yasumura S, Koyano W. Longitudinal changes of serum albumin in elderly people living in the community. Age and Ageing 1991;20:417-20.  Back to cited text no. 3
    
4.Corti MC, Guralnik JM, Salive ME, Sorkin JD. Serum albumin level and physical disability as predictors of mortality in older persons. J Am Med Ass 1994;272:1036-42.  Back to cited text no. 4
    
5.Don BR, Kaysen G. Serum albumin: Relationship to inflammation and nutrition. Semin Dial 2004;17:432-7.  Back to cited text no. 5
    
6.Genco RJ, Goldman HM, Cohen DW. Classification and Clinical and Radiographic Features of Periodontal Disease. Contemporary Periodontics. St Louis: Mosby Company; 1990. p. 63-81.   Back to cited text no. 6
    
7.Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiological perspective. Ann Periodontol 2001;6:99-112.  Back to cited text no. 7
    
8.Enwonwu CO, Phillips RS, Falkler WA. Nutrition and oral infectious diseases: state of the science. Compend Contin Educ Dent 2002;23:431-4, 436, 438.  Back to cited text no. 8
    
9.Ogawa H, Yoshihara A, Amarasena N, Hirotomi T, Miyazaki H. Association between serum albumin and periodontal disease in community-dwelling elderly. J Clin Periodontol 2006;33:312-6.  Back to cited text no. 9
    
10.Yoshihara A, Hanada N, Miyazaki H. Association between serum albumin and root caries in community-dwelling older adults. J Dent Res 2003;82:218-22.  Back to cited text no. 10
    
11.Iwasaki M, Yoshihara A, Hirotomi T, Ogawa H, Hanada N, Miyazaki H. Longitudinal study on the relationship between serum albumin and periodontal disease. J Clin Periodontol 2008;35:291-6.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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