Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 9  |  Issue : 2  |  Page : 111-113

A biochemical study to assess and compare salivary magnesium levels in periodontal health and diseases


Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences, Deemed University, Karad, Maharashtra, India

Date of Web Publication8-Jan-2018

Correspondence Address:
Dr. Sameer A Zope
Department of Periodontology, School of Dental Sciences, KIMSDU, Karad 415110, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jofs.jofs_105_16

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  Abstract 


Background: Chronic magnesium (Mg) deficiency has been associated with a number of chronic systemic diseases, including osteoporosis, hypertension, diabetes and coronary heart disease. Mg may also alter the course and outcome of the periodontal disease. Aim: To evaluate salivary Mg levels in healthy individuals and patients with chronic gingivitis and chronic periodontitis (CP). Materials and Methods: A total of 150 individuals were selected randomly, which included both males and females with age range between 20 and 45 years. Periodontal status was recorded using the following parameters − gingival index, plaque index, oral hygiene index − simplified and clinical attachment loss. Following periodontal examination, individuals were divided into three groups as follows: Group 1: (n = 50) − comprised of healthy individuals; Group 2: (n = 50) − comprised of patients with gingivitis; Group 3: (n = 50) − comprised of patients with CP. The unstimulated saliva samples from the study individuals were collected and subjected to the estimation of salivary Mg levels using Abcam’s Mg assay kit and Erba EM 360 fully automated auto analyzer (Erba Diagnostic, Mannheim, Germany). Results: In this study, there was an increase in salivary Mg level with increasing severity of the periodontal disease. A significant increase in salivary Mg levels was recorded in patients with gingivitis (1.66 ± 0.28 mg/dl) and periodontitis (2.05 ± 0.66 mg/dl) as compared to healthy individuals (1.35 ± 0.28 mg/dl). Conclusion: Salivary Mg does not play an active role in the modulation of periodontal disease process and, hence, cannot be used as a reliable biomarker associated with periodontal health and disease.

Keywords: Gingivitis, periodontitis, saliva, salivary magnesium


How to cite this article:
Shetty TJ, Zope SA, Suragimath G, Varma S, Abbayya K, Kale V. A biochemical study to assess and compare salivary magnesium levels in periodontal health and diseases. J Orofac Sci 2017;9:111-3

How to cite this URL:
Shetty TJ, Zope SA, Suragimath G, Varma S, Abbayya K, Kale V. A biochemical study to assess and compare salivary magnesium levels in periodontal health and diseases. J Orofac Sci [serial online] 2017 [cited 2019 Jun 17];9:111-3. Available from: http://www.jofs.in/text.asp?2017/9/2/111/222382




  Introduction Top


Periodontal diseases are heterogeneous and include a variety of infections and inflammatory lesions. Notably, periodontitis is a prevalent disease of humans that is characterized by the loss of connective tissue attachment and bone around the teeth.[1] More recently, it has been realized that the host-related factors might be the key to the understanding of the disease processes in periodontitis. Chronic periodontitis (CP) is initiated by the microbial biofilm but the progression of destructive disease appears to be dependent on an abnormal host response to those organisms.[2] It is also characterized by hyper-inflammatory response involving excess oxygen radical release by polymorphonuclear leucocyte.[3] Magnesium (Mg) is an essential bivalent metal for the activity of over 300 enzymes. It features an anti-oxidant activity because it reduces the formation of peroxide radicals. Mg status has a strong relationship with the immune system, acting as a modulator of the immune response. The activation of neutrophils is an early effect of hypomagnesaemia, and high Mg concentrations inhibit free-radical generation. It is involved in the modulation of vascular permeability and in the endothelial function. Very few studies have investigated the association of salivary Mg with periodontal diseases.[4] Hence, the current study is undertaken to find out the role of salivary Mg levels in periodontal disease pathogenesis.


  Materials and Methods Top


This was a cross-sectional study, which consisted of 150 individuals selected randomly from the Department of Periodontology. After due approval from the Ethical Committee of Krishna Institute of Medical Sciences Deemed University (KIMSDU) [Ref no. KIMSDU/ICMR/STS/2015, dated 05/03/2015], this study was conducted between September 2015 and November 2015 in accordance with Declaration of Helsinki (1975).

Inclusion criteria

A total of 150 systemically healthy individuals, both males and females aged 20–45 years, were considered for the study.

Exclusion criteria

Patients with systemic diseases, history of periodontal treatment during past 6 months and those who had taken antibiotics or anti-inflammatory drugs within last 6 months were excluded. Smokers, pregnant or lactating women and those individuals who were on drugs that could alter bivalent cation levels were also not considered in the current study.

After the informed consent of enrolled individuals, periodontal status was recorded using the following parameters: the full mouth gingival index (Leo and Sillness, 1963)[5] and plaque index (Turskey–Gilmore–Glickman modification of the Quigley Hein Plaque Index, 1970)[6] were estimated by dividing the full mouth scores by the total surfaces recorded. Oral hygiene index − simplified (John C. Greene, 1960)[7] was also recorded. Clinical attachment loss (CAL) was recorded from the base of the sulcus to cementoenamel junction and periodontal probing depth (PPD) from gingival margin to the base of gingival sulcus. University of North Carolina-15 (UNC-15, Hu-friedy) probe was used to record PPD and CAL. All periodontal parameters were recorded by a single calibrated examiner.

Following periodontal examination, individuals were divided into three groups as follows:
  • Group 1: (n = 50) − healthy individuals with the absence of gingival inflammation and bleeding on probing.
  • Group 2: (n = 50) − patients with gingivitis with gingival inflammation and bleeding on probing without CAL.
  • Group 3: (n = 50) − patients with CP with CAL.


Saliva collection

Unstimulated 2 ml whole saliva samples were collected in the morning from 10 AM to 1 PM, two hours after the last meal to standardize the collections according to the circadian rhythm. The saliva was collected by making the patient to sit in upright position at rest, bow their head and try not to move during the test. Immediately before the test begins, they were instructed to swallow any residual saliva. The saliva was allowed to accumulate for 5–7 min and then expectorated into the collecting vessel. The sample was transferred into sterile Eppendorf tubes and then transported to the laboratory immediately using standard gel coolant packs to maintain the temperature between 2 and 4°C.

Biochemical assay

The salivary Mg was estimated using Abcam’s Mg assay kit and Erba EM 360 fully automated auto analyzer (Erba Diagnostic, Mannheim, Germany). The salivary Mg levels were measured in mg/dl.

Statistical analysis

All the data collected were statistically analyzed using the Statistical Package for the Social Sciences version 19.0 software (IBM Corporation, Armonk, New York, USA).


  Results Top


The distribution of salivary Mg levels showed significant variations among all the groups. The mean salivary Mg level of 1.35 ± 0.28 mg/dl was recorded in Group A (healthy). However, a higher Mg level with a mean value of 1.66 ± 0.28 mg/dl was recorded in Group B (chronic gingivitis). Individuals with the highest salivary Mg concentration of 2.05 ± 0.66 mg/dl were observed in Group C (CP). This noticeable difference in mean salivary Mg levels of a total of 150 enrolled individuals (82 males 68 females) is represented in [Table 1].
Table 1: Salivary magnesium levels among three groups

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[Table 2] presents the intergroup comparison of salivary Mg levels between healthy, gingivitis and periodontitis groups where a significant increase in salivary Mg levels were reported in patients with chronic gingivitis (P < 0.001) and CP (P < 0.001) as compared to healthy control group.
Table 2: Intergroup comparison of salivary magnesium levels

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  Discussion Top


In this study, a significant increase in salivary Mg levels was observed with increasing severity of the periodontal disease. The salivary Mg levels observed in healthy individuals were lowest, whereas they were highest in patients with CP. Similar results were reported by Manea and Nechifor[4] who reported increase in salivary Mg levels in patients with periodontitis, but this increase was not significant. This can be attributed to the inclusion of smokers in the study population and influence of smoking on salivary Mg levels. The results of the current study disagree with the studies conducted by several authors who found that Mg deficiency is associated with periodontal disease.[8],[9] The reduced Mg concentration is associated with decreased anti-inflammatory effect of salivary Mg, leading to increased inflammatory response to periodontal microbial challenge. Few authors reported no significant difference in salivary Mg level in healthy individuals and patients with periodontitis.[10],[11]

A higher salivary Mg level has a reducing action on the destruction mediated by some pro-inflammatory cytokines, such as TNF-α and IL-6. Mg deficiency favours the development of inflammatory conditions.[12] But in the present study, we did not find this anti-inflammatory role of salivary Mg levels, because these levels were found to be increased in periodontitis group as compared to healthy individuals. This increase in salivary Mg level in current study population can be attributed to the influence of drinking water Mg levels on salivary Mg concentration. The drinking water supply of our study population was reported to have more concentration of calcium and Mg leading to the increased prevalence of sialoliths and nephroliths in this region. This positive influence of drinking water calcium and Mg levels on salivary concentration has been recently confirmed by Schroder et al.[13] in the population of Denmark.


  Conclusion Top


The findings of our study revealed that salivary Mg levels increased with increasing severity of periodontal disease. Considering the results of the current study and available literature regarding the association of salivary Mg levels with periodontal health and disease, it can be concluded that salivary Mg level alone does not play an important role in the amelioration of periodontal inflammatory process.

Furthermore, longitudinal studies with larger sample size would be valuable to establish the temporal association between salivary Mg levels and periodontal status.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Delima A, Spyros K, Amar S, Graves DT. Inflammation and tissue loss caused by periodontal pathogens is reduced by IL-1 antagonists. J Infect Dis 2002;186:511-6.  Back to cited text no. 1
    
2.
Genco RJ. Current view of risk factors for periodontal diseases. J Periodontal 1996;67:1041-9.  Back to cited text no. 2
    
3.
Dahiya P, Kamal R, Gupta R, Bhardwaj R, Chaudhary K, Kaur S. Reactive oxygen species in periodontitis. J Indian Soc Periodontol 2013;17:411-6.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Manea A, Nechifor M. Research on plasma and saliva levels of some bivalent cations in patients with chronic periodontitis (salivary cations in chronic periodontitis). Rev Med Chir Soc Med Nat Iasi 2014;118:439-49.  Back to cited text no. 4
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5.
Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963;21:533-51.  Back to cited text no. 5
    
6.
Schneider HG, Göbbels E, Apel EM. Simplification of plaque index method of Quigley and Hein. Stomatol DDR 1989;39:91-4.  Back to cited text no. 6
    
7.
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13.  Back to cited text no. 7
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8.
Aun WA. Inorganic ions level in saliva of patients with chronic periodontitis and healthy subjects. J Bagh Coll Dent 2012;24:93-7.  Back to cited text no. 8
    
9.
Meisel P, Schwahn C, Luedemann J, John U, Kroemer HK, Kocher T. Magnesium deficiency is associated with periodontal disease. J Dent Res 2005;84:937-41.  Back to cited text no. 9
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10.
Ali BG, Ali OH. Detection of salivary flow rate and minerals in smokers and non-smokers with chronic periodontitis (clinical and biochemical study). J Bagh Coll Dent 2012;24:68-71.  Back to cited text no. 10
    
11.
Rajesh KS, Zareena Hegde S, Arun Kumar MS. Assessment of salivary calcium, phosphate, magnesium, pH, and flow rate in health subjects periodontitis and dental caries. Contempt Clin Dent 2015;6:461-5.  Back to cited text no. 11
    
12.
Mazur A, Maier JA, Rock E, Gueux E, Nowacki W, Rayssiguier Y. Magnesium and the inflammatory response: Potential physiopathological implications. Arch Biochem Biophys 2007;458:48-56.  Back to cited text no. 12
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13.
Schroder S, Homoe P, Wagner N, Vataire AL, Madsen HE, Bardow A. Does drinking water influence hospital-admitted sialolithiasis on an epidemiological level in Denmark. BMJ Open 2015;5:e007385. doi: 10.1136/bmjopen- 2014-007385.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2]



 

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