Periodontitis is seen as resulting from a complex interplay of bacterial infection and host response, modified by behavioral and systemic risk factors.There is high prevalence of endemic fluorosis among the patients in certain regions in India and scarcity of information on the effects of levels of fluoride in serum and saliva to the periodontal disease severity. Aim of the present study was to estimate the levels of fluoride in serum and saliva and in ground water of chronic periodontitis subjects in the endemic fluorosed area and to correlate the levels of fluoride in serum and saliva to the periodontal disease severity.140 subjects were divided into two groups. Group I (Test group) consisted of 100 dental subjects diagnosed with dental fluorosis and chronic periodontitis. Group II (Control group) consisted of 40 non-fluorosed subjects. Ion selective electrode method was used for assessingthe fluoride in serumand saliva. There was no significant correlation between salivary and serum fluoride levels and the periodontal disease severity. However the mean salivary fluoride levels were found to significantly influence the dental fluorosis severity (p<0.005*).
Periodontitis is a multifactorial disease which is associated with loss of the supporting tissues around the tooth surface. One of the major objectives of periodontal therapy is to remove mechanically the soft and hard, supra and subgingival deposits from the root surface to further stop the disease progression.[
Endemic fluorosis is widely prevalent in India and is one of the major health problems. Several reports are cited on the distribution of fluorine compounds in the environment, routes of penetration into living organisms, and analytical methods for the quantitative determinations of fluorine content in air, water, soil, and foods. Important contributions have been made by researchers on the role and patterns of fluorides in body fluids and soft and hard tissues, which remain in direct relationship to accumulation and elimination of fluorine.[
Several studies[
Higher percentage of cavitation and root resorption were observed influorosed teeth and this was a common finding when extensive alveolar bone loss takes place, where cementum repair was unable to compensate for resorption. Several scanning electron microscopic (SEM) studies[
Though large number of studies exists in literature comparing the influence of fluorosis on periodontal disease. No study exists in literature showing the correlation of levels of fluoride in serum and saliva to the periodontal disease severity. Hence the present study was planned to estimate the levels of fluoride in serum and saliva and in ground water of chronic periodontitis subjects in the endemic fluorosed area and to correlate the levels of fluoride in serum and saliva to the periodontal disease severity.
The present cross sectional case control study was carried out at a single center. The nature and purpose of the study was explained to the patient and a written informed consent was obtained from all participants prior to study. Ethical committee of the institution approved the study.
A total of 250 chronic periodontitis subjects with dental fluorosis within the age group of 35-55 years were screened. Out of which 140 subjects which fulfilled the inclusion and exclusion criteria were enrolled in the study. The subjects were selected from six regions of Nalgonda district affected with endemic fluorosis. A simple randomization approach [
100 subjects with periodontitis and dental fluorosis were included. They were categorized into 4 subgroups with 25 from each group according to the modified dean’s fluoride index
100 subjects with chronic periodontitis and dental flourosis were included. They were categorized into 4 subgroups with 25 individuals in each group according to the modified dean’s fluoride index.[
40 subjects without dental fluorosis consisting of 20 subjects with periodontitis and 20 without periodontitis.
After selection of subjects the following clinical parameters were recordedfor all the subjects in all the groups. A specially designed lightweight CPI probe with a 0.5mm ball tip was used, with a black band between 3.5 and 5.5mm and rings at 8.5 and 11.5mm from the ball tip.
CPI score (
CAL score (
Chronic periodontitis patients in the age group 35-55years.
Subjects with dental fluorosis as determined by Dean`s fluorosis index.
At least one site with probing depth >5mm and two sites with attachment loss >6mm in 2 quadrants.
No history of systemic antibiotic administration within the last 6 months.
No periodontal treatment 6 months prior to the study.
Signed informed consent.
Pregnant or lactating females.
Deleterious habits like smoking/alcohol/tobacco consumption.
Aggressive periodontitis.
Patients using fluoridated tooth paste since 6months.
For the estimation of fluoride levels in saliva, mix of resting saliva and stimulated saliva were collected respectively by expectorating into polypropylene tubes and were immediately subjected for analysis.
Venous blood samples were collected under aseptic precautions and centrifuged at 2500 rpm for 10 min and the supernatant serum which was separated in to 3ml sterile vials and immediately subjected for fluoride analysis by fluoride specific ion selective electrode method using TISAB buffer.
The data were analyzed using the SPSS -software 19.00 program (SPSS Inc., Chicago, IL, USA). Pearson correlation coefficient was used for descriptive analysis of the data.Inter group comparison was done by one-way analysis of variance (ANOVA). Differences were considered as statistically significant at p<0.005
This study was aimed at estimating the levels of fluoride levels in saliva and serum samples in all the 140 subjects and correlating these levels to the periodontal disease severity which was measured by calculating CPI and CAL scores.
030 when correlated to the mean CPI score which does not indicate any correlation between them (
fluoride in saliva | CPI Score | ||
fluoride in saliva | Pearson Correlation | 1 | 0.030 |
Sig. (2-tailed) | . | 0.73 | |
N | 140 | 140 | |
CPI Score | Pearson Correlation | 0.030 | 1 |
Sig. (2-tailed) | 0.762 | . | |
N | 140 | 140 |
CPI = Community periodontal index
The mean fluoride levels in serum and the standard deviation are calculated which was 0.018 indicated there is no correlation between the mean of serum fluoride and CPI scores (
Correlation of mean saliva fluoride scores to the mean CPI scores
fluoride in serum | CPI Score | ||
fluoride in serum | Pearson Correlation | 1 | 0.018 |
Sig. (2-tailed) | . | 0.831 | |
N | 140 | 140 | |
CPI Score | Pearson Correlation | 0.029 | 1 |
Sig. (2-tailed) | 0.842 | . | |
N | 140 | 140 |
CPI = Community periodontal index
Correlation coefficient value for mean and standard deviation of CAL scores and mean fluoride levels in saliva were is 0.029 which indicates no correlation between them (
Correlation of mean serum fluoride levels to the mean CPI scores
Fluoride in saliva | CAL score | ||
fluoride in saliva | Pearson Correlation | 1 | 0.029 |
Sig. (2-tailed) | . | 0.745 | |
N | 140 | 140 | |
CAL score | Pearson Correlation | 0.029 | 1 |
Sig. (2-tailed) | 0.764 | . | |
N | 140 | 140 |
CAL = Clinical attachment level
Correlation coefficient value for mean and standard deviation of CAL scores and mean fluoride levels in serum were is -0.019 which indicates no correlation between them (
Correlation of the mean salivary fluoride scores and mean CAL scores
fluoride in serum | CAL score | ||
fluoride in serum | Pearson Correlation | 1 | -0.01 |
Sig. (2-tailed) | . | 0.841 | |
N | 140 | 140 | |
CAL score | Pearson Correlation | -0.019 | 1 |
Sig. (2-tailed) | 0.841 | . | |
N | 140 | 140 |
CAL = Clinical attachment level
The means of fluoride in saliva between the groups were calculated and checked for any significant variation in the intra group mean values by ANOVA test. As the fluoride scores increased there was significant difference between the control group and severe fluoride score group. This indicates that there is some significant relation (p<0.005
005 * is significant, ANOVA = Analysis of variance
Sum of Squares | df | Mean Square | F | Sig. | |
Between Groups | 39.025 | 4 | 9.505 | 18.009 | 0.000 |
Within Groups | 60.707 | 115 | .528 | ||
Total | 99.731 | 119 |
Intra group comparison of means of fluoride in serum there was no significant difference in the means between the 2 groups (
Periodontal disease is the second most common dental ailment, after dental caries, causing tooth mortality. It is widespread throughout the world. Its severity distribution, progression depends on various microbial hosts, environmental and local factors.[
Among various environment etiological factors, the influence of fluoride on the periodontal health is still controversial. Although studies have been conducted on the effect of elevated fluoride in drinking water on gingivitis and periodontitis, the results have been inconsistent.[
Vandana and Sesha Reddy[
The present study when fluoride levels in drinking water ranging from 2.7 – 7-6 were compared to
In the present study there was no significant difference in the serum fluoride levels on CPI and CAL scores butsalivary fluoride levels were statistically significant, which may have impact on periodontal treatment. Heitz-Mayfield et al.[
Considering the limitations of this study we can conclude thatthere was no significant correlationbetween salivary and serum fluoride levels and theperiodontal disease severity. Mean salivaryfluoride levels were found to significantly influence the dental fluorosis severity (p<0.005