Gingival Cervicular Fluid Levels of Tumor Necrosis Factor-alpha and Glucosamine Sulphate Following its Adjunctive Use in Treatment of Chronic Periodontitis

Abstract

Tumor necrosis factor-alpha is a significant proinflammatory cytokine that stimulates the events in the process of periodontal destruction. Recent advances in the host modulatory agents as adjunctive therapies to the conventional periodontal treatment (Scaling and root planing), resulted in enormous achievements in controlling the host immune response through the down regulation of proinflammatory cytokines and in particular TNF-alpha. The exciting similarity between the pathogenesis of Rheumatoid arthritis and periodontal diseases as well as the central role of TNF-alpha in the soft tissue and bone destruction in both diseases, led investigators to look for new drugs and formulations that might be helpful in controlling both disease. Throughout time, Glucosamine sulphate has been used to relieve arthritic pain and to halt the progress of joint inflammation and destruction. Its use in periodontal treatment has long been questioned in regards to its TNF-alpha inhibiting effect, bone sparing action and its ability to concentrate in the GCF. There has been a positive correlation between the serum levels of glucosamine and the GCF levels. This linear relation proves that the drug is able to concentrate in the gingival fluid. Still the other hypotheses of the effect of the drug in chronic periodontitis have to be investigated. Although levels of TNF-alpha decreased in GCF following the non-surgical periodontal treatment in all groups of patients in our study, Glucosamine seemed to have little effect on the cytokine release or production.