IntroductionPeriodontal diseases, caused by gram-negative bacteria, often begin as gingivitis and can progress to periodontitis, characterized by inflammation extending to the periodontal ligament and alveolar bone. Individuals with Down syndrome (DS) commonly exhibit poorer oral hygiene and a higher prevalence of severe chronic periodontitis. This study aimed to identify unregulated risk factors in DS that contribute to increased periodontal breakdown.Materials and methodsWe conducted a study with 60 age-matched patients, including 20 DS patients from Balavihar Special School and 40 systemically healthy patients with and without periodontitis from Thai Moogambigai Dental College and Hospital. We collected patients' complete case histories and blood samples for evaluating matrix metalloproteinase 8 (MMP8) and matrix metalloproteinase 9 (MMP9) levels. All patients underwent nonsurgical periodontal therapy, and the samples were processed at the Central Research Laboratory at Meenakshi Ammal Dental College and Hospital. We calculated each group's mean and standard deviation and compared them using one-way analysis of variance and Kruskal-Wallis tests, followed by post hoc (Tukey honestly significant difference) multiple group comparisons. Statistical analysis was performed using Statistical Product and Service Solutions (SPSS) Statistics for Windows, Version 17.0. (Chicago: SPSS Inc.).ResultsThe mean value of MMP8 in the DS group with chronic periodontitis was -18.1895, which was statistically significant (P<.001) compared to the mean value of -20.3720 in systemically healthy subjects with chronic periodontitis and -21.7120 in systemically healthy controls. Similarly, the mean value of MMP9 in the DS group with chronic periodontitis was 18.6455, which was statistically significant (P<.001) compared to the mean values of 19.8540 in systemically healthy subjects with chronic periodontitis and 25.2505 in systemically healthy controls. These findings indicate that DS subjects exhibit increased levels of pro-inflammatory cytokines MMP8 and MMP9, serving as markers for identifying periodontal disease. The mean differences in MMP8 and MMP9 in the DS group with chronic periodontitis showed highly statistically significant levels compared to both systemically healthy groups.ConclusionThis study aimed to identify unregulated risk factors in DS that contribute to increased periodontal breakdown. Our findings revealed elevated MMP8 and MMP9 in DS patients with periodontitis, indicating an increased risk for early development of destructive forms of periodontal disease in this population. Extensive gingival tissue inflammation, bleeding on probing, increasing probing depths, loss of periodontal attachment, and alveolar bone loss are all common symptoms.