Discussion
periodontitis, inflammation, infectious disease, PD, CHD, calculus, coronary heart disease
PCT, PERIODONTITIS, INFLAMMATION, DISEASE, PLAQUE, INFECTIOUS DISEASE, PERIODONTAL DISEASE, PERIODONTITIS, CORONARY HEART DISEASE
The goal of periodontal treatment is to eliminate the bacterial plaque and the associated factors enhancing its accumulation. Despite SRP being the routine therapeutic modality [The use of natural herbal products in dentistry has become ever-increasing. This can be attributed to their low cost, limited side effects, and inherent availability [Furthermore, the assessment of salivary biomarkers such as PCT has become an important part of laboratory diagnosis for the prediction of periodontitis [Regarding the results of this study, all baseline recorded clinical parameters; GI, PI, CAL, and PD showed insignificant variance among both the study group (group III) and positive control group (group II), whereas there was a statistically significant variance among the two groups of periodontitis (group II and III) as opposed to the clinically healthy control group. Furthermore, there was a significant improvement in all clinical indices in both group II and group III at six weeks after treatment. This can be explained due to SRP being considered the gold standard for mechanical therapy in the treatment of periodontitis [On the other hand, regarding the salivary PCT baseline levels in the study, there wasn’t a statistically significant variance between group II and group III. However, the PCT level in both groups was significantly elevated as opposed to group I. After six weeks of recall appointments and follow-ups, the levels of salivary PCT reduced significantly in both groups II and group III and dropped to that of group I as there wasn’t a statistically significant difference between the three groups after treatment.In this study, there was a significant improvement in all clinical indices in both group II and group III after treatment. This can be explained due to SRP being considered the gold standard [The results of the study are consistent with those of Behal, et al., (2011) and Bhatia, et al.,(2014) who evaluated a local drug delivery containing curcumin gel with SRP compared to SRP alone and found a significant reduction in all clinical indices with greater improvement was seen in all indices in the curcumin group as opposed to the SRP group with better restoring of gingival health [Likewise, Anitha, et al., (2015), Hugar, et al., (2016), and Siddharth, et al., (2020) in their studies comparing curcumin as local drug delivery and chlorohexidine ( which is a gold standard), found better improvement in both groups with a greater reduction in all measured parameters in curcumin group [Regarding the baseline salivary PCT levels in this study, there wasn’t a statistically significant difference between group II and group III and the level in both groups was significantly higher as opposed to group I. This could be attributed to the production of PCT in response to inflammation with the simultaneous release of endotoxin from nearly all body tissues. As per the literature, Periodontitis is an infectious disease caused by Gram-negative pathogenic bacteria generating endotoxins with subsequent enhancement of PCT secretion in saliva [However, the results of one study indicated that patients with periodontitis and with periodontitis associated with coronary heart disease had higher serum and salivary Galectin-3 levels compared with CHD patients and healthy controls [After six weeks of recall appointments and follow-ups, the levels of salivary PCT reduced significantly in both groups II and group III and dropped to that of group I as there wasn’t a statistically significant difference between the three groups after treatment. The reduction of salivary PCT levels after treatment can be attributed in -part to the effective SRP as it is considered the gold standard in the treatment of periodontitis [These results are in line with Hendek, et al., (2015), which found an increase in salivary PCT level in periodontitis and positively correlated the level to clinical indices such as PD, CAL, and GI. RENJITH, et al., (2021), assessed salivary and serum PCT in systemically healthy periodontitis patients before and after SRP. They found a significant reduction in saliva and serum PCT levels one month after SRP indicating the impact of periodontal therapy on systemic inflammation. They also concluded that salivary PCT is positively correlated with serum PCT, so it can be considered as an alternative biomarker to its serum counterpart [Finally, this study demonstrated a statistically significant positive correlation between salivary PCT levels and clinical indices in the periodontitis patients (group II and group III). This correlation was found in the total patients in both group II and group III. And this statistically positive significant correlation was only in the total patient population and not in the individual groups as the sample size was too small in each group.These results could be explained by the common contributing factors that caused elevation in both the clinical indices and salivary PCT levels before treatment such as poor oral hygiene, accumulation of plaque and calculus with subsequent elevation of oral microbial flora, associated periodontal destruction with the secretion of inflammatory biomarkers (including salivary PCT) [Although there was a statistically significant decrease in clinical parameters and salivary PCT levels after treatment, there wasn’t a statistically significant correlation between clinical indices and salivary PCT levels. This is in agreement with Bassim et al.(2008) who observed a reduction in salivary PCT levels 3 months after periodontal therapy, but it was not statistically significant [So, Repeated clinical applications of curcumin gel as an adjunct to standard SRP have demonstrated a substantial outcome on all assessed clinical indices between the selected pockets with greater improvement as compared to SRP only as well as excellent restitution of attachment loss, and repair of periodontal tissue even with further deep periodontal pockets PCT levels in saliva in periodontal health and disease were estimated and results suggested that its levels increased progressively in saliva with the severity of the periodontal disease.PCT concentration in saliva was found to be highest in both periodontitis groups and lowest in the periodontally healthy group. After the periodontal treatment, the level of PCT in saliva was significantly decreased in periodontitis patients.