PERIODONTICS
Discussion
Saliva is an excellent natural ultrafiltrate that
contains local substances as well as others derived
from the blood. In saliva we can detect a myriad
markers such as: cytokines (TNF-α, IL-6, IFN-γ,
MIP-1β), C Reactive Protein (CRP), antioxidant
biomarkers
(uric
acid,
malondialdehyde,
antioxidant enzymes, total antioxidant ca pacity)
insulin resistance markes (adipokines) or cortisol
(13, 14,16).
Steroids, such as cortisol, not bound by carrier
proteins, can diffuse freely into saliva, being the
free fraction. The concentration of cortisol in saliva
is independent of the salivary flow rate and strongly
correlated with circulating cortisol concentration.
In the reference literature, cortisol is the most
common used indicator of stress, released by the
hypothalamo-pituitary-adrenal (HPA) axis, under
the influence of several factors such as chronic
inflammation (13,17).
The most important effects of cortisol release
are: supression of the inflammatory response,
modifying cytokine profiles, elevation of blood
glucose levels and alteration of certain growth
factors levels (18, 19). Low levels of cortisol
were detected in patients with primary adrenal
insufficiency (Addison’s disease) and ACTH
deficiency (20,21). Higher levels of cortisol were
found in patients with systemic (Cushing’s disease,
malignancy) and oral diseases (22-34).
In healthy subjects, cortisol is higher in the
morning (0.20-1.41 μg/mL), compared to the
afternoon values (0.04-0.41 μg/mL). Salivary
concentrations reflect the activity of HPA axis (35)
very well. Salivary cortisol levels reflect endocrine
abnormalities, insulin resistance, hypertension,
dyslipidemia and type 2 diabete (13).
Previous studies reported higher levels of this
biomarker in patients’ saliva. Salivary cortisol was
detected from stimulated, unstimulated whole
saliva and from gingival crevicular fluid. The
results were the same: higher levels of cortisol
in all different forms of periodontitis (aggressive,
chronic periodontitis). Anxious patients with
chronic periodontitis present higher levels of
cortisol and anxiety. Anxiety may be regarded
as an important factor in the progression of
periodontal diseases (8, 9, 25-30).
In our study we detected cortisol from unstimulated whole saliva and serum and detected
increased levels with patients with chronic
periontitis versus healthy subjects.
During periods of stress it is believed that
oral hygiene is neglected and is associated
with attachment loss and missing teeth.
Cortisol exercise inhibitory effects on the
inflammatory immune response, because
IL-12 is inhibited and IL-10 is stimulated by
macrophages. These changes have major effects
on the immune and inflammatory response and
conduce to increased susceptibility to pathogenic
microorganisms (18, 19, 36).
Figure 1. Cortisol release factors by HPA axis (17)
46
STOMA.EDUJ (2015) 2 (1)