EC Dental Science

Background and Objective: Periodontitis is an infectious immunoinflammatory disease, triggered and aggravated by subgingival microbiota. Locally secreted cytokines and periodontal pathogens can induce low grade systemic inflammation. It may act as a common pathophysiological mechanism that links periodontal diseases and systemic conditions. Periodontitis is associated with anemia of chronic disease which is occurring in chronic infections, inflammatory conditions, etc. Cytokines associated with periodontal inflammation inhibit proliferation and differentiation of erythrocytes and affect iron metabolism leading to anaemia. The present study was undertaken to evaluate the relation between chronic periodontitis, hemoglobin level and serum ferritin.

Materials and Methods: This observational study consists of two groups. Case group comprised of 40 male patients aged between 35 - 65 with chronic periodontitis (CAL > 5 mm, PPD > 6 mm) and were consecutively selected from the Dept. of Periodontics, GDC Kozhikode. 40 healthy volunteers aged between 35 - 65 with (PPD < 3 mm, CAL < 3 mm) were selected as control group. All subject were assessed for periodontal parameters (BOP, PPD, CAL, OHI-S Index and Gingival index) and hematological parameters (Hb, MCV, MCH, MCHC, PCV, and serum ferritin).

Result and Discussion: Mean hemoglobin level in case and control group was 13.18 ± .57 and 14.04 ± .57 respectively and the difference was significant (p < 0.001). Serum ferritin level was significantly high in subject with chronic periodontitis (p < 0.03) as compared to control group. Significant difference was observed in MCHC, MCH and PCV level (p < 0.001, p < 0.001 and p < 0.001 respectively). A negative correlation showed between PPD and Hb level, there was a weak positive correlation exist between serum ferritin and mean PPD.

Interpretation and Conclusion: Inflammation associated with chronic periodontitis influences serum hemoglobin level, ferritin level and other hematological parameters. Chronic periodontitis may have a definite role in the occurrence of anaemia of chronic disease (ACD). Successful management of periodontal infection could improve the level of haemoglobin.

Keywords: Anemia of Chronic Disease; Chronic Periodontitis; Hemoglobin; Ferritin

1. Papapanou PN., et al. “Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions”. Journal of Clinical PeriodontologyS20 (2018): S162-170.
2. Kim J., et al. “Periodontal disease and systemic conditions: a bidirectional relationship”. Odontology1 (2006): 10-21.
3. Dhadse P., et al. “The link between periodontal disease and cardiovascular disease: How far we have come in last two decades?” Journal of Indian Society of Periodontology3 (2010): 148-154.
4. Grau AJ., et al. “Periodontal disease as a risk factor for ischemic stroke”. Stroke2 (2004): 496-501.
5. López NJ., et al. “Higher risk of preterm birth and low birth weight in women with periodontal disease”. Journal of Dental Research1 (2002): 58-63.
6. Anumolu VN., et al. “Evaluation of the relation between anemia and periodontitis by estimation of blood parameters: A cross-sectional study”. Journal of Indian Society of Periodontology3 (2016): 265-272.
7. Weiss G and Goodnough LT. “Anemia of chronic disease”. The New England Journal of Medicine10 (2005): 1011-1023.
8. Jenabian N., et al. “The Relation between Periodontitis and Anemia Associated Parameters”. Journal of Dent Maxillofacial3 (2013): 26-33.
9. Jenabian N., et al. “The Relation between Periodontitis and Anemia Associated Parameters”. Journal of Dent Maxillofacial Radiology, Pathology and Surgery3 (2014): 26-33.
10. Hutter JW., et al. “Lower numbers of erythrocytes and lower levels of hemoglobin in periodontitis patients compared to control subjects”. Journal of Clinical Periodontology10 (2001): 930-936.
11. Gokhale SR., et al. “Evaluation of blood parameters in patients with chronic periodontitis for signs of anemia”. Journal of Periodontology8 (2010): 1202-1206.
12. Santosh H., et al. “Chronic Periodontitis and Anaemia of Chronic Disease: An Observational Study:9”. Archives of Orofacial Sciences2 (2015): 57-64.
13. Lobene RR., et al. “A modified gingival index for use in clinical trials”. International Journal of Clinical Preventive Dentistry1 (1986): 3-6.
14. Greene JC and Vermillion JR., et al. “The Simplified Oral Hygiene Index”. Journal of the American Dental Association 68 (1964): 7-13.
15. Löe H., et al. “The Gingival Index, the Plaque Index and the Retention Index Systems”. Journal of Periodontology6 (1967): 610-616.
16. Erdemir EO., et al. “Evaluation of Systemic Markers Related To Anemia of Chronic Disease in the Peripheral Blood of Smokers and Non-Smokers with Chronic Periodontitis”. European Journal of Dentistry 2 (2008): 102-109.
17. Amar S and Chung KM. “Effect of hormonal variation on the periodontium in women”. Periodontology 2000 (1994): 79-87.
18. Takami Y., et al. “Blood Test Values and Community Periodontal Index Scores in Medical Checkup Recipients”. Journal of Periodontology12 (2003): 1778-1784.
19. Voruganti K. “Clinical periodontology and implant dentistry, 5th edition”. British Dental Journal4 (2008): 216-216.
20. Agarwal N., et al. “Effect of periodontal therapy on hemoglobin and erythrocyte levels in chronic generalized periodontitis patients: An interventional study”. Journal of Indian Society of Periodontology1 (2009): 6-11.
21. Jenabian N., et al. “The Relation between Periodontitis and Anemia Associated Parameters”. Journal of Dent Maxillofacial Radiology, Pathology, and Surgery3 (2014): 26-33.
22. Lowe GD. “The relationship between infection, inflammation, and cardiovascular disease: an overview”. Annals of Periodontology1 (2001): 1-8.
23. Patel MD., et al. “Interrelationship between chronic periodontitis and anemia: A 6-month follow-up study”. Journal of Indian Society of Periodontology1 (2014): 19.
24. Parihar S., et al. “Comparison of hematological parameters for signs of anemia among participants with and without chronic periodontitis: A cross-sectional study”. Journal of Indian Association of Public Health Dentistry1 (2019): 4-7.
25. , et al. “Relationship between Periodontitis and Aanemia Do exist?” Indian Journal of Dental Sciences 2.7 (2015): 13-16.
26. Hutter JW., et al. “Lower numbers of erythrocytes and lower levels of hemoglobin in periodontitis patients compared to control subjects”. Journal of Clinical Periodontology10 (2001): 930-936.
27. Lipschitz DA., et al. “A clinical evaluation of serum ferritin as an index of iron stores”. The New England Journal of Medicine22 (1974): 1213-1216.
28. Chakraborty S., et al. “Impact of iron deficiency anemia on chronic periodontitis and superoxide dismutase activity: a cross-sectional study”. Journal of Periodontal and Implant Science2 (2014): 57-64.
29. Prakash S., et al. “Similar hematological and biochemical parameters among periodontitis and control group subjects”. European Journal of Dentistry3 (2012): 287-294.