Cortisol level in mixed saliva as a marker of periodontal lesions in metabolic associated diseases

Abstract

Dysregulation of cortisol levels at account of the increase in inflammatory mediators increases the risk of developing metabolic associated diseases, suppresses secretion of secretory immunoglobulins and neutrophil function, which results in a decrease in protection against periodontal pathogens in the oral cavity.
 Objective — to evaluate the possible association of salivary cortisol levels with the main inflammatory markers of metabolic associated diseases and periodontal disease.
 Materials and methods. The study included 67 patients, 44 of whom had cardiometabolic diseases. The comparison group consisted of patients, matched by sex and age who did not have clinical manifestations of metabolic associated diseases. To confirm the underlying disease, patients underwent assessment of carbohydrate and lipid metabolism, questionnaire survey on the main dental complaints and a dental examination, and evaluation of salivation rate, saliva viscosity and determination of cortisol level of mixed saliva with enzyme linked immunosorbent assay. Statistical analysis was performed using SPSS software with the calculation of the mean value M, standard error, Student’s test. Percentages were compared using the z‑criterion. The Pearson correlation test was used to identify the relationship between indicators.
 Results. Significantly higher levels of mixed salivary cortisol were recorded in patients of the main group (3.34±0.20 ng/ml) (p <0.05). Direct correlation has been established between cortisol levels and presence of diabetes mellitus (r=0.342; p=0.016), levels of blood glucose (r=0.379; p=0.002), low‑density lipoprotein cholesterol (r=0.348; p=0.017); indirect correlation was established with non‑alcoholic fatty liver disease (NAFLD) through triglycerides levels (r=0.345; p=0.007). In addition, reverse correlations were observed between cortisol and alkaline phosphatase (r=–0.328; p=0.0014), salivation rate and the presence of metabolic associated diseases (the most significant with NAFLD (r=–0.499; p=0.000)).
 Conclusions. Under conditions of prolonged chronic stress, patients with metabolic associated diseases have a significantly increased rate of gingival lesions. The study of cortisol in mixed saliva is a convenient non‑invasive method that allows the assessment of the presence of chronic stress in patients, as well as its impact on the development, duration, chronicity and response to treatment of metabolic associated diseases.