The Effect Of Anxiety On The Change Of Elastase In Gingival Crevicular Fluid Of Chronic Periodontitis Before And After Periodontal Initial Therapy

Objective: To analyze the effect of anxiety on the basic therapy of patients with moderate and severe periodontitis through comparing the changes of the periodontal depth,attachment loss,gingival bleeding index,plaque index and elastase(EA)level in gingival crevicular fluid(GCF)before and after periodontal therapy,so as to provide a theoretical basis for the adjuvant treatment of periodontitis.Methods:1 Inclusion criteriaTwenty-seven participants with chronic periodontitis were enrolled in the study,including thirteen males and fourteen females.Patients with the total remaining teeth?20,periodontal depth>4mm,attachment loss?3mm,absorption larger than 1/3 of teeth root length(as indicated in X-ray),and the involved teeth>30%.Anxious patients without anxiolytic therapy.Patients without periodontal treatment within three months.Patients without obvious jaw deformity.Patients who had not taken antibiotics or non-steroidal drugs within three months.Non-smokers.Non-pregnant female or female patients in lactation.Patients without systemic diseases,such as diabetes,hepatitis and so on.All patients had signed consent forms.2 Experiment groups27 patients who meet the above criteria were evaluated by self-rating anxiety scale(SAS):a total of 13 cases that with SAS?50 were selected as anxiety periodontitis group(AP);a total of 14 cases that with SAS<50 were selected as non-anxiety periodontitis group(NP).3 Experimental methodsThe basic condition questionnaire and SAS were filled by patients.Thegeneral data of patients enrolled in the experiment were recorded before treatment,including name,age,gender,occupation,education level,medication history,periodontal treatment history and so on.And the psychological situation of patients was investigated by SAS at baseline and 3 months after periodontal treatment.Clinical examination: The clinical examinations for full-month oral hygiene and periodontal status were conducted among patients,and clinical indexes were recorded,so as to determine baseline value.It mainly included probing depth(PD),clinical attachment loss(CAL),gingival bleeding index(BI)and plaque index(PI).Extracting test teeth gingival crevicular fluid: The molars with probing depth>4mm,attachment loss?3mm,absorption large than 1/3 of teeth root length and no caries at dental cervix,no periapical inflammation were selected.GCF of 4 sites was collected with the usage of absorbent paper points.After staying for 30 minutes,they were taken out.The sample was taken again after an interval for 10 min.The samples were weighed and sealed in a low-temperature refrigerator at-20°C for reservation.Initial periodontal treatment: Propaganda and education of oral hygiene were conducted for each patient,and supragingival scaling was taken.Subgingival scaling and root planning were taken during the second visit.The periodontal clinical indexes were recorded again three months after treatment,and the samples of the same index teeth were collected again,so as to evaluate the post-treatment effect.The GCF-EA level in samples was detected by substrate(Meosuc-alaala-pro-val-NA)method,and the experimental data was statistically analyzed by SPSS21.0 software.Results:1 Clinical indexes1.1 Periodontal probing depthBefore the initial periodontal treatment,by comparison of the baseline value of PD between AP group and NP group,there was no statistically significant difference(P>0.05).After the initial periodontal treatment,the decreased of PD in AP groupwas lower than the decrease in NP group,and the difference had statistical significance(P<0.05).The PD in AP group and NP group were decreased when compared with the pre-treatment,and the differences had statistical significance(P<0.05).1.2 Clinical attachment lossBefore the initial periodontal treatment,by comparison of the baseline value of CAL between AP group and NP group,there was no statistically significant difference(P>0.05).After the initial periodontal treatment,the decrease of CAL in AP group was lower than the decrease of NP group,and the difference had statistical significance(P<0.05).The CAL in AP group and NP group were decreased when compared with the pre-treatment,and the differences had statistical significance(P<0.05).1.3 Bleeding indexBefore the basic periodontal treatment,by comparison of the baseline value of BI between AP group and NP group,there was no statistically significant difference(P>0.05).After the basic periodontal treatment,by comparison of the decrease of BI between AP group and NP group,there was no statistically significance difference(P>0.05).The BI in AP group and NP group were decreased when compared with the pre-treatment,and the differences had statistical significance(P<0.05).1.4 Plaque indexBefore the basic periodontal treatment,by comparison of the baseline value of PI between AP group and NP group,there was no statistically significant difference(P>0.05).After the basic periodontal treatment,the decrease of the PI in AP group was lower than the decrease in NP group,and the difference had statistical significance(P<0.05).The PI in AP group and NP group were decreased when compared with the pre-treatment,and the differences had statistical significance(P<0.05).2 The level of EA in GCFBefore the basic periodontal treatment,by comparison of the baseline level of EA between AP group and NP group,there was statistically distinguished significant difference(P<0.05).After the basic periodontal treatment,the decrease of the GCF-EA level in AP group was lower than the decrease of NP group,and the difference had statistical significance(P<0.05).The GCF-EA level in AP group and NP group were decreased when compared with the pre-treatment,and the differences had statistical significance(P<0.05).Conclusion:1 The initial periodontal therapy could significantly improve the inflammatory condition for AP and NP,and anxiety may be an unfavorable factor of the initial periodontal therapy in periodontitis.2 Anxiety might impact the expression of GCF-EA,which may be one of the mechanisms that influences the recovery of periodontal tissue after periodontal therapy.3 GCF-EA may be an auxiliary indicator to evaluate the prognosis of chronic periodontitis.