Saliva Alkaloids of Areca Nut or Tobacco, Inflammatory and Antioxidants Status and Oral Hygiene in Periodontitis Patients

About 90% adults above 40 years old have some form of periodontal disease (PD) in Taiwan. There was a 52% increase in the number of patients who received PD medical treatment in the last decade. Betel and tobacco users are at increased risk for PD. More than 75% of betel chewers or smokers have suffered from PD. PD is an inflammatory process caused by the bacteria infection or/and tobacco and areca nut alkaloid stimulate inflammation response. Oral hygiene education is currently auxiliary process of treatment on periodontitis. The clinical treatment outcomes of PD are included plaque index, gingival index, sulcus bleeding index, probing depth, and mobility. The biomarker of inflammatory status in saliva and oral hygiene behaviors not only can assess disease activity of PD but also can improve the efficiency of clinical outcome. So far, no study has elucidated the effect of oral hygiene on reduction of areca nut and tobacco alkaloids exposure or saliva inflammatory status on PD. This project will elucidate the association among alkaloids of areca nut and tobacco, saliva inflammatory status, antioxidant capacity and oral hygiene on PD. The saliva level of areca nut and tobacco alkaloids, inflammatory status and antioxidant capacity will be tested and analyzed as environmental and endogenous susceptibility factors of PD treatment in this project. The specific aims of this project are: 1. To establish subjects recruitment procedures. 2. To establish analytical method of saliva areca nut and tobacco alkaloids (arecoline, arecaidine, nicotine and cotinine). 3. To investigate the association among oral hygiene, areca nut and tobacco alkaloids, and PD. 4. To investigate the relationship among oral hygiene, areca nut and tobacco alkaloids, saliva inflammatory factors (TNF-α, IL-1α, IL-1, IL-6, and IL-8) and PD. 5. To investigate the relationship among oral hygiene, areca nut and tobacco alkaloids, saliva antioxidant capacity and PD. 6. To investigate the interaction among oral hygiene, areca nut and tobacco alkaloids, saliva inflammatory factors, saliva antioxidant capacity on treatment outcome of PD. This project will collect 100 PD patients (ICD9: 523) who are betel chewer or smoker at Taipei Medical University Hospital. Socioeconomic characteristics and general potential risk factors such as cigarette smoking, betel chewing, alcohol consumption, and personal and family history of disease will be collected by standardized personal interviews based on a structured questionnaire. Subject’s saliva will be collected at the first appointment when they decided receive periodontal treatment at Taipei Medical University Hospital. The inflammatory factors was measured with multiplex magnetic bead panel commercial kit. The total antioxidant in each patient’s saliva was measured with commercial kit and ELISA reader. saliva areca nut and tobacco alkaloids are determined by liquid chromatography tandem mass spectrometry (LC/MS/MS). Finally, we will incorporate all external exposure dose, internal dose and susceptibility biomarkers of PD success therapy to perform statistical analyses. The findings from the three years projects are expected to publish in internationally prestigious journals.