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This study aims to evaluate the periodontal status of patients with Multiple Sclerosis (MS) through clinical, microbiological, and biochemical parameters. Multiple sclerosis and periodontal diseases are both chronic inflammatory conditions that may share common immunopathological pathways. The primary objective is to investigate the relationship between MS and periodontal health by comparing clinical measurements with the microbial composition and biochemical markers found in saliva samples of patients followed by the Neurology Department.
The research is designed as a multidimensional study involving patients from the Neurology and Periodontology Departments. Participants will undergo a comprehensive periodontal examination to record clinical parameters (such as probing depth, clinical attachment level, and bleeding on probing). In addition to clinical assessments, the study includes:
Saliva Collection and Analysis: Whole unstimulated saliva samples will be collected from all participants under standardized conditions.
Microbiological Evaluation: The collected saliva will be analyzed to determine the microbial profile and identify specific periodontal pathogens associated with MS.
Biochemical Evaluation: Salivary samples will be further analyzed for biochemical markers (such as inflammatory cytokines or enzymes) to evaluate their role in the relationship between systemic inflammation in MS and oral health.
The study will be conducted at the Health Sciences University Gulhane Faculty of Dentistry and Ankara Bilkent City Hospital to provide a thorough understanding of how MS affects the oral ecosystem.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Multiple Sclerosis - Clinical Health Periodontium | This group consists of patients diagnosed with Multiple Sclerosis (MS) based on clinical, biochemical, and radiological features according to the 2017 McDonald Criteria. The cohort includes various clinical types: Relapsing-Remitting (RRMS), Secondary Progressive (SPMS), Primary Progressive (PPMS), and Progressive-Relapsing (PRMS). The participants in this group must have a clinically healthy periodontium. The term clinically healthy should be adopted to cover the absence of (or very significant reduction in) clinical periodontal inflammation on either an anatomically intact periodontium or a reduced periodontium. Participants will undergo clinical periodontal examinations and provide saliva samples for microbiological and biochemical analysis | ||
| Multiple Sclerosis - Periodontal Disease | This group consists of patients diagnosed with Multiple Sclerosis (MS) based on clinical, biochemical, and radiological features according to the 2017 McDonald Criteria. The cohort includes various clinical types: Relapsing-Remitting (RRMS), Secondary Progressive (SPMS), Primary Progressive (PPMS), and Progressive-Relapsing (PRMS). Periodontal disease comprises a spectrum of pathological conditions involving the tooth-supporting tissues, namely the gingiva, periodontal ligament, cementum, and alveolar bone. The disease often initially manifests as gingivitis, a plaque-induced and reversible inflammatory condition affecting a large proportion of the population. In the absence of appropriate management, gingivitis may advance to periodontitis, a chronic and destructive disorder marked by irreversible attachment loss, progressive alveolar bone resorption, and potential tooth loss. | ||
| Systemically Health - Clinical Healthy Periodontium | This group consists of systemically healthy volunteers who do not have any systemic diseases, including Multiple Sclerosis. The participants in this group must have a clinically healthy periodontium. The term clinically healthy should be adopted to cover the absence of (or very significant reduction in) clinical periodontal inflammation on either an anatomically intact periodontium or a reduced periodontium. Participants will undergo clinical periodontal examinations and provide saliva samples for microbiological and biochemical analysis |
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| Measure | Description | Time Frame |
|---|---|---|
| Clinical Attachment Level (CAL) | Measurement of the distance from the cemento-enamel junction to the base of the periodontal pocket in millimeters. Higher values indicate greater attachment loss. | Baseline |
| Probing Pocket Depth (PPD) | Measurement of the distance from the gingival margin to the base of the periodontal pocket in millimeters using a periodontal probe. | Baseline |
| Plaque Index (PI) | An index used to assess the thickness of plaque at the gingival margin. It evaluates oral hygiene status on a scale from 0 to 3 for each tooth surface, measured according to the criteria of Silness and Löe. | Baseline |
| Gingival Index (GI) | A clinical index used to assess the severity of gingival inflammation and bleeding tendency. It evaluates the color, consistency, and bleeding of the gums on a scale from 0 to 3, measured according to the criteria of Silness and Löe. | Baseline |
| Measure | Description | Time Frame |
|---|---|---|
| Salivary P.gingivalis Levels | P.gingivalis in saliva samples using Real-time PCR to assess their correlation with MS disease status. | Baseline |
| Salivary F.nucleatum Levels | F.nucleatum in saliva samples using Real-time PCR to assess their correlation with MS disease status. |
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Inclusion Criteria (Test Group):
Inclusion Criteria (Control Group):
Exclusion Criteria (Test Group):
Exclusion Criteria (Control Group):
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The study population consists of patients diagnosed with Multiple Sclerosis who are followed by the Neurology Department of Ankara Bilkent City Hospital, and age-and-gender-matched systemically healthy volunteers as a control group.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Nuriye Işıl SAYGUN, Professor | Contact | +903125671500 | nuriyeisil.saygun@sbu.edu.tr | |
| Merve İNCEÖZ, Research Assistant | Contact | +903125671500 | merve.inceoz@sbu.edu.tr |
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The individual participant data will not be shared to protect participant privacy.
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| ID | Term |
|---|---|
| D009103 | Multiple Sclerosis |
| D010518 | Periodontitis |
| D010510 | Periodontal Diseases |
| ID | Term |
|---|---|
| D020278 | Demyelinating Autoimmune Diseases, CNS |
| D020274 | Autoimmune Diseases of the Nervous System |
| D009422 | Nervous System Diseases |
| D003711 | Demyelinating Diseases |
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| Systemically health - Periodontal Disease | This group consists of systemically healthy volunteers without any systemic diseases. However, these participants are diagnosed with periodontal disease (gingivitis or periodontitis). Periodontal disease comprises a spectrum of pathological conditions involving the tooth-supporting tissues, namely the gingiva, periodontal ligament, cementum, and alveolar bone. The disease often initially manifests as gingivitis, a plaque-induced and reversible inflammatory condition affecting a large proportion of the population. In the absence of appropriate management, gingivitis may advance to periodontitis, a chronic and destructive disorder marked by irreversible attachment loss, progressive alveolar bone resorption, and potential tooth loss. |
| Baseline |
| Salivary EBV Levels | EBV in saliva samples using Real-time PCR to assess their correlation with MS disease status. | Baseline |
| Salivary IL-17 Levels | The concentration of IL-17 in saliva samples will be measured to evaluate the Th17-mediated inflammatory response. IL-17 is a key pro-inflammatory cytokine linked to both the pathogenesis of Multiple Sclerosis (MS) and the severity of periodontal tissue destruction. | Baseline |
| Salivary IL-11 Levels | Concentration of IL-11 in saliva samples will be measured using the ELISA method. IL-11 is an anti-inflammatory cytokine from the IL-6 family; its levels will be evaluated to understand its potential regulatory role in periodontal inflammation and its systemic reflection in patients with Multiple Sclerosis. | Baseline |
| Salivary TNF-alpha Levels | The concentration of TNF-alpha in saliva samples will be quantified using the ELISA technique. As a potent pro-inflammatory cytokine, TNF-alpha levels will be analyzed to assess the degree of local inflammation in the oral cavity and its potential correlation with systemic inflammatory activity in patients with Multiple Sclerosis. | Baseline |
| Salivary SIRT-1 Levels | The concentration of SIRT-1 in saliva samples will be measured using the ELISA technique. SIRT-1 is a NAD+-dependent deacetylase known for its role in cellular homeostasis, neuroprotection, and anti-inflammatory pathways. This outcome aims to evaluate the potential of SIRT-1 as a biomarker for disease activity in Multiple Sclerosis and its association with periodontal health status. | Baseline |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
| D009059 | Mouth Diseases |
| D009057 | Stomatognathic Diseases |