title: Modulation of P-selection and platelet aggregation in chronic periodontitis: A clinical study.
abstract: BACKGROUND
  The primary etiologic factor of periodontitis is the subgingival infection with a group of Gram negative pathogens. Transient bacteremia in periodontitis patients underlie chronic production and systemic increases of various proinflammatory mediators, including Interleukin (IL)-1α, IL-6, C-reactive protein and Tumor necrosis factor (TNF)-α. P- selectin is a member of selectin family of cell surface receptor which is located in the membrane of the secretory granules (alpha granules) of platelets and in the membrane of the Weibel-Palade bodies of the vascular endothelial cells. P selectin redistributes from the membrane of the granules to the plasma membrane when platelets and endothelial cells are activated and thus degranulated.
  
  
  OBJECTIVE
  To compare the level of platelet activation, soluble P Selectin level and morphological changes and aggregation of platelets in patients in periodontitis patients compared to healthy controls.
  
  
  METHODS
  80 patients were included in the study with the age group of 35-60. The patients were divided into 2 groups, 40 subjects with generalized chronic periodontitis and 40 healthy subjects taken as control. Periodontal Examination using clinical parameters namely, Bleeding Index, Plaque Index, Probing Pocket Depth and Clinical Attachment Level were recorded. Collection of blood samples for estimation of serum soluble P- selectin level by ELISA method. Evaluation of Platelet morphology and grading the platelet aggregation.
  
  
  RESULTS
  P-selectin expression shows that the mean value for control group is 4.97 ± 16.56 ng/mL and study group 13.05 ± 29.94 ng/mL which was significantly higher than control group with P value 0.001. Platelet morphological changes shows small form - mean value for control group is 75.83% ± 14.24% while for study group is 39.08%. ± 21.59; Big form - mean value for control group 0.80% ± 0.35% while for study group 0.48% ± 1.3%and Spider form- mean value for control group 23.88% ± 14.13 while study group 59.32% ±. 23.42. The observation showed high statistical significance with P- value < 0.001 for small and spider form and no statistical significance for big form P = 0.075.
  
  
  CONCLUSIONS
  Increased expression of P-selectin, spider form of platelets and pathological aggregation pattern which indicates that platelet activation may be associated with chronic periodontitis. The results of the study showed, higher number of spider forms and significant pathological aggregation pattern in periodontitis patients which indicates activation of platelets thus emphasized that periodontitis can be an contributing factor in the development of cardiovascular disease.
authors.affiliation: Department of Periodontics, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Perumal
authors.affiliation: Department of Periodontics, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India.
authors.forename: Maheashwari
authors.initials: M
authors.lastname: Rajendran
authors.affiliation: Department of Periodontics, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India.
authors.forename: Malathi
authors.initials: M
authors.lastname: Krishnamurthy
authors.affiliation: Department of Periodontics, Sharad Pawar Dental College, Sawangi Meghe, Wardha, Maharashtra, India.
authors.forename: Kiran Kumar
authors.initials: KK
authors.lastname: Ganji
authors.affiliation: Department of Periodontics, Sharad Pawar Dental College, Sawangi Meghe, Wardha, Maharashtra, India.
authors.forename: Sunil Dattuji
authors.initials: SD
authors.lastname: Pendor
keywords: Chronic periodontitis; P selectin; platelet aggregation