Enzyme Activity in Crevicular Fluid for Detection and Prediction of Clinical Attachment Loss in Patients with Chronic Adult Periodontitis

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Abstract
Previous reports have described a method by which multiple constituents can be analyzed from a sample of gingival crevicular fluid (GCF) collected with a precut filter paper strip. In this study the relationship of changes in GCF levels of the vertebrate (lysosomal) enzymes β‐glucuronidase (BG) and arylsulfatase (AS) and the cytoplasmic enzyme lactate dehydrogenase (LDH) was evaluated longitudinally in reference to loss of clinical attachment in patients with existing chronic adult Periodontitis. Thirty‐six patients were followed for six months. Clinical attachment loss was recorded as the change between the baseline and three month examinations, and the three‐ and six‐month examinations. GCF analysis was performed at baseline and three months. Three groups of patients were identified based on disease progression. Group I patients (N = 5) displayed a generalized form of disease activity. In these patients we observed clinical attachment loss of at least 2.0 mm at a minimum of three unrelated sites. Group II patients (N = 4) displayed a localized form of disease activity. In these patients clinical attachment loss of at least 2.5 mm occurred at one site, or two anatomically related sites. Group III patients (N = 27) did not display clinical attachment loss as defined here. Enzyme analysis was evaluated as a whole mouth score (the per cent of samples from a patient in which enzyme activity was at least twice the population mean) and at individual samples. Group I patients could be identified by elevated whole mouth scores for BG, while Group II patients could not be identified by whole mouth scores for any of the enzymes. The region of clinical attachment loss in Group II patients could be identified by individual GCF samples that demonstrated BG activity that was at least 4 times the population mean at baseline, and remained elevated at three months. In contrast, AS and LDH did not provide a statistically significant measure of localized clinical attachment loss in Group II patients. Using this two‐tiered criteria, calculation of sensitivity (89%), specificity (89%) and k (0.72) for the relationship of BG activity in GCF to detection and prediction of clinical attachment loss indicated that analysis of this enzyme, GCF, has diagnostic value. BG is considered a marker for primary granule release from polymorphonuclear leukocytes (PMN). Therefore, clinical attachment loss in patients with existing adult Periodontitis appears to be related to an exuberant PMN response in the crevicular environment.