University of Oulu

Pietiäinen, M.; Liljestrand, J.M.; Akhi, R.; Buhlin, K.; Johansson, A.; Paju, S.; Salminen, A.; Mäntylä, P.; Sinisalo, J.; Tjäderhane, L.; Hörkkö, S.; Pussinen, P.J. Saliva and Serum Immune Responses in Apical Periodontitis. J. Clin. Med. 2019, 8, 889.

Saliva and serum immune responses in apical periodontitis

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Author: Pietiäinen, Milla1; Liljestrand, John M.1; Akhi, Ramin2,3,4;
Organizations: 1Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland
2Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, FI-90014 Oulu, Finland
3Medical Research Center, Oulu University Hospital and University of Oulu, FI-90014 Oulu, Finland
4Nordlab, Oulu University Hospital, FI-90220 Oulu, Finland
5Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, S-141 04 Huddinge, Sweden
6Department of Odontology, Molecular Periodontology Research, Umeå University, S-901 87 Umeå, Sweden
7Institute of Dentistry, University of Eastern Finland, FI-70211 Kuopio, Finland
8Kuopio University Hospital, Oral and Maxillofacial Diseases, FI-70029 Kuopio, Finland
9HUCH Heart and Lung Center, Helsinki University Hospital, FI-00029 Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.1 MB)
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Language: English
Published: Multidisciplinary Digital Publishing Institute, 2019
Publish Date: 2020-02-24


Apical periodontitis is an inflammatory reaction at the apex of an infected tooth. Its microbiota resembles that of marginal periodontitis and may induce local and systemic antibodies binding to bacteria- and host-derived epitopes. Our aim was to investigate the features of the adaptive immune response in apical periodontitis. The present Parogene cohort (n = 453) comprises patients with cardiac symptoms. Clinical and radiographic oral examination was performed to diagnose apical and marginal periodontitis. A three-category endodontic lesion score was designed. Antibodies binding to the bacteria- and host-derived epitopes were determined from saliva and serum, and bacterial compositions were examined from saliva and subgingival samples. The significant ORs (95% CI) for the highest endodontic scores were observed for saliva IgA and IgG to bacterial antigens (2.90 (1.01–8.33) and 4.91 (2.48–9.71)/log10 unit), saliva cross-reacting IgG (2.10 (1.48–2.97)), serum IgG to bacterial antigens (4.66 (1.22–10.1)), and Gram-negative subgingival species (1.98 (1.16–3.37)). In a subgroup without marginal periodontitis, only saliva IgG against bacterial antigens associated with untreated apical periodontitis (4.77 (1.05–21.7)). Apical periodontitis associates with versatile adaptive immune responses against both bacterial- and host-derived epitopes independently of marginal periodontitis. Saliva immunoglobulins could be useful biomarkers of oral infections including apical periodontitis—a putative risk factor for systemic diseases.

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Series: Journal of clinical medicine
ISSN: 2077-0383
ISSN-E: 2077-0383
ISSN-L: 2077-0383
Volume: 8
Issue: 6
Article number: 889
DOI: 10.3390/jcm8060889
Type of Publication: A1 Journal article – refereed
Field of Science: 313 Dentistry
Funding: This research was funded by Academy of Finland [grant number 1266053 (P.J.P.), 1296541 (S.P.), and 1316777 (S.P.)], Paulo Foundation (P.J.P.), Finnish Dental Society Apollonia (P.J.P. and R.A.), University of Oulu Scholarship Foundation (R.A.) European Endodontic Society (P.J.P.), and Sigrid Juselius Foundation (P.J.P.).
Copyright information: © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (