الفهرس 
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Abstract
Summary
Periodontal disease results from a complex interplay between host susceptibility and oral cavity micro flora. Various systemic factors and conditions of the host may affect the prevalence, progression, and severity of the disease. Among these variables, sex hormones likely influence the pathogenesis of periodontal diseases. Androgen, estrogen, and progesterone receptors are also localized in periodontal tissues.
Menopause in women is a physiological state that gives rise to adaptive changes at both the systemic and oral level. Menopause literally means “without estrogen” and by definition, it is the time at which cyclic ovarian function, as manifested by menstruation ceases. Estrogen has a number of effects on the modulation of the inflammatory response and immune cell function. These effects are largely mediated by ERs which are present on monocytes and macrophages.
Neopterin is produced and released by human monocytes/macrophages in disease states after induction by IFN-γ secreted by T-lymphocytes. Neopterin can be detected in various body fluids like saliva and GCF and its level is elevated in infections. Assessment of salivary and GCF neopterin levels may be of a great value in evaluating both periodontal disease status and the outcome of therapy.
The aim of this study was to assess salivary and gingival crevicular fluid neopterin levels in patients with chronic periodontitis in pre- and post-menopausal women as primary objective and evaluate the reliability of neopterin as a biomarker to assess the intensity of periodontal tissue destruction and its response to nonsurgical periodontal therapy as secondary objective.
A total of 30 patients were selected, 15 per-menopause and 15 post-menopausal women. Full mouth scaling and root planing were performed. All clinical parameters were recorded at the baseline visit before mechanical debridement and after 3 months of treatment. Saliva samples were collected at the primary visit before scaling and root planing as a baseline value, and after 1 month and 3 months postoperatively. GCF samples were collected at the primary visit before scaling and root planing as a baseline value, and after 1 month and 3 months postoperatively. Neopterin was measured in the samples using commercially available Enzyme Linked Immunosorbent Assay (ELISA) kit. Statistical analysis was performed to the results.
The present study revealed that the mean values of neopterin levels in saliva and GCF in both groups showed significant reduction from baseline to 3 months postoperatively. The mean values of neopterin levels in saliva were higher in the postmenopausal group than the premenopausal one at baseline and also after 3 months. While the mean neopterin values in GCF were higher in the postmenopausal group than the premenopausal one at baseline but at 3 months the premenopausal group was higher but with no significant difference. All clinical parameters in both groups demonstrated a significant reduction after 3 months of NSPT. Neopterin can be used as a biomarker to assess the intensity of periodontal tissue destruction and its response to nonsurgical periodontal therapy.
Conclusion
Conclusion
Within the limitations of this study, the following could be concluded:
1. Premenopausal women showed more significant percentage decrease in neopterin levels in both saliva and GCF after 3 months of follow up than postmenopausal women
2. The high neopterin level in both saliva and GCF in both groups with chronic periodontitis and its significant decrease after NSPT showed that neopterin can be used as a biomarker to assess the progression of periodontal tissue destruction and its response to nonsurgical periodontal therapy.
3. All clinical parameters significantly improved after NSPT in pre and postmenopausal women suggesting that the influence of sex hormones can be minimized with NSPT, good plaque control and oral hygiene measures.
4. Postmenopausal women responded less favorably than premenopausal women to NSPT with statistical significant difference as regards PI and GI.
5. There was no significant difference in PD and CAL when comparing the premenopausal with the postmenopausal women at baseline and after 3 months.
6. Non-surgical periodontal therapy reduced neopterin levels significantly in both saliva and GCF in premenopausal and postmenopausal women with chronic periodontitis.
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