Lipids in periodontal diseases in dentistry

risk of different oral problems (root caries, tooth mobility, and tooth loss) can be increased by the presence of periodontal disease, which has also been associated with a growing list of systemic diseases. The presence of some bacteria is the primary etiology of this disease; a susceptible host is also necessary for disease initiation. In this respect, the progression of periodontal disease and healing of the periodontal tissues can be modulated by nutritional status. To clarify the role of lipids in the establishment, progression, and/or treatment of this pathology, a systematic review was conducted of English-written literature in PubMed until May 2016, which included research on the relationship of these dietary components with the onset and progression of periodontal disease. According to publication type, randomized-controlled trials, cohort, case-control and cross-sectional studies were included. Among all the analyzed components, those that have any effect on oxidative stress and/or inflammation seem to be the most interesting according to current evidence. On one hand, there is quite a lot of information in favor of a positive role of n-3 fatty acids, due to their antioxidant and immunomodulatory effects. On the other hand, saturated fat-rich diets increase oxidative stress as well the as intensity and duration of inflammatory processesrisk of different oral problems (root caries, tooth mobility, and tooth loss) can be increased by the presence of periodontal disease, which has also been associated with a growing list of systemic diseases. The presence of some bacteria is the primary etiology of this disease; a susceptible host is also necessary for disease initiation. In this respect, the progression of periodontal disease and healing of the periodontal tissues can be modulated by nutritional status. To clarify the role of lipids in the establishment, progression, and/or treatment of this pathology, a systematic review was conducted of English-written literature in PubMed until May 2016, which included research on the relationship of these dietary components with the onset and progression of periodontal disease. According to publication type, randomized-controlled trials, cohort, case-control and cross-sectional studies were included. Among all the analyzed components, those that have any effect on oxidative stress and/or inflammation seem to be the most interesting according to current evidence. On one hand, there is quite a lot of information in favor of a positive role of n-3 fatty acids, due to their antioxidant and immunomodulatory effects. On the other hand, saturated fat-rich diets increase oxidative stress as well the as intensity and duration of inflammatory processes

1. S. Dineshdharshan I - MDS Role Of Lipids In Periodontal Health And Disease

2. Contents Introduction Definition Classification of Lipids Functions of lipids Fatty acids Lipids and oral Biofilm Lipids as virulence factors of periodontopathic bacteria Lipids and the Mechanisms of Periodontogenic Bacteria to Invade Cells Lipid Components of Human Biological Media in Infectious Inflammatory Periodontal Diseases Omega-3 Fatty acids in Periodontal therapy Metabolic disorders related to lipids Conclusion References

3. Introduction The presence of periodontitis increases the level of triglyceride and total cholesterol in serum. When the periodontitis patients’ triglyceride and cholesterol levels were compared with those of healthy people, their levels were significantly higher. Age is a factor that increases the effect of chronic diseases. Considering this factor, the difference in serum triglyceride, cholesterol and LDL (Low density lipoprotein) levels of older periodontitis patients increased compared to the healthy ones.

4. Definition Lipids may be regarded as organic substances relatively insoluble in water, soluble in organic solvents (alcohol, ether etc.), actually or potentially related to fatty acids and utilized by the living cells.

5. Classification of Lipids

6. They are esters of FA with various alcohols Simple Lipids

7. These are esters of FA with alcohol containing additional[prosthetic] groups. Subclassified according to the type of prosthetic group Complex lipids

8. Phospholipids FA + ALCOHOL + PHOSPHORIC ACID They frequently have nitrogen containing bases Phospholipids may be classified on the basis of the type of alcohol present

9. Functions of Phospholipids In association with proteins, phospholipids form the structural components of membranes and regulate membrane permeability. Phospholipids participate in the absorption of fat from the intestine. Essential for the synthesis of different lipoproteins Accumulation of fat in liver (fatty liver) can be prevented by phospholipids, hence they are regarded as lipotropic factors. Phospholipids act as surfactants (agent lowering surface tension).

10. Arachidonic acid, an unsaturated fatty acid liberated from phospholipids, serves as a precursor for the synthesis of eicosanoids . Phospholipids participate in the reverse cholesterol transport . Cephalins , an important group of phosphol ipids participate in blood clotting . Phospholipids ( phosphatidyl inositol ) involved in signal transmission across membranes.

11. FA + ALCOHOL[SPINGOSINE] +CARBOHYDRATE WITH NITROGEN BASE They do not contain phosphate group Glycolipids

12. Chylomicrons Very low density lipoprotein (VLDL) Low density lipoprotein (LDL) High density lipoprotein (HDL) Lipid with prosthetic group PROTEIN Lipoproteins

13. Derived Lipids These are the derivatives obtained on the hydrolysis of group 1 and group 2 lipids which possess the characteristics of lipids. Fatty acids Cholesterols Lipid (fat) soluble vitamins Steroid hormones,

14. Functions of Lipids

15. Functions of Lipids

16. Structure of cell membrane

17. Fatty Acids Fatty acids are naturally occurring carboxylic acids with an unbranched carbon chain and an even number of carbon atoms. Long-chain fatty acids (14 to 24 carbon atoms) are found in meats and fish medium-chain fatty acids (6 to 12 carbon atoms) and short-chain fatty acids (fewer than 6 carbon atoms) occur primarily in dairy products.

18. Functions of Essential Fatty Acids Essential fatty acids are required for the membrane structure and function. Transport of cholesterol. Formation of lipoproteins. Prevention of fatty liver etc. They are also needed for the synthesis of another important group of compounds, namely eicosanoids .

19. Properties of Triacylglycerols Hydrolysis Saponification Rancidity Lipid peroxidation in vivo

20. Role of Lipids in the Etiopathogenesis of Periodontal Diseases

21. Lipids and Oral Biofilm Formation Formation of a pellicle Lipids are likely to be of crucial importance for implementing its protective properties Lipids on tooth surface can provide pellicle with hydrophobic properties . Lipid-enriched pellicle is more resistant to acids . Lipids as fatty acids.

22. Fatty acid profiles of pellicle samples obtained from various individuals are rather similar. Pellicle contains eleven fatty acids, of them, palmitic (32%), stearic (21%), oleic (14%), erucic (10%), and linoleic (5%) acids are the most common ones. Therefore, lipids are exactly the components which are responsible for the early steps of biofilm formation, i.e., its attachment to tooth surface or oral mucosa.

23. Lipids as Virulence Factors of Periodontogenic Bacteria Porphyromonas gingivalis is the key periodontal pathogen identified in the biofilm of the gingival sulcus . Lipopolysaccharides (LPS). LPS is composed of three elements - O-antigen, core, and lipid A O-antigen has a strain-, group-, type-, and variant-specific structure and consists of monosaccharide repeating units Core includes keto-deoxy-octanoic acid, heptoses, and neutral saccharides (e.g., galactose )

24. Lipid A - Most active biological component that provide LPS with the properties of endotoxin . Lipid A is composed of di -glucosamine with 1′- and 4′-phosphate residues and attached acyl chains.

25. However, P. gingivalis can deceptively change its lipid structure. Among heterogeneous patterns of the acetylation of P. gingivalis lipid A, two variants are predominant, i.e., tetraacylated and penta-acylated ones. It was demonstrated that LPS1690 and LPS1435/1449 of P. gingivalis differentially modulate host immune response. Proinflammatory cytokines Expression of human β-defensin-2 E- selectin

26. LPS/LBP complex can thereby modulate the expression of proinflammatory cytokines (IL-1, IL-6, and IL-8) by periodontal monocytes induced by various isoforms of P. gingivalis LPS. LPS/LBP complex CD14 on monocytes Activation of TLR 4

27. A. actinomycetemcomitans LPS - myristic acid F. nucleatum lipid A - hexa-acylated lipid A similar to that of Escherichia coli. Structural differences in the LPS accounts for a more potent stimulation of IL-1β secretion . Р. gingivalis synthesizes major ceramides . In addition, these bacteria produce two serine lipids (lipid 654 and lipid 430).

28. ( P.gingivalis ) ( Dentritic Cells) (Bone cells) As a result, P. gingivalis contributes to bone tissue loss in experimental animals and modulates osteoclastogenesis Phosphorylated dihydroceramides serine dipeptides TLR2 Inhibit osteoblast functions and mineral deposition Stimulate IL-6 production

29. Lipids and the Mechanisms of Periodontogenic Bacteria to Invade Cells Cross-contact between host cells and pathogens initiates microbial interactions with signal transduction machinery of infected cells. The major interface of this machinery is lipid rafts and their associated receptors.

30. Cholesterol-enriched membrane microdomains are involved in the induction of both innate and adaptive immunity Lipid rafts act as platforms for protein sorting and signal transduction.

31. P. gingivalis and А. actinomycetemcomitans are now recognized to penetrate the lipid rafts . Lipid rafts orchestrate a number of epithelial cell functions, e.g., epithelial barrier function and fighting against bacterial invasion. Advantages The avoidance of intracellular degradation pathway The induction of intracellular signaling

32. Recent data demonstrate that pathogenic microorganisms entering the macrophage s through the lipid rafts are generally localized in autophagosomes . The presence of alive P. gingivalis within the macrophages may be sufficient to allow this microbe for using the migratory potential of macrophages (Mediated by sphingolipids ). This lipid-dependent pathway of intracellular invasion largely promotes the survival of periodontogenic bacteria within the cells.

33. Lipid Components of Human Biological Media in Infectious Inflammatory Periodontal Diseases

34. Four potential mechanisms of the antimicrobial activity of fatty lipids and sphingolipids against bacteria are: Membrane destruction mediated by detergent activity The inclusion of lipids in a bacterial cytoplasmic membrane The transport of lipids across the bacterial membrane into cytosol Specific interactions between the lipids and proteins of the bacterial membrane.

35. Poly Unsaturated Fatty Acids

36. OMEGA-3 FATTY ACIDS IN PERIODONTAL THERAPY Interestingly, a recent microbiological study demonstrated a broad range of antibacterial activity for both EPA and DHA, including the inhibition of putative periodontal pathogens, such as Porphyromonas gingivalis , Fusobacterium nucleatum and Prevotella intermedia . The arachidonic -acid-derived lipoxins were the first lipid mediators recognised to have pro-resolution action. More recently, other classes of lipid mediators with anti-inflammatory and proresolving actions have been identified, including the resolvins , protectins and maresins

37. PDs and MaRs may play effective roles in pathogenesis associated with worsening cardiometabolic and periodontal status. These SPMs could also be predictors for conversion from a healthy (systemically and periodontally ) to diseased state (CVD and/or periodontitis ). Elucidation of the role of SPMs in the relationship between periodontal disease and CVD will enable the development of new host modulation strategies in the prevention and treatment of both diseases, and may also constitute an important public health step by increasing the quality of life of patients with CVD and periodontal disease Mehmet et al, J Periodont Res. 2021;00:1–10.

38. Metabolic disorders related to lipids

39. Hyperlipoproteinemia Frederickson’s classification of hyperliporoteinemias —based on the electrophoretic patterns of plasma lipoproteins.

40. Hypolipoproteinemia Although low levels of plasma lipids (not HDL!) within the normal range may be beneficial to the body, very low lipid levels are undesirable Familial hypobetalipoproteinemia Abetalipoproteinemia Familial alpha-lipoprotein deficiency

41. The Role of Dyslipidemia in Periodontitis According to Cekici et al., the relationship between dyslipidemia and periodontitis may result from the systemic inflammatory burden induced by the alteration of serum lipids. These effects are influenced by an exacerbated production of advanced glycation end products (AGEs), including low-density lipoprotein (LDL)-AGE and LDL-oxidized, which may act as proinflammatory co-stimulators. The overproduction of AGEs associated with the elevation of ROS Thus, all these elements may connect dyslipidemia and periodontitis

42. Conclusion : Patients with hyperlipidemia manifested higher values of periodontal parameters compared to control group. Poorly controlled hyperlipidemia had a destructive impact on periodontium . A cyclic relationship exists between serum lipids, periodontitis and systemic health. TP Shivakumar et al. The Journal of Contemporary Dental Practice. 2013;14(5):785-789

43. Glycolipid storage diseases

44. Conclusion Lipid metabolism in periodontogenic bacteria and host organism (both local and systemic ones) is important for the development and progression of periodontal diseases. Experiments with small animals have demonstrated that the control of inflammation and adaptive immune response using resolvins contribute to the prevention and treatment of experimental periodontitis . Also, p eriodontal lipids exhibit antimicrobial properties, prevent inflammation and bone resorption , and affect the immune status.

45. References U. Satyanarana , U. Chakrapani . Biochemistry. 4 th Edition. Elsevier; 2013. Balmasova IP1, Arutyunov SD, Tsarev VN, Unanyan KG. Role of Lipids in the Etiopathogenesis of Periodontal Diseases. Int J Biochem Physiol. 2020;5(2): 1-11. Özge Ç , Ayşen Y. Lipids and Their Importance in Dentistry. European Journal of Research in Dentistry. 2020;4(2):89–93. B. Chee , B. Park, T. Fitzsimmons, A. M. Coates, P. M. Bartold . Omega-3 fatty acids as an adjunct for periodontal therapy—a review. Clin Oral Invest. Mehmet AO, Özlem F, Fatih A, Mustafa C, Ercan V, Hikmet O. Salivary levels of last generation specific pro-resolving lipid mediators (SPMs) ( protectin and maresin ) in patients with cardiovascular and periodontal disease: A case-control study. J Periodont Res . 2021;00:1–10.

46. Fernando VB, Gustavo GN, Susilena AC , Silvana RPO, Cecilia CCR, Fábio RML. The Role of Dyslipidemia in Periodontitis . Nutrients . 2023;15(300):1-11. Shivakumar TP, Veena AP, Manthan HD. Periodontal Status in Subjects with Hyperlipidemia and Determination of Association between Hyperlipidemia and Periodontal Health: A Clinicobiochemical Study. The Journal of Contemporary Dental Practice. 2013;14(5):785-89.