Assessment of Chromogranin a Levels in Gingival Crevicular Fluid in patients with Chronic Periodontitis, With and Without Psychosocial Stress: A Clinicobiochemical study

BACKGROUND: Periodontitis is a multifactorial disease and is a major factor for tooth loss. The pathogenesis of this disease is varied and the understanding of this has evolved over the decade. It is now believed that the host has a major role to play in the progression of periodontal destruction. The changes that occur in the periodontium are often hard to explain clinically and require an understanding at the biochemical level. Biomarkers, such as acute phase proteins, have the potential to shed more light on the changes occurring within the tissues and are believed to be more reliable. Systemic diseases, habits, social factors, and psychological stress are considered risk factors influencing disease onset and progression. Although psychological stress was found to be an important risk factor for periodontitis, the relationship between periodontitis and stress related markers remains unclear. Recently studied stress marker, Chromogranin A (CgA), is reported to be a risk factor of periodontal disease. In this study, we investigated the associations between stress and periodontal disease. AIM AND OBJECTIVES: The aim of this study is to assess and compare CgA levels in gingival crevicular fluid (GCF) in patients with chronic periodontitis (CP) and healthy (H), with and without psychosocial stress. MATERIALS AND METHODS: A total of 80 subjects were included in this study with 20 participants in each group (20 each in CP with and without stress and in H with and without stress). Following the assessment of the clinical parameters, sites with the greatest mean modified Sulcular Bleeding Index (mSBI) were selected in every subject to serve as a source of GCF collection. GCF was collected using microcapillary pipettes and processed to estimate CgA levels using enzyme linked immunosorbent assay (ELISA). RESULTS: The values obtained were statistically compared. Overall comparisons were made using One-way ANOVA test, pairwise comparisons were made using Tukey's Post hoc Analysis and overall correlation was assessed by means of Pearson correlation. In the present study, CgA levels were the highest in the Group 1 (235.15 ng/ml) and Group 2 (166.79 ng/ml) followed by Group 3 (94.56 ng/ml) and Group 4 (93.92 ng/ml). There was a statistically significant difference in the CgA levels when the CP and H patients were compared with and without stress (p < 0.001). On the whole, there was a positive correlation observed between the clinical parameters and CgA levels in GCF of all study groups. Among all the periodontal parameters measured, there was a strongest correlation between CgA levels and CAL, mSBI in Group 1. CONCLUSION: We can conclude that, the psychosocial stress may play an important role as a risk factor for periodontal disease. In this study, CgA, being a marker for stress, can be used as a diagnostic tool for evaluating the relationship between stress and periodontal diseases