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Review
. 2024 Oct;96(1):281-315.
doi: 10.1111/prd.12612. Epub 2024 Sep 24.

Inflammation indices in association with periodontitis and cancer

Kay-Arne Walther  1   2 , Sabine Gröger  1   3 , Jonas Adrian Helmut Vogler  2 , Bernd Wöstmann  1   2 , Jörg Meyle  1   4
Affiliations
Review

Inflammation indices in association with periodontitis and cancer

Kay-Arne Walther et al. Periodontol 2000. 2024 Oct.

Abstract

Inflammation is a complex physiological process that plays a pivotal role in many if not all pathological conditions, including infectious as well as inflammatory diseases, like periodontitis and autoimmune disorders. Inflammatory response to periodontal biofilms and tissue destruction in periodontitis is associated with the release of inflammatory mediators. Chronic inflammation can promote the development of cancer. Persistence of inflammatory mediators plays a crucial role in this process. Quantification and monitoring of the severity of inflammation in relation to cancer is essential. Periodontitis is mainly quantified based on the severity and extent of attachment loss and/or pocket probing depth, in addition with bleeding on probing. In recent years, studies started to investigate inflammation indices in association with periodontal diseases. To date, only few reviews have been published focusing on the relationship between blood cell count, inflammation indices, and periodontitis. This review presents a comprehensive overview of different systemic inflammation indices, their methods of measurement, and the clinical applications in relation to periodontitis and cancer. This review outlines the physiological basis of inflammation and the underlying cellular and molecular mechanisms of the parameters described. Key inflammation indices are commonly utilized in periodontology such as the neutrophil to lymphocyte ratio. Inflammation indices like the platelet to lymphocyte ratio, platelet distribution width, plateletcrit, red blood cell distribution width, lymphocyte to monocyte ratio, delta neutrophil index, and the systemic immune inflammation index are also used in hospital settings and will be discussed. The clinical roles and limitations, relationship to systemic diseases as well as their association to periodontitis and treatment response are described.

Keywords: cancer; delta neutrophil index; inflammation indices; inflammation markers; lymphocyte to monocyte ratio; neutrophil to lymphocyte ratio; periodontitis; platelet distribution width; platelet to lymphocyte ratio; plateletcrit; red blood cell distribution width; systemic immune inflammation index.

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Conflict of interest statement

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Figures

FIGURE 1
FIGURE 1
Inflammation resulting from periodontitis may extend to a systemic level, thereby influencing the subject's overall inflammatory burden and systemic health. Conversely, systemic diseases can influence systemic inflammation, which in turn may affect periodontal health. Patients suffering from periodontitis may have elevated levels of circulating systemic inflammatory markers, including higher inflammation indices. Figure modified after Cecoro et al.
FIGURE 2
FIGURE 2
Calculation of the neutrophil to lymphocyte ratio (NLR).
FIGURE 3
FIGURE 3
Calculation of the delta neutrophil index (DNI).
FIGURE 4
FIGURE 4
Calculation of the lymphocyte to monocyte ratio (LMR).
FIGURE 5
FIGURE 5
Calculation of the platelet to lymphocyte ratio (PLR).
FIGURE 6
FIGURE 6
Calculation of the platelet distribution width (PDW).
FIGURE 7
FIGURE 7
Calculation of the plateletcrit (PCT).
FIGURE 8
FIGURE 8
Calculation of the systemic immune inflammation index (SII).
FIGURE 9
FIGURE 9
The relationship between systemic immune inflammation index (SII) and moderate/severe periodontitis follows a J‐shaped curve. Figure was published by Cao et al. and reprinted here with editorial permission.
FIGURE 10
FIGURE 10
Calculation of the red blood cell distribution width (RDW).
See this image and copyright information in PMC

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References

    1. Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Clin Periodontol. 2018;45(Suppl 20):S149‐S161. - PubMed
    1. Bartold PM, Van Dyke TE. Periodontitis: a host‐mediated disruption of microbial homeostasis. Unlearning learned concepts. Periodontol 2000. 2013;62(1):203‐217. - PMC - PubMed
    1. Hajishengallis G, Darveau RP, Curtis MA. The keystone‐pathogen hypothesis. Nat Rev Microbiol. 2012;10(10):717‐725. - PMC - PubMed
    1. Meyle J, Chapple I. Molecular aspects of the pathogenesis of periodontitis. Periodontol 2000. 2015;69(1):7‐17. - PubMed
    1. Van Dyke TE, Bartold PM, Reynolds EC. The nexus between periodontal inflammation and Dysbiosis. Front Immunol. 2020;11:511. - PMC - PubMed

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