SECRETORY IMMUNOGLOBULIN A ( SIGA ) AND PERIODONTAL STATUS IN CHILDREN WITH DISEASES AND CONDITIONS INFLUENCING THE ORAL

The secretory IgA-antibodies play an important role in the oral homeostasis. They are an indicator of the adaptive immunity in the mouth and influence the oral pathology by interaction on the oral microorganisms. It is the purpose of the present study to evaluate SIgA and the connection of those antibodies with the periodontal status of children with different diseases and conditions influencing their oral medium. The study was done with 116 children with diabetes, asthma, orthodontic treatment and healty controls. The following methods were used: (1) ELISA with "Salivary secretory IgA kit" of Salimetrics LLCUSA was used to determine quantitatively the SIgA in the saliva; (2) evaluation of the oral risk medium and periodontal status (PSR, PBI, OHI) of the children studied. The results show that plaque-induced gingivitis is observed in 50% of the children with diabetes and 30% of the children with orthodontic treatment. The gingivitis of healthy children and children with asthma is considerably lower (10%). The gingival diseases observed vary. The indexes used, (Papilla Bleeding Index(PBI) and Periodontal Screening and Recording Index (PSR), confirm the extent of inflammation of children studied and also confirm the clinical diagnosis made. SIgA of children with gingivitis does not differ statistically from the SIgA of children without gingivitis. This is a confirmation of the opinion of the weak influence of the secretory immunity on the periodontal health.


INTRODUCTION:
The oral environment is formed as a result of the complex interrelations between the saliva, the microorganisms, the defence mechanisms, the system factors and the external environment.The mouth is the gate for many external pathogenic factors, causing both a local and a general pathology ( 2,12,9).
The Secretory IgA-antibodies (SIgA) play an important role in preserving the oral homeostasis.They certify the adaptive immunity of the mouth and affect the oral pathology by interacting with microorganisms from the dental biofilm and microorganisms colonizing the oral mucous membrane (3,4,5).SIgA do not enter the gingival sulcus.Thus, they cannot control the subgingival biofilm.Nevertheless, it is possible that SIgA antibodies modulate the accumulation of supragingival biofilm and by so controlling the formation and structure of plaque-biofim.Inflamed gingiva is more permeable due to higher permeability of blood vessels.IgA as well as other antibodies (IgG, IgM, IgD) are found in larger amounts in gingival sulcus (6,10).
The aim of this research is understanding the meaning of SIgA-antibodies in the complex periodontal pathology in children with different diseases and conditions influencing the oral medium. Tasks: 1. Quantitative assessment of SIgA in children with different diseases and conditions influencing the oral medium.
2. Examining periodontal status in children with different diseases and conditions influencing the oral medium.
3. Examining the dependency of SIgA of and periodontal status in children with different diseases and conditions influencing the oral medium.

MATERIALS AND METHODS
The study was performed on 116 children: The selected groups of children are suitable for this study because in the three of them we can expect a change in the oral immunity.In diabetic children this change is in relation to the main disease; in asthmatic children-allergic

SECRETORY IMMUNOGLOBULIN A (SIGA) AND PERIODONTAL STATUS IN CHILDREN WITH DISEASES AND CONDITIONS INFLUENCING THE ORAL ENVIRONMENT
The following indexes were used: (3) PSR -Periodontal Screening and Recording Index(ADA) -Probing is made in 6 locations of every representative tooth (16,11,26,36,31,46).In 7-12 year old children we use values in the range 0-2 (7,11).
2. The ELISA method of examining the SIgA in the saliva(13): The sample was taken in the morning on an empty stomach after the salivation has been stimulated for five minutes by chewing standard indifferent chewing gum (from the test for saliva "Saliva cheñk" -GC).After that the saliva was collected in a plastic container.From it by means of a dropper a certain amount was taken that was then frozen in a refrigerator (-10 î Ñ).
For the quantitative determination of the SIgA in the saliva we employed the ELISA method with "Salivary secretory IgA KIT" of SalimetricsLLC -USA.The method is indirect, a constant quantity of goat anti-human SIgA conugated with horseradish peroxidase(HRP) being used.The antibody-conjugate is added in test-tubes with specific dilutations of standards or samples from the saliva studied.From each sample sprinkling is made in separate small holes with human SIgA grouped on the same plaque.The

Identifying local risk factors
Patient's personal information and evaluation of risk factors (systemic)

Clinical examination of periodontal status
Periodontal status and oral hygiene index  We noticed that in 13 (56,7%) of the children with diabetes index values of 1 and 2 are found.This suggests mild and average forms of gingival inflammation.Only in 4 of the asthmatic children and the healthy ones the PSR index shows 1(mild gingival inflammation).In the last group (orthodontic treatment group) 7 children suffer gingivitis and half of them show PSR value 2. PSR values 3 or 4 were not found in the examined children.The highest percent of bleeding papillae is again in the group of the diabetic children.1/3 of the papillae are inflamed in a matter that provokes bleeding during probe examination.Gingival inflammation is generalized in this group.Affected papillae are between 0-100%.This may be influenced by the systemic disease.In the rest of the groups the gingival inflammation takes up to 42,85% of the papillae due to local irritating factors.

Fig. 1 .
Fig. 1.Periodontal status examination algorithm and evaluation of the risky oral medium in children

1 .
Average values of SIgA in the three groups in comparison to the healthy children group are shown in the following diagram:
Results show that in more of the diabetic children(63.33%)and in ¼ of the orthodontically treated children there is plaque-induced gingivitis.The other two groups have a lower number of gingival inflammation (P < 0,05).There are different degrees of gingival inflammation.Diabetic children suffer the most severe degrees.Used indexes (PBI and PSR) confirm clinical diagnosis and disease degree.3.The dependency of SIgA of oral hygiene and periodontal status in children with different diseases which change the oral medium 3.1.OHI S&L evaluation in examined children: Results are shown in the next table.