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Current clinical framework on nitric oxide role in periodontal disease and blood pressure
Publication . Lima, Leonel; Gaspar, Sara; Rocha, Bárbara S.; Alves, Ricardo; Almeida, M. Gabriela; Faculdade de Ciências e Tecnologia (FCT); UCIBIO - Applied Molecular Biosciences Unit; Springer Science Business Media
Objectives: In this review, we explored potential associations between NO and its derivatives, nitrite and nitrate, with periodontal and cardiovascular diseases, with special emphasis on the former. By providing a state-of-the-art and integrative understanding of this topic, we aimed to shed light on the potential role of these three nitrogen oxides in the periodontitis-hypertension nexus, identify knowledge gaps, and point out critical aspects of the experimental methodologies. Materials and methods: A comprehensive literature review was conducted on human salivary and plasma concentrations of nitrate and nitrite, and their impact on periodontal and cardiovascular health. Results: A nitrate-rich diet increases nitrate and nitrite levels in saliva and plasma, promoting oral health by favorably altering the oral microbiome. Chlorhexidine (CHX) mouthrinses disrupt the nitrate-nitrite-NO pathway, reducing NO bioavailability, and potentially affecting blood pressure. This is because CHX eliminates nitrate-reducing bacteria, which are essential for NO production. Although endogenous NO production may be insufficient, the nitrate-nitrite-NO pathway plays a critical role in maintaining appropriate endothelial function, which is balanced by the microbiome and dietary nitrate intake. Dietary nitrate supplementation may lead to beneficial changes in the oral microbiome, thereby increasing the NO bioavailability. However, NO bioavailability can be compromised by reactive oxygen species (ROS) and the uncoupling of endothelial nitric oxide synthase (eNOS), leading to further ROS generation and creating a detrimental cycle. Studies on NO and periodontal disease have shown increased nitrite concentrations in patients with periodontal disease, although these studies have some methodological limitations. In terms of blood pressure, literature suggests that CHX mouthrinses may reduce the capacity of nitrate-reducing bacteria, potentially leading to an increase in blood pressure. Conclusions: Several studies have suggested an association between NO levels and the development of cardiovascular and periodontal diseases. However, the exact mechanisms linking these diseases remains to be fully elucidated. Clinical relevance: Nitric oxide (NO) is a signaling molecule that plays a crucial role in several physiological processes such as vascular homeostasis, inflammation, immune cell activity, and pathologies such as hypertension and periodontitis.
Point-of-care testing of nitrite in oral medicine
Publication . Gaspar, Sara Rodrigues; Proença, Luís; Alves, Ricardo; Almeida, Maria Gabriela; DQ - Departamento de Química; UCIBIO - Applied Molecular Biosciences Unit; Elsevier BV
Periodontal disease (PD) is a chronic inflammatory condition triggered by bacterial biofilms and progresses through two main stages: gingivitis and periodontitis. The existing diagnostic methods remain time-consuming and require clinical expertise. Salivary nitrite, a stable end-product of nitric oxide produced during inflammation, has emerged as a promising biomarker for PD. However, its reliable quantification in saliva typically relies on laboratory-based assays that are unsuited to clinical workflows. This study aimed to test and validate a new nitrite point-of-care test (POCT) for oral medicine. Building on previous research, we developed a biosensing platform based on screen-printed carbon electrodes modified with a selective enzyme, the cytochrome c nitrite reductase. To adapt bioelectrodes for salivary analysis, they were further modified with a poly(vinyl) alcohol coating and a biochemical oxygen scavenger system (ascorbate oxidase and ascorbate). The nitrite biosensor achieved a suitable linear range of 5–300 μM, with a sensitivity of 0.015 μM−1, validated against the gold-standard Griess method. Unlike the Griess reaction, the biosensor was unaffected by sample turbidity, rendering centrifugation unnecessary. Additionally, we observed that sample freezing altered nitrite concentrations, increasing levels in non-centrifuged samples, while decreasing them in previously clarified samples. These findings highlight the need for real-time analysis and call into question the reliability of previously published data that overlooked these variables. Therefore, our results demonstrate the potential of the nitrite biosensor as a novel salivary POCT and emphasize the critical need for standardized sample-handling protocols.
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Fundação para a Ciência e a Tecnologia
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3599-PPCDT
Número da atribuição
2022.04940.PTDC