JOURNAL CLUB
Dr Meera Nandan
3rd Year MD ClinicalYoga
Effect ofSudharshan
Effect of SudharshanKriya
KriyaPranayama
Pranayama onon
Salivary ExpressionofofHuman
Salivary Expression HumanBetaBeta Defensin-2,
Defensin-2,
Peroxisome Proliferator-Activated
Peroxisome Proliferator-Activated Receptor
Receptor
Gamma, and
Gamma, andNuclear
NuclearFactor-Kappa
Factor-Kappa B in Chronic
B in
Periodontitis
Chronic Periodontitis
Ananthalakshmi Ramamoorthy , Jaideep
Mahendra,Little Mahendra et al
PERIONDONTITS
Periodontitis is inflammation of the gums and
supporting structures of the teeth.
ETIOLOGY
Initiating factor.
A number of specific bacteria,
such as porphyromonas
Microbial gingivals (P. gingivalis),
Plague Tanneralla forsythia,
Formation Treponema denticola,
Aggregatibacter
actinomycetemcomitans ,
prevotella intermedia, and
Loss of others including
Periodontal Fusobacterium nucleatum,
attachment and
Inflammation Wolinella recta,
alveolar bone
Gram negative anerobic bacteria
Colonizes the subgingal area
Host Response
connective tissue breakdown
and loss of alveolar bone
Muna S Elburki (2018) The Etiology and Pathogenesis of Periodontal Disease.
BAOJ Dentistry 4: 042
‘;
SEVERITY
RISK FACTORS
• Smoking
• Diabetes
• Condition that compromise immunity
• Nutritional defect
• Medication gingival overgrowth
(calcium channel blokers,cyclosporin)
SMOKING
• Increased micro flora
• Reduced biological defence mechanism
• Adverse effect on fibroblast function,
chemotaxis and immunoglobulin production
Kinane DF, Chestnutt IG. Smoking and periodontal disease. Critical Reviews in Oral Biology
& Medicine. 2000 Jul;11(3):356-65.
DIABETES
Diabetes and Perionditis plays a two way
relations
systemic
Oral infection
disease
Diabetes‐induced changes in
immune cell function
• Upregulation of
proinflammatory
produce an inflammatory immune cytokines from
monocytes/poly
cell phenotype morphonuclear
leukocytes
• Downregulation
of growth
factors from
macrophages
chronic inflammation,
progressive tissue breakdown,
diminished tissue repair capacity
Iacopino AM. Periodontitis and diabetes interrelationships: role of inflammation.
Annals of periodontology. 2001 Dec;6(1):125-37.
ABSTRACT
INTRODUCTION
Sudharshan kriya pranayama (SKP) is a form of yoga that reduces
inflammation and contributes to general health.
Very few prior studies have examined the role of pranayama on
oral health.
Evaluated the clinical status and inflammatory biomarkers in
patients with chronic periodontitis before and after SKP.
MATERIALS AND METHODS
90 male subjects
Group 1 Group 2 Group 3
Healthy Periodontium Chronic Gingivitis Chronic Periodontitis
PARAMETERS
plaque index (PI)
Gingival index (GI)
Probing pocket depth (PPD)
Clinical attachment level (CAL)
Salivary markers
Human beta-defensin-2(HBD-2)
Peroxisome proliferator-activated receptor gamma
(PPAR-γ)
Nuclear factor-kappa B (NF-κB).
RESULTS
• Significant improvement in PI in all three groups.
• GI showed an improvement in Groups 2 and 3.
• PPD and CAL also showed an improvement in
Group 3.
• HBD-2 and NF-Κb decreased with SKP, whereas
PPAR-γ expression increased after the
intervention.
• In Groups 2 and 3 with the decrease in GI, there
was a corresponding decrease in HBD-2.
• In Group 3 with an improvement in PPD and CAL,
there was an improvement in PPAR-γ expression.
CONCLUSION
• Significantly decrease periodontal inflammation and
improve periodontal status.
• Effectively improves the expression of PPAR-γ,
thereby decreasing salivary levels of HBD-2 and NF-κB,
respectively.
Pranayama can be an effective adjunct in
maintaining oral health.
INTRODUCTION
• Periodontitis is the most common oral inflammation
• Various reviews on the prevalence of periodontal disease
identified a high prevalence among Indian adults (95%),
specifically in the economically weaker population .
• Due to the current socioeconomic status of developing countries
like India, health care is expensive and cannot be afforded by
everyone.
• In such a scenario, 5,000-year-old complementary and alternative
medicine practices such as yoga have proven to be a cost-effective
aid in the physical, psychological, and social well-being of
individuals, thereby increasing innate immunity.
• [
• Yoga has been demonstrated as a curative
measure for the modifiable and non-
modifiable risk factors of periodontitis .
• Numerous researchers have proven the
positive effect of Sudharshankriya on various
systemic and psychological diseases and
shown a favorable effect on inflammation
• Defensins are secreted by the oral mucosal
surfaces. They are a marker with high sensitivity
and specificity in saliva
• Human beta-defensin-2(HBD-2) is a cationic
peptide influenced by the severity of the
periodontal disease.
• Nuclear factor-kappa B (NF-κB) induces an
inflammatory response in periodontal structures
• Peroxisome proliferator-activated receptor
gamma(PPAR-γ) has an anti-inflammatory effect
by down-regulating NF-κB
• We analyzed the effect of Sudharshan Kriya
pranayama (SKP) on the levels of salivary HBD-
2,NF-κB, PPAR-γ, and periodontal parameters of
subjects with gingival and periodontal disease.
• We hypothesized that via the practice of SKP,
levels of proinflammatory markers such as NF-
κBand anti-inflammatory markers such as HBD-
2 and PPAR-γ could be regulated, thereby
preventing further progression of periodontal
disease and maintaining overall oral health.
MATERIALS AND METHODS
• 110 men aged 18 to 35 years – Art Of Living
Centre
• Minimum of 24 teeth present
• 9 didn’t agree
3 HTN
2 DM
5 Smokers
• omission of women
• Institutional ethical clearance was provided by
the Meenakshi Academy of Higher Education
and Research (MAHER) (MAHER-MU-002-
IEC/2016) following the Declaration of
Helsinki.
• The study was conducted after obtaining
informed written consent from each
participant.
DATA COLLECTION
The periodontal evaluation covered
• Plaque index (PI)
• Gingival index (GI)
• Probing pocket depth(PPD)
• Clinical attachment level (CAL)
PLAGUE INDEX
The PI was recorded with an interpretation of
0= no plaque
1=film of plaque
2=moderate accumulation of deposits
3=abundance of deposits
GINGIVAL INDEX
The GI was done with an interpretation of
• 0= no inflammation
• 0.1 to 1= mild inflammation
• 1.1 to 2= moderate inflammation
• 2.1 to 3= severe inflammation.
PROBING POCKET DEBT
1-3 Normal space below the gum tissue
3-5 Early or Mild Periodontitis
5 -7 Moderate Periondontitis
7-10 Advanced Periondontitis
SAMPLE COLLECTION
• 5 ml of unstimulated saliva sample was collected
at baseline and after the 90-day practice of SKP
• Saliva samples were stored at -50°C and preserved
until the end of the study.
• The samples were thawed before processing.
• Levels of HBD-2 were estimated by enzyme-linked
immunosorbent assay while PPAR-γ and NF-κB
were estimated by a polymerase chain reaction.
INTERVENTION
• SKP session was held from 6 am to 7 am.
• Certified yoga teacher of the AOL taught and
monitored the practice for 90 days.
The kriya started with three
• Stages of ujjayipranayama (victorious breath),
• Three cycles of bhastrika pranayama (bellow
breath)
• Om chanting three times.
• The last stage of SKP was with normal breathing in
slow, medium, and fast cycles followed by rest
STATISTICAL ANALYSIS
• McNemar's test was done to compare clinical
parameters before and after the intervention
• Paired sample t-test was used to compare the
pre- and post-intervention mean values of
biologic parameters
• One-way analysis of variance was used to
compare the parameters between groups at
the end of the study.
• P<.001 was considered statistically significant.
RESULTS
Statistical improvement in PI in all three groups
after 90 days of SKP
GI also showed significant improvement in Groups
2 and 3 after SKP.
Group 3 had significant improvements in mean
PPD and CAL when compared to baseline after SKP
The mean expression of PPAR-γ
increased significantly from baseline
after the SKP intervention in Group3
(P<.001)
The expression of NF-κB decreased
significantly after 90 days of SKP
Comparison of clinical and biological parameters before and
after Sudharshan Kriya pranayama among the healthy group
Comparison of clinical and biological parameters before and after
Sudharshan Kriya pranayama among the healthy group (Group 1)
Comparison of clinical and biological parameters before and after
Sudharshan Kriya pranayama among the chronic periodontitis group (Group
3)
DISCUSSION
• Chronic periodontal disease is a form of oral inflammation that
affects the gingival and periodontal tissues, ultimately causing
loss of alveolar bone.
• Periodontal diseases such as chronic periodontitis can affect the
progression of systemic diseases, thereby affecting the overall
health of the individual.
• Complications from periodontal inflammation and its causative
pathogens are not restricted to the oral cavity.
• These infections can be related to major systemic diseases
such as subacute bacterial endocarditis, rheumatoid arthritis,
ocular disease, skin disorders, gastrointestinal, renal, and
even pregnancy complications like
low birth weight, preterm birth, and pre-eclampsia
• SKP is a form of yoga that has promising effects on
psychological stress, thus boosting innate immunity against
oral inflammation
• HBD-2, an innate immunity marker, is antimicrobial and has
been proven to increase after yogic stretching.
• HBD-2 has a potent role in the pathogenesis of caries,
periodontal disease and oral squamous cell carcinoma .
• NF-κB is a protein complex that regulates DNA transcription,
the production of cytokines and cell survival.
• NF-κB is found in almost all cell types and is involved in
cellular responses to stimuli such as stress.
• It has an important role in the onset of periodontal
inflammation and inhibits osteoblastic bone formation
• PPAR-γ is a transcription factor and an anti-inflammatory molecule
considered to improve immunity.
• Because there are no data demonstrating the impact of pranayama
on levels of HBD-2, PPAR-γ, and NF-κB in oral inflammation, we
examined the levels of salivary HBD-2, NF-κB and PPAR-γ in
subjects with the periodontal disease using SKP as an intervention.
SKY
Hypothaloamo Pituitary Adrenal Axis
Regulation of Sympathetic and Parasympathetic
System
Inflammation
mean PI
Oral hygeine
Reduced
Ananthalakshmi et al. and Farsi et al stated that the plaque
index increases with decreases in salivary flow. SKP increased
the flow rate of saliva and there by maintain oral health
Eda et al, who stated that yogasana would increase
the rate of saliva flow, a natural oral cleanser
proinflammatory cytokines
such as interleukin (IL)-1, IL-6, SKY
and IL-8,tumor necrosis factor
increases
antioxidant levels
Gingivitis decreasing levels of
proinflammatory cytokines and
reactive oxygen species
destruction of the
periodontium breaking the inflammatory
cascade
• Gingivitis is a pathologic response to microbial byproducts
• Mean inflammatory scores for GI were reduced significantly in Groups 2
and 3 after SKP.
• Sharma et al. also noted an increase in antioxidant levels after SKP
• Mahendra et al found a significant decrease in bleeding index in subjects
after SKP intervention
• Mean PPD and CAL on the 90th day of SKP
practice were found to have improved from
baseline in chronic periodontitis patients
(Group 3), indicating an improvement in pocket
depth and clinical attachment level.
• Gingival fibroblasts play a key role in the healing
of periodontium, thereby improving PPD and
CAL.
SKY
Reduction of
Apoptosis of
these fibroblasts
strengthening
the
periodontium
Su Qu et al observed that there was an increase in the expression of genes that
prevented apoptosis (such as COX2, BCL2)
Aggregatibacter actinomycetemcomitans, Porphyromonas
gingivalis,and Fusobacterium nucleatum
HBD-2
periodontal inflammation.
• In our study, HBD-2 was found to be higher in the chronic periodontitis group
than the gingivitis and healthy groups both at baseline and after the
intervention.
• The anti-inflammatory effects of SKP down-regulated HBD-2 and improved
periodontal status in our study group.
periodontal Practice of sky
diseases
Upregulation of PPAR-γ
NF-κB
differentiate
s Downregulationof NF-
κB
osteoclastic Decreases osteoclastic
activity activity
Our results showed the downregulation of NF-κB and the upregulation of
PPAR-γ in Group 3.
LIMITATION
• Explore periodontal pathogens
• Clinical evaluation of periodontitis in women
with SKP intervention.
CONCLUSION
SKP effectively decreased periodontal inflammation, HBD-2
levels, and NF-κB expression,thereby maintaining healthy
periodontium.
In addition, SKP increased the expression of PPAR-
γ, which modulates NF-κB, thereby improving the host
immune response.
In the future, SKPcan be considered as an important
adjunct to an integrated inflammatory treatment modality.
THANK YOU
