INTRODUCTION:

Chronic desquamative gingivitis (CDG) was first described in 1894¹ and later recognized as a clinical reaction to mucocutaneous disorders rather than a distinct diagnosis².

Mucous membrane pemphigoid and pemphigus vulgaris are the most frequent immunological causes of CDG, accounting for about 75% of cases³. Clinically, CDG varies in severity, ranging from mild erythema to severe gingival desquamation⁴. It is more common in women, particularly those experiencing hormonal changes⁵, and is rarely seen in children⁶.

Saliva is an emerging diagnostic tool due to its biomarker-rich content, aiding in disease detection and monitoring^7,8,9. Finding biomarkers for screening, prognosis, and disease activity evaluation as well as therapeutic efficacy has proven somewhat difficult in oral diagnostics.^10,11 The primary cause of periodontal disease is oxidative stress, which is caused by a negative relationship between antioxidants and reactive oxygen species (ROS).^12,13,14. Malondialdehyde (MDA) serves as a marker of oxidative stress-induced tissue damage, while superoxide dismutase (SOD) acts as an antioxidant defence^15,16,17.

Nonsurgical periodontal therapy (NSPT), the gold standard for periodontal care, aims to reduce inflammation by eliminating plaque, calculus, and bacterial toxins¹⁸. While NSPT improves clinical outcomes^19,20, its effect on oxidative stress markers in CDG remains unclear, warranting further investigation ²¹.

MATERIALS AND METHODS:

The Department of Periodontology ABSMIDS INDIA, was the site of this investigation, from November 2023 to June 2024, with ethical approval from the Institutional Ethical Committee of NITTE University (Reference Number: ETHICS/ABSMIDS/387/2023). The sample size was determined using SPSS version 20, with a 95% confidence level and 80% power, requiring 46 patients, divided into two groups of 23 each. A statistical evaluation was carried out with either Mann-Whitney test or an unpaired t-test. All the participants were taken from the Department of Periodontology, and all 46 patients who complied with the inclusion criteria were provided written informed consent before the study began.

Inclusion criteria specified that participants must have a minimum of 20 teeth and be aged between 30 and 65 years. Individuals with systemic conditions such as diabetes or hypertension were excluded, as were those who had taken corticosteroids, antibiotics, or anti-anxiety medications within the past six months. Additionally, patients with habits harmful to oral health, such as smoking, alcohol consumption, betel nut chewing, or other forms of tobacco use, were not included in the study.

SAMPLE COLLECTION:

Salivary samples were collected after instructing subjects to abstain from food and liquids for 30–60 minutes. Unstimulated whole saliva was collected in plastic uricol containers with patients seated upright. After collection, nonsurgical periodontal treatment was provided, and post-treatment samples were collected after 10 days. Samples were separated into 0.5ml aliquots, centrifuged at 3000rpm for 10 minutes to remove cells and debris, then kept at -80°C. MDA levels were assessed using the TCA-TBA method, and SOD levels by the Nitroblue tetrazolium method at the Central Research Laboratory, KSHEMA. (Table – 1,3)

STATISTICAL ANALYSIS:

The formula N=Z_α²⋅s²/d²was used in calculating the sample size of the study, where Z_α=1.96 corresponds to a 95% confidence level, s represents the standard deviation, and d is the relative precision set at 10% of the mean. Given a mean of 0.13 and a standard deviation of s, a minimum sample size of 46 participants was determined to achieve both a 95% confidence level and 80% power. Based on the distributional properties of the data, the Mann-Whitney test or unpaired t-test was used in the statistical analysis of the gathered data. All analyses were conducted with SPSS (version 20), considering a p-value under 0.05 as statistically significant.

RESULTS:

The effects of nonsurgical periodontal therapy (scaling) on salivary malondialdehyde (MDA) and superoxide dismutase (SOD) levels were analyzed within and between the two groups: chronic desquamative gingivitis (CDG) and healthy individuals.

The paired t-test for MDA levels before and after scaling (Table 1) showed no significant change (p = 0.712). The mean difference was -0.02878μM/L, with a 95% confidence interval of -0.18840 to 0.13084 (Table 2). Similarly, the paired t-test for SOD levels (Table 3) revealed no significant change after scaling (p = 0.385), with a mean difference of -0.02261 U/mg and a confidence interval ranging from -0.07551 to 0.03029 (Table 4).

Comparisons between the CDG and healthy groups before treatment using an unpaired t-test indicated no statistically significant difference in MDA levels (p = 0.576) (Table 5). The mean difference of 0.03769μM/L (Table 6) further supports that MDA levels were comparable between the two groups. Similarly, for SOD levels, the unpaired t-test (Table 7) revealed no appreciable variation among individuals (p = 0.333), with a mean difference of 0.01870 U/mg (Table 8).

These results suggest that nonsurgical periodontal therapy does not significantly alter oxidative stress markers in CDG patients. Additionally, MDA and SOD levels do not show a notable difference between CDG patients and healthy controls, indicating that oxidative stress may not be markedly elevated in this condition.

Table 1: MDA (μM/L) Before and After Scaling (Paired Samples Test)

	N	Mean	Std. Deviation
MDA (uM/L) before scaling	23	0.76270	0.240617
MDA (uM/L) after scaling	23	0.79148	0.285332

Table 2: Paired Samples Test of MDA levels

	Paired Differences			T	P
	Mean	95% Confidence Interval of the Difference
		Lower	Upper
MDA (uM/L) before scaling - MDA (uM/L) after scaling	-0.02878	-0.18840	0.13084	-0.374	0.712

Table 3: SOD (μM/L) Before and After Scaling (Paired Samples Test)

	N	Mean	Std. Deviation
SOD (U/mg) before scaling	23	0.2957	0.08675
SOD (U/mg) after scaling	23	0.3183	0.08250

Table 4: Paired Samples Test of SOD levels

	Paired Differences			t	P
	Mean	95% Confidence Interval of the Difference
		Lower	Upper
SOD (U/mg) before scaling - SOD (U/mg) after scaling	-0.02261	-0.07551	0.03029	-0.886	0.385

Table 5: Results of an unpaired t-test comparing MDA (μM/L) levels between the Chronic desquamative gingivitis and Healthy groups before scaling

	Group	N	Mean	Std. Deviation
MDA (uM/L) before scaling	Chronic desquamative gingivitis	23	0.76270	0.24062
MDA (uM/L) before scaling	Healthy	23	0.72500	0.21289

Table 6: Mean difference of MDA levels

	t-test for Equality of Means
	T	P	Mean Difference	95% Confidence Interval of the Difference
				Lower	Upper
MDA (uM/L) before scaling	0.563	0.576	0.03769	-0.097317	0.17271

Table 7: results for SOD (U/mg) levels between the Chronic desquamative gingivitis and Healthy groups

	Group	N	Mean	Std. Deviation
SOD (U/mg) before scaling	Chronic desquamative gingivitis	23	0.2957	0.08675
SOD (U/mg) before scaling	Healthy	23	0.2770	0.02704

Table 8: Mean difference of SOD levels

	t-test for Equality of Means
	T	P	Mean Difference	95% Confidence Interval of the Difference
				Lower	Upper
SOD (U/mg) before scaling	0.987	0.333	0.01870	-0.02023	0.05763

DISCUSSION:

The study goals at evaluating and comparing salivary levels of two biomarkers of oxidative stress which are malondialdehyde and superoxide dismutase in individuals with chronic desquamative gingivitis before and after nonsurgical periodontal therapy. The results revealed that there were no statistically major differences in either MDA or SOD levels following the scaling procedure or between the chronic desquamative gingivitis and healthy groups. Results from research conducted in 2015 by NA Ghallab et al. revealed that the generalized aggressive periodontitis (GAgP) group had substantially greater levels of GCF-malondialdehyde than the chronic periodontitis (CP) and control groups (p < 0.001), as well as the CP group relative to the C group (p < 0.001). SOD GCF levels were considerably less in the GAgP group than in the CP group (p < 0.05) and much higher in the control group than in the GAgP and CP groups.²²

Oxidative Stress and Chronic Desquamative Gingivitis: Chronic desquamative gingivitis is featured by inflammation and tissue degeneration, potentially leading to increased oxidative stress. MDA, a byproduct of lipid peroxidation, shows as a reliable indicator of oxidative stress, while SOD functions as a critical antioxidant defence mechanism in the body. The absence of remarkable changes in MDA and SOD levels in our study suggests that nonsurgical periodontal therapy may not substantially alter the oxidative stress status with chronic desquamative gingivitis patients. Finding was same as previous studies indicating that nonsurgical interventions, while effective in reducing inflammation and improving clinical outcomes, may not directly influence oxidative stress biomarkers. Salivary MDA levels were significantly greater in patients with periodontitis than in the control group, according to a 2017 study by Canan et al. (p < 0.001). Salivary MDA levels did not significantly change as a result of periodontal therapy (p = 0.093). ²³ Another study done by Sukhpal et al in 2020, the study found that compared to the healthy control group, the levels of MDA in the obese group and the obese patients with diabetes are much elevated. ²⁴

COMPARISON AND CLINICAL IMPLICATIONS:

Salivary MDA and SOD levels showed no appreciable variations between chronic desquamative gingivitis (CDG) patients and healthy controls, suggesting oxidative stress may not be markedly elevated in CDG. While nonsurgical periodontal therapy improves clinical parameters, its effect on oxidative stress markers appears limited. Future studies should explore surgical interventions and long-term changes in oxidative stress markers. Larger, more diverse studies incorporating additional oxidative stress biomarkers and inflammatory cytokines are needed for a comprehensive understanding of oxidative stress in CDG.

CONCLUSION:

Superoxide dismutase (SOD) and malondialdehyde (MDA) levels in the saliva were measured in individuals with chronic desquamative gingivitis (CDG) both before and after nonsurgical periodontal therapy. No significant changes in oxidative stress markers were observed post-treatment or when compared to healthy controls. These findings suggest that nonsurgical therapy alone may not significantly impact oxidative stress in CDG. Further research with larger sample sizes and varied treatment approaches is needed to better understand the role of oxidative stress in periodontal health.

LIST OF SYMBOLS AND ABBREVIATIONS:

N – Sample size

Z_α- 1.96 corresponds to a 95% confidence level

S - standard deviation

d - relative precision set at 10% of the mean

ROS - Reactive oxygen species

MDA - Malondialdehyde

SOD - Superoxide dismutase

NSPT - Nonsurgical periodontal treatment

TCA-TBA – Trichloroacetic acid-Thiobarbituric Acid Analysis

GAgP - Generalised aggressive periodontitis

CP - Chronic periodontitis

C group – Control group

GCF - Gingival crevicular fluid

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Received on 24.10.2024 Revised on 15.02.2025

Accepted on 19.04.2025 Published on 01.12.2025

Available online from December 06, 2025

Research J. Pharmacy and Technology. 2025;18(12):6011-6015.

DOI: 10.52711/0974-360X.2025.00868

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