Assessment of Oral Biological Markers in Root Carious Lesion and Periodontitis Manifestation Traits: An In- Vitro Cross Sectional Analytical Study

Abstract

Background: Root carious lesion and Periodontitis frequently coexist because of shared clinical and biological factors, including gingival recession, exposed root surfaces, microbial dysbiosis, inflammation, altered salivary characteristics, and impaired antioxidant defenses. Oral biological markers may provide additional information regarding disease activity and the relationship between these two conditions.

Objective: To assess oral biological markers in root carious lesions and periodontal manifestation traits and to determine their association with root caries, periodontal disease, and the coexistence of both conditions.

Methods: This An In- Vitro Cross Sectional Analytical Study was conducted in the Department of Operative Dentistry and Endodontics, Shahida Islam Medical Complex, Lodhran, from 1^st January 2025 to 30^th June 2026 for a period of 18 months (One and a half year). A total of 430 participants were included. Root carious lesions characteristics and periodontal parameters, including plaque index, gingival index, bleeding on probing, probing pocket depth, clinical attachment loss, and gingival recession, were recorded. Unstimulated whole saliva was analyzed for pH, flow rate, vitamin C, total antioxidant capacity, IL-1β, IL-6, TNF-α, and MMP-8. Data were analyzed using IBM SPSS Statistics version 32.0. Appropriate comparative tests, correlation analysis, and multivariable logistic regression were applied, with p<0.05 considered statistically significant.

Results: Root carious lesion was identified in 186 (43.3%) participants, while Periodontitis was present in 258 (60.0%). Both conditions coexisted in 139 (32.3%) participants. Individuals with root carious lesion had significantly greater probing pocket depth, clinical attachment loss, gingival recession, plaque index, and bleeding on probing than those without root carious lesion (all p<0.001). Salivary pH, salivary flow rate, vitamin C, and total antioxidant capacity were significantly lower in participants with root caries, whereas IL-1β, IL-6, TNF-α, and MMP-8 were significantly elevated. The highest MMP-8 concentration was observed among participants with both root carious lesion and periodontitis. Multivariable analysis showed that periodontitis, gingival recession, lower salivary pH, and elevated MMP-8 were independently associated with root carious lesion.

Conclusion: Root carious lesion was significantly associated with adverse periodontal characteristics and alterations in the oral biological environment. Coexisting root carious lesion and periodontitis demonstrated the most pronounced inflammatory and antioxidant imbalance. Salivary biomarkers, particularly MMP-8, together with conventional clinical parameters, may have potential value in integrated risk assessment, although longitudinal validation is required before routine clinical application.