Efficacy of a chairside diagnostic test kit for estimation of C-reactive protein levels in periodontal disease
Identifieur interne : 003184 ( Pmc/Corpus ); précédent : 003183; suivant : 003185Efficacy of a chairside diagnostic test kit for estimation of C-reactive protein levels in periodontal disease
Auteurs : Girish Nagarale ; S. Ravindra ; Srinath Thakur ; Swati SettySource :
- Journal of Indian Society of Periodontology [ 0972-124X ] ; 2010.
Abstract
C-reactive protein [CRP] levels increase to hundreds of mg/mL within hours following infection. Studies have shown that serum CRP levels were elevated in periodontal disease. However, in all the previous studies, CRP levels were measured by using high-sensitivity CRP assay kits with minimal detection limits of 0.1 to 3 mg/L, which was much below the normal value of 10 mg/L. These high-sensitivity CRP assays need a proper laboratory setup, and these methods cannot be used as a routine chair-side test in the dental office.
The purpose of this study was to investigate the serum CRP levels in subjects with periodontal disease by using a rapid chair-side diagnostic test kit with a lower detection limit of 6 mg/L and to compare the CRP levels before and after periodontal therapy.
A total of 45 systemically healthy subjects were selected for the study. Subjects were divided into three groups: group A: healthy controls, group B: gingivitis, group C: periodontitis. Serum levels of CRP were determined by using a latex slide agglutination method with commercially available kit with lower detection limit of 6 mg/L.
CRP was negative in all the 15 subjects in groups A and B at baseline, 7th and 30th day. CRP was positive only in 2 subjects in Group C at baseline and 7th day.
Estimation of serum CRP by using a rapid chair-side diagnostic test kit is not of any significance in subjects with periodontitis.
Url:
DOI: 10.4103/0972-124X.76919
PubMed: 21731244
PubMed Central: 3118069
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Efficacy of a chairside diagnostic test kit for estimation of C-reactive protein levels in periodontal disease</title><author><name sortKey="Nagarale, Girish" sort="Nagarale, Girish" uniqKey="Nagarale G" first="Girish" last="Nagarale">Girish Nagarale</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Ravindra, S" sort="Ravindra, S" uniqKey="Ravindra S" first="S." last="Ravindra">S. Ravindra</name><affiliation><nlm:aff id="aff2"><italic>Department of Periodontics, Hassanamba Dental College, Hassan, Karnataka, India</italic></nlm:aff></affiliation></author><author><name sortKey="Thakur, Srinath" sort="Thakur, Srinath" uniqKey="Thakur S" first="Srinath" last="Thakur">Srinath Thakur</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Setty, Swati" sort="Setty, Swati" uniqKey="Setty S" first="Swati" last="Setty">Swati Setty</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21731244</idno><idno type="pmc">3118069</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118069</idno><idno type="RBID">PMC:3118069</idno><idno type="doi">10.4103/0972-124X.76919</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">003184</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003184</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Efficacy of a chairside diagnostic test kit for estimation of C-reactive protein levels in periodontal disease</title><author><name sortKey="Nagarale, Girish" sort="Nagarale, Girish" uniqKey="Nagarale G" first="Girish" last="Nagarale">Girish Nagarale</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Ravindra, S" sort="Ravindra, S" uniqKey="Ravindra S" first="S." last="Ravindra">S. Ravindra</name><affiliation><nlm:aff id="aff2"><italic>Department of Periodontics, Hassanamba Dental College, Hassan, Karnataka, India</italic></nlm:aff></affiliation></author><author><name sortKey="Thakur, Srinath" sort="Thakur, Srinath" uniqKey="Thakur S" first="Srinath" last="Thakur">Srinath Thakur</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Setty, Swati" sort="Setty, Swati" uniqKey="Setty S" first="Swati" last="Setty">Swati Setty</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Indian Society of Periodontology</title><idno type="ISSN">0972-124X</idno><idno type="eISSN">0975-1580</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background:</title><p>C-reactive protein [CRP] levels increase to hundreds of mg/mL within hours following infection. Studies have shown that serum CRP levels were elevated in periodontal disease. However, in all the previous studies, CRP levels were measured by using high-sensitivity CRP assay kits with minimal detection limits of 0.1 to 3 mg/L, which was much below the normal value of 10 mg/L. These high-sensitivity CRP assays need a proper laboratory setup, and these methods cannot be used as a routine chair-side test in the dental office.</p></sec><sec id="st2"><title>Aim:</title><p>The purpose of this study was to investigate the serum CRP levels in subjects with periodontal disease by using a rapid chair-side diagnostic test kit with a lower detection limit of 6 mg/L and to compare the CRP levels before and after periodontal therapy.</p></sec><sec id="st3"><title>Materials and Methods:</title><p>A total of 45 systemically healthy subjects were selected for the study. Subjects were divided into three groups: group A: healthy controls, group B: gingivitis, group C: periodontitis. Serum levels of CRP were determined by using a latex slide agglutination method with commercially available kit with lower detection limit of 6 mg/L.</p></sec><sec id="st4"><title>Results:</title><p>CRP was negative in all the 15 subjects in groups A and B at baseline, 7th and 30th day. CRP was positive only in 2 subjects in Group C at baseline and 7th day.</p></sec><sec id="st5"><title>Conclusion:</title><p>Estimation of serum CRP by using a rapid chair-side diagnostic test kit is not of any significance in subjects with periodontitis.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ebersole, Jl" uniqKey="Ebersole J">JL Ebersole</name></author><author><name sortKey="Cappelli, D" uniqKey="Cappelli D">D Cappelli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morey, Jj" uniqKey="Morey J">JJ Morey</name></author><author><name sortKey="Kushner, I" uniqKey="Kushner I">I Kushner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gabay, C" uniqKey="Gabay C">C Gabay</name></author><author><name sortKey="Kushner, I" uniqKey="Kushner I">I Kushner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shine, B" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Indian Soc Periodontol</journal-id><journal-id journal-id-type="publisher-id">JISP</journal-id><journal-title-group><journal-title>Journal of Indian Society of Periodontology</journal-title></journal-title-group><issn pub-type="ppub">0972-124X</issn><issn pub-type="epub">0975-1580</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21731244</article-id><article-id pub-id-type="pmc">3118069</article-id><article-id pub-id-type="publisher-id">JISP-14-213</article-id><article-id pub-id-type="doi">10.4103/0972-124X.76919</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Efficacy of a chairside diagnostic test kit for estimation of C-reactive protein levels in periodontal disease</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Nagarale</surname><given-names>Girish</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Ravindra</surname><given-names>S.</given-names></name><xref ref-type="aff" rid="aff2">1</xref></contrib><contrib contrib-type="author"><name><surname>Thakur</surname><given-names>Srinath</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Setty</surname><given-names>Swati</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1"><italic>Department of Periodontics, S.D.M. College of Dental Sciences and Hospital, Dharwad, Karnataka, India</italic></aff><aff id="aff2"><label>1</label><italic>Department of Periodontics, Hassanamba Dental College, Hassan, Karnataka, India</italic></aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Girish Nagarale, Department of Periodontics, S.D.M. College of Dental Sciences and Hospital, Dharwad, Karnataka, India E-mail: <email xlink:href="naggirish@yahoo.com">naggirish@yahoo.com</email></corresp></author-notes><pub-date pub-type="ppub"><season>Oct-Dec</season><year>2010</year></pub-date><volume>14</volume><issue>4</issue><fpage>213</fpage><lpage>216</lpage><history><date date-type="received"><day>28</day><month>1</month><year>2010</year></date><date date-type="accepted"><day>27</day><month>7</month><year>2010</year></date></history><permissions><copyright-statement>Copyright: © Journal of Indian Society of Periodontology</copyright-statement><copyright-year>2010</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec id="st1"><title>Background:</title><p>C-reactive protein [CRP] levels increase to hundreds of mg/mL within hours following infection. Studies have shown that serum CRP levels were elevated in periodontal disease. However, in all the previous studies, CRP levels were measured by using high-sensitivity CRP assay kits with minimal detection limits of 0.1 to 3 mg/L, which was much below the normal value of 10 mg/L. These high-sensitivity CRP assays need a proper laboratory setup, and these methods cannot be used as a routine chair-side test in the dental office.</p></sec><sec id="st2"><title>Aim:</title><p>The purpose of this study was to investigate the serum CRP levels in subjects with periodontal disease by using a rapid chair-side diagnostic test kit with a lower detection limit of 6 mg/L and to compare the CRP levels before and after periodontal therapy.</p></sec><sec id="st3"><title>Materials and Methods:</title><p>A total of 45 systemically healthy subjects were selected for the study. Subjects were divided into three groups: group A: healthy controls, group B: gingivitis, group C: periodontitis. Serum levels of CRP were determined by using a latex slide agglutination method with commercially available kit with lower detection limit of 6 mg/L.</p></sec><sec id="st4"><title>Results:</title><p>CRP was negative in all the 15 subjects in groups A and B at baseline, 7th and 30th day. CRP was positive only in 2 subjects in Group C at baseline and 7th day.</p></sec><sec id="st5"><title>Conclusion:</title><p>Estimation of serum CRP by using a rapid chair-side diagnostic test kit is not of any significance in subjects with periodontitis.</p></sec></abstract><kwd-group><kwd>C-reactive protein</kwd><kwd>periodontal disease</kwd><kwd>chair-side diagnostic kit</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>INTRODUCTION</title><p>The systemic acute phase refers to physiological and metabolic alterations that result immediately after the onset of infection or tissue injury, such as bacterial, viral or parasitic infection; mechanical trauma; tissue necrosis; or inflammation.[<xref ref-type="bibr" rid="ref1">1</xref>] Acute-phase reactant proteins are defined as proteins whose serum concentration is altered by at least 25% in response to inflammation.[<xref ref-type="bibr" rid="ref2">2</xref>] Most of the acute-phase proteins are synthesized primarily by the liver hepatocytes in response to pro-inflammatory cytokines. C-reactive protein [CRP] was the first protein to be discovered which behaves as an acute-phase reactant. CRP binds to phosphocholine, phospholipids, plasma lipoproteins and the plasma membranes of damaged or apoptotic but not intact cells.[<xref ref-type="bibr" rid="ref3">3</xref>] Ligand-bound CRP activates the classical complement pathway 1 and can trigger inflammatory, opsonizing and complex solubilizing activities of the complement system. CRP levels reflect the extent and activity of disease.[<xref ref-type="bibr" rid="ref4">4</xref><xref ref-type="bibr" rid="ref5">5</xref>] CRP levels can be measured using immunoturbidimetric or immunoelectrophoretic assays[<xref ref-type="bibr" rid="ref6">6</xref>–<xref ref-type="bibr" rid="ref9">9</xref>] or latex slide agglutination method. The high-sensitivity CRP assay uses labeled monoclonal or polyclonal anti-CRP antibodies in an enzyme-linked immunosorbent assay (ELISA) or an immunofluorescent assay. CRP is normally present in ng/mL quantities but may increase dramatically to hundreds of mg/mL within 48 to 72 hours following tissue injury. CRP is a trace protein in healthy individuals, the median value of which was determined to be 0.8 mg/L in 483 healthy subjects, 90% of whom had CRP levels below 3 mg/L; and 99%, below 10 mg/L.[<xref ref-type="bibr" rid="ref4">4</xref>] The latter finding has led to the suggestion that values of less than 10 mg/L should be regarded as clinically unimportant.[<xref ref-type="bibr" rid="ref2">2</xref>] Periodontal disease is a chronic inflammatory process that occurs in response to a predominantly gram-negative bacterial infection originating from dental plaque. Periodontal pathogens affect local and systemic immune and inflammatory response.[<xref ref-type="bibr" rid="ref5">5</xref>] Recent studies have shown that serum CRP levels were elevated in periodontal disease.[<xref ref-type="bibr" rid="ref6">6</xref>–<xref ref-type="bibr" rid="ref13">13</xref>] However, in all the previous studies,[<xref ref-type="bibr" rid="ref6">6</xref>–<xref ref-type="bibr" rid="ref13">13</xref>] CRP levels were measured by using high-sensitivity CRP assay kits with minimal detection limits of 0.1 to 3 mg/L, which was much below the normal value of 10 mg/L.[<xref ref-type="bibr" rid="ref2">2</xref>] These high-sensitivity CRP assays need a proper laboratory setup, and these methods cannot be used as a routine chair-side test in the dental office. The purpose of this study was to investigate the serum CRP levels in subjects with gingival and periodontal disease by using a rapid chair-side diagnostic test kit with a lower detection limit of 6 mg/L and to compare the CRP levels before and after periodontal therapy.</p></sec><sec sec-type="materials|methods" id="sec1-2"><title>MATERIALS AND METHODS</title><p>A total of 45 systemically healthy, nonsmoking subjects, aged 25 to 48 years [31 males and 14 females], were selected from the outpatient department of SDM College of Dental Sciences and Hospital, Dharwad, India. Inclusion criteria required that subjects have a minimum of 20 natural teeth; have not received antibiotic or periodontal therapy within the past 6 months; and do not require any dental treatment which needs antibiotic prophylaxis. Patients were not included in the study if they were pregnant; or if they were suffering from any chronic inflammatory or immunological conditions such as arthritis or gastrointestinal disorders. Fifteen subjects were selected and assigned each to group A, group B and group C. Group A comprised healthy controls (no sign of gingival or periodontal disease); group B, subjects with gingivitis (Loe and Silness Gingival Index score of ≥2); group C, subjects with periodontitis (clinical probing pocket depth of ≥6 mm in minimum of 6 teeth). The study protocol was approved by the institutional ethical and review board. All the subjects were informed about the purpose of the study, and they signed an informed consent document prior to participation.</p><p>Comprehensive medical and dental histories were obtained from all the subjects at baseline. Clinical measurements such as those obtained using Loe and Silness Gingival Index and Turesky Gilmore Glickman modification of the Quigley Hein Plaque Index were recorded at 4 sites per tooth [mesio-buccal, buccal, disto-buccal and lingual / palatal] on all teeth except third molars at baseline in all the 3 groups, and on the 7<sup>th</sup> and 30<sup>th</sup> day post-baseline in groups B and C.Probing pocket depth was measured with Williams graduated periodontal probe on 4 sites per tooth of all teeth except third molars at baseline in group C. All the clinical measurements were carried out by the same examiner to minimize inter-examiner variation.</p><p>Venous blood samples were obtained from the antecubital vein by venipuncture using a standard 2-mL syringe from each subject in all the 3 groups at baseline; and on the 7<sup>th</sup> day and 30<sup>th</sup> day post-baseline, blood samples were obtained only from subjects in groups B and C. Samples were allowed to coagulate for 1 to 2 hours at room temperature in a serum-collecting tube [<xref ref-type="fig" rid="F1">Figure 1</xref>]. Serum was then separated by using micropipette. Serum levels of CRP were determined by using a latex slide agglutination method with commercially available kit obtained from Span Diagnostic Ltd. [Figures <xref ref-type="fig" rid="F2">2</xref> and <xref ref-type="fig" rid="F3">3</xref>], as it has the advantage of rapid performance (within 2 minutes) in comparison to other methods for detection of CRP.[<xref ref-type="bibr" rid="ref6">6</xref>–<xref ref-type="bibr" rid="ref9">9</xref>] Since the lower detection limit of CRP was 6 μg/mL, subjects with CRP values <6 μg/mL were regarded sero-negative. After recording baseline clinical and biochemical measurements, only oral hygiene instructions were given to subjects belonging to group A. Full-mouth scaling and root planing was carried out in subjects belonging to groups B and C. Recall visits were scheduled for all the subjects belonging to groups B and C on 7<sup>th</sup> and 30<sup>th</sup> day to record both clinical and biochemical measurements. Descriptive statistics included mean and standard deviation for each of the measured clinical parameters. Clinical parameters at baseline and reassessment were compared using t tests. Since CRP levels were negative in most of the cases and as there were no variables present, CRP values were not subjected to statistical analysis.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>Serum samples</p></caption><graphic xlink:href="JISP-14-213-g001"></graphic></fig><fig id="F2" position="float"><label>Figure 2</label><caption><p>Commercially available test kit for estimation of CRP</p></caption><graphic xlink:href="JISP-14-213-g002"></graphic></fig><fig id="F3" position="float"><label>Figure 3</label><caption><p>Negative and positive slide agglutination test</p></caption><graphic xlink:href="JISP-14-213-g003"></graphic></fig></sec><sec sec-type="results" id="sec1-3"><title>RESULTS</title><p>A total of 45 subjects completed the study, which was of 1-month duration. Descriptive statistics, including mean, standard deviation and standard error for Gingival Index, Plaque Index and CRP, are listed in <xref ref-type="table" rid="T1">Table 1</xref>. There was a significant improvement in Gingival Index and Plaque Index in groups B and C when compared to baseline values, as shown in <xref ref-type="table" rid="T1">Table 1</xref>. In this study, CRP was negative in all the 15 subjects in group A; it was also negative in all the 15 subjects in group B at baseline, 7<sup>th</sup> and 30<sup>th</sup> day, as shown in <xref ref-type="fig" rid="F4">Figure 4</xref>. In only 2 subjects, CRP was positive in group C at baseline and 7<sup>th</sup> day; in 1 of these subjects, CRP turned negative on 30<sup>th</sup> day.</p><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Descriptive statistics, including mean, standard deviation and standard error for Gingival Index, Plaque Index and CRP</p></caption><graphic xlink:href="JISP-14-213-g004"></graphic></table-wrap><fig id="F4" position="float"><label>Figure 4</label><caption><p>C-reactive protein levels in groups A, B and C</p></caption><graphic xlink:href="JISP-14-213-g005"></graphic></fig></sec><sec sec-type="discussion" id="sec1-4"><title>DISCUSSION</title><p>C-reactive protein is a well-known acute-phase reactant produced by the liver in response to inflammation due to various stimuli.[<xref ref-type="bibr" rid="ref1">1</xref>] In acute inflammation, serum CRP levels exceed 100 mg/L, and the level decreases in chronic inflammation. Consequently, CRP has been used as a marker of the course of infection. There have been several cross-sectional studies demonstrating elevated levels of CRP in periodontitis patients.[<xref ref-type="bibr" rid="ref6">6</xref>–<xref ref-type="bibr" rid="ref13">13</xref>] These studies fall short in indicating that periodontitis was the cause for the observed serum CRP levels,[<xref ref-type="bibr" rid="ref6">6</xref>–<xref ref-type="bibr" rid="ref13">13</xref>] as CRP levels fluctuate with aging, high blood pressure, alcohol use, smoking, low levels of physical activity, chronic fatigue, coffee consumption, having elevated triglycerides, insulin-resistance diabetes, taking estrogen, eating a high-protein diet, suffering from sleep disturbances, and depression.</p><p>However, to fully confirm that elevation in CRP is due to periodontal infection, it is essential to see whether periodontal treatment is effective in reducing CRP levels following successful periodontal therapy. Ebersole <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref6">6</xref>] Slade <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref7">7</xref>] Ide <italic>et al</italic>. [<xref ref-type="bibr" rid="ref14">14</xref>] and Armitage <italic>et al</italic>.[<xref ref-type="bibr" rid="ref15">15</xref>] found a positive correlation between CRP and periodontitis, but they failed to illustrate changes in CRP following treatment.</p><p>In the present study, CRP was negative in all the 15 subjects in groups A and B. CRP was also negative among the 13 subjects in group C, in spite of the fact that subjects in group C had probing pocket depth of ≥6 mm in 6 or more sites. This was in contrast to the studies conducted by Ebersole <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref6">6</xref>] Slade <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref7">7</xref>] Ide <italic>et al</italic>.[<xref ref-type="bibr" rid="ref14">14</xref>] and Beck <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref16">16</xref>] where they found a positive correlation between CRP and probing pocket depth of ≥4 mm in periodontitis patients. In our study, CRP was positive only in 2 subjects in group C at baseline. In 1 subject, CRP remained positive on 7<sup>th</sup> and 30<sup>th</sup> days even after full-mouth scaling and root planing (SRP). In other subjects, CRP was positive on 7<sup>th</sup> day, but it turned negative on 30<sup>th</sup> day, as the patients had undergone extraction of few teeth which were periodontally compromised. This was in contrast to the study conducted by Slade <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref7">7</xref>] in which they found similar CRP values in edentulous patients and patients with severe periodontitis. In this study, we observed a significant improvement in gingival and plaque scores following SRP but failed to observe any change in CRP. Some other authors also observed similar findings.[<xref ref-type="bibr" rid="ref5">5</xref><xref ref-type="bibr" rid="ref6">6</xref><xref ref-type="bibr" rid="ref14">14</xref><xref ref-type="bibr" rid="ref15">15</xref>] The results of our study suggest a negative correlation between gingivitis, periodontitis and CRP.</p><p>Possible explanations for the negative CRP-periodontal disease relationship are as follows:</p><p>Periodontal disease in the study subjects may be in an inactive state; since periodontal disease is a chronic one, it may remain asymptomatic for decades, during which it can be detected by clinical and radiological examination. Therefore, possibilities exist that CRP concentration may be more closely associated with severe or progressive periodontal disease than simply disease status alone.[<xref ref-type="bibr" rid="ref6">6</xref><xref ref-type="bibr" rid="ref7">7</xref><xref ref-type="bibr" rid="ref14">14</xref><xref ref-type="bibr" rid="ref15">15</xref>]</p><p>There is no standardization of CRP values in healthy subjects and those with periodontal disease, as observed from previous studies.[<xref ref-type="bibr" rid="ref6">6</xref>–<xref ref-type="bibr" rid="ref13">13</xref>] Roberts <italic>et al</italic>.[<xref ref-type="bibr" rid="ref17">17</xref>] recorded median CRP levels of 0.9 mg/L in 388 healthy subjects, 75% of whom had CRP levels below 2 mg/L; and 95%, below 8.4 mg/L. Wu <italic>et al</italic>.[<xref ref-type="bibr" rid="ref18">18</xref>] recorded CRP values of below 3 mg/L in 73% of 5,342 healthy subjects; and 94%, below 9 mg/L. Based on these studies and the studies done by Shine <italic>et al</italic>.[<xref ref-type="bibr" rid="ref4">4</xref>] and Morey <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref2">2</xref>] CRP values <10 mg/L were considered normal.</p><p>There is no standardization of the lower detection limit of commercially available CRP test kits. In the present study, we have used a chair-side diagnostic test kit for the estimation of CRP, which had a lower detection limit of 6 μg/mL, which is equivalent to 6 mg/L. In this study, subjects who had negative CRP readings could actually have CRP value between 0 and 6 mg/L, which may also be one of the reasons for getting negative results. During the present study, authors have observed the following advantages of using chair-side diagnostic test kit for the estimation of CRP: less time consuming, easy to use in dental clinics and economical.</p></sec><sec sec-type="conclusion" id="sec1-5"><title>CONCLUSIONS</title><p>Based on the results of this study, we infer that estimation of serum CRP using a chair-side diagnostic test kit with a lower detection limit of 6 mg/L is not of any significance in subjects with periodontitis. Even though the detection limit of CRP test kit was much below the normal value, i.e., 10 mg/L, the negative CRP values in the present study suggest that periodontal infection may not be severe enough to raise systemic CRP values to a significant level.</p></sec></body><back><ack><p>The authors thank Dr. Anirudh B. Acharya, Professor, Department of Periodontics, S. D. M. 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