MASTER OF DENTAL SURGERY IN ORAL AND MAXILLOFACIAL SURGERY.
DATE OF ADMISSION
TITLE OF THE TOPIC: C–REACTIVE PROTEIN AS AN INFLAMMATORY MARKER IN MONITORING THERAPY EFFECTIVENESS OF ACUTE ODONTOGENIC INFECTIONS.
Brief Resume of Intended Work:
6.1 Need for the study: -
C-reactive protein is one of the most dynamic acute phase proteins in the pentraxin protein family. Its serum concentration are often elevated in patients with odontogenic infection and postoperative complication. The discovery of C-reactive protein focused attention on the acute phase response. The levels of C-reactive protein correlate well with the severity and resolution of acute odontogenic infection and can be used as a reliable parameter in monitoring the effectiveness of acute odontogenic infection therapy.
6.2 Review of Literature:
A study was conducted to study the occurrence of C- reactive protein (CRP) in oral disease. Serum from patients with various forms of inflammatory oral disease was tested for CRP by means of a semiquantitative, capillary precipitation procedure. The result of the study showed that the highest incidence of positive CRP tests and the strongest CRP test reaction were observed in patients with acute alveolar abscess.1
A review study was done to study the role of C–reactive protein (CRP) in atherosclerotic disease. Study included review of structure and binding sites of CRP, biosynthesis and kinetics of CRP, biological properties of CRP, clinical uses of CRP and role of CRP in atherosclerotic disease. Study concluded that measuring hsCRP in patients who are at risk for arterial occlusive disease may become a new risk assessment tool.2
A chair side study of 40 dental emergency patients with odontogenic infection was conducted to quantitatively determine serum CRP level in these patients. Quantitative CRP test was performed at the time of dental emergency treatment and 1 week after. CRP levels were compared between groups. Serum CRP levels greater than 5mg/L was observed in patients with acute odontogenic infection and which rapidly returned below 5mg/L following successful treatment. Study showed that QuikRead CRP is useful tool in assessing dynamics of serum CRP in patient’s with acute odontogenic infection and postoperative complication. Rapid reduction in serum C–reactive protein levels was likely to occur following successful treatment of acute alveolar abscess.3
A study was conducted in 54 patients to monitor changes of CRP levels, to correlate its values with symptoms of different acute odontogenic infections and to monitor the effectiveness of applied therapy. Study concluded that CRP levels correlate well with the severity and resolution of odontogenic infection and could be used as reliable parameter in monitoring the effectiveness of applied therapy.4
A study was done on 20 patients with fascial space infection of odontogenic origin to assess the efficacy of serum CRP levels as monitoring tools for determining severity of infections, hospital stay and efficacy of treatment. Blood samples were taken on days 0, 4 and 8 for measuring serum levels of CRP. Study concluded that CRP can be effective marker for determining severity of infection.5
6.3 Objectives of the study:
To monitor changes of C–reactive protein (CRP) levels, to correlate its value with symptoms of different acute odontogenic infections, and to monitor the effectiveness of applied therapy.
MATERIALS AND METHODS :
7.1 SOURCE OF DATA:
Patients with odontogenic infection who are coming for the treatment in Department of Oral and Maxillofacial Surgery in Dr. Syamala Reddy Dental College, Hospital & Research Centre, Bangalore.
Patients, both male and female, in the age group of 17- 57 years, with odontogenic infection. Study object must be in a good mental and physical health.
Exclusion criteria –
Medically compromised patients.
Known mentally challenged patients and patients unable to communicate.
Pregnant patients and patient on oral contraceptives.
Patient on steroid therapy
A study will be conducted in patients with odontogenic infection. Patient’s blood sample will be collected. Level of serum CRP will be measured in VIMS hospital in 30 patients at the time of diagnosis and 1 week post operatively. Serum CRP will be measured by quantitative, microparticle - enhanced immunoturbidemetry.
Evaluation criteria -
Evaluation will be done by comparing preoperative and 1 week post operative CRP values.
7.3 Does the study require any investigation or interventions to be conducted on patients or other Humans or Animals? If so, please describe briefly: Yes, Radio graphical and hematological Assessment will be done. Intra Oral Periapical Radiograph (IOPAR) will be taken.
7.4. Has ethical clearance been obtained from your institution in case of 7.3?
List of References:
Boucher N. E., JR, Hanrahan J. J. and Kihara F. Y. Occurence of C-Reactive Protein in oral disease.( J DENT RES 1967 46: 624)
Ablij H. C., Meinders A. E. C-reactive protein: history and revival(European journal of Internal Medicine 13(2002)412-422)
Ren Y.F., Malmstrom H. S.Rapid quantitative determination of C – reactive protein at chair side in dental emergency patients.(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:49-55)
Drazic R, Jurisic M, Markovic A, Colic S, Gacic B, Stojcev-Stajcic L.[C-reactive protein as an inflammatory marker in monitoring therapy effectiveness of acute odontogenic infections.(Srp Arh Celok Lek 2011 Jul-Aug;139(7-8):446-45).
Sharma A,Gokkulakrishnan S, […], and Kumar V. Efficacy of CRP levels as monitoring tools for patients with fascial space infections of odontogenic origin: (A clinicobiochemical study.Natl J Maxillofacial Surg. 2012 Jul-Dec;3(2): 148-151).