Estimation of Salivary Advanced Glycation End Products in Polycystic Ovarian Syndrome Patients with and without Chronic Periodontitis: A Cross-sectional Study

Introduction: Polycystic Ovarian Syndrome (PCOS), formerly known as Stein-Leventhal syndrome, is a common hormonal disorder associated with chronic low-grade inflammation, oxidative burden and insulin resistance. Many studies have reported that PCOS negatively impacts periodontal health, resulting in the worsening of chronic periodontitis. Chronic periodontitis, an inflammatory condition, is one of the most prevalent oral diseases affecting the supporting tissues of the teeth. Oxidative burden plays a crucial role in the pathophysiology of both conditions. Aim: To evaluate and compare the salivary levels of Advanced Glycation End products (AGEs), which are markers of oxidative stress, in patients with PCOS, both with and without chronic periodontitis. Materials and Methods: A cross-sectional study was conducted at the Department of Periodontology, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India between July 2023 and January 2024, with 48 women aged 18-35 years, divided into four groups: healthy controls (H+H), systemically healthy with periodontitis (H+P), PCOS with a healthy periodontium (PCOS+H) and PCOS with periodontitis (PCOS+P). Periodontal clinical parameters, including Oral Hygiene Index Simplified (OHI-S), Probing Pocket Depth (PPD), Clinical Attachment Loss (CAL), Bleeding On Probing (BOP) and Periodontal Inflamed Surface Area (PISA), were recorded. Salivary AGEs levels were measured using an Enzyme-linked Immunoassay (ELISA) kit. Statistical analyses were performed using IBM Statistical Package for Social Sciences (SPSS) software. Results: The PCOS+P group exhibited the highest levels of salivary AGEs (72.28±4.76 pg/mL) and clinical parameters, followed by the H+P (63.46±9.87 pg/mL) and PCOS+H (62.87±6.91 pg/mL) groups. A significant correlation was observed between the PISA scores and AGE levels for all groups, with a moderately positive correlation for the PCOS+H group (r=0.765, p<0.01). There was no significant difference (p=1.000) in AGE levels between the H+P and PCOS+H groups, suggesting independent contributions of each condition to systemic AGE levels. Conclusion: Salivary AGE levels were markedly elevated in patients with both PCOS and chronic periodontitis, suggesting a synergistic effect. The present study also highlights that PCOS and periodontitis independently contribute to oxidative stress, even in the absence of the other. These findings support the use of salivary AGEs as potential biomarkers of periodontal inflammation in patients with PCOS.