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QUANTITATIVE DETERMINATIONOF
SERUM C- REACTIVE PROTEIN
LEVELS IN PATIENTS WITH
ODONTOGENIC INFECTIONS
www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education

• CRP were discovered in 1930 by Tillett and
Francis.
• CRP is an Acute-Phase Serum Protein.
• Member of the Pentraxin Protein family.
• Identified in serum of Patients with Pneumonia
that reacted with the cell wall Polysaccharide.

• CRP augments the
Immune response to certain antigens.
Activates Complement.
Monocytic production of tissue factors.
• CRP levels are 1000-fold in response to
Inflammatory,
Infectious,
Neoplastic diseases.

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• www.indiandentalacademy.com
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STRUCTURE

Purpose of the Study
To measure the serum CRP levels and
its significance in monitoring prognosis
of Odontogenic infections.

• 30 patients with Periapical infections & 30 Pts with
Periodontal infections were randomly selected from
OPD.
• Blood samples were taken from these patients in
vials with EDTA.
• Collected Samples were sent for Lab analysis of CRP
levels using Immunoturbidimetry.
• CRP levels were again evaluated for the same
patients after appropriate treatment.
METHODOLOGY

Immunoturbidimetry

INCLUSION CRITERIA
Periapical infections included
Chronic Apical Periodontitis (CAP)
Acute Periapical Abscess (APA)
Chronic Periapical Abscess (CPA)
Dento Alveolar Abscess (DAA)
Ludwig's Angina (LA)

Periodontal infections included
Chronic Generalized Gingivitis (CGG)
Chronic Generalized Periodontitis (CGP)
Pericoronitis (PC)
Pericoronal Abscess (PA)
Acute Periodontal Abscess (APA)
Chronic Periodontal Abscess (CPA)

Exclusion Criteria
• Non-Odontogenic Infections
• Patients on antibiotic therapy
• Patients on Immuno Suppressants
• Immune Mediated Diseases
• Immuno Compromised Patients.
• Neoplasms
• Other Inflammatory conditions

PERIAPICAL INFECTION PATIENTS
GENDER
0
2
4
6
8
10
12
14
16
Female Male
15 15

AGE
0
2
4
6
8
10
12
14
16
18
20
<40 >40
19
11

CRP Levels
0
0.5
1
1.5
2
2.5
3
3.5
4
CAP CPA APA DAA LA
Post Treatment
Pre Treatment

t- Test Paired
0
0.0002
0.0004
0.0006
0.0008
0.001
0.0012
CAP APA CPA DAA
< 0.05 - Significant

GENDER
PERIODONTAL INFECTION PATIENTS
0
2
4
6
8
10
12
14
16
18
Female Male
12
18

AGE
0
2
4
6
8
10
12
14
16
<40 >40
15 15

CRP Levels
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
CGG CGP CPA APA PC PA
Post Treatment
Pre Treatment

t- Test Paired
0
0.001
0.002
0.003
0.004
0.005
0.006
0.007
0.008
0.009
CGP CPA CGG PC PA APA
< 0.05 - Significant

SUMMARY OF RESULTS
• In the present study, the CRP levels were
analyzed for Odontogenic infections and
the results showed high levels of CRP in all
cases with marked elevated levels in
Ludwig’s Angina and Pericoronal Abscess.
• However, with appropriate treatment the
patients CRP levels showed immediate
normal levels in all cases.

OVERVIEW

• CRP is Primarily Synthesized as a monomer in
the Endoplasmic Reticulum (ER) of the Liver.
• In the resting state, CRP is retained in the ER
of Hepatocytes.
• Major stimuli that induce CRP synthesis
include IL-6 & IL-1.

• Any infectious stimulation causes ↓ in binding of
CRP to these sites thereby ↑ CRP levels in blood
ranging from 1 to 600 μg/mL.
• CRP significantly within 4-6 hrs, peak in 24-28 hrs
after the acute infection of tissue injury occurs, and
falls rapidly after the inflammation resolves.
• Making it a useful marker to follow clinical disease
course and response to treatment.

• Rapid raise and fall of CRP with the
inflammatory process makes it a much more
sensitive indicator of inflammation than ESR
and WBC count.
• The half life of CRP in the circulation is not
significantly influenced by age and gender.

CRP is Elevated
• Cancer
• Connective tissue disease
• MI
• Infection
• Inflammatory bowel disease (IBD)
• Lupus
• Pneumococcal Pneumonia
• Rheumatoid arthritis
• Osteomyelitis
• Last half of pregnancy
• Oral contraceptives.

• Many patients with Pericoronal infections of
3rd molar area may be Asymptomatic.
• IL-1 & PGE were found to be in pts with
Asymptomatic 3rd molars, indicating presence
of occult infections.
• Such occult infections which are difficult to
detect clinically in the 3rd molar area constitute
a risk for the development of post operative
complications.

• Preoperative CRP testing may have the
potential to identify such patients with risk of
Post operative infections
• Provide guidance for the use of preventive
therapeutics.

• High CRP levels were found in Odontogenic
infections that require intensive care.
• Significant elevation of CRP is associated with
infections secondary to fracture & 3rd molar
surgeries.
• CRP levels in inflammed dental Pulp were
elevated in comparison to those with no
inflammation.

Determination CRP levels used for
• Monitoring Postoperative infections.
• Monitoring Antimicrobial efficacy.
• May be useful tool in monitoring the recovery
process after 3rd molar surgery.
• Identifying patients who need Antibiotic therapy.

Conclusion
This study shows conclusively that CRP levels are
elevated in both Periapical and Periodontal infections.
However CRP levels show marked elevation in
conditions like
MI & Atherosclerosis.
Proper identification of these Odontogenic infections
and their elimination by appropriate antimicrobial
therapy leads to lowering of the CRP levels in these
patients. This will help to improve the overall health of
these patients.
“Thus improvement of Oral Health will
contribute to Overall Health of the Patients.”www.indiandentalacademy.com

REFERENCES
• Ioannidou, E., et al (2006) Effect of periodontal treatment on serum
C-reactive protein levels: a systematic review and meta-analysis.
Journal of Periodontology 77, 1635–1642.
• Koenig, W. (2005) Predicting risk and treatment benefit in
atherosclerosis: the role of C-reactive protein.
International Journal of Cardiology 98, 199–206.
• Loos, B. G. (2005) Systemic markers of inflammation in
periodontitis.
Journal of Periodontology 76 (Suppl. 11), 2106–2115.
• Noack, B., Genco, R. J., Trevisan, M., Grossi, S., Zambon, J. J. &
De Nardin, E. (2001) Periodontal infections contribute to elevated
systemic C-reactive protein level.
Journal of Periodontology 72, 1221–1227.

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