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| LETTER |
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| Year : 2013 | Volume
: 5
| Issue : 4 | Page : 328-329 |
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Aspirin intake: Can be a confounding factor in clinical trial for periodontal disease
Ashish Agarwal
Department of Periodontology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| Date of Web Publication | 19-Oct-2013 |
Correspondence Address:
Ashish Agarwal
Department of Periodontology, Institute of Dental Sciences, Bareilly, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0975-7406.120072
How to cite this article:
Agarwal A. Aspirin intake: Can be a confounding factor in clinical trial for periodontal disease. J Pharm Bioall Sci 2013;5:328-9 |
Sir,
Bleeding indices are used for the screening of gingivitis and periodontitis, measuring disease prevalence, assessment of treatment effectiveness in clinical trial and monitoring disease progression. [1] The presence of bleeding on probing (BOP) is widely accepted as an objective sign of inflammation in gingival and periodontal tissues. [2] Although bleeding is caused by hyperaemic inflammatory events, other variables such as defective platelets function can also cause BOP. In this scenario, acquired platelets disorder is commonly caused by the use of aspirin and inflammatory drugs. [3] Beginning in 1988, Food and Drug Administration has repeatedly expanded the indication of aspirin used beyond pain relief to induce risk reduction for various cerebrovascular and cardiovascular diseases, rheumatoid arthritis, osteoarthritis, rheumatoid fever, and other inflammatory joint diseases. These benefits are derived from aspirin's antithrombotic and anti-inflammatory activity. Aspirin via cyclo-oxygenase pathway inhibits thromboxane, which are responsible for platelet aggregation for a period of 7-10 days. [3] This change in platelet aggregation could increase the chance of bleeding and BOP for that period of time. Thus, aspirin ingestion is considered as factor that has a potential to alter the appearance of bleeding in various bleeding indices. Schrodi et al. [4] investigated the antithrombotic effect of aspirin on BOP in patients with healthy periodontium. Their results demonstrated that 81 mg (low dose) and 325 mg (regular dose) aspirin did not effect on BOP of healthy individuals. However, aspirin intake of 325 mg daily for 7 days moderately increased the appearance of BOP in a population that had 20% BOP sites. Royzman et al. [5] observed that in naturally occurring gingivitis, low dose 81 mg and regular dose 325 mg aspirin showed statistically significant increase in the percentage of BOP. Thus, increase in BOP following aspirin ingestion would challenge the notion that bleeding is a necessary sign of inflammation. [2],[5] Failure of the clinicians to take into account aspirin use in patients undergoing periodontal treatment could lead to false positive results, which would lead to an improper diagnosis, treatment choice, and assessment of disease activity and progression. So aspirin intake is an important factor to be considered in the clinical trials as an inclusion/exclusion criterion for potential patient when the outcome of interest will be measured by BOP. This is especially pertinent since the daily use of aspirin now plays a major role in the prevention of myocardial infarction with long term use of low dose of it.
 References | |  |
| 1. | Armitage GC, Research, Science and Therapy Committee of the American Academy of Periodontology. Diagnosis of periodontal diseases. J Periodontol 2003;74:1237-47. 
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| 2. | Sundram E, Kharaharilal P, Ilavarasu S, Devi R, Nalini E, Karunamoorthy V. Evaluative comparison of systemic aspirin therapy effects on gingival bleeding in post non-surgical periodontal therapy individuals. J Pharm Bioallied Sci 2012;4:S221-5.
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| 3. | Capone ML, Tacconelli S, Sciulli MG, Grana M, Ricciotti E, Minuz P, et al. Clinical pharmacology of platelet, monocyte, and vascular cyclooxygenase inhibition by naproxen and low-dose aspirin in healthy subjects. Circulation 2004;109:1468-71.
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| 4. | Schrodi J, Recio L, Fiorellini J, Howell H, Goodson M, Karimbux N. The effect of aspirin on the periodontal parameter bleeding on probing. J Periodontol 2002;73:871-6.
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| 5. | Royzman D, Recio L, Badovinac RL, Fiorellini J, Goodson M, Howell H, et al. The effect of aspirin intake on bleeding on probing in patients with gingivitis. J Periodontol 2004;75:679-84.
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