The Difference Between Matrix Metalloproteinase-8 Levels and The Severity of Periodontal Disease in Children with Cerebral Palsy Receiving Anticonvulsant Monotherapy and Polytherapy: A Cross-Sectional Study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Children with cerebral palsy have increased periodontal risk because motor impairment limits oral hygiene and creates caregiver dependence. Long-term anticonvulsant use may affect periodontal inflammation and tissue remodelling. Matrix metalloproteinase-8 (MMP-8) in gingival crevicular fluid reflects collagen degradation. Objective This study aimed to analyse differences in gingival crevicular fluid MMP-8 levels and periodontal disease severity between children with cerebral palsy receiving anticonvulsant monotherapy and polytherapy. Methods This comparative analytical cross-sectional study was conducted at Yayasan Anak Bunda Istimewa and the RSP Eijkman laboratory, Bandung, from October to December 2025. Consecutive sampling enrolled children with physician-diagnosed cerebral palsy who received anticonvulsants, had periodontal disease, and whose parents provided consent. Noncooperative children were excluded. Sixty children aged 2–17 years were classified into monotherapy and polytherapy groups (n = 30 each). The minimum required sample was 25 per group. Six examiners, calibrated against a reference examiner (Friedman test, all p > 0.05), measured probing depth, clinical attachment loss, bleeding on probing, and periodontal disease severity using standardised procedures. Gingival crevicular fluid MMP-8 was quantified by enzyme-linked immunosorbent assay. Unadjusted comparisons used Mann–Whitney U, Fisher’s exact, and chi-square tests, with p < 0.05. No missing outcome data, subgroup analyses, or sensitivity analyses were reported. Results All 60 participants, comprising 24 boys and 36 girls, were analysed. Mean age was 8.73 years in the monotherapy group and 8.50 years in the polytherapy group. Mean treatment duration was 5.34 and 5.98 years, respectively. Median MMP-8 was higher with polytherapy (4.42 ng/mL, range 3.36–6.68) than with monotherapy (3.47 ng/mL, range 2.20–4.48; p < 0.001). Median probing-depth and clinical attachment-loss scores were 3 in both groups. Bleeding on probing affected 28 monotherapy and 24 polytherapy participants. The groups did not differ in probing depth (p = 0.503), clinical attachment loss (p = 0.114), bleeding on probing (p = 0.254), or overall periodontal disease severity (p = 0.368). Conclusions Anticonvulsant polytherapy was associated with higher gingival crevicular fluid MMP-8 levels, but this was not accompanied by a corresponding difference in clinical periodontal disease severity. The cross-sectional, single-site, unadjusted design, small sample, and uncontrolled confounders limit causal interpretation and generalisability. MMP-8 may complement, but should not replace, conventional clinical periodontal assessment.
Source: Research Square
Institution: Padjadjaran University
Language: English
Subfield: Periodontics
Field: Dentistry
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225337142