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. 2022 May 13;22(1):177.
doi: 10.1186/s12903-022-02186-2.

Sex-related differences in endothelium-dependent vasodilation of human gingiva

János Vág  1 , Tamás László Nagy  2 , Barbara Mikecs  2
Affiliations

Sex-related differences in endothelium-dependent vasodilation of human gingiva

János Vág et al. BMC Oral Health. .

Abstract

Background: Sex hormones influence circulation, periodontitis, and wound healing. The aim of the study was to compare the endothelium-dependent and independent vasodilation in human gingiva in men and women.

Methods: Gingival blood flow was evaluated in twelve male and twelve female subjects with healthy gingiva and no systemic conditions after acetylcholine or nitric oxide donor (NitroPOHL). Agonists were administered into the gingival sulcus at the right secondary incisor (test site). Regional gingival blood flow (GBF) was imaged by Laser Speckle Contrast Imager from the marginal gingiva to the mucogingival junction in four consecutive regions (coronal, midway1, midway2 and apical). Blood flow was expressed in Laser Speckle Perfusion Unit (LSPU). The absolute maximal blood flow change (Dmax), the area under the blood flow curve (AUC), and the time to peak (TTP) were calculated.

Results: Males had higher baseline GBF than females (257 ± 18.2 vs. 225 ± 18.8 LSPU, p < 0.001). Acetylcholine and NitroPOHL significantly increased the GBF in all test regions. The Dmax after the acetylcholine was reduced apically compared to the coronal (90 ± 13 LSPU vs. 117 ± 7 LSPU, p < 0.01), but it was similar after NitroPOHL (78 ± 9 LSPU vs. 86 ± 6 LSPU, p = 0.398) in both sexes. The Dmax and AUC were higher, and the TTP was smaller in men in most regions after acetylcholine but not after NitroPOHL.

Conclusion: In the human gingiva, the endothelium-independent vasodilation propagates without attenuation in the line of the vascular supply in both sexes. At the same time, the endothelium-dependent ascending vasodilation attenuates similarly in men and women. However, men had more pronounced endothelium-dependent vasodilation than women. Therefore, it might contribute to the increased severity of periodontal disease in men.

Trial registration: The study was registered with ClinicalTrials.gov on 09.06.2021 (NCT04918563).

Keywords: Acetylcholine; Endothelium; Gingiva; Microcirculation; Nitric oxide; Sex.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Measurement setup. The patient's head is fixed with a vacuum pillow, and the lips are retracted with a cheek retractor (A). Silicon bite for stabilizing the jaws (left side), semi-circular wells on the labial surface of the upper right second incisor, and upper left first incisor. Coronal, Midway1, Midway2, Apical regions of interest (B)
Fig. 2
Fig. 2
Systolic, diastolic, mean blood pressure and pulse rate were recorded upon arrival of the patient, before LSCI, and after LSCI measurement. Each woman (red column) and man (blue column) visited the clinic twice (sessions), once for the acetylcholine and once for the NitroPOHL application. BP indicates blood pressure; MAP stands for mean arterial blood pressure. *above the columns indicates significant differences between women and men, *p < 0.05, ***p < 0.001. # in the columns indicates significant differences between the patient arrival and the before LSCI measurement (i.e., change during the resting period), # p < 0.05, ## p < 0.01, ### p < 0.001. & indicates significant differences in the blood flow measurement between the before and after LSCI measurement (i.e., change during the LSCI measurement), & p < 0.05
Fig. 3
Fig. 3
The comparison of baseline gingival blood flow (GBF) between sex groups at negative control, saline, and test site in different regions. GBF is expressed in the laser speckle perfusion unit (LSPU). The baseline GBF was not significantly different between agonists and sites. However, the GBF was gradually increased from coronal to apical. The men had higher baseline GBF than women in all sites and regions
Fig. 4
Fig. 4
The changes of gingival blood flow (GBF) at the negative control site in different regions over time. Negative control means no intervention was applied here. The change from the baseline was normalized to the saline site. Pairwise comparison between women and men revealed no significant difference at any time points
Fig. 5
Fig. 5
Blood flow changes from the baseline normalized to the saline site at different regions after acetylcholine or NitroPOHL administration in different regions. The black boxes indicate the duration of significant differences between sexes at least p < 0.05
Fig. 6
Fig. 6
The maximal change in gingival blood flow normalized to the saline site (Dmax) in the different regions after acetylcholine or NitroPOHL in women and men. * indicates significant differences between sexes, *p < 0.05, **p < 0.01
Fig. 7
Fig. 7
The time to reach the peak (TTP) in the different regions after acetylcholine or NitroPOHL in men and women. * indicates significant differences between sexes, p < 0.05
Fig. 8
Fig. 8
The area under the curve of blood flow changes (AUC) as a function of time normalized to the saline site in different regions after acetylcholine or NitroPOHL in men and women. * indicates significant differences between sexes, p < 0.05
Fig. 9
Fig. 9
Blood flow changes from the baseline normalized to the saline site in different regions after acetylcholine or NitroPOHL administration in different regions
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