Salivary Cortisone as a Potential Alternative to Cortisol in Periodontitis Severity Assessment

Salivary cortisol is widely used to investigate stress-periodontitis interactions, but its measurement is affected by methodological limitations. Cortisone, the predominant salivary glucocorticoid, may offer analytical advantages, yet its role in periodontitis remains unexplored. This study evaluated salivary cortisone in relation to periodontal disease severity and compared its performance with cortisol. Sixty-seven periodontitis patients were classified as Stage I/II (n = 32) or Stage III/IV (n = 35). A comprehensive periodontal examination was performed, including FMPS, FMBS, PPD, CAL, BoP, and the BL/Age ratio. Unstimulated morning saliva samples were analyzed for cortisone and cortisol using liquid chromatography-tandem mass spectrometry, and for IL-1β and IL-6 using ELISA. Both cortisone and cortisol levels were significantly higher in Stage III/IV periodontitis (p = 0.014). Cortisone correlated strongly with cortisol (ρ = 0.523, p < 0.001) and was positively associated with IL-6 (ρ = 0.322, p = 0.008) and multiple clinical indicators of periodontal disease severity. ROC analysis showed comparable discriminatory performance for cortisone and cortisol (AUC = 0.675), with cortisone demonstrating higher specificity (94%) for Stage III/IV periodontitis. Our findings suggest that salivary cortisone performs similarly to cortisol and warrants further investigation as an alternative salivary glucocorticoid marker in periodontal research.