Association of Mast Cell Density with the Severity Stages of Human Periodontal Disease

Periodontal disease is a chronic inflammatory condition characterized by progressive destruction of the supporting structures of the teeth. Immune cells, particularly mast cells, are known to play a critical role in modulating inflammation and tissue degradation. Evaluating mast cell distribution across varying stages of periodontal disease may provide insights into their pathological relevance.

The aim of this study was to assess the association between mast cell density and the severity stages of human periodontal disease by quantitatively and qualitatively analyzing mast cells in gingival tissues from healthy individuals, gingivitis patients, and those with localized chronic periodontitis (LCP).

This cross-sectional observational study included 60 participants categorized into three groups based on the American Academy of Periodontology criteria: healthy controls, patients with dental plaque-induced gingivitis (DPIG), and those with LCP. Gingival tissue samples were collected during routine dental surgeries and stained with toluidine blue to identify mast cells. Mast cell density was measured in 10 representative fields per section using an oculometer grid under ×40. The results were expressed as mean ± standard deviation per mm 2 . Statistical analysis was conducted using the Statistical Package for the Social Sciences version 26.0, with one-way analysis of variance and Tukey's posthoc test to determine significance ( P < 0.05).

Mast cell density showed a statistically significant increase from healthy gingiva (3.45 ± 0.60/mm 2 ) to DPIG (8.85 ± 1.10/mm 2 ) and was highest in LCP (14.60 ± 1.85/mm 2 ) ( P < 0.001). A qualitative shift was also observed, with intact mast cells predominant in controls (92.45%) and degranulated mast cells significantly elevated in LCP (61.75%). Clinical parameters such as plaque index, gingival index, probing depth, and attachment loss were positively correlated with mast cell count. Observer agreement was high, with intraobserver intraclass correlation coefficient (ICC) at 0.952 and interobserver ICC at 0.894.

Mast cell density and degranulation increase significantly with the severity of periodontal disease, indicating their contributory role in periodontal inflammation and tissue destruction. These findings support the potential of mast cells as diagnostic markers and therapeutic targets in periodontal disease management.