Periodontal disease related to diabetic status. A pilot study of the response to periodontal therapy in type 1 diabetes

The effect of antimicrobial photodynamic therapy adjunct to non-surgical periodontal therapy on the treatment of periodontitis in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

The purpose of the present systematic review and meta-analysis was to assess the impact of antimicrobial photodynamic therapy adjunct to non-surgical periodontal treatment on individuals with type 2 diabetes mellitus.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were carried out in six databases without restriction regarding publication year. Studies comparing periodontal clinical parameters among individuals submitted to non-surgical periodontal therapy associated with antimicrobial photodynamic therapy and a control group of individuals submitted to only non-surgical periodontal treatment were included. Study selection, data extraction, and risk of bias assessment (RoB 2.0) were performed by two review authors. Meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided.

RESULTS

Two hundred and five studies were identified and 11 studies were included. The meta-analysis demonstrated that antimicrobial photodynamic therapy adjunctive to periodontal therapy, in individuals with diabetes, resulted in a greater reduction of bleeding on probing at 6 months and in probing depth at 3 and 6 months in comparison to periodontal treatment alone (p<0.05). The included studies exhibited low risk of bias.

CONCLUSION

Antimicrobial photodynamic therapy adjunct to periodontal therapy contributes to the improvement of periodontal clinical parameter bleeding on probing and probing depth in individuals with type 2 diabetes mellitus.

Involvement of Periodontal Disease in the Pathogenesis and Exacerbation of Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis: A Review

The increasing incidence of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), along with global lifestyle changes, requires further in-depth research to elucidate the mechanisms and develop new treatment strategies. In addition, the number of patients with periodontal disease has increased recently, suggesting that periodontal disease is sometimes associated with systemic conditions. In this review, we summarize recent studies linking periodontal disease and NAFLD, the concept of the mouth-gut-liver axis, oral and intestinal microbiota, and liver disease. We suggest new research directions toward a detailed mechanistic understanding and novel targets for treatment and prevention. Forty years have passed since the concepts of NAFLD and NASH were first proposed. however, no effective prevention or treatment has been established. We also found that the pathogenesis of NAFLD/NASH is not limited to liver-related diseases but has been reported to be associated with various systemic diseases and an increasing number of causes of death. In addition, changes in the intestinal microbiota have been shown to be a risk factor for periodontal diseases, such as atherosclerosis, diabetes, rheumatoid arthritis, nonalcoholic fatty liver disease, and obesity.

Periodontitis and implant complications in diabetes

Epidemiologic evidence indicates that periodontitis is more frequent in patients with uncontrolled diabetes mellitus than in healthy controls, suggesting that it could be considered the "sixth complication" of diabetes. Actually, diabetes mellitus and periodontitis are two extraordinarily prevalent chronic diseases that share a number of comorbidities all converging toward an increased risk of cardiovascular disease. Periodontal treatment has recently been shown to have the potential to improve the metabolic control of diabetes, although long-term studies are lacking. Uncontrolled diabetes also seems to affect the response to periodontal treatment, as well as the risk to develop peri-implant diseases. Mechanisms of associations between diabetes mellitus and periodontal disease include the release of advanced glycation end products as a result of hyperglycemia and a range of shared predisposing factors of genetic, microbial, and lifestyle nature. This review discusses the evidence for the risk of periodontal and peri-implant disease in diabetic patients and the potential role of the dental professional in the diabetes-periodontal interface.

A Tale of Two Fimbriae: How Invasion of Dendritic Cells by Porphyromonas gingivalis Disrupts DC Maturation and Depolarizes the T-Cell-Mediated Immune Response

Porphyromonas gingivalis (P. gingivalis) is a unique pathogen implicated in severe forms of periodontitis (PD), a disease that affects around 50% of the US population. P. gingivalis is equipped with a plethora of virulence factors that it uses to exploit its environment and survive. These include distinct fimbrial adhesins that enable it to bind to other microbes, colonize inflamed tissues, acquire nutrients, and invade cells of the stroma and immune system. Most notable for this review is its ability to invade dendritic cells (DCs), which bridge the innate and adaptive immune systems. This invasion process is tightly linked to the bridging functions of resultant DCs, in that it can disable (or stimulate) the maturation function of DCs and cytokines that are secreted. Maturation molecules (e.g., MHCII, CD80/CD86, CD40) and inflammatory cytokines (e.g., IL-1b, TNFa, IL-6) are essential signals for antigen presentation and for proliferation of effector T-cells such as Th17 cells. In this regard, the ability of P. gingivalis to coordinately regulate its expression of major (fimA) and minor (mfa-1) fimbriae under different environmental influences becomes highly relevant. This review will, therefore, focus on the immunoregulatory role of P. gingivalis fimbriae in the invasion of DCs, intracellular signaling, and functional outcomes such as alveolar bone loss and immune senescence.

Low Intensity Extracorporeal Shock Wave Therapy as a Novel Treatment for Stress Urinary Incontinence: A Randomized-Controlled Clinical Study

Background and Objectives: To evaluate the effects of low intensity extracorporeal shock wave therapy (LiESWT) on stress urinary incontinence (SUI). Materials and Methods: This investigation was a multicenter, single-blind, randomized-controlled trial study. Sixty female SUI patients were randomly assigned to receive LiESWT with 0.25 mJ/mm² intensity, 3000 pulses, and 3 pulses/s, once weekly for a 4-week (W4) and 8-week (W8) period, or an identical sham LiESWT treatment without energy transmission. The primary endpoint was the changes in urine leakage as measured by a pad test and validated standardized questionnaires, while the secondary endpoint was the changes in a 3-day urinary diary among the baseline (W0), the W4 and W8 of LiESWT, and 1-month (F1), 3-month (F3), and 6-month (F6) follow-up after LiESWT. Results: The results showed that 4 weeks of LiESWT could significantly decrease urine leakage based on the pad test and validated standardized questionnaire scores, as compared to the sham group. Moreover, 8 weeks of LiESWT could significantly reduce urine leakage but increase urine volume and attenuate urgency symptoms, which showed meaningful and persistent improvement at W8, F1, F3, and F6. Furthermore, validated standardized questionnaire scores were significantly improved at W8, F1, F3, and F6 as compared to the baseline (W0). Conclusions: Eight weeks of LiESWT attenuated SUI symptoms upon physical activity, reduced urine leakage, and ameliorated overactive bladder symptoms, which implied that LiESWT significantly improved the quality of life. Our findings suggested that LiESWT could serve as a potentially novel and non-invasive treatment for SUI.

Oral Health Knowledge and Habits of People With Type 1 and Type 2 Diabetes

Objectives

This study aimed to collect information about oral health knowledge and the habits of people living with diabetes (PwD), primarily type 1 diabetes, using the newly developed World Health Organisation Oral Health Questionnaire for Adults (Annex 7).

Materials and methods

Comparable and reliable questionnaires, comprising 23 questions for PwD, were sent to diabetes social media groups, mailing lists, and associations. The survey explored the relationships amongst demographic factors, age, dental education, eating habits, and other factors.

Results

The 23-question survey was answered by 307 individuals from 60 different countries. Alcohol and tobacco use, dental anxiety, and bad habits were often reported. Of the participants, 61.2% (n = 188) had at least 1 drink during the past 30 days. Of the participants, 22.8% (n = 70) were smokers. In total, 80.8% (n = 248) of the participants consumed biscuits, 76.2% (n = 234) consumed sweets, and 63.2% (n = 194) consumed soft drinks regularly. A total of 26.4% (n = 81) of the participants reported being afraid of dental treatment. Of the participants, 48.5% (n = 149) reported dry mouth and other oral complications. The frequency of visits to the dentist was satisfactory. A total of 71.3% (n = 219) of the participants reported visiting a dentist during the past 12 months.

Conclusions

There is a need for proper oral health education for PwD. Trained diabetes advocates could be core messengers. However, interdisciplinary cooperation is mandatory for both education and the clinical aspect of diabetes care. For example, diabetes nurses need to be educated with the help of dentists or oral hygienists.

Low Intensity Extracorporeal Shock Wave Therapy as a Potential Treatment for Overactive Bladder Syndrome

Simple Summary

Overactive bladder (OAB) is a common urologic condition with urinary frequency, urinary urgency, nocturia, and urgency incontinence, which can get in the way of a patient’s social life, exercise, work, and sleep. Exploring a promising option for OAB patients is very important, especially one with less side effects or invasive alternations. This study uses low intensity extracorporeal shock wave therapy (LiESWT) to investigate the therapeutic effect and duration on OAB symptoms.

Abstract

Background: The present study attempted to investigate the therapeutic effect and duration of low intensity extracorporeal shock wave therapy (LiESWT) on overactive bladder (OAB) symptoms, including social activity and the quality of life (QoL). Methods: In this prospective, randomized, single-blinded clinical trial, 65 participants with OAB symptom were randomly divided into receive LiESWT (0.25 mJ/mm², 3000 pulses, 3 pulses/second) once a week for 8 weeks, or an identical sham LiESWT treatment without the energy transmission. We analyzed the difference in overactive bladder symptom score (OABSS) and 3-day urinary diary as the primary end. The secondary endpoint consisted of the change in uroflowmetry, post-voided residual (PVR) urine, and validated standardized questionnaires at the baseline (W0), 4-week (W4) and 8-week (W8) of LiESWT, and 1-month (F1), 3-month (F3) and 6-month (F6) follow-up after LiESWT. Results: 8-week LiESWT could significantly decrease urinary frequency, nocturia, urgency, and PVR volume, but meaningfully increase functional bladder capacity, average voided volume and maximal flow rate (Qmax) as compared with the W0 in the LiESWT group. In addition, the scores calculated from questionnaires were meaningfully reduced at W4, W8, F1, F3, and F6 in the LiESWT group. Conclusions: Our results revealed that the therapeutic efficacy of LiESWT could improve voided volume and ameliorate OAB symptoms, such as urgency, frequency, nocturia, and urinary incontinence, and lasted up to 6 month of follow-up. Moreover, LiESWT treatment brought statistically significant and clinically meaningful improvements in social activity and QoL of patients. These findings suggested that LiESWT could serve as an alternative non-invasive therapy for OAB patients.

The association between diabetic retinopathy and periodontal disease

PURPOSE:

The purpose of the study was to study the association between diabetic retinopathy (DR) and periodontal disease (PD) in a South Indian cohort.

METHODS:

This was a cross-sectional, observational, interdisciplinary hospital-based study wherein patients with diabetes mellitus visiting the ophthalmology department of a university teaching hospital in coastal Karnataka, south India, during the study period, were screened independently for retinopathy by an ophthalmologist and PD by a periodontal surgeon. All the patients were above 18 years of age and did not have juvenile or gestational diabetes. A total of 213 patients consented to participate in the study. The data were analyzed for association using the Chi-square test.

RESULTS:

There was a statistically significant association between the presence of DR and PD (P = 0.02). The increasing severity of DR was associated with an increase in the components of PD including plaque index (P < 0.001) and gingival index (P < 0.001).

CONCLUSION:

There is a significant association between DR and PD. The awareness of this association can aid in the screening of potentially sight-threatening retinopathy in diabetics presenting to the dental clinic with PD.

Significant aspects and correlation between glycemic control and generalized chronic periodontitis in type 2 diabetes mellitus patients

The purpose of this research was to assess the correlation between glycemic control and clinical periodontal characteristics in type 2 diabetics with generalized chronic periodontitis. A total of 182 patients with type 2 diabetes mellitus and generalized chronic periodontitis were included in our study. The clinical examination included full-mouth plaque accumulation, bleeding on probing (BoP), probing depth (PD), presence of suppuration (SUP), clinical attachment level (CAL) and number of remaining teeth. Blood analyses were conducted for glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG). The correlation between the extent of periodontitis, defined as the percentage of PD and CAL sites ≥5 mm, and glycemic control was also analyzed. In addition, clinical parameters were compared between two (<7 and ≥7%) glycemic subsets. The frequency of uncontrolled diabetic subjects (HbA1c ≥7%) was higher than that of the well-controlled subjects (HbA1c <7%), 57.15 vs. 42.85%. Among the clinical parameters evaluated, mean full-mouth plaque accumulation was significantly higher among patients without glucose control (74.2±25.2 vs. 62.5±28.7%, P<0.01), as well as mean PD (3.78±0.9 vs. 3.42±0.8 mm, P<0.01) and mean CAL (4.5±1.2 vs. 4.1±1.2 mm, P=0.02). The sites with PD ≥5 mm were statistically more prevalent among patients with HbA1c ≥7% compared with patients with HbA1c <7% (27.8±6.2 vs. 23.4±5.8%, P<0.01). The mean number of remaining teeth was statistically significantly lower in patients with HbA1c ≥7% compared with patients with HbA1c <7% (18.5±3.2 vs. 20.4±4.1, P<0.01). In conclusion, the severity and extension of generalized chronic periodontitis was higher in type 2 diabetes mellitus patients with poor glucose control compared with those with good glucose control.

Periodontal regenerative therapy in patients with type 2 diabetes using minimally invasive surgical technique with enamel matrix derivative under 3-year observation: A prospective cohort study

BACKGROUND

Information regarding periodontal regenerative therapy in patients with diabetes mellitus (DM) is limited. This pilot study compared the regenerative outcomes of minimally invasive periodontal surgery using enamel matrix derivative (EMD) between DM and non-DM patients.

METHODS

This prospective study included deep intrabony defects in patients with or without type 2 DM. Minimally invasive surgical technique (MIST) or modified MIST (M-MIST) using EMD, without bone graft materials, was performed. Periodontal examination and intraoral radiography were performed at baseline, 6 months, and 1 and 3 years after surgery.

RESULTS

Ten sites of 10 subjects in the DM group, and 20 sites of 18 subjects in non-DM group were evaluated (mean age; 67.5 ± 7.6 and 63.1 ± 9.7, respectively). Probing depth significantly decreased from 7.1 ± 1.6 and 7.0 ± 1.3 mm to 2.2 ± 0.9 and 2.3 ± 1.1 mm at the 1-year examination in the DM and non-DM groups, respectively. Clinical attachment level (CAL) gain and radiographical defect fill at the 3-year examination were 3.8 ± 1.1 mm and 58.3% ± 10.4%, respectively, in the DM group, and 4.1 ± 1.1 mm and 65.5% ± 18.8%, respectively, in the non-DM group, showing no significant differences between the groups. Multiple regression analysis showed no significant association of CAL gain with DM or age after adjustments for relevant confounders.

CONCLUSIONS

This is the first documented study of successful periodontal tissue regeneration in patients with DM. Minimally invasive surgery combined with EMD yielded significant clinical attachment gain and bone fill in the DM and non-DM groups at comparable levels.

The Effect of Phase I Therapy on the Clinical Parameters, VSC Levels, and RBS Levels in Chronic Periodontitis Patients With Diagnosed Diabetes

Introduction:

The relationship between chronic periodontitis and type 2 diabetes mellitus (DM) is bidirectional. Halitosis or oral malodor has an effect on psychological and social life of persons, and is seen in individuals with diabetes.

Aims and Objectives:

The aim of this study was to find out the effect of phase I therapy on the clinical parameters, volatile sulfur compound (VSC) levels, and random blood sugar (RBS) levels in chronic periodontitis patients with diagnosed DM.

Materials and Methods:

Our study included 80 patients with diabetes and chronic periodontitis. We collected subgingival plaque samples at 1 week and 1 month after scaling and root planing. The parameters measured were probing pocket depth and clinical attachment level for all the teeth at four sites per each tooth. RBS levels were recorded for all the patients. Malodor was measured with Tanita Breath Checker (Tanita India Private Limited, Mumbai, Maharashtra, India).

Results:

We found a statistically significant reduction in clinical parameter levels, VSC levels, and N-benzoyl-DL-arginine-2-naphthylamide (BANA) levels in both the groups from baseline to 4 weeks with highest levels in diabetic chronic generalized periodontitis (CGP) and lowest in nondiabetic CGP at baseline. The mean intergroup comparison of BANA levels was statistically significant at all intervals of time between the two the groups.

Conclusion:

There is a significant correlation observed between oral malodor levels, RBS, and clinical parameters in the diabetic group.

Massive data analyses show negative impact of type 1 and 2 diabetes on the outcome of periodontal treatment

Objectives

The aim was to evaluate the impact of diabetes on the outcome of periodontal treatment based on massive data analyses.

Materials and methods

Data originated from the database of a major German National Health Insurance. Patients who underwent periodontal treatment were allocated to four groups according to their medical condition: type 1 diabetes (D1), type 2 diabetes with the intake of oral anti-diabetics (D2M), type 2 diabetes without the intake of oral anti-diabetics (D2), and a control group without diabetes (ND). Four-year Kaplan-Meier survival analyses on the patient level and multivariate regression analyses were conducted for tooth extraction.

Results

Of 415,718 patients, 4139 matched the criteria for D1, 22,430 for D2M, and 23,576 for D2. At 4 years, the cumulative survival rate (no extraction) was 51.7% in the D1 group, 54.0% in the D2M group, and 57.7% in the D2 group. The ND control group had a significantly higher survival rate of 65.9% (P < 0.0001). In the multivariate analyses, both diabetes types were significantly associated with further tooth loss after periodontal treatment.

Conclusions

The diagnosis of diabetes type 1 or 2 seems to be associated with a higher risk of tooth loss after periodontal treatment.

Clinical relevance

The long-term prognosis of teeth in diabetes patients should be judged carefully.

Adjunctive antimicrobial photodynamic therapy using methylene blue/ethanol formulation in experimental periodontitis in diabetic rats: short-term results

The aim of this study was to evaluate the effect of an MB experimental formulation (ethanol 20%) in aPDT used as an adjuvant to scaling and root planing (SRP) in the periodontal treatment of diabetic rats. Forty male Wistar rats received streptozotocin-intraperitonial injections to induce diabetes. After 14 days, 5 animals were allocated in the non-ligate group (NLG), and 35 animals received ligature at the first right mandibular molar to induce periodontitis. After 7 days, the ligature was removed and the animals were randomized into 4 groups: LG (without treatment, n = 5), SRPG (SRP, n = 10), aPDTW (SRP+aPDT-MB/water, n = 10), and aPDTEt (SRP + aPDT-MB/water/ethanol/carboxymethylcellulose, n = 10). Animals were euthanized after 7 days. Data of bone loss (BL) area, degree of inflammatory cell response, and collagen fibers percentages were statistically analyzed (p < 0.05). Percentage of animals that presented mild and severe inflammatory infiltrate was 10% and 40% for SRPG, 20% and 30% for aPDTW, and 50% and 0% for aPDTEt, respectively. BL area (mm²) was statistically higher in the LG (0.39 ± 0.15) than NLG (0.05 ± 0.02). aPDTEt showed the lowest value of BL (0.08 ± 0.03), followed by aPDTW (0.21 ± 0.15) and SRPG (0.31 ± 0.18). Statistical differences were verified between aPDTEt and SRPG. In relation to the LG, aPDTEt, aPDTW, and SRPG recovered the equivalent 80%, 46%, and 20% of the BL. aPDTEt showed collagen content statistically higher than SRPG and LG, and presented higher mean values than NLG (p > 0.05). Our findings showed aPDTEt presented promising results. aPDT using MB/ethanol can have potential as an adjunctive periodontal treatment in diabetics.

Diabetes mellitus and periodontal disease: awareness and practice among doctors working in public general out-patient clinics in Kowloon West Cluster of Hong Kong

BACKGROUND

Diabetes mellitus (DM) and periodontitis are very common and they interact with each other bidirectionally. This survey studied public primary care doctors on their awareness of this bidirectional relationship and their corresponding practice.

METHODS

All Family Medicine doctors in Kowloon West Cluster, Hospital Authority were invited to a cross-sectional questionnaire survey. Results were analyzed statistically.

RESULTS

One hundred sixty-eight questionnaires were sent out, 143 were returned (response rate 85.1%). One hundred forty valid questionnaires were analyzed. Ninety-two percent of participants were aware of a relationship between DM and periodontal disease and this awareness was not associated with their years of experience, training status and personal oral health behavior. Ninety percent knew the effect of poor DM control on periodontal disease but only 76% were aware of the reverse effect of periodontal disease on DM. The difference was statistically significant (p = 0.002, Related-samples Sign Test). In clinical practice on DM patients, only 5.7% asked dental history often (defined as 50% patients or above), 7.1% examined their mouths often and 12.1% recommended them to see dentist often. Logistic regression showed that awareness factors had no association with periodontology related clinical practice whereas clinical experience, being a Family Medicine specialist and personal interdental cleaning habit were linked with more positive practice.

CONCLUSIONS

A high proportion of doctors in the study were aware of the relationship between DM and periodontal disease. However, this did not appear to influence their practice. Further measures among doctors and patients to promote comprehensive management of DM and periodontal disease should be explored.

Periodontal regenerative effect of enamel matrix derivative in diabetes

The present study aimed to investigate the periodontal regenerative effect of enamel matrix derivative (EMD) in diabetes. Thirty-six rats were assigned to streptozotocin-induced diabetes or control (non-diabetic) groups. Three-wall intrabony defects were surgically generated in the bilateral maxilla molar, followed by application of EMD or saline. Primary wound closure and defect fill were evaluated via histomorphological analysis and micro-computed tomography. mRNA expression levels of inflammatory and angiogenic factors in the defects were quantified via real-time polymerase chain reaction. Gingival fibroblasts were isolated from control animals and cultured in high-glucose (HG) or control medium. The effects of EMD on insulin resistance and PI3K/Akt/VEGF signaling were evaluated. The achievement rate of primary closure and the parameters of defect fill were significantly higher at EMD-treated site than at EMD-untreated sites in both diabetic and non-diabetic rats, although defect fill in the diabetic groups was significantly lower in the control groups on two-way repeated-measures analysis of variance (for both, p<0.05). Newly formed bone and cementum were significantly increased at EMD-treated sites in diabetic rats than at EMD-untreated sites in control rats (for both, p<0.05). Vegf was significantly upregulated at EMD-treated sites in both diabetic and non-diabetic rats (for both, p<0.05). In vitro, insulin or EMD-induced Akt phosphorylation was significantly lower in cells cultured in HG medium (p<0.05). EMD-mediated Vegf upregulation was suppressed by the Akt inhibitor wortmannin, although the effect was significantly lower in HG medium (p<0.01). In conclusion, EMD might promote periodontal tissue regeneration via Akt/VEGF signaling, even in a diabetic condition.

Nonsurgical and surgical treatment of periodontitis: how many options for one disease?

Treatment of periodontitis aims at preventing further disease progression with the intentions to reduce the risk of tooth loss, minimize symptoms and perception of the disease, possibly restore lost periodontal tissue and provide information on maintaining a healthy periodontium. Therapeutic intervention includes introduction of techniques to change behavior, such as: individually tailored oral-hygiene instructions; a smoking-cessation program; dietary adjustment; subgingival instrumentation to remove plaque and calculus; local and systemic pharmacotherapy; and various types of surgery. No single treatment option has shown superiority, and virtually all types of mechanical periodontal treatment benefit from adjunctive antimicrobial chemotherapy. Periodontal treatment, because of the chronic nature of periodontitis, is a lifelong commitment to intricate oral-hygiene techniques, which, when properly implemented, will minimize the risk of disease initiation and progression.

Does the adjunctive use of statins provide additional benefits to nonsurgical periodontal treatment? A systematic review and meta-analysis

Adjunctive therapeutic agents may be used to improve the response to nonsurgical periodontal therapy. Local delivery of statins (simvastatin, artovastatin and rosuvastatin) is a promising adjunct to scaling and root planing (SRP). Thus, the aim of this review is to evaluate if adjunctive local delivery of statins is more effective than SRP alone. Randomized clinical trials that presented a test group evaluating local delivery of statins as adjuncts in healthy, diabetic and smoking patients were included. Medline and the Cochrane library database were searched up to November 2016. Random effects meta-analyses were conducted for pocket depth change and clinical attachment gain. One hundred and twenty-five studies potentially related to the aim of this review were screened, but only 10 were included. The majority of the trials reported additional clinical benefits in the groups that were treated with adjunctive local delivery of statins. Pooled calculations showed that local delivery of statins resulted in additional reduction of pocket depth and clinical attachment gain in healthy people, smokers and diabetic patients. Local statins may offer additional clinical benefits to SRP, even in smokers and diabetics.

Nonsurgical periodontal-therapy improves glycosylated hemoglobin levels in pre-diabetic patients with chronic periodontitis

AIM

To evaluate the effect of nonsurgical periodontal therapy on glycosylated haemoglobin levels in pre-diabetic patients with chronic periodontitis (CHP).

METHODS

Sixty pre-diabetic patients with CHP were selected and equally allocated to case and control group. All subjects were evaluated at base line for periodontal parameters (plaque index, oral hygiene index, modified gingival index, probing pocket depth, clinical attachment level) and systemic parameters [glycosylated hemoglobin (HbA1c), fasting lipid profile, and fasting blood glucose]. The case group received non-surgical periodontal therapy. Subjects were re-evaluated for periodontal and systemic parameters after three months.

RESULTS

Both groups were comparable at baseline. Three months after non surgical periodontal therapy (NSPT), there was significant improvement in periodontal parameters in case group. The mean difference in systemic parameters like HbA1c and fasting plasma glucose from baseline to fourth month for case group was 0.22 ± 0.11 and 3.90 ± 8.48 respectively and control group was -0.056 ± 0.10 and -1.66 ± 6.04 respectively, which was significant between case and control group (P < 0.05). In the case group there was a significant decrease in HbA1c from baseline to three months following NSPT (P < 0.05).

CONCLUSION

This study showed that periodontal inflammation could affect the glycemic control in otherwise systemically healthy individuals. Periodontal therapy improved periodontal health status and decreased glycosylated haemoglobin levels, thus reducing the probability of occurrence of inflammation induced prediabetes in patients with CHP.

The association between diabetes mellitus and incident infections: a systematic review and meta-analysis of observational studies

OBJECTIVE

To quantify the association between diabetes and the risk of incident infections by conducting a systematic review and meta-analysis.

RESEARCH DESIGN AND METHODS

Two reviewers independently screened articles identified from PubMed, EMBASE, Cochrane Library, IPA, and Web of Science databases. Cohort studies (CS) or case-control studies (CCS) evaluating the incidence of infections in adults with diabetes were included. Infections were classified as: skin and soft tissue, respiratory, blood, genitourinary, head and neck, gastrointestinal, bone, viral, and non-specified infections. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Summary crude and adjusted OR with 95% CIs were calculated using random effects models, stratified by study design. Heterogeneity was measured using the I²statistic and explored using subgroup analyses.

RESULTS

A total of 345 (243 CS and 102 CCS) studies were included. Combining adjusted results from all CS, diabetes was associated with an increased incidence of skin (OR 1.94, 95% CI 1.78 to 2.12), respiratory (OR 1.35, 95% CI 1.28 to 1.43), blood (OR 1.72, 95% CI 1.48 to 2.00), genitourinary (OR 1.61, 95% CI 1.42 to 1.82), head and neck (OR 1.17, 95% CI 1.13 to 1.22), gastrointestinal (OR 1.48, 95% CI 1.40 to 1.57), viral (OR 1.29, 95% CI 1.13 to 1.46), and non-specified (OR 1.84, 95% CI 1.66 to 2.04) infections. A stronger association was observed among CCS: skin (OR 2.64, 95% CI 2.20 to 3.17), respiratory (OR 1.62, 95% CI 1.37 to 1.92), blood (OR 2.40, 95% CI 1.68 to 3.42), genitourinary (OR 2.59, 95% CI 1.60 to 4.17), gastrointestinal (OR 3.61, 95% CI 2.94 to 4.43), and non-specified (OR 3.53, 95% CI 2.62 to 4.75).

CONCLUSION

Diabetes is associated with an increased risk of multiple types of infections. A high degree of heterogeneity was observed; however, subgroup analysis decreased the amount of heterogeneity within most groups. Results were generally consistent across types of infections.

Efficacy of Local Antimicrobials in the Non-Surgical Treatment of Patients With Periodontitis and Diabetes: A Systematic Review

BACKGROUND

Patients with diabetes present a worse response to periodontal treatment. Local antimicrobials as an adjunct to scaling and root planing (SRP) provide additional benefits in the treatment of periodontitis in healthy patients. This review aims to evaluate the effects of local antimicrobials as an adjunct to SRP, compared with SRP alone, on periodontal clinical parameters of patients with chronic periodontitis (CP) and diabetes mellitus (DM).

METHODS

Only randomized controlled trials with: 1) at least 6 months of follow-up; 2) SRP, in combination with local antimicrobials; and 3) patients with periodontitis and DM were considered eligible. MEDLINE, EMBASE, and LILACS databases were searched for articles published up to January 2016. Random-effects meta-analyses were conducted for clinical attachment level (CAL), probing depth (PD), bleeding on probing, and gingival index change after treatment.

RESULTS

Of 153 papers potentially relevant to this review, six were included. The majority of trials showed a significant PD reduction and CAL gain associated with use of local antimicrobials in patients with type 1 and type 2 DM. Only studies that included well-controlled patients and applied antimicrobials at the deepest sites or sites with baseline PD ≥5 mm presented significant PD reduction and CAL gain.

CONCLUSION

In patients with DM and CP, use of local antimicrobials as an adjunct to SRP may result in additional benefits compared with SRP alone in PD reduction and CAL gain, especially in well-controlled individuals and deep sites.

Bone metabolic microarray analysis of ligature-induced periodontitis in streptozotocin-induced diabetic mice

BACKGROUND AND OBJECTIVE

Periodontal disease is a chronic infectious disease that results in bone loss. Many epidemiological studies have reported the progression of periodontal tissue destruction in patients with diabetes; however, the associated mechanism remains unclear. In this study, we comprehensively investigated how diabetes affects the periodontal tissue and alveolar bone loss using a ligature-induced periodontitis model in streptozotocin-induced diabetic (STZ) mice.

MATERIAL AND METHODS

Diabetes was induced by intraperitoneal injection with streptozotocin in 6-wk-old C57/BL6J male mice. A silk ligature was tied around the maxillary left second molar in 9-wk-old wild-type (WT) and STZ mice. Bone loss was evaluated at 3 and 7 d after ligation. mRNA expression levels in the gingiva between the two groups were examined by DNA microarray and quantitative polymerase chain reaction at 1, 3 and 7 d post-ligation. Tartrate-resistant acid phosphatase and alkaline phosphatase staining of the periodontal tissue was performed for evaluation of osteoclasts and osteoblasts in histological analysis.

RESULTS

In the gingiva, hyperglycemia upregulated the osteoprotegerin (Opg) mRNA expression and downregulated Osteocalcin mRNA expression. In the ligated gingiva, tumor necrosis factor-α (Tnf-α) mRNA expression was upregulated at 1 d post-ligation in STZ mice but not in WT mice. At 3 d post-ligation, alveolar bone loss was observed in STZ mice, but not in WT mice. Significantly severe alveolar bone loss was observed in STZ mice compared to WT mice at 7 d post-ligation. Bone metabolic analysis using DNA microarray showed significant downregulation in the mRNA expression of glioma-associated oncogene homologue 1 (Gli1) and collagen type VI alpha 1 (Col6a1) at the gingiva of the ligated site in STZ mice compared to that in WT mice. Quantitative polymerase chain reaction showed that Gli1 and Col6a1 mRNA expression levels were significantly downregulated in the gingiva of the ligated site in STZ mice compared to WT mice. Histological analysis showed lower alkaline phosphatase activity in STZ mice. In addition, an increased number of tartrate-resistant acid phosphatase-positive multinucleated cells were observed at the ligated sites in STZ mice.

CONCLUSIONS

These results suggest that an imbalance of bone metabolism causes osteoclastosis in insulin-deficient diabetes, and that alveolar bone loss could occur at an early phase under this condition.

Effect of hyperlipidemia on response to nonsurgical periodontal therapy: Statin users versus nonusers

Objective:

To evaluate the response to nonsurgical periodontal therapy among hyperlipidemic subjects and whether statin use by hyperlipidemic subjects influences the response.

Materials and Methods:

This study was conducted on 107 chronic periodontitis subjects (35 normolipidemic [NL] controls, 36 hyperlipidemics on nonpharmacological therapy and 36 hyperlipidemics on statins). Periodontal (plaque index, gingival index [GI], probing depth [PD], and clinical attachment level [CAL]) and biochemical (plasma triglyceride [TG], total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], and high-DL-C [HDL-C] levels) examination was done at baseline and 3 months after nonsurgical periodontal treatment.

Results:

Both the NL and statin groups exhibited significantly greater improvement in GI as compared to the hyperlipidemic group on nonpharmacological therapy (P = 0.004 and 0.006, respectively). Mean change in PD correlated negatively with baseline TC (r = −0.306) and LDL-C (r = −0.360) while mean change in GI positively correlated with baseline HDL-C (r = 0.219). Regression analyses revealed that mean change in PD was negatively associated with LDL-C (β = −0.358, P < 0.001) while mean change in GI was positively associated with HDL-C (β = 0.219, P = 0.023).

Conclusions:

While higher baseline lipid levels were somewhat detrimental to the resolution of inflammation postperiodontal treatment, the inclusion of statin therapy among hyperlipidemic subjects seemed to improve clinical response as compared to those devoid of the drug. The findings of the study are suggestive of a possible adjunctive role of statins in periodontal treatment that warrants future studies.

Towards microbiome transplant as a therapy for periodontitis: an exploratory study of periodontitis microbial signature contrasted by oral health, caries and edentulism

BACKGROUND

Conventional periodontal therapy aims at controlling supra- and subgingival biofilms. Although periodontal therapy was shown to improve periodontal health, it does not completely arrest the disease. Almost all subjects compliant with periodontal maintenance continue to experience progressive clinical attachment loss and a fraction of them loses teeth. An oral microbial transplant may be a new alternative for treating periodontitis (inspired by fecal transplant). First, it must be established that microbiomes of oral health and periodontitis are distinct. In that case, the health-associated microbiome could be introduced into the oral cavity of periodontitis patients. This relates to the goals of our study: (i) to assess if microbial communities of the entire oral cavity of subjects with periodontitis were different from or oral health contrasted by microbiotas of caries and edentulism patients; (ii) to test in vitro if safe concentration of sodium hypochlorite could be used for initial eradication of the original oral microbiota followed by a safe neutralization of the hypochlorite prior transplantation.

METHODS

Sixteen systemically healthy white adults with clinical signs of one of the following oral conditions were enrolled: periodontitis, established caries, edentulism, and oral health. Oral biofilm samples were collected from sub- and supra-gingival sites, and oral mucosae. DNA was extracted and 16S rRNA genes were amplified. Amplicons from the same patient were pooled, sequenced and quantified. Volunteer's oral plaque was treated with saline, 16 mM NaOCl and NaOCl neutralized by ascorbate buffer followed by plating on blood agar.

RESULTS

Ordination plots of rRNA gene abundances revealed distinct groupings for the oral microbiomes of subjects with periodontitis, edentulism, or oral health. The oral microbiome in subjects with periodontitis showed the greatest diversity harboring 29 bacterial species at significantly higher abundance compared to subjects with the other assessed conditions. Healthy subjects had significantly higher abundance in 10 microbial species compared to the other conditions. NaOCl showed strong antimicrobial properties; nontoxic ascorbate was capable of neutralizing the hypochlorite.

CONCLUSIONS

Distinct oral microbial signatures were found in subjects with periodontitis, edentulism, or oral health. This finding opens up a potential for a new therapy, whereby a health-related entire oral microbial community would be transplanted to the diseased patient.

Effect of glycated albumin and cranberry components on interleukin-6 and matrix metalloproteinase-3 production by human gingival fibroblasts

BACKGROUND AND OBJECTIVE

Gingival fibroblasts have the potential to participate in periodontal inflammation and breakdown, producing interleukin (IL)-6 and matrix metalloproteinase (MMP)-3. Advanced glycation end products (AGEs), formed during diabetic hyperglycemia, might aggravate periodontal inflammation. The cranberry contains anti-inflammatory polyphenols, which inhibit proinflammatory activities of lipopolysaccharide (LPS)- and IL-1β-stimulated human cells. Little is known of its effects on gingival fibroblast IL-6 or MMP-3 production stimulated by AGEs. The objectives were to determine cranberry effects on IL-6 and MMP-3 production by gingival fibroblasts exposed to the representative AGE, glycated human serum albumin (G-HSA), or LPS ± G-HSA.

MATERIAL AND METHODS

Cranberry high molecular weight non-dialyzable material (NDM), was derived from cranberry juice. Normal human gingival fibroblasts were incubated with G-HSA or normal HSA or Porphyromonas gingivalis LPS (1 μg/mL) ± G-HSA, in the presence or absence of preincubation with NDM. IL-6 and MMP-3 were measured by enzyme-linked immunosorbent assay. Data were analyzed using one-way analysis of variance and Scheffe's F procedure.

RESULTS

IL-6 production was stimulated by G-HSA or LPS (p < 0.01), which was inhibited in both cases by NDM (p < 0.002). [G-HSA+LPS] synergistically stimulated IL-6 production (p < 0.0001), which was inhibited by NDM. MMP-3 levels were not stimulated by G-HSA but were decreased by LPS (p < 0.02). [G-HSA+LPS] increased MMP-3 production significantly, vs. LPS (p = 0.0005). NDM inhibited MMP-3 levels in the presence of G-HSA or LPS, and in the presence of [G-HSA+LPS] (p < 0.0001).

CONCLUSIONS

G-HSA ± LPS may have differential effects on IL-6 and MMP-3 production by human gingival fibroblasts, but both are inhibited by NDM. The study suggests that cranberry phenols may be useful in regulating the host response and perhaps treating periodontitis in patients with poorly controlled diabetes.

Effects of nonsurgical periodontal therapy on clinical response, microbiological profile, and glycemic control in Malaysian subjects with type 1 diabetes

The association between diabetes mellitus and chronic periodontal disease has long been established. Most of the researches linking these two very common chronic diseases were based on type 2 diabetes mellitus and chronic periodontal disease. However, this study was conducted to investigate the association between type 1 diabetes and chronic periodontal disease in Malaysian subjects. Forty-one Malaysian subjects, of which 20 subjects were type 1 diabetics and with chronic periodontal disease (test group) and 21 subjects with only chronic periodontal disease (control group), were included in the study. Periodontal parameters and plaque samples for microbiological evaluation were done at baseline, 2 and 3 months after nonsurgical periodontal therapy. Blood samples were taken from only the test group and evaluated for HbA1c at baseline and 3 months after periodontal therapy. There were no statistically significant difference in periodontal parameters between groups (P>0.05) and no significant improvement in the level of HbA1c in the test group. Microbiological studies indicated that there were significant reductions in the levels of the tested pathogens in both groups. The results of our study were similar to the findings of several other studies that had been done previously.

Beneficial effects of adiponectin on periodontal ligament cells under normal and regenerative conditions

Type 2 diabetes and obesity are increasing worldwide and linked to periodontitis, a chronic disease which is characterized by the irreversible destruction of the tooth-supporting tissues, that is, periodontium. The mechanisms underlying the association of diabetes mellitus and obesity with periodontal destruction and compromised periodontal healing are not well understood, but decreased plasma levels of adiponectin, as found in diabetic and obese individuals, might be a critical mechanistic link. The aim of this in vitro study was to examine the effects of adiponectin on periodontal ligament (PDL) cells under normal and regenerative conditions, and to study the regulation of adiponectin and its receptors in these cells. Adiponectin stimulated significantly the expression of growth factors and extracellular matrix, proliferation, and in vitro wound healing, reduced significantly the constitutive tumor necrosis factor-α expression, and caused a significant upregulation of its own expression. The beneficial actions of enamel matrix derivative on a number of PDL cell functions critical for periodontal regeneration were partially enhanced by adiponectin. The periodontopathogen Porphyromonas gingivalis inhibited the adiponectin expression and stimulated the expression of its receptors. In conclusion, reduced levels of adiponectin, as found in type 2 diabetes and obesity, may compromise periodontal health and healing.

Type 2 diabetes and edentulism as chronic co-morbid factors affecting Indian elderly: an overview

In past 50 years, type 2 diabetes has emerged as one of the major public health problem. India leads the world with the largest number of diabetic patients and has a huge elderly population. The present article discusses the effect of diabetes and edentulism on the overall general health of elderly. The prevalence of type 2 diabetes and edentulism in Indian elderly and their inter-relationship has been discussed. Dentists must provide optimum oral care with special attention towards comprehensive periodontal management and oral hygiene awareness among diabetics to prevent tooth loss. Dental and medical professionals can improve patient management of the oral and overall effects of diabetes by implementing various awareness programs; organizing camps; distributing informative pamphlets and dietary counseling. Dentists can detect undiagnosed cases of diabetes and refer patients to physicians for further evaluation and management.

Clinical case report of long-term follow-up in type-2 diabetes patient with severe chronic periodontitis and nifedipine-induced gingival overgrowth

In this case report, we describe the clinical course over a 14-year follow-up in a 47-year-old diabetes patient with severe chronic periodontitis and nifedipine-induced gingival overgrowth. The patient had a history of hypertension for over 5 years and uncontrolled type 2 diabetes. Overgrown gingiva was observed in most of the teeth and was marked in the upper and lower anterior teeth. A probing pocket depth of ≥ 4 mm and bleeding on probing (BOP) were observed in 94 and 90% of sites examined, respectively. At baseline, his hemoglobin A1c (HbA1c) was 8.5%. The patient received periodontal and diabetic treatment simultaneously. Medication was changed from nifedipine chloride to an angiotensin-converting enzyme inhibitor. After initial therapy and subsequent periodontal surgery, gingival overgrowth disappeared and probing depth and BOP showed a significant improvement. No recurrence was observed during supportive periodontal therapy (SPT). The HbA1c level improved from 8.5 to 6.3% after periodontal treatment, subsequently remaining at a good level during SPT over 10 years. This study demonstrated that periodontal treatment, withdrawal of medication and control of diabetes can result in remarkable improvements in type 2 diabetes patients with chronic periodontitis and nifedipine-induced gingival overgrowth. These results suggest that comprehensive periodontal treatment in combination with treatment for diabetes mellitus can exert a positive influence on blood glucose levels and periodontal condition in diabetic patients.

The influence of type 1 and type 2 diabetes on periodontal disease progression: prospective results from the Study of Health in Pomerania (SHIP)

OBJECTIVE

To explore associations between diabetes etiology (type 1 diabetes mellitus [T1DM] vs. T2DM) and glycemic control in the prediction of 5-year periodontal status change.

RESEARCH DESIGN AND METHODS

The Study of Health in Pomerania (SHIP) is a population-based stratified sample of German men and women. Healthy participants and those determined to have T2DM arose from the SHIP cohort, and T1DM participants were recruited from diabetes clinics in the catchment area that gave rise to SHIP. Dentate participants (n = 2,626; 53% women; 20-81 years of age) were included. Diabetes was determined via physician diagnosis and/or HbA(1c) ≥6.5% (uncontrolled diabetes >7.0%). Examiners blinded to diabetes status performed random half-mouth periodontal examinations, assessing probing depth (PD) and attachment loss (AL) (four sites/tooth) at baseline and follow-up. Participants were categorized into six groups as follows: 1) diabetes free (n = 2,280), 2) incident T2DM (n = 79), 3) controlled T2DM (n = 80), 4) uncontrolled T2DM (n = 72), 5) controlled T1DM (n = 43), and 6) uncontrolled T1DM (n = 72). In multivariable regressions, mean PD change (ΔMPD), mean AL change (ΔMAL), or incident tooth-loss values were regressed across the aforementioned diabetes categories.

RESULTS

Mean (SD) ΔMPD and ΔMAL values among all participants were -0.08 ± 0.5 mm and 0.08 ± 1.03 mm, respectively, and 34% lost one or more teeth. Relative to diabetes-free participants, those with uncontrolled T2DM experienced greater ΔMPD ± SE (P < 0.05), whereas participants with either uncontrolled T1DM or uncontrolled T2DM realized greater ΔMAL (P < 0.05). Uncontrolled T1DM and T2DM were both associated with an increased risk of future tooth loss (P < 0.05).

CONCLUSIONS

Diabetes control, but not etiology, was associated with future tooth loss and accelerated AL progression.

Evaluating components of dental care utilization among adults with diabetes and matched controls via hurdle models

Background

About one-third of adults with diabetes have severe oral complications. However, limited previous research has investigated dental care utilization associated with diabetes. This project had two purposes: to develop a methodology to estimate dental care utilization using claims data and to use this methodology to compare utilization of dental care between adults with and without diabetes.

Methods

Data included secondary enrollment and demographic data from Washington Dental Service (WDS) and Group Health Cooperative (GH), clinical data from GH, and dental-utilization data from WDS claims during 2002–2006. Dental and medical records from WDS and GH were linked for enrolees continuously and dually insured during the study. We employed hurdle models in a quasi-experimental setting to assess differences between adults with and without diabetes in 5-year cumulative utilization of dental services. Propensity score matching adjusted for differences in baseline covariates between the two groups.

Results

We found that adults with diabetes had lower odds of visiting a dentist (OR = 0.74, p < 0.001). Among those with a dental visit, diabetes patients had lower odds of receiving prophylaxes (OR = 0.77), fillings (OR = 0.80) and crowns (OR = 0.84) (p < 0.005 for all) and higher odds of receiving periodontal maintenance (OR = 1.24), non-surgical periodontal procedures (OR = 1.30), extractions (OR = 1.38) and removable prosthetics (OR = 1.36) (p < 0.001 for all).

Conclusions

Patients with diabetes are less likely to use dental services. Those who do are less likely to use preventive care and more likely to receive periodontal care and tooth-extractions. Future research should address the possible effectiveness of additional prevention in reducing subsequent severe oral disease in patients with diabetes.

Diabetes and periodontitis

The main aim of this review is to update the reader with practical knowledge concerning the relationship between diabetes mellitus and periodontal diseases. Exclusive data is available on the association between these two chronic diseases till date. Articles published on this relationship often provide the knowledge of definitions of diabetes mellitus and periodontal diseases, prevalence, extent, severity of periodontal disease, complications of diabetes along with the possible underlying mechanisms. The authors reviewed human epidemiological studies, cross-sectional observations and longitudinal cohort, case control that evaluated variables exclusively over the past 30 years and the predominant findings from the “certain” articles are summarized in this review. This review clarifies certain queries such as 1) Do periodontal diseases have an effect on the metabolic control of diabetes? 2) Does diabetes act as a risk factor of periodontitis? 3) What are the possible underlying mechanisms relating the connection between these two chronic diseases? 4) What is the effect of periodontal intervention on metabolic control of diabetes? After a thorough survey of literature, it was observed that diabetes acts as a risk factor in development of periodontitis as periodontitis is significantly aggravated in patients suffering from diabetes having long term hyperglycemia. Different mechanisms underlying the association between the accelerated periodontal disease and diabetes are emerging but still more work is required. Major efforts are required to elucidate the impact of periodontal diseases on diabetes. At the same time, patients are needed to be made aware of regular periodontal maintenance schedule and oral hygiene.

Diabetes mellitus and periodontitis: a tale of two common interrelated diseases

Diabetes mellitus (a group of metabolic disorders characterized by hyperglycemia) and periodontitis (a microbially induced inflammatory disorder that affects the supporting structures of teeth) are both common, chronic conditions. Multiple studies have demonstrated that diabetes mellitus (type 1 and type 2) is an established risk factor for periodontitis. Findings from mechanistic studies indicate that diabetes mellitus leads to a hyperinflammatory response to the periodontal microbiota and also impairs resolution of inflammation and repair, which leads to accelerated periodontal destruction. The cell surface receptor for advanced glycation end products and its ligands are expressed in the periodontium of individuals with diabetes mellitus and seem to mediate these processes. The association between the two diseases is bidirectional, as periodontitis has been reported to adversely affect glycemic control in patients with diabetes mellitus and to contribute to the development of diabetic complications. In addition, meta-analyses conclude that periodontal therapy in individuals with diabetes mellitus can result in a modest improvement of glycemic control. The effect of periodontal infections on diabetes mellitus is potentially explained by the resulting increase in levels of systemic proinflammatory mediators, which exacerbates insulin resistance. As our understanding of the relationship between diabetes mellitus and periodontitis deepens, increased patient awareness of the link between diabetes mellitus and oral health and collaboration among medical and dental professionals for the management of affected individuals become increasingly important.

Non-surgical periodontal therapy with and without subgingival minocycline administration in patients with poorly controlled type II diabetes: a randomized controlled clinical trial

The aim of this study was to evaluate changes in clinical parameters and levels of inflammatory biomarkers in plasma in periodontal patients with poorly controlled type 2 diabetes mellitus (T2DM) after non-surgical periodontal therapy. Twenty-eight poorly controlled T2DM patients were randomly assigned to treatment with scaling and root planning (SRP) and SRP + subgingival minocycline administration. Clinical parameters, including the probing depth (PD), bleeding on probing (BOP), plaque score (PS), clinical attachment level (CAL), and plasma interleukin (IL)-6, soluble receptor of advanced glycation end products (sRAGE), chronic reactive protein (CRP), and hemoglobin A1c (HbA1c) were measured before and after a 6-month treatment period. Significant changes in PD, BOP, PS, and CAL were found in both groups. The latent growth curve model showed an overall reduction in the log HbA1c level in the SRP group (-0.082, p = 0.033). Small changes in the log sRAGE level and log CRP level in plasma were found in both groups. IL-6 in the plasma increased in the SRP group, but slightly decreased in the SRP+minocycline group (0.469 pg/ml, p = 0.172). Non-surgical periodontal therapy with or without subgingival minocycline application may achieve significant periodontal improvement and moderate improvement in HbA1c, but had no significant effect on plasma levels of IL-6, CRP, or sRAGE in patients with poorly controlled T2DM. For patients with both periodontal diseases and diabetes, non-surgical periodontal treatments may be helpful in their diabetic control.

[Pathogenesis of parodontitis in rheumatic diseases]

Inflammatory periodontal disease (PD) is a common disease worldwide that has a primarily bacterial aetiology and is characterized by dysregulation of the host inflammatory response. The degree of inflammation varies among individuals with PD independently of the degree of bacterial infection, suggesting that alteration of the immune function may substantially contribute to its extent. Factors such as smoking, education, and body mass index (BMI) are discussed as potential risk factors for PD. Most PD patients respond to bacterial invaders by mobilizing their defensive cells and releasing cytokines such as interleukin (IL)-1beta, tumour necrosis factor (TNF)-alpha, and IL-6, which ultimately causes tissue destruction by stimulating the production of collagenolytic enzymes, such matrix metalloproteinases. Recently, there has been growing evidence suggesting an association between PD and the increased risk of systemic diseases, such ateriosclerosis, diabetes mellitus, stroke, and rheumatoid arthritis (RA). PD and rheumatologic diseases such as RA share many pathological aspects and immunological findings.

Treatment of periodontal disease for glycaemic control in people with diabetes

BACKGROUND

Glycaemic control is a key issue in the care of people with diabetes mellitus (DM). Some studies have suggested a bidirectional relationship between glycaemic control and periodontal disease.

OBJECTIVES

To investigate the relationship between periodontal therapy and glycaemic control in people with diabetes and to identify the appropriate future strategy for this question.

SEARCH STRATEGY

A comprehensive approach was adopted employing handsearching; searching of electronic databases including the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE, CINAHL, ZETOC, ISI Web of Knowledge and LILACS; contact with appropriate non-English language healthcare professionals; authors and organisations. The final date for searching for studies was 24th March 2010.

SELECTION CRITERIA

This review studied randomised controlled trials of people with Type 1 or 2 diabetes mellitus (DM) with a diagnosis of periodontitis. Suitable interventions included mechanical periodontal therapy with or without adjunctives and oral hygiene education.

DATA COLLECTION AND ANALYSIS

The titles and abstracts of 690 papers were examined by two review authors independently. Ultimately, seven studies were included and 19 excluded after full text scrutiny. All trials were assessed for risk of bias.

MAIN RESULTS

Three studies had results pooled into a meta-analysis. The effect for the mean percentage difference in HbA1c for scaling/root planing and oral hygiene (+/- antibiotic therapy) versus no treatment/usual treatment after 3/4 months was -0.40% (95% confidence interval (CI) fixed effect -0.78% to -0.01%), representing a statistically significant reduction in HbA1c (P = 0.04) for scaling/root planing. One study was assessed as being at low risk of bias with the other two at moderate to high risk of bias. A subgroup analysis examined studies without adjunctive antibiotics -0.80% (one study: 95% CI -1.73% to 0.13%; P = 0.09), with adjunctive antibiotics in the test group -0.36% (one study: 95% CI -0.83% to 0.11%; P = 0.14), and with antibiotics in both test and control groups after 3/4 months -0.15% (one study: 95% CI -1.04% to 0.74%; P = 0.74).

AUTHORS' CONCLUSIONS

There is some evidence of improvement in metabolic control in people with diabetes, after treating periodontal disease. There are few studies available and individually these lacked the power to detect a significant effect. Most of the participants in the study had poorly controlled Type 2 DM with little data from randomised trials on the effects on people with Type 1 DM.Improving periodontal health is an important objective in itself. However, in order to understand the potential of this treatment to improve glycaemic control among people with diabetes, larger, carefully conducted and reported studies are needed.

Characteristics of inflammation common to both diabetes and periodontitis: are predictive diagnosis and targeted preventive measures possible?

Diabetes and periodontitis are chronic inflammatory disorders that contribute to each others' severity and worsen each others' prognosis. Studies have shown that patients with diabetes are at increased risk of developing periodontitis, and that diabetics with untreated periodontitis have more difficulty controlling serum glucose. Periodontal treatment that reduces gingival inflammation aids in the control of hyperglycemia. Periodontitis is accompanied by gingival bleeding and the production of an inflammatory exudate termed gingival crevicular fluid (GCF) that arises from the inflamed gingival tissues surrounding the teeth. GCF contains byproducts of connective tissue degradation, enzymes from host and bacterial cells, cytokines and other inflammatory mediators, and has been studied for screening blood glucose and for biomarkers of both diabetes and periodontitis. This review focuses on the inter-relationship between diabetes and periodontitis and the biomarkers common to both these diseases that may enable earlier detection, targeted preventive measures and individualized therapeutic intervention of these chronic conditions.

Effectiveness of full-mouth and partial-mouth scaling and root planing in treating chronic periodontitis in subjects with type 2 diabetes

BACKGROUND

This study evaluated the clinical and metabolic effects of full-mouth scaling and root planing (FMSRP) compared to partial-mouth scaling and root planing (PMSRP) in patients with type 2 diabetes and chronic periodontitis, and it assessed the impact of the glycemic status on the clinical and metabolic response to periodontal therapy.

METHODS

In this clinical trial, 18 subjects with diabetes received FMSRP in a maximum of 24 hours, and 18 subjects received PMSRP in a maximum of 21 days. Visible plaque accumulation, bleeding on probing, suppuration, probing depth, clinical attachment level (CAL), and glycosylated hemoglobin (HbA1c) levels were obtained at baseline and at 3 and 6 months post-therapy. Baseline HbA1c values > or =9% and <9% defined subjects with poorly and better-controlled diabetes, respectively.

RESULTS

All clinical parameters improved after therapy (P <0.05). No significant differences were observed between treatment groups for clinical and metabolic parameters at any time (P >0.05). There were no changes in the HbA1c levels after therapy (P >0.05). No subject reported any adverse effects during the study. Individuals with better-controlled diabetes achieved a lower mean CAL at 6 months post-therapy, when FMSRP and PMSRP were evaluated together (P <0.05).

CONCLUSIONS

FMSRP and PMSRP were equally effective in treating chronic periodontitis in subjects with type 2 diabetes, without significant improvements in the glycemic control at 3 and 6 months. Considering the periodontal therapy as a whole (FMSRP plus PMSRP), subjects with better-controlled diabetes exhibited a benefit in CAL at 6 months compared to subjects with poorly controlled disease.