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de Brito Avelino L, Rodrigues KT, da Silva Cruz NT, Martins AA, de Aquino Martins ARL. Effectiveness of Probiotic Therapy in the Management of PeriodontalDisease in Diabetic Patients: A Scoping Review. Curr Diabetes Rev 2024; 20:e281123223961. [PMID: 38018184 DOI: 10.2174/0115733998271193231108054254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Probiotics can compete with periodontal pathogens in the formation of dental biofilm, and they are able to modulate local and systemic immune responses. Thus, its use in diabetic patients with periodontal disease (PD) can overcome the limitations of conventional periodontal treatment. OBJECTIVE This scoping review aimed to understand the extent and type of evidence in relation to the effects of probiotic therapy on periodontal and glycaemic parameters of diabetic patients with PD. METHODS An electronic search was performed in the following databases: Cochrane Library, EMBASE, Virtual Health Library (including LILACS and BBO), PubMed (including Medline), Scopus, Web of Science, and Google Scholar. The review included clinical trials on patients with type 2 diabetes, diagnosed with gingivitis or periodontitis, who received probiotic therapy as a single therapy or adjuvant to scaling and root planning, and on whom the analyses of clinical periodontal, immunological, microbiological, or glycaemic parameters were performed. RESULTS The electronic search yielded a total of 1165 articles. After removing duplicate titles and performing systematic screening, 6 studies were included in the qualitative summary. Probiotic administration improved clinical periodontal parameters (bleeding on probing and probing depth), oxidative stress markers, and inflammatory cytokines (IL-8, IL-10, and TNF-α) in relation to control groups. Experimental groups were also more advantageous in reducing the frequency of periodontopathogenic bacteria. However, the evidence of probiotics in decreasing glycated hemoglobin is still uncertain. CONCLUSION Probiotics may provide safe additional benefits to periodontal parameters of patients with type 2 diabetes and periodontal disease.
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Affiliation(s)
| | | | | | - Agnes Andrade Martins
- Department of Dentistry, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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Kaur J, Grover V, Gupta J, Gupta M, Kapur V, Mehta M, Lyle DM, Samujh T, Jain A. Effectiveness of subgingival irrigation and powered toothbrush as home care maintenance protocol in type 2 diabetic patients with active periodontal disease: A 4-month randomized controlled trial. J Indian Soc Periodontol 2023; 27:515-523. [PMID: 37781333 PMCID: PMC10538506 DOI: 10.4103/jisp.jisp_509_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/23/2022] [Accepted: 11/27/2022] [Indexed: 10/03/2023] Open
Abstract
Background There is a bidirectional link between diabetes and periodontal disease. Control of active periodontal infection is an essential requisite to maintain optimal oral and systemic health in diabetic patients. The purpose of this study was to evaluate the efficacy of subgingival irrigation and powered toothbrush as home care maintenance protocol in type 2 diabetic patients with active periodontal disease compared to routine oral hygiene. Materials and Methods Forty (n = 40) diabetic (HbA1c >7%) patients were enrolled in this parallel, examiner-blind, interventional clinical trial. Patients were randomized into two groups: Group A (sonic toothbrush and irrigation with water twice daily) or Group B (manual toothbrush and mouth rinsing with 0.12% Chlorhexidine gluconate (CHX) twice daily)). All patients received Phase I therapybefore the start of the study. Clinical parameters (plaque index [PI], gingival index [GI], oral hygiene index [OHI], pocket depth [PD], clinical attachment level [CAL], and bleeding index [BI]) were assessed at baseline, 1, 2, and 4 months. Levels of C-reactive protein (CRP), HbA1c, and interleukin (IL)-1 β were assessed at baseline and 4 months only. Verbal and written instructions were provided to each subject specific to their intervention allocation. Descriptive, parametric, and nonparametric analyses were used where appropriate. Results Sixteen (n = 16) patients in Group A and fifteen (n = 15) patients in Group B completed the 4-month study. Both groups showed a significant difference in BI, PD, CAL, and HbA1c from baseline to 4 months. There were no differences within groups for OHI, GI, or PI and CRP, IL-1 β. The results are based on an underpowered study due to the drop out of 9 patients reducing the number below the needed 19 patients per group based on the power analysis. Conclusion Results from this study provide information for future studies on self-care regimens for individuals living with Type 2 diabetes.
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Affiliation(s)
- Jaspreet Kaur
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences, Panjab University, Chandigarh, India
| | - Vishakha Grover
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences, Panjab University, Chandigarh, India
| | - Jyoti Gupta
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences, Panjab University, Chandigarh, India
| | - Mili Gupta
- Department of Biochemistry, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Vinay Kapur
- Department of Medicine, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Manjula Mehta
- Department of Microbiology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | | | - Tanvi Samujh
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences, Panjab University, Chandigarh, India
| | - Ashish Jain
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences, Panjab University, Chandigarh, India
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Komatsu S, Oshikiri S, Nagano T, Yashima A, Matsushima Y, Shirakawa S, Komatsu K, Mokubo A, Gomi K. Effects of One-Stage Full-Mouth Scaling and Root Planing with Azithromycin on Diabetes and Periodontal Disease: A Randomized Controlled Trial. Antibiotics (Basel) 2022; 11:antibiotics11091266. [PMID: 36140045 PMCID: PMC9495786 DOI: 10.3390/antibiotics11091266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 08/31/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Recent reports show that hemoglobin A1c (HbA1c) can be lowered by improving chronic inflammation in periodontal patients with diabetes mellitus and that full-mouth scaling and root planing (FM-SRP), in combination with azithromycin (AZM) treatment, can reduce early periodontal inflammation. However, the association of FM-SRP and AZM with periodontitis and HbA1c in patients with diabetes is largely unknown. This study investigated periodontitis and HbA1c in patients with diabetes after receiving FM-SRP and AZM to evaluate which clinical parameters most reflect the diabetic condition. Fifty-one periodontal patients with diabetes mellitus were included in this study. In total, 25 patients were assigned to the FM-SRP group in which patients were treated with FM-SRP in combination with AZM, and 26 patients were assigned to the control group in which only supragingival calculus removal was performed along with the provision of oral hygiene instructions. We evaluated periodontal parameters (probing pocket depth, periodontal inflamed surface area (PISA), bleeding on probing), and periodontal bacteria and biochemical parameters (HbA1c, high-sensitive C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and monocyte chemoattractant protein-1 (MCP-1)) at baseline (BL) and 1, 3, 6, and 9 months after treatment. Compared with BL values, the FM-SRP group showed improved clinical parameters, reduced periodontal pathogens, and significantly lower HbA1c. Inflammatory cytokines (hs-CRP, TNF-α, IL-6) were significantly reduced one month after treatment and remained low thereafter. MCP-1 did not change significantly during the experimental period. PISA showed a strong correlation with HbA1c, hs-CRP, and TNF-α. FM-SRP, in combination with AZM, produced clinical, microbiological, and HbA1c improvements in periodontal patients with previously diagnosed diabetes mellitus. Additionally, PISA was shown to be a useful index for assessing the diabetic status of patients with periodontal disease.
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Affiliation(s)
- Sho Komatsu
- Department of Periodontology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi ku, Yokohama 230-8501, Japan
| | - Shotaro Oshikiri
- Department of Periodontology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi ku, Yokohama 230-8501, Japan
| | - Takatoshi Nagano
- Department of Periodontology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi ku, Yokohama 230-8501, Japan
| | - Akihiro Yashima
- Department of Periodontology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi ku, Yokohama 230-8501, Japan
| | - Yuji Matsushima
- Department of Periodontology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi ku, Yokohama 230-8501, Japan
| | - Satoshi Shirakawa
- Department of Dental Hygiene, Tsurumi Junior College, 2-1-3 Tsurumi, Tsurumi ku, Yokohama 230-8501, Japan
| | | | - Akiko Mokubo
- Mokubo Internal Medicine Clinic, 2-25 Kizukimotosumicho, Kawasaki 211-0021, Japan
| | - Kazuhiro Gomi
- Department of Periodontology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi ku, Yokohama 230-8501, Japan
- Correspondence: ; Tel.: +81-(45)-580-8431
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Yildiz AS, Ustundag FD, Tiber PM, Dogan B. The relationship between vitamin D receptor gene polymorphisms and periodontitis in turkish individuals with type 2 diabetes mellitus. Niger J Clin Pract 2022; 25:1163-1172. [PMID: 35859479 DOI: 10.4103/njcp.njcp_1894_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background and Aim Vitamin D receptor (VDR) gene polymorphisms have been implicated in the pathogenesis of many diseases, such as periodontitis and diabetes mellitus (DM). The present study aimed to evaluate the distributions of VDR polymorphisms in diabetic individuals with healthy periodontium (DMH), diabetic individuals with periodontitis (DMP), nondiabetic individuals with healthy periodontium (H), and nondiabetic individuals with periodontitis (P). Material and Methods A total of 200 individuals (DMH = 40, DMP = 60, H = 40, and P = 60) were recruited. All clinical periodontal parameters, demographical, and biochemical variables were recorded. Blood samples were collected, and genomic DNA was isolated by Purelink® Genomic DNA Mini Kit. Genotyping of VDR polymorphisms ApaI, BsmI, FokI, and TaqI were determined by real-time polymerase chain reaction (PCR) using allele-specific probes. Results The distribution of the BsmI variant showed differences between DMH and H groups (P = 0.034). In addition, carrying the GG genotype (OR = 0.317; 95% CI = 0.126-0.797; P = 0.013) and the G allele (OR = 2.373; 95% CI = 1.203-4.681; P = 0.012) increased the risk of type 2 DM. Moreover, it was determined that the frequency of CC genotype of FokI variant was higher in DMP compared to DMH (P = 0.046). It was determined that having the CC genotype (OR = 2.706; 95% CI = 1.185-6.176; P = 0.017) and the C allele (OR = 1.917; 95% CI = 0.995-3.694; P = 0.049) increased the risk of periodontitis among diabetic individuals. No differences were detected among groups in the genotype and allele distributions of ApaI and TaqI variants (P > 0.05). Conclusions The present study showed that the BsmI variant was a risk factor for DM among periodontally healthy individuals and the FokI variant for periodontitis among diabetic individuals.
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Affiliation(s)
- A Saatman Yildiz
- Department of Periodontology, Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - F D Ustundag
- Department of Biophysics, Institute of Health Sciences, Istanbul, Turkey
| | - P Mega Tiber
- Department of Biophysics, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - B Dogan
- Department of Periodontology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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[Comparison of initial periodontal therapy and its correlation with white blood cell level in periodontitis patients with or without diabetes mellitus]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022. [PMID: 35165467 PMCID: PMC8860660 DOI: 10.19723/j.issn.1671-167x.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To compare the clinical efficacy of initial periodontal therapy in periodontitis patients with or without type 2 diabetes mellitus and its correlation with white blood cell counts. METHODS In this study, 32 chronic periodontitis patients without systemic disease (CP group) and 27 chronic periodontitis patients with type 2 diabetes mellitus (CP+DM group) were enrolled. At admission, all the patients went through periodontal examination and fasting blood examination(baseline). Probing depth (PD), attachment loss (AL), bleeding index (BI), plaque index (PLI), white blood cells (WBC) counts and fasting blood glucose (FBG) were recorded respectively, while hemoglobin A1c (HbA1c) was recorded only in CP+DM group. After that, initial periodontal therapy was performed. All the tests were repeated 3 and 6 months after treatment. The changes of periodontal clinical indexes and WBC levels were compared between the two groups before and after treatment, and the correlation between WBC and periodontal clinical indexes and glucose metabolism indexes were analyzed by generalized linear mixed model. RESULTS At baseline, the periodontal inflammation and destruction were similar in CP and CP+DM group, but the WBC level was significantly higher in CP+DM groups [(6.01±1.26)×109/L vs. (7.14±1.99)×109/L, P=0.01]. After 3 and 6 months of initial periodontal therapy, the mean PD, AL, BI, and PLI in CP+DM and CP groups were significantly lower than the baseline, and the PD in CP+DM group was further decreased by 6 months compared with 3 months [(3.33±0.62) mm vs. (3.61±0.60) mm, P < 0.05]. However, none of these periodontal indexes showed significant difference between the two groups by 3 or 6 months. In CP+DM group, HbA1c at 3 months and 6 months were significantly lower than the baseline [(7.09±0.79)% vs. (7.64±1.16)%, P < 0.05; (7.06±0.78)% vs. (7.64±1.16)%, P < 0.05], and FBG was significantly lower than the baseline by 6 months [(7.35±1.14) mmol/L vs. (8.40±1.43) mmol/L, P < 0.05]. The WBC level in CP group was significantly lower than the baseline level by 3 months [(5.35±1.37)×109/L vs. (6.01±1.26)×109/L, P < 0.05], while that in CP+DM group was significantly lower than the baseline level by 6 months [(6.00±1.37)×109/L vs. (7.14±1.99)×109/L, P < 0.05]. The analysis of genera-lized linear mixed model showed that WBC level was significantly positively correlated with PD and FBG (P < 0.05). CONCLUSION Initial periodontal therapy can effectively improve the periodontal clinical status of patients with or without type 2 diabetes mellitus, and have benefits on glycemic control in diabetic patients. However, the response of periodontal indexes and WBC level to initial therapy were relatively delayed in diabetic patients. WBC plays an important role in the correlation between diabetes mellitus and periodontitis.
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Chava V, Pulivarthi P, Gunupati S. Salivary tumor necrosis factor-alpha levels in periodontitis associated with diabetes mellitus after low level laser therapy as an adjunct to scaling and root planning: A randomized clinical trial. J Indian Soc Periodontol 2022; 26:236-244. [PMID: 35602530 PMCID: PMC9118935 DOI: 10.4103/jisp.jisp_150_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/18/2021] [Accepted: 09/19/2021] [Indexed: 11/06/2022] Open
Abstract
Context: Tumor necrosis factor-alpha (TNF-α) has been shown to play a critical role in the pathogenesis of periodontitis and diabetes. Nonsurgical periodontal therapy was shown to reduce inflammation and improves glycemic status. Recently, adjunctive low level laser therapy (LLLT) has been shown to alter the inflammatory process. Aim: To evaluate and compare the alteration in TNF-α levels before and after treatment in patients with periodontitis with and without type 2 diabetes mellitus (T2DM). Settings and Design: Randomised clinico-biochemical study was carried out for 8 weeks from September 2019 to December 2020. Materials and Methods: Sixty-four participants were divided into Groups A (periodontitis) and B (periodontitis associated with T2DM), based on probing depth ≥5 mm, clinical attachment level ≥2 mm, and history of T2DM. Later were subdivided into A1, A2, B1, B2, based on assigned treatments. Clinical periodontal parameters and salivary TNF-α levels were evaluated and compared at baseline to 8 weeks. Statistical Analysis: Multiple group comparisons were done using analysis of variance, intra group comparisons were made using t-tests. Results: Comparison of periodontal parameters and salivary TNF-α levels from baseline to 8 weeks showed statistically significant difference (P < 0.05) in all groups, indicating a positive effect of scaling and root planing (SRP) and adjunctive LLLT. Conclusion: Both SRP and SRP with adjunctive LLLT effectively altered TNF-α levels, correlating reduced periodontal inflammation.
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Alwan AM, Mousa HA, Talib HJ, Jassim TK. Impact of Air and Manual Scaling on Dental Anxiety and Blood Glucose Level among Diabetic Patients. J Int Soc Prev Community Dent 2021; 11:510-515. [PMID: 34760794 PMCID: PMC8533038 DOI: 10.4103/jispcd.jispcd_411_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/14/2021] [Accepted: 04/06/2021] [Indexed: 11/05/2022] Open
Abstract
Aims: The current study aimed at describing the short-term effect of nonsurgical periodontal treatment on dental anxiety and blood glucose level change among diabetic patients. Materials and Methods: One hundred and fifty patients with diabetes participated in a cross-sectional study design. All of them were divided into two groups, with 75 patients in each group. The first group was treated with air scaling, whereas the second group was treated with manual scaling. The determination of treatment needs and the evaluation of periodontal health status were achieved by using Community Periodontal Index for Treatment Need (CPITN). The level of dental anxiety was assessed by using Visual Analogue Scale (VAS). The glucose change was calculated by subtracting the glucose level before treatment from the glucose level straight after treatment. Results: No significant difference in glucose level was observed between manual scaling and air scaling after treatment (P = 0.076), and the level of glucose was significantly lower after scaling treatment within the treatment groups (P = 0.000). The level of glucose change between the groups was significantly lower for the manual scaling treatment group (P = 0.013), and it was significantly correlated with VAS (P = 0.000). Multiple regression analysis showed a significant association between the treatment groups (P = 0.007). Conclusions: Scaling reduced blood glucose and dental anxiety levels in patients with diabetes. Manual scaling was associated with reduced glucose level change less than air scaling after treatment.
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Affiliation(s)
- Alyamama M Alwan
- Department of Periodontal Dentistry, College of Dentistry, University of Mustansiriyah, Baghdad, Iraq
| | - Hussein A Mousa
- Department of Periodontal Dentistry, College of Dentistry, University of Mustansiriyah, Baghdad, Iraq
| | - Haider J Talib
- Department of Periodontal Dentistry, College of Dentistry, University of Mustansiriyah, Baghdad, Iraq
| | - Tameem K Jassim
- Department of Prosthetic Dentistry, College of Dentistry, University of Mustansiriyah, Baghdad, Iraq
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Wernicke K, Grischke J, Stiesch M, Zeissler S, Krüger K, Bauer P, Hillebrecht A, Eberhard J. Influence of physical activity on periodontal health in patients with type 2 diabetes mellitus. A blinded, randomized, controlled trial. Clin Oral Investig 2021; 25:6101-6107. [PMID: 33796948 PMCID: PMC8531088 DOI: 10.1007/s00784-021-03908-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim was to investigate the effect of physical activity on periodontal health and HbA1c levels in patients with type 2 diabetes mellitus (T2DM) over a period of 6 months. MATERIALS AND METHODS Thirty-seven patients with non-insulin-dependent T2DM were included in the study. The intervention group (n=20) performed physical activity over a period of 6 months. The control group (n=17) did not receive any intervention. Baseline and final examinations included dental parameters and concentrations of glycosylated hemoglobin (HbA1c) and high-sensitivity C-reactive protein (hsCRP). RESULTS Physical activity showed a positive effect on periodontal health. Both the BOP (p= 0.005) and the severity of periodontitis (p= 0.001) were significantly reduced in the intervention group compared to the control group. Furthermore, HbA1c levels were reduced (p= 0.010) significantly in the intervention group while hsCRP levels significantly increased in the control group (p= 0.04). CONCLUSIONS Within the limitations of this randomized, controlled trial, physical activity over a period of 6 months is a health-promoting measure for patients with T2DM and improves both periodontal health and HbA1c concentrations.
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Affiliation(s)
- K Wernicke
- Hannover Medical School, Hanover, Germany
| | - J Grischke
- Hannover Medical School, Hanover, Germany.
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
| | - M Stiesch
- Hannover Medical School, Hanover, Germany
| | | | - K Krüger
- Justus-Liebig-Universität Gießen, Gießen, Germany
| | - P Bauer
- Justus-Liebig-Universität Gießen, Gießen, Germany
| | | | - J Eberhard
- The University of Sydney School of Dentistry and the Charles Perkins Centre, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia
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Zhang B, Yang Y, Yi J, Zhao Z, Ye R. Hyperglycemia modulates M1/M2 macrophage polarization via reactive oxygen species overproduction in ligature-induced periodontitis. J Periodontal Res 2021; 56:991-1005. [PMID: 34190354 DOI: 10.1111/jre.12912] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Periodontitis in diabetic patients is characterized by enhanced inflammation and aggravated tissue damage in comparison with that in non-diabetic counterparts. The progression of periodontal damage under diabetic condition can be partly ascribed to hyperglycemia-induced disturbance between immune activation and inflammation resolution, where macrophages are capable of participating given their plasticity in response to different stimuli. Herein, we aimed to investigate the changes of macrophage polarization in periodontitis under diabetic condition and the underlying mechanism. MATERIALS AND METHODS Type-1 diabetes was induced by the injection of streptozotocin (STZ, 60 mg/kg) in Sprague-Dawley rats. Rats in N-acetyl cysteine (NAC)-treated groups received NAC dissolved in drinking water (200 mg/kg/day). Experimental periodontitis was induced by ligating 3-0 silk around left maxillary second molars for 4 weeks. Alveolar bone destruction was tested by micro-computed tomography and tartrate-resistant acid phosphatase (TRAP) staining. M1/M2 macrophage polarization in periodontal tissue was detected by immunohistochemistry staining. RAW264.7 were cultured in normal glucose (5.5 mM) or high glucose environment (25 mM) with or without NAC (8 mmol/L). LPS (100 ng/ml) and IL-4 (20 ng/ml) were used to induce M1 macrophages and M2 macrophages, respectively. M1/M2 macrophage polarization was detected by qRT-PCR, immunofluorescent staining, and flow cytometry. Reactive oxygen species (ROS) accumulation was detected by fluorogenic probes. RANKL (100 ng/ml) were applied to induce osteoclastogenic differentiation of RAW264.7, and osteoclast formation was examined by TRAP staining. RESULTS Rats with diabetes displayed enhanced macrophages infiltration and M1 macrophage polarization in periodontal lesions compared with vehicle-treated rats. Under LPS or IL-4 stimulation, high glucose culture of RAW264.7 elevated ROS level and increased the expression of M1 macrophage markers (iNOS, TNF-α, and IL-6) whereas decreased the expression of M2 macrophage markers (Arg-1 and CD206). Supernatants of high glucose-treated M1/M2 macrophages enhanced osteoclast formation compared to normal glucose-cultured cells. Decreasing ROS level via NAC partially reversed the effect of high glucose on M1/M2 macrophage polarization. Meanwhile, daily intake of NAC in rodent models inhibited M1 macrophage polarization, which subsequently ameliorated alveolar bone loss and decreased osteoclast numbers in periodontitis in diabetic rats. CONCLUSION These findings demonstrated that hyperglycemia could polarize macrophage toward M1 macrophages via overproducing ROS under inflammatory condition, which might take responsibility for aggravated periodontal damage in periodontitis under diabetic condition. Inhibiting M1 macrophages and restoring M2 macrophages by ROS scavenger is hopefully a potential adjunct treatment strategy for diabetic periodontitis.
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Affiliation(s)
- Bo Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yang Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of General Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jianru Yi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhihe Zhao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Rui Ye
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Ziaei N, Golmohammadi S, Ataee M, Ardalani F, Mesgari Abbasi M. Effect of non-surgical periodontal treatment on three salivary adipokines in diabetic patients with periodontitis. J Dent Res Dent Clin Dent Prospects 2021; 14:199-205. [PMID: 33408827 PMCID: PMC7770404 DOI: 10.34172/joddd.2020.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background. This study investigated the effect of non-surgical periodontal treatment on clinical indices and salivary levels of visfatin, chemerin, and progranulin in diabetic patients with periodontitis. Methods. This interventional clinical trial was performed on 20 patients with type II diabetes mellitus (T2DM) with moderate to severe chronic periodontitis (periodontitis stages II or III according to the new classification of periodontal diseases). Clinical indices, including gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL) and plaque index (PI), were recorded and visfatin, chemerin, and progranulin adipokines levels were also measured in unstimulated saliva by ELISA technique at baseline and twelve weeks after non-surgical periodontal treatment. Results. GI dropped from 1.92±0.27 to 0.71±0.14 after the intervention (P<0.001). Also, there were significant changes in the PPD and PI (P<0.001). However, no significant changes were observed in the CAL (P<0.05). The concentrations of all three salivary adipokines decreased after treatment, but this change was statistically significant only for progranulin (P<0.05). Conclusion. Non-surgical periodontal therapy resulted in improvements in the clinical indices of GI, PPD, and PI in T2DM patients with periodontitis. Moreover, the significant reduction in the salivary level of progranulin after treatment suggests that it might be considered a target inflammatory marker in periodontal diseases.
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Affiliation(s)
- Narges Ziaei
- Department of Periodontics, Dental School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shima Golmohammadi
- Department of Periodontics, Dental School, Islamic Azad University of Borujerd, Borujerd, Iran
| | - Mari Ataee
- Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Mehran Mesgari Abbasi
- Researcher, Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Mizutani K, Shioyama H, Matsuura T, Mikami R, Takeda K, Izumi Y, Aoki A, Iwata T. 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. J Periodontol 2020; 92:1262-1273. [PMID: 33301187 DOI: 10.1002/jper.20-0590] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/18/2020] [Accepted: 10/27/2020] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Koji Mizutani
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hidehiro Shioyama
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takanori Matsuura
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Risako Mikami
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kohei Takeda
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuichi Izumi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Oral Care Perio Center, Southern Tohoku General Hospital, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Akira Aoki
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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12
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Rabelo MDS, Gomes GH, Foz AM, Stadler AF, Cutler CW, Susin C, Romito GA. Short-term effect of non-surgical periodontal treatment on local and systemic cytokine levels: Role of hyperglycemia. Cytokine 2020; 138:155360. [PMID: 33221157 DOI: 10.1016/j.cyto.2020.155360] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/14/2020] [Accepted: 10/31/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The effect of non-surgical periodontal treatment on oral and systemic inflammatory mediators in subjects with periodontitis and hyperglycemia remains largely unknown. Therefore, the aim of this clinical study was to compare the short-term effect of non-surgical periodontal treatment on serum, saliva and GCF inflammatory markers levels in GP subjects with or without hyperglycemia. METHODS Sixty subjects divided into four groups of equal size were selected to participate: type 2 diabetics with generalized periodontitis (T2DM + GP), pre-diabetics with GP (PD + GP), normoglycemic subjects with GP (NG + GP), and healthy controls. GCF, serum, and saliva samples were obtained at baseline and 30 days after scaling and root planning (SRP) and the levels of interleukin-1β (IL-1 β), IL-8, IL-6, IL-2, IL-5, IL-4, IL-10, Interferon gamma (IFN-γ), Granulocyte macrophage colony-stimulating factor (GM-CSF) and Tumor necrosis factor-alpha (TNF-α) were determined by ultrasensitive multiplex assay. Clinical periodontal measurements were recorded. RESULTS SRP yielded significant improvement of all periodontal parameters for all GP groups (p < 0.01). A significant reduction in GCF levels of several cytokines were observed; however, only IL-1B and IFN-γ were consistently reduced post-treatment across all GP groups. Salivary levels of IL-1β were significantly reduced in all GP groups following treatment. No significant differences were observed for serum levels after SRP. CONCLUSIONS Periodontal treatment reduced local inflammatory markers, specifically IL-1B and IFN-γ, irrespective of the diabetes status. Periodontal treatment had no significant effect on serum levels of the inflammatory markers evaluated in this study.
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Affiliation(s)
- Mariana de Sousa Rabelo
- Department of Stomatology, Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil; Department of Periodontics, The Dental College of Georgia, Augusta University, Augusta, USA
| | - Giovane Hisse Gomes
- Department of Stomatology, Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Adriana Moura Foz
- Department of Stomatology, Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Amanda Finger Stadler
- Division of Comprehensive Oral Health, Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher W Cutler
- Department of Periodontics, The Dental College of Georgia, Augusta University, Augusta, USA
| | - Cristiano Susin
- Division of Comprehensive Oral Health, Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Giuseppe Alexandre Romito
- Department of Stomatology, Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil.
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13
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Luo H, Zhu W, Mo W, Liang M. High‐glucose concentration aggravates TNF‐alpha‐induced cell viability reduction in human CD146‐positive periodontal ligament cells via TNFR‐1 gene demethylation. Cell Biol Int 2020; 44:2383-2394. [PMID: 32808710 DOI: 10.1002/cbin.11445] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/30/2020] [Accepted: 08/16/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Haoyuan Luo
- Department of Periodontology, Guanghua School of Stomatology, Hospital of Stomatology Sun Yat‐Sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Stomatology Guangzhou China
| | - Wenjun Zhu
- Department of Periodontology, Guanghua School of Stomatology, Hospital of Stomatology Sun Yat‐Sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Stomatology Guangzhou China
| | - Weiyan Mo
- Department of Periodontology, Guanghua School of Stomatology, Hospital of Stomatology Sun Yat‐Sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Stomatology Guangzhou China
| | - Min Liang
- Department of Periodontology, Guanghua School of Stomatology, Hospital of Stomatology Sun Yat‐Sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Stomatology Guangzhou China
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14
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Kumar G, Ponnaiyan D, Parthasarathy H, Tadepalli A, Veeramani S. Evaluation of Endocan and Tumor Necrosis Factor-α as Inflammatory Biomarkers in Type 2 Diabetes and Periodontal Disease. Genet Test Mol Biomarkers 2020; 24:431-435. [DOI: 10.1089/gtmb.2020.0037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Gayathri Kumar
- Department of Periodontology, SRM Dental College, Chennai, India
| | - Deepa Ponnaiyan
- Department of Periodontology, SRM Dental College, Chennai, India
| | | | | | - Suresh Veeramani
- Department of Craniofacial, Esthetic and Plastic Surgery, SIMS Hospital, Chennai, India
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15
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Castro Dos Santos NC, Andere NMRB, Araujo CF, de Marco AC, Kantarci A, Van Dyke TE, Santamaria MP. Omega-3 PUFA and aspirin as adjuncts to periodontal debridement in patients with periodontitis and type 2 diabetes mellitus: Randomized clinical trial. J Periodontol 2020; 91:1318-1327. [PMID: 32103495 DOI: 10.1002/jper.19-0613] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/29/2019] [Accepted: 02/05/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Supplementation with omega-3 polyunsaturated fatty acids (ω-3 PUFA) and low-dose aspirin (ASA) have been proposed as a host modulation regimen to control chronic inflammatory diseases. The aim of this study was to investigate the clinical and immunological impact of orally administered ω-3 PUFA and ASA as adjuncts to periodontal debridement for the treatment of periodontitis in patients type 2 diabetes. METHODS Seventy-five patients (n = 25/group) were randomly assigned to receive placebo and periodontal debridement (CG), ω-3 PUFA + ASA (3 g of fish oil/d + 100 mg ASA/d for 2 months) after periodontal debridement (test group [TG]1), or ω-3 PUFA + ASA (3 g of fish oil/d + 100 mg ASA/d for 2 months) before periodontal debridement (TG2). Periodontal parameters and GCF were collected at baseline (t0), 3 months after periodontal debridement and ω-3 PUFA + ASA or placebo for TG1 and CG (t1), after ω-3 PUFA + ASA (before periodontal debridement) for TG2 (t1), and 6 months after periodontal debridement (all groups) (t2). GCF was analyzed for cytokine levels by multiplex ELISA. RESULTS Ten patients (40%) in TG1 and nine patients (36%) in TG2 achieved the clinical endpoint for treatment (less than or equal to four sites with probing depth ≥ 5 mm), as opposed to four (16%) in CG. There was clinical attachment gain in moderate and deep pockets for TG1. IFN-γ and interleukin (IL)-8 levels decreased over time for both test groups. IL-6 levels were lower for TG1. HbA1c levels reduced for TG1. CONCLUSION Adjunctive ω-3 and ASA after periodontal debridement provides clinical and immunological benefits to the treatment of periodontitis in patients with type 2 diabetes.
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Affiliation(s)
- Nidia C Castro Dos Santos
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil.,Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA.,Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Naira M R B Andere
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Cássia F Araujo
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Andrea C de Marco
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
| | - Alpdogan Kantarci
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA
| | - Thomas E Van Dyke
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA
| | - Mauro P Santamaria
- Division of Periodontics, Unesp - São Paulo State University, Institute of Science and Technology, São José dos Campos, São Paulo, Brazil
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16
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Preshaw PM, Taylor JJ, Jaedicke KM, De Jager M, Bikker JW, Selten W, Bissett SM, Whall KM, Merwe R, Areibi A, Jitprasertwong P, Al‐Shahwani R, Weaver J, Taylor R, Wassall RR. Treatment of periodontitis reduces systemic inflammation in type 2 diabetes. J Clin Periodontol 2020; 47:737-746. [DOI: 10.1111/jcpe.13274] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/07/2020] [Accepted: 02/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Philip M. Preshaw
- School of Dental Sciences Newcastle University Newcastle upon Tyne UK
- Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK
| | - John J. Taylor
- School of Dental Sciences Newcastle University Newcastle upon Tyne UK
- Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK
| | - Katrin M. Jaedicke
- School of Dental Sciences Newcastle University Newcastle upon Tyne UK
- Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK
| | | | | | - Wieke Selten
- Consultants in Quantitative Methods Eindhoven The Netherlands
| | - Susan M. Bissett
- School of Dental Sciences Newcastle University Newcastle upon Tyne UK
- Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK
| | - Kerry M. Whall
- School of Dental Sciences Newcastle University Newcastle upon Tyne UK
| | - Rachel Merwe
- School of Dental Sciences Newcastle University Newcastle upon Tyne UK
- Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK
| | - Aisha Areibi
- School of Dental Sciences Newcastle University Newcastle upon Tyne UK
- Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK
| | - Paiboon Jitprasertwong
- School of Dental Sciences Newcastle University Newcastle upon Tyne UK
- Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK
| | - Rana Al‐Shahwani
- School of Dental Sciences Newcastle University Newcastle upon Tyne UK
- Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK
| | - Jolanta Weaver
- Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK
| | - Roy Taylor
- Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK
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17
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Tian J, Liu C, Zheng X, Jia X, Peng X, Yang R, Zhou X, Xu X. Porphyromonas gingivalis Induces Insulin Resistance by Increasing BCAA Levels in Mice. J Dent Res 2020; 99:839-846. [PMID: 32176550 DOI: 10.1177/0022034520911037] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Insulin resistance is one of the critical pathogeneses of type 2 diabetes mellitus (T2DM). Elevated levels of plasma branched-chain amino acids (BCAAs) are associated with insulin resistance. Recent studies have demonstrated the role of Porphyromonas gingivalis in the development of insulin resistance. However, the mechanisms by which P. gingivalis induces insulin resistance are still unclear. The purpose of this study was to investigate whether P. gingivalis induces insulin resistance through BCAA biosynthesis. We established a murine model of periodontitis by infecting mice with P. gingivalis. Alveolar bone loss, insulin sensitivity, and the plasma level of BCAAs were measured. A P. gingivalis BCAA aminotransferase-deficient strain (∆bcat) was constructed, and its kinetic growth, biofilm formation, and in vivo colonization were compared with its wild-type strain. Alveolar bone loss, insulin sensitivity, and the plasma level of BCAAs of the mice infected with either wild-type strain or ∆bcat strain were further measured. We found that periodontal infection with P. gingivalis significantly upregulated the plasma level of BCAAs and aggravated the high-fat diet (HFD)-induced insulin resistance. Bcat deletion did not alter the growth, biofilm formation, and in vivo colonization of P. gingivalis. More important, the ∆bcat strain was unable to upregulate the plasma level of BCAAs and induce insulin resistance in HFD-fed mice. These findings suggest that the BCAA biosynthesis of P. gingivalis plays a critical role in the development of insulin resistance in the HFD-fed mice. The BCAA biosynthesis pathways may provide a potential target for the disruption of linkage between periodontitis and T2DM.
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Affiliation(s)
- J Tian
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - C Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Periodontology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Zheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Jia
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Peng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - R Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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18
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Bazyar H, Maghsoumi-Norouzabad L, Yarahmadi M, Gholinezhad H, Moradi L, Salehi P, Haghighi-zadeh MH, Zare Javid A. The Impacts of Synbiotic Supplementation on Periodontal Indices and Biomarkers of Oxidative Stress in Type 2 Diabetes Mellitus Patients with Chronic Periodontitis Under Non-Surgical Periodontal Therapy. A Double-Blind, Placebo-Controlled Trial. Diabetes Metab Syndr Obes 2020; 13:19-29. [PMID: 32021348 PMCID: PMC6954633 DOI: 10.2147/dmso.s230060] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/10/2019] [Indexed: 12/19/2022] Open
Abstract
AIM The aim of the current study was to investigate that combination of the synbiotic supplementation in adjunct with non-surgical periodontal therapy (NSPT) is useful in treating periodontitis and biomarkers of oxidative stress in type 2 diabetes mellitus (T2DM) patients. METHODS In this study, 47 patients suffering from DM and CP were recruited and randomly assigned to two groups. The intervention (n= 23) and control (n=24) groups received either multispecies probiotic supplement plus 100 mg fructo-oligosaccharide (500 mg in each capsule) or placebo capsule containing 500 mg wheat flour, respectively, every day for 8 weeks. All subjects were treated with NSPT during the intervention period. Serum levels of interleukin-1β (IL-1β), malondialdehyde (MDA), total antioxidant capacity (TAC), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and periodontal indices including clinical attachment loss (CAL), pocket depth (PD) (main outcome), BOP, and plaque index were measured before and after the intervention. RESULTS Supplementation with the synbiotic with NSPT led to a significant decrease in the levels of IL-1β, MDA, plaque index, PD, and CAL in the intervention group post-intervention (p < 0.05). The serum levels of TAC, SOD, and GPx were significantly increased in the intervention group compared with the baseline (p < 0.05). Consumption of synbiotic with NSPT, compared to the control, resulted in a significant decrease in the mean changes of IL-1β, MDA, and CAL (p < 0.05). Also, the mean changes of TAC and GPx were significantly higher in the intervention group compared with the control group (p < 0.05). Also, in the intervention group was seen a significant reduction in plaque index (p = 0.035) and BOP (p = 0.04) compared with the control group. CONCLUSION It was observed that synbiotic supplementation with NSPT may be beneficial in improving inflammatory, antioxidant, and periodontal status in T2DM patients with CP.
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Affiliation(s)
- Hadi Bazyar
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Leila Maghsoumi-Norouzabad
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Yarahmadi
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hassan Gholinezhad
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Leila Moradi
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parvin Salehi
- Department of Periodontology, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Ahmad Zare Javid
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Correspondence: Ahmad Zare Javid Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IranTel +98 914 317 6237 Email
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A comparative clinical, microbiological and glycemic analysis of photodynamic therapy and Lactobacillus reuteri in the treatment of chronic periodontitis in type-2 diabetes mellitus patients. Photodiagnosis Photodyn Ther 2019; 29:101629. [PMID: 31870899 DOI: 10.1016/j.pdpdt.2019.101629] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/03/2019] [Accepted: 12/18/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Evidence indicates that patients with type 2 diabetes mellitus (DM) exhibit impaired wound healing and are at higher risk for periodontal disease. In DM patients, adjunctive periodontal treatment provides small but statistically significant benefits in terms of reductions in clinical periodontal parameters. This study incorporates antimicrobial and immune modulatory treatment approach specifically targeted at these patients. PURPOSE To evaluate and compare the clinical periodontal, microbiological and HbA1c levels with the use of photodynamic therapy (PDT) and probiotic therapy (PT) as adjunct to root surface debridement (RSD) in the treatment of periodontitis in DM. MATERIALS AND METHODS Demographic data was collected using a questionnaire. Treatment-wise, chronic periodontitis with 2DM patients were subdivided into: (i) Group-A: Patients that underwent RSD with adjunct PDT; (ii) Group-B: Patients that underwent RSD with adjunct PT and; (iii) Group-C: RSD alone. In all groups, probing depth (PD), plaque scores (PS), bleeding on probing (BOP) and clinical attachment level (CAL) gain were measured at baseline and 3 months. Microbiological data consisted the assessment of detection percentage of Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola. RESULTS A total of 58 patients completed the trial. All clinical and microbiological parameters showed statistically significant reduction from baseline to 3 months in all groups (p < 0.05). On inter-group comparison, the proportion of PD with ≥4 mm and ≥5 mm showed statistically significant reduction for Group-A compared to Group-B and Group-C (p < 0.01). Only Group-A showed statistically significant reduction in percentage of HbA1c levels from baseline to 3 months (p < 0.05). Groups A and B showed significantly higher reductions for all the three bacteria compared to Group-C (p < 0.05). However, this reduction was comparable between Groups-A and B, respectively (p > 0.05). CONCLUSION PDT showed additional benefit in deep periodontal pockets and slightly modest reduction in HbA1c levels in DM patients. Further clinical trials are required with large sample size and longer follow up duration to ascertain the findings of the present clinical study.
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20
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The effect of photobiomodulation therapy on nonsurgical periodontal treatment in patients with type 2 diabetes mellitus: a randomized controlled, single-blind, split-mouth clinical trial. Lasers Med Sci 2019; 35:497-504. [DOI: 10.1007/s10103-019-02897-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 09/29/2019] [Indexed: 10/25/2022]
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21
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Martínez-Aguilar VM, Carrillo-Ávila BA, Sauri-Esquivel EA, Guzmán-Marín E, Jiménez-Coello M, Escobar-García DM, Pozos-Guillén A. Quantification of TNF- α in Patients with Periodontitis and Type 2 Diabetes. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7984891. [PMID: 31355282 PMCID: PMC6637683 DOI: 10.1155/2019/7984891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/24/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The present study aimed to compare variations in quantified tumor necrosis factor-alpha (TNF-α) levels in patients with periodontitis stage 2 grade B (POD2B) and/or type 2 diabetes (T2D) and to identify any relationships between this cytokine and these diseases. METHODS Levels of the cytokine TNF-α in gingival crevicular fluid in patients with POD2B and/or T2D were evaluated. A total of 160 subjects were distributed into four groups: those with POD2B (n=44); those with T2D (n=37); those with POD2B/T2D (n=40); and healthy subjects (n=39). Glycosylated hemoglobin (HbA1c) and blood glucose (BG) levels were quantified in each subject. Data were collected on body mass index (BMI), loss of insertion (LI), and probe depth (PD). Gingival crevicular fluid samples were collected from the most acutely affected periodontal pocket and gingival sulcus in each subject, and TNF-α was quantified by multiplex analysis. RESULTS Kruskal Wallis tests was used to identify differences in TNF-α levels, LI, PD, BMI, BG, and HbA1c by group. Differences (p<0.001) were found for LI, PD, BG, and HbA1c. A Spearman test was used to calculate possible correlations between TNF-α levels and LI or PD identified a weak but significant negative correlation of TNF-α with LI (Rho=-0199; p=0.012), and a moderately positive correlation of LI with PD (Rho=0.509; p < 0.001). CONCLUSIONS No variation was found between TNF-α levels and the presence of POD2B, POD2B/T2D, or T2D, suggesting the absence of any direct relationship between progression of these diseases and TNF-α levels. However, a correlation was present between low TNF-α concentrations and greater LI.
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Affiliation(s)
- Víctor M. Martínez-Aguilar
- Department of Specialization in Periodontology, Faculty of Dentistry, Autonomous University of Yucatan, Mérida, YUC 97000, Mexico
| | - Bertha A. Carrillo-Ávila
- Department of Specialization in Periodontology, Faculty of Dentistry, Autonomous University of Yucatan, Mérida, YUC 97000, Mexico
| | - Eduardo A. Sauri-Esquivel
- Department of Specialization in Periodontology, Faculty of Dentistry, Autonomous University of Yucatan, Mérida, YUC 97000, Mexico
| | - Eugenia Guzmán-Marín
- Cellular Biology Laboratory, Regional Research Center “Dr. Hideyo Noguchi”, University of Yucatan, Mérida, YUC 97000, Mexico
| | - Matilde Jiménez-Coello
- Cellular Biology Laboratory, Regional Research Center “Dr. Hideyo Noguchi”, University of Yucatan, Mérida, YUC 97000, Mexico
| | - Diana María Escobar-García
- Basic Sciences Laboratory, Faculty of Dentistry, San Luis Potosi University, San Luis Potosí, SLP 78290, Mexico
| | - Amaury Pozos-Guillén
- Basic Sciences Laboratory, Faculty of Dentistry, San Luis Potosi University, San Luis Potosí, SLP 78290, Mexico
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Alsahhaf A, Alshiddi IF, Alshagroud RS, Al-Aali KA, Vohra F, Abduljabbar T. Clinical and radiographic indices around narrow diameter implants placed in different glycemic-level patients. Clin Implant Dent Relat Res 2019; 21:621-626. [PMID: 31037825 DOI: 10.1111/cid.12778] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Studies assessing peri-implant clinical and marginal bone resorption (MBR) around narrow diameter implants (NDIs) placed in different glycemic levels are uninvestigated. OBJECTIVE The present 3-year retrospective follow-up investigation was designed to explore clinical and radiographic status of NDIs placed in individuals with different glycemic control levels. MATERIALS AND METHODS Patients with serum hemoglobin A1c (HbA1c) levels ≥6.5% (Group-1), 5.7%-6.4% (Group-2), and 4.0%-5.0% (Group-3) were included. Clinical indices evaluating bleeding on probing (BOP), plaque scores (PI), peri-implant probing depth (PD), and MBR were recorded around NDIs at 1-, 2-, and 3-year follow-up. Serum HbA1c test was carried out for all patients to assess the profile of glycosylated hemoglobin at 1 and 3 years of follow-up. RESULTS A significant reduction in mean HbA1c levels from year 1 to year 3 follow-up period was seen in Group-1 only. PI varied from 0.40 in Group 1 at 2 year and 0.42 at 3-year follow-up to 0.18 at 2-year (P = 0.032) and 0.17 at 3-year (P = 0.018) follow-up, respectively. Greater BOP was noted in Group 1 (0.53) as compared with Group 2 (0.42) and Group 3 (0.21) (P = 0.048) at 3-year follow-up. PD after 3 year ranged from 2.04 mm in Group 3 to 2.32 mm in Group 1 that showed statistically significant difference (P = 0.037). No statistical significant differences were observed in MBR at any time point between the groups. CONCLUSION The results of this short-term follow-up study indicate that NDIs show clinical and radiographic stability, provided oral cleanliness and glycemic levels are relatively maintained. Further long-term clinical studies are needed to evaluate implant stability over the period along with controlled glycemic status.
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Affiliation(s)
- Abdulaziz Alsahhaf
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Ibraheem F Alshiddi
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Rana Saud Alshagroud
- Department of Oral Medicine and Diagnostic Science, King Saud University, Riyadh, Saudi Arabia
| | - Khulud Abdulrahman Al-Aali
- Department of Clinical Dental Sciences, College Of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Fahim Vohra
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Tariq Abduljabbar
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Dengizek Eltas S, Gursel M, Eltas A, Alptekin NO, Ataoglu T. Evaluation of long‐term effects of diode laser application in periodontal treatment of poorly controlled type 2 diabetic patients with chronic periodontitis. Int J Dent Hyg 2019; 17:292-299. [DOI: 10.1111/idh.12384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/14/2019] [Accepted: 01/24/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | - Mihtikar Gursel
- Department of Periodontology, Faculty of Dentistry Selcuk University Konya Turkey
| | - Abubekir Eltas
- Department of Periodontology, Faculty of Dentistry University of Health Science Istanbul Turkey
| | | | - Tamer Ataoglu
- Department of Periodontology, Faculty of Dentistry Selcuk University Konya Turkey
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Hsu Y, Nair M, Angelov N, Lalla E, Lee C. Impact of diabetes on clinical periodontal outcomes following non‐surgical periodontal therapy. J Clin Periodontol 2019; 46:206-217. [DOI: 10.1111/jcpe.13044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/25/2018] [Accepted: 11/28/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Yung‐Ting Hsu
- Division of Graduate Periodontology Department of Graduate Studies University of Detroit Mercy School of Dentistry Detroit Michigan
| | - Maya Nair
- University of Texas at Austin Austin Texas
| | - Nikola Angelov
- Department of Periodontics and Dental Hygiene University of Texas Health Science Center at Houston Houston Texas
| | - Evanthia Lalla
- Division of Periodontics Columbia University College of Dental Medicine New York City New York
| | - Chun‐Teh Lee
- Department of Periodontics and Dental Hygiene University of Texas Health Science Center at Houston Houston Texas
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Al‐Shibani N, Al‐Aali KA, Al‐Hamdan RS, Alrabiah M, Basunbul G, Abduljabbar T. Comparison of clinical peri‐implant indices and crestal bone levels around narrow and regular diameter implants placed in diabetic and non‐diabetic patients: A 3‐year follow‐up study. Clin Implant Dent Relat Res 2019; 21:247-252. [DOI: 10.1111/cid.12712] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Nouf Al‐Shibani
- Department of Periodontics and Community DentistryKing Saud University Riyadh Saudi Arabia
| | - Khulud Abdulrahman Al‐Aali
- Department of ProsthodonticsCollege of Dentistry, Princess Nourah Bint Abdulrahman University Riyadh Saudi Arabia
| | - Rana Sulaiman Al‐Hamdan
- Department of Restorative Dental Science, Operative DivisionCollege of Dentistry, King Saud University Riyadh Saudi Arabia
| | - Mohammed Alrabiah
- Department of Prosthetic Dental ScienceCollege of Dentistry, King Saud University Riyadh Saudi Arabia
| | - Ghadeer Basunbul
- Oral and Maxillofacial Rehabilitation Department, Faculty of DentistryKing Abdul Aziz University Jeddah Saudi Arabia
| | - Tariq Abduljabbar
- Department of Prosthetic Dental ScienceCollege of Dentistry, King Saud University Riyadh Saudi Arabia
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Chandra S, Shashikumar P. Diode Laser - A Novel Therapeutic Approach in the Treatment of Chronic Periodontitis in Type 2 Diabetes Mellitus Patients: A Prospective Randomized Controlled Clinical Trial. J Lasers Med Sci 2018; 10:56-63. [PMID: 31360370 DOI: 10.15171/jlms.2019.09] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Maturity-onset diabetes mellitus affecting the elderly population is marked by insulin resistance and decreased insulin production. The relationship between periodontitis and diabetes is bidirectional. Type 2 diabetic patients are more prone to chronic periodontitis (CP) and severe periodontitis affects the glycemic control in such patients. Recently, dental diode laser has become an effective tool in controlling CP. To date, very few studies have been conducted to check the efficacy of diode laser in control of periodontal destruction in type 2 diabetes mellitus (DM2) patients. Hence, the need of the study was to evaluate whether diode laser helps improvement of periodontal outcome and reduction in anaerobic bacteria in elderly diabetic patients with CP. Methods: Forty DM2 patients with CP were randomized into group A (control): scaling and root planing (SRP) only and group B (test): SRP followed by soft tissue dental diode laser (808 nm) application. Four patients (2 in each group) were lost during follow up. Clinical parameters, plaque samples and glycated hemoglobin levels were evaluated at both baseline and 90 days post-treatment. Results: Improvement in clinical, microbiological and glycemic parameters were noted in the group that received SRP as well as SRP + LANAP (laser-assisted new attachment procedure). The reductions in clinical parameters were statistically significant after 3 months (P<0.001). The microbial analysis of plaque samples for Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) decreased significantly after 3 months in group B than in group A. Glycated hemoglobin level (HbA1c) decreased significantly after 90 days in both the groups (P<0.001) with more reduction in the SRP+LANAP group (6.49%) in comparison to SRP alone (16.25% vs. 9.76%). However, on the intergroup comparison, the difference in HbA1c reduction was nonsignificant. Conclusion: Laser as an adjunct to SRP is an effective procedure for improving clinical and microbiological parameters in maturity onset diabetes mellitus patients with CP. Also, there was a better improvement in glycemic control in the test group compared to control group after 3 months. Hence, medically compromised patients like DM2 with CP with delayed wound healing can effectively be treated by laser as an adjunct to nonsurgical periodontal therapy for better results.
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Affiliation(s)
- Sourav Chandra
- Department of Periodontology & Implantology, Hazaribag College of Dental Sciences & Hospital, Hazaribag, Jharkhand825301, India
| | - Pratibha Shashikumar
- Department of Periodontology, JSS Dental College & Hospital (Constituent College), Jagadguru Sri Shivarathreeshwara University, Mysuru- 570015, Karnataka, India
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Cytokine levels in crevicular fluid associated with compliance during periodontal maintenance therapy. Clin Oral Investig 2018; 23:3517-3526. [DOI: 10.1007/s00784-018-2770-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/05/2018] [Indexed: 12/14/2022]
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Takeda K, Mizutani K, Matsuura T, Kido D, Mikami R, Noda M, Buranasin P, Sasaki Y, Izumi Y. Periodontal regenerative effect of enamel matrix derivative in diabetes. PLoS One 2018; 13:e0207201. [PMID: 30439990 PMCID: PMC6237339 DOI: 10.1371/journal.pone.0207201] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/26/2018] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Kohei Takeda
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Koji Mizutani
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- * E-mail:
| | - Takanori Matsuura
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Daisuke Kido
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Risako Mikami
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Masahiro Noda
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Prima Buranasin
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yoshiyuki Sasaki
- Medical Innovation Promotion Center, Institute of Research, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuichi Izumi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Kocher T, König J, Borgnakke WS, Pink C, Meisel P. Periodontal complications of hyperglycemia/diabetes mellitus: Epidemiologic complexity and clinical challenge. Periodontol 2000 2018; 78:59-97. [DOI: 10.1111/prd.12235] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Jörgen König
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Wenche Sylling Borgnakke
- Department of Periodontics and Oral Medicine; University of Michigan School of Dentistry; Ann Arbor Michigan
| | - Christiane Pink
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Peter Meisel
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
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Buranasin P, Mizutani K, Iwasaki K, Pawaputanon Na Mahasarakham C, Kido D, Takeda K, Izumi Y. High glucose-induced oxidative stress impairs proliferation and migration of human gingival fibroblasts. PLoS One 2018; 13:e0201855. [PMID: 30092096 PMCID: PMC6084939 DOI: 10.1371/journal.pone.0201855] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/23/2018] [Indexed: 12/18/2022] Open
Abstract
Delayed gingival wound healing is widely observed in periodontal patients with diabetes. However, the molecular mechanisms of the impaired function of gingival fibroblasts in diabetes remain unclear. The purpose of this study was to investigate changes in the properties of human gingival fibroblasts (HGFs) under high-glucose conditions. Primary HGFs were isolated from healthy gingiva and cultured with 5.5, 25, 50, and 75 mM glucose for 72 h. In vitro wound healing, 5-ethynyl-2′-deoxyuridine (EdU), and water-soluble tetrazolium salt (WST-8) assays were performed to examine cell migration and proliferation. Lactase dehydrogenase (LDH) levels were measured to determine cytotoxicity. The mRNA expression levels of oxidative stress markers were quantified by real-time PCR. Intracellular reactive oxygen species (ROS) were also measured in live cells. The antioxidant N-acetyl-l-cysteine (NAC, 1 mM) was added to evaluate the involvement of ROS in the glucose effect on HGFs. As a result, the in vitro wound healing assay showed that high glucose levels significantly reduced fibroblast migration and proliferation at 6, 12, 24, 36, and 48 h. The numbers of cells positive for EdU staining were decreased, as was cell viability, at 50 and 75 mM glucose. A significant increase in LDH was proportional to the glucose concentration. The mRNA levels of heme oxygenase-1 and superoxide dismutase-1 and ROS levels were significantly increased in HGFs after 72 h of exposure to 50 mM glucose concentration. The addition of NAC diminished the inhibitory effect of high glucose in the in vitro wound healing assay. The results of the present study show that high glucose impairs the proliferation and migration of HGFs. Fibroblast dysfunction may therefore be caused by high glucose-induced oxidative stress and may explain the delayed gingival wound healing in diabetic patients.
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Affiliation(s)
- Prima Buranasin
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Koji Mizutani
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- * E-mail:
| | - Kengo Iwasaki
- Department of Nanomedicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | | | - Daisuke Kido
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kohei Takeda
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuichi Izumi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Duarte PM, Feres M, Yassine LLS, Soares GMS, Miranda TS, Faveri M, Retamal-Valdes B, Figueiredo LC. Clinical and microbiological effects of scaling and root planing, metronidazole and amoxicillin in the treatment of diabetic and non-diabetic subjects with periodontitis: A cohort study. J Clin Periodontol 2018; 45:1326-1335. [PMID: 30076615 DOI: 10.1111/jcpe.12994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/19/2018] [Accepted: 08/01/2018] [Indexed: 01/03/2023]
Abstract
AIM To evaluate if non-diabetic subjects with periodontitis respond better than subjects with type 2 diabetes to the treatment protocol of scaling and root planing (SRP), metronidazole (MTZ) and amoxicillin (AMX). MATERIAL AND METHODS Diabetic and nondiabetic subjects with severe periodontitis received SRP + MTZ (400 mg/thrice a day [TID]) + AMX (500 mg/TID) for 14 days. Subgingival biofilm samples were analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species. Subjects were monitored at baseline, 3, 6 and 12 months post-therapy. RESULTS Twenty-nine type 2 diabetics and 29 non-diabetic subjects participated of this study. Of the non-diabetics and diabetics, 68.9% and 75.9%, respectively, reached the clinical endpoint for treatment (≤4 sites with probing depth [PD] ≥5 mm) at 1 year post-therapy (p > 0.05). The diabetic group presented lower mean clinical attachment gain from baseline to 1 year post-therapy and higher mean proportions of the red and orange complexes than the non-diabetic group (p < 0.05). CONCLUSIONS Non-diabetic subjects with severe periodontitis did not respond better than type 2 diabetic subjects to the treatment protocol of SRP + MTZ + AMX, both in terms of achieving the clinical endpoint for treatment and of PD improvement. Diabetic subjects exhibited a slightly worse microbiological response and showed a healing process more associated with gingival recession than the non-diabetics.
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Affiliation(s)
- Poliana Mendes Duarte
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Magda Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Lina Lameh Smeili Yassine
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | | | - Tamires Szeremeske Miranda
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Marcelo Faveri
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Belen Retamal-Valdes
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
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Barbosa FI, Araújo PV, Machado LJC, Magalhães CS, Guimarães MMM, Moreira AN. Effect of photodynamic therapy as an adjuvant to non-surgical periodontal therapy: Periodontal and metabolic evaluation in patients with type 2 diabetes mellitus. Photodiagnosis Photodyn Ther 2018; 22:245-250. [DOI: 10.1016/j.pdpdt.2018.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 02/05/2023]
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Tsobgny-Tsague NF, Lontchi-Yimagou E, Nana ARN, Tankeu AT, Katte JC, Dehayem MY, Bengondo CM, Sobngwi E. Effects of nonsurgical periodontal treatment on glycated haemoglobin on type 2 diabetes patients (PARODIA 1 study): a randomized controlled trial in a sub-Saharan Africa population. BMC Oral Health 2018; 18:28. [PMID: 29482543 PMCID: PMC5828384 DOI: 10.1186/s12903-018-0479-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/29/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There is a burglar association between diabetes and periodontitis. Many studies has shown that periodontitis treatment can help improving glycemic control in diabetes patients but little evidence of non-surgical treatment benefit is available in sub Saharan african diabetes patients. We aimed to assess the effects of non-surgical periodontal treatment (NSPT) of chronic periodontitis on glycaemic control in poorly controlled type 2 diabetes patients (T2D) in a sub-Saharan Africa urban setting. METHODS A total of 34 poorly controlled T2D patients with chronic periodontitis aged 51.4 ± 8.8 years (mean ± SD), with known duration of diabetes of 55.5 ± 42.6 months, and HbA1c of 9.3 ± 1.3% were randomly assigned to two groups. The treatment group (Group 1, n = 17) received immediate ultrasonic scaling, scaling and root planning along with subgingival 10% povidone iodine irrigation, whereas the control group (Group 2, n = 17) was assigned to receive delayed periodontal treatment 3 months later. Pharmacological treatment was unchanged and all participants received the same standardized education session on diabetes management and dental hygiene. The primary outcome was the 3-month change in HbA1c from baseline. Plaque index (PI), gingival bleeding index (GBI), pocket depth (PD), clinical attachment loss (CAL) were also assessed prior to, at 6 and 12 weeks after enrolment. RESULTS Two subjects in each group were excluded from the study. Data were analyzed on thirty patients (15 per group). Non-surgical periodontal treatment with education for better dental hygiene (group 1) significantly improved all periodontal parameters whereas education only (group 2) improved only the plaque index among all periodontal parameters. Immediate non-surgical periodontal treatment induced a reduction of HbA1c levels by 3.0 ± 2.4 points from 9.7 ± 1.6% at baseline to 6.7 ± 2.0% 3 months after NSPT, (p ˂ 0.001) but the change was not significant in group 2, from mean 8.9 ± 0.9% at baseline vs 8.1 ± 2.6% after 3 months (p = 0.24). CONCLUSION Non-surgical periodontal treatment markedly improved glycaemic control with an attributable reduction of 2.2 points of HbA1c in poorly controlled T2D patients in a sub Saharan setting. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02745015 Date of registration: July 17, 2016 'Retrospectively registered'.
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Affiliation(s)
- Nadia-Flore Tsobgny-Tsague
- Department of periodontology, oral and maxillofacial surgery, Faculty of Medicine and Biomedical Sciences of The University of Yaoundé 1, Yaoundé, Cameroon
- National Obesity Center, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Eric Lontchi-Yimagou
- Diabetes Research and Training Center, Division of Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Laboratory of Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, Yaoundé, Cameroon
| | - Arnel Redon Nana Nana
- Department of periodontology, oral and maxillofacial surgery, Faculty of Medicine and Biomedical Sciences of The University of Yaoundé 1, Yaoundé, Cameroon
- National Obesity Center, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Aurel T Tankeu
- National Obesity Center, Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Internal Medicine and specialties, Faculty of Medicine and Biomedical Sciences of The University of Yaoundé 1, Yaoundé, Cameroon
| | - Jean Claude Katte
- Laboratory of Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, Yaoundé, Cameroon
- Department of Public Health, Faculty of Medicine and Biomedical Sciences of The University of Yaoundé 1, Yaoundé, Cameroon
| | - Mesmin Y Dehayem
- National Obesity Center, Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Internal Medicine and specialties, Faculty of Medicine and Biomedical Sciences of The University of Yaoundé 1, Yaoundé, Cameroon
| | - Charles Messanga Bengondo
- Department of periodontology, oral and maxillofacial surgery, Faculty of Medicine and Biomedical Sciences of The University of Yaoundé 1, Yaoundé, Cameroon
- Dental surgery Unit, Yaoundé Teaching Hospital, Yaoundé, Cameroon
| | - Eugene Sobngwi
- National Obesity Center, Yaoundé Central Hospital, Yaoundé, Cameroon.
- Laboratory of Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé 1, Yaoundé, Cameroon.
- Department of Internal Medicine and specialties, Faculty of Medicine and Biomedical Sciences of The University of Yaoundé 1, Yaoundé, Cameroon.
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Mauri-Obradors E, Merlos A, Estrugo-Devesa A, Jané-Salas E, López-López J, Viñas M. Benefits of non-surgical periodontal treatment in patients with type 2 diabetes mellitus and chronic periodontitis: A randomized controlled trial. J Clin Periodontol 2018; 45:345-353. [DOI: 10.1111/jcpe.12858] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 12/11/2022]
Affiliation(s)
| | - Alexandra Merlos
- Department of Pathology and Experimental Therapeutics; Medical School; IDIBELL-University of Barcelona; Barcelona Spain
| | | | - Enric Jané-Salas
- Department of Dentistry; Dental School; University of Barcelona; Barcelona Spain
- Oral Medicine Unit; Department of Dentistry; Faculty of Medicine and Health Sciences (Dental School) and Dental Hospital Barcelona University (University of Barcelona) and Health and Masticatory System Group (Bellvitge Biomedical Research, Institute) IDIBELL; Barcelona Spain
| | - José López-López
- Department of Dentistry; Dental School; University of Barcelona; Barcelona Spain
- Oral Medicine Unit; Department of Dentistry; Faculty of Medicine and Health Sciences (Dental School) and Dental Hospital Barcelona University (University of Barcelona) and Health and Masticatory System Group (Bellvitge Biomedical Research, Institute) IDIBELL; Barcelona Spain
| | - Miguel Viñas
- Department of Pathology and Experimental Therapeutics; Medical School; IDIBELL-University of Barcelona; Barcelona Spain
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35
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Zare Javid A, Maghsoumi-Norouzabad L, Ashrafzadeh E, Yousefimanesh HA, Zakerkish M, Ahmadi Angali K, Ravanbakhsh M, Babaei H. Impact of Cranberry Juice Enriched with Omega-3 Fatty Acids Adjunct with Nonsurgical Periodontal Treatment on Metabolic Control and Periodontal Status in Type 2 Patients with Diabetes with Periodontal Disease. J Am Coll Nutr 2017; 37:71-79. [DOI: 10.1080/07315724.2017.1357509] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Ahmad Zare Javid
- Nutrition and Metabolic Diseases Research Center & Hyperlipidemia Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Leila Maghsoumi-Norouzabad
- Nutrition and Metabolic Diseases Research Center & Hyperlipidemia Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Nutrition, School of Para Medicine, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Elnaz Ashrafzadeh
- Nutrition and Metabolic Diseases Research Center & Hyperlipidemia Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Nutrition, School of Para Medicine, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Hojat Allah Yousefimanesh
- Department of Periodontology, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehrnoosh Zakerkish
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kambiz Ahmadi Angali
- Biostatistics Division, Health Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Ravanbakhsh
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hosein Babaei
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Kido D, Mizutani K, Takeda K, Mikami R, Matsuura T, Iwasaki K, Izumi Y. Impact of diabetes on gingival wound healing via oxidative stress. PLoS One 2017; 12:e0189601. [PMID: 29267310 PMCID: PMC5739411 DOI: 10.1371/journal.pone.0189601] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/28/2017] [Indexed: 12/21/2022] Open
Abstract
The aim of this study is to investigate the mechanisms linking high glucose to gingival wound healing. Bilateral wounds were created in the palatal gingiva adjacent to maxillary molars of control rats and rats with streptozotocin-induced diabetes. After evaluating postsurgical wound closure by digital imaging, the maxillae including wounds were resected for histological examinations. mRNA expressions of angiogenesis, inflammation, and oxidative stress markers in the surgical sites were quantified by real-time polymerase chain reaction. Primary fibroblast culture from the gingiva of both rats was performed in high glucose and normal medium. In vitro wound healing and cell proliferation assays were performed. Oxidative stress marker mRNA expressions and reactive oxygen species production were measured. Insulin resistance was evaluated via PI3K/Akt and MAPK/Erk signaling following insulin stimulation using Western blotting. To clarify oxidative stress involvement in high glucose culture and cells of diabetic rats, cells underwent N-acetyl-L-cysteine treatment; subsequent Akt activity was measured. Wound healing in diabetic rats was significantly delayed compared with that in control rats. Nox1, Nox2, Nox4, p-47, and tumor necrosis factor-α mRNA levels were significantly higher at baseline in diabetic rats than in control rats. In vitro study showed that cell proliferation and migration significantly decreased in diabetic and high glucose culture groups compared with control groups. Nox1, Nox2, Nox4, and p47 expressions and reactive oxygen species production were significantly higher in diabetic and high glucose culture groups than in control groups. Akt phosphorylation decreased in the high glucose groups compared with the control groups. Erk1/2 phosphorylation increased in the high glucose groups, with or without insulin treatment, compared with the control groups. Impaired Akt phosphorylation partially normalized after antioxidant N-acetyl-L-cysteine treatment. Thus, delayed gingival wound healing in diabetic rats occurred because of impaired fibroblast proliferation and migration. Fibroblast dysfunction may occur owing to high glucose-induced insulin resistance via oxidative stress.
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Affiliation(s)
- Daisuke Kido
- Department of Periodontology, Graduate school of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Koji Mizutani
- Department of Periodontology, Graduate school of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- * E-mail:
| | - Kohei Takeda
- Department of Periodontology, Graduate school of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Risako Mikami
- Department of Periodontology, Graduate school of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takanori Matsuura
- Department of Periodontology, Graduate school of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kengo Iwasaki
- Department of Nanomedicine, Graduate school of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuichi Izumi
- Department of Periodontology, Graduate school of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Gap Analysis of Older Adults With Type 2 Diabetes Receiving Nonsurgical Periodontal Therapy. J Evid Based Dent Pract 2017; 17:335-349. [DOI: 10.1016/j.jebdp.2017.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 01/16/2023]
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Arya S, Duhan J, Tewari S, Sangwan P, Ghalaut V, Aggarwal S. Healing of Apical Periodontitis after Nonsurgical Treatment in Patients with Type 2 Diabetes. J Endod 2017; 43:1623-1627. [PMID: 28803674 DOI: 10.1016/j.joen.2017.05.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/20/2017] [Accepted: 05/26/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The purpose of this prospective study was to compare the success of primary root canal treatment between type 2 diabetic and nondiabetic patients and to investigate the effect of periapical healing on glycated hemoglobin (HbA1c) in type 2 diabetic patients with apical periodontitis. METHODS Sixty mandibular molars with necrotic pulps and apical radiolucency (size ≥ 2 mm × 2 mm) were included in the study. Based on the HbA1c levels, patients were divided into 2 groups: type 2 diabetic (HbA1c ≥6.5%) and nondiabetic (HbA1c <6.5%). Forty-six teeth were evaluated at the 12-month follow-up time period. The primary outcome measure was the change in apical bone density as determined by the periapical index. RESULTS Both the diabetic and nondiabetic group depicted a significant reduction in the periapical score after endodontic treatment at the 12-month follow-up (P < .05). Significantly less periapical healing was observed in the diabetic group (43%) compared with the nondiabetic group (80%) at the 12-month follow-up (P < .05). HbA1c levels in the diabetic group increased at each follow-up after endodontic treatment. CONCLUSIONS Diabetes mellitus may have a negative impact on the outcome of endodontic treatment in terms of periapical healing. Nonsurgical endodontic treatment did not improve HbA1c levels in patients with type 2 diabetes.
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Affiliation(s)
- Suman Arya
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Jigyasa Duhan
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India.
| | - Sanjay Tewari
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Pankaj Sangwan
- Department of Conservative Dentistry and Endodontics, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Veena Ghalaut
- Department of Biochemistry, Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Sameer Aggarwal
- Department of Medicine/Endocrinology, Post Graduate Institute of Medical Sciences, Rohtak, India
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Goel K, Pradhan S, Bhattarai MD. Effects of nonsurgical periodontal therapy in patients with moderately controlled type 2 diabetes mellitus and chronic periodontitis in Nepalese population. Clin Cosmet Investig Dent 2017; 9:73-80. [PMID: 28761379 PMCID: PMC5522660 DOI: 10.2147/ccide.s138338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives Despite several investigations, evidence is still controversial regarding the effect of periodontal treatment on diabetes. This study evaluates and compares the effect on glycemic control and periodontal status with or without nonsurgical periodontal therapy in patients with type 2 diabetes mellitus and chronic periodontitis in a Nepalese population. Materials and methods A total of 82 patients attending the diabetes clinic and fulfilling enrollment criteria with moderate to severe periodontitis were selected. They were assigned in an alternative sequence, into test and control group. Both groups were instructed to continue with their medical treatment without modifications. Scaling and root surface debridement were performed in the test group whereas the control group received oral hygiene instructions with no treatment during the 3-month study period. Results There were 41 participants in each group with the mean age of 50.66±7.70 and 53.80±9.16 years, average diabetes duration of 6.32±4.21 and 6.24±4.00 years, mean body mass index of 24.78±1.85 and 24.6±1.79 kg/m2, and glycated hemoglobin (HbA1c) level of 6.71±0.50% and 6.80±0.45%, in the test and control group, respectively. After 3 months, there was significant reduction in HbA1c levels in the test group compared to the control group (p=0.029). Clinical periodontal parameters of gingival index, probing depth (PD), and clinical attachment level (CAL) significantly improved in the test group (p<0.001) with PD reduction by 0.9 mm and gain in CAL by 0.3 mm compared to the control group (p>0.001) who showed an increase by 0.05 mm. Conclusion This study showed that nonsurgical periodontal therapy may have a beneficial effect on HbA1c level in moderately controlled type 2 diabetic patients.
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Affiliation(s)
- Khushboo Goel
- Department of Periodontology and Oral Implantology, College of Dental Surgery, B.P. Koirala Institute of Health Sciences, Dharan
| | - Shaili Pradhan
- Department of Dental Surgery, Periodontics Unit, Bir Hospital
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Nishihara U, Tanabe N, Nakamura T, Okada Y, Nishida T, Akihara S. A periodontal disease care program for patients with type 2 diabetes: A randomized controlled trial. J Gen Fam Med 2017; 18:249-257. [PMID: 29264035 PMCID: PMC5689414 DOI: 10.1002/jgf2.58] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/26/2016] [Indexed: 01/26/2023] Open
Abstract
Background Diabetes and periodontitis are interrelated, and patient education and guidance are important. Therefore, we conducted a periodontitis care program for patients with type 2 diabetes to provide education about diabetes and periodontitis and to promote self‐care skills, and we evaluated the effectiveness of this program. Methods This was a randomized controlled trial. Thirty‐eight and 39 adult patients diagnosed with type 2 diabetes were allocated to the intervention and control groups, respectively. The program comprised content that promoted optimal behavior for the improvement of diabetes and periodontitis. Periodontitis status, diabetes status, tumor necrosis factor‐α levels, self‐efficacy in relation to periodontitis, and teeth‐brushing behaviors were evaluated before and after the intervention program. Results After the intervention program, the intervention group demonstrated significant improvements in bleeding on probing, which was used to evaluate periodontitis status (F=7.919; P<.01), and in clinic visit (F=11.765; P<.01), brushing teeth (F=21.606; P<.01), and meal (F=10.884; P<.01) scores on the Self‐Efficacy Scale for Self‐care among Periodontal Disease Patients; patients in the intervention group also exhibited improvements in dental health‐related behaviors (F=7.141; P<.01). Conclusions These results suggest that the intervention program was effective at improving periodontitis, self‐efficacy in relation to periodontitis, and dental health‐related behaviors in patients with type 2 diabetes.
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Affiliation(s)
- Utako Nishihara
- Graduate School of Nursing Osaka City University Osaka Japan.,Department of Nursing Kobe City Hospital Organization Kobe City Medical Center West Hospital Kobe Japan
| | - Nozomi Tanabe
- Department of Nursing Kobe City Hospital Organization Kobe City Medical Center West Hospital Kobe Japan
| | - Takehiro Nakamura
- Division of Diabetes Kobe City Hospital Organization Kobe City Medical Center West Hospital Kobe Japan
| | - Yuko Okada
- Division of Diabetes and Endocrinology Internal Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Tetsuya Nishida
- Department of Dentistry Oral and Maxillofacial Surgery Kobe City Hospital Organization Kobe City Medical Center West Hospital Kobe Japan
| | - Shiho Akihara
- Graduate School of Nursing Osaka City University Osaka Japan
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Abstract
Ample evidence strongly supports the fact that periodontal disease is a major risk factor for various systemic diseases namely cardio-vascular disease, diabetes mellitus, etc. Recently, investigators focussed on exploring the link between chronic periodontitis (CP) and erectile dysfunction (ED) by contributing to the endothelial dysfunction. Both the diseases share common risk factors. Various studies conducted in different parts of the world in recent years reported the evidence linking this relationship as well as improvement in ED with periodontal treatment. Systemic exposure to the periodontal pathogen and periodontal infection-induced systemic inflammation was thought to associate with these conditions. The objective of this review was to highlight the evidence of the link between CP and ED and the importance of oral health in preventing the systemic conditions.
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Affiliation(s)
- Vijendra P Singh
- Department of Periodontics, Faculty of Dentistry, Melaka Manipal Medical College, Manipal University, Melaka, Malaysia
| | - Sunil K Nettemu
- Department of Periodontics, Faculty of Dentistry, Melaka Manipal Medical College, Manipal University, Melaka, Malaysia
| | - Sowmya Nettem
- Department of Periodontics, Faculty of Dentistry, Melaka Manipal Medical College, Manipal University, Melaka, Malaysia
| | - Rajesh Hosadurga
- Department of Periodontics, Faculty of Dentistry, Melaka Manipal Medical College, Manipal University, Melaka, Malaysia
| | - Sangeeta U Nayak
- Department of Periodontics, Manipal College of Dental Sciences, Manipal University, Mangalore, India
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Stadler AF, Angst PDM, Arce RM, Gomes SC, Oppermann RV, Susin C. Gingival crevicular fluid levels of cytokines/chemokines in chronic periodontitis: a meta-analysis. J Clin Periodontol 2016; 43:727-45. [PMID: 27027257 DOI: 10.1111/jcpe.12557] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2016] [Indexed: 12/14/2022]
Abstract
AIMS To compare gingival crevicular fluid (GCF) cytokines/chemokines levels between periodontally healthy subjects and subjects diagnosed with chronic periodontitis (ChP), before and after non-surgical periodontal treatment, and to establish their predictive value for periodontal disease progression. METHODS Studies indexed in MEDLINE and EMBASE published in English, Portuguese and Spanish were eligible for this review. Database searches up to December 2015, and manual search of the reference list from reviews and selected articles was performed. Only studies providing data on GCF cytokines/chemokines levels in subjects diagnosed with ChP and periodontally healthy controls were included. Cross-sectional, case series, single-arm clinical studies, randomized controlled trials and prospective/retrospective cohort studies were included. Meta-analyses were conducted for those cytokines/chemokines with at least three available studies. RESULTS GCF levels of IL-1β, IL-6, IFN-γ and MCP-1/CCL2 were significantly higher in subjects diagnosed with ChP than periodontally healthy subjects. A significant decrease in GCF levels of IL-1β and IL-17 was observed after non-surgical periodontal treatment, whereas a significant increase was observed for IL-4. CONCLUSION Evidence for significant differences between periodontal health and ChP was observed for a few cytokines and one chemokine. No conclusions could be drawn with regards to increased risk of disease progression.
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Affiliation(s)
- Amanda F Stadler
- Section of Periodontology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.,Department of Periodontics, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Patrícia D M Angst
- Section of Periodontology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roger M Arce
- Department of Periodontics, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Sabrina C Gomes
- Section of Periodontology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rui V Oppermann
- Section of Periodontology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Cristiano Susin
- Department of Periodontics, Dental College of Georgia, Augusta University, Augusta, GA, USA
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Taylor JJ, Preshaw PM, Lalla E. A review of the evidence for pathogenic mechanisms that may link periodontitis and diabetes. J Clin Periodontol 2016; 40 Suppl 14:S113-34. [PMID: 23627323 DOI: 10.1111/jcpe.12059] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/16/2022]
Abstract
AIMS To review the evidence for the molecular and cellular processes that may potentially link periodontal disease and diabetes. The pathogenic roles of cytokines and metabolic molecules (e.g. glucose, lipids) are explored and the role of periodontal bacteria is also addressed. Paradigms for bidirectional relationships between periodontitis and diabetes are discussed and opportunities for elaborating these models are considered. METHODS Database searches were performed using MeSH terms, keywords, and title words. Studies were evaluated and summarized in a narrative review. RESULTS Periodontal microbiota appears unaltered by diabetes and there is little evidence that it may influence glycaemic control. Small-scale clinical studies and experiments in animal models suggest that IL-1β, TNF-α, IL-6, OPG and RANKL may mediate periodontitis in diabetes. The AGE-RAGE axis is likely an important pathway of tissue destruction and impaired repair in diabetes-associated periodontitis. A role for locally activated pro-inflammatory factors in the periodontium, which subsequently impact on diabetes, remains speculative. CONCLUSION There is substantial information on potential mechanistic pathways which support a close association between diabetes and periodontitis, but there is a real need for longitudinal clinical studies using larger patient groups, integrated with studies of animal models and cells/tissues in vitro.
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Affiliation(s)
- John J Taylor
- Centre for Oral Health Research and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
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Factors associated with the clinical response to nonsurgical periodontal therapy in people with type 2 diabetes mellitus. J Am Dent Assoc 2016; 145:1227-39. [PMID: 25429036 DOI: 10.14219/jada.2014.92] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a growing health problem worldwide. People with T2DM are at risk of experiencing periodontitis and likely require treatment. Using data from the national multicenter Diabetes and Periodontal Therapy Trial (DPTT), the authors assessed patient-based characteristics associated with the clinical response to nonsurgical therapy. METHODS The DPTT investigators randomly assigned adults with T2DM (hemoglobin A1c [HbA1c] ≥ 7 percent and < 9 percent) and moderate to advanced periodontitis to receive immediate or delayed therapy (scaling and root planing, oral hygiene instruction, chlorhexidine rinse). The investigators assessed probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and medical conditions at baseline, three months and six months. Six-month changes in mean PD, CAL and BOP defined the treatment response. Complete data were available for 473 of 514 DPTT participants. The authors used multiple regression models to evaluate participant-level factors associated with the response. RESULTS More severe baseline PD, CAL and BOP were associated with greater improvements in these same measurements (P < .0001). Hispanic participants experienced greater improvements in PD and CAL than did non-Hispanic participants (P < .0001). Obese participants (those with a body mass index > 30 kilograms per square meter) experienced greater reductions in PD and BOP than did participants who were not obese (P < .001). Age, sex, HbA1c values, diabetes duration, and smoking were not associated with change in any outcome (P > .1). CONCLUSIONS In patients with T2DM, baseline disease severity was associated with the clinical response to nonsurgical periodontal therapy. Body mass index and Hispanic ethnicity-but not glycemic control, diabetes duration or smoking-also may be useful in predicting clinical changes in this population.
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Botero JE, Rodríguez C, Agudelo-Suarez AA. Periodontal treatment and glycaemic control in patients with diabetes and periodontitis: an umbrella review. Aust Dent J 2016; 61:134-48. [DOI: 10.1111/adj.12413] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 12/28/2022]
Affiliation(s)
- JE Botero
- Faculty of Dentistry; Universidad de Antioquia; Medellín Colombia
| | - C Rodríguez
- Faculty of Dentistry; Universidad de Antioquia; Medellín Colombia
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Gurav AN. Management of diabolical diabetes mellitus and periodontitis nexus: Are we doing enough? World J Diabetes 2016; 7:50-66. [PMID: 26962409 PMCID: PMC4766246 DOI: 10.4239/wjd.v7.i4.50] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/16/2015] [Accepted: 01/19/2016] [Indexed: 02/05/2023] Open
Abstract
Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease is bacterial biofilm, which accumulates on the teeth as dental plaque. In addition to the biofilm microorganisms, other factors such as environmental, systemic and genetic are also responsible in progression of periodontitis. Diabetes mellitus (DM) is metabolic disorder which has an impact on the global health. DM plays a crucial role in the pathogenesis of periodontitis. Periodontitis is declared as the “sixth” major complication of DM. Evidence based literature has depicted an enhanced incidence and severity of periodontitis in subjects with DM. A “two way” relationship has been purported between periodontitis and DM. Mutual management of both conditions is necessary. Periodontal therapy (PT) may assist to diminish the progression of DM and improve glycemic control. Various advanced technological facilities may be utilized for the purpose of patient education and disease management. The present paper clarifies the etio-pathogenesis of periodontitis, establishing it as a complication of DM and elaborating the various mechanisms involved in the pathogenesis. The role of PT in amelioration of DM and application of digital communication will be discussed. Overall, it is judicious to create an increased patient cognizance of the periodontitis-DM relationship. Conjunctive efforts must be undertaken by the medical and oral health care professionals for the management of periodontitis affected DM patients.
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Ramos UD, Ayub LG, Reino DM, Grisi MF, Taba M, Souza SL, Palioto DB, Novaes AB. Antimicrobial photodynamic therapy as an alternative to systemic antibiotics: results from a double-blind, randomized, placebo-controlled, clinical study on type 2 diabetics. J Clin Periodontol 2016; 43:147-55. [DOI: 10.1111/jcpe.12498] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Umberto D. Ramos
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
| | - Lauro G. Ayub
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
| | - Danilo M. Reino
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
| | - Márcio F.M. Grisi
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
| | - Mário Taba
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
| | - Sérgio L.S. Souza
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
| | - Daniela B. Palioto
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
| | - Arthur B. Novaes
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology; School of Dentistry of Ribeirao Preto; University of Sao Paulo; Ribeirão Preto SP Brazil
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Koçak E, Sağlam M, Kayış SA, Dündar N, Kebapçılar L, Loos BG, Hakkı SS. Nonsurgical periodontal therapy with/without diode laser modulates metabolic control of type 2 diabetics with periodontitis: a randomized clinical trial. Lasers Med Sci 2016; 31:343-53. [PMID: 26754181 DOI: 10.1007/s10103-016-1868-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/03/2016] [Indexed: 12/16/2022]
Abstract
In order to evaluate whether nonsurgical periodontal treatment with/without diode laser (DL) decontamination improves clinical parameters, the levels of IL-1β, IL-6, IL-8, intercellular adhesion molecule (ICAM), and vascular cell adhesion molecule (VCAM) in gingival crevicular fluid and metabolic control (HbA1c) in chronic periodontitis (CP) patients with diabetes mellitus type 2 (DM2). Sixty patients with DM2 and CP were randomly assigned into two groups to receive scaling and root planing (SRP, n = 30) or SRP followed by diode laser application (SRP + DL, n = 30). Clinical periodontal and gingival crevicular fluid (GCF) parameters were assessed at baseline, 1, and 3 months after periodontal treatment. HbA1c levels were evaluated at baseline and 3 months post-therapy. Total amounts of cytokines and molecules were analyzed by ELISA. Nonsurgical periodontal treatment with/without DL appeared to improve clinical, biochemical parameters, and glycemic control in DM2 patients (BMI < 25 kg/m(2)) with CP. The SRP + DL group provided better reductions in probing depth (PD) and clinical attachment level (CAL) parameters compared to the SRP group (P < 0.05). Significant reductions were found in the total amounts of GCF levels of IL-1, IL-6, IL-8, ICAM, and VCAM after treatment (P < 0.05). HbA1c levels decreased significantly at 3 months after treatment (P < 0.05). SRP + DL reduced HbA1c levels more significantly compared to SRP alone (0.41 vs. 0.22 %, P < 0.05). SRP, especially in combination with DL, shows improvement of glycemic control for DM2 patients with CP.
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Affiliation(s)
- Emrah Koçak
- Department of Periodontology, Faculty of Dentistry, Selcuk University, Konya, Turkey
| | - Mehmet Sağlam
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey.
| | - Seyit Ali Kayış
- Department of Biostatistics, Faculty of Medicine, Karabük University, Karabuk, Turkey
| | - Niyazi Dündar
- Research Center of Dental Faculty, Selcuk University, Konya, Turkey
| | - Levent Kebapçılar
- Department of Endocrinology and Metabolism Disease, School of Medicine, Selcuk University, Konya, Turkey
| | - Bruno G Loos
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Sema S Hakkı
- Department of Periodontology, Faculty of Dentistry, Selcuk University, Konya, Turkey
- Research Center of Dental Faculty, Selcuk University, Konya, Turkey
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Bozkurt Doğan Ş, Öngöz Dede F, Ballı U, Sertoğlu E. Levels of vaspin and omentin-1 in gingival crevicular fluid as potential markers of inflammation in patients with chronic periodontitis and type 2 diabetes mellitus. J Oral Sci 2016; 58:379-89. [DOI: 10.2334/josnusd.15-0731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Şeyma Bozkurt Doğan
- Department of Periodontology, Faculty of Dentistry, Ankara Yıldırım Beyazıt University
| | - Figen Öngöz Dede
- Department of Periodontology, Faculty of Dentistry, Ordu University
| | - Umut Ballı
- Department of Periodontology, Faculty of Dentistry, Bülent Ecevit University
| | - Erdim Sertoğlu
- Department of Medical Biochemistry, GATA Haydarpasa Training Hospital
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Molina CA, Ojeda LF, Jiménez MS, Portillo CM, Olmedo IS, Hernández TM, Moreno GG. Diabetes and Periodontal Diseases: An Established Two-Way Relationship. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jdm.2016.64024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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