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Zhao Y, Shen QQ. Link between periodontitis and diabetic retinopathy: Inflammatory pathways and clinical implications. World J Diabetes 2024; 15:1842-1846. [PMID: 39280174 PMCID: PMC11372638 DOI: 10.4239/wjd.v15.i9.1842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 08/27/2024] Open
Abstract
The bidirectional relationship between periodontitis and type 2 diabetes mellitus has been well-established. However, the underlying molecular mechanisms remain unclear. Diabetic retinopathy (DR) is an important complication of diabetes, but there are few studies on the relationship between DR and periodontitis, especially on the intrinsic inflammatory pathway mechanism. This article reviews the latest clinical data on how diabetes promotes susceptibility to periodontitis from the epidemiological and molecular perspectives, with a special focus on the key roles of systemic inflammation and endothelial dysfunction in the interplay between DR and periodontitis. Comprehension of the intertwined pathogenesis of DR and periodontitis can better guide the development of comprehensive management strategies for glycemic control and periodontal health, with the aim of mitigating the progression of DR and enhancing overall well-being.
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Affiliation(s)
- Yu Zhao
- Geriatric Medicine Center, Department of Endocrinology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Quan-Quan Shen
- Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
- Department of Nephrology, Zhejiang Provincial People’s Hospital Bijie Hospital, Bijie 551700, Guizhou Province, China
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de Molon RS, Rodrigues JVS, Deroide MB, da Silva Barbirato D, Garcia VG, Theodoro LH. The Efficacy of Topical or Systemic Antibiotics as Adjuvants to Non-Surgical Periodontal Treatment in Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Clin Med 2024; 13:4763. [PMID: 39200907 PMCID: PMC11355856 DOI: 10.3390/jcm13164763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 07/31/2024] [Accepted: 08/08/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Periodontitis and diabetes mellitus (DM) exhibit a bidirectional relationship and are globally significant systemic chronic conditions. The utilization of antibiotics alongside non-surgical periodontal treatment (NSPT) has been a subject of investigation in numerous clinical studies involving human subjects. Thus, the objective of this systematic review is to address the following question: "What is the efficacy of scaling and root planing (SRP) associated with antimicrobials in patients with type 2 DM and periodontitis?". Methods: A systematic review of the literature was conducted encompassing databases such as MEDLINE/PubMed, Scopus, and Web of Science up to July 2024. Additionally, alerts were configured to capture studies published from the initial search until manuscript submission. Randomized clinical trials assessing clinical periodontal parameters in DM patients undergoing SRP and receiving either topical or systemic antibiotics were compared against a control group (SRP only). Two investigators independently screened articles, extracted data, and evaluated their quality. The selection process, study characteristics, risk of bias, impact of antibiotics on clinical parameters, and certainty of evidence were elucidated in both textual and tabular formats. Meta-analysis was performed separately with forest plots generated for treatment modalities, period of evaluation, and type of antibiotics used. Results: Following the analysis of abstracts and full articles, a total of 30 randomized clinical trials were incorporated into this review, comprising 9 studies on the association of topical antibiotics and 21 studies on systemic antibiotic administration. The principal periodontal parameters assessed included probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BoP). Conclusions: Analysis of the results led to the conclusion that adjunctive periodontal treatment with either topical or systemic antibiotics confers subtle clinical benefits. Nevertheless, owing to the heightened emergence of resistant bacteria and potential side effects, the use of antibiotic therapy in periodontal treatment should be judiciously administered.
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Affiliation(s)
- Rafael Scaf de Molon
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Aracatuba 16015-050, SP, Brazil; (J.V.S.R.); (M.B.D.); (V.G.G.); (L.H.T.)
| | - Joao Victor Soares Rodrigues
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Aracatuba 16015-050, SP, Brazil; (J.V.S.R.); (M.B.D.); (V.G.G.); (L.H.T.)
| | - Mariella Boaretti Deroide
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Aracatuba 16015-050, SP, Brazil; (J.V.S.R.); (M.B.D.); (V.G.G.); (L.H.T.)
| | - Davi da Silva Barbirato
- Department of Basic and Oral Biology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo (FORP/USP), Av. Café, S/N-Ribeirão Preto, São Paulo 14040-904, SP, Brazil;
| | - Valdir Gouveia Garcia
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Aracatuba 16015-050, SP, Brazil; (J.V.S.R.); (M.B.D.); (V.G.G.); (L.H.T.)
- Latin American Institute of Dental Research and Teaching (ILAPEO), Curitiba 80710-150, PR, Brazil
| | - Leticia Helena Theodoro
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Aracatuba 16015-050, SP, Brazil; (J.V.S.R.); (M.B.D.); (V.G.G.); (L.H.T.)
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Wu SY, Wu CY, Lin LY, Chen YH, Huang HY, Lai YL, Lee SY. Systemic antibiotics adjuvants to scaling and root planing in type 2 diabetic and periodontitis individuals: Systematic review with network meta-analysis. JAPANESE DENTAL SCIENCE REVIEW 2023; 59:167-178. [PMID: 38152384 PMCID: PMC10751746 DOI: 10.1016/j.jdsr.2023.06.001] [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: 01/10/2023] [Accepted: 06/04/2023] [Indexed: 12/29/2023] Open
Abstract
Targeting inflammatory pathways is considered a common strategy to control type 2 diabetes (T2D) and periodontitis. This overview was to validate systemic antibiotics as an adjuvant to scaling and root planing (SRP) for the treatments of periodontal patients with T2D. Literature searches were conducted using Web of Science, PubMed, Cochrane, and EMBASE. Randomized trials comparing SRP and systemic antibiotics on glycated hemoglobin (HbA1c) and probing pocket depth (PPD) in adults with T2D and periodontitis were analyzed using network meta-analysis and meta-regression. At 3-month postintervention, meta-analyses of 16 studies revealed that SRP and SRP plus systemic antibiotics (SRPa) had similar significant effects in reducing HbA1c levels of - 0.72% and - 0.96% respectively. While SRP and SRPa also, respectively, reduced PPD of - 0.67 and - 0.89 mm, SRPa showed a better reduction than SRP. At 6-month postintervention, meta-analyses of 7 trials revealed that only SRP was effective in reducing HbA1c levels (-0.29%) but not SRPa. Although both SRP and SRPa still significantly reduced PPD by - 0.56 and - 0.81 mm, respectively, there was no difference between them. The current overview suggested that routine SRP alone is highly recommended for patients with T2D and periodontitis, since systemic antibiotics as an adjuvant provide a rather short-term effect.
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Affiliation(s)
- Shih-Yun Wu
- Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Yi Wu
- Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang-Yu Lin
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-hsuan Chen
- Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Yi Huang
- Information Management Office, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Lin Lai
- Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shyh-Yuan Lee
- Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Zhang Y, Leveille SG, Camhi SM, Shi L. Association of oral care with periodontitis and glycemic control among US adults with diabetes. BMC Oral Health 2023; 23:903. [PMID: 37990177 PMCID: PMC10664594 DOI: 10.1186/s12903-023-03580-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Studies indicate that treating periodontitis may benefit glycemic control among people with diabetes. It is unclear whether oral self-care such as flossing may reduce risk for periodontitis and improve glycemic control among people with diabetes. The purpose of this study was to examine associations between oral care, specifically, flossing and preventive dental care, with periodontitis and glycemic control, among US dentate adults with diabetes. METHODS We analyzed data from the National Health and Nutrition Examination Survey 2011-2014 for 892 participants aged 30 years and older with diabetes who completed the periodontal examination and lab test for hemoglobin A1c (HbA1c). Sampling weights were applied. Multivariable logistic regression and multivariable linear modeling were performed to examine the associations of flossing and preventive dental services on periodontal health and HbA1c levels, respectively, controlling for sociodemographic characteristics, health behaviors, and other risk factors. RESULTS Among U.S. dentate adults with diabetes, 52.1% of flossers and 72.1% of non-flossers had periodontitis (p < 0.001). Flossers were 39% less likely to have periodontitis (Adj. OR 0.61, 95% CI 0.43-0.88) compared to non-flossers. Flossers had an average HbA1c reading 0.30% (95% CI 0.02%-0.58%) lower than non-flossers, adjusted for covariates (p = 0.037). Preventive dental visits were associated with reduced risk for periodontitis (Adj. OR 0.54, 95%CI, 0.38-0.75) but not glycemic control. CONCLUSION Flossing was associated with periodontal health and glycemic control among US adults with diabetes. Although further research is needed, the findings support that oral self-care may be particularly beneficial for adults with diabetes.
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Affiliation(s)
- Yuqing Zhang
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA.
- College of Nursing, University of Cincinnati, 3110 Vine Street, Cincinnati, OH, 45221, USA.
| | - Suzanne G Leveille
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
| | - Sarah M Camhi
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
- College of Arts and Sciences, Department of Kinesiology, University of San Francisco, Fulton Street, San Francisco, CA, 94117, USA
| | - Ling Shi
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
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Brinar S, Skvarča A, Gašpirc B, Schara R. The effect of antimicrobial photodynamic therapy on periodontal disease and glycemic control in patients with type 2 diabetes mellitus. Clin Oral Investig 2023; 27:6235-6244. [PMID: 37672083 PMCID: PMC10560165 DOI: 10.1007/s00784-023-05239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVES This study is aimed at determining the effect of concomitant antimicrobial photodynamic therapy (aPTD) on periodontal disease and glycaemic control in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS Twenty-four patients with T2DM were enrolled in the study. Periodontal clinical parameters were assessed by measuring probing pocket depth (PPD), clinical attachment loss (CAL), gingival recession (GR), full-mouth bleeding score (FMBS), full-mouth plaque score (FMPS), and full-mouth sulcus bleeding score (FMSBS). Glycated haemoglobin A1c (HbA1c) was measured. To determine the presence of the following periodontal pathogenic bacteria, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, subgingival plaque samples were taken from two periodontal pockets per jaw with the greatest PPD using paper tips. Patients were randomly divided into the test and control group. In the test group, full-mouth disinfection was performed in combination with aPTD. In the control group, only full-mouth disinfection was performed. RESULTS The results showed an improvement in periodontal clinical parameters in both groups. The difference between the groups in favour of the test group was statistically significant for BOP. The HbA1c level decreased in both groups. The difference was not statistically significant. The results of the microbiological analysis suggest that the presence of periodontal pathogenic bacteria is lower with additional antimicrobial photodynamic therapy with statistically significant difference for T. forsythia. CONCLUSIONS Additional aPDT causes a significant reduction in BoP in the proportion of positive sites for periodontal pathogens. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05816941. CLINICAL RELEVANCE aPTD is a noninvasive adjunctive therapy that can positively influence the periodontal treatment outcome.
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Affiliation(s)
- Sara Brinar
- Department of Oral Medicine and Periodontology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Community Health Centre Murska Sobota, Murska Sobota, Slovenia
| | - Aleš Skvarča
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Boris Gašpirc
- Department of Oral Medicine and Periodontology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rok Schara
- Department of Oral Medicine and Periodontology, University Medical Center Ljubljana, Ljubljana, Slovenia.
- Department of Oral Medicine and Periodontology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Swarnamali H, Medara N, Chopra A, Spahr A, Jayasinghe TN. Role of Dietary Fibre in Managing Periodontal Diseases-A Systematic Review and Meta-Analysis of Human Intervention Studies. Nutrients 2023; 15:4034. [PMID: 37764817 PMCID: PMC10536522 DOI: 10.3390/nu15184034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Periodontitis is a chronic multifactorial inflammatory disease, that leads to tooth loss and is associated with other systemic diseases. The role of dietary fibre in the prevention and management of periodontal diseases is not well understood. The objective of this systematic review and meta-analysis was to assess how an intake of dietary fibre affects periodontal diseases in humans and any concomitant effects on systemic inflammation. METHODOLOGY Human interventional studies investigating the effects of oral fibre intake on various clinical parameters of periodontal diseases were included. Search strategy with MeSH and free-text search terms was performed on the following database: CINAHL Complete, EMBASE, MEDLINE, SciVerse Scopus®, and Web of Science Core Collection on 21 October 2021 and updated on 19 February 2023 to identify relevant studies. Articles were filtered using the Covidence© web-based platform software. Data were pooled using random effects meta-analysis. RESULTS From all databases, a total of 19,971 studies were obtained. Upon title and abstract screening, 101 studies were included for full-text screening. Upon full-text screening, six studies were included for analysis. Of these, five were randomised controlled trials, and one was a sequential feeding trial involving fibre-rich daily diet for a 4-8 weeks period. Fibre-rich dietary intervention significantly reduced Clinical Attachment Loss/Level by 0.48 mm/tooth (95% CI, -0.63 to -0.33, p < 0.001), Bleeding On Probing by 27.57% sites/tooth (95% CI -50.40 to -4.74, p = 0.02), Periodontal Inflamed Surface Area by 173.88 mm2 (95% CI -288.06 to -59.69, p = 0.003), Plaque Index by 0.02 (95% CI -0.04 to -0.00, p = 0.04), and Gingival Index by 0.41 (95% -0.67 to -0.16, p= 0.002). A non-significant reduction was observed for Probing Depth (-0.17 mm/tooth; 95% CI, -0.37 to 0.02, p = 0.09). CONCLUSIONS Fibre-rich dietary interventions are associated with a reduction of clinical and particularly inflammatory markers of periodontal diseases. This shows a promising effect of dietary fibre as an intervention for inflammatory conditions like periodontal diseases.
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Affiliation(s)
- Hasinthi Swarnamali
- The Liggins Institute, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Nidhi Medara
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; (N.M.); (A.S.); (T.N.J.)
| | - Aditi Chopra
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal 576104, India;
| | - Axel Spahr
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; (N.M.); (A.S.); (T.N.J.)
| | - Thilini N. Jayasinghe
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; (N.M.); (A.S.); (T.N.J.)
- The Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia
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Amato M, Santonocito S, Polizzi A, Tartaglia GM, Ronsivalle V, Viglianisi G, Grippaudo C, Isola G. Local Delivery and Controlled Release Drugs Systems: A New Approach for the Clinical Treatment of Periodontitis Therapy. Pharmaceutics 2023; 15:pharmaceutics15041312. [PMID: 37111796 PMCID: PMC10143241 DOI: 10.3390/pharmaceutics15041312] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Periodontitis is an inflammatory disease of the gums characterized by the degeneration of periodontal ligaments, the formation of periodontal pockets, and the resorption of the alveolar bone, which results in the destruction of the teeth's supporting structure. Periodontitis is caused by the growth of diverse microflora (particularly anaerobes) in the pockets, releasing toxins and enzymes and stimulating the immune system. Various approaches, both local and systemic, have been used to treat periodontitis effectively. Successful treatment depends on reducing bacterial biofilm, bleeding on probing (BOP), and reducing or eliminating pockets. Currently, the use of local drug delivery systems (LDDSs) as an adjunctive therapy to scaling and root planing (SRP) in periodontitis is a promising strategy, resulting in greater efficacy and fewer adverse effects by controlling drug release. Selecting an appropriate bioactive agent and route of administration is the cornerstone of a successful periodontitis treatment plan. In this context, this review focuses on applications of LDDSs with varying properties in treating periodontitis with or without systemic diseases to identify current challenges and future research directions.
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Affiliation(s)
- Mariacristina Amato
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Gianluca Martino Tartaglia
- UOC Maxillo-Facial Surgery and Dentistry, Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy
| | - Vincenzo Ronsivalle
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Gaia Viglianisi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Cristina Grippaudo
- Department of Head and Neck, Division of Oral Surgery and Implantology, Catholic University of the Sacred Heart, Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
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Di Domenico GL, Minoli M, Discepoli N, Ambrosi A, de Sanctis M. Effectiveness of periodontal treatment to improve glycemic control: an umbrella review. Acta Diabetol 2023; 60:101-113. [PMID: 36261746 DOI: 10.1007/s00592-022-01991-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/03/2022] [Indexed: 01/10/2023]
Abstract
AIM The aim of the present umbrella review was to systematically assess existing evidence on the effect of non-surgical periodontal therapy, both per se' and with adjuvants, on glycemic control in patients with type 2 diabetes and periodontitis and to combine quantitative data with a meta-analysis. MATERIALS AND METHODS A detailed study protocol was registered on PROSPERO (CRD42021222279). Four electronic databases (Medline via Pubmed, EMBASE, Cochrane Database of Systematic Reviews and Scielo) were searched independently and in duplicate to identify potentially eligible systematic reviews up to March 2022. Two pre-calibrated independent reviewers performed study selection, data extraction and quality assessment with two checklists (AMSTAR 2 and PRISMA). Moreover, general characteristics of primary studies included in each systematic review were abstracted, and JADAD scale was used to assess the risk of bias for included randomized controlled trials. Data from the individual studies included in each meta-analysis were analyzed, using both fixed and random effect model. The statistical heterogeneity was calculated using the Q test and the I2 index. The publication bias was evaluated using a funnel plot and Egger's linear regression method. RESULTS Sixteen systematic reviews, published between 2010 and 2021, were included for qualitative synthesis. From these systematic reviews, a total of 27 studies were included in the meta-analysis: all of them were randomized clinical trials, except 1 controlled clinical study. A statistically significant mean difference of - 0.49% and of - 0.38% HbA1c reductions was seen respectively at 3- and 6-month post-treatment, favoring the treatment group (non-surgical periodontal therapy alone) compared to the control group (no treatment). The effect of periodontal treatment with the adjunctive use of antibiotics or laser on the glycemic control was not statistically significant compared to non-surgical periodontal therapy alone. CONCLUSIONS The findings of the present study, within its limitations, indicated that non-surgical treatment of periodontitis is an efficacious therapy for improving the glycemic control in type 2 diabetes mellitus patients, both at 3- and 6-month follow-up.
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Affiliation(s)
| | - Margherita Minoli
- Department of Periodontology, Università Vita-Salute San Raffaele, Milan, Italy
| | - Nicola Discepoli
- Unit of Periodontics, Department of Medical Biotechnologies, Università degli Studi di Siena, Siena, Italy
| | - Alessandro Ambrosi
- Faculty of Medicine and Surgery, Università Vita-Salute San Raffaele, Milan, Italy
| | - Massimo de Sanctis
- Department of Periodontology, Università Vita-Salute San Raffaele, Milan, Italy
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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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Kalhan AC, Wong ML, Allen F, Gao X. Periodontal disease and systemic health: An update for medical practitioners. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:567-574. [PMID: 36189701 DOI: 10.47102/annals-acadmedsg.2021503] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Chronic periodontal disease is a highly prevalent dental condition affecting tooth-supporting tissues. Scientific evidence is accumulating on links between periodontal disease and various systemic conditions. This narrative review provides a holistic yet succinct overview that would assist medical practitioners to deliver integrated care for better clinical outcomes. METHOD Scientific evidence on associations between periodontal disease and systemic conditions was synthesised and critically appraised. Key findings of latest prospective cohort studies, randomised clinical trials, and meta-analysis were closely assessed and compiled. RESULTS A bidirectional relationship has been established, indicating that diabetes and periodontal disease are closely linked and amplify one another, if not successfully controlled. Existing evidence also supports the associations of periodontal disease with cardiovascular diseases and adverse pregnancy outcomes. Successful treatment of periodontal disease and dental prophylaxis has been shown to improve clinical outcomes in these systemic conditions. Other systemic conditions associated with periodontal disease include respiratory diseases, Alzheimer's disease, rheumatoid arthritis and chronic kidney disease. Although the underlying mechanisms remain to be fully elucidated, it is generally accepted that the inflammatory burden of chronic periodontal disease has an important systemic impact. CONCLUSION Oral-systemic links are multifaceted and complex. While evidence linking periodontal disease with a variety of systemic conditions is still emerging, the nature of the relationship is becoming clearer. The updated understanding of these associations warrants the attention of medical experts and policymakers for a concerted effort to develop a patient-centric, integrated model for the treatment of comorbid dental and medical conditions.
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Yang ML, Lu C, Fan ZF, Zhao TR, Cheng GG, Wang YD, Cao JX, Liu YP. Hypoglycemic and hypolipidemic effects of Epigynum auritum in high fat diet and streptozotocin-induced diabetic rats. JOURNAL OF ETHNOPHARMACOLOGY 2022; 288:114986. [PMID: 35032587 DOI: 10.1016/j.jep.2022.114986] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/11/2021] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Epigynum auritum is mainly distributed in Southwest China, and has been used as a "dai" folk medicine with promising Besides, the leaves and barks of E. auritum have detoxifying, analgesic and relieving swelling effects. Previous studies evidenced that E. auritum was rich in pregnanes and their glycosides. However, the hypoglycemic and hypolipidemic effects of the extract from E. auritum (EAE) and its molecular mechanism are still not studied. AIM OF THE STUDY The aim of this study is to investigate the hypoglycemic and hypolipidemic effects of EAE on high-fat diet and streptozocin-induced type 2 diabetic rats. MATERIALS AND METHODS The high-fat diet and streptozocin induced type 2 diabetic model was established. The diabetic rats were treated with 70% ethanol extract of E. auritum (100 and 300 mg/kg/d) or metformin (DMBG, 100 mg/kg/d) every day for 4 weeks. Fasting blood glucose was recorded weekly. The phenotypic changes were evaluated by the measurement of biochemical indexes and immunohistochemical. The expressions of signaling-related proteins were explored by western blotting. RESULTS EAE could effectively regulate the metabolism of glucose and lipids in diabetic rats by increasing insulin sensitivity. In addition, EAE ameliorated the oxidative stress damage and further mitigated the liver, kidney, and pancreatic damage. Mechanism research results show that EAE treatment increased the phosphorylation of Akt, AMPK and GSK-3β, up-regulated the expression of GLUT-2, GLUT-4 and PPAR-α, and reduced PPAR-γ and FAS expressions. CONCLUSION EAE exhibited significant hypoglycemic and hypolipidemic effects in HFD/STZ-induced diabetes rats. The mechanism may be related to the effective upregulation of AMPK/Akt/GSK-3β pathway and the decreased expression of PPAR-γ and FAS. It could be a promising natural product with potential value for the development of drugs to prevent or treat type 2 diabetic.
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Affiliation(s)
- Mei-Lian Yang
- Faculty of Food Science and Engineering, Kunming University of Science and Technology, Kunming, 650500, People's Republic of China
| | - Can Lu
- Department of Cardiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Teco, People's Republic of China
| | - Zhi-Feng Fan
- Faculty of Food Science and Engineering, Kunming University of Science and Technology, Kunming, 650500, People's Republic of China; Engineering Research Center of Biopolymer Functional Materials of Yunnan, Yunnan Minzu University, Kunming, 650500, People's Republic of China
| | - Tian-Rui Zhao
- Faculty of Food Science and Engineering, Kunming University of Science and Technology, Kunming, 650500, People's Republic of China
| | - Gui-Guang Cheng
- Faculty of Food Science and Engineering, Kunming University of Science and Technology, Kunming, 650500, People's Republic of China
| | - Yu-Dan Wang
- Faculty of Food Science and Engineering, Kunming University of Science and Technology, Kunming, 650500, People's Republic of China; Engineering Research Center of Biopolymer Functional Materials of Yunnan, Yunnan Minzu University, Kunming, 650500, People's Republic of China.
| | - Jian-Xin Cao
- Faculty of Food Science and Engineering, Kunming University of Science and Technology, Kunming, 650500, People's Republic of China.
| | - Ya-Ping Liu
- Faculty of Food Science and Engineering, Kunming University of Science and Technology, Kunming, 650500, People's Republic of China.
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Nourah D, Aldahlawi S, Andreana S. Should the Quality of Glycemic Control Guide Dental Implant Therapy in Patients with Diabetes? Focus on Implant Survival. Curr Diabetes Rev 2022; 18:e060821195367. [PMID: 34365929 DOI: 10.2174/1573399817666210806120300] [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: 05/04/2021] [Revised: 06/21/2021] [Accepted: 07/01/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Optimal glycemic control is crucial to dental implant long-term functional and esthetic success. Despite HbA1c levels of 7% or lower used is as an indicator for good glycemic control, however, this level may not be attainable for all diabetic patients. Most dentists do not consider patients with poor glycemic control candidates for implant therapy due to higher implant failure, infection or other complications. AIM This review challenges the concept of one size fits all and aims to critically appraise the evidence for the success or failure rate of dental implants and peri-implant health outcomes in patients with less than optimal glycemic control. DISCUSSION Evidence suggests that estimating glycemic control from HbA1c measurement alone is misleading. Moreover, elevated preoperative HbA1c was not associated with increased mortality and morbidity after major surgical procedures. Literature for the survival or success of implants in diabetic patients is inconsistent due to a lack of standardized reporting of clinical data collection and outcomes. While a number of studies report that implant treatment in patients with well controlled diabetes has a similar success rate to healthy individuals, other studies suggest that the quality of glycemic control in diabetic patients does not make a difference in the implant failure rate or marginal bone loss. This discrepancy could indicate that risk factors other than hyperglycemia may contribute to the survival of implants in diabetic patients. CONCLUSION In the era of personalized medicine, the clinician should utilize individualized information and analyze all risk factors to provide the patient with evidence-based treatment options.
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Affiliation(s)
- Dalia Nourah
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Salwa Aldahlawi
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
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Pirih FQ, Monajemzadeh S, Singh N, Sinacola RS, Shin JM, Chen T, Fenno JC, Kamarajan P, Rickard AH, Travan S, Paster BJ, Kapila Y. Association between metabolic syndrome and periodontitis: The role of lipids, inflammatory cytokines, altered host response, and the microbiome. Periodontol 2000 2021; 87:50-75. [PMID: 34463996 PMCID: PMC8457155 DOI: 10.1111/prd.12379] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Periodontitis has been associated with many systemic diseases and conditions, including metabolic syndrome. Metabolic syndrome is a cluster of conditions that occur concomitantly and together they increase the risk of cardiovascular disease and double the risk of type 2 diabetes. In this review, we focus on the association between metabolic syndrome and periodontitis; however, we also include information on diabetes mellitus and cardiovascular disease, since these two conditions are significantly intertwined with metabolic syndrome. With regard to periodontitis and metabolic syndrome, to date, the vast majority of studies point to an association between these two conditions and also demonstrate that periodontitis can contribute to the development of, or can worsen, metabolic syndrome. Evaluating the effect of metabolic syndrome on the salivary microbiome, data presented herein support the hypothesis that the salivary bacterial profile is altered in metabolic syndrome patients compared with healthy patients. Considering periodontitis and these three conditions, the vast majority of human and animal studies point to an association between periodontitis and metabolic syndrome, diabetes, and cardiovascular disease. Moreover, there is evidence to suggest that metabolic syndrome and diabetes can alter the oral microbiome. However, more studies are needed to fully understand the influence these conditions have on each other.
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Affiliation(s)
- Flavia Q Pirih
- Section of Periodontics, UCLA School of Dentistry, Los Angeles, California
| | | | - Neelima Singh
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, California
| | | | - Jae Min Shin
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Tsute Chen
- The Forsyth Institute, Cambridge, Massachusetts
- Department of Oral Medicine, Infection & Immunity, Harvard School of Dental Medicine, Boston, Massachusetts
| | - J Christopher Fenno
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Pachiyappan Kamarajan
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, California
| | - Alexander H Rickard
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Suncica Travan
- Department of Periodontics & Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Bruce J Paster
- The Forsyth Institute, Cambridge, Massachusetts
- Department of Oral Medicine, Infection & Immunity, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Yvonne Kapila
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, California
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Sinha S, Sonoo PR, Siddhartha R, Singh SK, Singh A. Effect of Conventional Periodontal Treatment (Scaling and Root Planing) on Type-2 Diabetic Patient with Moderate Generalized Chronic Periodontitis: A Clinical Study. J Pharm Bioallied Sci 2021; 13:S706-S710. [PMID: 34447186 PMCID: PMC8375805 DOI: 10.4103/jpbs.jpbs_692_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/02/2020] [Accepted: 11/24/2020] [Indexed: 11/07/2022] Open
Abstract
Background: The aim is to assess the effect of periodontal therapy and scaling and root planing (SRP) on the metabolic control in Type 2 diabetes mellitus (DM) patients with chronic periodontitis based on the estimation of glycated hemoglobin (HbA1c). Materials and Methods: A prospective, comparative, clinical study was performed on 50 patients suffering from Type 2 DM with moderate, generalized chronic periodontitis. Type 2 moderately controlled diabetic patients with HbA1c values within the range of 6%–8% were selected. The parameters recorded were gingival index, plaque index, sulcus bleeding index, probing pocket depth, clinical attachment level, and HbA1c. The recordings were done at baseline and 6 months after SRP procedures. Results: Reductions in all the clinical parameters were observed and were found to be statistically significant (P < 0.05). Conclusion: SRP resulted in a statistically significant reduction in the clinical parameters and HbA1c. Hence, periodontal treatment should be included in the management of diabetic patients.
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Affiliation(s)
- Sachin Sinha
- Department of Periodontics, PHC, Patna, Bihar, India
| | - Priyanshu Ranjan Sonoo
- Department of Oral and Maxillofacial Surgery, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
| | - Rohit Siddhartha
- Department of Conservative Dentistry, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
| | - Sanjay Kumar Singh
- Department of Dentistry, Patna Medical College and Hospital, Patna, Bihar, India
| | - Anjali Singh
- Department of Periodontics, Private Practitioner, Patna, Bihar, India
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Zhang Z, Liang X, Tong L, Lv Y, Yi H, Gong P, Tian X, Cui Q, Liu T, Zhang L. Effect of Inonotus obliquus (Fr.) Pilat extract on the regulation of glycolipid metabolism via PI3K/Akt and AMPK/ACC pathways in mice. JOURNAL OF ETHNOPHARMACOLOGY 2021; 273:113963. [PMID: 33640441 DOI: 10.1016/j.jep.2021.113963] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/21/2021] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Inonotus obliquus (Fr.) Pilat is a mushroom belonging to the family Hymenochaetaceae. It is popularly called the Chaga mushroom in Russian folk medicine and has been used as a traditional medicine to treat diabetes mellitus in Eastern European and Asian countries. However, its effects on glycolipid metabolism disorders and underlying molecular mechanism of action remain unclear. AIM OF THE STUDY I. obliquus contains abundant functional components, which provide potential medicinal value. The purpose of this study was to investigate compositions of I. obliquus extract with a high-pressure water extraction method, and investigate the anti-type 2 diabetic effects of I. obliquus extract and the possible underlying mechanisms involved. MATERIALS AND METHODS The I. obliquus was extracted by a high-pressure water extraction method, and tested its main components by special assay kit and instrumental analysis. Type 2 diabetic C57BL/6 mice were induced by high-fat diet with low-dose STZ injection, and were daily gavaged with different doses of I. obliquus extract for 8 weeks. Glycemic, blood lipid profile, and histopathology of liver and pancreas were assessed. Underlying mechanisms related to glycemic control in liver were further performed. RESULTS The I. obliquus extract main compounds were β-Glucans, triterpenoids and polyphenol by determination. Oral administration of 250 mg/kg and 500 mg/kg I. obliquus extract significantly alleviated blood glucose and insulin resistance. Moreover, 250 mg/kg and 500 mg/kg of I. obliquus extract increased liver glycogen content and high-density lipoprotein cholesterol (HDL-C) levels while decreased total cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) levels. Furthermore, the protein expression levels of phosphatidylinositol-3 kinase (PI3K), p-protein kinase B (Akt), p-adenosine monophosphate activated protein kinase (AMPK), and p-acetyl-CoA carboxylase (ACC) were upregulated, whereas sterol regulatory element-binding protein-1c (SREBP-1c) and fatty acid synthase (FAS) were downregulated after supplement with 250 mg/kg and 500 mg/kg of I. obliquus extract. Interestingly, I. obliquus extract was a dose-effect relationship within a certain range. 250 mg/kg had obvious anti-diabetes effect, and the effect of 500 mg/kg dose was the same as that of metformin. CONCLUSION I. obliquus extract ameliorated insulin resistance and lipid metabolism disorders in diabetic mice. The hypoglycemic and hypolipidemic properties of I. obliquus extract were supposedly exerted via the regulation of the PI3K/Akt and AMPK/ACC signaling pathways.
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Affiliation(s)
- Zhe Zhang
- College of Food Science and Engineering, Ocean University of China, Qingdao, 266003, China
| | - Xi Liang
- College of Food Science and Engineering, Ocean University of China, Qingdao, 266003, China
| | - Lingjun Tong
- College of Food Science and Engineering, Ocean University of China, Qingdao, 266003, China
| | - Youyou Lv
- College of Food Science and Engineering, Ocean University of China, Qingdao, 266003, China
| | - Huaxi Yi
- College of Food Science and Engineering, Ocean University of China, Qingdao, 266003, China
| | - Pimin Gong
- College of Food Science and Engineering, Ocean University of China, Qingdao, 266003, China
| | - Xiaoying Tian
- College of Food Science and Engineering, Ocean University of China, Qingdao, 266003, China
| | - Qingyu Cui
- College of Food Science and Engineering, Ocean University of China, Qingdao, 266003, China
| | - Tongjie Liu
- College of Food Science and Engineering, Ocean University of China, Qingdao, 266003, China.
| | - Lanwei Zhang
- College of Food Science and Engineering, Ocean University of China, Qingdao, 266003, China.
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Wei Y, Deng Y, Ma S, Ran M, Jia Y, Meng J, Han F, Gou J, Yin T, He H, Wang Y, Zhang Y, Tang X. Local drug delivery systems as therapeutic strategies against periodontitis: A systematic review. J Control Release 2021; 333:269-282. [PMID: 33798664 DOI: 10.1016/j.jconrel.2021.03.041] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/27/2021] [Accepted: 03/27/2021] [Indexed: 12/14/2022]
Abstract
Periodontitis is a chronic inflammation of the soft tissue surrounding and supporting the teeth, which causes periodontal structural damage, alveolar bone resorption, and even tooth loss. Its prevalence is very high, with nearly 60% of the global population affected. Hence, periodontitis is an important public health concern, and the development of effective healing treatments for oral diseases is a major target of the health sciences. Currently, the application of local drug delivery systems (LDDS) as an adjunctive therapy to scaling and root planning (SRP) in periodontitis is a promising strategy, giving higher efficacy and fewer side effects by controlling drug release. The cornerstone of successful periodontitis therapy is to select an appropriate bioactive agent and route of administration. In this context, this review highlights applications of LDDS with different properties in the treatment of periodontitis with or without systemic diseases, in order to reveal existing challenges and future research directions.
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Affiliation(s)
- Ying Wei
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Yaxin Deng
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Shuting Ma
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Meixin Ran
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Yannan Jia
- Affiliated Hospital of Inner Mongolia University for the Nationalities, Tongliao 028000, Neimenggu, China
| | - Jia Meng
- Liaoning Institute of Basic Medicine, Shenyang 110016, Liaoning, China
| | - Fei Han
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China.
| | - Jingxin Gou
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Tian Yin
- School of Functional Food and Wine, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Haibing He
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Yanjiao Wang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Yu Zhang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China.
| | - Xing Tang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
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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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Medara N, Lenzo JC, Walsh KA, Reynolds EC, Darby IB, O'Brien-Simpson NM. A review of T helper 17 cell-related cytokines in serum and saliva in periodontitis. Cytokine 2020; 138:155340. [PMID: 33144024 DOI: 10.1016/j.cyto.2020.155340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/21/2020] [Accepted: 10/06/2020] [Indexed: 12/24/2022]
Abstract
Periodontitis is a chronic inflammatory disease with a complex underlying immunopathology. Cytokines, as molecular mediators of inflammation, play a role in all stages of disease progression. T helper 17 (Th17) cells are thought to play a role in periodontitis. Th17 cell development and maintenance requires a pro-inflammatory cytokine milieu, with many of the cytokines implicated in the pathogenesis of periodontitis. Serum and saliva are easily accessible biofluids which can represent the systemic and local environment to promote the development of Th17 cells. Here we review human clinical studies that investigate IL-1β, IL-4, IL-6, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, IFN-γ, sCD40L and TNF-α in serum and saliva in periodontitis. We highlight their putative role in the pathogenesis of periodontitis and place them within a wider context of animal and other clinical studies.
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Affiliation(s)
- Nidhi Medara
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia.
| | - Jason C Lenzo
- Centre for Oral Health Research, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia.
| | - Katrina A Walsh
- Department of Surgery, The University of Melbourne, Austin Health, Lance Townsend Building, Level 8, 145 Studley Road, Heidelberg, VIC 3084, Australia.
| | - Eric C Reynolds
- Centre for Oral Health Research, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia.
| | - Ivan B Darby
- Melbourne Dental School, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia.
| | - Neil M O'Brien-Simpson
- Centre for Oral Health Research, The University of Melbourne, 720 Swanston Street, Carlton, VIC 3053, Australia.
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Mechanical Debridement with Antibiotics in the Treatment of Chronic Periodontitis: Effect on Systemic Biomarkers-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155601. [PMID: 32756461 PMCID: PMC7432753 DOI: 10.3390/ijerph17155601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/24/2022]
Abstract
In this systematic review, we assessed the effectiveness of systemic antibiotics as an adjunctive therapy to mechanical debridement in improving inflammatory systemic biomarkers, as compared to mechanical debridement alone, among adults with chronic periodontitis. We searched relevant electronic databases for eligible randomized controlled trials. Two review authors independently screened, extracted data, and assessed risk of bias. We conducted meta-analysis, assessed heterogeneity, and assessed certainty of evidence using GRADEPro software. We included 19 studies (n = 1350 participants), representing 18 randomized controlled trials and found very little or no impact of antibiotics on inflammatory biomarkers. A meta-analysis of eight studies demonstrated a mean reduction of 0.26 mm in the periodontal pockets at three months (mean difference [MD] −0.26, 95%CI: −0.36 to −0.17, n = 372 participants, moderate certainty of evidence) in favor of the antibiotics. However, results from five studies reporting clinical attachment level (mm) yielded little or no difference at three months (MD −0.16, 95% CI: −0.35 to 0.03, n = 217 participants) between antibiotic and placebo groups. There is little or no evidence that adjunctive systemic antibiotics therapy improves inflammatory systemic biomarkers, compared to mechanical debridement alone, among adults with chronic periodontitis.
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20
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Genco RJ, Graziani F, Hasturk H. Effects of periodontal disease on glycemic control, complications, and incidence of diabetes mellitus. Periodontol 2000 2020; 83:59-65. [PMID: 32385875 DOI: 10.1111/prd.12271] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Diabetes mellitus is a group of metabolic disorders with high mortality and morbidity associated with complications such as cardiovascular disease, kidney disease, and stroke. The prevalence of diabetes is 9.4% in US adults, and prevalence increases markedly with age, with 1 in 4 adults aged ≥65 years affected by diabetes. The estimated number of adults with type 2 diabetes globally almost tripled between 2002 and 2017, reflecting increases seen in the USA and elsewhere. This increase raises concerns about the increased morbidity and mortality associated with the complications of diabetes, including periodontal disease and tooth loss. There is a reciprocal adverse relationship between diabetes and periodontal disease, with diabetes as a major risk factor for periodontal disease, and in those patients with diabetes who also have periodontal disease then there are adverse effects on glycemic control and complications such as cardiovascular disease and end stage renal disease. In this review, those studies detailing the adverse effects of periodontal disease and diabetes will be discussed. Also, evidence is accumulating that periodontitis may play a role in increasing the incidence of new cases of type 2 diabetes, and possibly gestational diabetes. Of course, these studies need to be expanded to better understand the effects of periodontitis on diabetes glycemic control, complications, prediabetes, and the incidence of new cases. However, given the tremendous burden of diabetes on society, the dental profession should be proactive in preventing and treating periodontal disease, not only to preserve the dentition, but also to minimize the adverse effects of periodontitis on diabetes and its complications.
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Affiliation(s)
- Robert J Genco
- Departments of Oral Biology, and Microbiology and Immunology, Center for Microbiome Research, University at Buffalo, Buffalo, New York, USA
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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Effect of diode laser application as an adjunct to nonsurgical periodontal therapy on the reduction of red complex microorganisms in type 2 diabetics with chronic periodontitis. Lasers Med Sci 2020; 35:1403-1410. [PMID: 32193820 DOI: 10.1007/s10103-020-02997-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
Bactericidal and detoxification effects of diode laser (DL) have been reported in periodontal treatment. The objective of this study was investigating the additional effect of DL with nonsurgical periodontal treatment on the red complex bacteria in type 2 diabetes mellitus (DM) patients with chronic periodontitis (CP). Sixty type 2 DM patients with chronic periodontitis (CP) were randomly assigned in two parallel groups to receive scaling root planning (SRP, n = 30) or SRP followed by DL periodontal pocket irradiation (SRP + DL, n = 30). Recording of clinical parameters and subgingival plaque sampling were performed at baseline, and post therapy (1 and 3 months after treatment). Amounts of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia were evaluated with quantitative RT-PCR. Significant reductions for numbers of all three bacterial species were observed at 1 and 3 months compared with baseline for both treatments (p < 0.001), but no significant differences were found between two groups regarding bacterial reductions at these follow-up time points. No additional benefit of DL as an adjunct to nonsurgical periodontal therapy was recognized in the reduction of P. gingivalis, T. denticola, and T. forsythia for type 2 DM patients with CP. Further studies are required to clarify the effects of diode laser on the other periodontopathogens.
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Liang J, Peng X, Zhou X, Zou J, Cheng L. Emerging Applications of Drug Delivery Systems in Oral Infectious Diseases Prevention and Treatment. Molecules 2020; 25:E516. [PMID: 31991678 PMCID: PMC7038021 DOI: 10.3390/molecules25030516] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 12/27/2022] Open
Abstract
The oral cavity is a unique complex ecosystem colonized with huge numbers of microorganism species. Oral cavities are closely associated with oral health and sequentially with systemic health. Many factors might cause the shift of composition of oral microbiota, thus leading to the dysbiosis of oral micro-environment and oral infectious diseases. Local therapies and dental hygiene procedures are the main kinds of treatment. Currently, oral drug delivery systems (DDS) have drawn great attention, and are considered as important adjuvant therapy for oral infectious diseases. DDS are devices that could transport and release the therapeutic drugs or bioactive agents to a certain site and a certain rate in vivo. They could significantly increase the therapeutic effect and reduce the side effect compared with traditional medicine. In the review, emerging recent applications of DDS in the treatment for oral infectious diseases have been summarized, including dental caries, periodontitis, peri-implantitis and oral candidiasis. Furthermore, oral stimuli-responsive DDS, also known as "smart" DDS, have been reported recently, which could react to oral environment and provide more accurate drug delivery or release. In this article, oral smart DDS have also been reviewed. The limits have been discussed, and the research potential demonstrates good prospects.
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Affiliation(s)
| | | | | | - Jing Zou
- State Key Laboratory of Oral Diseases& West China School of Stomatology& National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; (J.L.); (X.P.); (X.Z.)
| | - Lei Cheng
- State Key Laboratory of Oral Diseases& West China School of Stomatology& National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; (J.L.); (X.P.); (X.Z.)
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Baeza M, Morales A, Cisterna C, Cavalla F, Jara G, Isamitt Y, Pino P, Gamonal J. Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis. J Appl Oral Sci 2020; 28:e20190248. [PMID: 31939522 PMCID: PMC6919200 DOI: 10.1590/1678-7757-2019-0248] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/29/2019] [Accepted: 09/19/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The evidence is inconclusive regarding the effect of periodontal treatment on glycemic control and systemic inflammation in patients with type 2 diabetes (T2D) and periodontitis. To evaluate the effect of scaling and root planing (SRP) on the metabolic control and systemic inflammation of patients with type 2 diabetes (T2D). METHODOLOGY A literature search was conducted using the MEDLINE database via PubMed and the Cochrane Central Register of Controlled Trials, from their oldest records up to July 2018. Only randomized clinical trials (RCT) were considered eligible for evaluating the effect of periodontal treatment on markers of metabolic control [glycated hemoglobin (HbA1C)] and systemic inflammation [C-reactive protein (CRP)] in patients with T2D. The quality of the studies was evaluated using the Cochrane Collaboration risk assessment tool. Meta-analyses were performed for HbA1c and CRP using random effects models. The size of the overall intervention effect was estimated by calculating the weighted average of the differences in means (DM) between the groups in each study. Heterogeneity was assessed using the Q-statistic method (x2 and I²). The level of significance was established at p<0.05. RESULTS Nine RCT were included. SRP was effective in reducing HbA1c [DM=0.56 (0.36-0.75); p<0.01] and CRP [DM=1.89 (1.70-2.08); p<0.01]. No heterogeneity was detected (I2=0%, p>0.05). CONCLUSIONS SRP has an impact on metabolic control and reduction of systemic inflammation of patients with T2D.
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Affiliation(s)
- Mauricio Baeza
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Escuela de Salud Pública, Santiago, Chile
| | - Alicia Morales
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiología y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
| | - Carlos Cisterna
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
| | - Franco Cavalla
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
| | - Gisela Jara
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiología y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
| | - Yuri Isamitt
- Universidad de Chile, Facultad de Odontología, Departamento de Prótesis, Santiago, Chile
| | - Paulina Pino
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiología y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
| | - Jorge Gamonal
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiología y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
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Lopez-Oliva I, de Pablo P, Dietrich T, Chapple I. Gums and joints: is there a connection? Part two: the biological link. Br Dent J 2019; 227:611-617. [PMID: 31605072 DOI: 10.1038/s41415-019-0723-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Rheumatoid arthritis (RA) and periodontitis (PD) are inflammatory diseases characterised by an exacerbated immune-inflammatory reaction that leads to the destruction of bone and other connective tissues that share numerous similarities. Although a significant and independent association between these two conditions has been described, the pathophysiological processes that may explain this relationship remain unknown and multiple theories have been proposed. This review presents the most important theories currently proposed to explain the biological link between RA and PD.
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Affiliation(s)
- Isabel Lopez-Oliva
- Periodontal Research Group, Birmingham Dental School, 5 Mill Pool Way, Edgbaston, Birmingham, B5 7EG, UK
| | - Paola de Pablo
- Institute of Inflammation and Ageing, University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK
| | - Thomas Dietrich
- Periodontal Research Group, Birmingham Dental School, 5 Mill Pool Way, Edgbaston, Birmingham, B5 7EG, UK
| | - Iain Chapple
- Periodontal Research Group, Birmingham Dental School, 5 Mill Pool Way, Edgbaston, Birmingham, B5 7EG, UK.
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Yap KCH, Pulikkotil SJ. Systemic doxycycline as an adjunct to scaling and root planing in diabetic patients with periodontitis: a systematic review and meta-analysis. BMC Oral Health 2019; 19:209. [PMID: 31488125 PMCID: PMC6728970 DOI: 10.1186/s12903-019-0873-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To compare the effectiveness of systemic doxycycline as an adjunct to scaling and root planing (SRP) with SRP alone in improving periodontal clinical attachment level and glycemic control in diabetic patients with periodontitis. METHODS Two independent reviewers (KY and SJ) screened two electronic databases, PubMed and Scopus, for randomized clinical trials on the use of systemic doxycycline as an adjunct to scaling and root planing in improving periodontal status and glycemic control in diabetic patients with periodontitis using predetermined selection criteria within a 3-month period. The reviewers independently did data screening, data selection, data extraction and risk of bias. Quality of studies involved was analysed using the revised Cochrane Risk of Bias 2.0. Weighted standard mean differences (SMD) and 95% confidence intervals were calculated using a random effects meta-analysis model. Publication bias was evaluated using funnel plot. Quality of evidence was evaluated by Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS Electronic searches provided 1358 records and six studies were selected. The meta-analyses indicated that there was no statistically significant difference in the improvement of periodontal status with the use of systemic doxycycline as an adjunct for scaling and root planing (SRP). SMD of clinical attachment levels (- 0.22 [- 0.52, 0.08]) and HbA1c levels (- 0.13 [- 0.41, 0.15]) were calculated. Overall risk of bias is high in 2 out of 6 studies involved. CONCLUSION Systemic doxycycline when used in addition to scaling and root planing yields no significant improvement of clinical attachment levels for periodontal status and reduction of HbA1c levels in treatment of diabetic patients with periodontitis when comparing the test group to the control group.
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Affiliation(s)
- Kenneth Chou Hung Yap
- School of Dentistry, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Shaju Jacob Pulikkotil
- School of Dentistry, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur, Malaysia.
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Lecio G, Ribeiro FV, Pimentel SP, Reis AA, da Silva RVC, Nociti-Jr F, Moura L, Duek E, Casati M, Casarin RCV. Novel 20% doxycycline-loaded PLGA nanospheres as adjunctive therapy in chronic periodontitis in type-2 diabetics: randomized clinical, immune and microbiological trial. Clin Oral Investig 2019; 24:1269-1279. [PMID: 31327083 DOI: 10.1007/s00784-019-03005-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 07/01/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study evaluated the clinical, microbiological, and immunological results of poly lactic-co-glycolic acid (PLGA) nanospheres containing 20% doxycycline (DOXY) in the treatment of type-2 diabetic patients (DM-2) with chronic periodontitis (CP). MATERIAL AND METHODS A parallel, double-blind, randomized, placebo-controlled clinical trial was conducted in DM-2 presenting severe and generalized CP. All patients received one-stage full-mouth ultrasonic debridement (FMUD) and they were randomly divided into two groups: PLAC (n = 20)-local application of placebo PLGA nanospheres, and DOXY (n = 20)-local application of doxycycline-loaded nanospheres; both in six non-contiguous sites. Clinical, metabolic (fasting plasma glucose level-FPG and glycated hemoglobin-HbA1c), cytokine pattern (multiplexed bead immunoassay) and microbiological assessments were performed at baseline, and 1, 3, and 6 months after treatment. RESULTS Both groups showed clinical improvement in all parameters after treatment (p < 0.05). Deep pockets showed improvements in bleeding on probing-BoP (3 and 6 months), PD (at 3 months), and CAL gain (at 1 and 3 months) favoring DOXY (p < 0.05). The percentage of sites presenting PD reduction and CAL gain ≥ 2 mm was higher in DOXY at 3 months (p < 0.05). DOXY group exhibited a significant increase in the levels of anti-inflammatory interleukin (IL)-10 and a reduction in IL-8, IFN-y, IL-6, and IL-17 (p < 0.05), significant reduction in periodontal pathogens (p < 0.05), and a lower mean percentage of HbA1C at 3 months (p < 0.05). CONCLUSION DOXY nanospheres may be considered a potential adjunct to mechanical debridement in the therapy of periodontitis in DM-2, offering additional benefits in deep pockets, improving the cytokine profile, and reducing periodontal pathogen levels. CLINICAL RELEVANCE The use of locally applied doxycycline nanospheres may represent an adjunctive therapeutic approach in the treatment of periodontal disease in type-2 diabetic patients, achieving additional benefits in the local modulation of cytokines, microbial reduction, and clinical parameters, especially in deep pockets.
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Affiliation(s)
| | | | | | | | | | | | - Lucas Moura
- Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Eliane Duek
- School of Biological Sciences, Pontifical Catholic University of São Paulo, Sorocaba, Brazil
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Chen H, Nie Q, Hu J, Huang X, Zhang K, Pan S, Nie S. Hypoglycemic and Hypolipidemic Effects of Glucomannan Extracted from Konjac on Type 2 Diabetic Rats. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2019; 67:5278-5288. [PMID: 30964673 DOI: 10.1021/acs.jafc.9b01192] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Diabetes and its complications are one of the most concerned metabolic diseases worldwide and threaten human health severely. Hypoglycemic and hypolipidemic effects of glucomannan extracted from konjac on high-fat diet and streptozocin-induced type 2 diabetic rats were evaluated in this study. Administration of konjac glucomannan significantly decreased the levels of fasting blood glucose, serum insulin, glucagon-like peptide 1, and glycated serum protein. The concentrations of serum lipids, including total cholesterol, triacylglycerols, low-density lipoprotein cholesterol, and non-esterified fatty acid, were notably reduced by konjac glucomannan treatment. In addition, antioxidant capacity, pancreatic injury, and adipose cell hypertrophy were ameliorated by konjac glucomannan administration in type 2 diabetic rats. Besides, ultra performance liquid chromatography-quadrupole time-of-flight mass spectrometry-based lipidomics analysis was used to explore the improvement of lipid metabolic by konjac glucomannan treatment. The disturbance of glycerolipid (diacylglycerol, monoacylglycerol, and triacylglycerol), fatty acyl (acylcarnitine and hydroxyl fatty acid), sphingolipid (ceramide and sphingomyelin), and glycerophospholipid (phosphatidylcholine) metabolism were attenuated by the glucomannan treatment. This study provided new insights for investigating the anti-diabetic effects of konjac glucomannan and suggests that konjac glucomannan may be a promising nutraceutical for treating type 2 diabetes.
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Affiliation(s)
- Haihong Chen
- State Key Laboratory of Food Science and Technology, China-Canada Joint Laboratory of Food Science and Technology (Nanchang) , Nanchang University , 235 Nanjing East Road , Nanchang , Jiangxi 330047 , People's Republic of China
| | - Qixing Nie
- State Key Laboratory of Food Science and Technology, China-Canada Joint Laboratory of Food Science and Technology (Nanchang) , Nanchang University , 235 Nanjing East Road , Nanchang , Jiangxi 330047 , People's Republic of China
| | - Jielun Hu
- State Key Laboratory of Food Science and Technology, China-Canada Joint Laboratory of Food Science and Technology (Nanchang) , Nanchang University , 235 Nanjing East Road , Nanchang , Jiangxi 330047 , People's Republic of China
| | - Xiaojun Huang
- State Key Laboratory of Food Science and Technology, China-Canada Joint Laboratory of Food Science and Technology (Nanchang) , Nanchang University , 235 Nanjing East Road , Nanchang , Jiangxi 330047 , People's Republic of China
| | - Ke Zhang
- State Key Laboratory of Food Science and Technology, China-Canada Joint Laboratory of Food Science and Technology (Nanchang) , Nanchang University , 235 Nanjing East Road , Nanchang , Jiangxi 330047 , People's Republic of China
| | - Shijie Pan
- State Key Laboratory of Food Science and Technology, China-Canada Joint Laboratory of Food Science and Technology (Nanchang) , Nanchang University , 235 Nanjing East Road , Nanchang , Jiangxi 330047 , People's Republic of China
| | - Shaoping Nie
- State Key Laboratory of Food Science and Technology, China-Canada Joint Laboratory of Food Science and Technology (Nanchang) , Nanchang University , 235 Nanjing East Road , Nanchang , Jiangxi 330047 , People's Republic of China
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Abdel-Moneim A, Semmler M, Abdel-Reheim ES, Zanaty MI, Addaleel W. Association of glycemic status and interferon-γ production with leukocytes and platelet indices alterations in type2 diabetes. Diabetes Metab Syndr 2019; 13:1963-1969. [PMID: 31235122 DOI: 10.1016/j.dsx.2019.04.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/24/2019] [Indexed: 12/15/2022]
Abstract
AIMS The present study aimed to evaluate the correlation between glycemic status and the inflammation biomarkers; leukocytes, platelets indices and interferon gamma (IFN-γ) production in type 2 diabetes mellitus (T2DM) patients regarding diabetic complications. METHODS Study was conducted on 158 patients allocated as normal healthy subjects (50) and 108 patients diagnosed as T2DM. The diabetic patients were subdivided into six groups according to metformin administration as mono-or dual therapies. RESULTS The current results exhibited a significant elevation in systolic blood pressure, total and LDL-cholesterol levels and IFN-γ as well as a noticeable decrease in HDL-cholesterol and anti-atherogenic factor values compared to the healthy patients. Leukocytes and neutrophils count, main platelets volume (MPV) and platelet distribution width (PDW) values revealed noticeable elevations in most treated T2DM groups, while a marked depletion was recorded in platelets count compared to healthy subjects. Glycemic control, most treated diabetic patients with metformin mono- and dual therapies showed an ameliorative effect in HbA1c, IFN-γ, MPV, and PDW values compared to recent diabetic ones. CONCLUSION Diabetes was correlated significantly with dyslipidemia and atherogenic risk in parallel with an increase in IFN-γ production and hematological inflammatory biomarkers; leukocytes, neutrophil/lymphocyte and platelet/lymphocyte ratios, MPV and PDW values. The amelioration in inflammatory biomarkers was associated with improvement in glycemic control.
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Affiliation(s)
- Adel Abdel-Moneim
- Physiology Division, Zoology Department, Faculty of Science, Beni-Suef University, Egypt.
| | - Margit Semmler
- Institute, Diabetes Research Düsseldorf University, Düsseldorf, Germany
| | - Eman S Abdel-Reheim
- Physiology Division, Zoology Department, Faculty of Science, Beni-Suef University, Egypt
| | - Mohamed I Zanaty
- Biotechnology Department, Postgraduate Studies for Advanced Science, Beni-Suef University, Egypt
| | - Wessam Addaleel
- Physiology Division, Zoology Department, Faculty of Science, Beni-Suef University, Egypt
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Mourão L, Carillo Jr R, Linares SM, Canabarro A, Fischer RG. Homeopathy and Periodontal Treatment in Type II Diabetic Patients: a 1-Year Randomized Clinical Trial. Braz Dent J 2019; 30:139-145. [DOI: 10.1590/0103-6440201902124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/24/2018] [Indexed: 01/22/2023] Open
Abstract
Abstract Chronic periodontitis (CP) and Diabetes mellitus type 2 (DMII) are chronic diseases usually treated by conventional practices. On the other hand, homeopathy can help to treat many different diseases. The aim of this study was to evaluate the effects of homeopathy (H) as an adjunct for non-surgical periodontal therapy (NSPT) in individuals with DMII and CP. Eighty individuals with CP and DM II, of both sexes and aged between 32 and 70 years, participated in this randomized, double-blind, placebo-controlled study. They were divided into two groups: control group (CG) and the test group (TG), and both groups received the NSPT. TG also received homeopathic therapy, including Berberis, Mercurius solubilis/Belladonna/Hepar sulphur and Pyrogenium, while CG received placebo. Clinical and laboratorial examinations were evaluated at baseline and after 1, 6 and 12 months of treatment. Both groups showed significant improvement throughout the study, for most of the parameters studied, but TG presented significative gain of CAL at 1 and 12 months compared to CG. Mean glucose and glycated hemoglobin significantly decreased in both groups after 6 and 12 months. However, there was a significantly further reduction of these parameters in TG, as compared to CG. In conclusion, homeopathy as supplement of NSPT may further improve health condition, including glycemic control, in DMII patients with CP.
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Affiliation(s)
- Leila Mourão
- Universidade Veiga de Almeida Rio de Janeiro, Brazil
| | | | | | - Antonio Canabarro
- Universidade Veiga de Almeida Rio de Janeiro, Brazil; UERJ - Universidade do Estado do Rio de Janeiro, Brazil
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Makkar H, Reynolds MA, Wadhawan A, Dagdag A, Merchant AT, Postolache TT. Periodontal, metabolic, and cardiovascular disease: Exploring the role of inflammation and mental health. Pteridines 2018; 29:124-163. [PMID: 30705520 PMCID: PMC6350811 DOI: 10.1515/pteridines-2018-0013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Previous evidence connects periodontal disease, a modifiable condition affecting a majority of Americans, with metabolic and cardiovascular morbidity and mortality. This review focuses on the likely mediation of these associations by immune activation and their potential interactions with mental illness. Future longitudinal, and ideally interventional studies, should focus on reciprocal interactions and cascading effects, as well as points for effective preventative and therapeutic interventions across diagnostic domains to reduce morbidity, mortality and improve quality of life.
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Affiliation(s)
- Hina Makkar
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Mark A Reynolds
- Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Abhishek Wadhawan
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Aline Dagdag
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Teodor T Postolache
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO 80220, USA; Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD 21201, USA,
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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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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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Uraz A, Karaduman B, Isler SÇ, Gönen S, Çetiner D. Ozone application as adjunctive therapy in chronic periodontitis: Clinical, microbiological and biochemical aspects. J Dent Sci 2018; 14:27-37. [PMID: 30988877 PMCID: PMC6445981 DOI: 10.1016/j.jds.2018.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/30/2018] [Indexed: 12/01/2022] Open
Abstract
Background/purpose The application of ozone as an adjunctive treatment represents a new approach in the management of chronic periodontitis. The purpose of this study was to evaluate the clinical, biochemical and microbiological efficacy of ozone treatment as an adjunct to scaling and root planing (SRP) in generalized chronic periodontitis (GCP) patients. Materials and methods Eighteen patients (9 males and 9 females; aged from 28 to 47 years, mean age of 40 ± 6.51 years) with GCP were recruited in the study. In a split mouth design, two quadrants in each patient were randomly allocated to SRP-alone or SRP-ozone therapy (SRP + OT) groups by coin toss method. Subgingival plaque and gingival crevicular fluid (GCF) samples were collected at baseline, following 1st and 3rd months. The clinical parameters were monitored at baseline and after 3 months. Microbiological parameters were analyzed by quantitative-PCR and GCF biomarkers were determined by ELISA. Results were analyzed statistically. Results Statistically significant improvements in all clinical parameters were accompanied by a reduction in microbiological and biochemical parameters in both treatment groups. SRP treatment resulted in a significant reduction of Porphyromonas gingivalis (Pg) at 1st month and Tannerella forsythia (Tf) and Prevotella intermedia (Pi) at 3 months. Following SRP treatment the interleukin (IL)-8 levels were significantly reduced at month 1. There were no significant differences between two treatments for any of the parameters. Conclusion Within the limitations of this study, adjunctive ozone therapy did not provide additional benefits to clinical, microbiological and biochemical parameters over SRP in chronic periodontitis patients.
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Affiliation(s)
- Ahu Uraz
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Burcu Karaduman
- Department of Periodontology, Faculty of Dentistry, Biruni University, İstanbul, Turkey
| | - Sila Çagri Isler
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Sevim Gönen
- Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Deniz Çetiner
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
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Souto MLS, Rovai ES, Ganhito JA, Holzhausen M, Chambrone L, Pannuti CM. Efficacy of systemic antibiotics in nonsurgical periodontal therapy for diabetic subjects: a systematic review and meta-analysis. Int Dent J 2018; 68:207-220. [PMID: 29492963 PMCID: PMC9378894 DOI: 10.1111/idj.12384] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES To evaluate the effects of systemic antibiotics as adjuncts to nonsurgical periodontal treatment (NSPT), as opposed to using NSPT alone, on periodontal clinical parameters of diabetic patients with periodontitis. MATERIALS AND METHODS Randomised controlled trials with a follow-up of 3 months or more, assessing the effects of NSPT in combination with antibiotics, in diabetic patients with periodontitis were included. Trials published up to August 2016 were identified from MEDLINE, EMBASE and LILACS databases. Meta-analyses were conducted to determine changes in clinical attachment level (CAL), probing pocket depth (PPD), bleeding on probing (BOP) and gingival index (GI). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in this review. RESULTS Of the 164 papers potentially admissible to this systematic review, 15 articles on 11 randomised clinical trials were considered as eligible. The results of the meta-analyses presented a modest additional benefit of 0.14 mm (95% confidence interval: 0.08-0.20) in reducing PPD but no further benefit in CAL gain. CONCLUSION When the data for all antibiotic protocols were considered together for the treatment of periodontitis patients with DM, a significant, albeit small, reduction of PPD and no improvement in CAL gain was observed. When the antibiotic protocols were analysed separately, the combination of amoxicillin plus metronidazole yielded the best results for PPD.
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Affiliation(s)
- Maria Luisa S. Souto
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Emanuel S. Rovai
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Juliana A. Ganhito
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marinella Holzhausen
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Leandro Chambrone
- Unit of Basic Oral Investigations, El Bosque University, Bogota, Colombia
| | - Cláudio M. Pannuti
- Division of Periodontics, School of Dentistry, University of São Paulo, 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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Madianos PN, Koromantzos PA. An update of the evidence on the potential impact of periodontal therapy on diabetes outcomes. J Clin Periodontol 2017; 45:188-195. [DOI: 10.1111/jcpe.12836] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Phoebus N. Madianos
- Department of Periodontology; School of Dentistry; National and Kapodistrian University of Athens; Athens Greece
| | - Panagiotis A. Koromantzos
- Department of Periodontology; School of Dentistry; National and Kapodistrian University of Athens; Athens Greece
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Grellmann AP, Sfreddo CS, Maier J, Lenzi TL, Zanatta FB. Systemic antimicrobials adjuvant to periodontal therapy in diabetic subjects: a meta-analysis. J Clin Periodontol 2017; 43:250-60. [PMID: 26790108 DOI: 10.1111/jcpe.12514] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Adjuvant antibiotics have been suggested to improve periodontal therapy in diabetic subjects. AIM The aim of this study was to systematically review randomized clinical trials assessing systemic antimicrobial use adjuvant to scaling and root planing (SRP) versus SRP alone in diabetic subjects. MATERIAL AND METHODS The PubMed, Cochrane Central Register of Controlled Trials, EMBASE, TRIP, Web of Science and LILACS databases and the grey literature were searched through May 2015. Of 2534 potentially eligible studies, 13 were included in the systematic review. Weighted mean differences (WMDs) in probing depth (PD) reduction and clinical attachment level (CAL) gain (primary outcomes), and plaque index (PI) and bleeding on probing (BOP) reductions, were estimated using a random effect model. RESULTS The WMD in PD reduction [-0.15 mm, n = 11, p = 0.001, 95% confidence interval (CI) -0.24, -0.06] favoured antibiotic use. WMDs in CAL gain, PI and BOP reductions (-0.14 mm, n = 9, p = 0.11, 95% CI -0.32, 0.03; 4.01%, n = 7, p = 0.05, 95% CI -0.04, 8.07; and -1.91%, n = 7, p = 0.39, 95% CI -6.32, 2.51 respectively) did not favour adjunctive antibiotic use. CONCLUSION Adjunctive therapy may improve the efficacy of SRP in reducing PD in diabetic subjects.
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Affiliation(s)
| | - Camila Silveira Sfreddo
- Post-graduate Program in Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Juliana Maier
- Post-graduate Program in Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Tathiane Larissa Lenzi
- Post-graduate Program in Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil
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Effects on HbA1c in diabetic patients of adjunctive use of systemic antibiotics in nonsurgical periodontal treatment: A systematic review. J Dent 2017; 66:1-7. [PMID: 28827017 DOI: 10.1016/j.jdent.2017.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/20/2017] [Accepted: 08/02/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the effects of adjunctive use of systemic antibiotics in nonsurgical periodontal treatment compared to nonsurgical periodontal treatment alone, on mean glycated hemoglobin (HbA1c) reductions in patients with diabetes. DATA Two independent reviewers screened six electronic databases, registers of clinical trials, meeting abstracts and four major dental journals for controlled clinical trials with at least 3-month follow-up. SOURCES After duplicates removal, electronic and hand searches yielded 2136 records; 32 full-text articles were independently read by two reviewers. To evaluate the additional effect of antibiotic usage, pooled weighted mean differences and 95% confidence intervals were calculated using fixed and random effects models. STUDY SELECTION Twelve studies met the inclusion criteria, nine of which provided data that allowed their inclusion in meta-analyses. The meta-analyses showed no significant effect favouring scaling and root planing (SRP) plus antibiotic for reductions in mean HbA1c (-0.11% [-0.35, 0.13]; 6 studies), and an estimated prediction interval varying from -0.45 to 0.23. There was also no significant effect favouring the adjunctive usage of sub-antimicrobial doxycycline in HbA1c mean reduction (-0.19% [-1.04, 0.67]; 2 studies). CONCLUSION Adjunctive use of systemic antibiotic provides no statistically significant benefit in terms of HbA1c improvement in periodontal treatment of patients with diabetes. CLINICAL SIGNIFICANCE Adjunctive use of systemic antibiotics associated with nonsurgical periodontal treatment provides no additional benefit in terms of HbA1c of diabetic patients. Clinicians should weigh the trade-off between risks and benefits provided by the use of systemic antibiotics before prescribing them for periodontal disease treatment.
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Wahi S, Tripathi A, Wahi S, Mishra VD, Singh AP, Sinha N. Assessment of Levels of Glycosylated Hemoglobin in Patients with Periodontal Pathologies: A Comparative Study. J Contemp Dent Pract 2017. [PMID: 28621283 DOI: 10.5005/jp-journals-10024-2074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION One of the potential sources for the occurrence of various systemic pathologies, such as cardiovascular diseases, cerebrovascular diseases, and respiratory diseases is periodontitis. Testing of glycosylated hemoglobin (HbA) is a highly standardized procedure and is becoming increasingly popular these days due to its cost-effectiveness and ease of use. Literature quotes numerous studies associating the peri-odontal diseases with various hemoglobin markers in diabetic and nondiabetic patients. Hence, we planned the present study to assess the levels of HbA in patients with periodontitis among nondiabetic patients. MATERIALS AND METHODS For the present study, a total of 50 nondiabetic subjects who reported to the department with the chief complaint of periodontitis were included. Another set of 50 nondiabetic individuals were included in the present study of comparable age in whom no periodontitis was detected clinically. Clinical examination and radiographic evaluation was performed for the selection of the cases for the study group. The patients were sent to the laboratory after the clinical examination, for the testing of HbA. Testing of the hemoglobin A1c (HbA1c) levels of all the subjects and controls was performed and values were noted and evaluated. RESULTS Nonsignificant results were obtained while comparing the mean HbA1c concentrations among the study group and the control group. Nonsignificant results were obtained while comparing the mean HbA1c levels among males and females. While comparing the mean HbA1c levels between the study group and the control group divided on the basis of body mass index, nonsignificant results were obtained. CONCLUSION In nondiabetic subjects, no significant correlation could be observed between periodontitis and HbA1c levels. CLINICAL SIGNIFICANCE The HbA1c cannot be used as a reliable maker for differentiation of patients with periodontal pathologies from patients free of periodontal pathologies.
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Affiliation(s)
- Saurabh Wahi
- Department of Dentistry, Heritage Institute of Medical Sciences Varanasi, Uttar Pradesh, India, Phone: +919506325765, e-mail:
| | - Alok Tripathi
- Department of General Surgery, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Shradha Wahi
- Department of Orthodontics, Swami Devi Dyal Dental College Panchkula, Haryana, India
| | - Vikas D Mishra
- Department of TB and Chest, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Abhishek P Singh
- Department of Psychiatry, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Nikhil Sinha
- Department of General Medicine, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
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Gelato MC, Schoenfeld E, Hou W, Michalowicz B, Seaquist E, Oates T, Tripathy D, Engebretson S, Hyman L. Changes in diabetes medications in the Diabetes and Periodontal Therapy Trial and their effect on hemoglobin A1c (HbA1c). Contemp Clin Trials 2016; 50:21-7. [PMID: 27417981 DOI: 10.1016/j.cct.2016.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/16/2016] [Accepted: 07/10/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Evaluate the effect of medications and medication changes during the Diabetes and Periodontal Therapy Trial (DPTT) on the primary study outcome, namely, change in hemoglobin A1c (HbA1c) at 6months following baseline. METHODS The DPTT set strict criteria for changes in diabetes medications. Medication change was defined as: change in dose of any 1 oral hypoglycemic agent by more than two-fold, change in dose of insulin of >10% and/or addition or subtraction of an oral hypoglycemic agent, insulin or non-insulin injectable agents. Comparisons between the treatment (non- surgical periodontal therapy) and control (no therapy) groups used t-tests for continuous variables and chi-square tests for categorical variables, including DPTT defined diabetes medication changes between baseline (BL) and 3month visits and 3- and 6-month visits. Changes in HbA1c were compared across the four medication change categories using ANOVA models, overall and for each treatment group separately. RESULTS Baseline medication use was similar between the treatment groups (p>0.40), as were medication changes between BL- 3month visits and 3 and 6month visits (p=0.58). Participants with higher BL HbA1c (>8%) and those taking insulin at BL were more likely to have a change in medication (p=0.03). CONCLUSIONS The DPTT had the most rigorous definition of medication changes and medication monitoring of any trial in this field to date. The absence of a significant difference in medication changes between treatment groups may suggest that such changes did not play a role in the negative outcome of the DPTT.
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Affiliation(s)
- Marie C Gelato
- Division of Endocrinology, Stony Brook Medicine, HSC T16-027i, Stony Brook, New York 11794-8154, United States.
| | - Elinor Schoenfeld
- Department of Preventive Medicine, Stony Brook University, School of Medicine, Stony Brook, NY
| | - Wei Hou
- Department of Preventive Medicine, Stony Brook University, School of Medicine, Stony Brook, NY
| | - Bryan Michalowicz
- Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, MN
| | | | - Thomas Oates
- School of Dentistry, University of Texas at San Antonio, San Antonio, TX
| | - Devjit Tripathy
- Department of Medicine, University of Texas at San Antonio, San Antonio, TX
| | - Steven Engebretson
- Department of Periodontology and Implant Dentistry, New York University, New York, NY
| | - Leslie Hyman
- Department of Preventive Medicine, Stony Brook University, School of Medicine, Stony Brook, NY
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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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42
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D'Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Clin Periodontol 2016; 40 Suppl 14:S85-105. [PMID: 23627337 DOI: 10.1111/jcpe.12061] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/11/2022]
Abstract
AIM The aim of this review was to critically appraise the evidence on the impact of periodontal treatment of cardiovascular diseases (CVDs) biomarkers and outcomes. METHODS A systematic search was performed in Cinhal, Cochrane, Embase and Medline for relevant articles up to July 2012. Duplicate screening and reference hand searching were performed. Data were then summarized and evidence graded in tables. RESULTS The search resulted in: (a) no evidence on the effects of periodontal therapy on subclinical atherosclerosis, serum levels of CD40 ligand, serum amyloid A and monocyte chemoattractant protein-1, (b) limited evidence on the effects of periodontal therapy on arterial blood pressure, leucocyte counts, fibrinogen, tissue necrosis factor-α, sE-selectin, von Willebrand factors, d-dimers, matrix metalloproteinases, oxidative stress and CVD events, and (c) moderate evidence suggesting a negligible effect of periodontal therapy in reducing interleukin-6 and lipids levels, whilst a positive effect in reducing serum C-reactive protein levels and improving endothelial function. CONCLUSIONS Periodontal therapy triggers a short-term inflammatory response followed by (a) a progressive and consistent reduction of systemic inflammation and (b) an improvement in endothelial function. There is however limited evidence that these acute and chronic changes will either increase or reduce CVD burden of individuals suffering from periodontitis in the long term.
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Affiliation(s)
- Francesco D'Aiuto
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, London, UK.
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D'Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Periodontol 2016; 84:S85-S105. [PMID: 23631587 DOI: 10.1902/jop.2013.134007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM The aim of this review was to critically appraise the evidence on the impact of periodontal treatment of cardiovascular diseases (CVDs) biomarkers and outcomes. METHODS A systematic search was performed in Cinhal, Cochrane, Embase and Medline for relevant articles up to July 2012. Duplicate screening and reference hand searching were performed. Data were then summarized and evidence graded in tables. RESULTS The search resulted in: (a) no evidence on the effects of periodontal therapy on subclinical atherosclerosis, serum levels of CD40 ligand, serum amyloid A and monocyte chemoattractant protein-1, (b) limited evidence on the effects of periodontal therapy on arterial blood pressure, leucocyte counts, fibrinogen, tissue necrosis factor-a, sE-selectin, von Willebrand factors, d-dimers, matrix metalloproteinases, oxidative stress and CVD events, and (c) moderate evidence suggesting a negligible effect of periodontal therapy in reducing interleukin-6 and lipids levels, whilst a positive effect in reducing serum C-reactive protein levels and improving endothelial function. CONCLUSIONS Periodontal therapy triggers a short-term inflammatory response followed by (a) a progressive and consistent reduction of systemic inflammation and (b) an improvement in endothelial function. There is however limited evidence that these acute and chronic changes will either increase or reduce CVD burden of individuals suffering from periodontitis in the long term.
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Affiliation(s)
- Francesco D'Aiuto
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, University College London, UK.
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Pranckeviciene A, Siudikiene J, Ostrauskas R, Machiulskiene V. Long-term effect of periodontal surgery on oral health and metabolic control of diabetics. Clin Oral Investig 2016; 21:735-743. [DOI: 10.1007/s00784-016-1819-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/03/2016] [Indexed: 01/04/2023]
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Tamashiro N, Duarte P, Miranda T, Maciel S, Figueiredo L, Faveri M, Feres M. Amoxicillin Plus Metronidazole Therapy for Patients with Periodontitis and Type 2 Diabetes. J Dent Res 2016; 95:829-36. [DOI: 10.1177/0022034516639274] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The aim of this study was to assess the changes occurring in subgingival biofilm composition and in the periodontal clinical parameters of subjects with periodontitis and type 2 diabetes mellitus (DM) treated by means of scaling and root planing (SRP) only or combined with systemic metronidazole (MTZ) and amoxicillin (AMX). Fifty-eight subjects were randomly assigned to receive SRP only ( n = 29) or with MTZ (400 mg/thrice a day [TID]) and AMX (500 mg/TID) ( n = 29) for 14 d. Six subgingival plaque samples/subject were analyzed by checkerboard DNA–DNA hybridization for 40 bacterial species at baseline and 3 mo, 1 y, and 2 y posttherapy. At 2 y posttherapy, the antibiotic-treated group harbored lower mean proportions (5.5%) of red complex pathogens than the control group (12.1%) ( P < 0.05). The proportions of the Actinomyces species remained stable in the antibiotic group but showed a statistically significant reduction in the control group from 1 to 2 y in subjects achieving a low risk clinical profile for future disease progression (i.e., ≤4 sites with probing depth [PD] ≥5 mm). The test group also had a lower mean number of sites with PD ≥5 mm (3.5 ± 3.4) and a higher percentage of subjects reaching the low risk clinical profile (76%) than the control group (14.7 ± 13.1 and 22%, respectively) ( P < 0.05) at 2 y posttreatment. MTZ + AMX intake was the only significant predictor of subjects achieving the low risk at 2 y (odds ratio, 20.9; P = 0.0000). In conclusion, the results of this study showed that the adjunctive use of MTZ + AMX improves the microbiological and clinical outcomes of SRP in the treatment of subjects with generalized chronic periodontitis and type 2 DM up to 2 y ( ClinicalTrials.gov NCT02135952).
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Affiliation(s)
- N.S. Tamashiro
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - P.M. Duarte
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - T.S. Miranda
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - S.S. Maciel
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - L.C. Figueiredo
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - M. Faveri
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - M. Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
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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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49
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Spasovski S, Belazelkoska Z, Popovska M, Atanasovska-Stojanovska A, Radojkova-Nikolovska V, Muratovska I, Toseska-Spasova N, Dzipunova B, Nikolovski B. Clinical Therapeutic Effects of the Application of Doxycycline in the Treatment of Periodontal Disease. Open Access Maced J Med Sci 2016; 4:152-7. [PMID: 27275351 PMCID: PMC4884238 DOI: 10.3889/oamjms.2016.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the therapeutic effects of the application of doxycycline-full dose (100 mg) and sub-dose (20 mg) in the treatment of periodontal disease. MATERIAL AND METHODS A total of 60 patients with periodontal disease were examined. Patients are divided into two groups: A) treated with antimicrobial dose of 100 mg doxycycline once daily for 30 days, and B) treated with 2 x 20 mg/day. doxycycline, during 75 days. Among all patients a conservative treatment was carried out and ordinated the proper dose doxycycline in total dose during treatment from 3 gr. Index of dental plaque by Löe-Sillness, index of gingival inflammation and gingival bleeding by Cowell were followed. RESULTS Values of dental plaque in relation first examination, 10th, 20th day, 1 month and 2.5 months, showed that after 2.5 months, average value (x = 0.83) of dental plaque in second group is slightly less than the value (x = 0.93) of dental plaque in the first group. The average value (x = 0.17) of gingival inflammation in second group is significantly less than the value (x = 0.50) of gingival inflammation in the first group. The average value (x = 0.97) of gingival bleeding in patients from the first group was significantly higher than value(x = 0.37) of gingival bleeding in the second group. CONCLUSION Patients whose therapy was helped by a sub-dose doxycycline demonstrated positive therapeutic effects on gingival inflammation and bleeding.
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Affiliation(s)
| | - Zlatanka Belazelkoska
- Faculty of Dentistry, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, Republic of Macedonia
| | - Mirjana Popovska
- Faculty of Dentistry, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, Republic of Macedonia
| | | | - Vera Radojkova-Nikolovska
- Faculty of Dentistry, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, Republic of Macedonia
| | - Ilijana Muratovska
- Faculty of Dentistry, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, Republic of Macedonia
| | - Natasa Toseska-Spasova
- Faculty of Dentistry, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, Republic of Macedonia
| | - Biljana Dzipunova
- Faculty of Dentistry, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, Republic of Macedonia
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50
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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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