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Kang S, Liu ZY, Yuan HH, Wang SM, Pan GG, Wei W, Jiang Y, Hou Y. The impact of different states of type 2 diabetes when stratified by baseline HbA1c on the periodontal outcomes of non-surgical periodontal treatment: A systematic review and network meta-analysis. Int J Dent Hyg 2024; 22:401-413. [PMID: 38394099 DOI: 10.1111/idh.12789] [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: 07/15/2023] [Revised: 09/16/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) has been considered by many studies to have a bidirectional relationship with periodontitis. This systematic review and network meta-analysis aimed to investigate the impact of different states of T2DM when stratified by baseline HbA1c on the clinical outcomes of non-surgical periodontal treatment (NSPT). METHODS This study followed the Preferred Reporting Items for Meta-Analyses (PRISMA) guidelines and involved an electronic literature search (from inception to the 2nd of January 2023). The study included at least two groups of patients: chronic periodontitis only (No-DM) or periodontitis and well-controlled/poorly controlled type 2 diabetes mellitus (WC/PC-T2DM). Clinical outcomes included probing depth (PD) reduction, bleeding on probing reduction, and clinical attachment level (CAL) gain. Direct and indirect comparisons between groups were assessed by network meta-analysis, thus allowing us to establish a treatment ranking. RESULTS Ten prospective cohort studies (11 data sets) were included for qualitative analysis and network meta-analysis. The data included in this study had high consistency; in addition, a funnel plot and Egger's test showed that the articles had low publication bias. Network meta-analysis showed that the effect of NSPT in the No-DM group was significantly better than the WC-T2DM group [weighted mean difference (WMD) = 0.09, 95% confidence interval (CI) (0.01, 0.18)] and the PC-T2DM group [WMD = 0.09, 95% CI (0.01, 0.18)] in terms of CAL gain and better than the PC-T2DM group [WMD = 0.15, 95% CI (0.02, 0.28)] in terms of PD reduction. According to the surface under the cumulative ranking value, the No-DM group had the highest probability of achieving the best outcome following NSPT. CONCLUSIONS Collectively, our analyses show that T2DM exerts significant effects on the outcomes of NSPT.
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Affiliation(s)
- Shuai Kang
- Institute of Stomatology, Chinese People's Liberation Army No.989 hospital, Luoyang, China
| | - Zheng-Ya Liu
- Institute of Stomatology, Chinese People's Liberation Army No.989 hospital, Luoyang, China
| | - Huan-Huan Yuan
- Institute of Stomatology, Chinese People's Liberation Army No.989 hospital, Luoyang, China
| | - Shu-Min Wang
- Institute of Stomatology, Chinese People's Liberation Army No.989 hospital, Luoyang, China
| | - Ge-Ge Pan
- Institute of Stomatology, Chinese People's Liberation Army No.989 hospital, Luoyang, China
| | - Wei Wei
- Institute of Stomatology, Chinese People's Liberation Army No.989 hospital, Luoyang, China
| | - Yi Jiang
- Institute of Stomatology, First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yu Hou
- Institute of Stomatology, Chinese People's Liberation Army No.989 hospital, Luoyang, China
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Zhao Z, Sun X, Cao L, Zhu C, He K, Hu X, Liu C, Feng Q, Qin Y. Salivary Proteome and Intact N-Glycopeptides Analysis Reveal Specific Signatures in Periodontitis. J Proteome Res 2024; 23:25-39. [PMID: 38088868 DOI: 10.1021/acs.jproteome.3c00253] [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] [Indexed: 01/06/2024]
Abstract
Periodontitis is a prevalent oral inflammatory disease that can result in tooth loss and is closely linked to type 2 diabetes (T2D). In this study, we analyzed the salivary proteome and intact N-glycopeptides (IGPs) of individuals with mild-moderate, severe, aggressive periodontitis, and periodontitis with T2D, including those treated with antidiabetic drugs, to identify specific signatures associated with the disease. Our results revealed that salivary proteins and glycoproteins were altered in all periodontitis groups (PRIDE ID: 1-20230612-72345), with fucose- and sialic acid-containing N-glycans showing the greatest increase. Additionally, differentially expressed proteins were classified into 9 clusters, including those that were increased in all periodontitis groups and those that were only altered in certain types of periodontitis. Interestingly, treatment with antidiabetic drugs reversed many of the changes observed in the salivary proteome and IGPs in T2D-related periodontitis, suggesting a potential therapeutic approach for managing periodontitis in patients with T2D. Consistent with MS/MS results, the expression of salivary IGHA2 and Fucα1-3/6GlcNAc (AAL) was significantly increased in MP. These findings provide new insights into the pathogenesis of periodontitis and highlight the potential of salivary biomarkers for diagnosis, prognosis, and monitoring of disease progression and treatment response.
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Affiliation(s)
- Zhirong Zhao
- Department of Cell Biology and Genetics and Department of Pathogenic Microbiology & Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
- Xi'an Dian Medical Laboratory Co., Ltd., Xi'an, Shaanxi 710000, China
| | - Xiaoyu Sun
- Key Laboratory of Oral Diseases Research of Anhui Province, Department of Periodontology, Stomatologic Hospital & College, Anhui Medical University, Hefei 230032, China
| | - Li Cao
- Department of Cell Biology and Genetics and Department of Pathogenic Microbiology & Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
| | - Chunhui Zhu
- Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an 710069, China
| | - Kang He
- Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an 710069, China
| | - Xiaoyi Hu
- Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an 710069, China
| | - Chengcheng Liu
- Department of Cell Biology and Genetics and Department of Pathogenic Microbiology & Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
| | - Qiang Feng
- Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Department of Human Microbiome, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Yannan Qin
- Department of Cell Biology and Genetics and Department of Pathogenic Microbiology & Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
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Joseph P, Prabhakar P, Holtfreter B, Pink C, Suvan J, Kocher T, Pitchika V. Systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of non-surgical periodontal treatment in patients with concurrent systemic conditions. Clin Oral Investig 2023; 28:21. [PMID: 38147183 PMCID: PMC10751251 DOI: 10.1007/s00784-023-05392-6] [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: 08/22/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To conduct a systematic review of the published scientific evidence to evaluate the efficacy of nonsurgical periodontal therapy (NSPT) in treating periodontitis in patients with concurrent systemic conditions (diabetes, CVD, erectile dysfunction, chronic kidney disease, rheumatoid arthritis, polycystic ovarian syndrome, obesity, pregnancy). We hypothesised that NSPT results in better periodontal outcomes when compared to untreated controls after follow-up. MATERIALS AND METHODS A systematic search (PUBMED/EMBASE) was conducted from 1995 to 2023 to identify randomised controlled trials (RCTs) with a minimum follow-up of 3 months. The primary outcome was the difference in mean probing depth (PD), and the secondary outcomes were mean clinical attachment loss (CAL), percentage of sites with PD ≤ 3 mm (%PD ≤ 3 mm) and percentage of sites with bleeding on probing (%BOP) between the treated and untreated control group in patients with comorbidities. RESULTS The electronic search resulted in 2,403 hits. After removing duplicates, 1,565 titles and abstracts were screened according to the eligibility criteria, resulting in 126 articles for full-text screening. Following this, 44 studies were analysed. Restricting to studies with low bias or some concerns, NSPT group demonstrated a 0.55 mm lower mean PD (95%CI: -0.69; -0.41) after 3 months compared to the control group. CONCLUSION Compared to the untreated controls, NSPT notably reduced mean PD, mean CAL, and %BOP while increasing %PD ≤ 3 mm in patients with concurrent systemic conditions. These findings suggest that NSPT is also an effective procedure in managing periodontitis in patients with concurrent systemic conditions. TRIAL REGISTRATION This systematic review was registered under the protocol registration number CRD42021241517/PROSPERO.
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Affiliation(s)
- Prabhakar Joseph
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Priya Prabhakar
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - Christiane Pink
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
- Department of Orthodontics, University Medicine Greifswald, Greifswald, Germany
| | - Jeanie Suvan
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany.
| | - Vinay Pitchika
- Department of Restorative Dentistry, Periodontology, Endodontology, Preventive and Pediatric Dentistry, University Medicine Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
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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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Shunmuga PD, Tadepalli A, Parthasarathy H, Ponnaiyan D, Cholan PK, Ramachandran L. Clinical evaluation of the combined efficacy of injectable platelet-rich fibrin along with scaling and root planing in the non-surgical periodontal therapy of stage III and grade C periodontitis patients having type 2 diabetes mellitus: A randomized controlled trial. Clin Adv Periodontics 2023. [PMID: 37749861 DOI: 10.1002/cap.10266] [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: 03/21/2023] [Revised: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND This randomized controlled trial was aimed to evaluate the combined efficacy of injectable platelet-rich fibrin (i-PRF) and scaling and root planing (SRP) in type 2 diabetes mellitus subjects having periodontitis. METHODS Twenty-six Stage III, grade C periodontitis subjects (HbA1c > 7) were recruited in this split-mouth study. Following SRP, the test sites received subgingival application of i-PRF, while the control sites received saline. Plaque index, bleeding on probing, modified gingival index, probing pocket depth (PPD) and clinical attachment level (CAL) were measured at baseline, 3 and 6 months. RESULTS Twenty-three participants completed the course of research. The Friedman test followed by Dunn's post hoc test, revealed significant improvement in all the clinical parameters from baseline to 3 and 6 months in both the study groups (p ≤ 0.05). The mean PPD and CAL decreased from 6.30 ± 1.25 and 7.48 ± 1.75 at baseline to 3.48 ± 1.34 and 4.39 ± 1.67 at 6 months in control sites and from 6.57 ± 1.56 and 7.61 ± 1.69 to 3.39 ± 1.23 and 4.26 ± 1.81 at 6 months in test sites (p ≤ 0.0001). Intergroup analysis found no statistical significant differences in the evaluated parameters across all time intervals (p > 0.05) CONCLUSION: The results indicated that the adjunctive application of i-PRF to SRP provided similar benefits as saline and SRP in diabetes mellitus subjects. KEY POINTS Question: To find the combined efficacy of injectable platelet-rich fibrin (i-PRF) along with scaling and root planing (SRP) in the management of periodontal pockets of Stage III and Grade C periodontitis patients having Type 2 Diabetes Mellitus (T2DM). FINDING All of the treated sites showed satisfactory healing. Both the treatment modalities (i-PRF + SRP and Saline + SRP) were effective in the treatment of periodontal pockets. At 3 and 6 months, there were no significant differences in periodontal parameters between groups. Meaning: The application of i-PRF as an adjunct to SRP provided similar benefits as saline and SRP in improving clinical parameters in subjects with stage III and grade C periodontitis patients having T2DM (HbA1C > 7).
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Affiliation(s)
- Prasanth D Shunmuga
- Department Of Periodontics, S.R.M. Dental College and Hospital, Chennai, India
| | - Anupama Tadepalli
- Department Of Periodontics, S.R.M. Dental College and Hospital, Chennai, India
| | | | - Deepa Ponnaiyan
- Department Of Periodontics, S.R.M. Dental College and Hospital, Chennai, India
| | - Priyanka K Cholan
- Department Of Periodontics, S.R.M. Dental College and Hospital, Chennai, India
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Oliveira VB, Costa FWG, Haas AN, Júnior RMM, Rêgo RO. Effect of subgingival periodontal therapy on glycaemic control in type 2 diabetes patients: Meta-analysis and meta-regression of 6-month follow-up randomized clinical trials. J Clin Periodontol 2023; 50:1123-1137. [PMID: 37257917 DOI: 10.1111/jcpe.13830] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/05/2023] [Accepted: 05/06/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Periodontitis worsens the hyperglycaemia in patients with type 2 diabetes mellitus (T2DM). Subgingival instrumentation, with or without surgical access, is the gold-standard treatment for periodontitis. The aim was to summarize the evidence on the effect of subgingival instrumentation (with or without open flap) on the reduction of glycosylated haemoglobin (HbA1c). METHODS Nine electronic databases were searched up to 15 February 2023. Twelve randomized controlled trials with at least 6 months of follow-up were included. Studies using systemic or local-delivery antimicrobial therapies were excluded. Meta-analyses were performed using the random-effects model. The sources of heterogeneity were assessed by applying linear meta-regression. Risk of bias was assessed by RoB 2, and certainty of evidence by GRADE. RESULTS Eleven studies were included in the quantitative analyses (1374 patients). Subgingival instrumentation resulted in 0.29% lower HbA1c (95% confidence interval: 0.10-0.47; p = .03) compared with non-active treatment. DISCUSSION None of the 12 studies were assessed as having low risk of bias. The percentage of females and the time of diabetes diagnosis significantly explained the high level of heterogeneity. Subgingival periodontal therapy results in a significant and clinically relevant improvement in glycaemic control over 6 months in patients with T2DM and periodontitis. The grade of evidence was moderate.
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Affiliation(s)
- Victor Bento Oliveira
- Graduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | - Fábio Wildson Gurgel Costa
- Department of Clinical Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | - Alex Nogueira Haas
- Department of Conservative Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Rodrigo Otávio Rêgo
- Department of Clinical Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
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Elnour MA, Mirghani H. Periodontitis treatment (surgical and nonsurgical) effects on glycemic control: A review and meta-analysis. Ann Afr Med 2023; 22:131-135. [PMID: 37026192 DOI: 10.4103/aam.aam_53_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Background Periodontitis is the sixth most prevalent chronic disease. Literature suggests a relationship between diabetes and periodontitis and when coexist may aggravate each other deleterious consequences. Therefore, we aimed to assess the effects of periodontitis treatment on glycemic control. Materials and Methods A systematic literature search was conducted in PubMed, Cochrane Library, and the first 100 articles in Google Scholar from January 2011 to October 2021. The terms periodontitis, periodontal treatment, diabetes mellitus, nonsurgical treatment, glycated hemoglobin (HbA1c) were used, with the Protean "AND" and "OR." The titles, abstracts, and references of the included studies were screened. Any discrepancy was solved by an agreement between researchers. Out of 1059 studies retrieved, 320 stands after the removal of duplication, from them, 31 full texts were screened and only 11 studies were included in the final meta-analysis. Results In the present meta-analysis, 11 studies (1469 patients included) were pooled, and the overall effect showed that periodontitis treatment improved the HbA1c, odd ratio, -0.024, 95% confidence interval, -0.42-.06, P value, 0.009, Chi-square, 52.99. However, substantial heterogeneity was observed, P value, < 0.001, I2 for heterogeneity 81%. Conclusion Periodontitis treatment improved the HbA1c among patients with diabetes and poor glycemic control. Screening of this common disease is important in diabetes holistic care.
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Pham TAV, Nguyen PA, Tran TTP, Nguyen VTT. Nonsurgical periodontal treatment improved the type 2 diabetes mellitus status in smokers: A randomized controlled trial. Diabetes Res Clin Pract 2022; 194:110150. [PMID: 36375565 DOI: 10.1016/j.diabres.2022.110150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/27/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
AIM Type 2 diabetes mellitus (T2D) and periodontal disease have bilateral associations. The effect of periodontal treatment on T2D patients who smoke is scarce. This study aimed to assess the effect of nonsurgical periodontal treatment (NSPT) in periodontitis smokers with T2D for a duration of 6 months of follow-up. MATERIALS AND METHODS Forty moderate to severe periodontitis smokers with T2D were randomly distributed into two different treatment groups: the test group (NSPT including oral hygiene instructions, scaling and root planing; and 0.05% Chlorhexidine mouthrinse) and the control group (treatment including oral hygiene instructions, supragingival removal of plaque and calculus and 0.05% Chlorhexidine mouthrinse). Periodontal parameters including plaque index (PI), gingival index (GI), bleeding on probing (BOP), periodontal probing depth (PPD) and clinical attachment loss (CAL) were examined. Metabolic parameters, including fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c), and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline and at 1, 3, and 6 months of follow-up. RESULTS The test group significantly improved all periodontal parameters and reduced metabolic parameters and hs-CRP, whereas improvements in PI and GI were observed in the control group at 1, 3 and 6 months of follow-up. However, the PPD, CAL, metabolic parameters and hs-CRP increased in the control group at 3 and 6 months of follow-up, but the differences were not significant. CONCLUSIONS NSPT improves the periodontal status of smokers with T2D, has a favorable effect on glycemic control and reduces pro-inflammatory mediators, which may limit complications due to T2D in these patients.
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Affiliation(s)
- Thuy Anh Vu Pham
- Division of Odonto-Stomatology, School of Medicine, Ho Chi Minh City, Viet Nam; Vietnam National University, Ho Chi Minh City, Viet Nam.
| | - Phuc Anh Nguyen
- Division of Odonto-Stomatology, School of Medicine, Ho Chi Minh City, Viet Nam; Vietnam National University, Ho Chi Minh City, Viet Nam
| | - Thao Thi Phuong Tran
- Faculty of Odonto-Stomatology, Hong Bang International University, Ho Chi Minh City, Viet Nam
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Effects of Nonsurgical Periodontal Therapy on Salivary 8-Hydroxy-Deoxyguanosine Levels and Glycemic Control in Diabetes Mellitus Type 2 Patients. Biomedicines 2022; 10:biomedicines10092269. [PMID: 36140370 PMCID: PMC9496046 DOI: 10.3390/biomedicines10092269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/18/2022] Open
Abstract
Diabetes and periodontitis are complex chronic diseases that are potentially interrelated, as well as associated with oxidative stress. Thus, the aim of the present study was to evaluate the influence of nonsurgical periodontal treatment on salivary 8-hydroxy-deoxyguanosine (8-OHdG) levels and glycemic control in patients suffering from both diabetes mellitus type 2 (DM2) and periodontitis. The study sample included 53 DM2 patients, while 31 systemically healthy patients served as controls. Participants in both groups suffered from periodontitis of comparable severity. Periodontal clinical parameters, namely plaque index (PI), gingival index (GI), papilla bleeding index (PBI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded, along with salivary 8-OHdG levels and glycated hemoglobin (HbA1c). Levels of 8-OHdG were analyzed by ELISA. All aforementioned parameters were evaluated prior to commencing the study and at 90-day follow-up upon nonsurgical periodontal therapy completion. At baseline, salivary levels of 8-OHdG in DM2 patients were significantly higher (1.17 ng/mL) than those measured for the control group (0.75 ng/mL) and showed significant positive correlation with GI and PPD (p < 0.05). Three months after nonsurgical periodontal therapy, the salivary 8-OHdG levels were significantly reduced in DM2 patients (p < 0.05). Analysis results also revealed statistically significant changes in all measured clinical parameters between baseline and three-month follow-up in both groups (p < 0.05). Upon treatment completion, a decline in the HbA1c level was noted in DM group, but it did not reach statistical significance (p > 0.05). It can be concluded that DM2 patients benefit from non-surgical periodontal therapy, as indicated by a marked reduction in their salivary 8-OHdG level and a modest improvement in glycemic control. Short-term clinical benefits noted in the DM group were similar to those observed in the non-diabetic periodontal patients.
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Simpson TC, Clarkson JE, Worthington HV, MacDonald L, Weldon JC, Needleman I, Iheozor-Ejiofor Z, Wild SH, Qureshi A, Walker A, Patel VA, Boyers D, Twigg J. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev 2022; 4:CD004714. [PMID: 35420698 PMCID: PMC9009294 DOI: 10.1002/14651858.cd004714.pub4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Glycaemic control is a key component in diabetes mellitus (diabetes) management. Periodontitis is the inflammation and destruction of the underlying supporting tissues of the teeth. Some studies have suggested a bidirectional relationship between glycaemic control and periodontitis. Treatment for periodontitis involves subgingival instrumentation, which is the professional removal of plaque, calculus, and debris from below the gumline using hand or ultrasonic instruments. This is known variously as scaling and root planing, mechanical debridement, or non-surgical periodontal treatment. Subgingival instrumentation is sometimes accompanied by local or systemic antimicrobials, and occasionally by surgical intervention to cut away gum tissue when periodontitis is severe. This review is part one of an update of a review published in 2010 and first updated in 2015, and evaluates periodontal treatment versus no intervention or usual care. OBJECTIVES: To investigate the effects of periodontal treatment on glycaemic control in people with diabetes mellitus and periodontitis. SEARCH METHODS An information specialist searched six bibliographic databases up to 7 September 2021 and additional search methods were used to identify published, unpublished, and ongoing studies. SELECTION CRITERIA: We searched for randomised controlled trials (RCTs) of people with type 1 or type 2 diabetes mellitus and a diagnosis of periodontitis that compared subgingival instrumentation (sometimes with surgical treatment or adjunctive antimicrobial therapy or both) to no active intervention or 'usual care' (oral hygiene instruction, education or support interventions, and/or supragingival scaling (also known as PMPR, professional mechanical plaque removal)). To be included, the RCTs had to have lasted at least 3 months and have measured HbA1c (glycated haemoglobin). DATA COLLECTION AND ANALYSIS At least two review authors independently examined the titles and abstracts retrieved by the search, selected the included trials, extracted data from included trials, and assessed included trials for risk of bias. Where necessary and possible, we attempted to contact study authors. Our primary outcome was blood glucose levels measured as glycated (glycosylated) haemoglobin assay (HbA1c), which can be reported as a percentage of total haemoglobin or as millimoles per mole (mmol/mol). Our secondary outcomes included adverse effects, periodontal indices (bleeding on probing, clinical attachment level, gingival index, plaque index, and probing pocket depth), quality of life, cost implications, and diabetic complications. MAIN RESULTS We included 35 studies, which randomised 3249 participants to periodontal treatment or control. All studies used a parallel-RCT design and followed up participants for between 3 and 12 months. The studies focused on people with type 2 diabetes, other than one study that included participants with type 1 or type 2 diabetes. Most studies were mixed in terms of whether metabolic control of participants at baseline was good, fair, or poor. Most studies were carried out in secondary care. We assessed two studies as being at low risk of bias, 14 studies at high risk of bias, and the risk of bias in 19 studies was unclear. We undertook a sensitivity analysis for our primary outcome based on studies at low risk of bias and this supported the main findings. Moderate-certainty evidence from 30 studies (2443 analysed participants) showed an absolute reduction in HbA1c of 0.43% (4.7 mmol/mol) 3 to 4 months after treatment of periodontitis (95% confidence interval (CI) -0.59% to -0.28%; -6.4 mmol/mol to -3.0 mmol/mol). Similarly, after 6 months, we found an absolute reduction in HbA1c of 0.30% (3.3 mmol/mol) (95% CI -0.52% to -0.08%; -5.7 mmol/mol to -0.9 mmol/mol; 12 studies, 1457 participants), and after 12 months, an absolute reduction of 0.50% (5.4 mmol/mol) (95% CI -0.55% to -0.45%; -6.0 mmol/mol to -4.9 mmol/mol; 1 study, 264 participants). Studies that measured adverse effects generally reported that no or only mild harms occurred, and any serious adverse events were similar in intervention and control arms. However, adverse effects of periodontal treatments were not evaluated in most studies. AUTHORS' CONCLUSIONS Our 2022 update of this review has doubled the number of included studies and participants, which has led to a change in our conclusions about the primary outcome of glycaemic control and in our level of certainty in this conclusion. We now have moderate-certainty evidence that periodontal treatment using subgingival instrumentation improves glycaemic control in people with both periodontitis and diabetes by a clinically significant amount when compared to no treatment or usual care. Further trials evaluating periodontal treatment versus no treatment/usual care are unlikely to change the overall conclusion reached in this review.
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Affiliation(s)
- Terry C Simpson
- Edinburgh Dental Institute, University of Edinburgh, Edinburgh, UK
| | - Janet E Clarkson
- School of Dentistry, University of Dundee, Dundee, UK
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Laura MacDonald
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Jo C Weldon
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Ian Needleman
- Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, London, UK
| | | | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ambrina Qureshi
- Department of Community Dentistry, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Veena A Patel
- Orthodontic Department, Leeds Dental Institute, Leeds, UK
| | | | - Joshua Twigg
- School of Dentistry, University of Leeds, Leeds, UK
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11
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Salhi L, Reners M. Update on the Bidirectional Link Between Diabetes and Periodontitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1373:231-240. [DOI: 10.1007/978-3-030-96881-6_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Orlandi M, Muñoz Aguilera E, Marletta D, Petrie A, Suvan J, D'Aiuto F. Impact of the treatment of periodontitis on systemic health and quality of life: A systematic review. J Clin Periodontol 2021; 49 Suppl 24:314-327. [PMID: 34791686 DOI: 10.1111/jcpe.13554] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/02/2021] [Indexed: 12/16/2022]
Abstract
AIM To investigate the effect of treatment of periodontitis on systemic health outcomes, pregnancy complications, and associated quality of life. MATERIALS AND METHODS Systematic electronic searches were conducted to identify randomized controlled trials with minimum 6-month follow-up and reporting on the outcomes of interest. Qualitative and quantitative analyses were performed as deemed suitable. RESULTS Meta-analyses confirmed reductions of high-sensitivity C-reactive protein (hs-CRP) [0.56 mg/L, 95% confidence interval (CI) (-0.88, -0.25), p < .001]; interleukin (IL)-6 [0.48 pg/ml, 95% CI (-0.88, -0.08), p = .020], and plasma glucose [1.33 mmol/l, 95% CI (-2.41, -0.24), p = .016], and increase of flow-mediated dilation (FMD) [0.31%, 95% CI (0.07, 0.55), p = .012] and diastolic blood pressure [0.29 mmHg, 95% CI (0.10, 0.49), p = .003] 6 months after the treatment of periodontitis. A significant effect on preterm deliveries (<37 weeks) was observed [0.77 risk ratio, 95% CI (0.60, 0.98), p = .036]. Limited evidence was reported on quality-of-life (QoL) outcomes in the included studies. CONCLUSIONS Treatment of periodontitis results in systemic health improvements including improvement in cardiometabolic risk, reduction in systemic inflammation and the occurrence of preterm deliveries. Further research is however warranted to confirm whether these changes are sustained over time. Further, appropriate QoL outcomes should be included in the study designs of future clinical trials.
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Affiliation(s)
- Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute, London, UK
| | | | | | - Aviva Petrie
- Biostatistics Unit, UCL Eastman Dental Institute, London, UK
| | - Jean Suvan
- Periodontology Unit, UCL Eastman Dental Institute, London, UK
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Jacob L, Shin JI, Oh H, López-Sánchez GF, Smith L, Haro JM, Koyanagi A. Association between diabetes and edentulism and their joint effects on health status in 40 low and middle-income countries. BMJ Open Diabetes Res Care 2021; 9:9/1/e002514. [PMID: 34620622 PMCID: PMC8499266 DOI: 10.1136/bmjdrc-2021-002514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/26/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Previous studies on the diabetes-edentulism relationship have yielded conflicting results. Therefore, the goal of this study was to investigate the association between diabetes and edentulism, and their joint effects on health status in adults from 40 low and middle-income countries (LMICs). RESEARCH DESIGN AND METHODS Data from the World Health Survey were used for this cross-sectional study (2002-2004). Forty countries (18 low-income and 22 middle-income countries) were included. Edentulism and diabetes were assessed using yes-no questions based on self-report. Health status was assessed in seven different domains (self-care, pain/discomfort, cognition, interpersonal activities, sleep/energy, affect, and perceived stress). The association between diabetes (exposure) and edentulism (outcome) was analyzed using multivariable logistic regression models, while their joint effects on health status were assessed using multivariable linear regression models. RESULTS There were 175 814 adults aged ≥18 years included in this study (mean (SD) age 38.4 (16.0) years; 49.3% men). Overall, the prevalence of edentulism was 6.0% and diabetes was 2.9%. There was a positive and significant association between diabetes and edentulism in the overall sample (OR=1.40, 95% CI 1.18 to 1.66), in low-income countries (OR=1.78, 95% CI 1.21 to 2.62) and in middle-income countries (OR=1.24, 95% CI 1.04 to 1.47). In addition, people with comorbid diabetes and edentulism had worse health status in the domains of cognition, sleep/energy, and perceived stress, compared with those with diabetes only. CONCLUSIONS Diabetes was positively associated with edentulism in this sample of more than 175 000 individuals living in LMICs. Providing oral care to individuals with diabetes may potentially lead to a reduction in their risk of edentulism.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Guillermo F López-Sánchez
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University-Cambridge Campus, Cambridge, UK
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University-Cambridge Campus, Cambridge, UK
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
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14
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Esteves Lima RP, Atanazio ARS, Costa FO, Cunha FA, Abreu LG. IMPACT OF NON-SURGICAL PERIODONTAL TREATMENT ON SERUM TNF-α LEVELS IN INDIVIDUALS WITH TYPE 2 DIABETES: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2021; 21:101546. [PMID: 34391555 DOI: 10.1016/j.jebdp.2021.101546] [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: 11/04/2020] [Revised: 02/28/2021] [Accepted: 03/13/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The objective of this systematic review and meta-analysis was to search for scientific evidence on the impact of non-surgical periodontal therapy on tumor necrosis factor alpha (TNF-α) in type 2 diabetics. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement has been followed. The study was registered (CRD42020192790) in the International prospective register of systematic reviews. Searches were conducted in five databases. Restrictions on publication date were not imposed in anyway. The studies reporting the serum TNF-α levels of individuals with type 2 diabetes mellitus (DM) before and after non-surgical periodontal therapy were included. Studies' selection, extraction of data and risk of bias assessment were performed in duplicate. Consensus was achieved. Meta-analysis was carried out. The 95% confidence interval and odds ratio were provided. RESULTS Six hundred and twenty-three references were retrieved and eighteen studies were included. Meta-analysis demonstrated that the serum levels of TNF-α in individuals with type 2 DM decreased six months after non-surgical periodontal therapy (mean difference = -1.90, confidence interval = -3.05--0.74). Included studies presented low risk of bias. CONCLUSION Non-surgical periodontal therapy has an impact on serum TNF-α levels at six months in type 2 DM patients.
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Affiliation(s)
- Rafael Paschoal Esteves Lima
- Division of Periodontology, The Dental School, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil.
| | - Andressa Rafaela Silva Atanazio
- Division of Periodontology, The Dental School, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Fernando Oliveira Costa
- Division of Periodontology, The Dental School, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Fabiano Araújo Cunha
- Division of Periodontology, The Dental School, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Guimarães Abreu
- Division of Pediatric Dentistry, The Dental School, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
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15
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Chen YF, Zhan Q, Wu CZ, Yuan YH, Chen W, Yu FY, Li Y, Li LJ. Baseline HbA1c Level Influences the Effect of Periodontal Therapy on Glycemic Control in People with Type 2 Diabetes and Periodontitis: A Systematic Review on Randomized Controlled Trails. Diabetes Ther 2021; 12:1249-1278. [PMID: 33481189 PMCID: PMC8099950 DOI: 10.1007/s13300-021-01000-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The question of whether periodontal therapy is an effective strategy for achieving glycemic control in people with type 2 diabetes mellitus (T2DM) and periodontitis continues to be open to debate. To clarify this issue, we conducted a systematic review and meta-analysis. METHODS A systematic literature search of randomized controlled trials (RCTs) was carried out by searching four electronic databases and four journals up to April 2020. RCTs that evaluated the effect of periodontal therapy on glycemic control in people with T2DM were included. RESULTS A total of 23 RCTs were included in this systematic review and meta-analysis. We found that after 3 and 6 months, periodontal therapy could significantly reduce glycosylated hemoglobin (HbA1c) level (3-month: weighted mean difference [WMD] - 0.514, 95% confidence interval [CI] - 0.730, - 0.298, p = 0.000; 6-month: WMD - 0.548, 95% CI - 0.859, - 0.238, p = 0.000). However, huge heterogeneity existed. Further analyses on 11 potential sources of heterogeneity found that baseline HbA1c of the included studies was the most significant factor causing heterogeneity. The benefit of periodontal therapy on glycemic control was much more obvious in studies with a higher baseline HbA1c level than in those with a lower baseline HbA1c level. CONCLUSIONS Periodontal therapy significantly contributed to glycemic control in T2DM patients, especially in patients with higher baseline HbA1c level.
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Affiliation(s)
- Ya-Fei Chen
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qi Zhan
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Chen-Zhou Wu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi-Hang Yuan
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wen Chen
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Fan-Yuan Yu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Long-Jiang Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Dallaserra M, Morales A, Hussein N, Rivera M, Cavalla F, Baeza M, Strauss FJ, Yoma Y, Suazo C, Jara G, Contreras J, Villanueva J, Valenzuela-Villarroel F, Gamonal J. Periodontal Treatment Protocol for Decompensated Diabetes Patients. FRONTIERS IN ORAL HEALTH 2021; 2:666713. [PMID: 35048008 PMCID: PMC8757839 DOI: 10.3389/froh.2021.666713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Decompensated diabetes is associated with a higher prevalence and severity of periodontitis and poorer response to periodontal therapy. It is conceivable that periodontal therapy may cause systemic and local complications in this type of patients. The aim of the present study was to identify and describe the best available evidence for the treatment of periodontitis in decompensated diabetics. Material and methods: An expert committee including participants from different areas gathered to discuss and develop a treatment guideline under the guidance of the Cochrane Associate Center, Faculty of Dentistry, University of Chile. In total, four research questions were prepared. The questions prepared related to decompensated diabetic patients (glycated hemoglobin >8) were, (1) Does the exposure to periodontal treatment increase the risk of infectious or systemic complications? (2) Does the antibiotic treatment or prophylaxis, compared to not giving it, reduce infectious complications? (3) Does the exposure to periodontal treatment, compared to no treatment, reduce the glycated hemoglobin levels (HbA1c)? Last question was related to diabetic patients, (4) Does the exposure to a higher level of HbA1c, compared to stable levels, increase the risk of infectious complications? Based on these questions, a search strategy was developed using MEDLINE and EPISTEMONIKOS. Only systematic reviews were considered. Results: For question 1, the search yielded 12 records in EPISTEMONIKOS and 23 in MEDLINE. None of these studies addressed the question. For question 2, the search yielded 58 records in EPISTEMONIKOS and 11 in MEDLINE. None of these studies addressed the question. For question 3, the search yielded 16 records in EPISTEMONIKOS and 11 in MEDLINE. Thirteen addressed the question. For question 4, the search yielded 7 records in EPISTEMONIKOS and 9 in MEDLINE. One addressed the question. Conclusions: In decompensated diabetic patients, there is lack of scientific information about risk of infectious or systemic complications as a result of periodontal treatment and about the impact of antibiotic treatment or prophylaxis on reduction if infectious complications. A defined HbA1c threshold for dental and periodontal treatment in diabetic patients has yet to be determined. Finally, periodontal treatment does have an impact on HbA1c levels.
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Affiliation(s)
- Matías Dallaserra
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Santiago, Chile
- Cochrane Associate Center, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Alicia Morales
- Center for Epidemiology and Surveillance of Oral Diseases (CESOD), Faculty of Dentistry, University of Chile, Santiago, Chile
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
- *Correspondence: Alicia Morales
| | - Nayib Hussein
- Centro de Salud Familiar Dr. Francisco Boris Soler, Melipilla, Chile
| | - Marcela Rivera
- Departamento de Atención de las Personas, División de Atención Primaria, Subsecretaría de Redes Asistenciales del Ministerio de Salud, Santiago, Chile
| | - Franco Cavalla
- Center for Epidemiology and Surveillance of Oral Diseases (CESOD), Faculty of Dentistry, University of Chile, Santiago, Chile
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Mauricio Baeza
- Center for Epidemiology and Surveillance of Oral Diseases (CESOD), Faculty of Dentistry, University of Chile, Santiago, Chile
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Franz J. Strauss
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Department of Oral Biology, Medical University of Vienna, Vienna, Austria
| | - Yazmin Yoma
- Referencia Técnica Odontológica, Departamento de Gestión Clínica, Servicio de Salud Metropolitano Occidente, Santiago, Chile
| | - Claudio Suazo
- Programa Odontológico, Cesfam Steeger, Corporación Municipal Desarrollo Social de Cerro Navia, Santiago, Chile
| | - Gisela Jara
- Center for Epidemiology and Surveillance of Oral Diseases (CESOD), Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Johanna Contreras
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Julio Villanueva
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Santiago, Chile
- Cochrane Associate Center, Faculty of Dentistry, University of Chile, Santiago, Chile
- Servicio de Cirugía Maxilofacial, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | | | - Jorge Gamonal
- Center for Epidemiology and Surveillance of Oral Diseases (CESOD), Faculty of Dentistry, University of Chile, Santiago, Chile
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
- Jorge Gamonal
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Development and validation of a screening model for diabetes mellitus in patients with periodontitis in dental settings. Clin Oral Investig 2020; 24:4089-4100. [PMID: 32542584 PMCID: PMC7544748 DOI: 10.1007/s00784-020-03281-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/08/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To identify predictors in patient profiles and to develop, internally validate, and calibrate a screening model for diabetes mellitus (DM) in patients with periodontitis in dental settings MATERIALS AND METHODS: The study included 204 adult patients with periodontitis. Patients' socio-demographic characteristics, general health status, and periodontal status were recorded as potential predictors. The diabetic status was considered the outcome, classified into no DM, prediabetes (pre-DM), or DM. Multinomial logistic regression analysis was used to develop the model. The performance and clinical values of the model were determined. RESULTS Seventeen percent and 47% of patients were diagnosed with DM and pre-DM, respectively. Patients' age, BMI, European background, cholesterol levels, previous periodontal treatment, percentage of the number of teeth with mobility, and with gingival recession were significantly associated with the diabetic status of the patients. The model showed a reasonable calibration and moderate to good discrimination with area under the curve (AUC) values of 0.67 to 0.80. The added predictive values for ruling in the risk of DM and pre-DM were 0.42 and 0.11, respectively, and those for ruling it out were 0.05 and 0.17, respectively. CONCLUSIONS Predictors in patient profiles for screening of DM and pre-DM in patients with periodontitis were identified. The calibration, discrimination, and clinical values of the model were acceptable. CLINICAL RELEVANCE The model may well assist clinicians in screening of diabetic status of patients with periodontitis. The model can be used as a reliable screening tool for DM and pre-DM in patients with periodontitis in dental settings.
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Machado V, Escalda C, Proença L, Mendes JJ, Botelho J. Is There a Bidirectional Association between Polycystic Ovarian Syndrome and Periodontitis? A Systematic Review and Meta-analysis. J Clin Med 2020; 9:jcm9061961. [PMID: 32585861 PMCID: PMC7355910 DOI: 10.3390/jcm9061961] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) has reproductive and metabolic properties that may be linked to periodontitis (PD). This study aimed to update and render a robust critical assessment on all evidence linking PCOS and PD, and appraising a hypothetical bidirectional association. Five databases (PubMed, Scholar, EMBASE, Web of Science and CENTRAL) were searched up to May 2020. Case-control and cohort studies on the association of PCOS and PD were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses of standardized mean difference (SMD) and risk ratio (RR) were performed. We followed Strength of Recommendation Taxonomy (SORT) to appraise the strength and quality of the evidence. Twelve case-controls fulfilled the inclusion criteria (876 with PCOS and 48170 healthy controls), all scored as having a low risk of bias. Meta-analysis revealed that PCOS females have 28% more risk towards PD, and PD females have 46% more risk to have PCOS. PCOS females with PD had higher gum bleeding, periodontal pocket depth and clinical attachment loss than non-PCOS females with PD. Populations with undefined periodontal status contribute to underestimated results. On the basis of the available evidence, it is possible to assume a bidirectional link between PCOS and PD. That is, PCOS increases by 28% the risk of having PD and in the same fashion, PD increases by 46% the risk of having PCOS. Furthermore, women with PCOS were associated with worsening clinical characteristics and inflammation of PD. These findings suggest that PCOS and PD may be linked. Hence, further prospective and clinical trial studies with nonsurgical periodontal therapy are necessary to clarify the existence of an increased risk of PCOS in women with PD and vice-versa.
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Affiliation(s)
- Vanessa Machado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal; (C.E.); (J.J.M.); (J.B.)
- Correspondence:
| | - Cláudia Escalda
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal; (C.E.); (J.J.M.); (J.B.)
| | - Luís Proença
- Quantitative Methods for Health Research (MQIS), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal;
| | - José João Mendes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal; (C.E.); (J.J.M.); (J.B.)
| | - João Botelho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal; (C.E.); (J.J.M.); (J.B.)
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19
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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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20
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Yokoyama H, Yamamoto T, Tanaka M, Kudo C, Hidaka K, Kuribayashi N, Minabe M. Albuminuria, C-reactive protein, and socioeconomic factors are associated with periodontal status in subjects with type 2 diabetes. Diabetol Int 2019; 10:250-259. [PMID: 31592401 DOI: 10.1007/s13340-018-0388-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/02/2018] [Indexed: 01/14/2023]
Abstract
Diabetes and periodontitis may increase risk of cardiovascular disease. Whether albuminuria, C-reactive protein (CRP), and socioeconomic factors, known as cardiovascular risks in subjects with poorly controlled diabetes, are independently associated with periodontal status in well-controlled diabetes remains to be elucidated. In 503 subjects with type 2 diabetes, the cross-sectional associations of clinical and socioeconomic factors with periodontal parameters were investigated. Periodontal parameters on all teeth included the probing pocket depth at 6 sites per tooth, bleeding on probing, the plaque score, tooth mobility, and the number of teeth. The subjects had a mean HbA1c value of 6.85% and a median CRP value of 0.06 mg/dL, and 27.9% of the subjects had albuminuria. Albuminuria and CRP values had significant associations with several periodontal parameters, whereas other variables including HbA1c did not. Subjects with albuminuria had significantly higher HbA1c, CRP, and % sites of pocket depth ≥ 4 mm than subjects with normoalbuminuria; additionally, those with high CRP (≥ median) had significantly higher body mass index, HbA1c, % sites of pocket depth ≥ 4 mm, and plaque score than those with low CRP. In multiple linear regression analysis, albuminuria, CRP, education, smoking, and dental attendance exhibited significant associations with periodontal parameters, independent of the effect of age, sex, body mass index, and diabetes therapy. Albuminuria, CRP, education, smoking, and dental attendance were independently associated with periodontal parameters even in subjects with a mean of HbA1c of 6.85%, implying the importance of these factors for the prevention of cardiovascular disease.
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Affiliation(s)
- Hiroki Yokoyama
- Jiyugaoka Medical Clinic, Internal Medicine, West 6, South 6-4-3, Obihiro, 080-0016 Japan
| | - Tatsuo Yamamoto
- 2Division of Dental Sociology, Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, 238-8580 Japan
| | - Michio Tanaka
- 2Division of Dental Sociology, Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, 238-8580 Japan
| | - Chieko Kudo
- 3Division of Periodontology, Department of Interdisciplinary Medicine, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, 238-8580 Japan
| | - Koichi Hidaka
- 3Division of Periodontology, Department of Interdisciplinary Medicine, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, 238-8580 Japan
| | | | - Masato Minabe
- 3Division of Periodontology, Department of Interdisciplinary Medicine, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, 238-8580 Japan
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21
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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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22
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[The impact of periodontal therapy on the diabetes control: A systematic review]. Presse Med 2019; 48:4-18. [PMID: 30665791 DOI: 10.1016/j.lpm.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 11/23/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The bidirectional relationship between diabetes and periodontal disease has been established. Diabetes is a risk factor for periodontal disease while periodontal disease is a complication of diabetes. The objective of this systematic review is to determine whether the administration of periodontal therapy compared to the absence of this treatment would have an impact on the diabetes control in diabetic patients with periodontitis. METHODS A literature search was conducted on four databases (PubMed, Science direct, Scopus, Cochrane) to identify randomized clinical trials investigating the effect of periodontal therapy on levels of glycated hemoglobin and fasting plasma glucose for diabetic patients diagnosed with periodontitis. The quality assessment and the risk of bias of the included studies were carried out according to the Cochrane RoB tool. RESULTS Fourteen studies met the criteria and were included in this systematic review. Thirteen of these studies reported that periodontal therapy reduces glycated hemoglobin levels three months after periodontal therapy. Nine of these studies investigated the effect of periodontal therapy on fasting plasma glucose levels, five of which reported statistically significant differences of blood glucose levels between diabetics who received periodontal therapy and diabetics who did not receive treatment periodontal. CONCLUSION The results of this systematic review indicate that periodontal therapy can contribute to diabetes control in diabetic patients with periodontitis.
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23
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Tang Y, Liu J, Yan Y, Fang H, Guo C, Xie R, Liu Q. 1,25-dihydroxyvitamin-D3 promotes neutrophil apoptosis in periodontitis with type 2 diabetes mellitus patients via the p38/MAPK pathway. Medicine (Baltimore) 2018; 97:e13903. [PMID: 30593206 PMCID: PMC6314780 DOI: 10.1097/md.0000000000013903] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Abnormal neutrophils are involved in many chronic endocrine diseases, including type 2 diabetes mellitus (T2DM), and in periodontitis (PD), which is a chronic inflammatory disease in which neutrophils play a vital role. The p38 mitogen-activated protein kinase (MAPK) signaling pathway participates in the apoptosis of many inflammatory cells. Additionally, 1,25-dihydroxyvitamin-D3 (1,25VitD3) as a regulator can induce responses to infection and tumor cell apoptosis. However, the effect of 1,25VitD3 in the pathogenic relationship between T2DM and PD remains unclear. The aim of this study was to assess the effect of 1,25VitD3 on neutrophil apoptosis in patients with T2DM and PD and the p38-MAPK-relevant signaling pathway mechanism in this process in vitro. METHODS Neutrophils were stained with Wright's stain, and apoptosis was detected by flow cytometry and Annexin V-fluorescein isothiocyanate (FITC)/propidium iodide (PI) staining. Apoptosis- and p38-related mRNAs and proteins were examined by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR), Western blotting and ELISA. The internal relationships were analyzed using a linear regression equation and Pearson's correlation coefficient. RESULTS The highest rate of neutrophil apoptosis occurred in cultures treated with 10 mol/L 1,25VitD3 in the T2DM-PD group. The apoptosis rate in the T2DM-PD-p38 inhibitor group was higher than that in the healthy control group. Western blot, ELISA and qRT-PCR results showed that the mRNA and protein expression profiles of Caspase-3 and Bax were highly up-regulated and that Bcl-2 was down-regulated in the T2DM-PD-p38 inhibitor group. The expression levels of apoptotic mRNAs and proteins in the T2DM and T2DM-PD groups were significantly higher than those in the T2DM-p38 and T2DM-PD-p38 inhibitor groups. 1,25VitD3-induced neutrophil apoptosis and phosphorylated p38 (p-p38) expression were partially inhibited by the p38 inhibitor. Expression levels of apoptosis-related genes and p-p38 in neutrophils were positively associated with increasing concentrations of 1,25VitD3. p-p38 protein expression was positively associated with the level of serum 1,25VitD3. CONCLUSION 1,25VitD3 could promote peripheral blood neutrophil apoptosis in patients with T2DM and PD through activation of the p38-MAPK signaling pathway in vitro.
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Affiliation(s)
- Yaping Tang
- Affiliated Hospital of Zunyi Medical University
- Department of Periodontology, Stomatological Hospital, Zunyi Medical University
| | - Junyu Liu
- Department of Oral and Maxillofacial Surgery, Xinqiao Hospital, Army Medical University
| | - Yanmei Yan
- Department of Stomatology, First People's Hospital of Yueyang, China
| | - Hui Fang
- Affiliated Hospital of Zunyi Medical University
| | | | - Ruidi Xie
- Affiliated Hospital of Zunyi Medical University
| | - Qi Liu
- Affiliated Hospital of Zunyi Medical University
- Department of Periodontology, Stomatological Hospital, Zunyi Medical University
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24
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Vergnes JN, Canceill T, Vinel A, Laurencin-Dalicieux S, Maupas-Schwalm F, Blasco-Baqué V, Hanaire H, Arrivé E, Rigalleau V, Nabet C, Sixou M, Gourdy P, Monsarrat P. The effects of periodontal treatment on diabetic patients: The DIAPERIO randomized controlled trial. J Clin Periodontol 2018; 45:1150-1163. [PMID: 30136741 DOI: 10.1111/jcpe.13003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 07/13/2018] [Accepted: 08/19/2018] [Indexed: 12/14/2022]
Abstract
AIM To assess whether periodontal treatment can lead to clinical, glycaemic control and quality of life improvements in metabolically unbalanced diabetic patients (type 1 or type 2) diagnosed with periodontitis. METHODS In this open-labelled randomized controlled trial, diabetic subjects (n = 91) were given "immediate" or "delayed" periodontal treatment (full-mouth non-surgical scaling and root planing, systemic antibiotics, and oral health instructions). The main outcome was the effect on glycated haemoglobin (HbA1C ) and fructosamine levels. The General Oral Health Assessment Index and the SF-36 index were used to assess quality of life (QoL). RESULTS Periodontal health significantly improved after periodontal treatment (p < 0.001). Periodontal treatment seemed to be safe but had no significant effects on glycaemic control based on HbA1C (adjusted mean difference with a 95% confidence interval (aMD) of 0.04 [-0.16;0.24]) and fructosamine levels (aMD 5.0 [-10.2;20.2]). There was no obvious evidence of improvement in general QoL after periodontal treatment. However, there was significant improvement in oral health-related QoL (aMD 7.0 [2.4;11.6], p = 0.003). CONCLUSION Although periodontal treatment showed no clinical effect on glycaemic control in this trial, important data were provided to support periodontal care among diabetic patients. Periodontal treatment is safe and improves oral health-related QoL in patients living with diabetes. ISRCTN15334496.
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Affiliation(s)
- Jean-Noel Vergnes
- The Department of Epidemiology and Public Health, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France.,The Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Thibault Canceill
- The Department of Oral Rehabilitation, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France
| | - Alexia Vinel
- The Department of Oral Surgery, Periodontology and Oral Biology, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France.,The Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1048, INSERM, UPS, Université de Toulouse, Toulouse, France
| | - Sara Laurencin-Dalicieux
- The Department of Oral Surgery, Periodontology and Oral Biology, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France.,INSERM U1043, Université Toulouse III CHU Purpan, Toulouse, France
| | - Françoise Maupas-Schwalm
- The Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1048, INSERM, UPS, Université de Toulouse, Toulouse, France.,The Department of Biochemistry and Molecular Biology, Faculty of Medicine-Rangueil (CHU de Toulouse), Paul Sabatier Toulouse-3, IFR-150, Toulouse, France
| | - Vincent Blasco-Baqué
- The Department of Oral Surgery, Periodontology and Oral Biology, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France.,The Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1048, INSERM, UPS, Université de Toulouse, Toulouse, France
| | - Hélène Hanaire
- The Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1048, INSERM, UPS, Université de Toulouse, Toulouse, France.,The Department of Diabetology - Metabolic Diseases - Nutrition, CHU of Toulouse, Toulouse, France
| | - Elise Arrivé
- Department of Dentistry and Oral health, Bordeaux University Hospital, Bordeaux, France.,Department of Odontology, University of Bordeaux, Bordeaux, France
| | | | - Cathy Nabet
- The Department of Epidemiology and Public Health, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France.,INSERM U1027, Paul Sabatier University, Toulouse, France
| | - Michel Sixou
- The Department of Epidemiology and Public Health, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France
| | - Pierre Gourdy
- The Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1048, INSERM, UPS, Université de Toulouse, Toulouse, France.,The Department of Diabetology - Metabolic Diseases - Nutrition, CHU of Toulouse, Toulouse, France
| | - Paul Monsarrat
- The Department of Oral Rehabilitation, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France.,STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, ENVT, Inserm U1031, UPS, Toulouse, France
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25
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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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26
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Mauri-Obradors E, Merlos A, Estrugo-Devesa A, Jané-Salas E, López-López J, Viñas M. Benefits of non-surgical periodontal treatment in patients with type 2 diabetes mellitus and chronic periodontitis: A randomized controlled trial. J Clin Periodontol 2018; 45:345-353. [DOI: 10.1111/jcpe.12858] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 12/11/2022]
Affiliation(s)
| | - Alexandra Merlos
- Department of Pathology and Experimental Therapeutics; Medical School; IDIBELL-University of Barcelona; Barcelona Spain
| | | | - Enric Jané-Salas
- Department of Dentistry; Dental School; University of Barcelona; Barcelona Spain
- Oral Medicine Unit; Department of Dentistry; Faculty of Medicine and Health Sciences (Dental School) and Dental Hospital Barcelona University (University of Barcelona) and Health and Masticatory System Group (Bellvitge Biomedical Research, Institute) IDIBELL; Barcelona Spain
| | - José López-López
- Department of Dentistry; Dental School; University of Barcelona; Barcelona Spain
- Oral Medicine Unit; Department of Dentistry; Faculty of Medicine and Health Sciences (Dental School) and Dental Hospital Barcelona University (University of Barcelona) and Health and Masticatory System Group (Bellvitge Biomedical Research, Institute) IDIBELL; Barcelona Spain
| | - Miguel Viñas
- Department of Pathology and Experimental Therapeutics; Medical School; IDIBELL-University of Barcelona; Barcelona Spain
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27
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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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28
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Doğan ŞB, Ballı U, Dede FÖ, Sertoğlu E, Tazegül K. Chemerin as a Novel Crevicular Fluid Marker of Patients With Periodontitis and Type 2 Diabetes Mellitus. J Periodontol 2016; 87:923-33. [DOI: 10.1902/jop.2016.150657] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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29
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Teshome A, Yitayeh A. The effect of periodontal therapy on glycemic control and fasting plasma glucose level in type 2 diabetic patients: systematic review and meta-analysis. BMC Oral Health 2016; 17:31. [PMID: 27473177 PMCID: PMC4967318 DOI: 10.1186/s12903-016-0249-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/12/2016] [Indexed: 12/14/2022] Open
Abstract
Background Diabetic mellitus and periodontal disease have bilateral associations. However, there is a dilemma on the effect of periodontal therapy on glycemic control and/or fasting plasma glucose level in type 2 diabetic patients with periodontitis. Therefore, this review aimed to assess the effectiveness of periodontal therapy versus no periodontal therapy on glycated hemoglobin (HbA1c) and fasting plasma glucose level in type 2 diabetic patients. Methods Article searching was done using four databases (MEDLINE, Cochrane library (CENTRAL), EMBASE and CINAHL) and a manual search (until December 2015). We included randomized controlled trials testing the effectiveness of periodontal therapy on glycated hemoglobin and fasting plasma glucose level in patients with type 2 Diabetes mellitus with periodontal disease. Studies published in English between 2005 and 2015 were included. Risk of bias was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases. Results After the article selection process, seven Randomized controlled trials involving 940 participants with a primary outcome of change in glycated hemoglobin and/or fasting plasma glucose and having a minimum of 3 months follow-up were included. There was a reduction of glycated hemoglobin 0.48(95 % CI: 0.18–0.78) after 3 months follow-up and 0.53 (95 % CI: 0.24–0.81) at the end of the intervention period. There was also a significant reduction of fasting plasma glucose level, 8.95 mg/dl (95 % CI: 4.30–13.61) in the intervention group after the end of the intervention. The pooled analysis showed that patients with adjunctive antibiotic therapy and mouth wash had effect size of 0.51(0.03, 1.00, p = 0.04) and it was 0.53 (95 % CI: 0.19, 0.87; p = 0.002) in patients without adjunctive therapy. The publication bias of the studies was 0.066 according to Egger’s test. Conclusion In this systematic review and meta-analysis, there is a significant reduction of Glycated hemoglobin and Fasting plasma glucose level on type 2 diabetic and periodontal patients with non-surgical periodontal therapy.
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Affiliation(s)
- Amare Teshome
- Department of Dentistry, College of Medicine and Health Sciences, University of Gondar, Gondar, P.O. Box 196, Ethiopia.
| | - Asmare Yitayeh
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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30
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Wiener RC, Shen C, Sambamoorthi N, Sambamoorthi U. Preventive dental care in older adults with diabetes. J Am Dent Assoc 2016; 147:797-802. [PMID: 27189741 DOI: 10.1016/j.adaj.2016.03.022] [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] [Received: 01/19/2016] [Revised: 03/28/2016] [Accepted: 03/31/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND The association between poor oral health and diabetes is well documented. Preventive oral health care is, therefore, strongly indicated for people with diabetes. The authors conducted a study to determine if there was a difference in preventive dental care use among older adults with diabetes in 2002 and in 2011 and to compare preventive dental care use by older adults with and without diabetes in 2002 and in 2011. METHODS The authors used a data sample of participants from the Medicare Current Beneficiary Survey that included older (65 years and older) fee-for-service Medicare beneficiaries. The key outcome was self-reported preventive dental care. In 2002, there were 8,725 participants; in 2011, there were 7,425 participants. The authors conducted χ(2) and logistic regression analyses. RESULTS In 2002, 28.8% of participants with diabetes had preventive dental care. In 2011, this percentage increased to 36.0%. Similar results were seen among participants without diabetes (42.9% in 2002 and 45.5% in 2011). The increase in preventive dental care was statistically significant for participants with and without diabetes. The participants with diabetes, as compared with participants without diabetes, remained statistically less likely to have had preventive dental care in adjusted logistic regression analysis with and without considering the interaction between observation year and diabetes (adjusted odds ratios, 0.73 and 0.86, respectively). CONCLUSIONS Although the percentage increase in participants with diabetes receiving preventive dental care is welcomed, older adults with diabetes continue to have substantial preventive dental care needs. PRACTICAL IMPLICATIONS Additional efforts are needed to encourage people with diabetes to obtain preventive dental care.
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