Effect of non-surgical periodontal therapy on clinical and immunological response and glycaemic control in type 2 diabetic patients with moderate periodontitis

OBJECTIVES: The purpose of this study was to compare the local efficacy of nonsurgical periodontal therapy between type 2 diabetic and non-diabetic patients and the effect of periodontal therapy on glycaemic control. BACKGROUND: A complex two-way relationship exists between diabetes mellitus and periodontitis. Material AND METHODS: After selection, 20 subjects (10 diabetic and 10 non-diabetic) underwent baseline examination, periodontal clinical study and biochemical analysis of gingival crevicular fluid (GCF). After the pre-treatment phase, subgingival scaling and root planing were performed. Subsequently, all subjects continued the maintenance programme and were re-examined at 3 and 6 months. RESULTS: Diabetic and non-diabetic subjects responded well after therapy, showing a very similar progression during the follow-up period. Both groups showed clinically and immunologically significant improvements. Significant reductions were also found in the total volume of GCF and levels of interleukin-1beta and tumour necrosis factor-alpha. Diabetic subjects showed an improvement in their metabolic control. The change in glycosylated haemoglobin (HbA(1C)) was statistically significant at 3 and 6 months. CONCLUSIONS: The clinical and immunological improvements obtained were accompanied by a significant reduction in HbA(1C) values in type 2 diabetic subjects. Larger studies are needed to confirm this finding and establish whether periodontal therapy has a significant effect on glycaemic control.     

The relationship of inflammatory periodontal disease to diabetic status in insulin-dependent diabetes mellitus patients

This study was designed to evaluate the relationship of inflammatory periodontal disease to the diabetic status of the insulin-dependent diabetes mellitus (IDDM) patient. 52 IDDM patients, ages 11-22 years, were evaluated. These patients were closely monitored at regular intervals in the University of Kentucky pediatric diabetic clinic. A periodontal examination was carried out for each patient. The patients were then assigned to a periodontitis or non-periodontitis group. Moderate to advanced periodontitis was found in 5.8% of the subjects. The gingival index and sulcular bleeding index were significantly higher in the periodontitis group (P less than 0.05). There was no significant difference between groups for plaque index, age of diabetic onset, duration of diabetes, present age, insulin dosage/weight, or serum glucose (P greater than 0.05). There was a greater % of ketoacidosis, retinopathy and neuropathy in the periodontitis group. IDDM patients with neurological complications or a history of chronic infections had a significantly higher gingival index score than those without the complication (P less than 0.05).     

Improved metabolic control, clinical periodontal status and subgingival microbiology in insulin-dependent diabetes mellitus

The effect of improved metabolic control on the clinical periodontal condition and the subgingival microflora of diseased and healthy periodontal pockets in 6 ambulatory insulin-dependent diabetes mellitus (IDDM) patients was prospectively studied. Duplicate measurements with a time-interval of 3 days were made every 4 moths for assessment of the metabolic status, the clinical periodontal condition and the subgingival microflora. During the study, patients maintained personal oral hygiene measures as they usually did before the study. Neither supplementary dental prophylaxis nor oral hygiene measures were applied during the investigation. Long-term metabolic control (HbAlc) improved significantly with intensive conventional insulin treatment. Gingival redness decreased significantly whereas gingival swelling showed a not significant trend to decrease. It is suggested that microvascular changes associated with improved metabolic control in diabetes mellitus may mediate the observed change in gingival redness. No effect could be demonstrated for probing pocket depth, probing attachment level, bleeding on probing and the plaque index. Statistical analysis of the effect of improved metabolic control on the subgingival microflora revealed that only the % of streptococci increased significantly in diseased periodontal pockets. In general, no significant changes were found in either healthy or diseased pockets with regard to the bacterial flora associated with periodontal disease. The results of the present study indicate that improved metabolic control in IDDM patients may have no potential impetus for an improved clinical periodontal condition nor on the subgingival bacterial flora. It is concluded that the periodontal condition in IDDM patients may only ameliorate when local oral hygiene measures are applied.     

牙周基础治疗对糖化血红蛋白及胶原酶的影响

目的　观察牙周治疗对糖尿病患者的糖化血红蛋白及龈沟液中胶原酶的影响。方法　将全身健康状况相似的患牙周炎的非依赖型糖尿病患者随机分为牙周基础治疗组 (龈上洁治和龈下刮治 )和非治疗组。记录同一位点治疗前、治疗后一个月、三个月牙周临床指标 ,龈沟液中胶原酶以及糖化血红蛋白的情况。结果　治疗组的牙周临床指标、龈沟液胶原酶及糖化血红蛋白水平治疗前、后相比有显著差异。结论　牙周基础治疗可降低糖尿病患者的糖化血红蛋白及龈沟液中的胶原酶     

Clinical and metabolic changes after conventional treatment of type 2 diabetic patients with chronic periodontitis

BACKGROUND: The aim of this study was to compare the response to conventional periodontal treatment between patients with or without type 2 diabetes mellitus from a clinical and metabolic standpoint. METHODS: A prospective, parallel, comparative longitudinal clinical study was performed between type 2 diabetics and non-diabetics with moderate generalized chronic periodontitis. The study period was 6 months. Conventional periodontal scaling and root planing were performed, and the response to this treatment was compared between the groups at 3 and 6 months, measuring the plaque index, bleeding on probing, probing depth, level of clinical attachment, and gingival recession. In the diabetic patients, the clinical response was related to measurements of HbA1c and glucose in blood at 3 and 6 months. RESULTS: An improvement in all clinical variables was observed, with no statistically significant differences between the groups, with the exception of probing depth (P <0.0207). The improvement observed in blood HbA1c levels confirmed a positive metabolic response to periodontal treatment, with a lower value for this variable at each measurement time. CONCLUSIONS: Both groups of patients showed a clinical improvement after basic non-surgical periodontal treatment. The diabetic patients showed improved metabolic control (lower HbA1c) at 3 and 6 months after periodontal treatment.     

Crevicular fluid elastase levels in relation to periodontitis and metabolic control of diabetes

The purpose of this study was to investigate the associations between gingival crevicular fluid (GCF) elastase levels, clinical measures of periodontal status, and metabolic control of diabetes in insulin dependent (type 1) diabetes (IDDM) and non-insulin dependent (type 2) diabetes (NIDDM) patients. Sixty patients were recruited from the Diabetes Center at the University of California in San Francisco. Thirty subjects were type 1 diabetics and 30 subjects were type 2 diabetics. Metabolic control was evaluated by glycosylatted hemoglobin (HbA1c) levels. Demographic information was obtained using a structured interview with the subjects. Clinical measurements and GCF samples were taken from the mesio-buccal surfaces of 2 premolars and 2 molars from the most diseased sextant. GCF elastase was determined by measurement of p-Nitroanalide resulting from hydrolysis of elastase specific peptide. Crevicular fluid elastase levels were significantly correlated with gingival index, bleeding index, probing depth and attachment level in both type 1 and type 2 diabetes groups (0.01

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Total proteoglycan and chondroitin-4-sulfate levels in gingiva of patients with various types of periodontitis

BACKGROUND: The aim of the present study was to investigate the total proteoglycan (PG) and chondroitin-4-sulfate (C4S) levels in gingival tissue samples obtained from patients with aggressive periodontitis (AgP) and chronic periodontitis (CP) before therapy (baseline) and 1 month after completion of non-surgical periodontal therapy. METHODS: Gingival tissue samples were obtained from 10 AgP and 10 CP patients before initiation of treatment (baseline) and 1 month after non-surgical periodontal treatment. The control group comprised 10 systemically and periodontally healthy subjects. Total PG and C4S levels were determined by biochemical techniques. PG levels were analyzed using a modified Bitter and Muir method. C4S assay was carried out using chondroitin sulphate lyase AC and chondroitin-6 sulphate sulphohydrolase enzymes. The results were tested statistically using parametric tests. RESULTS: The clinical periodontal parameters demonstrated significant decreases in the periodontitis groups (P<0.05) after treatment, and there was no significant difference between AgP and CP groups at baseline and after treatment (P>0.05). At baseline, total PG and C4S levels in both of the periodontitis groups were significantly lower than that of the control group (P<0.05). One month after the non-surgical periodontal treatment, total PG levels in the periodontitis groups were comparable to the control group (P>0.05), whereas C4S levels in the AgP group were significantly lower than the other study groups (P<0.05). In the CP group, total PG and C4S levels increased significantly (P = 0.001 and P = 0.006, respectively) after non-surgical periodontal treatment, but they did not increase in the AgP group (P>0.05). CONCLUSION: The significant increases observed in total proteoglycan and chondroitin-4-sulfate levels after non-surgical periodontal treatment in the CP group but not in the AgP group may suggest that healing patterns differ between the two periodontitis types in terms of PG and C4S composition of extracellular matrix.     

Relationship Between Periodontal Status and HbA1c in Nondiabetics

Objectives: Many studies have reported an association between diabetes and periodontitis. We analyzed the periodontal status and glycosylated hemoglobin (HbA1c) level in nondiabetic subjects to investigate the relationship between periodontitis and glucose control in nondiabetics. Methods: Periodontal status, HbA1c, serum cholesterol, triglyceride, body mass index (BMI), and demographic variables were assessed in 141 Japanese adults. The difference in the HbA1c level was evaluated among subjects according to periodontal status. Results: After adjusting for age, gender, BMI, and smoking, alcohol, and exercise habits as covariates, the mean HbA1c was significantly elevated with periodontal deterioration ( P =  0.023). Conclusions: There was a significant relationship between periodontal status and HbA1c levels in nondiabetics.     

Effect of periodontal treatment on the C-reactive protein and proinflammatory cytokine levels in Japanese periodontitis patients

BACKGROUND: Recent epidemiological studies have shown that individuals with periodontitis have a significantly increased risk of developing coronary heart disease. In addition to conventional risk factors, chronic infection and subsequent production of systemic inflammatory markers may be associated with this increased risk. OBJECTIVES: The aim of the present study was to determine whether the presence of chronic periodontitis and subsequent periodontal treatment could influence the serum levels of C-reactive protein (CRP), interleukin-6 and tumor necrosis factor-alpha (TNF-alpha) in a Japanese population. METHODS: Sera were obtained from 24 patients with moderate to advanced periodontitis at the baseline examination and at reassessment after completion of treatment. As a control, sera were also obtained from 21 subjects without periodontitis. High-sensitivity CRP (hs-CRP) was measured using nephelometry with a latex particle-enhanced immunoassay and interleukin-6 and TNF-alpha were determined by sensitive enzyme-linked immunosorbent assay. RESULTS: The levels of hs-CRP and interleukin-6 in the sera of this Japanese population seemed to be much lower than those reported in other populations. TNF-alpha on the other hand, demonstrated similar levels between this Japanese and other populations. Periodontal status demonstrated a significant improvement in all patients following treatment. There was a trend toward higher hs-CRP levels in patients at baseline compared with control subjects. Hs-CRP level tended to decrease with improvement of the periodontal condition following treatment and approached that of control subjects, although this decline was not statistically significant. interleukin-6 and TNF-alpha levels did not change following periodontal treatment. Furthermore, there was no difference in the serum levels of these inflammatory cytokines between patients either at baseline or at reassessment and control subjects. CONCLUSIONS: In this pilot study, we were unable to show that periodontal disease significantly affects the serum levels of systemic inflammatory markers. However, this does not necessarily mean that periodontitis does not contribute to the total burden of inflammation as there was a tendency for hs-CRP to decrease following successful periodontal treatment. Large-scale studies are clearly needed to determine the impact of periodontal disease on systemic inflammation.     

慢性牙周炎患者治疗前后血清CRP、sICAM-1水平的变化

目的：了解慢性牙周炎患者经过牙周非手术治疗前后血清C反应蛋白（c-reactive protein,CRP）、可溶性细胞间黏附分子1（soluble intercellular adhesion molecule-1,sICAM-1）的水平的变化.方法：选择22例中重度慢性牙周炎患者,治疗前后分别收集患者的血清,用酶联免疫吸附反应法（ELISA）方法测定CRP、sICAM-1水平,并和16例无其它系统疾病的临床牙周健康的对照组比较.结果：慢性牙周炎患者血清CRP、sICAM-1水平显著高于临床牙周健康的对照组.治疗后血清CRP、sICAM-1水平下降,接近牙周正常者水平.结论：慢性牙周炎影响血清CRP、sICAM-1的水平.牙周非手术治疗可以明显控制牙周局部炎症,降低血液中CRP、sICAM-1的水平.     

Periodontal disease and diabetes metabolic control: a full-mouth disinfection approach

Some studies demonstrated that local mechanical periodontal treatment and systemic antibiotics might improve the level of metabolic control in patients with diabetes. The aim of this clinical pilot trial was to evaluate if type 1 diabetes patients with periodontitis will experience improvement in periodontal status and glycemic control after a full-mouth disinfection treatment. Ten adult patients with poor metabolic control (mean glycated hemoglobin (HbA1c) = 10.7 %) and periodontitis were included in the study. All patients received a full-mouth disinfection in 24 hours as described by Quirynen et al. (1995) at baseline and 6 months later. The periodontal parameters included plaque index (PI), bleeding on probing, probing depth and clinical attachment loss. Metabolic control was measured by the serum level of HbA1c. All measurements were done at baseline and at 3, 6, 9 and 12 months. The results demonstrated a significantly lower PI, less bleeding on probing, reduction in probing depth and gain of clinical attachment at 3 months and 9 months of the study. Similarly, a significant reduction in the serum level of HbA1c was measured three months after full-mouth disinfection but disappeared 6 months later at the 6- and 12-month check points. We conclude that a full-mouth disinfection approach significantly improves periodontal status and metabolic control in type 1 diabetes patients with periodontitis. However, the results of our study imply that a full-mouth disinfection method has to be applied at least every 3 months to control periodontal status and glycemic control in type 1 diabetes patients. Further studies with greater numbers of diabetes patients are needed to confirm the long-term beneficial effects of a full-mouth disinfection approach on diabetic metabolic control.     

Monocytic TNFα secretion patterns in IDDM patients with periodontal diseases*

Abstract The aim of the present study was to identify whether monocytic TNFα secretion patterns could serve as a potential phenotypic discriminator for periodontal disease susceptibility within insulin-dependent diabetes mellitus (IDDM) patients. In 32 IDDM individuals the lipopolysaccharide (LPS) stimulated monocytic TNFα secretion dose-response characteristics were analyzed and related to two different periodontal status categories. Diabetics were divided into group A (gingivitis or mild periodontal disease) and group B (moderate to severe periodontal disease). In addition, 17 non-diabetic individuals with various degrees of periodontal disease served as control patients. Diabetics as a group had a significantly higher monocytic TNFα production in response to increasing Porphyromonas gingivalis A 7436 lipopolysaccharide concentrations (0, 0.003, 0.03, 0.3 and 3.0 μg/ml) as compared to non-diabetic patients with gingivitis or adult periodontitis (p <0.05). A significant difference in the dose response was also noted in the level of TNFα secreted as a function of P. gingivalis LPS concentrations between group A and B diabetics, as determined by two-way repeated measurements ANOVA (p <0.05). Furthermore, there was no significant difference in the mean HbA_1C between the two diabetic groups, and the TNFα level was not significantly associated with the HbA_1C level within diabetic patients. These data suggest that the diabetic state results in an upregulated monocytic TNFα secretion phenotype (4.6-fold increase) which, in the presence of Gram-negative bacterial challenge, is associated with a more severe periodontal disease expression. In addition, approximately 40% (10 of 24) IDDM periodontitis patients in group B demonstrated a 62-fold elevation in TNFα secretion relative to non-diabetic gingivitis or periodontitis patients and a 13.5-fold increase relative to IDDM group A (gingivitis or mild periodontitis) patients.     

Effect of Non‐Surgical Periodontal Treatment on Visfatin Concentrations in Serum and Gingival Crevicular Fluid of Patients With Chronic Periodontitis and Type 2 Diabetes Mellitus

Background : This study aims to assess visfatin concentrations in serum and gingival crevicular fluid (GCF) and investigate this relationship in patients with type 2 diabetes mellitus (T2DM) and chronic periodontitis (CP) before and after non‐surgical periodontal treatment. Methods: Fifty‐four patients with T2DM and CP were recruited. The patients were randomly divided into two groups: treatment and control. Serum and GCF visfatin concentrations and glycated hemoglobin (HbA1c) levels were measured by enzyme‐linked immunosorbent assay at different time points (at baseline and 3 and 6 months after non‐surgical periodontal treatment). Results: Serum and GCF visfatin concentrations showed no significant differences between the groups at baseline (t test, P >0.05). A significant decline of visfatin in the treatment group was found in serum and GCF 3 months after non‐surgical periodontal treatment (t test, P <0.01). Baseline and 3‐month HbA1c levels were not significantly different, but at 6 months, a statistically significant difference was detected (t test, P >0.05). Conclusions: The data suggest that non‐surgical periodontal treatment is helpful for glucose control, an effect that may be associated with reduced visfatin in patients with T2DM and periodontitis. Furthermore, the data suggest that visfatin may be considered an inflammatory marker for periodontal diseases.     

Effect of non-surgical periodontal treatment on chronic kidney disease patients

Chronic kidney disease (CKD) is a debilitating systemic condition. Our working hypothesis is that CKD predialysis patients with periodontitis would respond poorly to periodontal treatment owing to immunologic compromise. Twenty-one predialysis patients (group 1) and 19 individuals without clinical evidence of kidney disease (group 2) with chronic periodontitis were subjected to non-surgical periodontal treatment with no antibiotics. Clinical periodontal and systemic parameters were evaluated at baseline and 3 months after treatment. Both groups showed significant and similar post-treatment improvements in all periodontal parameters examined. Most interestingly, periodontal treatment had a statistically significant positive effect on the glomerular filtration rate of each individual (group 1, p = 0.04; group 2, p = 0.002). Our results indicate that chronic periodontitis in predialysis kidney disease patients improved similarly in patients with chronic periodontitis and no history of CKD after receiving non-surgical periodontal therapy. This study demonstrates that CKD predialysis patients show a good response to non-surgical periodontal treatment.     

2型糖尿病合并牙周炎患者血清白细胞介素-1水平的检测

目的探讨2型糖尿病合并牙周炎患者血清白细胞介素-1（interleukin-1,IL-1）蛋白水平的表达。方法选择健康对照、糖尿病、重度慢性牙周炎和重度慢性牙周炎伴2型糖尿病患者各32例。用酶联免疫ELISA法测定血清IL-1α、IL-1β水平。结果 2型糖尿病合并牙周炎患者的血清IL-1β含量明显高于不伴牙周炎的糖尿病患者（P〈0.05）,牙周炎组高于健康对照组。4组中IL-1α水平无显著差异。结论 2型糖尿病合并牙周炎患者血清IL-1β水平明显升高。     

Assessment of periodontal conditions and systemic disease in older subjects

BACKGROUND: An increased risk for periodontitis has been associated both with type-1 or insulin dependent diabetes (IDDM) and with type-2 or non-insulin dependent diabetes (NIDDM). AIMS: 1) To describe and analyze periodontal conditions in older low-income ethnic diverse subjects with or without a diagnosis of diabetes. 2) To assess to what extent diabetes mellitus is associated with periodontal status, and 3) how periodontitis ranks as a coexisting disease among other diseases in subjects with diabetes mellitus. MATERIAL AND METHODS: Radiographic signs of alveolar bone loss were studied in 1101 older subjects 60-75 years old (mean age 67.6, SD+/-4.7). The number of periodontal sites and the proportions of teeth with probing depth (PD) > or =5 mm, clinical attachment levels (CAL) > or =4 mm were studied in a subset of 701 of the subjects. RESULTS: IDDM was reported by 2.9% and NIDDM by 9.2% of the subjects. The number of remaining teeth did not differ by diabetic status. The number of sites with PD > or =5 mm and the proportion of PD with > or =5 mm was significantly smaller in the non-diabetic group (chi2=46.8, p<0.01, and chi2=171.1, p<0.001, respectively). Statistical analysis failed to demonstrate group differences for the number and proportions of sites with CAL > or =4 mm and for radiographic findings of alveolar bone loss. Combining all periodontal parameters revealed that the Mantel-Haenszel common odds of having IDDM/NIDDM and periodontitis was 1.8 : 1 (95% CI: 1.1-3.1, p<0.03). The common odds ratio estimate of an association between heart disease and diabetes was 3.6 : 1 (95% CI: 2.1-2.6, p<0.001). CONCLUSIONS: Probing depth differences between IDDM/NIDDM vs. non-diabetic subjects may reflect the presences of pseudo-pockets and not progressive periodontitis in many subjects with diabetes mellitus. Periodontitis is not a predominant coexisting disease in older subjects with diabetes mellitus.     

Minor manifestations of periodontal diseases in young adults with type 1 diabetes mellitus. Periodontal and microbiological findings

Abstract Objective. The aim of this study was to evaluate periodontal status and microbiological conditions in young adults with insulin-dependent diabetes (IDDM) in comparison with age- and sex-matched non-diabetic controls. Materials and methods. Forty-one patients, 18-24 years of age with IDDM since childhood, were examined and the results were compared to those of a group of 41 sex- and age-matched non-diabetic controls. According to the HbA(1c) %, the group of diabetic patients was divided into two groups, with good or poor metabolic control. Results. Periodontal health, expressed in probing pocket depths and marginal bone loss, was fairly good in all patients. Fifty per cent of the patients in the study and control groups displayed probing pocket depths ≥4 mm, mostly pocket depths 4 mm. These findings were also equally distributed among the patients with good and poor metabolic control. No significant differences were found between the groups regarding bleeding on probing, but in the number of sites with excessive bleeding the study group exhibited higher scores than the healthy controls. Different microbiological species were equally distributed between the groups. Conclusion. Neither periodontal nor microbiological status in young adults with IDDM differs from that of healthy controls.     

程序性死亡配体1负性调控慢性牙周炎的炎症反应

目的 探讨程序性死亡配体1（PD-L1）在慢性牙周炎中是否有表达,以及与不同程度慢性牙周炎的相关关系,为阐明慢性牙周炎的免疫调控机制、临床治疗和预后提供依据。方法 收集健康人和慢性牙周炎患者的牙龈和牙周膜组织。根据临床探测,分为正常对照组、轻度牙周炎组、重度牙周炎组。运用荧光定量聚合酶链反应（PCR）测定不同组牙周组织中PD-L1 mRNA的表达;免疫印迹（Western blot）以及免疫组织化学方法测定不同组牙周组织中PD-L1蛋白的表达。结合临床影像资料,分析PD-L1的差异表达量和不同程度慢性牙周炎的关系。结果 轻度牙周炎组牙周组织中PD-L1的相对表达量显著高于重度牙周炎组（P<0.01）;正常对照组牙周组织中PD-L1的相对表达量与重度牙周炎组牙周组织相比无统计学意义（P>0.05）。结论 PD-L1在牙周组织的表达可负性调控炎症牙周组织损伤。     

The relationship between periodontal condition and serum levels of resistin and adiponectin in elderly Japanese

Background and Objective:  Diabetes and periodontitis are associated with each other. Adipokines, specifically adiponectin and resistin, are secreted from adipocytes and are thought to cause insulin resistance in rodents. Additionally, adiponectin and resistin may play a role in inflammation and immune responses. The aim of this study was to clarify the relationship between serum levels of adipokines and periodontal conditions in elderly Japanese people with and without periodontitis.
Material and Methods:  A total of 158 Japanese men and women (76 years old) with or without periodontitis were selected for the study. Serum adiponectin, resistin, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations were compared between subjects with and without periodontitis.
Results:  Serum resistin levels and total leukocyte counts in subjects with periodontitis were higher than in control subjects. No significant differences were observed in adiponectin, IL-6 and TNF-α levels between subjects with and without periodontitis. Logistic regression analysis showed that periodontitis with at least one tooth that displayed a probing pocket depth of ≥6 mm was significantly associated with higher serum resistin levels (odds ratio, 2.0; 95% confidence interval, 1.0–4.0). When excluding periodontitis subjects with ≤10% of bleeding on probing and excluding control subjects with >10% bleeding on probing, differences between groups and odds ratio increased. Serum adiponectin tended to decrease in patients with periodontitis, albeit not significantly.
Conclusion:  Increased serum resistin levels were significantly associated with periodontal condition, especially when considering bleeding on probing, in elderly Japanese people. There was also a trend, though non-significant, toward decreased levels of adiponectin in subjects with periodontitis.