Periodontal Inflammatory Conditions Among Gutka Chewers and Non‐chewers With and Without Prediabetes

Background: It is known that gutka chewing jeopardizes periodontal health; however, severity of periodontal inflammation in gutka chewers with and without prediabetes remains unknown. The aim of this study is to investigate the association of periodontal inflammatory conditions with gutka chewing and prediabetes. Methods: In this cross‐sectional study, the effect of gutka use on periodontal health is investigated among 44 individuals with prediabetes and 44 without prediabetes. Demographic information regarding age, sex, duration of prediabetes, and gutka‐chewing habits was collected using a questionnaire. Periodontal inflammatory conditions (plaque index [PI], bleeding on probing [BOP], probing depth [PD], marginal bone loss [MBL]) and fasting blood glucose levels (FBGLs) were recorded. Group differences in periodontal inflammatory parameters were tested using univariate and multivariable analyses (α ≤5%). Results: Periodontal inflammatory parameters (PI, BOP, and PD) were significantly higher in individuals with prediabetes irrespective of gutka‐chewing habit (P <0.05). Odds of periodontal inflammation in individuals with prediabetes were nine times higher than in healthy controls (95% confidence interval [CI] = 3.4 to 23.6). Gutka chewing alone, chewing among individuals with prediabetes, and chewing among healthy controls did not significantly increase the odds of periodontal inflammatory conditions. Individuals with prediabetes were significantly more likely to have periodontal inflammation than individuals without prediabetes even after controlling for sex and gutka chewing (odds ratio = 13.2; 95% CI = 4.3 to 40.7). Conclusion: In medically healthy individuals, periodontal inflammatory conditions are worse in gutka chewers compared to non‐chewers; in patients with prediabetes, the severity of periodontal inflammation is governed by hyperglycemia when compared to habitual gutka usage.     

Peri‐implant soft tissue inflammatory parameters and crestal bone loss among waterpipe (narghile) smokers and never‐smokers with and without type 2 diabetes mellitus

1 Background

Peri‐implant soft tissue inflammatory parameters and crestal bone loss (CBL) among waterpipe smokers (WS) with and without type 2 diabetes mellitus (T2DM) remains uninvestigated. The aim of the present study was to assess peri‐implant soft tissue inflammatory parameters and CBL among WS and never smokers (NS) with and without T2DM.

2 Methods

Demographic data and information regarding duration of implants in function, daily frequency of smoking, duration and treatment of T2DM, and daily toothbrushing was collected using a questionnaire. Peri‐implant plaque index (PI), bleeding on probing (BOP), probing depth (PD) ≥4 mm, CBL, and hemoglobin A1c (HbA1c) levels were assessed in all individuals. Level of significance was set at 5%.

3 Results

Seventy‐nine male individuals (39 patients with T2DM [20 WS and 19 NS] and 40 systemically healthy individuals [21 WS smokers and 19 NS]) were included. The mean age was comparable among individuals in all groups. The mean HbA1c levels were significantly higher among patients with T2DM compared to controls (P < 0.01). Peri‐implant PI, BOP, PD, and CBL were comparable among WS and NS with T2DM. Among patients without T2DM, PI (P < 0.05), PD ≥4 mm (P < 0.05) and mesial and distal CBL (P < 0.05) were significantly higher in WS than NS. Among individuals without T2DM, BOP was significantly higher among NS (P < 0.05) than WS. In patients with T2DM, BOP was comparable among WS and NS.

4 Conclusions

Peri‐implant soft tissue inflammatory parameters and CBL were comparable among WS and NS with T2DM. Among individuals without T2DM, these parameters were worse among WS than NS.     

Comparison of Clinical and Radiographic Periodontal Status Between Habitual Water‐Pipe Smokers and Cigarette Smokers

Background: There is a dearth of studies that have compared clinical and radiologic markers of periodontal inflammation between water‐pipe smokers (WPs) and cigarette smokers (CSs). The aim of the present study is to compare the clinical and radiographic periodontal status between habitual WPs and CSs. Methods: In total, 200 males (50 WPs, 50 CSs, and 100 controls) with comparable mean age and education were included. Demographic information was recorded using a questionnaire. Periodontal parameters (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment loss [AL], and marginal bone loss [MBL]) and numbers of missing teeth (MT) were recorded. Results: The duration of each smoking session for WPs and CSs was 50.2 ± 6.7 and 15.3 ± 0.4 minutes, respectively. Number of MT [P <0.0001], PI [P <0.0001], AL [P <0.0001], PD ≥4 mm [P <0.0001], and MBL [P <0.0001]) was significantly higher among WPs and CSs than controls. BOP was significantly higher among controls than WPs (P <0.0001) and CSs (P <0.0001). There was no statistically significant difference in the aforementioned parameters between WPs and CSs. Conclusions: Males in a Saudi Arabian community who were CSs or WPs had more MT and poorer periodontal condition than never smokers. The periodontal condition of WPs was equally as poor as CSs. Additional clinical observational studies with emphasis on sex and sociodemographic characteristics are needed.     

Adipose‐Derived Stem Cells Combined With Inorganic Bovine Bone in Calvarial Bone Healing in Rats With Type 2 Diabetes

Background: Clinical studies have revealed that patients with type 2 diabetes mellitus (DM) have higher implant and bone grafting failure rates than the general population, likely owing to inferior bone healing. The authors sought to investigate whether adipose‐derived stem cells (ASCs) combined with inorganic bovine bone improves bone repair in calvarial vertical critical‐sized defects (CSDs) in rats with type 2 DM. Methods: Bovine bone alone or seeded with 3 × 10⁵, 3 × 10⁶, or 3 × 10⁷ ASCs/graft was randomly transplanted into calvarial CSDs in rats with DM induced by a high‐fat diet with low‐dose streptozotocin. Specimens were assayed using microcomputed tomography and histomorphometry at 4 and 8 weeks postimplantation. Results: The histologic results showed an increase in new bone formation in the experimental groups compared with the control group. Both bone volume/total volume and trabecular thickness of newly formed bone within CSDs were the highest, and trabecular spacing was the lowest, in the 3 × 10⁶ group at 8 weeks for the most favorable outcome. The results showed that the amount of new bone was greatest in the 3 × 10⁶ group by 8 weeks. Conclusions: ASCs enhanced vertical bone regeneration in calvarial defects in rats with type 2 DM, when used in association with bovine bone scaffolds. The findings suggest that a combination of ASCs and bovine bone scaffolds could improve bone quantity in vertical bone defects.     

Comparison of periodontal and peri-implant inflammatory parameters among patients with prediabetes,type 2 diabetes mellitus and non-diabetic controls

Objective: The aim was to compare periodontal and periimplant inflammatory parameters (plaque index [PI], bleeding on probing [BOP], probing depth [PD] and marginal bone loss [MBL]) among patients with prediabetes, type-2 diabetes mellitus (T2DM) and non-diabetic controls.

Materials and methods: Forty-five patients with prediabetes (Group-1), 43 patients with T2DM (Group-2) and 42 controls (Group-3) were included. Demographic data was recorded using a questionnaire. Full mouth and periimplant clinical (PI, BOP and PD) were assessed and the radiographic MBL were measured on digital radiographs. In all groups, haemoglobin A1c (HbA1c) levels were also measured. p values less than .05 were considered statistically significant.

Results: The mean HbA1c levels of participants in groups 1, 2 and 3 were 6.1%, 8.4% and 4.8%, respectively. The mean duration of prediabetes and T2DM among patients in groups 1 and 2 were 1.9?±?0.3 and 3.1?±?0.5 years, respectively. Periodontal and periimplant PI, BOP, PD and MBL were higher in groups 1 (p?p?Conclusions: Periodontal and periimplant inflammatory parameters were worse among patients with prediabetes and T2DM compared with controls; however, these parameters were comparable among patients with prediabetes and T2DM.     

Periodontal treatment and HbA1c levels in subjects with diabetes mellitus

It has earlier been reported that individuals with poorly controlled diabetes have severe periodontal disease (PD) compared to well‐controlled diabetes. This longitudinal interventional study compared periodontal treatment outcomes with HbA1c level changes in four groups of diabetic and non‐diabetic patients with or without PD, respectively. HbA1c, bleeding on probing (BOP), plaque index and periodontal pocket depth (PPD) 4 < 6 mm and ≥6 mm were recorded at baseline to 3 months after non‐surgical treatment and 3–6 months for surgical treatment in subjects with or without T2D, and with or without PD. A total of 129 patients were followed from baseline to 6 months. Diabetics with PD and without PD showed reductions in HbA1c levels with a mean value of 0·3% after 3 months and mean values of 1% and 0·8%, respectively, after 6 months. Diabetics with PD showed higher levels of BOP versus non‐diabetics without PD (P < 0·01) and versus diabetics without PD (P < 0·05) at baseline. After 6 months, diabetics with PD showed higher number of PPD 4 < 6 mm versus diabetics without PD (P < 0·01) and non‐diabetics with PD (P < 0·01). Diabetics without PD showed higher levels of PPD 4 < 6 mm versus non‐diabetics without PD (P < 0·01). Surgical and non‐surgical periodontal treatment in all groups improved periodontal inflammatory conditions with a decrease in HbA1c levels in a period of three and 6 months. No change was seen in the number of pockets PPD 4 < 6 mm in diabetic subjects with PD after non‐surgical and surgical treatment.     

Short‐Term Effects of Non‐Surgical Periodontal Treatment on the Gingival Crevicular Fluid Cytokine Profiles in Sites With Induced Periodontal Defects: A Study on Dogs With and Without Streptozotocin‐Induced Diabetes

Background: The aim of this study is to assess the short‐term effects of non‐surgical periodontal therapy (NSPT) on the gingival crevicular fluid (GCF) cytokine profile in sites with standardized periodontal bony defects in beagle dogs with and without diabetes. Methods: Four beagle dogs with streptozotocin (STZ)‐induced diabetes and four healthy dogs were included. Fasting blood glucose levels were measured using a glucometer. In all animals, a 3‐walled bony defect was created on the mesial surface of the second premolar and first molar in all quadrants. After 12 weeks, all animals underwent weekly NSPT for 3 weeks. Baseline and post‐NSPT GCF samples were collected, and levels of interleukin (IL)‐1, IL‐1β, IL‐6, IL‐8, and tumor necrosis factor (TNF)‐α were measured using enzyme‐linked immunosorbent assay. Statistical analyses were performed using a software program, and P values <0.05 were considered statistically significant. Results: Mean fasting blood glucose levels were significantly higher in dogs with induced diabetes than those without diabetes (P <0.01). At baseline, mean IL‐6 (P <0.01) and IL‐8 (P <0.05) levels were higher in dogs with diabetes than those without diabetes. A significant reduction in levels of IL‐1, IL‐1β, IL‐6, IL‐8, and TNF‐α was noted in dogs without diabetes 1 week after NSPT. However, this significant reduction (P <0.05) only appeared 2 weeks after NSPT in dogs with diabetes. Conclusions: NSPT reduces GCF levels of proinflammatory cytokines in dogs with and without STZ‐induced diabetes; however, chronic hyperglycemia seems to retard the effect of NSPT on GCF cytokine concentration.     

Comparison of Periodontal Parameters and Self‐Perceived Oral Symptoms Among Cigarette Smokers,Individuals Vaping Electronic Cigarettes,and Never‐Smokers

Background: To the authors’ knowledge, there are no studies that have compared periodontal parameters and self‐perceived oral symptoms (OSs) among cigarette smokers (CSs) (group 1), individuals exclusively vaping electronic cigarettes (group 2), and never‐smokers (NSs) (group 3). The aim of this study is to assess periodontal parameters and self‐perceived OSs among vaping individuals, CSs, and NSs. Methods: Ninety‐four male participants (groups 1, 2, and 3: 33, 31, and 30 individuals, respectively) were included. Demographic data, self‐perceived OSs, and duration and daily frequency of vaping and smoking were gathered using a questionnaire. Full‐mouth plaque index (PI), bleeding on probing (BOP), probing depth (PD) ≥4 mm, and clinical attachment loss (AL) were measured; marginal bone loss (MBL) around all teeth was measured on digital radiographs. Numbers of missing teeth (MT) were also recorded. Odds ratios were calculated for OSs, and periodontal parameters were assessed using analysis of variance and Bonferroni post hoc tests. P <0.05 was considered statistically significant. Results: PI (P <0.01) and PD ≥4 mm (P <0.01) were significantly higher in groups 1 and 2 than in group 3. BOP was significantly higher in group 3 than in groups 1 (P <0.01) and 2 (P <0.01). There was no difference in number of MT, clinical AL, and MBL among all groups. Gingival pain was more often reported by individuals in group 1 than by individuals in groups 2 (P <0.01) and 3 (P <0.01). Conclusion: Periodontal inflammation and self‐perceived OSs were poorer among CSs than among vaping individuals and NSs.     

Periodontal Status and Whole Salivary Cytokine Profile Among Smokers and Never‐Smokers With and Without Prediabetes

Background: Whole salivary interleukin (IL)‐1β and IL‐6 in smokers and never‐smokers with prediabetes remains uninvestigated. The aim of this study is to assess the periodontal status and whole salivary IL‐1β and IL‐6 levels among smokers and never‐smokers with and without prediabetes (controls). Methods: Ninety‐five males (45 with prediabetes and 50 systemically healthy controls) were included. Twenty‐seven controls and 29 patients with prediabetes were smokers. Periodontal parameters (plaque index, bleeding on probing, probing depth, clinical attachment loss, and marginal bone loss) were measured, and the number of missing teeth were recorded. Fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels were recorded. Unstimulated whole saliva samples were collected, unstimulated whole salivary flow rate (UWSFR) was determined, and IL‐1β and IL‐6 levels were measured. P values <0.05 were considered statistically significant. Results: FBG (P <0.05) and HbA1c (P <0.05) levels were higher among patients with prediabetes than controls. All patients with prediabetes were hyperglycemic. UWSFR was significantly higher among controls than among patients with prediabetes (P <0.05). Periodontal parameters and whole salivary IL‐1β and IL‐6 levels were comparable among smokers and never‐smokers with prediabetes. Among controls, periodontal parameters and whole salivary IL‐1β and IL‐6 levels were higher among smokers than never‐smokers (P <0.05). Conclusions: Among controls, periodontal inflammation was worse, and whole salivary IL‐1β and IL‐6 levels are higher in smokers than never‐smokers. Among patients with prediabetes, periodontal inflammation and whole salivary IL‐1β and IL‐6 levels were comparable between smokers and never‐smokers.     

Comparison of Peri‐Implant Soft Tissue Parameters and Crestal Bone Loss Around Immediately Loaded and Delayed Loaded Implants in Smokers and Non‐Smokers: 5‐Year Follow‐Up Results

Background: The aim of this study is to compare peri‐implant soft tissue parameters (plaque index [PI], bleeding on probing [BOP], and probing depth [PD] ≥4 mm) and crestal bone loss (CBL) around immediately loaded (IL) and delayed loaded (DL) implants in smokers and non‐smokers. Methods: Thirty‐one patients with IL implants (16 smokers and 15 non‐smokers) and 30 patients with DL implants (17 smokers and 13 non‐smokers) were included. Personal data regarding age, sex, and duration and daily frequency of smoking were gathered using a questionnaire. Peri‐implant PI, BOP, and PD ≥4 mm were recorded, and mesial and distal CBL was measured on standardized digital radiographs. Multiple group comparisons were performed using the Bonferroni post hoc test (P <0.05). Results: All implants replaced mandibular premolars or molars. Mean scores of PI (P <0.05) and PD ≥4 mm (P <0.05) were statistically significantly higher in smokers compared with non‐smokers in patients with IL and DL dental implants. The mean score of BOP (P <0.05) was statistically significantly higher in non‐smokers compared with smokers in both groups. CBL (P <0.05) was statistically significantly higher in smokers compared with non‐smokers in both groups. There was no statistically significant difference in PI, BOP, PD ≥4 mm, and total CBL among smokers with IL and DL implants. Conclusions: Tobacco smoking enhances peri‐implant soft tissue inflammation and CBL around IL and DL implants. Loading protocol did not show a significant effect on peri‐implant hard and soft tissue status in healthy smokers and non‐smokers.     

The Sociodemographic Characteristics,Periodontal Health Status,and Subgingival Microbiota of Patients With Chronic Periodontitis and Type 2 Diabetes Mellitus: A Case‐Control Study in a Chinese Population

Background: In China, chronic periodontitis (CP) is common in patients with type 2 diabetes mellitus (T2DM). The purpose of this study is to identify the sociodemographic characteristics associated with such patients and to assess the periodontal health status and subgingival microbiota of patients with CP and T2DM (T2DMCP) in the Chinese population. Methods: A total of 150 patients with T2DMCP and 306 patients with CP without any systemic disease completed questionnaires, underwent clinical periodontal examinations and participated in diabetes‐related parameter examinations. Subgingival plaques were obtained to determine the prevalence and amounts of selected oral bacterial species using polymerase chain reaction (PCR) and real‐time PCR, respectively. Results: The income level and mean body mass index (BMI) of the patients with T2DMCP were significantly higher than those of the patients with CP. Additionally, the patients with T2DMCP were more likely to be urban residents, and they had significantly more severe periodontitis than did the patients with CP. In the patients with T2DMCP, the prevalence and amounts of Treponema denticola and Tannerella forsythia were significantly higher than those in the patients with CP. Finally, compared with the patients with CP, the patients with T2DMCP had a significantly lower prevalence and amount of Prevotella intermedia. Conclusions: Compared with the patients with CP, the patients with T2DMCP were more likely to be urban residents and generally had higher incomes, higher mean BMI, and poorer periodontal health status. Higher levels of T. denticola and T. forsythia and lower levels of P. intermedia were identified in the subgingival plaque of the patients with T2DMCP.     

Management of shortened dental arches and periodontal health: 5‐year results of a randomised trial

In a multicentre randomised trial (German Research Association, grants DFG WA 831/2‐1 to 2‐6, WO 677/2‐1.1 to 2‐2.1.; controlled‐trials.com ISRCTN97265367), patients with complete molar loss in one jaw received either a partial removable dental prosthesis (PRDP) with precision attachments or treatment according to the SDA concept aiming at pre‐molar occlusion. The objective of this current analysis was to evaluate the influence of different treatments on periodontal health. Linear mixed regression models were fitted to quantify the differences between the treatment groups. The assessment at 5 years encompassed 59 patients (PRDP group) and 46 patients (SDA group). For the distal measuring sites of the posterior‐most teeth of the study jaw, significant differences were found for the plaque index according to Silness and Löe, vertical clinical attachment loss (CAL‐V), probing pocket depth (PPD) and bleeding on probing. These differences were small and showed a slightly more unfavourable course in the PRDP group. With CAL‐V and PPD, significant differences were also found for the study jaw as a whole. For CAL‐V, the estimated group differences over 5 years amounted to 0·27 mm (95% CI 0·05; 0·48; P = 0·016) for the study jaw and 0·25 mm (95% CI 0·05; 0·45; P = 0·014) for the distal sites of the posterior‐most teeth. The respective values for PPD were 0·22 mm (95% CI 0·03; 0·41; P = 0·023) and 0·32 mm (95% CI 0·13; 0·5; P = 0·001). It can be concluded that even in a well‐maintained patient group statistically significant although minor detrimental effects of PRDPs on periodontal health are measurable.     

Resistin Levels in Gingival Crevicular Fluid of Patients With Chronic Periodontitis and Type 2 Diabetes Mellitus

Background: Resistin is associated with local and systemic inflammatory conditions with a direct correlation with type 2 diabetes mellitus (T2DM). The aim of this clinico‐biochemical study is to estimate and compare the levels of resistin in the gingival crevicular fluid (GCF) in health, chronic periodontitis (CP), and T2DM. Methods: Sixty patients (aged >35 years) who participated in this study were divided into four groups of 15 patients each: healthy individuals (group 1), patients with CP (group 2), patients with T2DM (group 3), and patients with T2DM and CP (group 4). The parameters assessed included plaque index (PI), gingival index (GI), probing depth (PD), periodontal index, body mass index, random blood sugar (RBS), and glycated hemoglobin (HbA1c). GCF (4 μL) was collected and analyzed for resistin levels using an enzyme‐linked immunosorbent assay. Results: Resistin was detected in the GCF of all patients. A significant difference was observed in GCF resistin concentrations from group 1 versus group 2 (P = 0.0093), group 3 (P = 0.0341), and group 4 (P = 0.0002); in group 2 versus group 4 (P = 0.0032); and in group 3 versus group 4 (P = 0.0008). When all the samples were analyzed together, GCF resistin levels positively correlated with GI, PD, PI, RBS, and HbA1c and were predictable with PD and HbA1c. Conclusions: Resistin levels are increased in CP and T2DM. Hence, GCF resistin levels may be considered as a potential inflammatory marker for periodontitis with T2DM.     

Periodontal Microorganisms and Cardiovascular Risk Markers in Youth With Type 1 Diabetes and Without Diabetes

Background: A subset of periodontal microorganisms has been associated with cardiovascular disease (CVD), which is the leading complication of type 1 diabetes (t1DM). The authors therefore evaluated the association between periodontal microorganism groups and early markers of CVD in youth with t1DM. Methods: A cross‐sectional analysis was conducted among youth aged 12 to 19 years at enrollment; 105 had t1DM for ≥5 years and were seeking care at the Barbara Davis Center, University of Colorado, from 2009 to 2011, and 71 did not have diabetes. Subgingival plaque samples were assessed for counts of 41 periodontal microorganisms using DNA–DNA hybridization. Microorganisms were classified using cluster analysis into four groups named red‐orange, orange‐green, blue/other, and yellow/other, modified from Socransky’s color scheme for periodontal microorganisms. Subsamples (54 with t1DM and 48 without diabetes) also received a periodontal examination at the University of Colorado School of Dental Medicine. Results: Participants were ≈15 years old on average, and 74% were white. Mean periodontal probing depth was 2 mm (SE 0.02), and 17% had bleeding on probing. In multivariable analyses, glycated hemoglobin (HbA1c) was inversely associated with the yellow/other cluster (microorganisms that are not associated with periodontal disease) among youth with t1DM. Blood pressure, triglycerides, low‐density lipoprotein, high‐density lipoprotein, and total cholesterol were not associated with microorganism clusters in this group. HbA1c was not associated with periodontal microorganism clusters among youth without diabetes. Conclusion: Among youth with t1DM who had good oral health, periodontal microorganisms were not associated with CVD risk factors.     

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.