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Zhuang J, Ren Y, Chen M, Yue M, Yuan C, Duan R. Efficacy of localized sustained-release drugs in periodontitis and comorbid diabetes: A systematic review and meta-analysis. iScience 2025; 28:112182. [PMID: 40201124 PMCID: PMC11978340 DOI: 10.1016/j.isci.2025.112182] [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: 12/13/2024] [Revised: 01/19/2025] [Accepted: 03/04/2025] [Indexed: 04/10/2025] Open
Abstract
Our meta-analysis aimed to evaluate the efficacy of localized sustained-release drugs in periodontitis and comorbid diabetes. PubMed, Cochrane Library, Embase, and Web of Science were comprehensively searched until 4 December 2024, and 10 randomized controlled trials (RCTs) were included. The results indicated that, compared to the control group, localized sustained-release drugs significantly reduced probing depth (PD) (SMD = -0.77, 95% confidence interval [CI] (-1.37, -0.16)) but did not reduce clinical attachment loss (CAL) (SMD = -0.18, 95% CI (-0.60, 0.23)), sites with glycated hemoglobin (HbA1c) (SMD = 0.03, 95% CI (-0.38, 0.43)), plaque index (SMD = -0.37, 95% CI (-0.80, 0.06)), sites with bleeding on probing (BOP) (SMD = -0.26, 95% CI (-0.68, 0.16)), and gingival index (SMD = 0.07, 95% CI (-0.30, 0.44)). Subgroup analysis by different drugs elicited that, compared to the control treatment, chlorhexidine was effective in reducing BOP% (SMD = -0.55, 95% CI (-0.90, -0.19)). Our meta-analysis finds that the efficacy of localized sustained-release drugs in periodontitis and comorbid diabetes is limited.
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Affiliation(s)
- Jingru Zhuang
- School of Stomatology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Ying Ren
- School of Stomatology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Minmin Chen
- School of Stomatology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Minghui Yue
- School of Stomatology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Changyong Yuan
- School of Stomatology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- The Affiliated Stomatological Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, China
| | - Rongquan Duan
- School of Stomatology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Sichuan Vista Medical Devices Co., Ltd., Luzhou, Sichuan 646000, China
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de Oliveira DMSL, de Souza ALM, Filho GDRN, Martins-Pfeifer CC, Stefani CM. Efficacy of Adjunctive Local Antimicrobials to Non-Surgical Periodontal Therapy in Pocket Reduction and Glycemic Control of Patients with Type 2 Diabetes: A Network Meta-Analysis. Curr Diabetes Rev 2025; 21:86-102. [PMID: 39229981 PMCID: PMC12082567 DOI: 10.2174/0115733998320667240805045742] [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: 04/24/2024] [Revised: 07/14/2024] [Accepted: 07/23/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVE This network meta-analysis [NMA] investigated the efficacy of adjunctive use of subgingivally delivered antimicrobials to non-surgical periodontal therapy [NSPT] in the glycemic control and periodontal pocket depth (PPD) reduction in patients with type 2 diabetes (T2D). METHODS Seven databases, grey literature, and registry platforms were searched up to February 2024 to identify randomized clinical trials (RCT) fulfilling the eligibility criteria. The risk of bias was assessed through Cochrane's tool (RoB 2). Two frequentist NMA were performed using a random-effects model to calculate mean differences (MD) as an effect measure and to quantitatively evaluate the glycated hemoglobin (HbA1c) and PPD. The certainty of evidence was assessed through the GRADE approach in a partially contextualized framework for interpreting results. Ten RCTs were included. RESULTS In total, 261 patients were treated with eight different local antimicrobials adjuvants to NSPT (azithromycin gel, clarithromycin gel, tetracycline fiber or ointment, chlorhexidine gel, doxycycline nanospheres, minocycline gel, and satranidazole gel), while 249 patients received NSPT alone or associated to placebo. Considering PPD reduction (8 included studies), the best results were found after six months for satranidazole gel (MD -2.64 mm; 95%CI -3.56, -1.72; moderate evidence certainty). For HbA1c control (7 included studies), doxycycline gel (MD - 0.80%; 95%CI -1.70, 0.10), chlorhexidine gel (MD -0.68%; 95%CI -1.34, -0.02), and tetracycline fiber (MD -0.62%; 95%CI -0.85, -0.39) showed promising results after three months (low evidence certainty). CONCLUSION The adjunctive use of satranidazole gel probably reduces PPD after a 6-month follow-up, while doxycycline gel, chlorhexidine gel, and tetracycline fiber may decrease HbA1c values in patients with T2D and periodontitis treated with NSPT after a 3-month follow up.
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Olszewska-Czyz I, Michalak E, Dudzik A. A Three-Month Clinical Trial on the Efficacy of Hyaluronic Acid Adjunctive Non-Surgical Therapy for Periodontitis in Patients with Type 2 Diabetes Mellitus. Biomedicines 2024; 12:2516. [PMID: 39595081 PMCID: PMC11591565 DOI: 10.3390/biomedicines12112516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 11/01/2024] [Accepted: 11/02/2024] [Indexed: 11/28/2024] Open
Abstract
Background/Objectives: Conventional periodontal treatment for patients with diabetes has shown promising results, primarily focusing on glycated hemoglobin (HbA1c) levels as an endpoint measure. The properties of hyaluronic acid (HA) have been harnessed in various periodontal therapies, and it is a promising agent also in a non-surgical approach. The aim of this clinical trial was to assess the efficacy of hyaluronic acid in a local adjunctive non-surgical treatment for periodontitis in patients with type 2 diabetes. Methods: Eighty adult participants with well-controlled type 2 diabetes (HbA1c 7% (53 mmol/mol) or less) took part in the trial. The clinical parameters of periodontitis as well as the glycated hemoglobin (HbA1c) levels were evaluated, and an analysis of the potential differences between the control (placebo) and intervention (HA) groups was performed. Results/Conclusions: A decrease in all the clinical values of periodontitis after treatment was observed in the vast majority of patients in both groups. Differences in the clinical parameters were observed 12 weeks after the intervention between the patients in the placebo and HA therapy groups. Bleeding on probing (BoP) was reduced in the control group to 15-25% and was approximately 5.5% more in the intervention group (9.5-18.25%). The clinical attachment level (CAL) decreased 1 mm more in the HA therapy group (1-2 mm) than in the no adjunctive treatment group (2-3 mm). The probing depth (PD) was reduced similarly in both groups (3-3.75 mm). Due to the bilateral relationship between diabetes and periodontitis, healthcare professionals seek advancements in managing periodontal inflammation. The results of this study indicate that non-surgical periodontal treatment with HA as an adjunctive agent is worth considering in the therapy for patients with diabetes.
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Affiliation(s)
- Iwona Olszewska-Czyz
- Department of Prophylaxis, Periodontology and Oral Pathology, Dental Institute, Medical Faculty, Jagielonian University, 30002 Krakow, Poland; (E.M.); (A.D.)
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Lin SY, Sun JS, Lin IP, Hung MC, Chang JZC. Efficacy of adjunctive local periodontal treatment for type 2 diabetes mellitus patients with periodontitis: A systematic review and network meta-analysis. J Dent 2024; 148:105212. [PMID: 38936456 DOI: 10.1016/j.jdent.2024.105212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVES To investigate the effectiveness of different adjunctive local treatments combined with non-surgical periodontal therapy (NSPT) to reduce pocket depth (PD), gain clinical attachment level (CAL), and/or reduce glycated hemoglobin (HbA1c) in individuals with both type 2 diabetes mellitus (T2DM) and periodontitis in a systematic review and network meta-analysis. DATA SOURCES Publications were searched in Cochrane databases, EMBASE, Google Scholar, MEDLINE, PubMed, opengrey.eu, and www. CLINICALTRIALS gov up to May 29, 2024 with no language restriction. STUDY SELECTION Only randomized controlled trials (RCTs) were included. Network meta-analysis utilized frequentist models. DATA The network meta-analysis of 30 RCTs involving 1224 patients revealed that, in short-term (2-3 months) and medium-term (4-6 months), adjunctive local treatment involving statins or metformin significantly outperformed scaling and root planning (SRP) with/without additional interventions such as photodynamic and laser therapies (PDT/LT), phytotherapy, doxycycline, bisphosphonates, antibiotics, antiseptics, or placebo for reducing PD and/or gaining CAL. In the long-term (>6 months), statins yielded the most significant additional PD reduction and CAL gain, followed by antibiotics, compared to SRP with antiseptics or placebo. Only PDT/LT demonstrated significantly greater HbA1c reduction in the short term compared to SRP with/without statins, antiseptics, or placebo. CONCLUSION This study moderately supports that adding metformin or statins locally to NSPT may enhance PD reduction and CAL gain compared to SRP with/without placebo. CLINICAL SIGNIFICANCE Clinicians are guided to optimize adjunctive therapies, enhancing the health of patients with type 2 diabetes and periodontitis. A strategic approach is proposed to tackle systemic and oral health challenges simultaneously.
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Affiliation(s)
- Shih-Ying Lin
- Department of Dentistry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Orthopedic Surgery, En Chu Kong Hospital, Taipei, Taiwan
| | - I-Ping Lin
- Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Chih Hung
- Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenny Zwei-Chieng Chang
- Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan; School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.
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de Molon RS, Rodrigues JVS, Deroide MB, da Silva Barbirato D, Garcia VG, Theodoro LH. The Efficacy of Topical or Systemic Antibiotics as Adjuvants to Non-Surgical Periodontal Treatment in Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Clin Med 2024; 13:4763. [PMID: 39200907 PMCID: PMC11355856 DOI: 10.3390/jcm13164763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 07/31/2024] [Accepted: 08/08/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Periodontitis and diabetes mellitus (DM) exhibit a bidirectional relationship and are globally significant systemic chronic conditions. The utilization of antibiotics alongside non-surgical periodontal treatment (NSPT) has been a subject of investigation in numerous clinical studies involving human subjects. Thus, the objective of this systematic review is to address the following question: "What is the efficacy of scaling and root planing (SRP) associated with antimicrobials in patients with type 2 DM and periodontitis?". Methods: A systematic review of the literature was conducted encompassing databases such as MEDLINE/PubMed, Scopus, and Web of Science up to July 2024. Additionally, alerts were configured to capture studies published from the initial search until manuscript submission. Randomized clinical trials assessing clinical periodontal parameters in DM patients undergoing SRP and receiving either topical or systemic antibiotics were compared against a control group (SRP only). Two investigators independently screened articles, extracted data, and evaluated their quality. The selection process, study characteristics, risk of bias, impact of antibiotics on clinical parameters, and certainty of evidence were elucidated in both textual and tabular formats. Meta-analysis was performed separately with forest plots generated for treatment modalities, period of evaluation, and type of antibiotics used. Results: Following the analysis of abstracts and full articles, a total of 30 randomized clinical trials were incorporated into this review, comprising 9 studies on the association of topical antibiotics and 21 studies on systemic antibiotic administration. The principal periodontal parameters assessed included probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BoP). Conclusions: Analysis of the results led to the conclusion that adjunctive periodontal treatment with either topical or systemic antibiotics confers subtle clinical benefits. Nevertheless, owing to the heightened emergence of resistant bacteria and potential side effects, the use of antibiotic therapy in periodontal treatment should be judiciously administered.
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Affiliation(s)
- Rafael Scaf de Molon
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Aracatuba 16015-050, SP, Brazil; (J.V.S.R.); (M.B.D.); (V.G.G.); (L.H.T.)
| | - Joao Victor Soares Rodrigues
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Aracatuba 16015-050, SP, Brazil; (J.V.S.R.); (M.B.D.); (V.G.G.); (L.H.T.)
| | - Mariella Boaretti Deroide
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Aracatuba 16015-050, SP, Brazil; (J.V.S.R.); (M.B.D.); (V.G.G.); (L.H.T.)
| | - Davi da Silva Barbirato
- Department of Basic and Oral Biology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo (FORP/USP), Av. Café, S/N-Ribeirão Preto, São Paulo 14040-904, SP, Brazil;
| | - Valdir Gouveia Garcia
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Aracatuba 16015-050, SP, Brazil; (J.V.S.R.); (M.B.D.); (V.G.G.); (L.H.T.)
- Latin American Institute of Dental Research and Teaching (ILAPEO), Curitiba 80710-150, PR, Brazil
| | - Leticia Helena Theodoro
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University—UNESP, Aracatuba 16015-050, SP, Brazil; (J.V.S.R.); (M.B.D.); (V.G.G.); (L.H.T.)
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Chang YH, Huang CL, Hsieh AT, Jao CA, Lu HK. Expression of advanced glycation end products and receptors in gingival tissues of patients with noninsulin-dependent diabetes mellitus-associated periodontitis. J Dent Sci 2022; 18:689-695. [PMID: 37021230 PMCID: PMC10068389 DOI: 10.1016/j.jds.2022.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/17/2022] [Indexed: 12/14/2022] Open
Abstract
Background/purpose Advanced glycation end products (AGEs) are known to accumulate in the periodontal tissues of patients with diabetes mellitus (DM). Through this study, we aimed to investigate the distribution of AGEs and the receptor of AGEs (RAGE) in the gingival tissues of patients with chronic periodontitis with and without non-insulin-dependent diabetes mellitus (NIDDM). Materials and methods Gingival biopsy samples from 13 patients with both NIDDM and periodontitis and 6 patients with both non-DM (NDM) and periodontitis were collected. The tissue sections were processed using immunohistochemical (IHC) staining to detect the distributions of AGEs and RAGE. Spearman correlation coefficients of all samples were calculated (P < 0.05) for the AGE and RAGE rankings of the following clinical parameters: plaque score (PI), probing depth (PD), bleeding on probing (BOP), and tooth loss (TL). Results IHC analysis revealed that AGEs among patients with NIDDM had a significantly higher ranking than those of the NDM group (P < 0.05). Positive staining for RAGE was observed in both groups but was not significantly different (P > 0.05). A positive correlation between AGE ranking and TL was observed in the NIDDM group, but not between AGE ranking and PI, PD, or BOP. The distribution of RAGE was not correlated with PI, PD, BOP, or TL. Conclusion AGEs were particularly distributed in the highly inflamed gingiva of patients with NIDDM-associated periodontitis and was statistically correlated with the long-term parameter TL.
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Affiliation(s)
- Ya-Han Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Periodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chen-Ling Huang
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - An-Tsz Hsieh
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Chia-Ai Jao
- Department of Dentistry, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Hsein-Kun Lu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Periodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
- Corresponding author. Division of Periodontics, Department of Dentistry, Taipei Medical University Hospital, No. 252, Wuxing St, Xinyi District, Taipei City, 110301, Taiwan. Fax: +886 2 2737 2181#3211.
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Clinical Benefits of Minimally Invasive Non-Surgical Periodontal Therapy as an Alternative of Conventional Non-Surgical Periodontal Therapy-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127456. [PMID: 35742702 PMCID: PMC9223734 DOI: 10.3390/ijerph19127456] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 02/01/2023]
Abstract
Minimally invasive procedures were introduced in periodontics, which could enhance clinical outcomes and reduce post-operative discomfort. However, minimally invasive non-surgical periodontal therapy (MINST) as an alternative modality of conventional non-surgical root surface debridement has not been clearly evaluated by randomized controlled clinical trial. The present study aimed to investigate clinical outcomes and patients’ comfort feedback of MINST compared to conventional non-surgical periodontal therapy (CNST). Patients with moderate to severe periodontitis were included. Nine out of ten patients were recruited and completed the post-treatment re-evaluation in this study. Randomized split-mouth design, CNST and MINST on each side, was performed. Clinical parameters, including periodontal probing depth (PD), gingival recession (REC), clinical attachment level (CAL), and gingival bleeding on probing (BOP), were recorded on baseline, 1 month and 3 months post-treatment. Non-parametric statistics were used for analysis. PD, REC, CAL, and BOP were improved after treatment in both CNST and MINST groups. Comfort feedback and gingival recession showed better outcomes in the MINST group than in the CNST group. No statistical significance of parameters was found between CNST and MINST. Within the limitations, minimally invasive non-surgical periodontal therapy could be an alternative modality of conventional non-surgical periodontal therapy. Further studies are required to establish clinical protocol and evidence of MINST.
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Chen JT, Wu IT, Huang RY, Lin YC, Chou YH, Lin T, Kuo PJ, Tu CC, Hou LT, Lai YL, Lu HK, Tsai CC, Yuan K, Chen CJ, Ho CS, Yang YC, Wu AYJ, Huang KC, Chiang CY, Chang PC. Recommendations for treating stage I-III periodontitis in the Taiwanese population: A consensus report from the Taiwan Academy of Periodontology. J Formos Med Assoc 2021; 120:2072-2088. [PMID: 34294496 DOI: 10.1016/j.jfma.2021.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/16/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/PURPOSE Based on the fundamental of the S3-level clinical practice guideline (CPG) for treating stage I-III periodontitis developed by the European Federation of Periodontology (EFP), this consensus report aimed to develop treatment recommendations for treating periodontitis in the Taiwanese population. METHODS The report was constructed by experts from the Taiwan Academy of Periodontology. The following topics were reviewed: (a) the prevalence of periodontitis in Asia and current status of treatment in Taiwan; (b) specific anatomical considerations for treating periodontitis in Asians; (d) educational and preventive interventions and supragingival plaque control; (d) subgingival instrumentation and adjunctive treatment; (e) surgical periodontal therapy; and (f) maintenance and supportive periodontal care. Recommendations were made according to the evidences from the EFP CPG, the published literature and clinical studies in Asians, and the expert opinions. RESULTS The treatment recommendations for the Taiwanese population were generally in parallel with the EFP CPG, and extra cautions during treatment and maintenance phases were advised due to the anatomical variations, such as shorter root trunk, higher prevalence of supernumerary distolingual root and lingual bony concavity in mandibular posteriors, and thinner anterior labial plate, of the Asian population. CONCLUSION The EFP CPG could be adopted for treating periodontitis and maintaining periodontal health of the Taiwanese population, and anatomical variations should be cautious when the treatment is delivered.
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Affiliation(s)
- Jung-Tsu Chen
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Ting Wu
- Department of Dentistry, China Medical University Hospital, Taichung, Taiwan
| | - Ren-Yeong Huang
- School of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Chun Lin
- Department of Dentistry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hsiang Chou
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Taichen Lin
- School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Po-Jan Kuo
- School of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Che-Chang Tu
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Lein-Tuan Hou
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Lin Lai
- Department of Dentistry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsein-Kun Lu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Cheng Tsai
- School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Kuo Yuan
- Institute of Oral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Jung Chen
- Department of Dentistry, Chi-Mei Medical Center, Tainan, Taiwan
| | | | - Yueh-Chao Yang
- Department of Dentistry, Cathay General Hospital, Taipei, Taiwan
| | - Aaron Yu-Jen Wu
- Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | | | - Cheng-Yang Chiang
- School of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Po-Chun Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
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Alqahtani F, Alqhtani N, Alkhtani F, Devang Divakar D, Al-Kheraif AA, Javed F. Clinicoradiographic markers of peri-implantitis in cigarette-smokers and never-smokers with type 2 diabetes mellitus at 7-years follow-up. J Periodontol 2020; 91:1132-1138. [PMID: 32017116 DOI: 10.1002/jper.19-0501] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/04/2020] [Accepted: 01/14/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND It is hypothesized that in the long-term, (a) peri-implant inflammatory variables (plaque index [PI], bleeding on probing [BOP], probing depth (PD) and crestal bone loss [CBL]) are worse in cigarette-smokers (CS) and patients with type-2 diabetes mellitus (T2DM) than never-smokers (NS) without T2DM. The aim of the present 7-year follow-up clinical observational study was to assess the survival of dental implant in CS and NS with T2DM. METHODS Study participants were divided into four groups based on glycemic status and self-reported cigarette-smoking habit: a) CS with T2DM; b) CS without T2DM; c) NS with T2DM; and d) NS without T2DM. Demographic information was collected using a questionnaire and hemoglobin A1c (HbA1c) levels were measured. Peri-implant PI, BOP, PD, and CBL were measured. Sample-size was estimated was statistical analysis was done using analysis of variance. P <0.01 was considered significant. RESULTS In total, 101 male patients were included. There was no significant contrast in age among the groups. Every partaker in the study groups had one dental implant placed in posterior maxilla or mandible. The mean HbA1c levels were significantly higher among CS (P <0.01) and NS (P <0.01) with T2DM than individuals without T2DM. Peri-implant PI (P <0.01), PD (P <0.01), and CBL (P <0.01) were significantly higher among CS and NS with T2DM and CS without T2DM than NS without T2DM. Peri-implant BOP was significantly higher among CS and NS with T2DM than CS and NS without T2DM (P <0.01). CONCLUSIONS Peri-implant inflammatory variables were worse among CS and NS with T2DM than NS without T2DM. A state of chronic hyperglycemia seems to be a stronger mediator of inflammation than cigarette smoking in patients with T2DM.
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Affiliation(s)
- Fawaz Alqahtani
- Department of Prosthodontics, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Nasser Alqhtani
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Fahad Alkhtani
- Department of Prosthodontics, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Darshan Devang Divakar
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz A Al-Kheraif
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Fawad Javed
- Department of Periodontology, Laboratory for Periodontal-, Implant-, Phototherapy (LA-PIP), School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.,Division of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
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Asadi A, Abdi M, Kouhsari E, Panahi P, Sholeh M, Sadeghifard N, Amiriani T, Ahmadi A, Maleki A, Gholami M. Minocycline, focus on mechanisms of resistance, antibacterial activity, and clinical effectiveness: Back to the future. J Glob Antimicrob Resist 2020; 22:161-174. [PMID: 32061815 DOI: 10.1016/j.jgar.2020.01.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/17/2020] [Accepted: 01/28/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The increasing crisis regarding multidrug-resistant (MDR) and extensively drug-resistant microorganisms leads to appealing therapeutic options. METHODS During the last 30 years, minocycline, a wide-spectrum antimicrobial agent, has been effective against MDR Gram-positive and Gram-negative bacterial infections. As with other tetracyclines, the mechanism of action of minocycline involves attaching to the bacterial 30S ribosomal subunit and preventing protein synthesis. RESULTS This antimicrobial agent has been approved for the treatment of acne vulgaris, some sexually transmitted diseases and rheumatoid arthritis. Although many reports have been published, there remains limited information regarding the prevalence, mechanism of resistance and clinical effectiveness of minocycline. CONCLUSION Thus, we summarize here the currently available data concerning pharmacokinetics and pharmacodynamics, mechanism of action and resistance, antibacterial activity and clinical effectiveness of minocycline.
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Affiliation(s)
- Arezoo Asadi
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Abdi
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Kouhsari
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran; Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
| | - Pegah Panahi
- Department of Microbiology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Sholeh
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nourkhoda Sadeghifard
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Taghi Amiriani
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Alireza Ahmadi
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abbas Maleki
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Mehrdad Gholami
- Department of Microbiology and Virology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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11
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Mourão L, Carillo Jr R, Linares SM, Canabarro A, Fischer RG. Homeopathy and Periodontal Treatment in Type II Diabetic Patients: a 1-Year Randomized Clinical Trial. Braz Dent J 2019; 30:139-145. [DOI: 10.1590/0103-6440201902124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/24/2018] [Indexed: 01/22/2023] Open
Abstract
Abstract Chronic periodontitis (CP) and Diabetes mellitus type 2 (DMII) are chronic diseases usually treated by conventional practices. On the other hand, homeopathy can help to treat many different diseases. The aim of this study was to evaluate the effects of homeopathy (H) as an adjunct for non-surgical periodontal therapy (NSPT) in individuals with DMII and CP. Eighty individuals with CP and DM II, of both sexes and aged between 32 and 70 years, participated in this randomized, double-blind, placebo-controlled study. They were divided into two groups: control group (CG) and the test group (TG), and both groups received the NSPT. TG also received homeopathic therapy, including Berberis, Mercurius solubilis/Belladonna/Hepar sulphur and Pyrogenium, while CG received placebo. Clinical and laboratorial examinations were evaluated at baseline and after 1, 6 and 12 months of treatment. Both groups showed significant improvement throughout the study, for most of the parameters studied, but TG presented significative gain of CAL at 1 and 12 months compared to CG. Mean glucose and glycated hemoglobin significantly decreased in both groups after 6 and 12 months. However, there was a significantly further reduction of these parameters in TG, as compared to CG. In conclusion, homeopathy as supplement of NSPT may further improve health condition, including glycemic control, in DMII patients with CP.
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Affiliation(s)
- Leila Mourão
- Universidade Veiga de Almeida Rio de Janeiro, Brazil
| | | | | | - Antonio Canabarro
- Universidade Veiga de Almeida Rio de Janeiro, Brazil; UERJ - Universidade do Estado do Rio de Janeiro, Brazil
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Effects of Antimicrobial Photodynamic Therapy and Local Administration of Minocycline on Clinical, Microbiological, and Inflammatory Markers of Periodontal Pockets: A Pilot Study. Int J Dent 2018; 2018:1748584. [PMID: 29849634 PMCID: PMC5907519 DOI: 10.1155/2018/1748584] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/15/2018] [Accepted: 02/27/2018] [Indexed: 01/04/2023] Open
Abstract
Objective We evaluated the efficacies of antimicrobial photodynamic therapy (aPDT) and minocycline ointment (MO) on clinical and bacteriological markers and the local host inflammatory response. Materials and Methods A total of 30 patients with chronic periodontitis were randomly assigned to two groups. Selected periodontal pockets (probing depth 5-7 mm with bleeding on probing) were treated with aPDT or MO. Measurements of clinical parameters and the collection of gingival crevicular fluid (GCF) and subgingival plaque were performed at baseline, and at 1 and 4 weeks after treatment. Quantification of periodontopathic bacteria in the sulcus and a multiplex bead immunoassay of ten inflammatory cytokines in the GCF were performed. Results Local MO administration exhibited a significant decrease in scores for clinical parameters (P < 0.01) and a significant reduction in bacterial counts (P < 0.01) and interleukin-1β and interferon-γ levels at 1 and 4 weeks after treatment (P < 0.01). No significant changes were observed in the aPDT group, except in clinical parameters. Conclusions Although our study had some limitations, we found that while local administration of MO may slightly help to improve clinical, microbiological, and crevicular cytokine levels in periodontal pockets, aPDT did not show any effects. This trial is registered with the UMIN Clinical Trials Registry UMIN000013376.
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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: 6.3] [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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14
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Gap Analysis of Older Adults With Type 2 Diabetes Receiving Nonsurgical Periodontal Therapy. J Evid Based Dent Pract 2017; 17:335-349. [DOI: 10.1016/j.jebdp.2017.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 01/16/2023]
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Kuo HC, Chang LC, Chen TC, Lee KC, Lee KF, Chen CN, Yu HR. Sterol Regulatory Element-Binding Protein-1c Regulates Inflammasome Activation in Gingival Fibroblasts Infected with High-Glucose-Treated Porphyromonas gingivalis. Front Cell Infect Microbiol 2016; 6:195. [PMID: 28083517 PMCID: PMC5183582 DOI: 10.3389/fcimb.2016.00195] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/12/2016] [Indexed: 12/12/2022] Open
Abstract
Background:Porphyromonas gingivalis is a major bacterial species implicated in the progression of periodontal disease, which is recognized as a common complication of diabetes. The interleukin (IL)-1β, processed by the NLR family pyrin domain containing 3 (NLRP3) inflammasome, has been identified as a target for pathogenic infection of the inflammatory response. However, the effect of P. gingivalis in a high-glucose situation in the modulation of inflammasome activation in human gingival fibroblasts (HGFs) is not well-understood. Methods:P. gingivalis strain CCUG25226 was used to study the mechanisms underlying the regulation of HGF NLRP3 expression by the infection of high-glucose-treated P. gingivalis (HGPg). Results: HGF infection with HGPg increases the expression of IL-1β and NLRP3. We further demonstrated that the upregulation of sterol regulatory element-binding protein (SREBP)-1c by activation of the Akt and p70S6K pathways is critical for HGPg-induced NLRP3 expression. We showed that the inhibition of Janus kinase 2 (JAK2) blocks the Akt- and p70S6K-mediated SREBP-1c, NLRP3, and IL-1β expression. The effect of HGPg on HGF signaling and NLRP3 expression is mediated by β1 integrin. In addition, gingival tissues from diabetic patients with periodontal disease exhibited higher NLRP3 and SREBP-1c expression. Conclusions: Our findings identify the molecular pathways underlying HGPg-dependent NLRP3 inflammasome expression in HGFs, providing insight into the effect of P. gingivalis invasion in HGFs.
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Affiliation(s)
- Hsing-Chun Kuo
- Department of Nursing, Chang Gung University of Science and Technology (CGUST)Chiayi, Taiwan; Research Center for Industry of Human Ecology and Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology (CGUST)Taoyuan, Taiwan; Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology (CGUST)Chiayi, Taiwan
| | - Li-Ching Chang
- Department of Dentistry, Chang Gung Memorial Hospital Chiayi, Taiwan
| | - Te-Chuan Chen
- Division of Nephrology Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung, Taiwan
| | - Ko-Chao Lee
- Division of Colorectal Surgery, Department of Surgery, Chang Gung Memorial Hospital - Kaohsiung Medical Center Kaohsiung, Taiwan
| | - Kam-Fai Lee
- Department of Pathology, Chang Gung Memorial Hospital Chiayi, Taiwan
| | - Cheng-Nan Chen
- Department of Biochemical Science and Technology, National Chiayi University Chiayi, Taiwan
| | - Hong-Ren Yu
- Department of Pediatrics, Chang Gung Memorial Hospital - Kaohsiung Medical CenterKaohsiung, Taiwan; Graduate Institute of Clinical Medical Science, Chang Gung University College of MedicineKaohsiung, Taiwan
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Rovai ES, Souto MLS, Ganhito JA, Holzhausen M, Chambrone L, Pannuti CM. Efficacy of Local Antimicrobials in the Non-Surgical Treatment of Patients With Periodontitis and Diabetes: A Systematic Review. J Periodontol 2016; 87:1406-1417. [PMID: 27468792 DOI: 10.1902/jop.2016.160214] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients with diabetes present a worse response to periodontal treatment. Local antimicrobials as an adjunct to scaling and root planing (SRP) provide additional benefits in the treatment of periodontitis in healthy patients. This review aims to evaluate the effects of local antimicrobials as an adjunct to SRP, compared with SRP alone, on periodontal clinical parameters of patients with chronic periodontitis (CP) and diabetes mellitus (DM). METHODS Only randomized controlled trials with: 1) at least 6 months of follow-up; 2) SRP, in combination with local antimicrobials; and 3) patients with periodontitis and DM were considered eligible. MEDLINE, EMBASE, and LILACS databases were searched for articles published up to January 2016. Random-effects meta-analyses were conducted for clinical attachment level (CAL), probing depth (PD), bleeding on probing, and gingival index change after treatment. RESULTS Of 153 papers potentially relevant to this review, six were included. The majority of trials showed a significant PD reduction and CAL gain associated with use of local antimicrobials in patients with type 1 and type 2 DM. Only studies that included well-controlled patients and applied antimicrobials at the deepest sites or sites with baseline PD ≥5 mm presented significant PD reduction and CAL gain. CONCLUSION In patients with DM and CP, use of local antimicrobials as an adjunct to SRP may result in additional benefits compared with SRP alone in PD reduction and CAL gain, especially in well-controlled individuals and deep sites.
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Affiliation(s)
- Emanuel S Rovai
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Maria Luisa S Souto
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Juliana A Ganhito
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marinella Holzhausen
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Leandro Chambrone
- Unit of Basic Oral Investigation, El Bosque University, Bogota, Colombia
| | - Claudio M Pannuti
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Botero JE, Rodríguez C, Agudelo-Suarez AA. Periodontal treatment and glycaemic control in patients with diabetes and periodontitis: an umbrella review. Aust Dent J 2016; 61:134-48. [PMID: 26815303 DOI: 10.1111/adj.12413] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Studies suggest that non-surgical periodontal treatment improves glycaemic control in patients with diabetes and periodontitis. The aim of this umbrella review is to summarize the effects of periodontal treatment on glycaemic control in patients with periodontitis and diabetes. METHODS A systematic review of systematic reviews with or without meta-analysis published between 1995 and 2015 was performed. Three independent reviewers assessed for article selection, quality and data extraction. RESULTS Thirteen (13) systematic reviews/meta-analysis were included for qualitative synthesis. A reduction (0.23 to 1.03 percentage points) in the levels of HbA1c at 3 months after periodontal intervention was found. This reduction was statistically significant in 10/12 meta-analysis. One review with sufficiently large samples found a non-significant reduction (-0.014 percentage points; 95% CI -0.18 to 0.16; p = 0.87). Only three studies separated the use of adjunctive antibiotics and found a reduction of 0.36 percentage points but the difference was not statistically significant. CONCLUSIONS Highly heterogeneous short-term studies with small sample size suggest that periodontal treatment could help improve glycaemic control at 3 months in patients with type 2 diabetes and periodontitis. However, longer term studies having sufficient sample size do not provide evidence that periodontal therapy improves glycaemic control in these patients.
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Affiliation(s)
- J E Botero
- Faculty of Dentistry, Universidad de Antioquia, Medellín, Colombia
| | - C Rodríguez
- Faculty of Dentistry, Universidad de Antioquia, Medellín, Colombia
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Gurav AN. Management of diabolical diabetes mellitus and periodontitis nexus: Are we doing enough? World J Diabetes 2016; 7:50-66. [PMID: 26962409 PMCID: PMC4766246 DOI: 10.4239/wjd.v7.i4.50] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/16/2015] [Accepted: 01/19/2016] [Indexed: 02/05/2023] Open
Abstract
Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease is bacterial biofilm, which accumulates on the teeth as dental plaque. In addition to the biofilm microorganisms, other factors such as environmental, systemic and genetic are also responsible in progression of periodontitis. Diabetes mellitus (DM) is metabolic disorder which has an impact on the global health. DM plays a crucial role in the pathogenesis of periodontitis. Periodontitis is declared as the “sixth” major complication of DM. Evidence based literature has depicted an enhanced incidence and severity of periodontitis in subjects with DM. A “two way” relationship has been purported between periodontitis and DM. Mutual management of both conditions is necessary. Periodontal therapy (PT) may assist to diminish the progression of DM and improve glycemic control. Various advanced technological facilities may be utilized for the purpose of patient education and disease management. The present paper clarifies the etio-pathogenesis of periodontitis, establishing it as a complication of DM and elaborating the various mechanisms involved in the pathogenesis. The role of PT in amelioration of DM and application of digital communication will be discussed. Overall, it is judicious to create an increased patient cognizance of the periodontitis-DM relationship. Conjunctive efforts must be undertaken by the medical and oral health care professionals for the management of periodontitis affected DM patients.
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19
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Huang KC, Lai CH, Huang CF, Lu HK. A comprehensive periodontal treatment project: The periodontal status, compliance rates, and risk factors. J Dent Sci 2015; 11:182-188. [PMID: 30894969 PMCID: PMC6395145 DOI: 10.1016/j.jds.2015.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/20/2015] [Indexed: 11/13/2022] Open
Abstract
Background/purpose The comprehensive periodontal treatment project (CPTP) is being implemented in Taiwan since 2010. This retrospective study compared the periodontal status, compliance rates, and influence of risk factors for periodontal recurrence and tooth loss among groups of patients who accepted CPTP and conventional periodontal treatment (CPT). Materials and methods A total of 161 patients who received periodontal therapy were investigated and divided into compliant (n = 94) and noncompliant (n = 67) groups. Patients in the compliant group were further assigned to two subgroups: CPT with a postcard recall (PR) system (CPT + PR, n = 48) and CPTP with a PR system (CPTP + PR, n = 46). Demographic characteristics and periodontal parameters, including the probing pocket depth (PPD), bleeding on probing (BOP), and plaque control record (PCR), were collected for comparison between the subgroups. The risk factors for periodontal recurrence and tooth loss were statistically analyzed. Results The 161 patients were followed-up for a mean of 3.8 years. The patients in the CPTP + PR subgroup exhibited shallower PPD, less BOP, improved PCR, and fewer tooth loss. Age, smoking, PPD ≥7 mm, and PCR ≥30% were associated with periodontal recurrence, whereas age, diabetes, BOP ≥30%, and duration of the follow-up period were correlated with tooth loss. PR apparently increased the compliance rate of patients (27.3% vs. 77.7%). Conclusion CPTP with PR led to an optimal and stable periodontal status in patients. Compliant patients maintained a significantly improved periodontal status as compared with noncompliant patients.
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Affiliation(s)
| | - Chao-Han Lai
- Periodontal Department, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Periodontal Clinic, Dental Department, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiung-Fang Huang
- Periodontal Department, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Periodontal Clinic, Dental Department, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsein-Kun Lu
- Periodontal Department, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Periodontal Clinic, Dental Department, Taipei Medical University Hospital, Taipei, Taiwan
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20
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Simpson TC, Weldon JC, Worthington HV, Needleman I, Wild SH, Moles DR, Stevenson B, Furness S, Iheozor‐Ejiofor Z, Cochrane Oral Health Group. Treatment of periodontal disease for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev 2015; 2015:CD004714. [PMID: 26545069 PMCID: PMC6486035 DOI: 10.1002/14651858.cd004714.pub3] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Glycaemic control is a key issue in the care of people with diabetes mellitus (DM). Periodontal disease is the inflammation and destruction of the underlying supporting tissues of the teeth. Some studies have suggested a bidirectional relationship between glycaemic control and periodontal disease. This review updates the previous version published in 2010. OBJECTIVES The objective is to investigate the effect of periodontal therapy on glycaemic control in people with diabetes mellitus. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 31 December 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2014, Issue 11), MEDLINE via OVID (1946 to 31 December 2014), EMBASE via OVID (1980 to 31 December 2014), LILACS via BIREME (1982 to 31 December 2014), and CINAHL via EBSCO (1937 to 31 December 2014). ZETOC (1993 to 31 December 2014) and Web of Knowledge (1990 to 31 December 2014) were searched for conference proceedings. Additionally, two periodontology journals were handsearched for completeness, Annals of Periodontology (1996 to 2003) and Periodontology 2000 (1993 to 2003). We searched the US National Institutes of Health Trials Registry (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) of people with type 1 or type 2 DM (T1DM/T2DM) with a diagnosis of periodontitis. Interventions included periodontal treatments such as mechanical debridement, surgical treatment and antimicrobial therapy. Two broad comparisons were proposed:1. periodontal therapy versus no active intervention/usual care;2. periodontal therapy versus alternative periodontal therapy. DATA COLLECTION AND ANALYSIS For this review update, 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.Our primary outcome was blood glucose levels measured as glycated (glycosylated) haemoglobin assay (HbA1c).Our secondary outcomes included adverse effects, periodontal indices (bleeding on probing (BOP), clinical attachment level (CAL), gingival index (GI), plaque index (PI) and probing pocket depth (PPD)), cost implications and diabetic complications. MAIN RESULTS We included 35 studies (including seven from the previous version of the review), which included 2565 participants in total. All studies used a parallel RCT design, and 33 studies (94%) only targeted T2DM patients. There was variation between studies with regards to included age groups (ages 18 to 80), duration of follow-up (3 to 12 months), use of antidiabetic therapy, and included participants' baseline HbA1c levels (from 5.5% to 13.1%).We assessed 29 studies (83%) as being at high risk of bias, two studies (6%) as being at low risk of bias, and four studies (11%) as unclear. Thirty-four of the studies provided data suitable for analysis under one or both of the two comparisons.Comparison 1: low quality evidence from 14 studies (1499 participants) comparing periodontal therapy with no active intervention/usual care demonstrated that mean HbA1c was 0.29% lower (95% confidence interval (CI) 0.48% to 0.10% lower) 3 to 4 months post-treatment, and 0.02% lower after 6 months (five studies, 826 participants; 95% CI 0.20% lower to 0.16% higher).Comparison 2: 21 studies (920 participants) compared different periodontal therapies with each other. There was only very low quality evidence for the multiple head-to-head comparisons, the majority of which were unsuitable to be pooled, and provided no clear evidence of a benefit for one periodontal intervention over another. We were able to pool the specific comparison between scaling and root planing (SRP) plus antimicrobial versus SRP and there was no consistent evidence that the addition of antimicrobials to SRP was of any benefit to delivering SRP alone (mean HbA1c 0.00% lower: 12 studies, 450 participants; 95% CI 0.22% lower to 0.22% higher) at 3-4 months post-treatment, or after 6 months (mean HbA1c 0.04% lower: five studies, 206 patients; 95% CI 0.41% lower to 0.32% higher).Less than half of the studies measured adverse effects. The evidence was insufficient to conclude whether any of the treatments were associated with harm. No other patient-reported outcomes (e.g. quality of life) were measured by the included studies, and neither were cost implications or diabetic complications.Studies showed varying degrees of success with regards to achieving periodontal health, with some showing high levels of residual inflammation following treatment. Statistically significant improvements were shown for all periodontal indices (BOP, CAL, GI, PI and PPD) at 3-4 and 6 months in comparison 1; however, this was less clear for individual comparisons within the broad category of comparison 2. AUTHORS' CONCLUSIONS There is low quality evidence that the treatment of periodontal disease by SRP does improve glycaemic control in people with diabetes, with a mean percentage reduction in HbA1c of 0.29% at 3-4 months; however, there is insufficient evidence to demonstrate that this is maintained after 4 months.There was no evidence to support that one periodontal therapy was more effective than another in improving glycaemic control in people with diabetes mellitus.In clinical practice, ongoing professional periodontal treatment will be required to maintain clinical improvements beyond 6 months. Further research is required to determine whether adjunctive drug therapies should be used with periodontal treatment. Future RCTs should evaluate this, provide longer follow-up periods, and consider the inclusion of a third 'no treatment' control arm.Larger, well conducted and clearly reported studies are needed in order to understand the potential of periodontal treatment to improve glycaemic control among people with diabetes mellitus. In addition, it will be important in future studies that the intervention is effective in reducing periodontal inflammation and maintaining it at lowered levels throughout the period of observation.
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Affiliation(s)
- Terry C Simpson
- University of EdinburghEdinburgh Dental InstituteLauriston PlaceEdinburghScotlandUKEH3 8HA
| | - Jo C Weldon
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Ian Needleman
- UCL Eastman Dental InstituteUnit of Periodontology and International Centre for Evidence‐Based Oral Health256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Sarah H Wild
- Public Health Sciences, University of EdinburghCentre for Public Health and Primary Care ResearchTeviot PlaceEdinburghUKEH8 9AG
| | - David R Moles
- Peninsula Dental SchoolOral Health Services ResearchThe John Bull Building, Tamar Science Park, Research WayPlymouthUKPL6 8BU
| | - Brian Stevenson
- University of Dundee Dental Hospital and SchoolDepartment of Restorative DentistryPark PlaceDundeeTaysideUKDD1 4HN
| | - Susan Furness
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
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Artese HPC, Longo PL, Gomes GH, Mayer MPA, Romito GA. Supragingival biofilm control and systemic inflammation in patients with type 2 diabetes mellitus. Braz Oral Res 2015; 29:S1806-83242015000100266. [PMID: 26039911 DOI: 10.1590/1807-3107bor-2015.vol29.0071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/28/2015] [Indexed: 12/28/2022] Open
Abstract
The objective of this study was to evaluate the effect of strict supragingival biofilm control on serum inflammatory markers and on periodontal clinical parameters in type 2 diabetes mellitus (T2DM) patients with chronic severe periodontitis. Twenty-four individuals with T2DM and periodontitis were randomly allocated to two treatment groups. The supragingival therapy group (ST, n = 12) received supragingival scaling, whereas the intensive therapy group (IT, n = 12) underwent supra- and subgingival scaling, as well as root planing. Patients from both groups received professional oral hygiene instructions every month. Data regarding visible plaque index (VPI), gingival bleeding index (GBI), bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL), serum levels of interleukin (IL)-6, IL-17A, IL-8, tumor necrosis factor α (TNF-α), monocyte chemoattractant protein (MCP)-1 enzyme-linked immunosorbent assay (ELISA), and glycated hemoglobin (HbA1c) levels were obtained at baseline and at 6 months post-therapy. Both therapies resulted in the improvement of almost all clinical periodontal parameters (p < 0.05). There were no differences in TNF-α, IL-8, IL-17A and HbA1c levels in either group (p > 0.05), between the two periods. However, MCP-1 levels were significantly reduced in both the ST (p = 0.034) and the IT (p = 0.016) groups, whereas the serum IL-6 levels were significantly reduced only in the IT group (p = 0.001). Strict control of supragingival biofilm has a limited effect on systemic inflammatory markers, and a moderate effect on periodontal clinical parameters.
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Affiliation(s)
| | - Priscila Larcher Longo
- Department of Microbiology, Institute of Biomedical Sciences, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Giovane Hisse Gomes
- Department of Periodontics, School of Dentistry, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcia Pinto Alves Mayer
- Department of Microbiology, Institute of Biomedical Sciences, Universidade de São Paulo, São Paulo, SP, Brazil
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Artese HPC, Foz AM, Rabelo MDS, Gomes GH, Orlandi M, Suvan J, D’Aiuto F, Romito GA. Periodontal therapy and systemic inflammation in type 2 diabetes mellitus: a meta-analysis. PLoS One 2015; 10:e0128344. [PMID: 26010492 PMCID: PMC4444100 DOI: 10.1371/journal.pone.0128344] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 04/26/2015] [Indexed: 02/07/2023] Open
Abstract
AIM The aim of this systematic review was to assess the effect of periodontal therapy (PT) on serum levels of inflammatory markers in people with type 2 diabetes mellitus (T2DM). METHODS OF STUDY SELECTION A literature search was carried out using MEDLINE via Pubmed, EMBASE, LILACS and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Randomized-controlled trials (RCTs) and controlled clinical trials (CCTs) evaluating the effect of PT on systemic inflammatory markers were deemed eligible. Case series (CS), reports and pilot trials were excluded. Study quality was assessed using the Cochrane Collaboration's risk assessment tool. Meta-analysis was carried out using random effect methods. RESULTS The search strategy identified 3,164 potential studies of which 61 were assessed for eligibility and 9 (6 RCTs and 3 CCTs) were included in this systematic review. Three RCTs were classified by the authors as being at low risk of bias and three were "unclear" and classified as uncertain risk of bias. All CCTs were considered to be at a high risk of bias. The meta-analysis showed a statistically significant mean difference (MD) for TNF- α (-1.33 pg/ml, 95% CI: -2.10; -0.56, p<0.001) and CRP (-1.28 mg/l, 95% CI: -2.07; - 0.48, p<0.001) favoring periodontal intervention versus control. CONCLUSION The results of this meta-analysis support the hypothesis that PT reduces serum levels of TNF- α and CRP in T2DM individuals. The decrease of inflammatory burden has important implications for metabolic control and can, in part, explain the mechanisms linking periodontitis and increased risk for complications in people with T2DM.
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Affiliation(s)
- Hilana Paula Carillo Artese
- Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Adriana Moura Foz
- Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Mariana de Sousa Rabelo
- Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Giovane Hisse Gomes
- Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
| | - Marco Orlandi
- Unit of Periodontology, UCL Eastman Dental Institute, London, United Kingdom
| | - Jean Suvan
- Unit of Periodontology, UCL Eastman Dental Institute, London, United Kingdom
| | - Francesco D’Aiuto
- Unit of Periodontology, UCL Eastman Dental Institute, London, United Kingdom
| | - Giuseppe Alexandre Romito
- Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil
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Javed F, Al-Daghri NM, Wang HL, Wang CY, Al-Hezaimi K. 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. J Periodontol 2014; 85:1589-95. [DOI: 10.1902/jop.2014.140150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chee B, Park B, Bartold PM. Periodontitis and type II diabetes: a two-way relationship. INT J EVID-BASED HEA 2014; 11:317-29. [PMID: 24298927 DOI: 10.1111/1744-1609.12038] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
For many years an association between diabetes and periodontitis has been suspected. In more recent times this relationship has been suggested to be bidirectional with each condition being able to influence the other. In this review the two-way relationship between diabetes and periodontitis is considered. For this narrative review a very broad search strategy of the literature was developed using both EMBASE and MEDLINE (via PubMed) databases. The reference lists from the selected papers were also scanned, and this provided an additional source of papers for inclusion and further assessment. The data available suggest that diabetes is a risk as well as a modifying factor for periodontitis. Individuals with diabetes are more likely to have periodontitis and with increased severity when diabetes is uncontrolled/poorly controlled. Possible mechanisms of how diabetes affects periodontitis include adipokine-mediated inflammation, neutrophil dysfunction, uncoupling of bone and advanced glycation end-products-receptor for advanced glycation end-products interaction. Evidence is accruing to support how periodontitis can affect diabetes and complications associated with diabetes. There is some evidence demonstrating that periodontal therapy can result in a moderate improvement in glycaemic control. Available evidence indicates that diabetes and peridontitis are intricately interrelated and that each condition has the capacity to influence clinical features of each other.
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Affiliation(s)
- Brian Chee
- Department of Dentistry, University of Adelaide, Adelaide, South Australia, Australia
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25
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Mauri-Obradors E, Jané-Salas E, Sabater-Recolons MDM, Vinas M, López-López J. Effect of nonsurgical periodontal treatment on glycosylated hemoglobin in diabetic patients: a systematic review. Odontology 2014; 103:301-13. [PMID: 25062756 DOI: 10.1007/s10266-014-0165-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 05/25/2014] [Indexed: 12/12/2022]
Abstract
This review was designed to determine whether non-surgical periodontal treatment is able to reduce serum glycosylated hemoglobin (HbA1c) levels in patients with diabetes mellitus (DM). Several previous reports showed that scaling and root planning (SRP) improve periodontal status in patients with DM, but whether it also improves metabolic control of the disease is unclear. A systematic review was conducted according to the recommendations of the Cochrane Collaboration and PRISMA. A literature search was conducted in October 2012 using three libraries (Cochrane, Web of Knowledge, and Scopus) and the keywords "periodontal disease" and "diabetes mellitus." Only 21 of the articles met the inclusion criteria for this review. A total of 1,454 patients were thus included in this study to evaluate whether periodontal treatment improved serum HbA1c levels. Both the methodological quality and the risk of bias of each study were taken into account using the Jadad scale. Only ten of the included studies had an acceptable-good score of 3-5. Fourteen of the studies reported a significant decrease in serum HbA1c levels (p < 0.05) after periodontal treatment. The remaining seven studies failed to find a significant decrease in serum HbA1c. The findings of this review suggest that the published literature is insufficient and inconclusive to clearly support periodontal treatment as a means to improve serum HbA1c levels in patients with type 1 DM. It also demonstrates the need for homogeneous studies, with larger samples and longer follow-up periods, to properly address this question.
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Affiliation(s)
- Elisabet Mauri-Obradors
- School of Dentistry, Department of Stomatology, University Campus of Bellvitge, University of Barcelona, Pabellón de Gobierno, 2º planta, O8907 L' Hospitalet de Llobregat, Barcelona, Spain.
| | - Enric Jané-Salas
- School of Dentistry, Department of Stomatology, University Campus of Bellvitge, University of Barcelona, Pabellón de Gobierno, 2º planta, O8907 L' Hospitalet de Llobregat, Barcelona, Spain.
| | - Maria del Mar Sabater-Recolons
- School of Dentistry, Department of Stomatology, University Campus of Bellvitge, University of Barcelona, Pabellón de Gobierno, 2º planta, O8907 L' Hospitalet de Llobregat, Barcelona, Spain.
| | - Miguel Vinas
- Department Pathology and Experimental Therapeutics, University Campus of Bellvitge, University of Barcelona and IDIBELL, Barcelona, Spain.
| | - José López-López
- School of Dentistry, Department of Stomatology, University Campus of Bellvitge, University of Barcelona, Pabellón de Gobierno, 2º planta, O8907 L' Hospitalet de Llobregat, Barcelona, Spain.
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26
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Miranda TS, Feres M, Perez-Chaparro PJ, Faveri M, Figueiredo LC, Tamashiro NS, Bastos MF, Duarte PM. Metronidazole and amoxicillin as adjuncts to scaling and root planing for the treatment of type 2 diabetic subjects with periodontitis: 1-year outcomes of a randomized placebo-controlled clinical trial. J Clin Periodontol 2014; 41:890-9. [PMID: 24930639 DOI: 10.1111/jcpe.12282] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 12/19/2022]
Abstract
AIM To evaluate the clinical and microbiological effects of the use of metronidazole (MTZ) + amoxicillin (AMX) as adjuncts to scaling and root planing (SRP) for the treatment of chronic periodontitis (ChP) in type 2 diabetic subjects. MATERIAL AND METHODS Fifty-eight type 2 diabetic subjects (n = 29/group) with generalized ChP were randomly assigned to receive SRP alone or with MTZ [400 mg/thrice a day (TID)]+AMX (500 mg/TID) for 14 days. Subgingival biofilm samples were analyzed by qPCR for the presence of seven periodontal pathogens. Subjects were monitored at baseline, 3, 6 and 12 months post-therapies. RESULTS The group receiving SRP+MTZ+AMX presented greater mean probing depth (PD) reduction and clinical attachment gain, a lower number of sites with PD ≥5 mm (primary outcome variable) and a reduced number of subjects with ≥9 of these residual pockets than the control group at 1-year post-therapy (p < 0.05). The antibiotic-treated group also presented reduced levels and greater decreases of the three red complex species, Eubacterium nodatum and Prevotella intermedia, compared to the control group at 1 year (p < 0.05). CONCLUSIONS The adjunctive use of MTZ+AMX significantly improved the clinical and microbiological outcomes of SRP in the treatment of type 2 diabetic subjects with ChP.
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27
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Liew AKC, Punnanithinont N, Lee YC, Yang J. Effect of non-surgical periodontal treatment on HbA1c: a meta-analysis of randomized controlled trials. Aust Dent J 2014; 58:350-7. [PMID: 23981218 DOI: 10.1111/adj.12091] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 12/14/2012] [Accepted: 12/16/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND A meta-analysis of randomized clinical trials (RCTs) was conducted to evaluate whether non-surgical periodontal treatment can reduce the HbA1c% level in type 2 diabetic patients. Recent accumulation of RCTs necessitates updating of the findings of previous reviews. METHODS A search of the literature on English publications was conducted in Cochrane CENTRAL, Medline and EMBASE (until 31 March 2012). An RCT was selected if the study population was type 2 diabetic patients (≥16 years old) diagnosed with periodontitis, and compared HbA1c% change with or without non-surgical periodontal treatment for at least three months of the study duration. Weighted mean differences for pooled data and antibiotic use strata were calculated. Heterogeneity and publication bias were explored. RESULTS A total of 358 articles were identified but only six were suitable. Compared to the control group, the pooled analysis (n = 422) showed -0.41% (95% CI: -0.73% to -0.09%, p = 0.013) absolute difference in HbA1c% with treatment. Studies without adjunctive antibiotic had HbA1c% change of -0.64% (95% CI: -1.06% to -0.23%, p = 0.002), but we could not conclude on the effect of adjunctive antibiotic use (p = 0.734). Publication bias was significant with Egger's test (p = 0.014) but not with Begg's test (p = 0.06). CONCLUSIONS The meta-analysis suggested that non-surgical periodontal treatment was associated with a reduction in HbA1c%.
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Affiliation(s)
- A K C Liew
- Harvard School of Public Health, Boston, Massachusetts, USA
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Khaw A, Logan R, Keefe D, Bartold M. Radiation-induced oral mucositis and periodontitis - proposal for an inter-relationship. Oral Dis 2013; 20:e7-18. [DOI: 10.1111/odi.12199] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/14/2013] [Accepted: 10/14/2013] [Indexed: 01/14/2023]
Affiliation(s)
- A Khaw
- Faculty of Health Sciences; School of Dentistry; University of Adelaide; Adelaide SA Australia
- Colgate Australian Clinical Dental Research Centre; University of Adelaide; Adelaide SA Australia
| | - R Logan
- Faculty of Health Sciences; School of Dentistry; University of Adelaide; Adelaide SA Australia
| | - D Keefe
- Faculty of Health Sciences; School of Medicine; University of Adelaide; Adelaide SA Australia
| | - M Bartold
- Faculty of Health Sciences; School of Dentistry; University of Adelaide; Adelaide SA Australia
- Colgate Australian Clinical Dental Research Centre; University of Adelaide; Adelaide SA Australia
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29
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Demmer RT, Trinquart L, Zuk A, Fu BC, Blomkvist J, Michalowicz BS, Ravaud P, Desvarieux M. The influence of anti-infective periodontal treatment on C-reactive protein: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2013; 8:e77441. [PMID: 24155956 PMCID: PMC3796504 DOI: 10.1371/journal.pone.0077441] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 09/02/2013] [Indexed: 12/13/2022] Open
Abstract
Background Periodontal infections are hypothesized to increase the risk of adverse systemic outcomes through inflammatory mechanisms. The magnitude of effect, if any, of anti-infective periodontal treatment on systemic inflammation is unknown, as are the patient populations most likely to benefit. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to test the hypothesis that anti-infective periodontal treatment reduces systemic c-reactive protein (CRP). Methods and Findings MEDLINE, EMBASE, CENTRAL and CINAHL databases were searched using sensitivity-enhancing search terms. Eligible RCTs enrolled patients with periodontal infection, compared a clearly defined anti-infective periodontal intervention (experimental group) to an “inactive control” (no periodontal intervention) or to an “active control” (lower treatment intensity than the experimental group). Mean differences in final CRP values at the earliest post-treatment time point (typically 1-3 months) between experimental and control groups were analyzed using random-effects regression. Among 2,753 possible studies 20 were selected, which included 2,561 randomized patients(median=57). Baseline CRP values were >3.0 mg/L in 40% of trials. Among studies with a control group receiving no treatment, the mean difference in CRP final values among experimental treatment vs. control groups was -0.37 mg/L [95%CI=-0.64, -0.11], (P=0.005), favoring experimental treatment. Trials for which the experimental group received antibiotics had stronger effects (P for interaction=0.03) and the mean difference in CRP final values among experimental treatment vs. control was -0.75 mg/L [95%CI=-1.17,-0.33]. No treatment effect was observed among studies using an active treatment comparator. Treatment effects were stronger for studies that included patients with co-morbidities vs. studies that included “systemically healthy” patients, although the interaction was not significant (P=0.48). Conclusions Anti-infective periodontal treatment results in short-term modest reductions in systemic CRP.
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Affiliation(s)
- Ryan T. Demmer
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Ludovic Trinquart
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM U738, Paris, France
- Université Paris Descartes - Sorbonne Paris Cité, Paris, France
- French Cochrane Centre, Paris, France
| | - Aleksandra Zuk
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Benjamin C. Fu
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Josefin Blomkvist
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM U738, Paris, France
- Université Paris Descartes - Sorbonne Paris Cité, Paris, France
- French Cochrane Centre, Paris, France
| | - Bryan S. Michalowicz
- Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Philippe Ravaud
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM U738, Paris, France
- Université Paris Descartes - Sorbonne Paris Cité, Paris, France
- French Cochrane Centre, Paris, France
- EHESP School of Public Health, Rennes, France
| | - Moïse Desvarieux
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- INSERM U738, Paris, France
- EHESP School of Public Health, Rennes, France
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Corbella S, Francetti L, Taschieri S, De Siena F, Fabbro MD. Effect of periodontal treatment on glycemic control of patients with diabetes: A systematic review and meta-analysis. J Diabetes Investig 2013; 4:502-9. [PMID: 24843701 PMCID: PMC4025114 DOI: 10.1111/jdi.12088] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 02/21/2013] [Accepted: 02/24/2013] [Indexed: 12/20/2022] Open
Abstract
AIMS/INTRODUCTION The aim of the present study was to investigate whether non-surgical periodontal treatment reduces glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels in diabetic patients. MATERIALS AND METHODS An electronic search was carried out on MEDLINE (through PubMed interface), EMBASE and the Cochrane Central Register of Controlled Trials. Randomized controlled trials with a minimum of 3 months follow up were included. The risk of bias was assessed for each study. A meta-analysis was carried out to evaluate the effect of non-surgical periodontal treatment on HbA1c and FPG levels. The effect of the adjunctive use of antimicrobials was also assessed. RESULTS A total of 15 studies were included. A reduction of -0.38% (95% confidence interval [CI] -0.23 to -0.53) after 3-4 months (P < 0.001) and of -0.31% (95% CI 0.11 to -0.74) after 6 months (P = 0.15) of follow-up was found for HbA1c, favoring the treatment group. Similarly, in treated patients, a significantly greater decrease in FPG was observed in respect to control participants. Such difference amounted to -9.01 mg/dL (95% CI -2.24 to -15.78) after 3-4 months (P = 0.009) and -13.62 mg/dL (95% CI 0.45 to -27.69) after 6 months (P = 0.06) from treatment, respectively. In participants treated with adjunctive antimicrobials, a non-significant increase of HbA1c was observed 3 months after treatment, whereas FPG decreased by 0.27 mg/dL (95% CI 39.56 to -40.11; P = 0.99). CONCLUSIONS The meta-analysis showed that non-surgical periodontal treatment improves metabolic control in patients with both periodontitis and diabetes.
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Affiliation(s)
- Stefano Corbella
- Department of Biomedical, Surgical and Dental SciencesOral Implantology Research CenterUniversità degli Studi di MilanoIRCCS Istituto Ortopedico GaleazziMilanItaly
| | - Luca Francetti
- Department of Biomedical, Surgical and Dental SciencesOral Implantology Research CenterUniversità degli Studi di MilanoIRCCS Istituto Ortopedico GaleazziMilanItaly
- Department of Biomedical, Surgical and Dental SciencesOral Health Research CenterUniversità degli Studi di MilanoIRCCS Istituto Ortopedico GaleazziMilanItaly
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental SciencesOral Health Research CenterUniversità degli Studi di MilanoIRCCS Istituto Ortopedico GaleazziMilanItaly
| | - Francesca De Siena
- Department of Biomedical, Surgical and Dental SciencesOral Health Research CenterUniversità degli Studi di MilanoIRCCS Istituto Ortopedico GaleazziMilanItaly
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental SciencesOral Implantology Research CenterUniversità degli Studi di MilanoIRCCS Istituto Ortopedico GaleazziMilanItaly
- Department of Biomedical, Surgical and Dental SciencesOral Health Research CenterUniversità degli Studi di MilanoIRCCS Istituto Ortopedico GaleazziMilanItaly
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Zychowska M, Rojewska E, Kreiner G, Nalepa I, Przewlocka B, Mika J. Minocycline influences the anti-inflammatory interleukins and enhances the effectiveness of morphine under mice diabetic neuropathy. J Neuroimmunol 2013; 262:35-45. [PMID: 23870534 DOI: 10.1016/j.jneuroim.2013.06.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 06/10/2013] [Accepted: 06/16/2013] [Indexed: 01/27/2023]
Abstract
A single streptozotocin (STZ) injection in mice can induce significant neuropathic pain along with an increase in plasma glucose levels and a decrease in body weight. Seven days after the administration of STZ, an upregulation of C1q-positive cells was observed. Additionally, interleukins (IL-1beta, IL-3, IL-4, IL-6, IL-9, IL12p70, IL-17); proteins of the tumor necrosis factor (TNF) family, e.g., IFNgamma and sTNF RII, were upregulated. Chronic administration of minocycline increases antinociceptive factors (IL-1alpha, IL-2, IL-10, sTNFRII) in diabetic mice. Minocycline also reduces the occurrence of neuropathic pain and significantly potentiates the antiallodynic and antihyperalgesic effects of morphine.
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Affiliation(s)
- Magdalena Zychowska
- Department of Pain Pharmacology, Institute of Pharmacology, Polish Academy of Sciences, 12 Smetna Street, 31-343 Krakow, Poland
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Shirakata Y, Eliezer M, Nemcovsky CE, Weinreb M, Dard M, Sculean A, Bosshardt DD, Moses O. Periodontal healing after application of enamel matrix derivative in surgical supra/infrabony periodontal defects in rats with streptozotocin-induced diabetes. J Periodontal Res 2013; 49:93-101. [DOI: 10.1111/jre.12084] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2013] [Indexed: 01/21/2023]
Affiliation(s)
- Y. Shirakata
- Department of Periodontology; School of Dental Medicine; University of Bern; Bern Switzerland
- Department of Periodontology; Kagoshima University Graduate School of Medical and Dental Sciences; Kagoshima Japan
| | - M. Eliezer
- Department of Periodontology; The Maurice and Goldschleger School of Dental Medicine; Tel Aviv Israel
| | - C. E. Nemcovsky
- Department of Periodontology; The Maurice and Goldschleger School of Dental Medicine; Tel Aviv Israel
| | - M. Weinreb
- Department of Oral Biology; The Maurice and Goldschleger School of Dental Medicine; Tel Aviv Israel
| | - M. Dard
- Straumann AG; Basel Switzerland
- Department of Periodontology and Implant Dentistry; New York University; Basel Switzerland
| | - A. Sculean
- Department of Periodontology; School of Dental Medicine; University of Bern; Bern Switzerland
| | - D. D. Bosshardt
- Department of Periodontology; School of Dental Medicine; University of Bern; Bern Switzerland
- Department of Oral Surgery and Stomatology; School of Dental Medicine; University of Bern; Bern Switzerland
| | - O. Moses
- Department of Periodontology; The Maurice and Goldschleger School of Dental Medicine; Tel Aviv Israel
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Sgolastra F, Severino M, Pietropaoli D, Gatto R, Monaco A. Effectiveness of periodontal treatment to improve metabolic control in patients with chronic periodontitis and type 2 diabetes: a meta-analysis of randomized clinical trials. J Periodontol 2012; 84:958-73. [PMID: 23106512 DOI: 10.1902/jop.2012.120377] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND It was recently suggested that scaling and root planing (SRP) may help to improve glycemic and metabolic control in patients with chronic periodontitis (CP) and type 2 diabetes mellitus (DM2); however, the effectiveness of SRP in this role remains unclear. This meta-analysis assesses the effectiveness of SRP in improving glycemic and metabolic control in patients with CP and DM2. METHODS A literature search of electronic databases was performed for articles published through May 16, 2012, followed by a manual search of several dental journals. A meta-analysis was conducted according to the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Weighted mean differences (MDs) and 95% confidence intervals (CIs) were calculated for glycated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), and high- and low-density lipoprotein cholesterol (HDL and LDL, respectively). All outcomes were evaluated as changes from baseline to the end of follow-up. Heterogeneity was assessed with the χ(2)-based Cochran Q test and I(2) statistic. The level of significance was set at P <0.05. RESULTS After the study selection process, five randomized clinical trials were included. Results of the meta-analysis indicated that SRP was effective in the reduction of HbA1c (MD = 0.65; 95% CI 0.43 to 0.88; P <0.05) and FPG (MD = 9.04; 95% CI 2.17 to 15.9; P <0.05), but no significant differences were found in the reduction of TC, TG, HDL, or LDL. No evidence of heterogeneity was detected. CONCLUSION The meta-analysis results seem to support the effectiveness of SRP in the improvement of glycemic control in patients with CP and DM2; however, future studies are needed to confirm these results.
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Affiliation(s)
- Fabrizio Sgolastra
- Department of Health Sciences, School of Dentistry, University of L'Aquila, L'Aquila, Italy.
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