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Schädlich P, Symmank J, Dost A, Jacobs C, Wagner Y. Oral Health of Children and Adolescents with Diabetes Mellitus. J Clin Med 2024; 13:6742. [PMID: 39597886 PMCID: PMC11595264 DOI: 10.3390/jcm13226742] [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: 11/03/2024] [Accepted: 11/04/2024] [Indexed: 11/29/2024] Open
Abstract
Aim: To examine the oral health of children and adolescents with and without diabetes mellitus. Background: Diabetes mellitus is the most common metabolic disease in childhood and demonstrates an increasing incidence. Many children live with gingivitis as a precursor to periodontitis. If left untreated, it can cause the development of periodontitis. The links between periodontitis and diabetes mellitus are known but have been little studied in the age group of children and adolescents. Materials and Methods: Clinical examination and collection of sulcus fluid from participants aged 5 to 21 years was performed. The following data were collected: demographic variables, caries prevalence, DMF-T, VPI, PUFA, salivary flow rate, HbA1c, PSI, and the concentration of IL-1β, IL-6, MMP-8, and TNF-α. Results: Patients with diabetes mellitus showed a significantly lower salivary flow rate with higher concentrations of MMP-8 and IL-1β. The data indicate that at this age, regular visits to the dentist are of great importance for the promotion of oral health in children and adolescents regardless of diabetes and that patients with diabetes mellitus in particular benefit from prevention, as they belong to the periodontitis risk group. Conclusions: Patients with low salivary flow rates and increased inflammatory mediators are high-risk patients for whom dental preventive measures play a major role.
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Affiliation(s)
- Pauline Schädlich
- Center for Dental, Oral and Maxillofacial Medicine, Section Preventive and Pediatric Dentistry, University Hospital Jena, 07743 Jena, Germany;
| | - Judit Symmank
- Center for Dental, Oral and Maxillofacial Medicine, Department for Orthodontics, University Hospital Jena, 07743 Jena, Germany; (J.S.) (C.J.)
| | - Axel Dost
- Clinic for Pediatric and Adolescent Medicine, Section Diabetology, University Hospital Jena, 07747 Jena, Germany;
| | - Collin Jacobs
- Center for Dental, Oral and Maxillofacial Medicine, Department for Orthodontics, University Hospital Jena, 07743 Jena, Germany; (J.S.) (C.J.)
| | - Yvonne Wagner
- Dental Training Center Stuttgart, 70174 Stuttgart, Germany
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Hopkins S, Gajagowni S, Qadeer Y, Wang Z, Virani SS, Meurman JH, Leischik R, Lavie CJ, Strauss M, Krittanawong C. More than just teeth: How oral health can affect the heart. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 43:100407. [PMID: 38873102 PMCID: PMC11169959 DOI: 10.1016/j.ahjo.2024.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/14/2024] [Indexed: 06/15/2024]
Abstract
Epidemiological evidence has revealed a potential relationship between periodontal disease and cardiovascular disease (CVD). Consensus regarding a link between these pathologies remains elusive, however, largely secondary to the considerable overlap between risk factors and comorbidities common to both disease processes. This review article aims to update the evidence for an association by summarizing the evidence for causality between periodontitis and comorbidities linked to CVD, including endocarditis, hypertension (HTN), atrial fibrillation (AF), coronary artery disease (CAD), diabetes mellitus (DM) and hyperlipidemia (HLD). This article additionally discusses the role for periodontal therapy to improved management of the comorbidities, with the larger goal of examining the value of periodontal therapy on reduction of CVD risk. In doing so, we endeavor to further the understanding of the commonality between periodontitis, and CVD.
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Affiliation(s)
- Steven Hopkins
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Yusuf Qadeer
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Salim S. Virani
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Office of the Vice Provost (Research), The Aga Khan University, Karachi 74800, Pakistan
| | - Jukka H. Meurman
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Roman Leischik
- Department of Cardiology, Sector Preventive Medicine, Health Promotion, Faculty of Health, School of Medicine, University Witten/Herdecke, 58095 Hagen, Germany
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA 70121, USA
| | - Markus Strauss
- Department of Cardiology, Sector Preventive Medicine, Health Promotion, Faculty of Health, School of Medicine, University Witten/Herdecke, 58095 Hagen, Germany
- Department of Cardiology I- Coronary and Periphal Vascular Disease, Heart Failure Medicine, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
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Hopkins S, Gajagowni S, Qadeer Y, Wang Z, Virani SS, Meurman JH, Krittanawong C. Oral Health and Cardiovascular Disease. Am J Med 2024; 137:304-307. [PMID: 38141902 DOI: 10.1016/j.amjmed.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/25/2023]
Abstract
Several studies have examined a potential relationship between periodontal disease and cardiovascular disease. This article aims to update the evidence for a potential association by summarizing the evidence for causality between periodontitis and comorbidities linked to cardiovascular disease, including hypertension, atrial fibrillation, coronary artery disease, diabetes mellitus, and hyperlipidemia. We additionally discuss the evidence for periodontal therapy as a means to improved management of these comorbidities, with the larger goal of examining the value of periodontal therapy on reduction of cardiovascular disease risk.
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Affiliation(s)
- Steven Hopkins
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Yusuf Qadeer
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Salim S Virani
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Office of the Vice Provost (Research), The Aga Khan University, Karachi, Pakistan
| | - Jukka H Meurman
- Department of Oral and Maxillofacial Diseases, Institute of Dentistry, Helsinki University Central Hospital, University of Helsinki, Finland
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Borgnakke WS. Current scientific evidence for why periodontitis should be included in diabetes management. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 4:1257087. [PMID: 38274772 PMCID: PMC10809181 DOI: 10.3389/fcdhc.2023.1257087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/13/2023] [Indexed: 01/27/2024]
Abstract
This Perspective provides a brief summary of the scientific evidence for the two-way links between periodontal diseases and hyperglycemia (diabetes mellitus [DM] and pre-DM). It delivers in a nutshell current scientific evidence for manifestations of hyperglycemia on periodontal health status and effects of periodontal diseases on blood glucose levels and in turn incidence, progression, and complications of diabetes. Of outmost importance is presentation of scientific evidence for the potential of routine periodontal treatment to lower blood glucose levels, providing a novel, economical tool in DM management. Non-surgical periodontal treatment ("deep cleaning") can be provided by dental hygienists or dentists in general dental offices, although severe cases should be referred to specialists. Such therapy can decrease the costs of DM care and other health care costs for people with DM. The great importance of a healthy oral cavity free of infection and subsequent inflammation - especially periodontitis that if untreated will cause loosening and eventually loss of affected teeth - has largely gone unnoticed by the medical community as the health care curricula are largely void of content regarding the bi-directional links between oral health and systemic health, despite elevation of blood glucose levels being an integral part of the general systemic inflammation response. The importance of keeping disease-free, natural teeth for proper biting and chewing, smiling, self-esteem, and pain avoidance cannot be overestimated. Medical and dental professionals are strongly encouraged to collaborate in patient-centered care for their mutual patients with - or at risk for - hyperglycemia.
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Affiliation(s)
- Wenche Sylling Borgnakke
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
- Department of Periodontics and Preventive Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Seniya KM, Baiju KV, Ambili R. Evaluation of salivary glycated albumin in periodontitis patients with and without type 2 diabetes mellitus and its changes with non-surgical periodontal therapy. Niger J Clin Pract 2023; 26:1257-1263. [PMID: 37794537 DOI: 10.4103/njcp.njcp_503_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background Bidirectional relationship exists between diabetes mellitus and periodontitis. Glycated albumin is an emerging biomarker to assess intermediate glycemic control. Salivary glycated albumin has not been evaluated in periodontitis. Aim The aim of the study was to compare salivary glycated albumin in periodontitis patients with and without diabetes mellitus before and after periodontal therapy. Materials and Methods This comparative cross-sectional study was conducted in the Department of Periodontics. Ninety subjects (mean age 41.8 ± 6.82) were categorized into three groups. Clinical examination and saliva sample collection were done at baseline and 4 weeks after scaling and root debridement. Salivary glycated albumin levels were estimated using an enzyme-linked immunosorbent assay. One-way analysis of variance with post hoc test and paired t-test was done for inter- and intra-group comparison. The optimal cut-off value was calculated using the receiver operating characteristic curve and by maximization of the Youden index. Results Mean salivary glycated albumin was the highest in diabetic patients followed by non-diabetic periodontitis patients and least in healthy controls. All the intergroup comparisons were significant. A cut-off value of 72.19 ng/ml of salivary glycated albumin could predict diabetic status with a sensitivity and specificity of 75%. Salivary glycated albumin was significantly reduced in a similar manner in both groups after periodontal therapy (19.4% and 18.5%). Conclusion Periodontitis patients with diabetes mellitus were presented with the highest salivary glycated albumin. Non-surgical periodontal therapy resulted in a similar reduction of salivary glycated albumin in periodontitis with and without diabetes mellitus.
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Affiliation(s)
- K M Seniya
- Department of Periodontics, PMS College of Dental Sciences and Research, Trivandrum, Kerala, India
| | - K V Baiju
- Department of Statistics, Government college for women, Trivandrum, Kerala, India
| | - R Ambili
- Department of Periodontics, PMS College of Dental Sciences and Research, Trivandrum, Kerala, India
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Tominaga K, Abe T, Ando Y, Hamano T, Isomura M, Nabika T, Yano S. Changes in masticatory performance and the new onset of diabetes mellitus in older adults: a 5-year longitudinal study. Diabetol Int 2023; 14:165-171. [PMID: 37090125 PMCID: PMC10113411 DOI: 10.1007/s13340-022-00613-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
Objective Although masticatory performance is affected by age-related reduction in number of teeth (or treatment), the relationship between longitudinal changes in masticatory performance and diabetes mellitus is unknown. This longitudinal study investigated the association between changes in masticatory performance and new-onset diabetes mellitus among community-dwelling Japanese older adults. Methods The data of 214 older adults living in Ohnan Town, Shimane, Japan, who participated in two surveys conducted between 2012 and 2017 were analyzed. Diabetes mellitus was defined as a hemoglobin A1c level ≥ 6.5% or self-reported diabetes mellitus. The masticatory performance (measured by number of gummy jelly pieces collected after chewing) was evaluated by dental hygienists. Masticatory performance was categorized into two groups (high or low) based on the median in each survey; further, four groups (Group A: remained consistently high, Group B: changed from low to high, Group C: remained consistently low, Group D: changed from high to low) were used to determine longitudinal changes in masticatory performance. Logistic regression was used to analyze the association between changes in masticatory performance and new-onset diabetes mellitus. Results Overall, 10.3% of participants had diabetes mellitus at the follow-up survey. Multivariate analysis showed that Group D (odds ratio 8.69, 95% confidence interval 1.98-38.22) was positively associated with the development of diabetes mellitus compared with Group A after adjusting for sex, age, body mass index, alcohol consumption, physical activity, and eating speed. Conclusions Deteriorating masticatory performance for 5 years may cause diabetes mellitus among older adults.
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Affiliation(s)
- Kazumichi Tominaga
- Tominaga Dental Office, Ochi District, Shimane Japan
- Center for Community-Based Healthcare Research and Education (CoHRE), Head Office for Research and Academic Information, Shimane University, 225-8 Enya-Cho, Izumo, Shimane 693-8501 Japan
| | - Takafumi Abe
- Center for Community-Based Healthcare Research and Education (CoHRE), Head Office for Research and Academic Information, Shimane University, 225-8 Enya-Cho, Izumo, Shimane 693-8501 Japan
| | - Yuichi Ando
- Department of Health Promotion, National Institute of Public Health, Wako, Saitama Japan
| | - Tsuyoshi Hamano
- Center for Community-Based Healthcare Research and Education (CoHRE), Head Office for Research and Academic Information, Shimane University, 225-8 Enya-Cho, Izumo, Shimane 693-8501 Japan
- Department of Sports Sociology and Health Sciences, Faculty of Sociology, Kyoto Sangyo University, Kyoto, Kyoto Japan
| | - Minoru Isomura
- Center for Community-Based Healthcare Research and Education (CoHRE), Head Office for Research and Academic Information, Shimane University, 225-8 Enya-Cho, Izumo, Shimane 693-8501 Japan
- Faculty of Human Sciences, Shimane University, Matsue, Shimane Japan
| | - Toru Nabika
- Center for Community-Based Healthcare Research and Education (CoHRE), Head Office for Research and Academic Information, Shimane University, 225-8 Enya-Cho, Izumo, Shimane 693-8501 Japan
- Department of Functional Pathology, Faculty of Medicine, Shimane University, Izumo, Shimane Japan
| | - Shozo Yano
- Center for Community-Based Healthcare Research and Education (CoHRE), Head Office for Research and Academic Information, Shimane University, 225-8 Enya-Cho, Izumo, Shimane 693-8501 Japan
- Department of Laboratory Medicine, Faculty of Medicine, Shimane University, Izumo, Shimane Japan
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Elnour MAA, Mirghani HO. Periodontitis treatment (surgical and nonsurgical) effects on glycemic control: A review and meta-analysis. Ann Afr Med 2023; 22:131-135. [PMID: 37026192 PMCID: PMC10262851 DOI: 10.4103/aam.aam_53_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/30/2022] [Accepted: 09/27/2022] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Periodontitis is the sixth most prevalent chronic disease. Literature suggests a relationship between diabetes and periodontitis and when coexist may aggravate each other deleterious consequences. Therefore, we aimed to assess the effects of periodontitis treatment on glycemic control. MATERIALS AND METHODS A systematic literature search was conducted in PubMed, Cochrane Library, and the first 100 articles in Google Scholar from January 2011 to October 2021. The terms periodontitis, periodontal treatment, diabetes mellitus, nonsurgical treatment, glycated hemoglobin (HbA1c) were used, with the Protean "AND" and "OR." The titles, abstracts, and references of the included studies were screened. Any discrepancy was solved by an agreement between researchers. Out of 1059 studies retrieved, 320 stands after the removal of duplication, from them, 31 full texts were screened and only 11 studies were included in the final meta-analysis. RESULTS In the present meta-analysis, 11 studies (1469 patients included) were pooled, and the overall effect showed that periodontitis treatment improved the HbA1c, odd ratio, -0.024, 95% confidence interval, -0.42-.06, P value, 0.009, Chi-square, 52.99. However, substantial heterogeneity was observed, P value, < 0.001, I2 for heterogeneity 81%. CONCLUSION Periodontitis treatment improved the HbA1c among patients with diabetes and poor glycemic control. Screening of this common disease is important in diabetes holistic care.
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Di Domenico GL, Minoli M, Discepoli N, Ambrosi A, de Sanctis M. Effectiveness of periodontal treatment to improve glycemic control: an umbrella review. Acta Diabetol 2023; 60:101-113. [PMID: 36261746 DOI: 10.1007/s00592-022-01991-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/03/2022] [Indexed: 01/10/2023]
Abstract
AIM The aim of the present umbrella review was to systematically assess existing evidence on the effect of non-surgical periodontal therapy, both per se' and with adjuvants, on glycemic control in patients with type 2 diabetes and periodontitis and to combine quantitative data with a meta-analysis. MATERIALS AND METHODS A detailed study protocol was registered on PROSPERO (CRD42021222279). Four electronic databases (Medline via Pubmed, EMBASE, Cochrane Database of Systematic Reviews and Scielo) were searched independently and in duplicate to identify potentially eligible systematic reviews up to March 2022. Two pre-calibrated independent reviewers performed study selection, data extraction and quality assessment with two checklists (AMSTAR 2 and PRISMA). Moreover, general characteristics of primary studies included in each systematic review were abstracted, and JADAD scale was used to assess the risk of bias for included randomized controlled trials. Data from the individual studies included in each meta-analysis were analyzed, using both fixed and random effect model. The statistical heterogeneity was calculated using the Q test and the I2 index. The publication bias was evaluated using a funnel plot and Egger's linear regression method. RESULTS Sixteen systematic reviews, published between 2010 and 2021, were included for qualitative synthesis. From these systematic reviews, a total of 27 studies were included in the meta-analysis: all of them were randomized clinical trials, except 1 controlled clinical study. A statistically significant mean difference of - 0.49% and of - 0.38% HbA1c reductions was seen respectively at 3- and 6-month post-treatment, favoring the treatment group (non-surgical periodontal therapy alone) compared to the control group (no treatment). The effect of periodontal treatment with the adjunctive use of antibiotics or laser on the glycemic control was not statistically significant compared to non-surgical periodontal therapy alone. CONCLUSIONS The findings of the present study, within its limitations, indicated that non-surgical treatment of periodontitis is an efficacious therapy for improving the glycemic control in type 2 diabetes mellitus patients, both at 3- and 6-month follow-up.
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Affiliation(s)
| | - Margherita Minoli
- Department of Periodontology, Università Vita-Salute San Raffaele, Milan, Italy
| | - Nicola Discepoli
- Unit of Periodontics, Department of Medical Biotechnologies, Università degli Studi di Siena, Siena, Italy
| | - Alessandro Ambrosi
- Faculty of Medicine and Surgery, Università Vita-Salute San Raffaele, Milan, Italy
| | - Massimo de Sanctis
- Department of Periodontology, Università Vita-Salute San Raffaele, Milan, Italy
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Mehriz BM, Atteya MA, Skipina TM, Mostafa MA, Soliman EZ. Association between Periodontitis and Diabetes Mellitus in the General Population. J Diabetes Metab Disord 2022; 21:1249-1254. [PMID: 36404812 PMCID: PMC9672178 DOI: 10.1007/s40200-022-01010-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE- This study aimed to examine the association between periodontitis and diabetes mellitus. METHODS Participants with natural teeth in one jaw from the Third United States National Health and Nutrition Examination Survey (1988-1994) were included in this analysis. Participants with moderate (> 4mm attachment loss in ≥ 2 mesial sites or 5mm pocket depth in ≥ 2 mesial sites) or severe (> 6mm attachment loss in ≥ 2 mesial sites and > 5mm pocket depth in ≥ 1 mesial site) periodontitis were classified as having periodontal disease. The rest of the participants were considered without periodontal disease. Diabetes mellitus was defined as fasting glucose ≥ 126mg/dL, hemoglobin A1c ≥ 6.5% or the use of antihyperglycemic medications. Multivariable logistic regression was used to examine the association between periodontitis and diabetes mellitus in all study population and subgroups stratified by demographics and comorbidities. RESULTS This analysis included 13,000 participants [mean age 43.8 ± 19.1 years, 47.5% male, 30% whites]. About 12.7% (n = 1,656) of the study population had periodontitis, and 9.2% (n = 1,200) had diabetes. In a multivariable-adjusted model, presence (vs. absence) of periodontitis was associated with 66% increased odds of diabetes (OR (95% CI):1.66 (1.43-1.94); p < 0.001). Compared to those without periodontitis, the odds of diabetes among those with severe periodontitis was much higher (OR (95% CI): 2.31(1.72-3.11); p < 0.001) than in those with moderate periodontitis (OR (95% CI): 1.54(1.30-1.82); p < 0.001). CONCLUSIONS Periodontitis is associated with prevalent diabetes in a dose-response fashion, suggesting a bidirectional relationship between those two diseases. Patients with periodontal disease should be counseled regarding their elevated risk of diabetes. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40200-022-01010-6.
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Affiliation(s)
- Basant M. Mehriz
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, American University in Cairo, New Cairo, Cairo, Egypt
| | - Mirna A. Atteya
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, American University in Cairo, New Cairo, Cairo, Egypt
| | - Travis M. Skipina
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina United States
| | - Mohamed A. Mostafa
- Epidemiological Cardiology Research Center, Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina United States
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center, Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina United States
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Shah PD, Schooling CM, Borrell LN. Impact of Liability to Periodontitis on Glycemic Control and Type II Diabetes Risk: A Mendelian Randomization Study. Front Genet 2021; 12:767577. [PMID: 34899852 PMCID: PMC8660586 DOI: 10.3389/fgene.2021.767577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/15/2021] [Indexed: 01/04/2023] Open
Abstract
While the association of periodontitis with Type II diabetes (T2DM) is well-established, the causal relationship remains uncertain. We examined the causal association of periodontitis with glycemic traits (HbA1c, fasting glucose, and fasting insulin) and T2DM using Mendelian randomization (MR) taking advantage of large genome-wide association studies of European and East Asian adults, i.e., the UK Biobank (n ≈ 350,000) (HbA1c), trans-ancestral MAGIC (HbA1c, fasting glucose, and insulin), and DIAMANTE (74,124 cases/824,006 controls), and AGEN for T2DM in Europeans and East Asians, respectively. Periodontitis was instrumented using single-nucleotide polymorphisms (SNPs), strongly and independently predicting liability to periodontitis in each ancestry group. SNP-specific Wald estimates were combined using inverse variance weighting. Sensitivity analyses were performed using the weighted median and MR-Egger with meta-analysis of MR estimates for Europeans and East Asians. Genetically instrumented liability to periodontitis was not associated with glycemic traits or T2DM in either ancestry or when ancestry specific estimates were meta-analyzed. Our findings do not support a causal association of liability to periodontitis with glycemic traits or T2DM. However, further research is required confirming these findings among other racial/ethnic groups, especially groups who carry a heavy burden of both periodontitis and T2DM.
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Affiliation(s)
- Parth D Shah
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - C M Schooling
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Luisa N Borrell
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
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Abstract
Malnutrition and issues of nutrition are common in hospitalized patients. Identifying patients at nutritional risk can help to improve hospital-related outcomes. Specialized nutritional support in the form of oral nutritional supplementation, enteral nutrition, and parenteral nutrition is essential to meeting the nutritional needs of many patients. Disease-specific nutritional considerations are fundamental to the quality care of hospitalized patients. Many vitamin, macronutrient, and micronutrient deficiencies are relevant in hospital setting.
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Sekundo C, Bölk T, Kalmus O, Listl S. Accuracy of a 7-Item Patient-Reported Stand-Alone Tool for Periodontitis Screening. J Clin Med 2021; 10:E287. [PMID: 33466797 PMCID: PMC7830157 DOI: 10.3390/jcm10020287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
Periodontitis is interrelated with various other chronic diseases. Recent evidence suggests that treatment of periodontitis improves glycemic control in diabetes patients and reduces the costs of diabetes treatment. So far, however, screening for periodontitis in non-dental settings has been complicated by a lack of easily applicable and reliable screening tools which can be applied by non-dental professionals. The purpose of this study was to assess the diagnostic accuracy of a short seven-item tool developed by the German Society for Periodontology (DG PARO) to screen for periodontitis by means of patient-reported information. A total of 88 adult patients filled in the patient-reported Periodontitis Risk Score (pPRS; range: 0 points = lowest periodontitis risk; 20 points = very high periodontitis risk) questionnaire before dental check-up at Heidelberg University Hospital. Subsequent clinical assessments according to Periodontal Screening and Recording (PSR®) were compared with pPRS scores. The diagnostic accuracy of pPRS at different cutoff values was assessed according to sensitivity, specificity, positive, and negative predictive values, as well as Receiver-Operator-Characteristic curves, Area Under the Curve (AUC), and logistic regression analysis. According to combined specificity and sensitivity (AUC = 0.86; 95%-CI: 0.76-0.95), the diagnostic accuracy of the pPRS for detecting periodontal inflammation (PSR® ≥ 3) was highest for a pPRS cutoff distinguishing between pPRS scores < 7 vs. ≥ 7. Patients with pPRS scores ≥ 7 had a 36.09 (95%-CI: 9.82-132.61) times higher chance of having a PSR® ≥ 3 than patients with scores < 7. In conclusion, the pPRS may be considered an appropriately accurate stand-alone tool for the screening for periodontitis.
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Affiliation(s)
- Caroline Sekundo
- Translational Health Economics Group (THE Group), Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University, 69120 Heidelberg, Germany; (T.B.); (O.K.); (S.L.)
| | - Tobias Bölk
- Translational Health Economics Group (THE Group), Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University, 69120 Heidelberg, Germany; (T.B.); (O.K.); (S.L.)
| | - Olivier Kalmus
- Translational Health Economics Group (THE Group), Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University, 69120 Heidelberg, Germany; (T.B.); (O.K.); (S.L.)
| | - Stefan Listl
- Translational Health Economics Group (THE Group), Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University, 69120 Heidelberg, Germany; (T.B.); (O.K.); (S.L.)
- Department of Dentistry—Quality and Safety of Oral Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 Nijmegen, The Netherlands
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Jain A, Chawla M, Kumar A, Chawla R, Grover V, Ghosh S, Pandit N, Chawla P. Management of periodontal disease in patients with diabetes- good clinical practice guidelines: A joint statement by Indian Society of Periodontology and Research Society for the Study of Diabetes in India. J Indian Soc Periodontol 2020; 24:498-524. [PMID: 33424167 PMCID: PMC7781257 DOI: 10.4103/jisp.jisp_688_20] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/10/2020] [Indexed: 12/14/2022] Open
Abstract
There is a huge body of literature suggesting an association and a bidirectional relationship between periodontal disease and diabetes. Diabetes and periodontal diseases are both chronic diseases with a high prevalence. Dentists/periodontists, in their daily clinical practice, very often attend to diabetes patients with diverse oral health conditions and cater to their dental treatment needs. Safe and effective periodontal therapy in this population requires a broad understanding of diabetes, medical management of diabetes, and essential modifications to dental/periodontal therapy that may be required. This paper describes a joint statement put forth by the Indian Society of Periodontology and the Research Society for the Study of Diabetes in India aiming to provide expert consensus and evidence-based guidelines for optimal clinical management of periodontal conditions in diabetes patients or patients at risk for diabetes. Although this paper is not envisioned to be a comprehensive review of this topic, it intends to provide the guidelines for dental professionals and periodontists.
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Affiliation(s)
- Ashish Jain
- Department of Periodontology, Dr. H. S. J. Institute of Dental Sciences, Panjab University, Chandigarh, India
| | - Manoj Chawla
- Lina Diabetes Care Centre, Mumbai, Maharashtra, India
| | - Ashish Kumar
- Department of Periodontology, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Rajeev Chawla
- North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - Vishakha Grover
- Department of Periodontology, Dr. H. S. J. Institute of Dental Sciences, Panjab University, Chandigarh, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Nymphea Pandit
- Department of Periodontology, D. A. V. Dental College and Hospital, Yamunanagar, Haryana, India
| | - Purvi Chawla
- Lina Diabetes Care Centre, Mumbai, Maharashtra, India
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Genco RJ, Graziani F, Hasturk H. Effects of periodontal disease on glycemic control, complications, and incidence of diabetes mellitus. Periodontol 2000 2020; 83:59-65. [PMID: 32385875 DOI: 10.1111/prd.12271] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Diabetes mellitus is a group of metabolic disorders with high mortality and morbidity associated with complications such as cardiovascular disease, kidney disease, and stroke. The prevalence of diabetes is 9.4% in US adults, and prevalence increases markedly with age, with 1 in 4 adults aged ≥65 years affected by diabetes. The estimated number of adults with type 2 diabetes globally almost tripled between 2002 and 2017, reflecting increases seen in the USA and elsewhere. This increase raises concerns about the increased morbidity and mortality associated with the complications of diabetes, including periodontal disease and tooth loss. There is a reciprocal adverse relationship between diabetes and periodontal disease, with diabetes as a major risk factor for periodontal disease, and in those patients with diabetes who also have periodontal disease then there are adverse effects on glycemic control and complications such as cardiovascular disease and end stage renal disease. In this review, those studies detailing the adverse effects of periodontal disease and diabetes will be discussed. Also, evidence is accumulating that periodontitis may play a role in increasing the incidence of new cases of type 2 diabetes, and possibly gestational diabetes. Of course, these studies need to be expanded to better understand the effects of periodontitis on diabetes glycemic control, complications, prediabetes, and the incidence of new cases. However, given the tremendous burden of diabetes on society, the dental profession should be proactive in preventing and treating periodontal disease, not only to preserve the dentition, but also to minimize the adverse effects of periodontitis on diabetes and its complications.
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Affiliation(s)
- Robert J Genco
- Departments of Oral Biology, and Microbiology and Immunology, Center for Microbiome Research, University at Buffalo, Buffalo, New York, USA
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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Choi SE, Sima C, Pandya A. Impact of Treating Oral Disease on Preventing Vascular Diseases: A Model-Based Cost-effectiveness Analysis of Periodontal Treatment Among Patients With Type 2 Diabetes. Diabetes Care 2020; 43:563-571. [PMID: 31882408 DOI: 10.2337/dc19-1201] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/27/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Previous randomized trials found that treating periodontitis improved glycemic control in patients with type 2 diabetes (T2D), thus lowering the risks of developing T2D-related microvascular diseases and cardiovascular disease (CVD). Some payers in the U.S. have started covering nonsurgical periodontal treatment for those with chronic conditions, such as diabetes. We sought to identify the cost-effectiveness of expanding periodontal treatment coverage among patients with T2D. RESEARCH DESIGN AND METHODS A cost-effectiveness analysis was conducted to estimate lifetime costs and health gains using a stochastic microsimulation model of oral health conditions, T2D, T2D-related microvascular diseases, and CVD of the U.S. POPULATION Model parameters were obtained from the nationally representative National Health and Nutrition Examination Survey (NHANES) (2009-2014) and randomized trials of periodontal treatment among patients with T2D. RESULTS Expanding periodontal treatment coverage among patients with T2D and periodontitis would be expected to avert tooth loss by 34.1% (95% CI -39.9, -26.5) and microvascular diseases by 20.5% (95% CI -31.2, -9.1), 17.7% (95% CI -32.7, -4.7), and 18.4% (95% CI -34.5, -3.5) for nephropathy, neuropathy, and retinopathy, respectively. Providing periodontal treatment to the target population would be cost saving from a health care perspective at a total net savings of $5,904 (95% CI -6,039, -5,769) with an estimated gain of 0.6 quality-adjusted life years per capita (95% CI 0.5, 0.6). CONCLUSIONS Providing nonsurgical periodontal treatment to patients with T2D and periodontitis would be expected to significantly reduce tooth loss and T2D-related microvascular diseases via improved glycemic control. Encouraging patients with T2D and poor oral health conditions to receive periodontal treatment would improve health outcomes and still be cost saving or cost-effective.
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Affiliation(s)
- Sung Eun Choi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA
| | - Corneliu Sima
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
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The Connection of Periodontal Disease and Diabetes Mellitus: The Role of Matrix Metalloproteinases and Oxidative Stress. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2019-0051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
Diabetes mellitus, a chronic disease considered by the World Health Organization to be an epidemic, is now recognized as one of the factors behind the onset of periodontal disease. The connection between periodontal disease, which is an irreversible inflammatory disease of the supporting tissue of the teeth, and systemic diseases is reflected in the existence of common risk factors, subgingival dental biofilm, as a constant source of proinflamma-tory cytokines synthesized intensely in inflammatory periodontium. Diabetes mellitus leads to increased oxidative stress in periodontal tissues causing worsening of the disease and periodontopathy exacerbates deficiency of pancreatic β-cells. The most important role in primary inflammatory response in the pathogenesis of periodontopathy is played by neutrophils. Neutrophils cause periodontium destruction by the release of enzymes (matrix metalloproteinases), cytotoxic substances (free radicals, reactive oxygen and nitrogen species) and the expression of membrane receptors. Matrix metalloproteinases within the “protease network” are critical to many physiological and pathological processes, including immunity, inflammation, bone resorption and wound healing. Matrix metalloproteinases levels are elevated in patients with metabolic syndrome and diabetes mellitus, which may contribute to more frequent complications. In this paper, the review of available literature data shows the correlation between periodontal disease and diabetes mellitus, as well as the role of matrix metalloproteinases and oxidative stress in these. In this regard, determining the value of matrix metalloproteinases may be helpful in the diagnosis of periodontal disease complicated by diabetes mellitus. Also, the parameters of oxidative stress could help to clarify the mechanisms of pathogenesis and etiology of periodontal disease, or indicate the potential benefit of antioxidant supplementation in these individuals. As the role of matrix metalloproteinases has not been fully clarified in the pathogenesis of periodontopathy, additional studies will be needed to indicate their importance.
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Yap KCH, Pulikkotil SJ. Systemic doxycycline as an adjunct to scaling and root planing in diabetic patients with periodontitis: a systematic review and meta-analysis. BMC Oral Health 2019; 19:209. [PMID: 31488125 PMCID: PMC6728970 DOI: 10.1186/s12903-019-0873-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To compare the effectiveness of systemic doxycycline as an adjunct to scaling and root planing (SRP) with SRP alone in improving periodontal clinical attachment level and glycemic control in diabetic patients with periodontitis. METHODS Two independent reviewers (KY and SJ) screened two electronic databases, PubMed and Scopus, for randomized clinical trials on the use of systemic doxycycline as an adjunct to scaling and root planing in improving periodontal status and glycemic control in diabetic patients with periodontitis using predetermined selection criteria within a 3-month period. The reviewers independently did data screening, data selection, data extraction and risk of bias. Quality of studies involved was analysed using the revised Cochrane Risk of Bias 2.0. Weighted standard mean differences (SMD) and 95% confidence intervals were calculated using a random effects meta-analysis model. Publication bias was evaluated using funnel plot. Quality of evidence was evaluated by Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS Electronic searches provided 1358 records and six studies were selected. The meta-analyses indicated that there was no statistically significant difference in the improvement of periodontal status with the use of systemic doxycycline as an adjunct for scaling and root planing (SRP). SMD of clinical attachment levels (- 0.22 [- 0.52, 0.08]) and HbA1c levels (- 0.13 [- 0.41, 0.15]) were calculated. Overall risk of bias is high in 2 out of 6 studies involved. CONCLUSION Systemic doxycycline when used in addition to scaling and root planing yields no significant improvement of clinical attachment levels for periodontal status and reduction of HbA1c levels in treatment of diabetic patients with periodontitis when comparing the test group to the control group.
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Affiliation(s)
- Kenneth Chou Hung Yap
- School of Dentistry, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Shaju Jacob Pulikkotil
- School of Dentistry, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur, Malaysia.
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Cao R, Li Q, Wu Q, Yao M, Chen Y, Zhou H. Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis. BMC Oral Health 2019; 19:176. [PMID: 31387569 PMCID: PMC6685286 DOI: 10.1186/s12903-019-0829-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 06/23/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Glycemic control is vital in the care of type 2 diabetes mellitus (T2DM) and is significantly associated with the incidence of clinical complications. This Bayesian network analysis was conducted with an aim of evaluating the efficacy of scaling and root planning (SRP) and SRP + adjuvant treatments in improving glycemic control in chronic periodontitis (CP) and T2DM patients, and to guide clinical practice. METHODS We searched the Pubmed, Embase, Cochrane Library and Web of Science databases up to 4 May 2018 for randomized controlled trials (RCTs). This was at least three months of the duration of study that involved patients with periodontitis and T2DM without other systemic diseases given SRP. Patients in the control group did not receive treatment or SRP combination with adjuvant therapy. Outcomes were given as HbA1c% and levels fasting plasma glucose (FPG). Random-effects meta-analysis and Bayesian network meta-analysis were conducted to pool RCT data. Cochrane's risk of bias tool was used to assess the risk of bias. RESULTS Fourteen RCTs were included. Most were unclear or with high risk of bias. Compared to patients who did not receive treatment, patients who received periodontal treatments showed improved HbA1c% level, including SRP (the mean difference (MD) -0.399 95% CrI 0.088 to 0.79), SRP + antibiotic (MD 0.62, 95% CrI 0.18 to 1.11), SRP + photodynamic therapy (aPDT) + doxycycline (Doxy) (MD 1.082 95% CrI 0.13 to 2.077) and SRP + laser (MD 0.66 95% CrI 0.1037, 1.33). Among the different treatments, SRP + aPDT + Doxy ranked best. Regarding fasting plasma glucose (FPG), SRP did not show advantage over no treatment (MD 4.91 95% CI - 1.95 to 11.78) and SRP with adjuvant treatments were not better than SRP alone (MD -0.28 95% CI -8.66, 8.11). CONCLUSION The results of this meta-analysis seem to support that periodontal treatment with aPDT + Doxy possesses the best efficacy in lowering HbA1c% of non-smoking CP without severe T2DM complications. However, longer-term well-executed, multi-center trails are required to corroborate the results.
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Affiliation(s)
- Ruoyan Cao
- Department of Prosthodontics, Xiangya Stomatological Hospital & School of Stomatology, Central South University, 72 Xiangya Road, Changsha, 410000, China
| | - Qiulan Li
- Department of Stomatology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, China
| | - Qiqi Wu
- Department of Operative Dentistry and Endodontics, Xiangya Stomatological Hospital & School of Stomatology, Central South University, 72 Xiangya Road, Changsha, 410000, China
| | - Mianfeng Yao
- Department of Oral Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410083, China
| | - Yu Chen
- Department of Prosthodontics, Xiangya Stomatological Hospital & School of Stomatology, Central South University, 72 Xiangya Road, Changsha, 410000, China
| | - Hongbo Zhou
- Department of Prosthodontics, Xiangya Stomatological Hospital & School of Stomatology, Central South University, 72 Xiangya Road, Changsha, 410000, China.
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Periodontitis: A Multifaceted Disease of Tooth-Supporting Tissues. J Clin Med 2019; 8:jcm8081135. [PMID: 31370168 PMCID: PMC6723779 DOI: 10.3390/jcm8081135] [Citation(s) in RCA: 423] [Impact Index Per Article: 70.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/27/2019] [Accepted: 07/29/2019] [Indexed: 12/30/2022] Open
Abstract
Periodontitis is an infection-driven inflammatory disease in which the composition of biofilms plays a significant role. Dental plaque accumulation at the gingival margin initiates an inflammatory response that, in turn, causes microbial alterations and may lead to drastic consequences in the periodontium of susceptible individuals. Chronic inflammation affects the gingiva and can proceed to periodontitis, which characteristically results in irreversible loss of attachment and alveolar bone. Periodontitis appears typically in adult-aged populations, but young individuals can also experience it and its harmful outcome. Advanced disease is the major cause of tooth loss in adults. In addition, periodontitis is associated with many chronic diseases and conditions affecting general health.
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20
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Inflammation and Vascular Ageing: From Telomeres to Novel Emerging Mechanisms. High Blood Press Cardiovasc Prev 2019; 26:321-329. [DOI: 10.1007/s40292-019-00331-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/12/2019] [Indexed: 12/20/2022] Open
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Montenegro MM, Ribeiro IWJ, Kampits C, Saffi MAL, Furtado MV, Polanczyk CA, Haas AN, Rösing CK. Randomized controlled trial of the effect of periodontal treatment on cardiovascular risk biomarkers in patients with stable coronary artery disease: Preliminary findings of 3 months. J Clin Periodontol 2019; 46:321-331. [DOI: 10.1111/jcpe.13085] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 01/04/2019] [Accepted: 02/10/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Marlon M. Montenegro
- Department of PeriodontologyFaculty of DentistryFederal University of Rio Grande do Sul Porto Alegre Brazil
| | - Ingrid W. J. Ribeiro
- Department of PeriodontologyFaculty of DentistryFederal University of Rio Grande do Sul Porto Alegre Brazil
| | - Cassio Kampits
- Department of PeriodontologyFaculty of DentistryFederal University of Rio Grande do Sul Porto Alegre Brazil
| | - Marco A. L. Saffi
- Cardiology DivisionFederal University of Rio Grande do Sul Porto Alegre Brazil
| | - Mariana V. Furtado
- Service of CardiologyHospital de Clínicas de Porto Alegre Porto Alegre Brazil
| | - Carisi A. Polanczyk
- Cardiology DivisionFederal University of Rio Grande do Sul Porto Alegre Brazil
| | - Alex N. Haas
- Department of PeriodontologyFaculty of DentistryFederal University of Rio Grande do Sul Porto Alegre Brazil
| | - Cassiano K. Rösing
- Department of PeriodontologyFaculty of DentistryFederal University of Rio Grande do Sul Porto Alegre Brazil
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Rampally P, Koduganti RR, Ganapathi SN, Panthula VR, Surya PJ. Comparison of effectiveness of low-dose aspirin versus omega-3 fatty acids as adjuvants to nonsurgical periodontal therapy in Type II diabetic patients with chronic periodontitis. J Indian Soc Periodontol 2019; 23:249-256. [PMID: 31143006 PMCID: PMC6519093 DOI: 10.4103/jisp.jisp_528_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Context: Periodontitis and diabetes are universally prevalent diseases which are interlinked with each other. Inflammatory products released both by the microorganisms, and the host plays a pivotal role in causing both the diseases. Pentraxins are acute-phase proteins which are often found to be elevated in inflammatory states. Anti-inflammatory agents have a very important role to play in curbing infection of which, aspirin and omega-3 fatty acids (O3FAs) are being administered often nowadays. Nonsurgical periodontal therapy (NSPT) remains the gold standard of treatment, and other agents have been used as adjuvants only, to increase the efficacy of treatment. Aims: This study compares the effects of low-dose aspirin versus O3FAs when used as adjuvants to NSPT in patients with diabetes and chronic periodontitis. Settings and Design: A total of 42 patients (mean age of 30–65 years) from a diabetic center who were diagnosed with Type II diabetes and chronic periodontitis were included in the study. Materials and Methods: This study was done in the department of periodontics of a tertiary referral care hospital in Hyderabad, in collaboration with a reputed diabetic center. Statistical Analysis Used: Intragroup comparison was done using the paired t-test for continuous data and Wilcoxon signed-rank test for score data. Intergroup comparison was compiled using independent t-test. All P < 0.05 were considered statistically significant. Results: Intragroup comparison at baseline and 3 months after NSPT showed statistically significant results (P < 0.001) in all the three groups pertaining to the clinical (gingival index, probing pocket depth, and clinical attachment level) and biochemical (glycosylated hemoglobin and pentraxin) parameters. However, the intergroup comparison showed a significant improvement in Group II related to pentraxin levels only (P < 0.001). Conclusions: O3FAs proved to be better than low-dose aspirin and placebo after NSPT.
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Affiliation(s)
- Prathyusha Rampally
- Department of Periodontics, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Rekha Rani Koduganti
- Department of Periodontics, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | | | - Veerendranath Reddy Panthula
- Department of Periodontics, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
| | - Prasanna Jammula Surya
- Department of Periodontics, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
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Jain A, Gupta J, Bansal D, Sood S, Gupta S, Jain A. Effect of scaling and root planing as monotherapy on glycemic control in patients of Type 2 diabetes with chronic periodontitis: A systematic review and meta-analysis. J Indian Soc Periodontol 2019; 23:303-310. [PMID: 31367125 PMCID: PMC6628769 DOI: 10.4103/jisp.jisp_417_18] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: There is enough evidence, which suggests that nonsurgical periodontal therapy (NSPT) improved the glycemic control in patients of Type 2 diabetes mellitus (T2DM) with chronic periodontitis (CP). This meta-analysis is aimed to explore the effect of NSPT, exclusively scaling and root planing (SRP) as monotherapy on glycemic control and periodontal parameters in patients of T2DM with CP. Materials and Methods: Two databases, MEDLINE and EMBASE, were searched from June 2006 to June 2016. Initially, 464 potentially relevant studies were evaluated. Randomized controlled trials with duration of ≥3 months, based on the treatment group managed with SRP without any supportive use of local drug delivery or systemic antibiotics, while the control group received no periodontal therapy, were selected. This resulted in six appropriate articles with a total of 812 patients of T2DM with CP. Alteration in glycated hemoglobin (HbA1c) was the primary outcome measure, whereas the changes in clinical attachment level (CAL) and probing pocket depth (PPD) were the secondary outcome measures. Results: SRP treatment resulted in a decrease in HbA1c by 0.26% (P = 0.17) at 3–4 months compared to the control group. Further, on subgroup analysis, SRP therapy revealed a decrease in PPD and CAL at 3–4 months, though statistically insignificant. Conclusion: SRP treatment leads to modest improvement in glycemic status and periodontal parameters in T2DM patients with CP at 3–4 months.
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Affiliation(s)
- Akanksha Jain
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, Punjab, India
| | - Jyoti Gupta
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, Punjab, India
| | - Dipika Bansal
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Mohali, Punjab, India
| | - Shaveta Sood
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, Punjab, India
| | - Shipra Gupta
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, Punjab, India
| | - Ashish Jain
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, Punjab, India
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D'Aiuto F, Gkranias N, Bhowruth D, Khan T, Orlandi M, Suvan J, Masi S, Tsakos G, Hurel S, Hingorani AD, Donos N, Deanfield JE. Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial. Lancet Diabetes Endocrinol 2018; 6:954-965. [PMID: 30472992 DOI: 10.1016/s2213-8587(18)30038-x] [Citation(s) in RCA: 275] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/26/2017] [Accepted: 10/02/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic inflammation is believed to be a major mechanism underlying the pathophysiology of type 2 diabetes. Periodontitis is a cause of systemic inflammation. We aimed to assess the effects of periodontal treatment on glycaemic control in people with type 2 diabetes. METHODS In this 12 month, single-centre, parallel-group, investigator-masked, randomised trial, we recruited patients with type 2 diabetes, moderate-to-severe periodontitis, and at least 15 teeth from four local hospitals and 15 medical or dental practices in the UK. We randomly assigned patients (1:1) using a computer-generated table to receive intensive periodontal treatment (IPT; whole mouth subgingival scaling, surgical periodontal therapy [if the participants showed good oral hygiene practice; otherwise dental cleaning again], and supportive periodontal therapy every 3 months until completion of the study) or control periodontal treatment (CPT; supra-gingival scaling and polishing at the same timepoints as in the IPT group). Treatment allocation included a process of minimisation in terms of diabetes onset, smoking status, sex, and periodontitis severity. Allocation to treatment was concealed in an opaque envelope and revealed to the clinician on the day of first treatment. With the exception of dental staff who performed the treatment and clinical examinations, all study investigators were masked to group allocation. The primary outcome was between-group difference in HbA1c at 12 months in the intention-to-treat population. This study is registered with the ISRCTN registry, number ISRCTN83229304. FINDINGS Between Oct 1, 2008, and Oct 31, 2012, we randomly assigned 264 patients to IPT (n=133) or CPT (n=131), all of whom were included in the intention-to-treat population. At baseline, mean HbA1c was 8·1% (SD 1·7) in both groups. After 12 months, unadjusted mean HbA1c was 8·3% (SE 0·2) in the CPT group and 7·8% (0·2) in the IPT group; with adjustment for baseline HbA1c, age, sex, ethnicity, smoking status, duration of diabetes, and BMI, HbA1c was 0·6% (95% CI 0·3-0·9; p<0·0001) lower in the IPT group than in the CPT group. At least one adverse event was reported in 30 (23%) of 133 patients in the IPT group and 23 (18%) of 131 patients in the CPT group. Serious adverse events were reported in 11 (8%) patients in the IPT group, including one (1%) death, and 11 (8%) patients in the CPT group, including three (2%) deaths. INTERPRETATION Compared with CPT, IPT reduced HbA1c in patients with type 2 diabetes and moderate-to-severe periodontitis after 12 months. These results suggest that routine oral health assessment and treatment of periodontitis could be important for effective management of type 2 diabetes. FUNDING Diabetes UK and UK National Institute for Health Research.
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Affiliation(s)
- Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK.
| | - Nikolaos Gkranias
- Centre for Clinical Oral Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Devina Bhowruth
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Tauseef Khan
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Jean Suvan
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London, UK
| | - Stefano Masi
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Steve Hurel
- Department of Endocrinology, University College London Hospitals, University College London, London, UK
| | - Aroon D Hingorani
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Nikos Donos
- Centre for Clinical Oral Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - John E Deanfield
- Institute of Cardiovascular Sciences, University College London, London, UK
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Masi S, Orlandi M, Parkar M, Bhowruth D, Kingston I, O'Rourke C, Virdis A, Hingorani A, Hurel SJ, Donos N, D'Aiuto F, Deanfield J. Mitochondrial oxidative stress, endothelial function and metabolic control in patients with type II diabetes and periodontitis: A randomised controlled clinical trial. Int J Cardiol 2018; 271:263-268. [PMID: 30077530 PMCID: PMC6152589 DOI: 10.1016/j.ijcard.2018.05.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/12/2018] [Accepted: 05/08/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Periodontitis (PD) and type 2 diabetes (T2D) are characterized by increased mitochondrial oxidative stress production (mtROS), which has been associated with a greater risk of cardiovascular diseases (CVD). Intensive PD treatment (IPT) can significantly improve endothelial function and metabolic control, although the mechanisms remain unclear. We explored whether, in patients with PD and T2D, changes of mtROS are associated with improvement of endothelial function and metabolic control after IPT. METHODS 51 patients with T2D and PD were enrolled in a single-blind controlled trial and randomised to either intensive (n = 27) or standard (CPT, n = 24) PD treatment. Levels of mtROS in peripheral blood mononuclear cells (PBMC) were measured using a FACS-based assay at baseline and 24 h, 1 week, 2 and 6 months after PD treatment. Inflammatory cytokines, CVD risk factors, metabolic control and endothelial function were assessed at baseline and 6 months after intervention. RESULTS After 6 months from PD treatment, the IPT group had lower mtROS (in both the whole PBMC and lymphocytes), circulating levels of HbA1c, glucose, INF-γ, TNF-α (p < 0.05 for all), and improved endothelial function (p < 0.05) compared to the CPT group. There was an association between higher mtROS and lower endothelial function at baseline (r = -0.39; p = 0.01) and, in the IPT group, changes of mtROS were associated with changes of endothelial function (r = 0.41; p < 0.05). CONCLUSIONS Reduced mtROS is associated with improved endothelial function and accompanied by better metabolic control in patients with T2D and PD. mtROS could represent a novel therapeutic target to prevent CVD in T2D.
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Affiliation(s)
- Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy; National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Sciences, UCL, London, UK.
| | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute, UCL, London, UK
| | - Mohamed Parkar
- Cruciform Teaching Facilities Unit, Faculty of Life Sciences, UCL, London, UK
| | - Devina Bhowruth
- National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Sciences, UCL, London, UK
| | - Isabel Kingston
- Biomaterials and Tissue Engineering, University College London, UK
| | | | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Aroon Hingorani
- Institute of Cardiovascular Science, University College London, UK
| | - Steven J Hurel
- Department of Endocrinology, University College London Hospital, London, UK
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London (QMUL), UK
| | | | - John Deanfield
- National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Sciences, UCL, London, UK
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The association between Type 1 diabetes mellitus and periodontal diseases. J Formos Med Assoc 2018; 118:1047-1054. [PMID: 30391109 DOI: 10.1016/j.jfma.2018.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/08/2018] [Accepted: 10/17/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/PURPOSE Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease affecting oral health. Evidence shows possible association between T1DM and periodontal diseases (PDs). We conducted a nationwide population-based study in Taiwan, with a 14-year follow-up to investigate the risk of PDs in T1DM patients. METHODS We used data from the National Health Insurance Research Database in Taiwan. The T1DM cohort was identified with newly diagnosed T1DM from 1998 to 2011. The non-T1DM cohort was frequency matched with the T1DM cohort. Participants comprised 4248 patients in the T1DM cohort and 16992 persons in the non-T1DM cohort. RESULTS The T1DM patients showed an increased risk of PDs compared to non-T1DM individuals [adjusted hazard ratio (aHR) = 1.45]. T1DM patients who visited the emergency room more than twice per year had a higher aHR of 13.0 for developing PDs. The aHR for PDs was 13.2 in the T1DM patients who had been hospitalized more than twice per year. CONCLUSION T1DM patients are at higher risk of developing PDs than non-T1DM individuals. Our results further showed that the number of T1DM interventions; that is, annual emergency visits and hospitalizations were associated with increased the risk of developing PDs.
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Joshipura KJ, Muñoz-Torres FJ, Dye BA, Leroux BG, Ramírez-Vick M, Pérez CM. Longitudinal association between periodontitis and development of diabetes. Diabetes Res Clin Pract 2018; 141:284-293. [PMID: 29679620 PMCID: PMC6016543 DOI: 10.1016/j.diabres.2018.04.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/28/2018] [Accepted: 04/12/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Clinical trials have shown very modest short-term improvements in glycemic control among participants with diabetes after periodontitis treatment. Few longitudinal studies suggest that periodontitis may be related to prediabetes/diabetes risk. METHODS We evaluated 1206 diabetes free participants in the San Juan Overweight Adults Longitudinal Study (SOALS) and 941 with complete 3-year follow-up data were included. The National Health and Nutrition Examination Survey (NHANES) methods were used to assess periodontitis. Diabetes and prediabetes were classified using American Diabetes Association cutoffs for fasting and 2-hour post-load glucose and HbA1c. We used Poisson regression adjusting for baseline age, gender, smoking, education, family history of diabetes, physical activity, waist circumference, and alcohol intake. RESULTS Over the 3-year follow-up, 69 (7.3%) of the 941 individuals developed type 2 diabetes, and 142 (34.9%) of the 407 with normal glycemia at baseline developed prediabetes. In multivariable models, greater mean pocket depth and mean attachment loss at baseline were associated with lower risk of developing prediabetes/diabetes over the follow-up (IRR = 0.81; 95% CI: 0.67-0.99, and IRR = 0.86; 95% CI: 0.74-0.99, respectively). Increase in periodontal attachment loss from baseline to follow-up was associated with higher prediabetes/diabetes risk (multivariate IRR = 1.25; 95% CI: 1.09-1.42), and increase in pocket depth was associated with >20% fasting glucose increase (multivariate IRR = 1.43; 95% CI: 1.14-1.79). The inverse associations persisted after additionally adjusting for baseline income, sugar-sweetened beverages, number of teeth, oral hygiene, glycemia, or previous periodontal therapy. CONCLUSIONS There is no association between periodontitis and risk of prediabetes/diabetes in this longitudinal study.
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Affiliation(s)
- Kaumudi J Joshipura
- Center for Clinical Research and Health Promotion, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, United States; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States.
| | - Francisco J Muñoz-Torres
- Center for Clinical Research and Health Promotion, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, United States
| | - Bruce A Dye
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, MD, United States
| | - Brian G Leroux
- School of Dentistry, University of Washington, Seattle, WA, United States
| | - Margarita Ramírez-Vick
- Department of Medicine, Endocrinology, Diabetes and Metabolism Section, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico, United States
| | - Cynthia M Pérez
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico, United States
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Poudel P, Griffiths R, Wong VW, Arora A, Flack JR, Khoo CL, George A. Oral health knowledge, attitudes and care practices of people with diabetes: a systematic review. BMC Public Health 2018; 18:577. [PMID: 29716561 PMCID: PMC5930945 DOI: 10.1186/s12889-018-5485-7] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 04/19/2018] [Indexed: 01/26/2023] Open
Abstract
Background People with uncontrolled diabetes are at greater risk for several oral health problems, particularly periodontal (gum) disease. Periodontal disease also impacts diabetes control. Good oral hygiene and regular dental visits are recommended to prevent and manage oral health problems. Several studies have been conducted to assess the oral health knowledge, attitudes, and practices of people with diabetes yet a review of these findings has not yet been undertaken. The aim of this systematic review was to synthesize current evidence on the knowledge, attitudes and practices of people with diabetes in relation to their oral health care. Methods A systematic search of all literature was carried out in five databases using key search terms. The inclusion criteria were: 1) published in the English language; 2) from 2000 to November, 2017; 3) conducted on persons with any type of diabetes and of all ages; 4) explored at least one study outcome (knowledge or attitude or practices toward oral health care); and 5) used quantitative methods of data collection. No restrictions were placed on the quality and setting of the study. Results A total of 28 studies met the inclusion criteria. The studies included a total of 27,894 people with diabetes and were conducted in 14 countries. The review found that people with diabetes have inadequate oral health knowledge, poor oral health attitudes, and fewer dental visits. They rarely receive oral health education and dental referrals from their care providers. Provision of oral health education by diabetes care providers and referral to dentists when required, was associated with improved oral health behaviours among patients. Conclusions Overall, people with diabetes have limited oral health knowledge and poor oral health behaviours. It is therefore essential to educate patients about their increased risk for oral health problems, motivate them for good oral health behaviours and facilitate access to dental care. Electronic supplementary material The online version of this article (10.1186/s12889-018-5485-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Prakash Poudel
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751, NSW, Australia. .,Centre for Oral Health Outcomes, Research Translation and Evaluation (COHORTE), Ingham Institute Applied Medical Research, Locked Bag 7103, Liverpool, 1871, NSW, Australia. .,Ingham Institute for Applied Medical Research, Locked Bag 7103, Liverpool, 1871, NSW, Australia. .,South Western Sydney Local Health District, Liverpool, 2170, NSW, Australia.
| | - Rhonda Griffiths
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751, NSW, Australia
| | - Vincent W Wong
- Ingham Institute for Applied Medical Research, Locked Bag 7103, Liverpool, 1871, NSW, Australia.,South Western Sydney Local Health District, Liverpool, 2170, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Amit Arora
- Ingham Institute for Applied Medical Research, Locked Bag 7103, Liverpool, 1871, NSW, Australia.,South Western Sydney Local Health District, Liverpool, 2170, NSW, Australia.,School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, 2751, NSW, Australia.,Oral Health Services and Sydney Dental Hospital, Sydney Local Health District, Surry Hills, NSW, 2010, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Westmead, NSW, 2145, Australia
| | - Jeff R Flack
- South Western Sydney Local Health District, Liverpool, 2170, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia.,School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 1797, Australia
| | - Chee L Khoo
- Health Focus Family Practice, The Royal Australian College of General Practitioners (RACGP), National Association of Diabetes Centres (NADC), Ingleburn, NSW, 2565, Australia.,Diabetes , Obesity and Metabolism Translational Research Unit (DOMTRU), Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Ajesh George
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, 2751, NSW, Australia.,Centre for Oral Health Outcomes, Research Translation and Evaluation (COHORTE), Ingham Institute Applied Medical Research, Locked Bag 7103, Liverpool, 1871, NSW, Australia.,Ingham Institute for Applied Medical Research, Locked Bag 7103, Liverpool, 1871, NSW, Australia.,South Western Sydney Local Health District, Liverpool, 2170, NSW, Australia.,Faculty of Dentistry, University of Sydney, Camperdown, 2050, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, 2751, NSW, Australia
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Merchant AT, Virani SS. Evaluating Periodontal Treatment to Prevent Cardiovascular Disease: Challenges and Possible Solutions. Curr Atheroscler Rep 2018; 19:4. [PMID: 28120314 DOI: 10.1007/s11883-017-0640-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Periodontal disease is correlated with cardiovascular disease (CVD) in observational studies, but a causal connection has not been established. The empirical evidence linking periodontal disease and CVD consists of a large body of observational and mechanistic studies, but a limited number of clinical trials evaluating the effects of periodontal treatment on surrogate CVD endpoints. RECENT FINDINGS No randomized controlled trial has been conducted to evaluate the effect of periodontal treatment on CVD risk. In this review, we have summarized these data, described possible biological mechanisms linking periodontal disease and CVD, discussed barriers to conducting a randomized controlled trial to evaluate this hypothesis, and provided an alternative analytical approach using causal inference methods to answer the question. The public health implications of addressing this question can be significant because periodontal disease is under-treated, and highly prevalent among adults at risk of CVD. Even a small beneficial effect of periodontal treatment on CVD risk can be important.
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Affiliation(s)
- Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA. .,WJB Dorn VA Medical Center, Columbia, SC, USA.
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
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30
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Madianos PN, Koromantzos PA. An update of the evidence on the potential impact of periodontal therapy on diabetes outcomes. J Clin Periodontol 2017; 45:188-195. [DOI: 10.1111/jcpe.12836] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Phoebus N. Madianos
- Department of Periodontology; School of Dentistry; National and Kapodistrian University of Athens; Athens Greece
| | - Panagiotis A. Koromantzos
- Department of Periodontology; School of Dentistry; National and Kapodistrian University of Athens; Athens Greece
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31
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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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32
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Mizuno H, Ekuni D, Maruyama T, Kataoka K, Yoneda T, Fukuhara D, Sugiura Y, Tomofuji T, Wada J, Morita M. The effects of non-surgical periodontal treatment on glycemic control, oxidative stress balance and quality of life in patients with type 2 diabetes: A randomized clinical trial. PLoS One 2017; 12:e0188171. [PMID: 29145468 PMCID: PMC5689834 DOI: 10.1371/journal.pone.0188171] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/31/2017] [Indexed: 12/17/2022] Open
Abstract
Aim The purpose of this study was to investigate the effects of non-surgical periodontal treatment on hemoglobinA1c (HbA1c) levels, oxidative stress balance and quality of life (QOL) in patients with type 2 diabetes mellitus (T2DM) compared to no periodontal treatment (simple oral hygiene instructions only). Methods The design was a 6-month, single-masked, single center, randomized clinical trial. Patients had both T2DM and chronic periodontitis. Forty participants were enrolled between April 2014 and March 2016 at the Nephrology, Diabetology and Endocrinology Department of Okayama University Hospital. The periodontal treatment group (n = 20) received non-surgical periodontal therapy, including scaling and root planing plus oral hygiene instructions, and consecutive supportive periodontal therapy at 3 and 6 months. The control group (n = 17) received only oral hygiene instructions without treatment during the experimental period. The primary study outcome was the change in HbA1c levels from baseline to 3 months. Secondary outcomes included changes in oxidative stress balance (Oxidative-INDEX), the Diabetes Therapy-Related QOL and clinical periodontal parameters from baseline to 3 months and baseline to 6 months. Results Changes in HbA1c in the periodontal treatment group were not significantly different with those in the control group at 3 and 6 months. Systemic oxidative stress balance and QOL significantly improved in the periodontal treatment group compared to the control group at 3 months. In the subgroup analysis (moderately poor control of diabetes), the decrease in HbA1c levels in the periodontal treatment group was greater than that in the control group at 3 months but not significant. Conclusions In T2DM patients, non-surgical periodontal treatment improved systemic oxidative stress balance and QOL, but did not decrease HbA1c levels at 3 months follow-up. Trial registration Current Controlled Trials UMIN-ICDR UMIN 000013278 (Registered April 1, 2014).
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Affiliation(s)
- Hirofumi Mizuno
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Daisuke Ekuni
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Advanced Research Center for Oral and Craniofacial Sciences, Okayama University Dental School, Okayama, Japan
- * E-mail:
| | - Takayuki Maruyama
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Kota Kataoka
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiki Yoneda
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Daiki Fukuhara
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshio Sugiura
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takaaki Tomofuji
- Department of Community Oral Health, Asahi University School of Dentistry, Mizuho, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Manabu Morita
- Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Effects on HbA1c in diabetic patients of adjunctive use of systemic antibiotics in nonsurgical periodontal treatment: A systematic review. J Dent 2017; 66:1-7. [PMID: 28827017 DOI: 10.1016/j.jdent.2017.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/20/2017] [Accepted: 08/02/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the effects of adjunctive use of systemic antibiotics in nonsurgical periodontal treatment compared to nonsurgical periodontal treatment alone, on mean glycated hemoglobin (HbA1c) reductions in patients with diabetes. DATA Two independent reviewers screened six electronic databases, registers of clinical trials, meeting abstracts and four major dental journals for controlled clinical trials with at least 3-month follow-up. SOURCES After duplicates removal, electronic and hand searches yielded 2136 records; 32 full-text articles were independently read by two reviewers. To evaluate the additional effect of antibiotic usage, pooled weighted mean differences and 95% confidence intervals were calculated using fixed and random effects models. STUDY SELECTION Twelve studies met the inclusion criteria, nine of which provided data that allowed their inclusion in meta-analyses. The meta-analyses showed no significant effect favouring scaling and root planing (SRP) plus antibiotic for reductions in mean HbA1c (-0.11% [-0.35, 0.13]; 6 studies), and an estimated prediction interval varying from -0.45 to 0.23. There was also no significant effect favouring the adjunctive usage of sub-antimicrobial doxycycline in HbA1c mean reduction (-0.19% [-1.04, 0.67]; 2 studies). CONCLUSION Adjunctive use of systemic antibiotic provides no statistically significant benefit in terms of HbA1c improvement in periodontal treatment of patients with diabetes. CLINICAL SIGNIFICANCE Adjunctive use of systemic antibiotics associated with nonsurgical periodontal treatment provides no additional benefit in terms of HbA1c of diabetic patients. Clinicians should weigh the trade-off between risks and benefits provided by the use of systemic antibiotics before prescribing them for periodontal disease treatment.
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Goel K, Pradhan S, Bhattarai MD. Effects of nonsurgical periodontal therapy in patients with moderately controlled type 2 diabetes mellitus and chronic periodontitis in Nepalese population. Clin Cosmet Investig Dent 2017; 9:73-80. [PMID: 28761379 PMCID: PMC5522660 DOI: 10.2147/ccide.s138338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives Despite several investigations, evidence is still controversial regarding the effect of periodontal treatment on diabetes. This study evaluates and compares the effect on glycemic control and periodontal status with or without nonsurgical periodontal therapy in patients with type 2 diabetes mellitus and chronic periodontitis in a Nepalese population. Materials and methods A total of 82 patients attending the diabetes clinic and fulfilling enrollment criteria with moderate to severe periodontitis were selected. They were assigned in an alternative sequence, into test and control group. Both groups were instructed to continue with their medical treatment without modifications. Scaling and root surface debridement were performed in the test group whereas the control group received oral hygiene instructions with no treatment during the 3-month study period. Results There were 41 participants in each group with the mean age of 50.66±7.70 and 53.80±9.16 years, average diabetes duration of 6.32±4.21 and 6.24±4.00 years, mean body mass index of 24.78±1.85 and 24.6±1.79 kg/m2, and glycated hemoglobin (HbA1c) level of 6.71±0.50% and 6.80±0.45%, in the test and control group, respectively. After 3 months, there was significant reduction in HbA1c levels in the test group compared to the control group (p=0.029). Clinical periodontal parameters of gingival index, probing depth (PD), and clinical attachment level (CAL) significantly improved in the test group (p<0.001) with PD reduction by 0.9 mm and gain in CAL by 0.3 mm compared to the control group (p>0.001) who showed an increase by 0.05 mm. Conclusion This study showed that nonsurgical periodontal therapy may have a beneficial effect on HbA1c level in moderately controlled type 2 diabetic patients.
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Affiliation(s)
- Khushboo Goel
- Department of Periodontology and Oral Implantology, College of Dental Surgery, B.P. Koirala Institute of Health Sciences, Dharan
| | - Shaili Pradhan
- Department of Dental Surgery, Periodontics Unit, Bir Hospital
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钟 素, 倪 佳, 柴 巧, 陈 蕾, 章 锦. [Effects of non-surgical periodontal therapy on serum inflammatory markers and metabolic level in obese rats]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:807-811. [PMID: 28669957 PMCID: PMC6744135 DOI: 10.3969/j.issn.1673-4254.2017.06.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the effects of non-surgical periodontal therapy on serum inflammatory factors and metabolism levels in obese rats with experimental periodontitis. METHODS Sixteen obese rats with experimental periodontitis were randomly divided into treatment group and control group with non-surgical periodontal therapy and no treatment, respectively. Oral glucose tolerance test was performed before treatment and 2 weeks after the treatment. All the rats were sacrificed 2 weeks after treatment and the orbital vein blood was taken to detect fasting blood glucose, fasting insulin, and serum level of C-reactive protein (CRP). Results Two weeks after periodontal treatment, fasting blood glucose (t=2.445, P=0.034) and beta cell function index (t=-2.543, P=0.027) were significantly lower in the treatment group than in the control group. Compared with those in the control group, CRP level (t=2.388, P=0.028) and the area under the curve in the oral glucose tolerance test (t=12.053, P=0.000) decreased significantly in the treatment group. CONCLUSION Non-surgical periodontal treatment can reduce serum CRP level and improve glucose metabolism in obese rats.
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Affiliation(s)
- 素兰 钟
- 南方医科大学口腔医院//广东省口腔医院牙体牙髓科，广东 广州 510515Department of Endodontics, Affiliated Hospital of Stomatology of Southern Medical University/Guangdong Provincial Stomatological Hospital, Guangzhou 510515, China
| | - 佳 倪
- 南方医科大学口腔医院//广东省口腔医院牙体牙髓科，广东 广州 510515Department of Endodontics, Affiliated Hospital of Stomatology of Southern Medical University/Guangdong Provincial Stomatological Hospital, Guangzhou 510515, China
| | - 巧学 柴
- 南方医科大学口腔医院//广东省口腔医院牙体牙髓科，广东 广州 510515Department of Endodontics, Affiliated Hospital of Stomatology of Southern Medical University/Guangdong Provincial Stomatological Hospital, Guangzhou 510515, China
| | - 蕾 陈
- 南方医科大学口腔医院//广东省口腔医院牙体牙髓科，广东 广州 510515Department of Endodontics, Affiliated Hospital of Stomatology of Southern Medical University/Guangdong Provincial Stomatological Hospital, Guangzhou 510515, China
| | - 锦才 章
- 中国科学院大学存济医学院，北京University of Chinese Academy of Sciences, Beijing 100049, China
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Glurich I, Nycz G, Acharya A. Status Update on Translation of Integrated Primary Dental-Medical Care Delivery for Management of Diabetic Patients. Clin Med Res 2017; 15:21-32. [PMID: 28373288 PMCID: PMC5572842 DOI: 10.3121/cmr.2017.1348] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/02/2017] [Accepted: 03/24/2017] [Indexed: 02/08/2023]
Abstract
Escalating prevalence of both diabetes and periodontal disease, two diseases associated with bi-directional exacerbation, has been reported. Periodontal disease represents a modifiable risk factor that may reduce diabetes onset or progression, and integrated models of cross-disciplinary care are needed to establish and manage glycemic control in affected patients. An ad-hoc environmental scan of current literature and media sought to characterize factors impacting status of integrated care models based on review of the existing evidence base in literature and media surrounding: (1) current cross-disciplinary practice patterns, (2) epidemiological updates, (3) status on risk assessment and screening for dysglycemia in the dental setting, (4) status on implementation of quality metrics for oral health, (5) care model pilots, and (6) public health perspectives. The survey revealed: escalating prevalence of diabetes and periodontitis globally; greater emphasis on oral health assessment for diabetic patients in recent medical clinical practice guidelines; high knowledgeability surrounding oral-systemic impacts on diabetes and growing receptivity to medical-dental integration among medical and dental providers; increasing numbers of programs/studies reporting on positive impact of emerging integrated dental-medical care models on diabetic patient healthcare access and health outcomes; a growing evidence base for clinically significant rates of undiagnosed dysglycemia among dental patients reported by point-of-care pilot studies; no current recommendation for population-based screening for dysglycemia in dental settings pending a stronger evidence base; improved definition of true periodontitis prevalence in (pre)/diabetics; emerging recognition of the need for oral health quality indicators and tracking; evidence of persistence in dental access disparity; updated status on barriers to integration. The potential benefit of creating clinically-applicable integrated care models to support holistic management of an escalating diabetic population by targeting modifiable risk factors including periodontitis is being recognized by the health industry. Cross-disciplinary efforts supported by high quality research are needed to mitigate previously- and newly-defined barriers of care integration and expedite development and implementation of integrated care models in various practice settings. Implementation of quality monitoring in the dental setting will support definition of the impact and efficacy of interventional clinical care models on patient outcomes.
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Affiliation(s)
- Ingrid Glurich
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Gregory Nycz
- Family Health Center of Marshfield, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - Amit Acharya
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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Evaluation of Recombinant Human FGF-2 and PDGF-BB in Periodontal Regeneration: A Systematic Review and Meta-Analysis. Sci Rep 2017; 7:65. [PMID: 28246406 PMCID: PMC5427916 DOI: 10.1038/s41598-017-00113-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/07/2017] [Indexed: 02/05/2023] Open
Abstract
The prognosis for successful treatment of periodontal diseases is generally poor. Current therapeutic strategies often fail to regenerate infected periodontium. Recently an alternative strategy has been developed that combines conventional treatment with the application of recombinant human growth factors (rhGFs). But ambiguities in existed studies on the clinical efficacy of rhGFs do not permit either the identification of the specific growth factors effective for therapeutic interventions or the optimal concentration of them. Neither is it known whether the same rhGF can stimulate regeneration of both soft tissue and bone, or whether different patient populations call for differential use of the growth factors. In order to explore these issues, a meta-analysis was carried out. Particular attention was given to the therapeutic impact of fibroblast growth factor 2(FGF-2) and platelet derived growth factor BB (PDGF-BB). Our findings indicate that 0.3% rhFGF-2 and 0.3 mg/ml rhPDGF-BB show a greater capacity for periodontal regeneration than other concentrations and superiority to control groups with statistical significance. In the case of patients suffering only from gingival recession, however, the application of rhPDGF-BB produces no significant regenerative advantage. The findings of this study can potentially endow clinicians with guidelines for the appropriate application of these two rhGFs.
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Hasuike A, Iguchi S, Suzuki D, Kawano E, Sato S. Systematic review and assessment of systematic reviews examining the effect of periodontal treatment on glycemic control in patients with diabetes. Med Oral Patol Oral Cir Bucal 2017; 22:e167-e176. [PMID: 28160589 PMCID: PMC5359698 DOI: 10.4317/medoral.21555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/28/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES There have been several systematic reviews(SRs) on whether periodontal treatment for an individual with both periodontal disease and diabetes can improve diabetes outcomes. The purpose of this investigation was to conduct a systematic review (SR) of previous meta-analyses, and to assess the methodological quality of the SRs examining the effects of periodontal treatment and diabetes. (PROSPERO Registration # CRD 42015023470). STUDY DESIGN We searched five electronic databases and identified previous meta-analyses of randomized controlled trials published through July 2015. In cases where the meta-analysis did not meet our criteria, the meta-analyses were recalculated. General characteristics of each included trial were abstracted, analyzed, and compared. The mean difference, 95% confidence intervals (CIs) and the I2 statistic were abstracted or recalculated. The Assessment of Multiple Systematic Reviews Instrument (AMSTAR) was used to assess methodological quality. RESULTS Of the 475 citations screened, nine systematic reviews were included. In total, 13 meta-analyses included in nine SRs were examined. In comparability analyses, meta-analyses in four SRs did not meet our criteria, and were recalcuated. Of these 13 meta-analyses, 10 suggested significant effects of periodontal treatment on HbA1c improvement. Mean differences found in the 13 meta-analyses ranged from -0.93 to 0.13. AMSTAR assessment revealed six SRs with moderate and three with high overall quality. CONCLUSIONS We can conclude that there is a significant effect of periodontal treatment on improvement of HbA1c in diabetes patients, although the effect size is extremely small. In addition to the small effect size, not all SRs could be considered of high quality.
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Affiliation(s)
- A Hasuike
- Department of Periodontology, Nihon University School of Dentistry, 1-8-13, Kanda Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan,
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Demmer RT, Breskin A, Rosenbaum M, Zuk A, LeDuc C, Leibel R, Paster B, Desvarieux M, Jacobs DR, Papapanou PN. The subgingival microbiome, systemic inflammation and insulin resistance: The Oral Infections, Glucose Intolerance and Insulin Resistance Study. J Clin Periodontol 2017; 44:255-265. [PMID: 27978598 DOI: 10.1111/jcpe.12664] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Inflammation might link microbial exposures to insulin resistance. We investigated the cross-sectional association between periodontal microbiota, inflammation and insulin resistance. METHODS The Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS) enrolled 152 diabetes-free adults (77% female) aged 20-55 years (mean = 34 ± 10). Three hundred and four subgingival plaque samples were analysed using the Human Oral Microbe Identification Microarray to measure the relative abundances of 379 taxa. C-reactive protein, interleukin-6, tumour necrosis factor-α and adiponectin were assessed from venous blood and their z-scores were summed to create an inflammatory score (IS). Insulin resistance was defined via the HOMA-IR. Associations between the microbiota and both inflammation and HOMA-IR were explored using multivariable linear regressions; mediation analyses assessed the proportion of the association explained by inflammation. RESULTS The IS was inversely associated with Actinobacteria and Proteobacteria and positively associated with Firmicutes and TM7 (p-values < 0.05). Proteobacteria levels were associated with insulin resistance (p < 0.05). Inflammation explained 30-98% of the observed associations between levels of Actinobacteria, Proteobacteria or Firmicutes and insulin resistance (p-values < 0.05). Eighteen individual taxa were associated with inflammation (p < 0.05) and 22 with insulin resistance (p < 0.05). No findings for individual taxa met Bonferroni-adjusted statistical significance. CONCLUSION Bacterial measures were related to inflammation and insulin resistance among diabetes-free adults.
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Affiliation(s)
- Ryan T Demmer
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alexander Breskin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Michael Rosenbaum
- Division of Molecular Genetics, Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | - Aleksandra Zuk
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Charles LeDuc
- Division of Molecular Genetics, Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | - Rudolph Leibel
- Division of Molecular Genetics, Departments of Pediatrics and Medicine, Columbia University, New York, NY, USA
| | - Bruce Paster
- Department of Molecular Genetics, The Forsyth Institute, Cambridge, MA, USA.,Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Moïse Desvarieux
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.,Centre de recherche Epidémiologies et Biostatistique, INSERM U1153 Equipe: Méthodes en évaluation thérapeutique des maladies chroniques, Paris, France
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Panos N Papapanou
- Division of Periodontics, Section of Oral and Diagnostic Sciences, College of Dental Medicine, Columbia University, New York, NY, USA
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Teshome A, Yitayeh A. The effect of periodontal therapy on glycemic control and fasting plasma glucose level in type 2 diabetic patients: systematic review and meta-analysis. BMC Oral Health 2016; 17:31. [PMID: 27473177 PMCID: PMC4967318 DOI: 10.1186/s12903-016-0249-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/12/2016] [Indexed: 12/14/2022] Open
Abstract
Background Diabetic mellitus and periodontal disease have bilateral associations. However, there is a dilemma on the effect of periodontal therapy on glycemic control and/or fasting plasma glucose level in type 2 diabetic patients with periodontitis. Therefore, this review aimed to assess the effectiveness of periodontal therapy versus no periodontal therapy on glycated hemoglobin (HbA1c) and fasting plasma glucose level in type 2 diabetic patients. Methods Article searching was done using four databases (MEDLINE, Cochrane library (CENTRAL), EMBASE and CINAHL) and a manual search (until December 2015). We included randomized controlled trials testing the effectiveness of periodontal therapy on glycated hemoglobin and fasting plasma glucose level in patients with type 2 Diabetes mellitus with periodontal disease. Studies published in English between 2005 and 2015 were included. Risk of bias was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases. Results After the article selection process, seven Randomized controlled trials involving 940 participants with a primary outcome of change in glycated hemoglobin and/or fasting plasma glucose and having a minimum of 3 months follow-up were included. There was a reduction of glycated hemoglobin 0.48(95 % CI: 0.18–0.78) after 3 months follow-up and 0.53 (95 % CI: 0.24–0.81) at the end of the intervention period. There was also a significant reduction of fasting plasma glucose level, 8.95 mg/dl (95 % CI: 4.30–13.61) in the intervention group after the end of the intervention. The pooled analysis showed that patients with adjunctive antibiotic therapy and mouth wash had effect size of 0.51(0.03, 1.00, p = 0.04) and it was 0.53 (95 % CI: 0.19, 0.87; p = 0.002) in patients without adjunctive therapy. The publication bias of the studies was 0.066 according to Egger’s test. Conclusion In this systematic review and meta-analysis, there is a significant reduction of Glycated hemoglobin and Fasting plasma glucose level on type 2 diabetic and periodontal patients with non-surgical periodontal therapy.
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Affiliation(s)
- Amare Teshome
- Department of Dentistry, College of Medicine and Health Sciences, University of Gondar, Gondar, P.O. Box 196, Ethiopia.
| | - Asmare Yitayeh
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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El-Sharkawy HM, Anees MM, Van Dyke TE. Propolis Improves Periodontal Status and Glycemic Control in Patients With Type 2 Diabetes Mellitus and Chronic Periodontitis: A Randomized Clinical Trial. J Periodontol 2016; 87:1418-1426. [PMID: 27468795 DOI: 10.1902/jop.2016.150694] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Propolis is a natural resin made by bees from various plant sources and exerts antimicrobial, anti-inflammatory, immunomodulatory, antioxidant, and antidiabetic properties. The purpose of this study is to assess adjunctive benefit of propolis supplementation in individuals with chronic periodontitis (CP) and type 2 diabetes mellitus (DMt2) receiving scaling and root planing (SRP). METHODS A 6-month masked, randomized clinical trial comparing SRP with placebo (placebo + SRP group, n = 26) or SRP combined with a 6-month regimen of 400 mg oral propolis once daily (propolis + SRP group, n = 24) was performed in patients with long-standing DMt2 and CP. Treatment outcomes included changes in hemoglobin (Hb) A1c (primary outcome), fasting plasma glucose (FPG), serum N€-(carboxymethyl) lysine (CML), and periodontal parameters (secondary outcomes). RESULTS After 3 and 6 months, average HbA1c levels in the propolis group decreased significantly by 0.82% and 0.96% units, respectively (P <0.01); however, there were no significant differences in the placebo group. Likewise, FPG and CML levels were significantly reduced in the propolis group, but not in the placebo group. After therapy, periodontal parameters of CP were significantly improved in both groups. The propolis group showed significantly greater probing depth reduction and clinical attachment level gain than the control group after 3 and 6 months. CONCLUSION A 6-month regimen of 400 mg propolis once daily is a potentially viable adjunct to SRP that significantly reduces levels of HbA1c, FPG, and CML, and improves periodontal therapy outcome in people with DMt2 and CP.
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Affiliation(s)
- Hesham M El-Sharkawy
- Department of Periodontology and Oral Medicine, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Mohamed M Anees
- Department of Periodontology and Oral Medicine, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Thomas E Van Dyke
- Department of Applied Oral Sciences, Forsyth Institute, Cambridge, MA
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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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Faggion CM, Cullinan MP, Atieh M. An overview of systematic reviews on the effectiveness of periodontal treatment to improve glycaemic control. J Periodontal Res 2016; 51:716-725. [PMID: 26913689 DOI: 10.1111/jre.12358] [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] [Accepted: 11/28/2015] [Indexed: 01/08/2023]
Abstract
Several systematic reviews with meta-analyses on the effectiveness of periodontal treatment to improve glycaemic control have been published. So far no overview of these systematic reviews has been performed. The main objective of this report was to assess critically these systematic reviews to provide the reader with a high-level synthesis of research evidence. MEDLINE (via PubMed) and EMBASE databases were searched independently and in duplicate to identify systematic reviews with meta-analyses of clinical studies that assessed the relationship between diabetes mellitus and periodontitis. The last database search was performed on 10 March 2015. The reference lists of included systematic reviews were also scrutinized for further publications. The methodological quality of the included systematic reviews was assessed independently with two validated checklists (AMSTAR and OQAQ) by two authors. Disagreements in the assessment were resolved by consensus. A total of 226 potential publications were initially retrieved. Eleven systematic reviews with meta-analyses were finally included. Glycosylated haemoglobin A1c (HbA1c) was the most commonly used clinical endpoint. Meta-analytic estimates from systematic reviews generated an average reduction of 0.46% (median 0.40%) of HbA1c in patients with diabetes mellitus who received periodontal treatment. These meta-analyses had, nevertheless, methodological limitations such as inclusion of trials with different types of risk of bias that hinder more robust conclusions. A recent meta-analysis that included recently published large randomized controlled trials did not show significant change in the level of HbA1c at the 6 mo follow-up. The AMSTAR checklist generated results that were more conservative than OQAQ. Findings from this overview do not support the information that periodontal treatment may improve glycaemic control. Methodological issues described in this overview may guide further research on this topic.
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Affiliation(s)
- C M Faggion
- Department of Periodontology and Operative Dentistry, Faculty of Dentistry, University of Münster, Münster, Germany
| | - M P Cullinan
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - M Atieh
- Oral Implantology Research Group, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Merchant AT, Nahhas GJ, Wadwa RP, Zhang J, Tang Y, Johnson LR, Maahs DM, Bishop F, Teles R, Morrato EH. Periodontal Microorganisms and Cardiovascular Risk Markers in Youth With Type 1 Diabetes and Without Diabetes. J Periodontol 2015; 87:376-84. [PMID: 26616842 DOI: 10.1902/jop.2015.150531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND A subset of periodontal microorganisms has been associated with cardiovascular disease (CVD), which is the leading complication of type 1 diabetes (t1DM). The authors therefore evaluated the association between periodontal microorganism groups and early markers of CVD in youth with t1DM. METHODS A cross-sectional analysis was conducted among youth aged 12 to 19 years at enrollment; 105 had t1DM for ≥5 years and were seeking care at the Barbara Davis Center, University of Colorado, from 2009 to 2011, and 71 did not have diabetes. Subgingival plaque samples were assessed for counts of 41 periodontal microorganisms using DNA-DNA hybridization. Microorganisms were classified using cluster analysis into four groups named red-orange, orange-green, blue/other, and yellow/other, modified from Socransky's color scheme for periodontal microorganisms. Subsamples (54 with t1DM and 48 without diabetes) also received a periodontal examination at the University of Colorado School of Dental Medicine. RESULTS Participants were ≈15 years old on average, and 74% were white. Mean periodontal probing depth was 2 mm (SE 0.02), and 17% had bleeding on probing. In multivariable analyses, glycated hemoglobin (HbA1c) was inversely associated with the yellow/other cluster (microorganisms that are not associated with periodontal disease) among youth with t1DM. Blood pressure, triglycerides, low-density lipoprotein, high-density lipoprotein, and total cholesterol were not associated with microorganism clusters in this group. HbA1c was not associated with periodontal microorganism clusters among youth without diabetes. CONCLUSION Among youth with t1DM who had good oral health, periodontal microorganisms were not associated with CVD risk factors.
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Affiliation(s)
- Anwar T Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Georges J Nahhas
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - R Paul Wadwa
- University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Yifan Tang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | | | - David M Maahs
- University of Colorado, Anschutz Medical Campus, Aurora, CO
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Abstract
Periodontal diseases are the most common human diseases globally, with gingivitis affecting up to 90% and periodontitis affecting 50% of adults. Tooth enamel is the only nonshedding tissue in the human body. In the absence of proper oral hygiene measures, microbial biofilm (dental plaque) develops on the teeth to include more than 700 different bacterial species, along with viruses, fungi, archea, and parasites. With time, ecological imbalances promote the growth of selected commensal species that induce host inflammatory pathways resulting in tissue destruction, including ulceration of the periodontal epithelium.
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Affiliation(s)
- Wenche S Borgnakke
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Avenue, Room# G049, Ann Arbor, MI 48109-1078, USA.
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Affiliation(s)
- Jean-Noel Vergnes
- Paul Sabatier University, Dental Faculty, Department of Epidemiology and Public Health, Toulouse, France and Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
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Kowall B, Holtfreter B, Völzke H, Schipf S, Mundt T, Rathmann W, Kocher T. Pre-diabetes and well-controlled diabetes are not associated with periodontal disease: the SHIP Trend Study. J Clin Periodontol 2015; 42:422-30. [DOI: 10.1111/jcpe.12391] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Bernd Kowall
- German Diabetes Center; Institute of Biometrics and Epidemiology; Düsseldorf Germany
- Center of Clinical Epidemiology; c/o Institute of Medical Informatics, Biometry and Epidemiology (IMIBE); University Hospital; Essen Germany
| | - Birte Holtfreter
- Unit of Periodontology; Department of Restorative Dentistry, Periodontology, and Endodontology; University Medicine; Ernst-Moritz-Arndt-University; Greifswald Germany
| | - Henry Völzke
- Institute for Community Medicine; University Medicine; Ernst-Moritz-Arndt-University; Greifswald Germany
| | - Sabine Schipf
- Institute for Community Medicine; University Medicine; Ernst-Moritz-Arndt-University; Greifswald Germany
| | - Torsten Mundt
- Department of Prosthodontics, Gerodontology and Biomaterials; Dental School; University Medicine; Ernst-Moritz-Arndt-University; Greifswald Germany
| | - Wolfgang Rathmann
- German Diabetes Center; Institute of Biometrics and Epidemiology; Düsseldorf Germany
| | - Thomas Kocher
- Unit of Periodontology; Department of Restorative Dentistry, Periodontology, and Endodontology; University Medicine; Ernst-Moritz-Arndt-University; Greifswald Germany
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Kuehl MN, Rodriguez H, Burkhardt BR, Alman AC. Tumor Necrosis Factor-α, Matrix-Metalloproteinases 8 and 9 Levels in the Saliva Are Associated with Increased Hemoglobin A1c in Type 1 Diabetes Subjects. PLoS One 2015; 10:e0125320. [PMID: 25915398 PMCID: PMC4411091 DOI: 10.1371/journal.pone.0125320] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/14/2015] [Indexed: 11/19/2022] Open
Abstract
Background Type 1 diabetes (T1D) is an autoimmune disease resulting in the targeted destruction of pancreatic β-cells and permanent loss of insulin production. Proper glucose management results in better clinical outcomes for T1D and provides a strong rationale to identify non-invasive biomarkers indicative or predictive of glycemic control. Therefore, we investigated the association of salivary inflammation with HbA1c in a T1D cohort. Methods Unstimulated saliva was collected from 144 subjects with T1D at the USF Diabetes Center. BMI, duration of diabetes, and HbA1c were recorded during clinical visit. Levels of interleukin (IL)-1β, -6, -8, -10, IFN-γ, TNF-α, MMP-3, -8, and -9 were measured using multiplexing immunoassay analysis. To account for smoking status, salivary cotinine levels were also determined. Results Multiple linear (HbA1c) and logistic (self-reported gingival condition) regression analyses were performed to examine the relationships between the Principal Component Analysis (PCA) components and HbA1c and gingival condition (adjusted for age, duration of diabetes, BMI, and sex; model for HbA1c also adjusted for gingival condition and model for gingival condition also adjusted for HbA1c). PCA components 1 (MMP-8 and MMP-9) and 3 (TNF-α) were significantly associated with HbA1c (β = 0.28 ±0.14, p = 0.045; β = 0.31 ±0.14, p = 0.029), while PCA component 2 (IL-6, IL-1β, and IL-8) was significantly associated with gingival condition (OR 1.60 95% CI 1.09–2.34, p = 0.016). In general, increased salivary inflammatory burden is associated with decreased glycemic control and self-reported gingival condition. Conclusions The saliva may represent a useful reservoir of novel noninvasive inflammatory biomarkers predictive of the progression and control of T1D.
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Affiliation(s)
- Melanie N. Kuehl
- Department of Cell Biology, Microbiology and Molecular Biology, University of South Florida, Tampa, Florida, the United States of America
| | - Henry Rodriguez
- Diabetes Center, College of Medicine, University of South Florida, Tampa, Florida, the United States of America
| | - Brant R. Burkhardt
- Department of Cell Biology, Microbiology and Molecular Biology, University of South Florida, Tampa, Florida, the United States of America
- Diabetes Center, College of Medicine, University of South Florida, Tampa, Florida, the United States of America
- * E-mail:
| | - Amy C. Alman
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida, United States of America
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