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Hennrich P, Queder A, Altiner A, Awounvo S, Dyczmons J, Eigendorf J, Erdmann S, Grobe T, Gutscher A, Herzig N, Jepsen S, Kairies-Schwarz N, Kalmus O, Kliemannel F, Santos S, Vanella P, Wensing M, Wilm S, Listl S. Implementation of integrated care for type 2 diabetes Mellitus and Periodontitis in Germany: study protocol for a practice-based and cluster-randomized trial. BMC Oral Health 2024; 24:879. [PMID: 39095753 PMCID: PMC11297783 DOI: 10.1186/s12903-024-04672-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Type 2 Diabetes mellitus (T2DM) and periodontitis share common risk factors and influence one another. However, primary care and oral health care continue to operate separate from each other and fail to synchronize care for patients with T2DM and periodontitis. The purpose of this practice-based trial is to evaluate the implementation of a new integrated care pathway for patients with T2DM and periodontitis. The new approach integrates a screening for T2DM risk in dental care settings in patients with periodontitis, a screening for periodontitis risk in primary care settings in patients with T2DM, and mutual referrals between dentists and primary care physicians. METHODS Two practice-based studies will be carried out in parallel: (i) In dental care settings: a practice-based, multi-centric, cluster-randomized, controlled trial with a control and an intervention group; (ii) in primary care settings: a practice-based, multi-centric, non-randomized, controlled trial with a synthetic control group calculated from claims data. Following a two-step recruitment approach, 166 dentists and 248 general practitioners will be recruited, who themselves will recruit a total of 3808 patients in their practices. Patient data will be collected at baseline, 12 months, and 24 months after study enrollment. The evaluation comprises: (i) impact evaluation, using a hierarchical linear mixed model; (ii) process evaluation, based on surveys alongside the trials; (iii) economic evaluation. In addition, a Discrete-Choice-Experiment will identify provider's payment preferences for the new care approach. DISCUSSION Upon successful implementation, the intervention will enable health care providers to detect a risk for T2DM and periodontitis in patients at an early stage, thus providing patients an opportunity for timely diagnosis and therapy. Ultimately, this can lead to increased quality of life and reduced health care expenditures. On a methodologic level, the project provides novel insights into a complex intervention on the intersection of general practice and dental care. TRIAL REGISTRATION The study was prospectively registered at the German Clinical Trials Register ( https://drks.de/search/de/trial/DRKS00030587 ) on 3. July 2023 under ID "DRKS00030587".
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Affiliation(s)
- Patrick Hennrich
- Heidelberg Institute of Global Health Section for Oral Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Annika Queder
- Department for General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Attila Altiner
- Department for General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Sinclair Awounvo
- Heidelberg University Hospital Institute of Medical Biometry, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Jan Dyczmons
- Düsseldorf University Hospital Institute for Health Services Research and Health Economics, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Julian Eigendorf
- aQua-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany
| | - Stella Erdmann
- Heidelberg University Hospital Institute of Medical Biometry, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Thomas Grobe
- aQua-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany
| | - Andreas Gutscher
- aQua-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany
| | - Nicole Herzig
- Techniker Krankenkasse, Bramfelder Str. 140, 22305, Hamburg, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, Bonn University Hospital, Welschnonnenstr. 17, 53111, Bonn, Germany
| | - Nadja Kairies-Schwarz
- Düsseldorf University Hospital Institute for Health Services Research and Health Economics, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Olivier Kalmus
- Heidelberg Institute of Global Health Section for Oral Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Fabian Kliemannel
- aQua-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany
| | - Sara Santos
- Düsseldorf University Hospital Institute of General Practice, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Patrizio Vanella
- aQua-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany
| | - Michel Wensing
- Department for General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Stefan Wilm
- Düsseldorf University Hospital Institute of General Practice, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Stefan Listl
- Heidelberg Institute of Global Health Section for Oral Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Xu X, Lu H, Huo P, Jin D, Zhu Y, Meng H. Effects of amoxicillin and metronidazole as an adjunct to scaling and root planing on glycemic control in patients with periodontitis and type 2 diabetes: A short-term randomized controlled trial. J Periodontal Res 2024; 59:249-258. [PMID: 38115631 DOI: 10.1111/jre.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To assess the effects of amoxicillin and metronidazole with scaling and root planing (SRP) on periodontal parameters and glycemic control in patients with severe periodontitis and diabetes mellitus. BACKGROUND Adjunctive antibiotics use is advantageous for treating periodontitis in patients with severe periodontitis and diabetes. However, the effects of adjunctive antibiotic use on hemoglobin A1c (HbA1c) levels remain unclear. METHODS This short-term, randomized controlled trial enrolled patients with severe periodontitis and type 2 diabetes. The patients were randomly allocated to SPR only (i.e., control) or SPR + antibiotics (500 mg of amoxicillin and 200 mg of metronidazole, three times daily for 7 days) groups. Periodontal and hematological parameters were assessed at baseline and 3 months after treatment. Inter- and intra-group analyses were performed using Student's t-tests, Mann-Whitney U tests, and the binary logistic regression models. p-values of <.05 were considered statistically significant. RESULTS This study enrolled 49 patients, with 23 and 26 patients in the SRP-only and SRP + antibiotics groups, respectively. The periodontal parameters improved significantly and similarly in both groups after treatment (p < .05). The SRP + antibiotics group had more sites of improvement than the SRP-only group when the initial probing depth was >6 mm. (698 [78.96%] vs. 545 [73.35%], p = .008). The HbA1c levels decreased in the SRP-only and SRP + antibiotics groups after treatment (0.39% and 0.53%, respectively). The multivariable binary logistic regression model demonstrated that antibiotics administration and a high baseline HbA1c level were associated with a greater reduction in the HbA1c level (odds ratio = 4.551, 95% confidence interval: 1.012-20.463; odds ratio = 7.162, 95% confidence interval: 1.359-37.753, respectively). CONCLUSIONS SRP and SRP plus systemic antibiotics were beneficial for glycemic control. Adjunctive antibiotic use slightly improved the outcome for patients with severe periodontitis and poorly controlled diabetes.
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Affiliation(s)
- Xinran Xu
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - He Lu
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Pengcheng Huo
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Dongsiqi Jin
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Yunxuan Zhu
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Huanxin Meng
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, China
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Wu SY, Wu CY, Lin LY, Chen YH, Huang HY, Lai YL, Lee SY. Systemic antibiotics adjuvants to scaling and root planing in type 2 diabetic and periodontitis individuals: Systematic review with network meta-analysis. JAPANESE DENTAL SCIENCE REVIEW 2023; 59:167-178. [PMID: 38152384 PMCID: PMC10751746 DOI: 10.1016/j.jdsr.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/04/2023] [Indexed: 12/29/2023] Open
Abstract
Targeting inflammatory pathways is considered a common strategy to control type 2 diabetes (T2D) and periodontitis. This overview was to validate systemic antibiotics as an adjuvant to scaling and root planing (SRP) for the treatments of periodontal patients with T2D. Literature searches were conducted using Web of Science, PubMed, Cochrane, and EMBASE. Randomized trials comparing SRP and systemic antibiotics on glycated hemoglobin (HbA1c) and probing pocket depth (PPD) in adults with T2D and periodontitis were analyzed using network meta-analysis and meta-regression. At 3-month postintervention, meta-analyses of 16 studies revealed that SRP and SRP plus systemic antibiotics (SRPa) had similar significant effects in reducing HbA1c levels of - 0.72% and - 0.96% respectively. While SRP and SRPa also, respectively, reduced PPD of - 0.67 and - 0.89 mm, SRPa showed a better reduction than SRP. At 6-month postintervention, meta-analyses of 7 trials revealed that only SRP was effective in reducing HbA1c levels (-0.29%) but not SRPa. Although both SRP and SRPa still significantly reduced PPD by - 0.56 and - 0.81 mm, respectively, there was no difference between them. The current overview suggested that routine SRP alone is highly recommended for patients with T2D and periodontitis, since systemic antibiotics as an adjuvant provide a rather short-term effect.
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Affiliation(s)
- Shih-Yun Wu
- Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Yi Wu
- Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang-Yu Lin
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-hsuan Chen
- Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Yi Huang
- Information Management Office, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Lin Lai
- Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shyh-Yuan Lee
- Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Afrasiabi S, Heidari M, Younespour S, Chiniforush N. Evaluating the effect of mechanical debridement with adjunctive antimicrobial photodynamic therapy in comparison with mechanical debridement alone on the peri-implant parameters in type 2 diabetic mellitus patients with peri-implantitis: a systematic review and meta-analysis. BMC Oral Health 2023; 23:751. [PMID: 37828479 PMCID: PMC10571232 DOI: 10.1186/s12903-023-03337-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/19/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a major risk factor for localized diseases such as peri-implantitis that may affect ideal implant treatment. This study was aimed to evaluate the effect of mechanical debridement (MD) + antimicrobial photodynamic therapy (a-PDT) in patients with peri-implantitis who have T2DM in terms of bleeding on probing (BOP) and probing depth (PD) as primary outcomes and plaque index (PI) and crestal bone loss (CBL) as secondary outcomes. METHODS Publications compared outcomes between MD + aPDT and MD alone in T2DM patients with peri-implantitis, containing more than 3-month follow-up duration, were involved in the systematic review and meta-analysis. Literature until July 2023 using MEDLINE (through PubMed), Scopus, Cochrane Library, Embase, Web of Science, and Google Scholar were collected. RESULTS Two randomized controlled trials (RCTs, 88 individuals) and one controlled clinical trial (CCT, 67 individuals) with follow-up periods ranged from 3 to 12 months were recruited. All studies used diode laser with wavelengths ranged from 660 to 810 nm. The results demonstrated that the MD + aPDT group showed significant benefits for BOP reduction after 6 months (SMD = -2.15, 95% CI: -3.78 to -0.51, p = 0.01). However, a great amount of heterogeneity was observed (I2 = 91.52%, p < 0.001). Moreover, there was a significant difference between MD + aPDT and MD alone groups in CBL (SMD = -0.69, 95% CI: -1.07 to -0.30, p < 0.001). In addition, homogeneity assumption was satisfied (I2 = 22.49%, p = 0.28). Significant differences in PD and PI reduction were not found except for PI reduction after 3 months (SMD = -0.79, 95% CI: -1.24 to -0.33, p < 0.001. Also, no heterogeneity was observed (I2 = 0.00%, p = 0.47). CONCLUSION Given that high heterogeneity in BOP and PD outcome was found in this systematic review, future long-term CTs with MD + aPDT should be examined to arrive at a firm conclusion.
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Affiliation(s)
- Shima Afrasiabi
- Laser Research Center of Dentistry, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Heidari
- Dental Implant Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Younespour
- Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nasim Chiniforush
- Laser Research Center of Dentistry, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
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Li B, Du M, Sun Q, Cao Z, He H. m 6 A demethylase Fto regulates the TNF-α-induced inflammatory response in cementoblasts. Oral Dis 2023; 29:2806-2815. [PMID: 36227651 DOI: 10.1111/odi.14396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/21/2022] [Accepted: 10/04/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Apical periodontitis is the most frequently occurring pathological lesion. Fat mass and obesity-associated protein (Fto) is the first identified RNA N6-methyladenosine demethylase. However, whether Fto regulates apical periodontitis remains unclear. This study aimed to explore the mechanisms of Fto in the tumor necrosis factor-α (TNF-α)-induced inflammatory response. MATERIALS AND METHODS We established an apical periodontitis model. An immortalized cementoblast cell line (OCCM-30) cells were exposed to TNF-α. Fto, Il6, Mcp1, and Mmp9 expressions were assessed by qRT-PCR. We knocked down Fto using lentiviruses and detected TNF-α-induced inflammation-related gene expressions and mRNA stability. RESULTS Mice with apical periodontitis showed downregulation of Fto expression. OCCM-30 cells exposed to TNF-α showed an upregulation of inflammation-related genes with a decrease in Fto. Furthermore, knockdown of Fto promoted the expressions of Il6, Mcp1, and Mmp9 in TNF-α-treated OCCM-30 cells as compared with negative control cells, whereas it did not affect the mRNA stability. Interestingly, Fto knockdown activated the p65, p38, and ERK1/2 pathways, and it slightly activated the JNK signaling pathway after TNF-α administration in OCCM-30 cells. CONCLUSION A TNF-α-induced decrease in the expression of Fto might play a critical role in the inflammatory response in cementoblasts, and knockdown of Fto might upregulate the inflammatory response.
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Affiliation(s)
- Biao Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Mingyuan Du
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qiao Sun
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhengguo Cao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Periodontology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Hong He
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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Sundaram SG, Ramakrishnan T, Krishnan SG, Narayan KV, Shankar S, Kanimozhi G. Effect of Non-Surgical Periodontal Therapy on Systemic Inflammatory Markers, Glycemic Status and Levels of Proteinuria in Type 2 Diabetic and Non-Diabetic Patients With Chronic Periodontitis. Cureus 2023; 15:e44757. [PMID: 37809241 PMCID: PMC10556791 DOI: 10.7759/cureus.44757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
AIMS AND OBJECTIVES The present study aimed to evaluate the effect of non-surgical periodontal therapy (NSPT) on systemic inflammatory markers, glycemic status, and levels of proteinuria in Type 2 diabetic and non-diabetic individuals with chronic periodontitis. METHODOLOGY A total of 120 patients, categorized into three groups of 40 each, were included in this randomized observational study. Group 1 comprised patients with chronic periodontitis; Group 2 had chronic periodontitis with controlled diabetes; and Group 3 represented patients with chronic periodontitis with uncontrolled diabetes based on fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) levels. Periodontal clinical parameters like plaque index, gingival index, bleeding on probing, pocket depth, and clinical attachment levels were evaluated. Blood samples and urine samples were collected and assessed for the levels of FBS, HbA1c, total protein, albumin, globulin, and proteinuria. All parameters recorded at baseline and three months after non-surgical periodontal therapy were analyzed for statistical significance at p <.05 using SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc. RESULTS A significant reduction in the periodontal clinical parameters within the groups, except for the clinical attachment level in Group 1 patients (p = 0.05), was observed. Glycemic status revealed a significant reduction after non-surgical periodontal therapy (p < 0.001), and on intragroup comparison, the total protein, albumin, globulin, and microprotein blood and urine levels showed significance among the evaluated groups (p < 0.001). CONCLUSION Non-surgical periodontal treatment can effectively improve the periodontal and circulating inflammatory status. Results of our study showed improved glycemic control and a reduction in systemic inflammatory markers and proteinuria after performing non-surgical periodontal treatment in patients with type 2 diabetes.
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Affiliation(s)
- S Gopalakrishnan Sundaram
- Periodontology, Thai Moogambigai Dental College and Hospital, Dr MGR Educational and Research Institute, Chennai, IND
| | | | - Sneha G Krishnan
- Dentistry, Sri Ramaswamy Memorial (SRM) Dental College and Hospital, Chennai, IND
| | - Keerthi V Narayan
- Oral and Maxillofacial Pathology, Axon Anaesthesia Associates, Hyderabad, IND
| | - Siva Shankar
- Periodontology, Tamil Nadu Government Dental College and Hospital, Chennai, IND
| | - G Kanimozhi
- Dentistry, Private Dental Clinic, Chennai, IND
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Ghosh S, Buyyanapragada GC, Gavali N, Ismail M, Elangovan R, Sri Lakshmi NR. Effects of Scaling and Root Planing on Salivary Interleukine-6 Levels in Chronic Periodontitis Patients and Glycemic Controls. Cureus 2023; 15:e45388. [PMID: 37854742 PMCID: PMC10579968 DOI: 10.7759/cureus.45388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) and periodontitis have a bidirectional relationship that is well documented in many reviews and epidemiological studies. Periodontitis has been referred to as the sixth complication of diabetes mellitus. Various studies showed improvement in Interleukin-6 levels as well as metabolic parameters after non-surgical periodontal therapy in chronic periodontitis patients with type 2 DM. Objective: To evaluate the effect of scaling and root planing (SRP) on salivary levels of IL-6 and assessment of clinical parameters in CP patients with and without T2DM. METHODS We included 50 CP patients with well-controlled T2DM (Group I), and 50 CP patients without T2DM as controls (Group II) with evident clinical inflammation, ≥ 5mm probing depth (PD) and a relative attachment level (RAL) of ≥ 5mm. Following a brief medical and dental history plaque index (PI), gingival index (GI), gingival bleeding index (BI), PD, and RAL were recorded, and an unstimulated saliva was collected. Following SRP therapy, the clinical parameters and IL-6 levels were measured after seven days, 14 days, and 30 days. Intragroup and intergroup comparisons were carried out using a paired t-test and an independent t-test. The statistical significance was set at P < 0.05. Data were analyzed using computer software, Statistical Package for Social Sciences (SPSS) v. 22.0 (IBM Corp., Armonk, NY). RESULTS Intergroup comparisons of IL-6 levels at different intervals showed a significantly higher reduction in Group II than in Group I (p=0.000). While the mean difference in the GI scores from baseline to 30 days was significantly higher in Group I patients (p=0.000), the difference in the mean PI (p=0.004), mean BI (p=0.000), mean PD (p=0.000) and mean RAL scores (p=0.000) were significantly higher in Group II patients. CONCLUSION This study indicates that scaling and root planing is effective in glycemic control and also has a role to play in the level of salivary IL-6 in periodontal health and T2DM with chronic periodontitis. Elevated salivary IL-6 levels indicate periodontal inflammation which is further increased in T2DM patients. Hence, elevated IL-6 can be considered a marker of periodontal destruction.
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Affiliation(s)
- Sanghamitra Ghosh
- Periodontology, New Horizon Dental College and Research Institute, Bilaspur, IND
| | | | - Neelam Gavali
- Periodontology, Bharati Vidyapeeth (deemed to be) University, Dental College and Hospital, Pune, IND
| | - Mohammad Ismail
- Periodontology, Mithila Minority Dental College and Hospital, Darbhanga, IND
| | - Ramnath Elangovan
- Periodontology, School of Dentistry, University of Rwanda, Kigali, RWA
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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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Haque MM, Yerex K, Kelekis-Cholakis A, Duan K. Advances in novel therapeutic approaches for periodontal diseases. BMC Oral Health 2022; 22:492. [PMID: 36380339 PMCID: PMC9664646 DOI: 10.1186/s12903-022-02530-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
AbstractPeriodontal diseases are pathological processes resulting from infections and inflammation affecting the periodontium or the tissue surrounding and supporting the teeth. Pathogenic bacteria living in complex biofilms initiate and perpetuate this disease in susceptible hosts. In some cases, broad-spectrum antibiotic therapy has been a treatment of choice to control bacterial infection. However, increasing antibiotic resistance among periodontal pathogens has become a significant challenge when treating periodontal diseases. Thanks to the improved understanding of the pathogenesis of periodontal disease, which involves the host immune response, and the importance of the human microbiome, the primary goal of periodontal therapy has shifted, in recent years, to the restoration of homeostasis in oral microbiota and its harmonious balance with the host periodontal tissues. This shift in therapeutic goals and the drug resistance challenge call for alternative approaches to antibiotic therapy that indiscriminately eliminate harmful or beneficial bacteria. In this review, we summarize the recent advancement of alternative methods and new compounds that offer promising potential for the treatment and prevention of periodontal disease. Agents that target biofilm formation, bacterial quorum-sensing systems and other virulence factors have been reviewed. New and exciting microbiome approaches, such as oral microbiota replacement therapy and probiotic therapy for periodontal disease, are also discussed.
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Torumtay Cin G, Fenkçi SM. Knowledge Levels and Attitudes of Type 2 Diabetic Patients on Periodontal Health: A Cross-sectional Study. MEANDROS MEDICAL AND DENTAL JOURNAL 2022. [DOI: 10.4274/meandros.galenos.2021.82787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Komatsu S, Oshikiri S, Nagano T, Yashima A, Matsushima Y, Shirakawa S, Komatsu K, Mokubo A, Gomi K. Effects of One-Stage Full-Mouth Scaling and Root Planing with Azithromycin on Diabetes and Periodontal Disease: A Randomized Controlled Trial. Antibiotics (Basel) 2022; 11:antibiotics11091266. [PMID: 36140045 PMCID: PMC9495786 DOI: 10.3390/antibiotics11091266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 08/31/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Recent reports show that hemoglobin A1c (HbA1c) can be lowered by improving chronic inflammation in periodontal patients with diabetes mellitus and that full-mouth scaling and root planing (FM-SRP), in combination with azithromycin (AZM) treatment, can reduce early periodontal inflammation. However, the association of FM-SRP and AZM with periodontitis and HbA1c in patients with diabetes is largely unknown. This study investigated periodontitis and HbA1c in patients with diabetes after receiving FM-SRP and AZM to evaluate which clinical parameters most reflect the diabetic condition. Fifty-one periodontal patients with diabetes mellitus were included in this study. In total, 25 patients were assigned to the FM-SRP group in which patients were treated with FM-SRP in combination with AZM, and 26 patients were assigned to the control group in which only supragingival calculus removal was performed along with the provision of oral hygiene instructions. We evaluated periodontal parameters (probing pocket depth, periodontal inflamed surface area (PISA), bleeding on probing), and periodontal bacteria and biochemical parameters (HbA1c, high-sensitive C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and monocyte chemoattractant protein-1 (MCP-1)) at baseline (BL) and 1, 3, 6, and 9 months after treatment. Compared with BL values, the FM-SRP group showed improved clinical parameters, reduced periodontal pathogens, and significantly lower HbA1c. Inflammatory cytokines (hs-CRP, TNF-α, IL-6) were significantly reduced one month after treatment and remained low thereafter. MCP-1 did not change significantly during the experimental period. PISA showed a strong correlation with HbA1c, hs-CRP, and TNF-α. FM-SRP, in combination with AZM, produced clinical, microbiological, and HbA1c improvements in periodontal patients with previously diagnosed diabetes mellitus. Additionally, PISA was shown to be a useful index for assessing the diabetic status of patients with periodontal disease.
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Affiliation(s)
- Sho Komatsu
- Department of Periodontology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi ku, Yokohama 230-8501, Japan
| | - Shotaro Oshikiri
- Department of Periodontology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi ku, Yokohama 230-8501, Japan
| | - Takatoshi Nagano
- Department of Periodontology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi ku, Yokohama 230-8501, Japan
| | - Akihiro Yashima
- Department of Periodontology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi ku, Yokohama 230-8501, Japan
| | - Yuji Matsushima
- Department of Periodontology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi ku, Yokohama 230-8501, Japan
| | - Satoshi Shirakawa
- Department of Dental Hygiene, Tsurumi Junior College, 2-1-3 Tsurumi, Tsurumi ku, Yokohama 230-8501, Japan
| | | | - Akiko Mokubo
- Mokubo Internal Medicine Clinic, 2-25 Kizukimotosumicho, Kawasaki 211-0021, Japan
| | - Kazuhiro Gomi
- Department of Periodontology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi ku, Yokohama 230-8501, Japan
- Correspondence: ; Tel.: +81-(45)-580-8431
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Kalhan AC, Wong ML, Allen F, Gao X. Periodontal disease and systemic health: An update for medical practitioners. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:567-574. [PMID: 36189701 DOI: 10.47102/annals-acadmedsg.2021503] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Chronic periodontal disease is a highly prevalent dental condition affecting tooth-supporting tissues. Scientific evidence is accumulating on links between periodontal disease and various systemic conditions. This narrative review provides a holistic yet succinct overview that would assist medical practitioners to deliver integrated care for better clinical outcomes. METHOD Scientific evidence on associations between periodontal disease and systemic conditions was synthesised and critically appraised. Key findings of latest prospective cohort studies, randomised clinical trials, and meta-analysis were closely assessed and compiled. RESULTS A bidirectional relationship has been established, indicating that diabetes and periodontal disease are closely linked and amplify one another, if not successfully controlled. Existing evidence also supports the associations of periodontal disease with cardiovascular diseases and adverse pregnancy outcomes. Successful treatment of periodontal disease and dental prophylaxis has been shown to improve clinical outcomes in these systemic conditions. Other systemic conditions associated with periodontal disease include respiratory diseases, Alzheimer's disease, rheumatoid arthritis and chronic kidney disease. Although the underlying mechanisms remain to be fully elucidated, it is generally accepted that the inflammatory burden of chronic periodontal disease has an important systemic impact. CONCLUSION Oral-systemic links are multifaceted and complex. While evidence linking periodontal disease with a variety of systemic conditions is still emerging, the nature of the relationship is becoming clearer. The updated understanding of these associations warrants the attention of medical experts and policymakers for a concerted effort to develop a patient-centric, integrated model for the treatment of comorbid dental and medical conditions.
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Simpson TC, Clarkson JE, Worthington HV, MacDonald L, Weldon JC, Needleman I, Iheozor-Ejiofor Z, Wild SH, Qureshi A, Walker A, Patel VA, Boyers D, Twigg J. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev 2022; 4:CD004714. [PMID: 35420698 PMCID: PMC9009294 DOI: 10.1002/14651858.cd004714.pub4] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Glycaemic control is a key component in diabetes mellitus (diabetes) management. Periodontitis is the inflammation and destruction of the underlying supporting tissues of the teeth. Some studies have suggested a bidirectional relationship between glycaemic control and periodontitis. Treatment for periodontitis involves subgingival instrumentation, which is the professional removal of plaque, calculus, and debris from below the gumline using hand or ultrasonic instruments. This is known variously as scaling and root planing, mechanical debridement, or non-surgical periodontal treatment. Subgingival instrumentation is sometimes accompanied by local or systemic antimicrobials, and occasionally by surgical intervention to cut away gum tissue when periodontitis is severe. This review is part one of an update of a review published in 2010 and first updated in 2015, and evaluates periodontal treatment versus no intervention or usual care. OBJECTIVES: To investigate the effects of periodontal treatment on glycaemic control in people with diabetes mellitus and periodontitis. SEARCH METHODS An information specialist searched six bibliographic databases up to 7 September 2021 and additional search methods were used to identify published, unpublished, and ongoing studies. SELECTION CRITERIA: We searched for randomised controlled trials (RCTs) of people with type 1 or type 2 diabetes mellitus and a diagnosis of periodontitis that compared subgingival instrumentation (sometimes with surgical treatment or adjunctive antimicrobial therapy or both) to no active intervention or 'usual care' (oral hygiene instruction, education or support interventions, and/or supragingival scaling (also known as PMPR, professional mechanical plaque removal)). To be included, the RCTs had to have lasted at least 3 months and have measured HbA1c (glycated haemoglobin). DATA COLLECTION AND ANALYSIS At least two review authors independently examined the titles and abstracts retrieved by the search, selected the included trials, extracted data from included trials, and assessed included trials for risk of bias. Where necessary and possible, we attempted to contact study authors. Our primary outcome was blood glucose levels measured as glycated (glycosylated) haemoglobin assay (HbA1c), which can be reported as a percentage of total haemoglobin or as millimoles per mole (mmol/mol). Our secondary outcomes included adverse effects, periodontal indices (bleeding on probing, clinical attachment level, gingival index, plaque index, and probing pocket depth), quality of life, cost implications, and diabetic complications. MAIN RESULTS We included 35 studies, which randomised 3249 participants to periodontal treatment or control. All studies used a parallel-RCT design and followed up participants for between 3 and 12 months. The studies focused on people with type 2 diabetes, other than one study that included participants with type 1 or type 2 diabetes. Most studies were mixed in terms of whether metabolic control of participants at baseline was good, fair, or poor. Most studies were carried out in secondary care. We assessed two studies as being at low risk of bias, 14 studies at high risk of bias, and the risk of bias in 19 studies was unclear. We undertook a sensitivity analysis for our primary outcome based on studies at low risk of bias and this supported the main findings. Moderate-certainty evidence from 30 studies (2443 analysed participants) showed an absolute reduction in HbA1c of 0.43% (4.7 mmol/mol) 3 to 4 months after treatment of periodontitis (95% confidence interval (CI) -0.59% to -0.28%; -6.4 mmol/mol to -3.0 mmol/mol). Similarly, after 6 months, we found an absolute reduction in HbA1c of 0.30% (3.3 mmol/mol) (95% CI -0.52% to -0.08%; -5.7 mmol/mol to -0.9 mmol/mol; 12 studies, 1457 participants), and after 12 months, an absolute reduction of 0.50% (5.4 mmol/mol) (95% CI -0.55% to -0.45%; -6.0 mmol/mol to -4.9 mmol/mol; 1 study, 264 participants). Studies that measured adverse effects generally reported that no or only mild harms occurred, and any serious adverse events were similar in intervention and control arms. However, adverse effects of periodontal treatments were not evaluated in most studies. AUTHORS' CONCLUSIONS Our 2022 update of this review has doubled the number of included studies and participants, which has led to a change in our conclusions about the primary outcome of glycaemic control and in our level of certainty in this conclusion. We now have moderate-certainty evidence that periodontal treatment using subgingival instrumentation improves glycaemic control in people with both periodontitis and diabetes by a clinically significant amount when compared to no treatment or usual care. Further trials evaluating periodontal treatment versus no treatment/usual care are unlikely to change the overall conclusion reached in this review.
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Affiliation(s)
- Terry C Simpson
- Edinburgh Dental Institute, University of Edinburgh, Edinburgh, UK
| | - Janet E Clarkson
- School of Dentistry, University of Dundee, Dundee, UK
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Laura MacDonald
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Jo C Weldon
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Ian Needleman
- Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, London, UK
| | | | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ambrina Qureshi
- Department of Community Dentistry, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Veena A Patel
- Orthodontic Department, Leeds Dental Institute, Leeds, UK
| | | | - Joshua Twigg
- School of Dentistry, University of Leeds, Leeds, UK
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Treatment of intrabony periodontal defects in controlled diabetic patients with an enamel matrix derivative: a split-mouth randomized clinical trial. Clin Oral Investig 2021; 26:2479-2489. [PMID: 34643808 DOI: 10.1007/s00784-021-04215-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/26/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This split-mouth randomized controlled trial aimed to evaluate the effect of enamel matrix derivative (EMD) associated with a simplified papilla preservation flap (SPPF) compared to SPPF alone in the surgical treatment of intrabony defects (ID) in type 2 diabetic mellitus (T2DM) patients. MATERIAL AND METHODS Thirteen patients with controlled T2DM presenting with ID in at least two quadrants were included. In each patient, the test site (TS) was treated with SPPF plus EMD, whereas the control site (CS) was treated only with SPPF. Prior to surgery and at 6 months after intervention, the following parameters were evaluated: clinical attachment level (CAL), probing pocket depth (PPD), and gingival recession (GR). RESULTS The TS and CS demonstrated a mean CAL gain of 3.31 ± 0.96 mm and 1.61 ± 1.12 mm, and a PPD reduction from 8.15 ± 0.98 to 3.00 ± 0.57 mm and 7.53 ± 0.96 to 4.69 ± 0.63 mm after 6 months, respectively. In both sites, the mean CAL gain and PPD reduction improved significantly after 6 months compared to baseline; however, the improvement was higher in the TS (p < 0.001). CONCLUSIONS Both surgical procedures presented with clinical improvements in controlled T2DM patients. However, the additional use of EMD showed enhanced clinical results after 6 months with regard to CAL gain and PPD reduction. CLINICAL RELEVANCE This study showed a better PPD reduction and CAL gain when an EMD was applied in addition to SPPF. Therefore, EMD may be used to enhance clinical outcomes in periodontal ID of controlled T2DM patients.
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Sinha S, Sonoo PR, Siddhartha R, Singh SK, Singh A. Effect of Conventional Periodontal Treatment (Scaling and Root Planing) on Type-2 Diabetic Patient with Moderate Generalized Chronic Periodontitis: A Clinical Study. J Pharm Bioallied Sci 2021; 13:S706-S710. [PMID: 34447186 PMCID: PMC8375805 DOI: 10.4103/jpbs.jpbs_692_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/02/2020] [Accepted: 11/24/2020] [Indexed: 11/07/2022] Open
Abstract
Background: The aim is to assess the effect of periodontal therapy and scaling and root planing (SRP) on the metabolic control in Type 2 diabetes mellitus (DM) patients with chronic periodontitis based on the estimation of glycated hemoglobin (HbA1c). Materials and Methods: A prospective, comparative, clinical study was performed on 50 patients suffering from Type 2 DM with moderate, generalized chronic periodontitis. Type 2 moderately controlled diabetic patients with HbA1c values within the range of 6%–8% were selected. The parameters recorded were gingival index, plaque index, sulcus bleeding index, probing pocket depth, clinical attachment level, and HbA1c. The recordings were done at baseline and 6 months after SRP procedures. Results: Reductions in all the clinical parameters were observed and were found to be statistically significant (P < 0.05). Conclusion: SRP resulted in a statistically significant reduction in the clinical parameters and HbA1c. Hence, periodontal treatment should be included in the management of diabetic patients.
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Affiliation(s)
- Sachin Sinha
- Department of Periodontics, PHC, Patna, Bihar, India
| | - Priyanshu Ranjan Sonoo
- Department of Oral and Maxillofacial Surgery, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
| | - Rohit Siddhartha
- Department of Conservative Dentistry, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
| | - Sanjay Kumar Singh
- Department of Dentistry, Patna Medical College and Hospital, Patna, Bihar, India
| | - Anjali Singh
- Department of Periodontics, Private Practitioner, Patna, Bihar, India
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Baeza M, Morales A, Cisterna C, Cavalla F, Jara G, Isamitt Y, Pino P, Gamonal J. Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis. J Appl Oral Sci 2020; 28:e20190248. [PMID: 31939522 PMCID: PMC6919200 DOI: 10.1590/1678-7757-2019-0248] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/29/2019] [Accepted: 09/19/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The evidence is inconclusive regarding the effect of periodontal treatment on glycemic control and systemic inflammation in patients with type 2 diabetes (T2D) and periodontitis. To evaluate the effect of scaling and root planing (SRP) on the metabolic control and systemic inflammation of patients with type 2 diabetes (T2D). METHODOLOGY A literature search was conducted using the MEDLINE database via PubMed and the Cochrane Central Register of Controlled Trials, from their oldest records up to July 2018. Only randomized clinical trials (RCT) were considered eligible for evaluating the effect of periodontal treatment on markers of metabolic control [glycated hemoglobin (HbA1C)] and systemic inflammation [C-reactive protein (CRP)] in patients with T2D. The quality of the studies was evaluated using the Cochrane Collaboration risk assessment tool. Meta-analyses were performed for HbA1c and CRP using random effects models. The size of the overall intervention effect was estimated by calculating the weighted average of the differences in means (DM) between the groups in each study. Heterogeneity was assessed using the Q-statistic method (x2 and I²). The level of significance was established at p<0.05. RESULTS Nine RCT were included. SRP was effective in reducing HbA1c [DM=0.56 (0.36-0.75); p<0.01] and CRP [DM=1.89 (1.70-2.08); p<0.01]. No heterogeneity was detected (I2=0%, p>0.05). CONCLUSIONS SRP has an impact on metabolic control and reduction of systemic inflammation of patients with T2D.
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Affiliation(s)
- Mauricio Baeza
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Escuela de Salud Pública, Santiago, Chile
| | - Alicia Morales
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiología y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
| | - Carlos Cisterna
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
| | - Franco Cavalla
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
| | - Gisela Jara
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiología y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
| | - Yuri Isamitt
- Universidad de Chile, Facultad de Odontología, Departamento de Prótesis, Santiago, Chile
| | - Paulina Pino
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiología y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
| | - Jorge Gamonal
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiología y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
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Sundaram G, Theagarajan R, Gopalakrishnan K, Babu G, Murthy G. Effect of fenugreek consumption with metformin treatment in improving plaque index in diabetic patients. J Nat Sci Biol Med 2020. [DOI: 10.4103/jnsbm.jnsbm_96_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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A comparative clinical, microbiological and glycemic analysis of photodynamic therapy and Lactobacillus reuteri in the treatment of chronic periodontitis in type-2 diabetes mellitus patients. Photodiagnosis Photodyn Ther 2019; 29:101629. [PMID: 31870899 DOI: 10.1016/j.pdpdt.2019.101629] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/03/2019] [Accepted: 12/18/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Evidence indicates that patients with type 2 diabetes mellitus (DM) exhibit impaired wound healing and are at higher risk for periodontal disease. In DM patients, adjunctive periodontal treatment provides small but statistically significant benefits in terms of reductions in clinical periodontal parameters. This study incorporates antimicrobial and immune modulatory treatment approach specifically targeted at these patients. PURPOSE To evaluate and compare the clinical periodontal, microbiological and HbA1c levels with the use of photodynamic therapy (PDT) and probiotic therapy (PT) as adjunct to root surface debridement (RSD) in the treatment of periodontitis in DM. MATERIALS AND METHODS Demographic data was collected using a questionnaire. Treatment-wise, chronic periodontitis with 2DM patients were subdivided into: (i) Group-A: Patients that underwent RSD with adjunct PDT; (ii) Group-B: Patients that underwent RSD with adjunct PT and; (iii) Group-C: RSD alone. In all groups, probing depth (PD), plaque scores (PS), bleeding on probing (BOP) and clinical attachment level (CAL) gain were measured at baseline and 3 months. Microbiological data consisted the assessment of detection percentage of Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola. RESULTS A total of 58 patients completed the trial. All clinical and microbiological parameters showed statistically significant reduction from baseline to 3 months in all groups (p < 0.05). On inter-group comparison, the proportion of PD with ≥4 mm and ≥5 mm showed statistically significant reduction for Group-A compared to Group-B and Group-C (p < 0.01). Only Group-A showed statistically significant reduction in percentage of HbA1c levels from baseline to 3 months (p < 0.05). Groups A and B showed significantly higher reductions for all the three bacteria compared to Group-C (p < 0.05). However, this reduction was comparable between Groups-A and B, respectively (p > 0.05). CONCLUSION PDT showed additional benefit in deep periodontal pockets and slightly modest reduction in HbA1c levels in DM patients. Further clinical trials are required with large sample size and longer follow up duration to ascertain the findings of the present clinical study.
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El-Makaky Y, Shalaby HK. The effects of non-surgical periodontal therapy on glycemic control in diabetic patients: A randomized controlled trial. Oral Dis 2019; 26:822-829. [PMID: 31834660 DOI: 10.1111/odi.13256] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/12/2019] [Accepted: 12/07/2019] [Indexed: 12/16/2022]
Abstract
AIM The present study aimed to monitor the clinical outcomes and the metabolic response of periodontal therapy (non-surgical) in patients with periodontitis (chronic) and uncontrolled diabetes (type 2). METHODS Eighty-eight subjects with periodontitis (chronic) and uncontrolled diabetes (type 2) were enrolled in this controlled trial and allocated randomly to the test group (44 patients were received immediate periodontal therapy) or the control group (44 patients were received delayed periodontal therapy). The metabolic and clinical evaluations were conducted at baseline and 3 months. This included clinical attachment level, glycated hemoglobin (HbA1c), bleeding on probing, visible plaque, and pocket depth. The periodontal therapy in this study consists of one-stage scaling and root planning, a combination of systemic antibiotics (amoxicillin 500 mg and metronidazole 400 mg), and oral hygiene instructions. RESULTS Regarding clinical and metabolic parameters at baseline, no statistically significant differences were displayed between the two groups. However, at 3-month follow-up period the patients within the test group demonstrated significantly better clinical and metabolic outcomes than patients in the control group. CONCLUSION The non-surgical periodontal treatment using a combination of metronidazole and amoxicillin significantly improved the metabolic outcome in addition to periodontal health in diabetic subjects with chronic periodontitis.
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Affiliation(s)
- Yasser El-Makaky
- Department of Periodontology, Faculty of Dentistry, Tanta University, Tanta, Egypt.,Department of Periodontology, College of Dentistry, Taibah University, Saudi Arabia
| | - Hany K Shalaby
- Department of Periodontology, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt
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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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Qi W, Yang X, Ye N, Li S, Han Q, Huang J, Wu B. TLR4 gene in the regulation of periodontitis and its molecular mechanism. Exp Ther Med 2019; 18:1961-1966. [PMID: 31452696 PMCID: PMC6704533 DOI: 10.3892/etm.2019.7809] [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: 11/22/2018] [Accepted: 05/09/2019] [Indexed: 12/14/2022] Open
Abstract
Regulatory effect of Toll-like receptor 4 (TLR4) gene on periodontitis in mice was investigated to explore its possible mechanism. Thirty C57/BL6 mice were randomly divided into the blank control group (N group, n=10), the periodontitis group (P group, n=10) and the periodontitis + TAK-242 group (PT group, n=10). The mice in P and PT group were ligatured with silk threads dipped with porphyromonas gingivalis (P. gingivalis) in the logarithmic phase to induce experimental periodontitis, and TAK-242 was intraperitoneally injected on the day when the periodontitis model was established. After fasting for 8 h, the expression levels of high-sensitivity C-reactive protein and inflammatory cytokines were measured in each group of mice. Their alveolar bones were isolated and changes were detected. Quantitative polymerase chain reaction was used to detect the expression levels of TLR4. After the mice were given TAK-242, the levels of hs-CPR, MCP-1, IL-6 and IL-1β in the PT group evidently increased (P<0.01) compared with those in the N group. After the mice were administered TAK-242, the alveolar bone density, the percentage of bone volume and the number of bone trabeculae in PT group were significantly reduced, and the bone trabecular space and structural model index were evidently decreased (P<0.01). In addition, the expression levels of and T-bet/GATA3 messenger ribonucleic acids (mRNAs) in peria of mice in the P group were significantly higher than those in the N group (P<0.01), whereas the expression level of Foxp3 mRNA was notably decreased (P<0.01). The involvement of TLR4 gene in the inflammatory response of periodontitis results in periodontitis, and its mechanism may be that it activates TLR4, so as to affect the expression of T-bet, GATA3 and Foxp3.
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Affiliation(s)
- Weijuan Qi
- Department of Periodontics, Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong 510280, P.R. China.,College of Stomatology, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xi Yang
- Department of Periodontics, Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong 510280, P.R. China
| | - Ning Ye
- Department of Orthodontics, Guangdong Xieda Stomatological Hospital, Guangzhou, Guangdong 510399, P.R. China
| | - Shujun Li
- Department of Orthodontics, Taike Dentalcare Clinic, Guangzhou, Guangdong 510000, P.R. China
| | - Qianqian Han
- Department of Periodontics, Stomatological Hospital, Southern Medical University, Guangzhou, Guangdong 510280, P.R. China
| | - Jinyu Huang
- Department of Endodontics, Stomatological Hospital, Guangzhou, Guangdong 510515, P.R. China
| | - Buling Wu
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China.,College of Stomatology, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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Al‐Shibani N, Al‐Aali KA, Al‐Hamdan RS, Alrabiah M, Basunbul G, Abduljabbar T. Comparison of clinical peri‐implant indices and crestal bone levels around narrow and regular diameter implants placed in diabetic and non‐diabetic patients: A 3‐year follow‐up study. Clin Implant Dent Relat Res 2019; 21:247-252. [DOI: 10.1111/cid.12712] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Nouf Al‐Shibani
- Department of Periodontics and Community DentistryKing Saud University Riyadh Saudi Arabia
| | - Khulud Abdulrahman Al‐Aali
- Department of ProsthodonticsCollege of Dentistry, Princess Nourah Bint Abdulrahman University Riyadh Saudi Arabia
| | - Rana Sulaiman Al‐Hamdan
- Department of Restorative Dental Science, Operative DivisionCollege of Dentistry, King Saud University Riyadh Saudi Arabia
| | - Mohammed Alrabiah
- Department of Prosthetic Dental ScienceCollege of Dentistry, King Saud University Riyadh Saudi Arabia
| | - Ghadeer Basunbul
- Oral and Maxillofacial Rehabilitation Department, Faculty of DentistryKing Abdul Aziz University Jeddah Saudi Arabia
| | - Tariq Abduljabbar
- Department of Prosthetic Dental ScienceCollege of Dentistry, King Saud University Riyadh Saudi Arabia
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Gopalakrishnan D, Miller PD, Mahuli AV, Sangamithra S, Phantumvanit P, Buranawat B. Evaluation of periodontally diseased molars in diabetics with Miller-McEntire Periodontal Prognostic Index. J Indian Soc Periodontol 2018; 22:401-405. [PMID: 30210188 PMCID: PMC6128126 DOI: 10.4103/jisp.jisp_271_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aim and Objective: The aim of this study was to prospectively determine and establish the periodontal prognosis of diseased molars in diabetic patients using the Miller–McEntire Periodontal Prognostic Index (MMPPI) with an additional criterion for diabetes (changes in glycosylated hemoglobin levels), at 2-year postperiodontal therapy. Materials and Methods: A sample of 200 molars in 25 patients with diabetes mellitus (DM) and chronic periodontitis were evaluated. The prognostic parameters evaluated include age, probing depth (PD), mobility, furcation involvement, diabetes, and molar type. The total score calculated from all parameters was used considered prognosis score for each molar. All patients were evaluated at baseline and 2-year posttreatment. Results: The results of this study suggest that following prognostic factors, DM (hazard ratio [HR] =5.2), age (HR = 0.4), and molar type (HR = 0.6) were clinically significant at the end of the 2-year posttherapy from baseline. A total of 4 (2%) teeth were extracted from the 200 teeth with a mean of 0.02 for the tooth lost during 2-year posttreatment. Significant improvements (P < 0.05) in the frequency PD, furcation, and mobility scores were noted at 2 years. Conclusions: These findings demonstrate that score for DM as prognostic criterion is a valid addition to MMPPI. The factors such as DM, age, and molar type can impact the prognosis of molar survival. Studies with a larger sample size and longer follow-up are required to affirm the findings of this preliminary study.
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Affiliation(s)
- Dharmarajan Gopalakrishnan
- Department of Periodontics and Implant Dentistry, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand.,Department of Periodontology and Oral Implantology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Preston Dallas Miller
- Department of Stomatology, Division of Periodontics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amit Vasant Mahuli
- Department of Public Health Dentistry, NIMS University Dental College, Jaipur, Rajasthan, India
| | - Sidharthan Sangamithra
- Department of Periodontology and Oral Implantology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Prathip Phantumvanit
- Department of Community Dentistry, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
| | - Borvornwut Buranawat
- Department of Periodontics and Implant Dentistry, Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
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Quintero AJ, Chaparro A, Quirynen M, Ramirez V, Prieto D, Morales H, Prada P, Hernández M, Sanz A. Effect of two periodontal treatment modalities in patients with uncontrolled type 2 diabetes mellitus: A randomized clinical trial. J Clin Periodontol 2018; 45:1098-1106. [PMID: 30024030 DOI: 10.1111/jcpe.12991] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/11/2018] [Accepted: 07/16/2018] [Indexed: 01/22/2023]
Abstract
AIM To evaluate the impact of two non-surgical periodontal treatment modalities on metabolic and periodontal clinical parameters in subjects with type 2 diabetes mellitus (T2DM) and poor glycaemic control and chronic periodontitis. MATERIAL AND METHODS A randomized controlled clinical trial was conducted. Ninety-three T2DM subjects with glycosylated haemoglobin (HbA1c) > 7% were randomly assigned to one of two groups receiving scaling with root planing in multiple sessions quadrant-by-quadrant (Q by Q) or within 24 hr (one stage). Periodontal parameters, HbA1c, glycaemia blood levels (FPG) and C-reactive protein (CRP) values were assessed at baseline and at 3 and 6 months post-therapy. RESULTS At 6 months, HbA1c had decreased by 0.48% in the Q by Q group and by 0.18% in the one-stage group (p = 0.455). After therapy, subjects with an initial HbA1c < 9% showed an increase of 0.31% (p = 0.145), compared with a decrease of 0.88% (p = 0.006) in those with an initial HbA1c ≥ 9%. Periodontal parameters improved significantly (p < 0.0001) post-therapy, with similar results for both treatment modalities. CONCLUSION Periodontal therapy had the greatest impact on HbA1c reduction on patients with an HbA1c > 9% regardless of treatment modality. Both modalities resulted in significant improvements in periodontal parameters.
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Affiliation(s)
- Antonio J Quintero
- Department of Periodontology, Dentistry Faculty, Universidad de los Andes, Santiago, Chile
| | - Alejandra Chaparro
- Department of Periodontology, Dentistry Faculty, Universidad de los Andes, Santiago, Chile
| | - Marc Quirynen
- Department of Oral Health Sciences, Department of Periodontology, KU Leuven & University Hospitals Leuven, Leuven, Belgium
| | - Valeria Ramirez
- Department of Public Health and Biostatistics, Universidad de los Andes, Santiago, Chile
| | - Diego Prieto
- Department of Periodontology, Dentistry Faculty, Universidad de los Andes, Santiago, Chile
| | - Helia Morales
- Department of Endocrinology, Medicine Faculty, Universidad de los Andes, Santiago, Chile
| | - Pamela Prada
- Periodontics, Universidad de los Andes, Santiago, Chile
| | | | - Antonio Sanz
- Department of Periodontology, Dentistry Faculty, Universidad de los Andes, Santiago, Chile
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Duarte PM, Feres M, Yassine LLS, Soares GMS, Miranda TS, Faveri M, Retamal-Valdes B, Figueiredo LC. Clinical and microbiological effects of scaling and root planing, metronidazole and amoxicillin in the treatment of diabetic and non-diabetic subjects with periodontitis: A cohort study. J Clin Periodontol 2018; 45:1326-1335. [PMID: 30076615 DOI: 10.1111/jcpe.12994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/19/2018] [Accepted: 08/01/2018] [Indexed: 01/03/2023]
Abstract
AIM To evaluate if non-diabetic subjects with periodontitis respond better than subjects with type 2 diabetes to the treatment protocol of scaling and root planing (SRP), metronidazole (MTZ) and amoxicillin (AMX). MATERIAL AND METHODS Diabetic and nondiabetic subjects with severe periodontitis received SRP + MTZ (400 mg/thrice a day [TID]) + AMX (500 mg/TID) for 14 days. Subgingival biofilm samples were analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species. Subjects were monitored at baseline, 3, 6 and 12 months post-therapy. RESULTS Twenty-nine type 2 diabetics and 29 non-diabetic subjects participated of this study. Of the non-diabetics and diabetics, 68.9% and 75.9%, respectively, reached the clinical endpoint for treatment (≤4 sites with probing depth [PD] ≥5 mm) at 1 year post-therapy (p > 0.05). The diabetic group presented lower mean clinical attachment gain from baseline to 1 year post-therapy and higher mean proportions of the red and orange complexes than the non-diabetic group (p < 0.05). CONCLUSIONS Non-diabetic subjects with severe periodontitis did not respond better than type 2 diabetic subjects to the treatment protocol of SRP + MTZ + AMX, both in terms of achieving the clinical endpoint for treatment and of PD improvement. Diabetic subjects exhibited a slightly worse microbiological response and showed a healing process more associated with gingival recession than the non-diabetics.
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Affiliation(s)
- Poliana Mendes Duarte
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Magda Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Lina Lameh Smeili Yassine
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | | | - Tamires Szeremeske Miranda
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Marcelo Faveri
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Belen Retamal-Valdes
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
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Souto MLS, Rovai ES, Ganhito JA, Holzhausen M, Chambrone L, Pannuti CM. Efficacy of systemic antibiotics in nonsurgical periodontal therapy for diabetic subjects: a systematic review and meta-analysis. Int Dent J 2018; 68:207-220. [PMID: 29492963 PMCID: PMC9378894 DOI: 10.1111/idj.12384] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES To evaluate the effects of systemic antibiotics as adjuncts to nonsurgical periodontal treatment (NSPT), as opposed to using NSPT alone, on periodontal clinical parameters of diabetic patients with periodontitis. MATERIALS AND METHODS Randomised controlled trials with a follow-up of 3 months or more, assessing the effects of NSPT in combination with antibiotics, in diabetic patients with periodontitis were included. Trials published up to August 2016 were identified from MEDLINE, EMBASE and LILACS databases. Meta-analyses were conducted to determine changes in clinical attachment level (CAL), probing pocket depth (PPD), bleeding on probing (BOP) and gingival index (GI). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in this review. RESULTS Of the 164 papers potentially admissible to this systematic review, 15 articles on 11 randomised clinical trials were considered as eligible. The results of the meta-analyses presented a modest additional benefit of 0.14 mm (95% confidence interval: 0.08-0.20) in reducing PPD but no further benefit in CAL gain. CONCLUSION When the data for all antibiotic protocols were considered together for the treatment of periodontitis patients with DM, a significant, albeit small, reduction of PPD and no improvement in CAL gain was observed. When the antibiotic protocols were analysed separately, the combination of amoxicillin plus metronidazole yielded the best results for PPD.
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Affiliation(s)
- Maria Luisa S. Souto
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Emanuel S. Rovai
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Juliana A. Ganhito
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marinella Holzhausen
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Leandro Chambrone
- Unit of Basic Oral Investigations, El Bosque University, Bogota, Colombia
| | - Cláudio M. Pannuti
- Division of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Mauri-Obradors E, Merlos A, Estrugo-Devesa A, Jané-Salas E, López-López J, Viñas M. Benefits of non-surgical periodontal treatment in patients with type 2 diabetes mellitus and chronic periodontitis: A randomized controlled trial. J Clin Periodontol 2018; 45:345-353. [DOI: 10.1111/jcpe.12858] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 12/11/2022]
Affiliation(s)
| | - Alexandra Merlos
- Department of Pathology and Experimental Therapeutics; Medical School; IDIBELL-University of Barcelona; Barcelona Spain
| | | | - Enric Jané-Salas
- Department of Dentistry; Dental School; University of Barcelona; Barcelona Spain
- Oral Medicine Unit; Department of Dentistry; Faculty of Medicine and Health Sciences (Dental School) and Dental Hospital Barcelona University (University of Barcelona) and Health and Masticatory System Group (Bellvitge Biomedical Research, Institute) IDIBELL; Barcelona Spain
| | - José López-López
- Department of Dentistry; Dental School; University of Barcelona; Barcelona Spain
- Oral Medicine Unit; Department of Dentistry; Faculty of Medicine and Health Sciences (Dental School) and Dental Hospital Barcelona University (University of Barcelona) and Health and Masticatory System Group (Bellvitge Biomedical Research, Institute) IDIBELL; Barcelona Spain
| | - Miguel Viñas
- Department of Pathology and Experimental Therapeutics; Medical School; IDIBELL-University of Barcelona; Barcelona Spain
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Sundaram G, Ramakrishnan T, Parthasarathy H, Raja M, Raj S. Fenugreek, diabetes, and periodontal disease: A cross-link of sorts! J Indian Soc Periodontol 2018; 22:122-126. [PMID: 29769766 PMCID: PMC5939019 DOI: 10.4103/jisp.jisp_322_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aims The aim of this study was to observe the sequelae of fenugreek adjunctive to nonsurgical periodontal therapy and its comparison to a group treated with scaling and root planing (SRP) and metformin alone by assessing their respective effects on periodontal parameters, glycemic status, and serum lipid levels. Materials and Methods The study comprised eighty patients who were further divided into two groups. Each group consisted of 40 patients. Group 1 consisted of uncontrolled noninsulin-dependent diabetes mellitus (NIDDM) patients with chronic generalized periodontitis, who received SRP and treatment with metformin. Group 2 consisted of uncontrolled NIDDM with chronic generalized periodontitis, who received SRP and metformin plus fenugreek powder. Periodontal parameters such as gingival index, plaque index, bleeding on probing, pocket depth, and clinical attachment levels were evaluated before treatment and 1 month after nonsurgical periodontal therapy. The values of low-density lipoprotein (LDL), triglycerides, total cholesterol (TC), and glycosylated hemoglobin (HbA1c) were assessed by collecting the blood samples before treatment and 1 month after treatment. Results There was a statistically significant change in all the parameters seen clinically in both the groups. The glycemic status also showed a statistically significant reduction for fasting blood sugar (P < 0.001) on intragroup comparison. Intragroup comparison shows a statistically significant reduction (P < 0.001) for serum lipids, whereas intergroup comparison showed a statistically significant reduction after treatment only in TC and LDL levels (P < 0.02 and <0.012). Conclusion This study shows that fenugreek powder can be used adjunctive to SRP to control the glycemic status and serum lipid levels in uncontrolled NIDDM patients.
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Affiliation(s)
- Gopalakrishnan Sundaram
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | | | | | - Manoj Raja
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Samuel Raj
- Department of Public Health Dentistry, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
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Awareness of oral complications and oral hygiene habits of subjects with diagnosed Diabetes Mellitus. BALKAN JOURNAL OF DENTAL MEDICINE 2018. [DOI: 10.2478/bjdm-2018-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background/Aim: The aim was to evaluate Diabetes Mellitus (DM) patients' awareness of their risk for oral and dental complications, to evaluate their oral health behaviors, assess their sources of related information, and to detect the influence of their awareness on oral health and dental management. Material and Methods: Total of 240 DM patients presenting to a university outpatient dental facility for routine care completed a self-administered questionnaire about demographic socioeconomic characteristics, oral health care and awareness on oral complications of DM. Dental status of each patient was recorded. Data were analyzed with Chi- square test; p was set as 0.05. Results: The patients' mean age was 52.85 years; the majority had Type 2 DM (72.1%) and 61.7% were females. Two thirds of the patients had tooth loss; 65% brushed daily and used toothpick for interproximal cleaning (35%). Only 12.9% had regular dental visits and 37.5% reported their oral health as 'poor'. DM patients rarely received guidance from their health care professionals regarding their oral health (28.3%). Even though 62.5% were aware of oral complications of DM, only 46.3% knew that oral health may affect DM. The patients with Type 1 and Type 2 DM had similar perceptions about their oral health status (p=0.15>0.05). However, insulin users were more aware of the interaction between oral health and DM (p>0.05), and were more likely to consider their oral health as 'poor' (p>0.05). Conclusions: DM patients' awareness of the effect of DM on oral health was higher than that of the effect of oral health on DM management. Medical health care providers were failing to provide the necessary information regarding these issues when compared to dentists.
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Zare Javid A, Maghsoumi-Norouzabad L, Ashrafzadeh E, Yousefimanesh HA, Zakerkish M, Ahmadi Angali K, Ravanbakhsh M, Babaei H. Impact of Cranberry Juice Enriched with Omega-3 Fatty Acids Adjunct with Nonsurgical Periodontal Treatment on Metabolic Control and Periodontal Status in Type 2 Patients with Diabetes with Periodontal Disease. J Am Coll Nutr 2017; 37:71-79. [DOI: 10.1080/07315724.2017.1357509] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Ahmad Zare Javid
- Nutrition and Metabolic Diseases Research Center & Hyperlipidemia Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Leila Maghsoumi-Norouzabad
- Nutrition and Metabolic Diseases Research Center & Hyperlipidemia Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Nutrition, School of Para Medicine, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Elnaz Ashrafzadeh
- Nutrition and Metabolic Diseases Research Center & Hyperlipidemia Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Nutrition, School of Para Medicine, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Hojat Allah Yousefimanesh
- Department of Periodontology, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehrnoosh Zakerkish
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kambiz Ahmadi Angali
- Biostatistics Division, Health Faculty, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Ravanbakhsh
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hosein Babaei
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Grellmann AP, Sfreddo CS, Maier J, Lenzi TL, Zanatta FB. Systemic antimicrobials adjuvant to periodontal therapy in diabetic subjects: a meta-analysis. J Clin Periodontol 2017; 43:250-60. [PMID: 26790108 DOI: 10.1111/jcpe.12514] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Adjuvant antibiotics have been suggested to improve periodontal therapy in diabetic subjects. AIM The aim of this study was to systematically review randomized clinical trials assessing systemic antimicrobial use adjuvant to scaling and root planing (SRP) versus SRP alone in diabetic subjects. MATERIAL AND METHODS The PubMed, Cochrane Central Register of Controlled Trials, EMBASE, TRIP, Web of Science and LILACS databases and the grey literature were searched through May 2015. Of 2534 potentially eligible studies, 13 were included in the systematic review. Weighted mean differences (WMDs) in probing depth (PD) reduction and clinical attachment level (CAL) gain (primary outcomes), and plaque index (PI) and bleeding on probing (BOP) reductions, were estimated using a random effect model. RESULTS The WMD in PD reduction [-0.15 mm, n = 11, p = 0.001, 95% confidence interval (CI) -0.24, -0.06] favoured antibiotic use. WMDs in CAL gain, PI and BOP reductions (-0.14 mm, n = 9, p = 0.11, 95% CI -0.32, 0.03; 4.01%, n = 7, p = 0.05, 95% CI -0.04, 8.07; and -1.91%, n = 7, p = 0.39, 95% CI -6.32, 2.51 respectively) did not favour adjunctive antibiotic use. CONCLUSION Adjunctive therapy may improve the efficacy of SRP in reducing PD in diabetic subjects.
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Affiliation(s)
| | - Camila Silveira Sfreddo
- Post-graduate Program in Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Juliana Maier
- Post-graduate Program in Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Tathiane Larissa Lenzi
- Post-graduate Program in Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil
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Al-Hamoudi N. Is antimicrobial photodynamic therapy an effective treatment for chronic periodontitis in diabetes mellitus and cigarette smokers: a systematic review and meta-analysis. Photodiagnosis Photodyn Ther 2017; 19:375-382. [DOI: 10.1016/j.pdpdt.2017.05.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 05/21/2017] [Accepted: 05/24/2017] [Indexed: 12/22/2022]
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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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Kaur PK, Narula SC, Rajput R, K Sharma R, Tewari S. Periodontal and glycemic effects of nonsurgical periodontal therapy in patients with type 2 diabetes stratified by baseline HbA1c. J Oral Sci 2017; 57:201-11. [PMID: 26369484 DOI: 10.2334/josnusd.57.201] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
We evaluated the effects of nonsurgical periodontal therapy in 100 patients with type 2 diabetes and chronic periodontitis. The participants were classified as having good (n = 48) or poor (n = 52) glycemic control and were further randomly allocated to receive either scaling and root planning treatment group or no treatment (n = 50 each). The effect of nonsurgical periodontal therapy was compared among diabetic patients with good glycemic control, those with poor glycemic control, and 25 nondiabetic individuals. Periodontal and metabolic status was recorded at baseline, 3 months, and 6 months. In patients receiving treatment, periodontal parameters significantly improved and HbA1c decreased by 10.8%. Improvements in gingival index and bleeding on probing were greater in the nondiabetic participants and the treated patients with good glycemic control than in the treated patients with poor glycemic control (P < 0.05). Regression analysis showed that improvement in periodontal status was independently associated with glycemic improvement. Nonsurgical periodontal therapy improved glycemic control and periodontal health in patients with type 2 diabetes. However, patients with poor baseline glycemic control had less clinical improvement than did those without diabetes and those with good glycemic control.
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Affiliation(s)
- Palka K Kaur
- Department of Periodontics and Oral Implantology, Post Graduate Institute of Dental Sciences
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Abduljabbar T, Vohra F, Javed F, Akram Z. Antimicrobial photodynamic therapy adjuvant to non-surgical periodontal therapy in patients with diabetes mellitus: A meta-analysis. Photodiagnosis Photodyn Ther 2017; 17:138-146. [DOI: 10.1016/j.pdpdt.2016.11.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/05/2016] [Accepted: 11/17/2016] [Indexed: 01/01/2023]
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Feres M, Figueiredo LC, Soares GMS, Faveri M. Systemic antibiotics in the treatment of periodontitis. Periodontol 2000 2017; 67:131-86. [PMID: 25494600 DOI: 10.1111/prd.12075] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2014] [Indexed: 12/12/2022]
Abstract
Despite the fact that several clinical studies have shown additional benefits when certain systemic antibiotics are used as adjuncts to periodontal treatment, clear guidelines for the use of these agents in the clinical practice are not yet available. Basic questions concerning the use of systemic antibiotics to treat periodontitis remain unanswered, such as: which drug(s) should be used; which patients would most benefit from treatment; which are the most effective protocols (i.e. doses and durations); and in which phase of the mechanical therapy should the drug(s) be administered? Although not all of those questions have been directly addressed by controlled randomized clinical trials, recent concepts related to the ecology of periodontal diseases, as well as the major advances in laboratory and clinical research methods that have occurred in the past decade, have significantly broadened our knowledge in this field. This article endeavored to provide a 'state of the art' overview on the use of systemic antibiotics in the treatment of periodontitis, based on the most recent literature on the topic as well as on a compilation of data from studies conducted at the Center of Clinical Trials at Guarulhos University (São Paulo, Brazil) from 2002 to 2012.
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Sundaram G, Ramakrishnan T, Parthasarathy H, Moses J, Lalitha T. Evaluation of Micronutrient (Zinc, Magnesium, and Copper) Levels in Serum and Glycemic Status after Nonsurgical Periodontal Therapy in Type 2 Diabetic Patients with Chronic Periodontitis. Contemp Clin Dent 2017; 8:26-32. [PMID: 28566847 PMCID: PMC5426161 DOI: 10.4103/0976-237x.205036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS AND OBJECTIVES To find out the effect of nonsurgical periodontal therapy on serum zinc (Zn), magnesium (Mg), and copper (Cu) concentration and glycemic status in type 2 diabetes with chronic periodontitis (CP). MATERIALS AND METHODS One hundred and twenty patients were included in this study, which was further divided into three groups. Group 1 consisted of forty patients with CP, Group 2 consisted of forty patients of CP with controlled diabetes, and Group 3 consisted of forty patients of CP with uncontrolled diabetes. Periodontal parameters such as plaque index, gingival index, bleeding on probing, pocket depth, and clinical attachment levels (CALs) were evaluated. Blood samples were collected to assess the levels of fasting blood sugar, glycosylated hemoglobin, Zn, Mg, and Cu. All parameters were evaluated at baseline and 3 months after nonsurgical periodontal therapy. RESULTS The results showed statistically significant reduction in all the clinical parameters within the groups except for the CAL in group 1 patients (P = 0.05). The glycemic status also showed a statistically significant reduction after treatment (P < 0.001). The intragroup comparison was taken between the values of micronutrients, showed substantial increase in the levels of both Zn and Mg and decrease in the level of Cu after nonsurgical periodontal treatment (P < 0.001). CONCLUSION Patients with diabetes and periodontitis had altered metabolism of Zn, Mg, and Cu contributing to the progression and complication of diabetes mellitus and periodontitis. Nonsurgical periodontal treatment improved the variation and concentration of plasma micronutrients and also the periodontal status and glycemic level.
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Affiliation(s)
- Gopalakrishnan Sundaram
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - T Ramakrishnan
- Department of Periodontics, Adhiparasakthi Dental College, Chennai, Tamil Nadu, India
| | - Harinath Parthasarathy
- Department of Periodontics, SRM Dental College and Hospitals, Chennai, Tamil Nadu, India
| | - Joyson Moses
- Department of Pedodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - T Lalitha
- Department of Periodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
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Zare Javid A, Hormoznejad R, Yousefimanesh HA, Zakerkish M, Haghighi-Zadeh MH, Dehghan P, Ravanbakhsh M. The Impact of Resveratrol Supplementation on Blood Glucose, Insulin, Insulin Resistance, Triglyceride, and Periodontal Markers in Type 2 Diabetic Patients with Chronic Periodontitis. Phytother Res 2016; 31:108-114. [PMID: 27807887 DOI: 10.1002/ptr.5737] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 09/18/2016] [Accepted: 09/19/2016] [Indexed: 01/18/2023]
Abstract
The aim of this study was to investigate the impact of resveratrol supplementation along with non-surgical periodontal treatment on blood glucose, insulin, insulin resistance, triglyceride (TG), and periodontal markers in patients with type 2 diabetes with periodontal disease. In this double-blind clinical trial study, 43 patients with diabetes with chronic periodontitis were participated. Subjects were randomly allocated to intervention and control groups. The intervention and control groups received either 480 mg/day of resveratrol or placebo capsules (two pills) for 4 weeks. Fasting blood glucose, insulin, insulin resistance (homeostasis model assessment of insulin resistance), TGs, and pocket depth were measured in all subjects' pre-intervention and post-intervention. The mean serum levels of fasting insulin and insulin resistance (homeostasis model assessment of insulin resistance) were significantly lower in the intervention group compared with control group (10.42 ± 0.28 and 10.92 ± 0.9; 3.66 ± 0.97 and 4.49 ± 1.56, respectively). There was a significant difference in the mean pocket depth between intervention and control groups (2.35 ± 0.6 and 3.38 ± 0.5, respectively) following intervention. No significant differences were observed in the mean levels of fasting blood glucose and TGs between two groups' post-intervention. It is recommended that resveratrol supplementation may be beneficial as adjuvant therapy along with non-surgical periodontal treatment in insulin resistance and improving periodontal status among patients with diabetes with periodontal disease. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ahmad Zare Javid
- Nutrition and Metabolic Diseases Research Center and Hyperlipidemia Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Razie Hormoznejad
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hojat Allah Yousefimanesh
- Department of Periodontology, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehrnoosh Zakerkish
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Parvin Dehghan
- Nutrition Research Center, Food Science and Technology Department, Nutrition Faculty, Tabriz University of Medical Science, Tabriz, Iran
| | - Maryam Ravanbakhsh
- Student Research Committee, Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Abstract
BACKGROUND Investigators of previous studies regarding the correlation between area-level health care resources and obesity have not examined the association between the prevalence of dentists and rates of adult obesity. The authors conducted a study to address that knowledge gap. METHODS Using data compiled in the Robert Wood Johnson County Health Rankings and Roadmaps database, the authors conducted multivariable analyses of the relationship between the prevalence of dentists (from the 2011 Health Resources and Services Administration Area Resource File) and rates of obesity within counties. The authors controlled for prevalence of primary care providers, measures of the built environment (for example, number of recreational facilities per 10,000 population, the percentage of restaurants serving fast food) and county-level sociodemographic and economic factors. RESULTS When the authors conducted a multivariable analysis adjusted for state-level fixed effects, they found that having one additional dentist per 10,000 population was associated significantly with a 1-percentage point reduction in the rate of obesity (P < .001). This effect was significantly larger in counties in which 25 percent of children or more (versus less than 25 percent of children) lived in poverty and in counties that had more primary care physicians per 10,000 population (P ≤ .009). CONCLUSIONS The association between the prevalence of dentists and obesity, even after adjusting for primary care resources and sociodemographic factors, was evident. Although these data could not be used to assess causality, given the strength of the ecological, cross-sectional association, additional research involving person-level, longitudinal data is warranted. PRACTICAL IMPLICATIONS The correlation between the prevalence of dentists and obesity rates highlights the potential for dental professionals, as well as other primary care providers, to provide meaningful health education and support for improved nutritional behaviors, although the increased obesity rates in counties with fewer dentists per capita present challenges.
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Gelato MC, Schoenfeld E, Hou W, Michalowicz B, Seaquist E, Oates T, Tripathy D, Engebretson S, Hyman L. Changes in diabetes medications in the Diabetes and Periodontal Therapy Trial and their effect on hemoglobin A1c (HbA1c). Contemp Clin Trials 2016; 50:21-7. [PMID: 27417981 DOI: 10.1016/j.cct.2016.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/16/2016] [Accepted: 07/10/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Evaluate the effect of medications and medication changes during the Diabetes and Periodontal Therapy Trial (DPTT) on the primary study outcome, namely, change in hemoglobin A1c (HbA1c) at 6months following baseline. METHODS The DPTT set strict criteria for changes in diabetes medications. Medication change was defined as: change in dose of any 1 oral hypoglycemic agent by more than two-fold, change in dose of insulin of >10% and/or addition or subtraction of an oral hypoglycemic agent, insulin or non-insulin injectable agents. Comparisons between the treatment (non- surgical periodontal therapy) and control (no therapy) groups used t-tests for continuous variables and chi-square tests for categorical variables, including DPTT defined diabetes medication changes between baseline (BL) and 3month visits and 3- and 6-month visits. Changes in HbA1c were compared across the four medication change categories using ANOVA models, overall and for each treatment group separately. RESULTS Baseline medication use was similar between the treatment groups (p>0.40), as were medication changes between BL- 3month visits and 3 and 6month visits (p=0.58). Participants with higher BL HbA1c (>8%) and those taking insulin at BL were more likely to have a change in medication (p=0.03). CONCLUSIONS The DPTT had the most rigorous definition of medication changes and medication monitoring of any trial in this field to date. The absence of a significant difference in medication changes between treatment groups may suggest that such changes did not play a role in the negative outcome of the DPTT.
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Affiliation(s)
- Marie C Gelato
- Division of Endocrinology, Stony Brook Medicine, HSC T16-027i, Stony Brook, New York 11794-8154, United States.
| | - Elinor Schoenfeld
- Department of Preventive Medicine, Stony Brook University, School of Medicine, Stony Brook, NY
| | - Wei Hou
- Department of Preventive Medicine, Stony Brook University, School of Medicine, Stony Brook, NY
| | - Bryan Michalowicz
- Department of Developmental and Surgical Sciences, University of Minnesota, Minneapolis, MN
| | | | - Thomas Oates
- School of Dentistry, University of Texas at San Antonio, San Antonio, TX
| | - Devjit Tripathy
- Department of Medicine, University of Texas at San Antonio, San Antonio, TX
| | - Steven Engebretson
- Department of Periodontology and Implant Dentistry, New York University, New York, NY
| | - Leslie Hyman
- Department of Preventive Medicine, Stony Brook University, School of Medicine, Stony Brook, NY
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Pérez-Losada FL, Jané-Salas E, Sabater-Recolons MM, Estrugo-Devesa A, Segura-Egea JJ, López-López J. Correlation between periodontal disease management and metabolic control of type 2 diabetes mellitus. A systematic literature review. Med Oral Patol Oral Cir Bucal 2016; 21:e440-6. [PMID: 26827070 PMCID: PMC4920457 DOI: 10.4317/medoral.21048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/11/2015] [Indexed: 12/23/2022] Open
Abstract
Background Diabetes and periodontal disease share common features in terms of inflammatory responses. Current scientific evidence suggests that treatment of periodontal disease might contribute to glycemic control. The objective of the study is a review of the last three years. Material and Methods A literature search was performed in the MEDLINE (PubMed), Cochrane, and Scopus databases, for articles published between 01-01-2013 and 30-06-2015, applying the key terms “periodontal disease” AND “diabetes mellitus”. The review analyzed clinical trials of humans published in English and Spanish. Results Thirteen clinical trials were reviewed, representing a total of 1,912 patients. Three of them had samples of <40 patients, making a total of 108 patients and the remaining ten samples had >40 patients, representing a total of 1,804. Only one article achieved a Jadad score of five. Seven articles (998 patients, 52.3% total), presented a statistically significant decrease in HbA1c (p<
0.05) as a result of periodontal treatment. In the six remaining articles (representing 914 patients, 47.8% of the total), the decrease in HbA1c was not significant. Patient follow-up varied between 3 to 12 months. In three articles, the follow-up was of 3, 4, and 9 months, in two 6 and 12 months. Conclusions The majority of clinical trials showed that radicular curettage and smoothing, whether associated with antibiotics or not, can improve periodontal conditions in patients with diabetes mellitus. However, few studies suggest that this periodontal treatment improves metabolic control. However, there is no clear evidence of a relation between periodontal treatment and improved glycemic control in patients with type 2 diabetes mellitus. Key words:Diabetes, periodontal disease, HbA1c, metabolic control.
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Affiliation(s)
- F-L Pérez-Losada
- Department of Odontostomatology, School of Dentistry, Pabellón de Gobierno, Bellvitge University Campus, C/Feixa LLarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain,
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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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Effect of high-glucose conditions on human periodontal ligament endothelial cells: in vitro analysis. Odontology 2016; 105:76-83. [DOI: 10.1007/s10266-016-0235-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/04/2016] [Indexed: 01/19/2023]
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Knight ET, Liu J, Seymour GJ, Faggion CM, Cullinan MP. Risk factors that may modify the innate and adaptive immune responses in periodontal diseases. Periodontol 2000 2016; 71:22-51. [DOI: 10.1111/prd.12110] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2015] [Indexed: 12/31/2022]
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Tamashiro N, Duarte P, Miranda T, Maciel S, Figueiredo L, Faveri M, Feres M. Amoxicillin Plus Metronidazole Therapy for Patients with Periodontitis and Type 2 Diabetes. J Dent Res 2016; 95:829-36. [DOI: 10.1177/0022034516639274] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The aim of this study was to assess the changes occurring in subgingival biofilm composition and in the periodontal clinical parameters of subjects with periodontitis and type 2 diabetes mellitus (DM) treated by means of scaling and root planing (SRP) only or combined with systemic metronidazole (MTZ) and amoxicillin (AMX). Fifty-eight subjects were randomly assigned to receive SRP only ( n = 29) or with MTZ (400 mg/thrice a day [TID]) and AMX (500 mg/TID) ( n = 29) for 14 d. Six subgingival plaque samples/subject were analyzed by checkerboard DNA–DNA hybridization for 40 bacterial species at baseline and 3 mo, 1 y, and 2 y posttherapy. At 2 y posttherapy, the antibiotic-treated group harbored lower mean proportions (5.5%) of red complex pathogens than the control group (12.1%) ( P < 0.05). The proportions of the Actinomyces species remained stable in the antibiotic group but showed a statistically significant reduction in the control group from 1 to 2 y in subjects achieving a low risk clinical profile for future disease progression (i.e., ≤4 sites with probing depth [PD] ≥5 mm). The test group also had a lower mean number of sites with PD ≥5 mm (3.5 ± 3.4) and a higher percentage of subjects reaching the low risk clinical profile (76%) than the control group (14.7 ± 13.1 and 22%, respectively) ( P < 0.05) at 2 y posttreatment. MTZ + AMX intake was the only significant predictor of subjects achieving the low risk at 2 y (odds ratio, 20.9; P = 0.0000). In conclusion, the results of this study showed that the adjunctive use of MTZ + AMX improves the microbiological and clinical outcomes of SRP in the treatment of subjects with generalized chronic periodontitis and type 2 DM up to 2 y ( ClinicalTrials.gov NCT02135952).
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Affiliation(s)
- N.S. Tamashiro
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - P.M. Duarte
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - T.S. Miranda
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - S.S. Maciel
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - L.C. Figueiredo
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - M. Faveri
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - M. Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
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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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Spasovski S, Belazelkoska Z, Popovska M, Atanasovska-Stojanovska A, Radojkova-Nikolovska V, Muratovska I, Toseska-Spasova N, Dzipunova B, Nikolovski B. Clinical Therapeutic Effects of the Application of Doxycycline in the Treatment of Periodontal Disease. Open Access Maced J Med Sci 2016; 4:152-7. [PMID: 27275351 PMCID: PMC4884238 DOI: 10.3889/oamjms.2016.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the therapeutic effects of the application of doxycycline-full dose (100 mg) and sub-dose (20 mg) in the treatment of periodontal disease. MATERIAL AND METHODS A total of 60 patients with periodontal disease were examined. Patients are divided into two groups: A) treated with antimicrobial dose of 100 mg doxycycline once daily for 30 days, and B) treated with 2 x 20 mg/day. doxycycline, during 75 days. Among all patients a conservative treatment was carried out and ordinated the proper dose doxycycline in total dose during treatment from 3 gr. Index of dental plaque by Löe-Sillness, index of gingival inflammation and gingival bleeding by Cowell were followed. RESULTS Values of dental plaque in relation first examination, 10th, 20th day, 1 month and 2.5 months, showed that after 2.5 months, average value (x = 0.83) of dental plaque in second group is slightly less than the value (x = 0.93) of dental plaque in the first group. The average value (x = 0.17) of gingival inflammation in second group is significantly less than the value (x = 0.50) of gingival inflammation in the first group. The average value (x = 0.97) of gingival bleeding in patients from the first group was significantly higher than value(x = 0.37) of gingival bleeding in the second group. CONCLUSION Patients whose therapy was helped by a sub-dose doxycycline demonstrated positive therapeutic effects on gingival inflammation and bleeding.
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Affiliation(s)
| | - Zlatanka Belazelkoska
- Faculty of Dentistry, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, Republic of Macedonia
| | - Mirjana Popovska
- Faculty of Dentistry, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, Republic of Macedonia
| | | | - Vera Radojkova-Nikolovska
- Faculty of Dentistry, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, Republic of Macedonia
| | - Ilijana Muratovska
- Faculty of Dentistry, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, Republic of Macedonia
| | - Natasa Toseska-Spasova
- Faculty of Dentistry, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, Republic of Macedonia
| | - Biljana Dzipunova
- Faculty of Dentistry, Ss. Cyril and Methodius University of Skopje, 1000 Skopje, Republic of Macedonia
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Al Amri MD, Kellesarian SV, Al-Kheraif AA, Malmstrom H, Javed F, Romanos GE. Effect of oral hygiene maintenance on HbA1c levels and peri-implant parameters around immediately-loaded dental implants placed in type-2 diabetic patients: 2 years follow-up. Clin Oral Implants Res 2016; 27:1439-1443. [PMID: 26756309 DOI: 10.1111/clr.12758] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of the present 2-year follow-up study was to assess the effect of oral hygiene maintenance on hemoglobin Alc (HbA1c) levels and peri-implant parameters around immediately-loaded dental implants placed in type-2 diabetic patients with varying glycemic levels. MATERIAL AND METHODS Ninety-one individuals were divided into three groups. In group 1, 30 systemically healthy individuals were included (HbA1c < 6%). Patients in group 2 and 3, comprised of 30 patients with T2DM (HbA1c 6.1-8%); and 31 patients with T2DM (HbA1c 8.1-10%) respectively. In all groups, patients received immediately loaded bone level implants. All participants were enrolled in a 6 monthly periodontal/peri-implant maintenance program. Peri-implant bleeding on probing (BOP), probing depth (PD), and marginal bone loss (MBL) were measured at 6, 12, and 24 months of follow-up. RESULTS Mean preoperative HbA1c levels in patients in groups 1, 2, and 3 were 4.5%, 6.8%, and 8.7% respectively. In group-1, there was no significant difference in HbA1c levels at all follow-up durations. Among patients in groups 2 and 3, there was a significant decrease in HbA1c levels at 24-months follow-up than 6-months follow-up. At 6 months follow-up, BOP, PD, and MBL were significantly higher among patients in group-3 than group-1. At 12 and 24 months follow-up, there was no significant difference in BOP, PD, and MBL in all groups. CONCLUSIONS Oral hygiene maintenance reduces hyperglycemia and peri-implant inflammatory parameters around immediately loaded dental implants placed in type 2 diabetic patients.
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Affiliation(s)
- Mohammad D Al Amri
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Sergio Varela Kellesarian
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Abdulaziz A Al-Kheraif
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hans Malmstrom
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Fawad Javed
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Georgios E Romanos
- Department of Periodontology, School of Dental Medicine, Stony Brook University, New York, NY, USA. .,Department of Oral Surgery and Implant Dentistry, Dental School Frankfurt, Frankfurt, Germany.
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49
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Santos CMML, Lira-Junior R, Fischer RG, Santos APP, Oliveira BH. Systemic Antibiotics in Periodontal Treatment of Diabetic Patients: A Systematic Review. PLoS One 2015; 10:e0145262. [PMID: 26693909 PMCID: PMC4687852 DOI: 10.1371/journal.pone.0145262] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 11/30/2015] [Indexed: 01/19/2023] Open
Abstract
Aim To evaluate the effects of systemic antibiotics in combination with scaling and root planing (SRP) on periodontal parameters, tooth loss and oral health-related quality of life in diabetes patients. Materials and Methods Two independent reviewers screened for controlled clinical trials with at least 6-month follow-up in six electronic databases, registers of clinical trials, meeting abstracts and four major dental journals. After duplicates removal, electronic and hand searches yielded 1,878 records; 18 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 a fixed effects model. Results Five studies met the inclusion criteria, four of which were included in meta-analyses. The meta-analyses showed a significant effect favouring SRP plus antibiotic for reductions in mean probing depth (PD) (-0.22 mm [-0.34, -0.11]) and mean percentage of bleeding on probing (BoP) (4% [-7, -1]). There was no significant effect for clinical attachment level gain and plaque index reduction. No study reported on tooth loss and oral health-related quality of life. Conclusion Adjunctive systemic antibiotic use in diabetic patients provides a small additional benefit in terms of reductions in mean PD and mean percentage of BoP. Registration PROSPERO: CRD42013006389.
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Affiliation(s)
| | - Ronaldo Lira-Junior
- Department of Periodontology, School of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ricardo Guimarães Fischer
- Department of Periodontology, School of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ana Paula Pires Santos
- Department of Community and Preventive Dentistry, School of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Branca Heloisa Oliveira
- Department of Community and Preventive Dentistry, School of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
- * E-mail:
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50
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Torumtay G, Kırzıoğlu FY, Öztürk Tonguç M, Kale B, Calapoğlu M, Orhan H. Effects of periodontal treatment on inflammation and oxidative stress markers in patients with metabolic syndrome. J Periodontal Res 2015; 51:489-98. [DOI: 10.1111/jre.12328] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2015] [Indexed: 12/20/2022]
Affiliation(s)
- G. Torumtay
- Department of Periodontology; Faculty of Dentistry; Süleyman Demirel University; Isparta Turkey
| | - F. Y. Kırzıoğlu
- Department of Periodontology; Faculty of Dentistry; Süleyman Demirel University; Isparta Turkey
| | - M. Öztürk Tonguç
- Department of Periodontology; Faculty of Dentistry; Süleyman Demirel University; Isparta Turkey
| | - B. Kale
- Department of Internal Medicine; Faculty of Medicine; Süleyman Demirel University; Isparta Turkey
| | - M. Calapoğlu
- Department of Biochemistry; Faculty of Arts and Sciences; Süleyman Demirel University; Isparta Turkey
| | - H. Orhan
- Department of Biostatistics and Medical Informatics; Faculty of Medicine; Süleyman Demirel University; Isparta Turkey
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