Effects of Periodontal Therapy on Systemic Markers of Inflammation in Patients With Metabolic Syndrome: A Controlled Clinical Trial

Construction of a Biological Age Score to Predict Tooth Loss over 10 Years

The aim of the present study was to construct a biological age score reflecting one’s physiologic capability and aging condition with respect to tooth loss over 10 y. From the follow-up to the population-based Study of Health in Pomerania (i.e., SHIP-2), 2,049 participants were studied for their baseline biomarker measures 10 y before (i.e., in SHIP-0). Metabolic and periodontal data were regressed onto chronological age to construct a score designated as “biological age.” For either sex separately, the impact of this individualized score was used to predict tooth loss in the follow-up cohort in comparison with each participant’s chronological age. Outcome data after 10 y with respect to tooth loss, periodontitis, obesity, and inflammation were shown to be better for biologically younger subjects than as expected by their chronological age, whereas for the older subjects, data were worse. Especially for tooth loss, a striking increase was observed in subjects whose biological age at baseline appeared to be higher than their chronological age. Biological age produced significantly better tooth loss predictions than chronological age ( P < 0.001). Areas under receiver operating characteristic curves for tooth loss of ≥3 teeth in men during follow-up were 0.811 and 0.745 for biological and chronological age, respectively. For women, these figures were 0.788 and 0.724. For total tooth loss, areas under the curve were 0.890 and 0.749 in men and 0.872 and 0.752 in women. Biological age combines various measures into a single score and allows identifying individuals at increased risk of tooth loss.

Systemic Antibiotic Therapy Reduces Circulating Inflammatory Dendritic Cells and Treg-Th17 Plasticity in Periodontitis

Periodontitis (PD) is a common dysbiotic inflammatory disease that leads to local bone deterioration and tooth loss. PD patients experience low-grade bacteremias with oral microbes implicated in the risk of heart disease, cancer, and kidney failure. Although Th17 effectors are vital to fighting infection, functional imbalance of Th17 effectors and regulatory T cells (Tregs) promote inflammatory diseases. In this study, we investigated, in a small pilot randomized clinical trial, whether expansion of inflammatory blood myeloid dendritic cells (DCs) and conversion of Tregs to Th17 cells could be modulated with antibiotics (AB) as part of initial therapy in PD patients. PD patients were randomly assigned to either 7 d of peroral metronidazole/amoxicillin AB treatment or no AB, along with standard care debridement and chlorhexidine mouthwash. 16s ribosomal RNA analysis of keystone pathogen Porphyromonas gingivalis and its consortium members Fusobacterium nucleatum and Streptococcus gordonii confirmed the presence of all three species in the reservoirs (subgingival pockets and blood DCs) of PD patients before treatment. Of the three species, P. gingivalis was reduced in both reservoirs 4-6 wk after therapy. Further, the frequency of CD1C⁺CCR6⁺ myeloid DCs and IL-1R1 expression on IL-17A⁺FOXP3⁺CD4⁺ T cells in PD patients were reduced to healthy control levels. The latter led to decreased IL-1β-stimulated Treg plasticity in PD patients and improvement in clinical measures of PD. Overall, we identified an important, albeit short-term, beneficial role of AB therapy in reducing inflammatory DCs and Treg-Th17 plasticity in humans with PD.

Effect of Periodontal Treatment on HbA1c among Patients with Prediabetes

Evidence is limited regarding whether periodontal treatment improves hemoglobin A1c (HbA1c) among people with prediabetes and periodontal disease, and it is unknown whether improvement of metabolic status persists >3 mo. In an exploratory post hoc analysis of the multicenter randomized controlled trial “Antibiotika und Parodontitis” (Antibiotics and Periodontitis)—a prospective, stratified, double-blind study—we assessed whether nonsurgical periodontal treatment with or without an adjunctive systemic antibiotic treatment affects HbA1c and high-sensitivity C-reactive protein (hsCRP) levels among periodontitis patients with normal HbA1c (≤5.7%, n = 218), prediabetes (5.7% < HbA1c < 6.5%, n = 101), or unknown diabetes (HbA1c ≥ 6.5%, n = 8) over a period of 27.5 mo. Nonsurgical periodontal treatment reduced mean pocket probing depth by >1 mm in both groups. In the normal HbA1c group, HbA1c values remained unchanged at 5.0% (95% CI, 4.9% to 6.1%) during the observation period. Among periodontitis patients with prediabetes, HbA1c decreased from 5.9% (95% CI, 5.9% to 6.0%) to 5.4% (95% CI, 5.3% to 5.5%) at 15.5 mo and increased to 5.6% (95% CI, 5.4% to 5.7%) after 27.5 mo. At 27.5 mo, 46% of periodontitis patients with prediabetes had normal HbA1c levels, whereas 47.9% remained unchanged and 6.3% progressed to diabetes. Median hsCRP values were reduced in the normal HbA1c and prediabetes groups from 1.2 and 1.4 mg/L to 0.7 and 0.7 mg/L, respectively. Nonsurgical periodontal treatment may improve blood glucose values among periodontitis patients with prediabetes (ClinicalTrials.gov NCT00707369).

Prevalence and Risk Factors for Periodontitis Among Patients with Metabolic Syndrome

BACKGROUND

The incidence of periodontitis is higher when metabolic syndrome (MS) is present. However, only few Korean studies have compared the risk factors for MS and periodontitis. Therefore, this study aimed to investigate the prevalence and risk factors for periodontitis relative to the presence of MS.

METHODS

The data collected from 13,196 respondents of the 2010-2015 Korea National Health and Nutrition Examination Survey in South Korea, which include periodontitis and MS parameters, were analyzed after propensity score matching of sex and age.

RESULTS

A total of 29% of the participants had periodontitis. The periodontitis group had more males (53%), lower number of participants who had a high educational level (66.6%), and higher body mass index (24.3 ± 3.2) and waist circumference (83.8 ± 9.2) than the nonperiodontitis group. Moreover, the periodontitis group exhibited higher systolic blood pressure and fasting plasma glucose and plasma triglyceride levels, but lower high-density lipoprotein cholesterol levels than the nonperiodontitis group (P < 0.001). Several patients in the periodontitis group had hypertension (43.3%) and diabetes mellitus (17.3%), but only few had chronic kidney disease (3.4%). Multiple regression analysis showed that the risk of periodontitis increased when MS, diabetes mellitus, and smoking history were present. Particularly, the risk of periodontitis increased as the number of MS components increased (P < 0.001).

CONCLUSIONS

Patients with MS had 1.12-fold higher risk of periodontitis than those without. Additionally, patients who had diabetes mellitus and were smokers had a particularly high risk of periodontitis. The risk of periodontitis increased as the number of MS components increased.

Provision of oral hygiene services as a potential method for preventing periodontal disease and control hypertension and diabetes in a community health centre in Korea

This study aimed to evaluate the effects of a community-based oral hygiene service on general and periodontal health indicators of patients with hypertension and type 2 diabetes mellitus visiting a community health centre in Korea. The study used a one-group pretest-posttest and interrupted time-series design. A total of 151 participants (45% male), with a mean age of 63 ± 8.4 years, were included in the study; these included patients with hypertension (62%), diabetes (12%) and both hypertension and diabetes (26%). Two dental hygienists dedicated 2 days per week to this project, providing oral hygiene services to 10-13 participants per day. Four oral hygiene service sessions were provided per patient. The objective oral hygiene status and subjective self-reported periodontal status were compared before and after the service. The changes in blood pressure and glycosylated haemoglobin levels were also assessed. A lower frequency of subjective swelling was reported at the fourth session (37.9%) compared to the first (55.6%) session. Further, significantly fewer cases of calculus and bleeding were observed (p < .05), and significantly more patients reported having no gum problems at the fourth session (43.1% vs. 27.2%; p < .05) than at the first session. Finally, the participants maintained stable blood pressures at each of the four sessions, and their glycosylated haemoglobin levels were significantly lower at the fourth session. In conclusion, the findings of this study suggest that community oral hygiene services provided by dental hygienists can promote objective oral hygiene and subjective periodontal status in the local community, and may help in the control of hypertension and diabetes.

Modulation of periodontitis progression using pH-responsive nanosphere encapsulating metronidazole or N-phenacylthialzolium bromide

BACKGROUND AND OBJECTIVE

This study aimed to develop pH-responsive polylactide-glycolic acid co-polymer and chitosan (PLGA/chitosan) nanosphere as an inflammation-responsive vehicle and evaluate the potential of the nanosphere encapsulating metronidazole, an antibiotic, and N-phenacylthiazolium bromide (PTB), a host modulator, for treating periodontitis.

MATERIAL AND METHODS

PLGA/chitosan nanospheres were fabricated using oil-in-water emulsion method. Experimental periodontitis was induced on the rat maxillae, and the sites were randomly allocated to four treatment categories, including periodontitis alone (PR), periodontitis with nanospheres alone, nanospheres encapsulating metronidazole (MT) and nanospheres encapsulating PTB (PB). The ligature was retained until the animals were killed, and the treatment outcome was evaluated by the progression of periodontal bone loss (PPBL), inflammatory cell infiltration and collagen deposition.

RESULTS

The encapsulated drug was released rapidly from the nanospheres without significant initial burst release at pH 5.5. Compared with group PR, PPBL was significantly reduced in groups MT and PB on day 4 (P<.05). On day 21, PPBL was significantly lower in group PB (P<.05). In groups MT and PB, inflammation was significantly reduced in groups MT and PB relative to groups PR and periodontitis with nanospheres alone (P<.05), and collagen deposition was significantly greater relative to group PR (P<.05).

CONCLUSION

PLGA/chitosan nanospheres encapsulating metronidazole or PTB showed potential for modulating periodontitis progression.

Effect of Intensive Periodontal Therapy on Blood Pressure and Endothelial Microparticles in Patients With Prehypertension and Periodontitis: A Randomized Controlled Trial

BACKGROUND

Although some studies show a positive association between periodontitis and blood pressure (BP) elevation, research on the effect of intensive periodontal treatment on decline in BP levels and endothelial microparticles (EMPs) without any antihypertensive management is lacking. Therefore, the present clinical trial explores whether intensive periodontal therapy would lower BP levels and EMPs of patients with prehypertension with periodontitis.

METHODS

From a total 107 patients, 95 underwent randomization (47 assigned to control-treatment [CT] group and 48 assigned to intensive-treatment [IT] group) and completed the trial. Patients received intervention for 4 consecutive weeks and were followed for 6 months. Levels of BP and EMPs were evaluated at baseline and 1, 3, and 6 months after intervention.

RESULTS

Periodontal conditions were significantly improved (P <0.05) 6 months after intensive periodontal treatment. In parallel, the primary outcomes including systolic and diastolic BP and EMPs were markedly reduced in the IT group compared with the CT group (absolute difference: 12.57 and 9.65 mm Hg and 581.59/μL, respectively; 95% confidence intervals: 10.45 to 14.69, 7.06 to 12.24, and 348.12 to 815.06, respectively; P <0.05). Reduction in BP levels and EMPs was related to improvement in probing depth (r = 0.358, 0.363, and 0.676, respectively, by the Pearson product-moment correlation; P = 0.009, 0.008, and P <0.001, respectively).

CONCLUSION

To the best knowledge of the authors, the present study demonstrates for the first time that intensive periodontal intervention without any antihypertensive medication therapy may be an effective means to lower levels of BP and EMPs in patients with prehypertension with periodontitis.

Effect of periodontal therapy with systemic antimicrobials on parameters of metabolic syndrome: A randomized clinical trial

Aim

To investigate the effect of basic periodontal therapy (BPT) with antimicrobials (AM) on the parameters of metabolic syndrome (MetS) (waist circumference, systolic/diastolic blood pressure [BP], HDL‐cholesterol, triglycerides, glucose).

Methods

One hundred and ten periodontitis patients without known comorbidities and unaware of possible MetS were randomly assigned to BPT (n = 56) or BPT+AM (n = 54) and followed for 12 months post‐therapy. Number of patients with undiagnosed MetS was also determined.

Results

In all patients, the periodontal condition improved; however, the BTP+AM group showed greater pocket depth reduction than the BPT group. Post‐therapy, systolic BP (p < .05) and triglycerides (p < .05) reduced significantly during the follow‐up period. No significant differences could be assessed between the BPT+AM and BPT group. Despite the absence of self‐reported comorbidities, 27.2% (n = 30) periodontitis patients fulfilled the criteria of MetS at baseline. After therapy, this proportion changed to 14.5% at 3 months (p = .007), to 17.3% at 6 months (p = .017) and to 21.8% at 12‐month follow‐up (p = .383).

Conclusion

Although a reduction in systolic BP and triglycerides and a temporarily improvement in the whole metabolic status were observed, the use of antimicrobials in conjunction with BTP does not yield any additional improvement in the parameters of MetS.

Effect of Non-Surgical Periodontal Therapy Along With Myo-Inositol on High-Sensitivity C-Reactive Protein and Insulin Resistance in Women With Polycystic Ovary Syndrome and Chronic Periodontitis: A Randomized Controlled Trial

BACKGROUND

The purpose of this study is to evaluate the effect of non-surgical periodontal therapy and medical treatment on the level of a serologic marker of inflammation (high-sensitivity C-reactive protein [hsCRP]) and insulin resistance (homeostatic model assessment [HOMA]) in women with polycystic ovary syndrome (PCOS) and chronic periodontitis (CP).

METHODS

Women with PCOS and CP (n = 60) were randomly divided into two groups. The test group was treated with scaling and root planing (SRP) and myo-inositol (MI). The control group was treated with MI and given oral hygiene instructions. Anthropometric, metabolic, and periodontal parameters were assessed at baseline and re-evaluated at 3 and 6 months. All parameters of both groups at 6 months were compared with 25 systemically and periodontally healthy females (group A).

RESULTS

Periodontal parameters were significantly improved in the test group compared with the control group at 3- and 6-month follow-up (P <0.001). A statistically significant reduction was observed in hsCRP and HOMA in both groups at 3- and 6-month follow-up (P <0.05). However, significantly more improvement in hsCRP (P <0.05) and a statistically comparable reduction in HOMA (P >0.05) was observed in the test group compared with the control group at 3 and 6 months. Both the test and control group showed significant consistent improvement in metabolic parameters at 3- and 6-month follow-up, which was further comparable to group A.

CONCLUSION

SRP together with medical treatment results in a greater reduction of systemic inflammatory burden compared with medical treatment alone in management of women with PCOS and CP.

Association of metabolic syndrome and chronic periodontitis in Colombians

BACKGROUND

Metabolic syndrome (MetS) is a common chronic condition that increases the cardiovascular disease risk and is also linked to periodontitis. The study aim was to determine if a relationship exists between MetS and chronic periodontitis in adult Colombians.

METHODS

Participants were 220 healthy-gingivitis subjects and 431 periodontitis patients coming from the three largest Colombian cities. Periodontal status and MetS were determined in subjects. Univariate analysis and odds ratio were calculated within the 95 % confidence intervals and chi2 test compared the groups. Variables were compared among the clinical periodontal groups and MetS by Wilcoxon and multivariate analysis, and logistic regression was performed for MetS and periodontitis.

RESULTS

MetS had higher prevalence in periodontitis group (6.3 %) versus controls (3.2 %). In multivariate analysis, periodontitis was associated with MetS (adjusted OR = 2.72, 95 % CI 1.09-6.79), glucose intolerance with another component of MetS (adjusted OR = 1.78, 1.16 to 2.72), glucose resistance (adjusted OR = 11.46, 95 % CI 1.41-92.88), smoking (OR = 1.72, 95 % CI 1.09-2.71), and city of origin (2.69, 95 % CI 1.79-4.04).

CONCLUSION

The study confirmed the positive association between MetS and periodontitis, being glucose sensitivity the strongly associated component.

CLINICAL RELEVANCE

MetS must be taken into account by the dentist when evaluating risk factors for periodontitis, being useful for dentists to evaluate glycemia, lipidic profile, central obesity, and high blood pressure in patients. Interdisciplinary treatment must be recommended when a patient with MetS and periodontitis is being treated.

Periodontal disease and the metabolic syndrome

The metabolic syndrome (MetS) is a spectrum of conditions that increase the risk of cardiovascular disease and diabetes mellitus. The components of MetS include dysglycemia, visceral obesity, atherogenic dyslipidemia (elevated triglycerides and low levels of high-density lipoprotein) and hypertension. An association of periodontal disease and MetS has been suggested. This association is believed to be the result of systemic oxidative stress and an exuberant inflammatory response. When examined individually, the components of the MetS that are most closely related to the risk of periodontitis are dysglycemia and obesity, with lesser contributions by atherogenic dyslipidemia and hypertension. Data suggest that the odds of periodontitis increase with the number of MetS components present in an individual. The direction of the relationship between MetS and periodontal disease cannot currently be determined because the majority of studies are cross-sectional. The association between MetS and periodontitis, however, suggests that improved understanding of this association could promote interprofessional practice. Evidence suggests that periodontal therapy can reduce the levels of inflammatory mediators in serum. If this finding is confirmed, periodontal treatment could become part of therapy for MetS. Oral health providers who identify patients at risk for MetS could refer them to a medical provider, and physicians could refer patients to dentists to ensure that patients with MetS receive a dental evaluation and any necessary treatment. These clinical activities would improve both oral and general health outcomes.

Systemic antibiotics in the treatment of periodontitis

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.

The relationship between insulin resistance and periodontitis is not affected by Mediterranean diet in a Spanish population

OBJETIVE

To examine the insulin resistance measured by surrogate indices in subjects with and without periodontitis and to find out any correlation among dietary intake with insulin resistance.

DESIGN

Fifty-five patients were recruited to participate in this cross-sectional study. Insulin resistance measured by the homoeostasis model assessment (HOMA-IR) and the quantitative insulin sensitivity check index moreover glycaemia, creatinine, uric acid, high density lipoproteins, low density lipoproteins, very low density lipoproteins and triglycerides among others. True periodontal disease was elucidated through the examination of probing pocket depth, clinical attachment level, recession of the gingival margin and gingival bleeding. The statistical analyses used were the student's T-test for independent variables, Kolmogorov-Smirnov if variations were homogeneous; if not, the Mann-Whitney U Test was applied instead. Correlations between variables were assessed using Pearson's correlation coefficients. True periodontal disease was confirmed through the greater values of probing pocket depth, clinical attachment level, gingival margin and gingival bleeding in the periodontitis group in comparison with non-periodontitis group.

RESULTS

Insulin resistance was evidenced by the greater values of HOMA-IR as well as by the lower quantitative insulin sensitivity check index values in the periodontitis group. Fasting insulin, glucose, uric acid, creatinine, low density lipoproteins, triglycerides and very low density lipoprotein levels were significant higher in periodontitis group. Pearson's correlations did not show any association among diet data and insulin resistance parameters in periodontitis patients.

CONCLUSION

A putative systemic relationship between insulin resistance and periodontitis exists but it does not seem conceivable any effect of diet over such relationship.

Systemic Inflammatory Biomarkers and Their Association With Periodontal and Diabetes-Related Factors in the Diabetes and Periodontal Therapy Trial, A Randomized Controlled Trial

BACKGROUND

The present study evaluates effects of non-surgical periodontal treatment on serum biomarkers in patients with type 2 diabetes mellitus (t2DM) and chronic periodontitis who participated in the Diabetes and Periodontal Therapy Trial (DPTT); and associations among diabetes markers, serum biomarkers, and periodontal measures in these patients.

METHODS

DPTT participants randomized to receive immediate or delayed non-surgical periodontal therapy were evaluated at baseline and 6 months. Serum samples from 475 participants with 6-month data were analyzed for the following biomarkers: 1) high sensitivity C-reactive protein; 2) E-selectin; 3) tumor necrosis factor (TNF)-α; 4) vascular cell adhesion molecule (VCAM); 5) interleukin (IL)-6; 6) IL-8; 7) intercellular adhesion molecule; and 8) IL-10. Changes in biomarker levels from baseline and correlations among biomarker levels and clinical findings were analyzed.

RESULTS

No differences between treatment and control groups were observed for any biomarkers at baseline or 6 months (P >0.05 for all variables). VCAM levels increased by an average (standard deviation) of 17.9 (99.5); ng/mL (P = 0.006) and E-selectin decreased by 2.33 (16.08) ng/mL (P = 0.03) in the treatment group after 6 months. E-selectin levels were significantly correlated with DM-related variables (hemoglobin A1c [HbA1c] and fasting glucose) at baseline and with 6-month change in both groups; no significant correlations were found among periodontal clinical parameters and serum biomarkers or DM-related variables. Neither HbA1c or body mass index varied during the study period in either study group.

CONCLUSIONS

Non-surgical periodontal therapy and periodontal disease severity were not associated with significant changes in serum biomarkers in DPTT participants during the 6-month follow-up. Correlations among changes in E-selectin, IL-6, and DM-related variables suggest that t2DM may be the primary driver of systemic inflammation in these patients.

A brief review on the periodontal health in metabolic syndrome patients

Metabolic syndrome (METs) and periodontal diseases are emerging worldwide community health problem. These common health problems may result with significant complications and increase community health expenses. METs is defined with the presence of hypertension, increased triglyceride levels, decreased high-density lipoprotein cholesterol levels, abdominal obesity and elevated fasting glucose levels. The term "periodontal diseases" defines pathological inflammatory conditions of the gingiva and supporting tooth structures. In this review, basic clinical features and associations between metabolic syndrome and periodontal diseases have been underlined. In addition, basic research topics have been noted.

Impact of chronic periodontitis on quality-of-life and on the level of blood metabolic markers

CONTEXT

Despite the recognition that systemic factors can alter the risk to the chronic periodontitis (CP), only recently has evidence begun to emerge, still under investigation, that infections of the oral cavity are related with low quality-of-life (QoL) and are able to influence the occurrence and severity of certain conditions and systemic diseases.

AIMS

The aim of this study was to evaluate the impact of CP on the QoL and on the metabolic systemic condition of CP patients.

SETTINGS AND DESIGNS

Cross-sectional, case-controlled, age- and gender-matched study.

SUBJECTS AND METHODS

Quality-of-life assessment (Functional Assessment of Chronic Illness Therapy-Fatigue), periodontal examinations and blood tests were obtained from 20 CP patients and 20 age- and gender-matched healthy controls (HC).

STATISTICAL ANALYSIS USED

parametric paired t-test for numerical data (metabolic parameters) and nonparametric paired Wilcoxon signed rank test to compare the QoL ordinal data of both groups. Statistical significance was determined at the 0.05 level.

RESULTS

Healthy controls had fewer negative impacts in all QoL areas studied. CP patients showed higher levels of low-density lipoprotein cholesterol, glucose, and uric acid compared with the HC.

CONCLUSIONS

Chronic periodontitis negatively affected the overall well-being and systemic condition of a group of Brazilian individuals.

Periodontitis and type II diabetes: a two-way relationship

For many years an association between diabetes and periodontitis has been suspected. In more recent times this relationship has been suggested to be bidirectional with each condition being able to influence the other. In this review the two-way relationship between diabetes and periodontitis is considered. For this narrative review a very broad search strategy of the literature was developed using both EMBASE and MEDLINE (via PubMed) databases. The reference lists from the selected papers were also scanned, and this provided an additional source of papers for inclusion and further assessment. The data available suggest that diabetes is a risk as well as a modifying factor for periodontitis. Individuals with diabetes are more likely to have periodontitis and with increased severity when diabetes is uncontrolled/poorly controlled. Possible mechanisms of how diabetes affects periodontitis include adipokine-mediated inflammation, neutrophil dysfunction, uncoupling of bone and advanced glycation end-products-receptor for advanced glycation end-products interaction. Evidence is accruing to support how periodontitis can affect diabetes and complications associated with diabetes. There is some evidence demonstrating that periodontal therapy can result in a moderate improvement in glycaemic control. Available evidence indicates that diabetes and peridontitis are intricately interrelated and that each condition has the capacity to influence clinical features of each other.

Additional effects of homeopathy on chronic periodontitis: a 1-year follow-up randomized clinical trial

BACKGROUND AND OBJECTIVE

The aim of this study was test the hypothesis that homeopathy (H) enhances the effects of scaling and root planing (SRP) in patients with chronic periodontitis (CP).

MATERIALS AND METHODS

50 patients with CP were randomly allocated to one of two treatment groups: SRP (C-G) or SRP + H (H-G). Assessments were made at baseline and after 3 and 12 months of treatments. The local and systemic responses to the treatments were evaluated by clinical and serologic parameters, respectively.

RESULTS

Both groups displayed significant improvements, however, using clinical attachment gain and reductions in HDL, LDL and Total Cholesterol, Triglycerides, Glucose and Uric acid, from baseline to 1 year, as criteria for treatment success, H-G performed significantly better than C-G.

CONCLUSION

The findings of this 1-year follow-up randomized clinical trial suggest that homeopathic medicines, as an adjunctive to SRP, can provide significant local and systemic improvements for CP patients.

Periodontal disease and metabolic syndrome: a qualitative critical review of their association

BACKGROUND

Metabolic syndrome (MetS) is a conglomerate of several physical conditions/diseases that, as a group, increases the risk of mortality resulting from development of T2DM and cardiovascular diseases (CVD). These conditions/diseases include glucose intolerance/insulin resistance, hypertension, obesity, and dyslipidemia. The results from epidemiological studies suggest that there is an association between metabolic syndrome (MetS) and periodontitis, it is therefore important to understand the current status of the association and a possible contribution of periodontitis to MetS.

OBJECTIVE

This review will qualitatively analyze published papers on the association of MetS and periodontitis/periodontal disease to clarify the current status of the association and suggest future directions for studies which may unravel the causal relationship between them.

RESULTS

Of 309 papers related to MetS and periodontitis, 26 are original research papers that investigated the relationship/association between periodontal disease and MetS. Criteria used to assess periodontitis and MetS as well as overall study designs and patient recruitment criteria varied greatly among these studies.

CONCLUSION

All these studies demonstrated a positive association between periodontal disease and MetS. However, due to the heterogeneity of criteria to assess periodontitis and MetS and also paucity of longitudinal studies, it is difficult to determine the relative contribution of periodontitis to MetS. Age and the number of positive components of MetS appear to strengthen the relationship, however, incidence of each disease entity increases with ageing. Thus, mechanistic studies are also necessary to unravel the inter-relationship between periodontitis and MetS. In this regard, a use of animal models will be helpful as they are more uniform in regards to genetic background and have minimum confounding factors. Finally, development of accurate, quantitative assessment of gingival inflammation are necessary in order to determine the influence of periodontal disease on the development of MetS and its components.

Sex Differences of Tooth Loss and Obesity on Systemic Markers of Inflammation

Sex-specific differences in the incidence of periodontitis and tooth loss may be related to different phenotypes of obesity and their associations with low-grade inflammation. The aim of this study was to evaluate associations of adiposity and low-grade inflammation with tooth loss in men and women. Follow-up data of 2,714 participants from the cohort of Study of Health in Pomerania were analyzed for anthropometric measures, periodontitis, tooth loss, C-reactive protein (CRP), and interleukin 6. Regression analyses were used to estimate the effect of obesity on tooth loss within sex strata. During the follow-up period, men lost more teeth in relation to their obesity status than did women. In contrast, there was a steeper increase in CRP levels across obesity levels in women as compared to men. Incidence rate ratio (IRR) of tooth loss associated with elevated CRP, however, was higher in men (IRR = 1.50; 95% confidence interval [CI]: 1.27, 1.77) than women (IRR = 1.18; 95% CI: 1.02, 1.37). Negative binomial regression with number of lost teeth as outcome revealed dose-response dependencies on body mass index and waist-to-hip ratio. Adjusted for covariates, the IRR of tooth loss associated with the third tertile of waist-to-hip ratio was 1.37 (95% CI: 1.04, 1.80) and 1.53 (95% CI: 1.14, 2.05) in men and women, respectively. Tooth loss related to CRP cutoff of 2 mg/L was significant in men (IRR = 1.33; 95% CI: 1.07, 1.66; p = .006) but not in women (IRR = 0.92; 95% CI: 0.73, 1.17; p = .689). This study suggests that both adiposity and subclinical inflammation affect tooth loss, with distinct differences between men and women. Obesity as a risk factor of tooth loss is particularly related to CRP in men but not in women.

Risk factors for periodontal disease

Risk factors play an important role in an individual's response to periodontal infection. Identification of these risk factors helps to target patients for prevention and treatment, with modification of risk factors critical to the control of periodontal disease. Shifts in our understanding of periodontal disease prevalence, and advances in scientific methodology and statistical analysis in the last few decades, have allowed identification of several major systemic risk factors for periodontal disease. The first change in our thinking was the understanding that periodontal disease is not universal, but that severe forms are found only in a portion of the adult population who show abnormal susceptibility. Analysis of risk factors and the ability to statistically adjust and stratify populations to eliminate the effects of confounding factors have allowed identification of independent risk factors. These independent but modifiable, risk factors for periodontal disease include lifestyle factors, such as smoking and alcohol consumption. They also include diseases and unhealthy conditions such as diabetes mellitus, obesity, metabolic syndrome, osteoporosis, and low dietary calcium and vitamin D. These risk factors are modifiable and their management is a major component of the contemporary care of many periodontal patients. Genetic factors also play a role in periodontal disease and allow one to target individuals for prevention and early detection. The role of genetic factors in aggressive periodontitis is clear. However, although genetic factors (i.e., specific genes) are strongly suspected to have an association with chronic adult periodontitis, there is as yet no clear evidence for this in the general population. It is important to pursue efforts to identify genetic factors associated with chronic periodontitis because such factors have potential in identifying patients who have a high susceptibility for development of this disease. Many of the systemic risk factors for periodontal disease, such as smoking, diabetes and obesity, and osteoporosis in postmenopausal women, are relatively common and can be expected to affect most patients with periodontal disease seen in clinics and dental practices. Hence, risk factor identification and management has become a key component of care for periodontal patients.

Effects of full-mouth scaling on the periodontal health of Indigenous Australians: a randomized controlled trial

BACKGROUND

Simplified periodontal therapy might be a pragmatic strategy for public health programmes targeting Indigenous Australian adults. The objective of this randomized controlled trial was to evaluate oral health effects of single-visit, non-surgical periodontal therapy compared to no treatment.

METHODS

This parallel-group, randomized, open label clinical trial enrolled 273 Indigenous Australians aged ≥18 years with periodontitis. Intervention participants received full-mouth periodontal scaling and root planing during a single visit while the control group received no treatment. Endpoints were summary variables derived from clinical assessments of probing depth, clinical attachment loss, plaque, calculus and gingival bleeding before treatment and 3 months later.

RESULTS

Endpoints could be calculated for 169 participants with follow-up data. Compared to the control group, there were statistically significant reductions in extent of shallow pockets: PD ≥4 mm (mean difference -2.86, [95% CI -5.01 to -0.71], p = 0.009) and gingival bleeding (mean difference -0.25, [95% CI -0.43 to -0.08], p = 0.005) but not deeper pockets PD ≥5 mm (mean difference -0.48, [95% CI -1.78 to 0.82], p = 0.468) or plaque scores.

CONCLUSIONS

Periodontal therapy produced improvements in shallow periodontal pockets and measures of gingival bleeding in these Indigenous Australians.

Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis

AIM

Systematic review and meta-analyses to study the robustness of observations that treatment of periodontitis improves the atherosclerotic profile.

MATERIAL AND METHODS

Literature was searched in Medline-PubMed, Cochrane CENTRAL and EMBASE, based on controlled periodontal intervention trials, including also a non-intervention group. Data were extracted and meta-analyses were performed.

RESULTS

From 3928 screened studies, 25 trials met the eligibility criteria. These trials enrolled 1748 periodontitis patients. Seven trials enrolled periodontitis patients that were otherwise healthy, 18 trials recruited periodontal patients with various co-morbidities, such as CVD or diabetes. None of the trials used hard clinical endpoints of CVD. However, improvement of endothelial function has been consistently reported. Meta-analyses demonstrated significant weighted mean difference (WMD) for hsCRP (-0.50 mg/l, 95% CI:-0.78; -0.22), IL-6 (-0.48 ng/l, 95% CI: -0.90; -0.06), TNF-α (-0.75 pg/ml, 95% CI: -1.34; -0.17), fibrinogen (-0.47 g/l, 95% CI: -0.76; -0.17), total cholesterol (-0.11 mmol/l, 95% CI: -0.21; -0.01) and HDL-C (0.04 mmol/l, 95% CI: 0.03; 0.06) favouring periodontal intervention. Importantly, periodontitis patients with co-morbidity benefitted most from periodontal therapy; significant WMD were observed for levels of hsCRP (-0.71 mg/l, 95% CI: -1.05; -0.36), IL-6 (-0.87 ng/l, 95% CI: -0.97; -0.78), triglycerides (-0.24 mmol/l, 95% CI: -0.26; -0.22), total cholesterol (-0.15 mmol/l, 95% CI: -0.29; -0.01), HDL-C (0.05 mmol/l, 95% CI: 0.03; 0.06) and HbA1c (-0.43%, 95% CI: -0.60; -0.25).

CONCLUSIONS

This systematic review and meta-analyses demonstrate that periodontal treatment improves endothelial function and reduces biomarkers of atherosclerotic disease, especially in those already suffering from CVD and/or diabetes.

Association between Chronic Periodontal Disease and Lower Urinary Tract Symptoms in Both Sexes

OBJECTIVE

To investigate the relationship between chronic periodontal disease (CPD) and lower urinary tract symptoms (LUTS) in both sexes.

METHODS

The interview sheet of the CPD self-checklist and LUTS was distributed to 600 adult men and women (300 each) who visited the first dental examination at dental clinics. The International Prostate Symptom Score (IPSS) questionnaire/Quality Of Life (IPSS/QOL) and Overactive Bladder Symptom Score (OABSS) were used to assess LUTS. The relationship between the CPD score and LUTS or OAB was examined.

RESULTS

The interview sheet was collected from 88 men (50.9 ± 16.6 years old) and 97 women (51.1 ± 15.5 years old). There was no statistically significant correlation between the CPD score and age, or between the CPD score and the presence of LUTS in either men or women. However, urgency and weak stream score of IPSS were significantly correlated with the severity of CPD in both sexes. Significant correlation between the severity of CPD and the presence of OAB was only noted in men but not in women.

CONCLUSIONS

The present study demonstrated for the first time that some storage and voiding symptoms were significantly associated with CPD in both sexes. Thus, although CPD and LUTS seem to have common pathophysiological factors, the interrelationship between CPD and LUTS is slightly different between men and women.

The influence of anti-infective periodontal treatment on C-reactive protein: a systematic review and meta-analysis of randomized controlled trials

Background

Periodontal infections are hypothesized to increase the risk of adverse systemic outcomes through inflammatory mechanisms. The magnitude of effect, if any, of anti-infective periodontal treatment on systemic inflammation is unknown, as are the patient populations most likely to benefit. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to test the hypothesis that anti-infective periodontal treatment reduces systemic c-reactive protein (CRP).

Methods and Findings

MEDLINE, EMBASE, CENTRAL and CINAHL databases were searched using sensitivity-enhancing search terms. Eligible RCTs enrolled patients with periodontal infection, compared a clearly defined anti-infective periodontal intervention (experimental group) to an “inactive control” (no periodontal intervention) or to an “active control” (lower treatment intensity than the experimental group). Mean differences in final CRP values at the earliest post-treatment time point (typically 1-3 months) between experimental and control groups were analyzed using random-effects regression. Among 2,753 possible studies 20 were selected, which included 2,561 randomized patients(median=57). Baseline CRP values were >3.0 mg/L in 40% of trials. Among studies with a control group receiving no treatment, the mean difference in CRP final values among experimental treatment vs. control groups was -0.37 mg/L [95%CI=-0.64, -0.11], (P=0.005), favoring experimental treatment. Trials for which the experimental group received antibiotics had stronger effects (P for interaction=0.03) and the mean difference in CRP final values among experimental treatment vs. control was -0.75 mg/L [95%CI=-1.17,-0.33]. No treatment effect was observed among studies using an active treatment comparator. Treatment effects were stronger for studies that included patients with co-morbidities vs. studies that included “systemically healthy” patients, although the interaction was not significant (P=0.48).

Conclusions

Anti-infective periodontal treatment results in short-term modest reductions in systemic CRP.

Clinical review: Association between metabolic syndrome and periodontitis: a systematic review and meta-analysis

BACKGROUND

Several epidemiological studies have reported an association between metabolic syndrome (MetS) and periodontal diseases (PDs). The aim of this systematic review was to investigate the existence and magnitude of this association.

MATERIALS AND METHODS

A systematic search of the literature was conducted looking for case-control, cross-sectional, cohort studies and population surveys including patients with measures of MetS and PD. Ovid MEDLINE, EMBASE, LILACS, and Cochrane library databases were used for the search by 2 independent reviewers. A meta-analysis was conducted to investigate the association for coexistence of MetS and PD.

RESULTS

A total of 20 studies were included in the review, from an initial search of 3486 titles. Only 1 study reported longitudinal data on the onset of MetS components in association with periodontal measures. However, several studies investigated coexistence. A random effects meta-analysis showed that the presence of MetS is associated with the presence of periodontitis in a total of 36 337 subjects (odds ratio = 1.71; 95% confidence interval = 1.42 to 2.03). When only studies with "secure" diagnoses were included (n = 16 405), the magnitude of association increased (odds ratio = 2.09; 95% confidence interval = 1.28 to 3.44). Moderate heterogeneity was detected (I(2) = 53.6%; P = .004).

CONCLUSIONS

This review presents clear evidence for an association between MetS and periodontitis. The direction of the association and factors influencing it should be investigated by longitudinal and treatment studies. Periodontal diagnostic procedures should be routinely carried out in MetS patients.

Periodontal disease: the influence of metabolic syndrome

Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors that include obesity, impaired glucose tolerance or diabetes, hyperinsulinemia, hypertension, and dyslipidemia. Recently, more attention has been reserved to the correlation between periodontitis and systemic health. MetS is characterized by oxidative stress, a condition in which the equilibrium between the production and the inactivation of reactive oxygen species (ROS) becomes disrupted. ROS have an essential role in a variety of physiological systems, but under a condition of oxidative stress, they contribute to cellular dysfunction and damage. Oxidative stress may act as a common link to explain the relationship between each component of MetS and periodontitis. All those conditions show increased serum levels of products derived from oxidative damage, promoting a proinflammatory state. Moreover, adipocytokines, produced by the fat cells of fat tissue, might modulate the balance between oxidant and antioxidant activities. An increased caloric intake involves a higher metabolic activity, which results in an increased production of ROS, inducing insulin resistance. At the same time, obese patients require more insulin to maintain blood glucose homeostasis – a state known as hyperinsulinemia, a condition that can evolve into type 2 diabetes. Oxidation products can increase neutrophil adhesion and chemotaxis, thus favoring oxidative damage. Hyperglycemia and an oxidizing state promote the genesis of advanced glycation end-products, which could also be implicated in the degeneration and damage of periodontal tissue. Thus, MetS, the whole of interconnected factors, presents systemic and local manifestations, such as cardiovascular disease and periodontitis, related by a common factor known as oxidative stress.