The relationship between glycated hemoglobin level and the stage of periodontitis in individuals without diabetes

The Relationship of HbA1c Serum Levels with the Severity of Periodontal Disease in Patients with Type 1 Diabetes Mellitus: A Cross-Sectional Study

OBJECTIVE

 According to the evidence, the level of glycemic control is of key importance in determining the increased risk of periodontal disease (PD). The aim of the study was to evaluate the role of metabolic control as a key factor leading to the development and severity of periodontitis and compare the periodontal and oral hygiene status with the glycated hemoglobin levels.

MATERIALS AND METHODS

 The evaluation was undertaken with diabetic patients (59 uncontrolled diabetics and 36 controlled diabetics) from a patient cohort of the Hospitalar Center of Tâmega e Sousa and subjects without diabetes (n = 95).

STATISTICAL ANALYSIS

 The data were analyzed using IBM SPSS Statistics software (Statistical Program for Social Sciences), version 29.0 for Windows. In the logistic regression analysis, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The significance level was set at 0.05.

RESULTS

 Periodontal parameters were increased in systemically compromised individuals especially those who were poorly controlled as compared with their healthy counterparts, which are important indicators of PD progression. Furthermore, uncontrolled type 1 diabetic mellitus (T1DM) patients showed increased plaque index (PI), which predisposes these individuals to a greater degree of periodontal destruction and tooth loss. Using a binary logistic regression, we observe a significant relation of the risk of severe periodontitis in T1DM subjects with family history of T1DM (p = 0.019; OR: 3.36; 95% CI: 1.22-9.21), alcohol consumption (p = 0.02; OR: 3.78; 95% CI: 1.23-11.63), periodontal probing depth (PPD) (p < 0.001; OR: 3.64; 95% CI: 14.74-90.34), and clinical attachment loss (p = 0.033; OR: 4.71; 95% CI: 1.13-19.59).

CONCLUSION

 Increased glycated hemoglobin levels were positively related with periodontal status. Uncontrolled systemically compromised individuals showed an increased Plaque index (PI), which predisposes to greater periodontal inflammation and tooth loss. Increased clinical attachment level, Periodontal probing depth (PPD) and family history of T1DM, and alcohol consumption were identified as potential risk factors for severe periodontitis in subjects with T1DM.

Effects of Non-Surgical Periodontal Therapy on Glycemic Control in Prediabetes and Diabetes Patients with Stage II-IV Periodontitis as Monitored by Active-Matrix Metalloproteinase-8 Levels

Background/Objectives: Previous research indicates that non-surgical periodontal therapy (NSPT) improves glycemic control in individuals with prediabetes and diabetes who have periodontitis. Few studies have demonstrated its effects on mouthrinse active-matrix metalloproteinase-8 (aMMP-8) levels as it relates to glycemic control. We assessed the periodontal treatment response of stage II-IV periodontitis patients with prediabetes, diabetes, and normoglycemia, regarding glycated hemoglobin (HbA1c) and mouthrinse aMMP-8 levels using point-of-care kits (PoC). Materials and Methods: Eighty-eight adults (11 normoglycemic, 32 prediabetic, 45 with type 2 diabetes), aged 25-78, with stage II-IV periodontitis were included. Full-mouth clinical examinations were used to evaluate their periodontal parameters. HbA1c and mouthrinse aMMP-8 levels were assessed using PoC kits before and approximately three months after scaling and root planing. Results: There were positive treatment effects of non-surgical periodontal therapy on periodontal clinical parameters, aMMP-8 and HbA1c levels in the prediabetes and diabetes groups. The aMMP-8 reduction was significant (p < 0.001) in the prediabetes and prediabetes + diabetes groups, while HbA1c decreased significantly in the diabetes and prediabetes + diabetes (p < 0.001) groups. In contrast, a non-significant increase in mean aMMP-8 levels, HbA1c, and CAL was observed in normoglycemia (p > 0.05). Stage III + IV periodontitis showed significant treatment effects for aMMP-8 (p < 0.001) and HbA1c (p < 0.01) compared to stage II, regardless of glycemic status. Conclusions: Non-surgical periodontal therapy significantly improves periodontal health as well as HbA1c and aMMP-8 levels in people living with prediabetes and diabetes.

Risk correlates of cardiovascular diseases, diabetes, and periodontal diseases: a cross-sectional study in India

BACKGROUND

Quantifying shared risk factors among periodontal disease (PD), cardiovascular disease (CVD), type 2 diabetes (DM2) can bolster Common Risk Factor Approach (CRFA), enabling integration of PD prevention into non-communicable disease (NCD) prevention strategies. The objective of the study is to assess extent of overlap of shared risk factors between CVD, DM2, PD.

MATERIALS AND METHODS

This is an analytical cross-sectional study conducted at a tertiary care medical and dental teaching hospital in South India, from July 2022 to April 2024. Study included 600 participants (ages 18-75) divided into three groups: Group A: DM2, CVD, or both and PD; Group B: DM2 or CVD; and Group C: PD alone. Various demographic, metabolic, habit related, dietary and periodontal disease severity related risk factors were evaluated in the study.

RESULTS

Among 600 participants, 55.5% were male, 58.8% were under 50 years. Statistically significant odds ratios (ORs) for shared risk factors between Group A and Group B were observed for age > 50 (0.58), sedentary lifestyle (0.43), fat intake > 41 g/d (1.87), HbA1C ≥ 6.5% (0.56), FBS > 126 mg/dL (2.35) and family history of NCDs (9.8). For Group A versus Group C, statistically significant ORs were seen for age > 50 (0.55), HbA1c 5.7%-6.4% (0.34), triglycerides > 150 mg/dL (0.04), education (0.52), alcohol use (1.53) and poor oral hygiene (3.01). Severity of periodontal disease assessed using PSR, HbA1c, triglycerides, fat intake, age, education, obesity were identified as vital shared risk factors. CONCLUSION AND RELEVANCE: Age, education, obesity, PSR, HbA1c, triglycerides emerged as significant shared risk factors. Integrating these factors into surveillance tools may enhance NCD and PD risk identification, supporting CRFA-based healthcare approach.

TRIAL REGISTRATION

CTRI/ 2022/06/043279 registered on 15th of June 2022.

Salivary peptidomic profiling of chronic gingivostomatitis in cats by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry and nanoscale liquid chromatography-tandem mass spectrometry

BACKGROUND

Chronic gingivostomatitis in cats (FCGS) is a moderately to severely painful condition, potentially caused by inadequate immune response to oral antigenic stimulation. Salivary peptidome analysis can identify inflammatory protein mediators and pathways involved in oral mucosal immune activation and may indicate potential therapeutic options for FCGS.

OBJECTIVE

Evaluate the diversity and abundance of salivary peptides in cats with FCGS using matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS) and nanoscale liquid chromatography-tandem mass spectrometry (nano LC-MS/MS).

ANIMALS

Thirty-two cats with FCGS and 18 healthy controls.

METHODS

Case-control cross-sectional study. We compared the salivary peptide profiles of diseased and healthy cats. The diagnosis of FCGS was confirmed by histopathology. Saliva samples were analyzed for viral infections using polymerase chain reaction (PCR), peptide mass fingerprint (PMF) using MALDI-TOF MS, and peptide identification using nano LC-MS/MS.

RESULTS

Distinct clusters of peptide profiles were observed between groups. In FCGS, 26 salivary peptides were altered, including apolipoprotein A1, nuclear receptor subfamily 1 group I member 3, fibrinogen alpha chain, interleukin 2 receptor gamma, interleukin 23 receptor, hemoglobin subunit alpha, and serpin peptidase inhibitor clade A (alpha-1 antiproteinase, antitrypsin) member 12, protein-tyrosine-phosphatase, and cholinergic receptor nicotinic alpha 10 subunit. Protein-anti-inflammatory drug interaction networks were observed.

CONCLUSIONS AND CLINICAL IMPORTANCE

Peptide mass fingerprint and peptide profiles identified distinct clusters between FCGS and healthy cats. The 9 novel salivary peptide markers were associated with the JAK/STAT and PI3K/Akt pathways and immune responses. These potentially noninvasive biomarkers may facilitate understanding of FCGS pathophysiology and guide future therapeutic research.

Bidirectional link between periodontitis and systemic inflammation in diabetic retinopathy

Periodontitis is independently associated with numerous lifestyle diseases. Diabetic patients have approximately threefold increased odds of periodontitis, which in turn increases the risk of systemic inflammation. The study by Thazhe Poyil et al is an effort to establish the inflammatory link between diabetic re-tinopathy (DR) and periodontitis based on the periodontal inflamed surface area in diabetic patients with and without DR. To further advance the study, we suggest refining the eligibility criteria to explicitly state the clinical correlates of periodontitis and DR, larger sample size and improved sampling methodology, matching of baseline characteristics of the two groups, as well as improved statistical approach and interpretation of the study findings. Measurement of hemoglobin A1c (HbA1c) in studies comparing type 2 diabetes mellitus patients with DR of matched severity with and without periodontitis could provide a clearer picture of whether HbA1c level is indeed influenced by periodontitis.

Perceptions of mental health screening and referral to treatment in National Dental-Practice Based Research Network practices: A qualitative study

OBJECTIVES

Dental practices can have additional positive impacts on public health by implementing mental health screening and referral to treatment in dental care workflows. In this study, we examined how dental practices identify and address adult patient mental health concerns, attitudes about implementing mental health screening and referral, and potential barriers and facilitators to treatment.

METHODS

We conducted semi-structured focus groups with 17 dentists, 10 dental hygienists, and 5 dental assistants/office staff in the South-Central region of the National Dental Practice-Based Research Network. Transcribed interviews were analyzed using thematic analysis.

RESULTS

We identified five main themes from dental practitioners and office staff responses. Practitioners and office staff: (1) discover patient mental health concerns through record review, patient/caregiver disclosure, and patient observation; (2) respond to patients' mental health concerns by making the patient more comfortable, documenting the concern in the patient's chart, and directly addressing the mental health concern; (3) want a systematic process for mental health screening and referral to treatment in their dental office; (4) recognize potential barriers in implementing health screening and referral to treatment processes; (5) desire training on mental health matters. An overarching theme emerged: developing a trusting relationship with patients.

CONCLUSIONS

Participants noted the importance of implementing systematic procedures for mental health screening and referral to services into dental practices, while also recognizing the potential barriers for integrating such processes. They also expressed a desire for quality training and resources that can support better care for patients with mental health concerns.

Current scientific evidence for why periodontitis should be included in diabetes management

This Perspective provides a brief summary of the scientific evidence for the two-way links between periodontal diseases and hyperglycemia (diabetes mellitus [DM] and pre-DM). It delivers in a nutshell current scientific evidence for manifestations of hyperglycemia on periodontal health status and effects of periodontal diseases on blood glucose levels and in turn incidence, progression, and complications of diabetes. Of outmost importance is presentation of scientific evidence for the potential of routine periodontal treatment to lower blood glucose levels, providing a novel, economical tool in DM management. Non-surgical periodontal treatment ("deep cleaning") can be provided by dental hygienists or dentists in general dental offices, although severe cases should be referred to specialists. Such therapy can decrease the costs of DM care and other health care costs for people with DM. The great importance of a healthy oral cavity free of infection and subsequent inflammation - especially periodontitis that if untreated will cause loosening and eventually loss of affected teeth - has largely gone unnoticed by the medical community as the health care curricula are largely void of content regarding the bi-directional links between oral health and systemic health, despite elevation of blood glucose levels being an integral part of the general systemic inflammation response. The importance of keeping disease-free, natural teeth for proper biting and chewing, smiling, self-esteem, and pain avoidance cannot be overestimated. Medical and dental professionals are strongly encouraged to collaborate in patient-centered care for their mutual patients with - or at risk for - hyperglycemia.

Effects of low-level laser on the expression of interleukin-6, tumor necrosis factor‑α, osteoprotegerin, and receptor activator of nuclear factor-κB ligand in human periodontal ligament cells

OBJECTIVES

This study aims to determine the effects of low-level laser (LLL) on the expression of interleukin-6 (IL-6), tumor necrosis factor (TNF)-α, osteoprotegerin (OPG), and receptor activator of nuclear factor-κB ligand (RANKL) in human periodontal ligament cells (HPDLCs) stimulated by high glucose; and identify the molecular mechanism of LLL therapy in the regulation of periodontal inflammation and bone remodeling during orthodontic treatment in diabetic patients.

METHODS

HPDLCs were cultured in vitro to simulate orthodontic after loading and irradiated with LLL therapy. The cultured cells were randomly divided into four groups: low glucose Dulbecco's modification of Eagle's medium (DMEM)+stress stimulation (group A), high glucose DMEM+stress stimulation (group B), hypoglycemic DMEM+LLL therapy+stress stimulation (group C), and hyperglycemic DMEM+LLL therapy+stress stimulation (group D). Groups C and D were further divided into C1 and D1 (energy density: 3.75 J/cm2) and C2 and D2 (energy density: 5.625 J/cm2). Cells in groups A, B, C, and D were irradiated by LLL before irradiation. At 0, 12, 24, 48, and 72 h, the supernatants of the cell cultures were extracted at regular intervals, and the protein expression levels of IL-6, TNF-α, OPG, and RANKL were detected by enzyme-linked immunosorbent assay.

RESULTS

1) The levels of IL-6 and TNF-α secreted by HPDLCs increased gradually with time under static pressure stimulation. After 12 h, the levels of IL-6 and TNF-α secreted by HPDLCs in group A were significantly higher than those in groups B, C1, and C2 (P<0.05), which in group B were significantly higher than those in groups D1, and D2 (P<0.01). 2) The OPG protein concentration showed an upward trend before 24 h and a downward trend thereafter. The RANKL protein concentration increased, whereas the OPG/RANKL ratio decreased with time. Significant differen-ces in OPG, RANKL, and OPG/RANKL ratio were found among group A and groups B, C1, C2 as well as group B and groups D1, D2 (P<0.05).

CONCLUSIONS

1) In the high glucose+stress stimulation environment, the concentrations of IL-6 and TNF-α secreted by HPDLCs increased with time, the expression of OPG decreased, the expression of RANKL increased, and the ratio of OPG/RANKL decreased. As such, high glucose environment can promote bone resorption. After LLL therapy, the levels of IL-6 and TNF-α decreased, indicating that LLL therapy could antagonize the increase in the levels of inflammatory factors induced by high glucose environment and upregulate the expression of OPG in human HPDLCs, downregulation of RANKL expression in HPDLCs resulted in the upregulation of the ratio of OPG/RANKL and reversed the imbalance of bone metabolism induced by high glucose levels. 2) The decrease in inflammatory factors and the regulation of bone metabolism in HPDLCs were enhanced with increasing laser energy density within 3.75-5.625 J/cm2. Hence, the ability of LLL therapy to modulate bone remodeling increases with increasing dose.

Epigenetic changes underlie the association between diabetes mellitus and oral diseases

Patients with diabetes mellitus (DM) suffer from oral complications related to oral infections, periodontal diseases, and endodontic lesions. Emerging evidence has revealed the contribution of the epigenetic process as the underlying mechanism of DM complications. DNA methylation, histone modifications, and non-coding RNAs are epigenetic regulators that directly affect gene expression. The present review elaborated on the role of epigenetic dysregulation in the etiology of diabetes-related periodontal and endodontic diseases. The narrative review study was prepared using databases such as PubMed, Google Scholar, Science Direct, and Scopus. The formation of glycation products as a result of hyperglycemic condition increases oxidative stress, and elevates chronic inflammatory mediators that could in turn adversely change the cellular environment and alter the epigenetic status. This process contributes to the alteration of regulatory genes expression, leading to the development of diabetes-induced bone complications and impaired odontogenic capacity of pulp. Indeed, epigenetic mechanisms mediate the interaction between gene expression and DM cellular environment. Further investigations on epigenetic factors involved in DM oral complications may provide novel therapeutic targets.

Association and comparison of periodontal and oral hygiene status with serum HbA1c levels: a cross-sectional study

BACKGROUND

Diabetes Mellitus and periodontitis are chronic diseases with known reciprocal association. Studies have shown that uncontrolled diabetes increases the risk of development and progression of periodontal disease. This study aimed to explore the association and severity of periodontal clinical parameters and oral hygiene with HbA1c levels in non-diabetics and T2DM patients.

MATERIALS AND METHODS

In this cross-sectional study, the periodontal status of 144 participants, categorized into non-diabetics, controlled T2DM, and uncontrolled T2DM and were assessed via the Community Periodontal Index (CPI), Loss of Attachment Index (LOA index), and the number of missing teeth, while oral hygiene was measured by utilizing the Oral Hygiene Index Simplified (OHI-S). SPSS was used for data analysis. Chi-square test was used to find out the association of different independent variables with HbA1c groups, while ANOVA and post-hoc tests were run for inter-group and intra-group comparison respectively.

RESULTS

Out of 144 participants, the missing dentition was prevalent in uncontrolled T2DM with mean 2.64 ± 1.97 (95% CI 2.07-3.21; p = 0.01) followed by controlled T2DM 1.70 ± 1.79 (95% CI 1.18-2.23; p = 0.01) and non-diabetics 1.35 ± 1.63 (95% CI 0.88-1.82; p = 0.01) respectively. Furthermore, non-diabetics had a higher proportion of CPI score 0 (Healthy) [30 (20.8%); p = 0.001] as compared to uncontrolled T2DM [6 (4.2%); p = 0.001], while CPI score 3 was more prevalent in uncontrolled T2DM in comparison to non-diabetics. Loss of attachment (codes-2,3 and 4) was also frequently observed in uncontrolled T2DM compared to non-diabetics (p = 0.001). Similarly, based on Oral Hygiene Index- Simplified (OHI-S), the result showed that poor oral hygiene was most commonly observed in uncontrolled T2DM 29 (20.1%) followed by controlled T2DM patients 22 (15.3%) and non-diabetic [14 (9.7%); p = 0.03].

CONCLUSION

This study showed that periodontal status and oral hygiene status were deteriorated in uncontrolled T2DM patients compared to non-diabetic participants and controlled T2DM.