Keywords
pocket depth
clinical attachment level
glycated haemoglobin
C-reactive protein
periodontal therapy
Abstract
Background: Periodontal disease is considered as the “sixth complication of diabetes mellitus”. Patients suffering from diabetes mellitus (DM) are known to have increased susceptibility to infections which lead to poor metabolic control. Although it has been reported that improved metabolic control may lead to improved periodontal health it is still unclear whether the control of periodontal infections may improve the metabolic control of diabetes.
Aim: To compare the effect of periodontal therapy on metabolic and inflammatory markers in diabetic patients.
Materials and Methods: The study type was in vivo comparative study. 60 patients were selected for the study using simple random sampling method. The patients were grouped into control and case with 30 in each group. In all patients, plaque index, gingival index, probing pocket depth and clinical attachment level were assessed with the help of with The University of North Carolina probe (UNC-15) probe at baseline, 1 month and 3 month. Similarly, venous blood samples were taken for evaluating fasting glucose level, post prandial glucose level, glycated haemoglobin and C-reactive protein (CRP) at baseline, 1 month and 3 month. In treatment group, full mouth scaling and root planing was done and oral hygiene instructions was provided.
Results: The result of the study suggested that non surgical periodontal therapy helps in controlling glycemic level and CRP values in patients with diabetes mellitus.
Conclusion: Non-surgical periodontal treatment is associated with improved glycaemic control and reduction in CRP level in patients with DM.
Key Words: Diabetes mellitus, pocket depth, clinical attachment level, glycated haemoglobin, C-reactive protein, periodontal therapy
References
Ueta E, Osaki T, Yoneda K, Yamamoto T. Prevalence of diabetes mellitus in odontogenic infections and oral candidiasis. An analysis of neutrophil suppression. J Oral Pathol Medicine. 1993;22:168–74
Shlossman M, Knowler WC, Pettitt DJ, Genco RJ. Type 2 diabetes mellitus and periodontal disease. J Am Dent Assoc. 1990;121:532–6.
Loe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care. 1993;16 (Suppl 1):329-34.
Emrich LJ, Shlossman M, Genco RJ: Periodontal disease in non insulin-dependent diabetes mellitus. J Periodontol. 1991;62:123-31.
Wu T, Dorn JP, Donahue RP, Sempos CT, Trevisan M. Association of serum C-reactive protein with fasting insulin, glucose, and glycosylated hemoglobin: the Third National Health and Nutrition Examination Survey, 1988-1994. Am J Epidemiol. 2002;155:65–71.
Cohen DW, Friedman LA, Shapiro J, Kyle GC, Franklin S. Diabetes mellitus and periodontal disease: two-year longitudinal observations. Part 1. J Periodontol. 1970;41:709–12.
Cianciola LJ, Park BH, Bruck E, Mosovich L, Genco RJ. Prevalence of periodontal disease in insulin- dependent diabetes mellitus (juvenile diabetes). J Am Dent Assoc. 1982;104:653–60.
Rylander H, Ramberg, P, Blohme G, Lindhe J. Prevalence of periodontal disease in young diabetics. J Clin Periodontol. 1987;14:38–43.
Taylor G W. Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective. Ann Periodontol. 2001;6:99–112.
Miller LS, Manwell MA, Newbold D, Reding ME, Rasheed A, Blodgett J, Kornman, KS. The relationship between reduction in periodontal inflammation and diabetes control: a report of 9 cases. J Periodontol. 1992;63:843–8.
Kıran M, Arpak N, Unsal E, Erdogan MF. The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus. J Clin Periodontol. 2005;32(6):266–72.
Williams RC, Mahan CJ. Periodontal disease and diabetes in young adults. J Am Med Assoc. 1960;172:776–8.
Westfelt E, Rylander H, Blohme G, Jonasson P, Lindhe J. The effect of periodontal therapy in diabetics. Results after 5 years. J Clin Periodontol. 1996;23:92–100.
Stewart JE, Wager KA, Friedlander AH, Zadeh HH. The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus. J Clin Periodontol. 2001;28:306–10.
Noack B, Genco RJ, Trevisan M, Grossi S, Zambon JJ, De Nardin E. Periodontal infections contribute to elevated systemic C-reactive protein level. J Periodontol. 2001;72(9):1221-7.
Slade GD, Ghezzi EM, Heiss G, Beck JD, Riche E, Offenbacher S. Relationship between periodontal disease and C- reactive protein among adults in the Atherosclerosis Risk in Communities study. Arch Intern Med. 2003;163(10):1172-9.
Ebersole JL, Cappelli D. Acute-Phase reactants in infections and inflammatory diseases. J Periodontol. 2000;23:19–49.
Ide M, McPartlin D, Coward PY, Crook M, Lumb P, Wilson RF. Effect of treatment of chronic periodontitis on levels of serum markers of acute-phase inflammatory and vascular responses. J Clin Periodontol. 2003;30:334–40.
Nagarale G, Ravindra S, Thakur S, Setty S. Efficacy of a chairside diagnostic test kit for estimation of C-reactive protein levels in periodontal disease. J Indian Soc Periodontol. 2010;14(4):213–6.