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Periodontal intervention effects on diabetes mellitus; periodontal infection and rheumatoid arthritis

July 18, 2012
Research and findings are presented for two methods of periodontal treatment. One deals with the effect of periodontal intervention on periodontal disease and Type 2 diabetes mellitus. The other addresses periodontal infection with P. gingivalis in patients with rheumatoid arthritis.

Effect of Periodontal Intervention on Periodontal Disease and Type 2 Diabetes Mellitus
By T.B. Taiyeb-Ali, R.P.C. Raman, R.D. Vaithilingam, S.P. Chan, Kuala Lumpur/Malaysia

Aim: To investigate effects of non-surgical periodontal intervention on metabolic control and systemic inflammatory challenge in Type 2 diabetics.

Material and Methods: Randomized, controlled clinical trial of 40 Type 2 Diabetes Mellitus (T2DM) patients with moderate-to-severe PD who were randomly distributed to either test group, receiving oral hygiene instructions (OHI) and full mouth scaling/root planing, or control group receiving OHI only. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high sensitivity C-Reactive Protein (hs-CRP) were evaluated atmbaseline, 2- and 3-month intervals.

Results: All periodontal parameters improved significantly in both groups except for GBI in control group at 3-month interval. Both groups recorded a decrease in HbA1c levels but only test group had statistically significant change (p=0.038). More participants were categorized as having good metabolic control at the end of study (53.3% for test and 58.8% for control). Participants who recorded an improvement in HbA1c levels of ≥ 1% recorded statistically significant reductions in means of PI, GBI and PPD (p=0.001, p=0.008 and p=0.005, respectively). Likewise, participants who recorded good response to periodontal therapy (in terms of reduction in PPD) showed significant reductions of HbA1c and hs-CRP levels (p=0.004 and p=0.012). A reduction in s-CRP levels recorded in test group, however, did not reach statistical significance, while in control group minimal change was observed.

Conclusion: Periodontal therapy contributed to improved metabolic control in Type 2 diabetics and overall reduction of systemic inflammatory challenge. The converse was also observed. It is advocated that in approach to management of either T2DM or PD, interdisciplinary care should be considered.

Periodontal infection with P. gingivalis in rheumatoid arthritis (RA) patients
By M. De Smit, E. Brouwer, A. Vissink, B. Doornbos-Van Der Meer, J. Westra, A.J. Van Winkelhoff, Groningen/Netherlands

Aim: Because of the hypothesized pathogenic role of periodontal infection with P. gingivalis in RA, this study aimed to assess clinical, microbiological and serological features of both diseases in RA patients.

Material and Methods: In 95 dentate RA patients, periodontal condition was examined using the validated Dutch Periodontal Screening Index (DPSI). RA disease activity was scored with DAS28. Subgingival plaque samples were tested for presence of P. gingivalis by culture technique. Serum was investigated for IgG- and IgM- antibody titers to P. gingivalis, antibodies specific for RA (rheumatoid factor (IgM-RF) and anti-citrullinated protein antibodies (anti-CCP), and CRP levels by ELISA. Serum and subgingival plaque measures were compared to an identical control group without RA or other systemic diseases (n=44).

Results: RA patients with severe periodontitis had higher DAS28 scores (p<0.001), CRP levels (p<0.05), IgG- anti P. gingivalis titers (p<0.05) and age (p<0.01) than RA patients with no or moderate periodontitis. No differences were seen in RA disease duration, IgM-RF, anti-CCP, and IgM-anti P.gingivalis titers. Subgingival prevalence of P. gingivalis was not different in RA patients compared to the control group. RA patients with severe periodontitis showed higher IgM- and IgG- anti P. gingivalis titers (p<0.01 resp. p<0.05) compared to severe periodontitis patients without RA. There was a significant difference between P. gingivalis culture positive and negative RA patients concerning IgM- and IgG- anti P. gingivalis titers (p<0.01 resp. p<0.001), but not in controls.

Conclusion: RA patients with periodontitis have higher RA disease activity, and a more pronounced antibody response against P. gingivalis compared to non-RA patients.