Effect of periodontal therapy on glycemic control and circulating TNF-α in type 2 diabetic patients
Tóm tắt
Studies suggest that elevated circulating tumour necrosis factor- α (TNF- α) may contribute to insulin resistance in patients with type 2 diabetes. The source of plasma TNF has been thought to be adipocytes associated with obesity, but inflammation and infection result in TNF- α production as well. The present study was a randomized controlled clinical trial to evaluate the role of periodontal treatment in glycemic control and its relationship with the inflammatory marker TNF-α in type 2 diabetic subjects with chronic generalized periodontitis. In total, 30 patients were enrolled in the study. The selected patients were randomly assigned into two groups (group A and B) comprising of fifteen patients each. Patients who refused periodontal treatment were automatically placed in the control group; others were randomly assigned to either treatment or control group. Group A (Treatment group) which received treatment with full mouth scaling and root planing followed by systemic Doxycycline (100 mg daily for 14 days) and Group B (Control group) which received no treatment. The plaque index, gingival index, probing depth, clinical attachment loss, HbA1c value, and circulating TNF- α concentrations were measured at baseline and three months after the non-surgical periodontal therapy in both the treatment and control groups. All periodontal parameters, serum TNF- α levels and HbA1c levels were significantly decreased three months after the nonsurgical periodontal therapy compared to the baseline values in the treatment group where as there was no significant change in the control group. The study results indicated that periodontal treatment could be undertaken along with the standard measures for the diabetic patient care and prevention, and control of periodontal disease must be considered as an integral part of diabetes control.
Tài liệu tham khảo
Diabetes and periodontal diseases [position paper]. J Periodontol 2000; 71:664–678.
Lalla E, Lamster IB, Drury S, Fu C, Schmidt AM. Hyperglycemia glycoxidation and receptor for advanced glycation end products: potential mechanisms underlying diabetic complications, including diabetes – associated periodontitis. Periodontology 2000. 2000;23:50–62.
Löe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care. 1993;16(1):329–34.
Navarro-Sanchez AB, Faria-Almeida R, Bascones-Martinez A. Effect of non-surgical periodontal therapy on clinical and immunological response and glycaemic control in type 2 diabetic patients with moderate periodontitis. J Clin Periodontol. 2007;34(10):835–43.
Taylor GW. The effects of periodontal treatment on diabetes. J Am Dent Assoc. 2003;134 Spec No:41S–8.
Nishimura F, Murayama Y. Periodontal inflammation and insulin resistance-lessons from obesity. J Dent Res. 2001;80(8):1690–4.
Iacopino AM. Periodontitis and diabetes interrelationships: role of inflammation. Ann Periodontol. 2001;6(1):125–37.
Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4(1):1–6.
Promsudthi A, Pimapansri S, Deerochanawong C, Kanchanavasita W. The effect of periodontal therapy on uncontrolled type 2 diabetes mellitus in older subjects. Oral Dis. 2005;11(5):293–8.
Silness J, Loe H. Periodontal disease in pregnancy (II). Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964;22:121–35.
Loe H, Silness J. Periodontal disease in pregnancy (I). Prevalence and severity. Acta Odontol Scand. 1963;21:533–51.
Shlossman M, Knowler WC, Pettit DJ, Genco RJ. Type 2 diabetes mellitus and periodontal disease. J Am Dent Assoc. 1990;121(4):532–6.
Grossi SG, Skrepcinski FB, Decaro T, Robertson DC, Ho AW, Dunford RG, et al. Treatment of periodontal disease in diabetes reduces glycated haemoglobin. J Periodontol. 1997;68(8):713–9.
Kiran 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(3):266–72.
Iwamoto Y, Nishimura F, Nakagawa M, Sugimoto H, Shikata K, Makino H, et al. The effect of antimicrobial periodontal treatment on circulating tumor necrosis factor-alpha and glycated hemoglobin level in patients with type 2 diabetes. J Periodontol. 2001;72(6):774–8.
Rodrigues DC, Taba MJ, Novaes AB, Souza SL, Grisi MF. Effect of non surgical periodontal therapy on glycemic control in patients with type 2 diabetes mellitus. J Periodontol. 2003;74(9):1361–7.
Dag A, Fırat ET, Arıkan S, Kadiroglu AK, Kaplan A. The effect of periodontal therapy on serum TNF-α and HbA1c levels in type 2 diabetic patients. Aust Dent J. 2009;54(1):17–22.
Christgau M, Palitzsch KD, Schmalz G, Kreiner U, Frenzel S. Healing response to nonsurgical periodontal therapy in patients with diabetes mellitus: clinical, microbiological and immunologic results. J Clin Periodontol. 1998;25(2):112–24.
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(2):92–100.
O’Connell PA, Taba M, Nomizo A, Foss Freitas MC, Suaid FA, Uyemura SA, et al. Effects of periodontal therapy on Glycemic control and inflammatory markers. J Periodontol. 2008;79(5):774–83.
Lim LP, Tay FB, Sum CF, Thai AC. Relationship between markers of metabolic control and inflammation on severity of periodontal disease in patients with diabetes mellitus. J Clin Periodontol. 2007;34(2):118–23.
Talbert J, Elter J, Jared HL, Offenbacher S, Southerland J, Wilder RS. The effect of periodontal therapy on TNF-α, IL-6 and metabolic control in type 2 diabetics. J Dent Hyg. 2006;80(2):1–16.
Mealey BL. Periodontal disease and diabetes: a two- way street. J Am Dent Assoc. 2006;137(Suppl):26S–31.
Yang PS, Wang Y, Oi XM, Ren JM, Ge SH. The effect of initial periodontal therapy on circulating TNF-α and HbA1c in type 2 diabetes patients with periodontitis. Zhongua Kou Qiang Yi Xue Za Zhi. 2003;38(5):364–6.
Iwamoto Y, Nishimura F, Soga Y, Takeuchi K, Kurihara M, Takashiba S, et al. Antimicrobial periodontal treatment decreases serum C-reactive protein, tumor necrosis factor-alpha, but not adiponectin levels in patients with chronic periodontitis. J Periodontol. 2003;74(8):1231–6.
Kardeşler L, Buduneli N, Cetinkalp S, Kinane DF. Adipokines and inflammatory mediators after initial periodontal treatment in patients with type 2 diabetes and chronic periodontitis. J Periodontol. 2010;81(1):24–33.
Yamazaki K, Honda T, Oda T, Ueki-Maruyama K, Nakajima T, Yoshie H, et al. Effect of periodontal therapy on the C-reactive protein and proinflammatory cytokine levels in Japanese periodontitis patients. J Periodontal Res. 2005;40(1):53–8.
Engebretson S, Chertog R, Nichols A, Hey-Hadavi J, Celenti R, Grbic J. Plasma levels of tumour necrosis factor-a in patients with chronic periodontitis and type 2 diabetes. J Clin Periodontol. 2007;34(1):18–24.
Bretz WA, Weyant RJ, Corby PM, Ren D, Weissfeld L, Kritchevsky SB, et al. Systemic inflammatory markers, periodontal diseases, and periodontal infections in an elderly population. J Am Geriatr Soc. 2005;53(9):1532–7.