Impact of periodontal treatment on systemic health

Background + Aims

• Periodontal treatment involves a stepwise framework, including non-surgical sub-gingival instrumentation as the cornerstone for managing periodontitis. This reduces gingival inflammation, probing pocket depth (PPD), and clinical attachment loss (CAL) while improving overall health and quality of life. However, non-surgical treatment can induce an acute-phase systemic inflammatory reaction post-operatively, including increased acute-phase proteins, endothelial dysfunction, elevated body temperature, clotting tendencies, and renal function reduction.
• In systemically healthy individuals, an acute-phase systemic inflammatory reaction is likely to have no long-term health consequences, but its impact on individuals with comorbidities may be of concern. Quadrant-based treatment, with shorter clinical sessions, has been shown to avoid systemic inflammation compared to the one-stage full-mouth approach.
• This study aimed to compare full-mouth versus quadrant non-surgical treatment on 24-hour post-operative CRP levels in periodontitis patients with type 2 diabetes mellitus (T2DM).

Materials + Methods

• This single-centre, randomised controlled trial (RCT) compared full-mouth (FM-SRP) and quadrant (Q-SRP) non-surgical periodontal treatments in subjects with type 2 diabetes and periodontitis.
• Participants aged 18–70 with type 2 diabetes, periodontitis (≥3 mm attachment loss in ≥2 teeth), and ≥20% dentition with ≥5 mm probing depth were enrolled. Exclusions included pregnancy, systemic diseases (other than diabetes), recent medications, or prior periodontal treatment.
• Patients were randomised into either FM-SRP in a single session or Q-SRP across three weeks. Both groups received oral hygiene instructions and subgingival instrumentation performed by a single periodontist.
• Primary outcomes included changes in C-reactive protein (CRP) levels at 24 hours (day 1), with secondary measures assessing periodontal health, quality of life (OHIP-14), and endothelial function (flow-mediated dilation (FMD)).
• Blood samples and vital signs were collected pre and post-treatment.
• Statistical analysis used regression models to adjust for confounders such as age, BMI, and smoking.
• Sample size calculations aimed to detect CRP differences with 90% power, resulting in 20 participants per group.

Results

• Of 327 screened individuals, 40 were enrolled and completed follow-up. Participants were predominantly male, obese, and non-smokers, with no significant baseline differences between FM-SRP and Q-SRP groups.
• Both treatment protocols significantly improved periodontal health, reducing pocket depth, plaque, and bleeding on probing (BOP) at Day 90, with no inter-group differences.
• The FM-SRP group exhibited significantly higher CRP and IL-6 levels on Day 1 compared to the Q-SRP group (p < .05), and CRP increases correlated with longer treatment times (R = 0.53, p < .01).
• HbA1c levels significantly decreased in both groups by Day 90, but the reduction was nearly twice as high in the Q-SRP group (HbA1c reduction= 1.59 vs. 0.8, p = .04). No significant changes were observed in lipid profiles, blood pressure, heart rate, or temperature.
• Endothelial function worsened in the FM-SRP group, with a greater decline in FMD at day 1 compared to the Q-SRP group (p = .04).
• Both groups improved oral health-related quality of life (OHIP-14) at day 90 without significant differences.
• A linear regression model showed that higher day 1 CRP increases and FM-SRP treatment were associated with smaller HbA1c reductions at day 90, highlighting potential systemic implications of acute inflammatory responses.

Limitations