Impact of periodontal treatment on systemic health

Background + Aims

• Inflammation plays a pivotal role in cardiovascular disease (CVD) progression, particularly in patients with diabetes mellitus (DM) and periodontitis, which share risk factors and systemic inflammatory pathways.
• Periodontitis worsens glycaemic control in type 2 diabetes mellitus (T2DM) and is linked to increased cardiovascular complications.
• Myocardial dysfunction, often asymptomatic, can be detected early via echocardiography using the E/e’ ratio—a key marker of left ventricular (LV) diastolic dysfunction.
• Elevated E/e’ ratios in T2DM predict heart failure and mortality.
• Emerging evidence links periodontitis to LV hypertrophy and dysfunction, but the potential of periodontal therapy to improve cardiac function remains unexplored.
• This trial evaluates the impact of non-surgical periodontal therapy (NSPT) on LV diastolic function and hypertrophy, measured through echocardiography with tissue Doppler imaging (TDI).

Materials + Methods

• This single-blind, randomised controlled trial (RCT) examined the effects of NSPT on cardiac function in 58 patients with T2DM and chronic periodontitis.
• Participants were recruited if they met the following:
  • Aged >40 years
  • T2DM diagnosis for > 5 years
  • ≥8 remaining teeth
  • Met criteria of chronic periodontitis (ChP):
    • ≥6 sites with probing depth (PD) ≥ 4 mm
    • over 25% of interproximal sites with clinical attachment loss (CAL) ≥ 5 mm
• Participants were excluded if they:
  • Were pregnant
  • Had used antibiotics, anti-inflammatory agents or immunosuppressants in the past 3 months;
  • Had required antibiotic prophylaxis
  • Had received periodontal treatment in the past 6 months
• Subjects were randomly assigned to a treatment group receiving NSPT or a control group provided with oral hygiene instructions (OHI) only.
• Periodontal assessment:
  • A calibrated examiner evaluated plaque presence, bleeding on probing (BOP), PD, gingival recession (GR), and CAL at six sites per tooth using a UNC-15 probe.
  • The kappa values for these measurements indicated strong reliability.
• NSPT was performed over 2–3 sessions, included OHI, scaling, and root debridement, using hand and ultrasonic instruments. Hopeless teeth were extracted, and OHI was reinforced at 2–3 months. The control group received OHI only until the six-month follow-up.
• Echocardiographic assessments evaluated LV mass index (LVMI) and diastolic function using pulse-wave TDI.
  • Early mitral inflow velocity (E) and peak early diastolic velocity (e’) were calculated, and E/e’ ratios were averaged to estimate LV filling pressure.
  • Measurements were highly reliable (intra-class correlation coefficient = .94).
  • The sample size calculation, based on prior data, required 29 participants per group to detect clinically significant changes in E/e’ ratio with 80% power.
• Blood samples were collected to measure high-sensitivity C-reactive protein (hs-CRP), NT-proBNP, and interleukin-6 (IL-6).
• Statistical analyses included intention-to-treat and per-protocol approaches.
  • Changes in periodontal conditions, LVMI, biomarkers, and blood pressure were analysed using t-tests, ANCOVA, and correlation analyses, adjusted for confounders like age, BMI, and smoking.
  • Statistical significance was set at p < .05.

Results

• The study involved 58 participants with T2DM and periodontitis, randomly allocated to a treatment group (NSPT) or control group (OHI) (29 participants in each).
• At baseline, no significant differences were observed between the groups in demographics, diabetes, hypertension, or lipid profiles.
• Follow-up assessments were completed for 55 participants, with three exclusions due to missing echocardiographic data.
• NSPT significantly improved periodontal health over six months, including reductions in (BOP from 56% to 28%, sites with PD ≥4 mm (25% to 11%), and number of sites with PD ≥4 mm (31 to 14) (p < .001).
• There were no significant changes in HbA1c levels or inflammatory biomarkers (hs-CRP, IL-6, NT-proBNP) between groups.
• Echocardiographic analysis revealed significant reductions in the mean E/e’ ratio, a marker of left ventricular (LV) diastolic function, in the treatment group (−1.66; 95% CI: −2.64 to −0.68; p < .01). The lateral E/e’ ratio decreased significantly (−1.34; p < .01), while the septal E/e’ ratio showed a non-significant reduction (−0.71; p = .09). Improvements in the mean E/e’ ratio correlated with enhanced periodontal parameters, such as BOP% (R² = .15, p < .01) and PD ≥4 mm (R² = .15, p < .01). LV mass index (LVMI) remained unchanged.

Limitations