Impact of periodontal treatment on systemic health

Background + Aims

• Periodontitis, an inflammatory disease causing tissue destruction of the tissues surrounding teeth, may influence systemic inflammation, particularly in individuals with diabetes.
• Elevated levels of pro-inflammatory biomarkers like IL-6, TNF-α, and hs-CRP, commonly seen in diabetes, can exacerbate insulin resistance and impair glycaemic control.
• Studies suggest that periodontal therapy can reduce systemic inflammation and improve metabolic control in diabetes, though findings remain inconsistent. While some research shows reductions in biomarkers like TNF-α and improved glycaemic outcomes after therapy, others report no significant changes.
• This study aimed to evaluate the impact of non-surgical periodontal therapy (NSPT) on systemic inflammation and metabolic control in type 2 diabetes (T2DM) patients by analysing pro- and anti-inflammatory cytokines, acute-phase proteins, and glycaemic markers. The findings will address conflicting evidence and explore the role of periodontal therapy in managing diabetes-associated systemic inflammation.

Materials + Methods

• Study participants were recruited from a diabetic clinical in Brazil.
• Inclusion criteria required participants to have:
  • T2DM
  • Chronic periodontitis (Based on American academy of Periodontology, 1999)
  • ≥15 natural teeth
  • ≥4 teeth with ≥1 site of periodontal pocket depths (PD) ≥5 mm, clinical attachment loss (CAL) ≥4mm and bleeding on probing (BOP).
• Exclusions included recent antibiotic or anti-inflammatory use, smoking, pregnancy, or periodontal treatment within the previous year.
• The baseline BMI for the group was 30.6 ± 4.8 kg/m², indicating that, on average, the participants were classified as obese.
• Baseline assessments included periodontal parameters (PD, CAL, and BOP), metabolic markers (HbA1c and fasting glucose), and inflammatory biomarkers (IL-4, IL-6, IL-8, IL-10, TNF-α, hs-CRP, and fibrinogen).
• NSPT consisting of scaling, root planning (SRP), and oral hygiene instructions (OHI), was provided over 4 sessions within one month. Participants underwent plaque control twice a month for 3 months post-treatment.
• Clinical, metabolic, and inflammatory parameters were evaluated at baseline and 3-months post-treatment.
• Data were analysed using non-parametric tests with Bonferroni correction for multiple comparisons. Correlations between clinical, metabolic, and immunological variables were calculated.

Results

• The study included 23 participants (9 men, 14 women; 14 white, 9 black) with T2DM and chronic periodontitis from a diabetes clinic in Brazil. Participants had a mean age of 47.5 years and a mean diabetes duration of 10 years. Nearly 39% had diabetes-related complications, primarily retinopathy and nephropathy.
• Patients underwent NSPT and no changes in lifestyle, medications, or adverse effects were reported during the study.
• Significant improvements were observed in clinical parameters, including reductions in plaque index, BOP, PD and CAL (p < 0.05).
• Biomarker analysis showed a significant reduction in TNF-α levels (p = 0.014), while decreases in IL-4 and hs-CRP were not statistically significant. Fibrinogen levels significantly decreased (p = 0.037), but HbA1c and fasting plasma glucose levels showed no significant changes post-treatment.
• Baseline HbA1c levels ranged from 7.0% to 12.5%, with no significant improvement after therapy.
• No correlation was found between immunological and clinical parameters. While periodontal treatment improved periodontal health and reduced some inflammatory markers, its impact on glycaemic control was limited.

Limitations