Periodontitis and metabolic syndrome

Background + Aims

• Metabolic syndrome (MetS) is a cluster of conditions—obesity, dyslipidemia, hypertension, and insulin resistance—that significantly increase the risk of diabetes and cardiovascular disease.
• Periodontitis, a chronic inflammatory disease of the gums, has been linked to systemic inflammation, insulin resistance, and worsening glycaemic control.
• This randomised clinical trial aimed to assess the effect of non-surgical periodontal treatment on glycated haemoglobin (HbA1c) and MetS diagnostic parameters, hypothesising that reducing periodontal inflammation may positively influence systemic metabolic markers.

Materials + Methods

• 158 patients with MetS and moderate to severe periodontitis were recruited from dental clinics of the School of Dentistry of the Federal University of Rio Grande do Sul (UFRGS), Brazil, and from local public healthcare facilities serving dental patients.
• They were then randomised into the following groups:
  • Test (n = 79): Received non-surgical periodontal treatment (NSPT – scaling and root planing (SRP), oral hygiene instructions)
  • Control (n = 79): Received no periodontal treatment for 6-months
• Medical treatment was delivered to both groups
• The following measures were recorded at baseline, 3- and 6-months:
  • Clinical periodontal parameters (plaque, bleeding, probing depths)
  • HbA1c levels
  • MetS components (blood pressure, fasting glucose, HDL cholesterol, triglycerides, waist circumference)
  • Systemic inflammation markers (C-reactive protein (CRP) and the homeostasis model assessment (HOMA) index).
• Statistical analysis included intra-group (within a group) and inter-group (between groups) comparisons.

Results

• Periodontal Outcomes:
  • The test group showed significant improvements in periodontal health:
    • Plaque levels (VPI) reduced from 44.3%to 10.8%.
    • Gingival bleeding index (GBI) dropped from 18.8%to 4.7%.
    • Bleeding on probing (BOP) decreased from 58.0%to 19.6%.
    • Probing pocket depth (PPD) ≥6 mm sites reduced by 84%.
  • Metabolic Outcomes:
    • No significant differences were observed in HbA1c, MetS diagnostic markers (waist circumference, triglycerides, fasting glucose, HDL cholesterol, blood pressure), or inflammatory markers (CRP, HOMA indexes) between test and control groups at 3- or 6-months.
    • Small intra-group reductions in fasting glucose and waist circumference were noted but not clinically significant.
  • Reversal of MetS at 6-months was not significant between groups:
    • 19% of the control group
    • 16.4% of the test group

Limitations