Impact of periodontal treatment on systemic health

Background + Aims

• Periodontitis, affecting 11.2% globally, causes tissue destruction, tooth loss, and reduced quality of life. Its bidirectional link with type 2 diabetes mellitus (T2DM) is well-established, with diabetes increasing periodontitis risk and periodontitis worsening glycemic control.
• Meta-analyses show periodontitis treatment reduces HbA1c by 0.3%–0.4% and improves endothelial function. Systemic inflammation, driven by elevated pro-inflammatory mediators and oxidative stress, likely connects these conditions, though mechanisms remain unclear. Entry of periodontal bacteria into circulation and advanced glycation interactions further exacerbate inflammation in diabetes.
• This study aimed to assess periodontal and systemic inflammation by periodontal status in individuals with and without T2DM and evaluate the effects of periodontitis treatment on these inflammatory markers in both groups.

Materials + Methods

• This descriptive study investigated the clinical and biochemical outcomes of periodontitis treatment in individuals with and without T2DM. Adults aged 30–55 with at least 20 teeth were recruited from clinics in the UK, with exclusion criteria including pregnancy, immunosuppression, recent periodontal treatment, and inflammatory conditions.
• Periodontal examinations assessed plaque, gingival indices, probing depths, and bleeding on probing (BOP).
• Participants were categorised as healthy, gingivitis, or periodontitis. Those with periodontitis received oral hygiene instructions and non-surgical therapy (root surface debridement), followed by maintenance appointments at 3, 6, and 12 months.
• Blood samples were collected at baseline and follow-up to measure HbA1c, high-sensitivity CRP (hsCRP), and inflammatory markers like IL-6, TNF-α, and MMP-8 using ELISA and multiplex assays. Gingival crevicular fluid (GCF) samples were analysed for local inflammation markers.
• Structural equation modelling (SEM) was used to evaluate systemic and oral inflammation as latent variables. The study was powered to detect HbA1c changes with 85% power, assuming a 0.6% difference. Statistical analysis included Wilcoxon tests and SEM to explore associations between systemic and oral inflammation, comparing baseline and 12-month outcomes within and across groups. Data transformations ensured normality for biochemical variables.

Results

• A total of 83 individuals with T2DM and 75 non-diabetic controls were included. Participants were similar in age, gender, and smoking habits, but those with diabetes had significantly higher BMI (p < .001).
• At baseline, individuals with diabetes and periodontitis had higher HbA1c levels and systemic inflammation markers compared to non-diabetic controls. At baseline, systemic inflammation correlated moderately with oral inflammation in the diabetes group (r = .58, p = .02).
• Non-diabetic individuals with periodontitis compared to their periodontally healthy counterparts had significantly higher hsCRP (p < .05). No significant differences in baseline serum IL-6 or TNF-α levels were observed between groups.
• Periodontitis treatment resulted in significant improvements in clinical periodontal indices and reductions in GCF biomarkers (e.g., IL-6, TNF-α, MMP-8, MMP-9) in both groups at all post-treatment time points (p < .05).
• HbA1c reductions in individuals with diabetes were not significant over 12 months, although systemic inflammation (assessed via SEM) showed greater reductions in the diabetes group compared to controls (HbA1c reduction: −0.25, p = .01).
• These findings indicate that periodontal treatment reduces systemic inflammation, with a stronger effect in individuals with diabetes, independent of BMI.

Limitations