Assessment of Effect of Periodontal and Prosthodontic Therapy on Glycemic Control in Patients with Diabetes.

BACKGROUND: Periodontitis is a chronic inflammatory disease of multifactorial etiology. The present study was conducted to assess the effect of periodontal and prosthodontic therapy on glycemic control in patients with diabetes.
MATERIALS AND METHODS: 80 type II diabetics patients of both genders were divided into Group I (periodontal and prosthodontic therapy) and Group II (Healthy). In control group, only oral hygiene instruction and mouth wash were prescribed.
RESULTS: Group I had 22 males and 18 females and Group II had 17 males and 23 females. The mean glycated hemoglobin level in Group I was 7.8% before and 6.7% after treatment and in Group II was 6.4% before and 6.2% after treatment. The difference was significant (P < 0.05).
CONCLUSION: There was improvement in glycemic status in diabetic patients undergoing periodontal and prosthodontic therapy as compared to those not undergoing treatment. Copyright:

INTRODUCTION

Periodontitis is a chronic inflammatory disease of multifactorial etiology. The primary ideological factor remains pathogenic microorganisms whereby the destruction of periodontal apparatus results from the interplay between host immune microbial interactions.[1] Moreover, microbiologic cause periodontitis is often influenced by systemic factors. Thus, many systemic disorders have an impact on periodontal health.[2] Diabetes mellitus an autoimmune disorder is considered as a risk factor of periodontitis, which is often regarded as six complications of diabetes. Diabetes mellitus and periodontal disease are two common diseases that are in close relation to one another. Diabetes mellitus alters glucose tolerance or impairs metabolism of lipids and carbohydrates.[3] Diabetes mellitus is often preceded by low-grade inflammatory response. This indicates that diabetes and periodontitis may be associated through the dysregulated inflammatory immune response. Diabetes mellitus patients usually present with advanced periodontal destruction, having deficit or impaired glucose tolerance depending on the type of diabetes.[4]

Gingival crevicular fluid is a serum transudate originating from the gingival plexus of blood vessels.[5] It has been shown that elevated serum levels of inflammatory mediators and cytokines such as tumor necrosis factor-alpha in diabetic patients correlated with increased levels of these mediators and cytokines in gingival crevicular fluid.[6] Systemic infection of Gram-negative organisms such as Porphyromonas gingivalis, Tannerella forsythensis, and Prevotella intermedia, or their products may promote an elevated inflammatory state and increased levels of serum inflammatory markers.[7] The present study was conducted to assess the effect of periodontal and prosthodontic therapy on glycemic control in patients with diabetes.

MATERIALS AND METHODS

The present study comprised of 80 type II diabetics of both genders. All were taken into study after obtaining their written consent.

Data such as name and age were recorded. Grouping of participants in Group I (periodontal and prosthodontic therapy) and Group II (no therapy) was done. The level of glycated hemoglobin was assessed. Full mouth scaling, subgingival curettage, extraction, and flap operation performed under local anesthesia. Prosthodontic therapy consisted of implant prosthodontics, single and bridge restorations, occlusal adjustment, and removable partial denture was done. Patients in the Group I received at least one of these therapies. In control group, only oral hygiene instruction and mouth wash was prescribed. Results were analyzed statistically. P <0.05 was considered significant.

RESULTS

Table 1 and Graph 1 show that Group I had 22 males and 18 females and Group II had 17 males and 23 females.

Table 1

Distribution of patients

Groups	Group I	Group II
Status	Periodontal and prosthodontic therapy	No therapy
Male: female	22:18	17:23

Graph 1

Distribution of patients

Table 2 and Graph 2 show that mean glycated hemoglobin (HbA1C) level in Group I was 7.8% before and 6.7% after treatment and in Group II was 6.4% before and 6.2% after treatment. The difference was significant (P < 0.05).

Table 2

Assessment of glycated hemoglobin level before and after treatment in both groups

HbA1c (%)	Group I	Group II	P
Before	7.8	6.4	0.02
After	6.7	6.2	0.05
P	0.05	0.04

HbA1c: Glycated hemoglobin

Graph 2

Assessment of glycated hemoglobin level before and after treatment in both groups

DISCUSSION

Diabetes is characterized by an increased susceptibility to infection, poor wound healing, and increased morbidity and mortality. Oral cavity provides a continuous source of infectious agents, and its condition often reflects the progression of systemic pathologies.[8] Diabetes is also recognized as an important risk factor for more severe and progressive periodontitis infection or lesions resulting in the destruction of tissues and supporting bone that forms the attachment around the tooth.[9] It is considered as a manifestation of a persistent chronic low-grade inflammation. Periodontal disease is a chronic inflammatory condition that causes an imbalance in anabolic and catabolic processes, ultimately resulting in resorption of alveolar bone or tooth-supporting tissues.[10] The present study was conducted to assess the effect of periodontal and prosthodontic therapy on glycemic control in patients with diabetes.

In the present study, Group I had 22 males and 18 females and Group II had 17 males and 23 females. Kim et al.[11] in their study among the 70 patients, 35 patients receive periodontal and prosthodontic therapy, while the other 35 patients did not receive such therapy. The HbA1c levels were compared before and after periodontal and prosthodontic therapy. Comparisons between groups and within groups were performed. The HbA1c levels in the group who have received periodontal and prosthodontic therapy decreased from 7.2 to 6.7 (P = .001). The HbA1c levels in the control group decreased from 7.2 to 7.1 (P = .580). The difference in changes between the two patient groups was statistically significant (P = .011).

We found that mean HbA1C level in Group I was 7.8% before and 6.7% after treatment and in Group II was 6.4% before and 6.2% after treatment. Polak and Shapira[12] suggested a biological pathway that the elevated pro-inflammatory factors in the gingiva of patients with poorly controlled serum glucose may aggravate periodontitis.

Munjal et al.[13] evaluated and investigated changes in HbA1c levels before and after nonsurgical periodontal therapy in type-2 diabetes mellitus patients with generalized periodontitis. The selected participants were randomly allocated to two groups. Group I: control group: participants who received only scaling and root planing. Group II: test group: participants received antibiotic coverage with nonsurgical periodontal therapy (scaling and root planning). Clinical parameters included plaque index, gingival index, PRO MIG pocket depth, and clinical attachment level. In addition, the metabolic parameters were recorded at the same time intervals, which included fasting blood sugar, random blood sugar, and HbA1c levels. HbA1c more significantly reduced by test group compared to the other group. There is definitely a positive effect of nonsurgical on HbA1c levels in type 2 diabetes mellitus. These point levels significantly reduced after conventional nonsurgical periodontal therapy.

Moeintaghavi et al.[14] noted a significant reduction of HbA1c level (0.74%) in the treatment group after 3 months. According to previous studies, the magnitude of the reduction in HbA1c ranged from 0.27% to 0.48%, 3–4 months after periodontal treatment. Despite periodontal treatment seeming to ameliorate metabolic control, evidence was not sufficient to significant associate periodontal treatment and metabolic control in patients with diabetes. According to a consensus report, there is a lack of data to manifest that this effect is maintained over 6 months following periodontal treatment.[15]

CONCLUSION

Authors found that there was improvement in glycemic status in diabetic patients undergoing periodontal and prosthodontic therapy as compared to those not undergoing treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.