Rathna Devi Vaithilingam

Relationship between periodontal disease and diabetes mellitus: an Asian perspective

Physicians and dentists have restricted themselves to their own respective fields in the past, only treating diseases that are relevant to their own fields of specialization. However, recent findings indicate that oral health may influence systemic health, and that this may be a bi-directional relationship for some conditions. This is particularly true for the relationship between periodontal disease and diabetes mellitus. The inter-relationship between periodontal disease and diabetes mellitus provides an example of a cyclical association, whereby a systemic disease predisposes the individual to oral infections, and, once the oral infection is established, it exacerbates the systemic disease. There are also associations between periodontal disease and systemic conditions such as cardiovascular problems, pulmonary conditions, osteoporosis, obesity, pancreatic cancer and Alzheimer s disease. Hence, emphasis should now be placed on treating periodontal and other chronic dental diseases as a means of ameliorating systemic diseases.

Effect of nonsurgical periodontal therapy verses oral hygiene instructions on Type 2 diabetes subjects with chronic periodontitis: a randomised clinical trial

Background40 subjects with type 2 diabetes and moderate to severe CP were randomly distributed to groups receiving either NSPT or OHI. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, 2- and 3-months intervals.Methods40 subjects with type 2 diabetes and moderate to severe CP were randomly distributed to groups receiving either NSPT or OHI. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, 2- and 3-months intervals.Results15 subjects from NSPT group and 17 from OHI group completed the study. The difference in plaque index (PI) between NSPT and OHI groups were significant at 2 months recall (p = 0.013). There was no significant difference between NSPT and OHI group for all other clinical periodontal parameters, HbA1c and CRP levels. At 3 months post-therapy, periodontal parameters improved significantly in both groups with sites with probing pocket depth (PPD) < 4 mm reported as 98 ± 1.8% in NSPT group and 92 ± 14.9% in OHI group. Mean PPD and mean probing attachment loss (PAL) within the NSPT group reduced significantly from baseline (2.56 ± 0.57 mm, 3.35 ± 0.83 mm) to final visit (1.94 ± 0.26 mm, 2.92 ± 0.72 mm) (p = 0.003, p < 0.001). For OHI group, improvements in mean PPD and mean PAL were also seen from baseline (2.29 ± 0.69 mm, 2.79 ± 0.96 mm) to final visit (2.09 ± 0.72 mm, 2.62 ± 0.97 mm) (p < 0.001 for both). Similarly, HbA1c levels decreased in both groups with NSPT group recording statistically significant reduction (p = 0.038). Participants who demonstrated ≥ 50% reduction in PPD showed significant reductions of HbA1c and hs-CRP levels (p = 0.004 and p = 0.012).ConclusionNSPT significantly reduced PI at 2 months post-therapy as compared to OHI. Both NSPT and OHI demonstrated improvements in other clinical parameters as well as HbA1c and CRP levels.Trial registrationClinicalTrials.gov: NCT01951547.

Effect of nonsurgical periodontal treatment on clinical periodontal variables and salivary resistin levels in obese Asians

This study investigated changes in periodontal outcomes after nonsurgical periodontal treatment (NSPT) and evaluated associations of change in salivary resistin level with periodontal outcomes in obese Malaysians with chronic periodontitis. Sixty-two obese adults with chronic periodontitis were randomly divided into a test group (n = 31), which received NSPT, and a control group (n = 31), which received no treatment. Plaque score (PS), gingival bleeding index (GBI), probing pocket depth (PPD), and clinical attachment loss (CAL) were measured at baseline and at 6 and 12 weeks after NSPT. Salivary resistin levels were evaluated by using an enzyme-linked immunosorbent assay. PS was significantly lower in patients who received NSPT than in the control group at 6 and 12 weeks (P < 0.05). In the NSPT group the percentages of sites with shallow and moderate pockets decreased significantly, but there was no significant change in deep pockets. Resistin levels significantly decreased after NSPT (P < 0.05). Change in salivary resistin level was not significantly associated with periodontal outcomes. In obese Malaysians, NSPT significantly improved PS and GBI, and improved PPD and CAL for shallow and moderately deep pockets but not for deep pockets. Salivary resistin level was not associated with improvement in either periodontal variable.

Histologic, histomorphometric, and cone-beam computerized tomography analyses of calcium sulfate and platelet-rich plasma in socket preservation: a pilot study.

Objectives: To assess dimensional changes and histologic/histomorphometric aspects of grafted sockets using either calcium sulfate-platelet-rich plasma (CS-PRP) or CS alone in socket preservation procedure. Study Design: Twelve subjects with single nonmolar teeth underwent atraumatic extraction. Six sockets received CS grafts and 6 sockets received CS-PRP grafts. Cone-beam computerized tomography scans taken immediately after extraction and 4 months after surgery were used to measure vertical and horizontal dimensional changes. Histologic and histomorphometric analyses of grafted sites were performed at 4 months after surgery. Intergroup changes were compared using Mann-Whitney U test. Results: CS group demonstrated 18.6% horizontal resorption as compared with 9.2% in CS-PRP group. Resorption for buccal height (BH) (14%) and palatal/lingual height (PH) (13.7%) in CS group was nearly 3 times more than resorption in BH (5%) and PH (4.6%) for CS-PRP group. Mineralized bone component in CS-PRP group (11.19% ± 6.59%) was significantly more than CS group (1.51% ± 2.86%) (P = 0.01). Conclusion: CS-PRP–grafted sites demonstrated higher mineralized bone content than CS-grafted sites.

Establishing and managing a periodontal biobank for research: the sharing of experience.

Periodontal bio-repositories, which allow banking of clinically validated human data and biological samples, provide an opportunity to derive biomarkers for periodontal diagnosis, prognosis and therapeutic activities which are expected to improve patient management. This article presents the establishing of the Malaysian Periodontal Database and Biobank System (MPDBS) which was initiated in 2011 with the aim to facilitate periodontal research. Partnerships were established with collaborating centres. Policies on specimen access, authorship and acknowledgement policies were agreed upon by all participating centres before the initiation of the periodontal biobank. Ethical approval for the collection of samples and data were obtained from institutional ethics review boards. A broad-based approach for informed consent was used, which covered areas related to quality of life impacts, genetics and molecular aspects of periodontal disease. Sample collection and processing was performed using a standardized protocol. Biobanking resources such as equipment and freezers were shared with the Malaysian Oral Cancer Database and Tissue Bank System (MOCDTBS). In the development of the MPDBS, challenges that were previously faced by the MOCDTBS were considered. Future challenges in terms of ethical and legal issues will be faced when international collaborations necessitate the transportation of specimens across borders.

Identification of biomarkers for periodontal disease using the immunoproteomics approach

Background Periodontitis is one of the most common oral diseases associated with the host’s immune response against periodontopathogenic infection. Failure to accurately diagnose the stage of periodontitis has limited the ability to predict disease status. Therefore, we aimed to look for reliable diagnostic markers for detection or differentiation of early stage periodontitis using the immunoprotemic approach. Method In the present study, patient serum samples from four distinct stages of periodontitis (i.e., mild chronic, moderate chronic, severe chronic, and aggressive) and healthy controls were subjected to two-dimensional gel electrophoresis (2-DE), followed by silver staining. Notably, we consistently identified 14 protein clusters in the sera of patients and normal controls. Results Overall, we found that protein levels were comparable between patients and controls, with the exception of the clusters corresponding to A1AT, HP, IGKC and KNG1 (p < 0.05). In addition, the immunogenicity of these proteins was analysed via immunoblotting, which revealed differential profiles for periodontal disease and controls. For this reason, IgM obtained from severe chronic periodontitis (CP) sera could be employed as a suitable autoantibody for the detection of periodontitis. Discussion Taken together, the present study suggests that differentially expressed host immune response proteins could be used as potential biomarkers for screening periodontitis. Future studies exploring the diagnostic potential of such factors are warranted.

Comparison of nonsurgical periodontal therapy with oral hygiene instruction alone for chronic periodontitis

We evaluated changes in clinical variables and microbiological profiles of periodontopathogens among 56 patients with moderate to severe CP who were randomly assigned to oral hygiene instruction (OHI; n = 28) or nonsurgical periodontal treatment (NSPT; n = 28). Periodontal variables were assessed and subgingival plaque samples were obtained from deep pockets (≥5 mm) at baseline and 3 months after treatment. Real-time polymerase chain reaction was used to quantify Actinobacillus actinomycetemcomitans, Tannerella forsythia, Porphyromonas gingivalis, and Prevotella intermedia. All clinical variables significantly improved in both groups. Improvements in gingival bleeding index (GBI), probing pocket depth (PPD), and periodontal attachment loss (PAL) were significantly greater at 3 months after treatment in the NSPT group. At baseline, the prevalences of all pathogens were high. Significant reductions in microbial count were observed for A. actinomycetemcomitans and T. forsythia (P ≤ 0.05) in the NSPT group. None of the improvements in clinical variables was associated with changes in microbiological profiles. At 3 months after treatment, NSPT was associated with significantly greater improvements in GBI, PPD, and PAL as compared with OHI. A. actinomycetemcomitans and T. forsythia counts were significantly lower in the NSPT group.

Impact of non-surgical periodontal therapy on OHRQoL in an obese population, a randomised control trial

BackgroundOral Health Related Quality of Life (OHRQoL) is an important measure of disease and intervention outcomes. Chronic periodontitis (CP) is an inflammatory condition that is associated with obesity and adversely affects OHRQoL. Obese patients with CP incur a double burden of disease. In this article we aimed to explore the effect of Non-Surgical Periodontal Therapy (NSPT) on OHRQoL among obese participants with chronic periodontitis.Materials and MethodsThis was a randomised control clinical trial at the Faculty of Dentistry, University of Malaya. A total of 66 obese patients with chronic periodontitis were randomly allocated into the treatment group (n=33) who received NSPT, while the control group (n=33) received no treatment. Four participants (2 from each group) were non-contactable 12 weeks post intervention. Therefore, their data were removed from the final analysis. The protocol involved questionnaires (characteristics and OHRQoL (Oral Health Impact Profile-14; OHIP-14)) and a clinical examination.ResultsThe OHIP prevalence of impact (PI), overall mean OHIP severity score (SS) and mean OHIP Extent of Impact (EI) at baseline and at the 12-week follow up were almost similar between the two groups and statistically not significant at (p=0.618), (p=0.573), and (p=0.915), respectively. However, in a within-group comparison, OHIP PI, OHIP SS, and OHIP EI showed a significant improvement for both treatment and control groups and the p values were ((0.002), (0.008) for PI), ((0.006) and (0.004) for SS) and ((0.006) and (0.002) for EI) in-treatment and control groups, respectively.ConclusionNSPT did not significantly affect the OHRQoL among those obese with CP. Regardless, NSPT, functional limitation and psychological discomfort domains had significantly improved.Trial registration(NCT02508415). Retrospectively registered on 2nd of April 2015.