The following research has emerged in the peer-reviewed literature related to periodontitis and systemic conditions in the last 30 days.
Mealey and Rose conducted and published a literature review which looked closely at the relationships between diabetes mellitus and periodontal disease, focusing specifically on common pathophysiological pathways associated with conditions such as insulin resistance and inflammation.
The authors found associations between elevated systematic inflammatory rates and enhanced risk of major cardiovascular adverse events such as stroke and myocardial infarction. There were also associations between systematic inflammatory rates and adverse events in pregnancy, and evidence indicating a relationship between impaired glycemic control and inflammation related to periodontitis. Mealey and Rose looked closely at intervention trials which demonstrated periodontal therapy can improve the condition of systemic inflammation, therefore glycemic control in diabetic patients with periodontal disease may improve as the result of an intervention. The authors emphasize the need for dentists and physicians to collaborate when treating patients with periodontitis and diabetes. For additional information on this article, please reference the full citation. Mealey BL, Rose LF. Diabetes mellitus and inflammatory periodontal disease. Compend Contin Educ Dent. 2008;29:402-408, 410, 412-413
Persson and Persson recently published an article which reviewed new literature since the European Workshop on Periodontology.
The authors also reviewed two meta-analyses which identified associations between cardiovascular diseases and periodontitis (OR: 1.1-2.2). As a result of the literature review, the authors reported “periodontitis may contribute to cardiovascular disease and stroke in susceptible subjects”, although they emphasized it is difficult to make definitive statements or conclusions regarding associations and risks between periodontitis and cardiovascular diseases due to a dearth of consistently designed epidemiologic studies on disease prevalence. The authors suggest sufficiently powered longitudinal case-control and intervention trials be conducted to determine the impact periodontitis and periodontal interventions may have on cardiovascular diseases. The authors make several recommendations for research questions associated with surrogate markers following periodontal therapy and assessment of outcomes related to periodontal therapy in cardiovascular patients. For additional information on this article, please review the following article: Persson GR, Persson RE. Cardiovascular disease and periodontitis: an update on the associations and risk. J Clin Periodontol. 2008(8 Suppl):362-79.
A systematic literature review was conducted to review the evidence-based literature for associations between periodontal and peri-implant conditions and diabetes, and the effect of periodontal therapy on outcomes in diabetic patients.
The literature review did not limit levels of evidence but focused solely on human studies. The review determined patients with periodontitis tended to have poor glycemic control and comorbid complications. The literature review found a significant association between diabetes and periodontitis in relation to severity but not extent of disease in patients whose diabetes was uncontrolled. The review lacked evidence indicating implant therapy affected long-term patient outcomes. The authors concluded “poorly controlled diabetes may be considered a risk factor for increased severity of periodontitis”; however, it was felt additional larger scale randomized controlled trials are necessary to make definitive conclusions related to the effects of periodontal therapy on glycemic control and systemic inflammation. For additional information, please review the following article: Salvi GE, Carollo-Bittel B, Lang NP. Effects of diabetes mellitus on periodontal and peri-implant conditions: update on associations and risks. J Clin Periodontol. 2008;35(8 Suppl):398-409
September 18, 2008.
The following research has emerged in the peer-reviewed literature related to periodontitis and systemic conditions in the last 30 days.
Source: ProMed
Kamer et al reviewed the role of inflammation related to chronic periodontitis and its effect on Alzheimer’s disease.
Although the article does not report results of an original study, the authors propose possible ways in which chronic periodontitis can contribute to clinical onset and progression of Alzheimer’s disease. The authors identify chornic periodontitis as a possible risk factor for Alzheimer’s disease which is able to be modified because it is a treatable infection. For additional information on this article, please reference the full citation: Kamer AR, Craig RG, Dasanayake AP, Brys M, Glodzik-Sobanska L, de Leon MJ. Inflammation and Alzheimer's disease: possible role of periodontal diseases. Alzheimers Dement. 2008;4:242-250
The results of a pilot trial were reported by Madden and colleagues, who studied 42 patients with type 2 diabetes with hemoglobin A1c (HgA1c) levels between 7% and 9% (mild elevation) and above 9% (severe elevation).
The patients were randomized to two groups of treatment as follows: MT – minimal therapy which consisted of scaling, root planing, and oral hygiene instructions twice on an every 6 month basis; and FT – frequent therapy which consisted of scaling, root planing, and oral hygiene instructions every 2 months with provision of 0.12% chlorhexidine rinse for at-home use twice a day. The results of the pilot study showed modest improvements in HgA1c levels in patients who received FT therapy compared to patients receiving MT therapy. The authors concluded additional studies need to be conducted, but it is important that patients with diabetes have periodontal care closely coordinated with diabetic clinical treatment, and receive intense and sustained preventive periodontal regimens for elimination of periodontal inflammation. For additional information on the data related to this pilot trial, please reference the full citation: Madden TE, Herriges B, Boyd LD, Laughlin G, Chiodo G, Rosenstein D. Alterations in HbA1c following minimal or enhanced non-surgical, non-antibiotic treatment of gingivitis or mild periodontitis in type 2 diabetic patients: a pilot trial. J Contemp Dent Pract. 2008;9:9-16
A supplement published in the August edition of the Journal of Periodontology was authored by Thomas E. Van Dyke and Kenneth S. Kornman.
The supplement reviewed the role of inflammation in periodontal disease and its relation systemically, as well as factors which regulate the inflammatory response. Many of the papers included in the supplement relate the topics recently discussed and reviewed in detail at a conference in Boston, which was convened to review the most recent evidence relating to inflammation. The article focuses on the inflammatory response of the immune system, and discussions related to atherogenesis and inflammation, metabolic disorders and inflammation, and inflammatory markers. The authors concluded additional research is needed to determine how advanced knowledge of inflammation can help diagnose or treat conditions or late-stage sequelae related to systemic diseases and inflammation. To view the entire supplement in depth, it is available at http://www.joponline.org/doi/pdf/10.1902/jop.2008.080239.
August 22, 2008
A review of the peer-reviewed literature over the past 30 days revealed several articles of interest in the field of oral health.
Source: ProMed
30 patients with type 2 diabetes mellitus in a double-masked, placebo-controlled study which analyzed the effects of scaling and root planing on glycosylated hemoglobin and inflammatory biomarkers.
O’Connell et al1[M1] conducted a small study on 30 patients with type 2 diabetes mellitus in a double-masked, placebo-controlled study which analyzed the effects of scaling and root planing on glycosylated hemoglobin and inflammatory biomarkers. Patients were treated with periodontal therapy and either doxycycline or placebo. No statistical differences were seen between the two treatment groups in relation to systemic conditions of patients with type 2 diabetes mellitus, but periodontal therapy may influence the systemic conditions. Patients receiving doxycycline had a 1.5% reduction (P<0.01) in HbA1c compared to a 0.9% reduction (P= 0.17); probing depth was 0.8 mm for the placebo group (P<0.01) vs 1.1 mm for the doxycycline group (P <0.01). There was a statistically significant decrease in all patients’ inflammatory serum markers, including interleukin-6; interferon-inducible protein10; soluble fas ligand; granulocyte colony-stimulating factor; RANTES; and interleuken-12 p70 serum levels. The authors did note the improvement in glycemic control and inflammatory markers may have been the direct result of patient diet changes, which were not measured or controlled in the study, and a larger patient population with diet controlled and measured in a future study would be a beneficial additional to the body of evidence.
Results of a 3-year study on effects of doxycycline in conjunction with periodontal therapy were reported by Bogren and colleagues2[M2]
And found in a total of 128 patients receiving mechanical debridement in conjunction with doxycycline (test group) vs the control group receiving mechanical debridement alone, there were statistically significant short term effects on clinical parameters in the test group; however, repeat application of doxycycline gel demonstrated clinical or microbiologic effects on par with maintenance patients receiving mechanical debridement alone with no additional benefits recognized.
Boggess3[M3] reviewed the issue of maternal oral health in pregnancy, discussing the epidemiology and pathophysiology of various maternal oral health issues, and outlining the relationships between oral and general health and maternal and infant oral health.
The author recommends education of women regarding oral health and appropriate treatment during pregnancy, utilizing this time period as an opportunity for identifying, preventing, and/or treating the patient, with a view to enhancing long term patient and infant outcomes.
July 1, 2008