Short-term effects of intensive periodontal therapy on serum inflammatory markers and cholesterol.
ABSTRACT Severe periodontitis has been associated with increased systemic inflammation. In a three-arm preliminary randomized trial, we investigated the impact of standard (SPT) and intensive periodontal therapy (IPT) on serum inflammatory markers and cholesterol levels. Medical and periodontal parameters, C-reactive protein (CRP), interleukin-6 (IL-6), total cholesterol, and LDL cholesterol were evaluated in 65 systemically healthy subjects suffering from severe generalized periodontitis. Two months after treatment, both SPT and IPT resulted in significant reductions in serum CRP compared with the untreated control (0.5 +/- 0.2 mg/L for SPT, P = 0.030 and 0.8 +/- 0.2 mg/L for IPT, P = 0.001). Similar results were observed for IL-6. Changes in inflammation were independent of age, gender, body mass index, and ethnicity, but a significant interaction between cigarette smoking and treatment regimen was found. The IPT group also showed a decrease in total and LDL cholesterol after 2 months. Analysis of these data indicates that periodontitis causes moderate systemic inflammation in systemically healthy subjects.
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ABSTRACT: Systematic review and meta-analyses to study the robustness of observations that treatment of periodontitis improves the atherosclerotic profile. Literature was searched in Medline-PubMed, Cochrane CENTRAL and EMBASE, based on controlled periodontal intervention trials, including also a non-intervention group. Data were extracted and meta-analyses were performed. From 3928 screened studies, 25 trials met the eligibility criteria. These trials enrolled 1748 periodontitis patients. Seven trials enrolled periodontitis patients that were otherwise healthy, 18 trials recruited periodontal patients with various co-morbidities, such as CVD or diabetes. None of the trials used hard clinical endpoints of CVD. However, improvement of endothelial function has been consistently reported. Meta-analyses demonstrated significant WMD for hsCRP (-0.50mg/L, 95%CI:-0.78;-0.22), IL-6 (-0.48ng/L, 95%CI:-0.90;-0.06), TNF-α (-0.75pg/mL, 95%CI:-1.34;-0.17), fibrinogen (-0.47g/L, 95%CI:-0.76;-0.17), total cholesterol (-0.11mmol/L, 95%CI:-0.21;-0.01), and HDL-C (0.04mmol/L, 95%CI:0.03;0.06) favoring periodontal intervention. Importantly, periodontitis patients with co-morbidity benefitted most from periodontal therapy; significant WMD were observed for levels of hsCRP (-0.71mg/L, 95%CI:-1.05;-0.36), IL-6 (-0.87ng/L, 95%CI:-0.97;-0.78), triglycerides (-0.24mmol/L, 95%CI:-0.26;-0.22), total cholesterol (-0.15mmol/L, 95%CI:-0.29;-0.01), HDL-C (0.05mmol/L, 95%CI:0.03;0.06) and HbA1c (-0.43%, 95%CI:-0.60;-0.25). This systematic review and meta-analyses demonstrate that periodontal treatment improves endothelial function and reduces biomarkers of atherosclerotic disease, especially in those already suffering from CVD and/or diabetes. This article is protected by copyright. All rights reserved.Journal Of Clinical Periodontology 09/2013; 41(1). DOI:10.1111/jcpe.12171 · 3.61 Impact Factor
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ABSTRACT: The aim of this study was to compare the serum levels of high-sensitivity C reactive protein (hs-CRP), inter- leukin-1 beta (IL-1β), interleukin-6 (IL-6) and tu- mour necrosis factor-alpha (TNF-α) between patients with and without periodontitis. Methods: Clinical periodontal parameters were measured at six sites per tooth in seventy-five subjects with periodontitis and in thirty-five periodontally healthy subjects. The following periodontal parameters were evaluated: the Löe-Sillness gingival index (0 - 3), the Sillness-Löe dental plaque index (0 - 3), the probing depth (mm), the clinical attachment level (mm), the bleeding index and the tooth mobility index. The laboratory para- meters that were included in this study were the levels of hs-CRP, IL-1β, IL-6 and TNF-α, which were all assessed via Enzyme-Linked ImmunoSorbent Assay (ELISA). Inter-group significance was determined with the statistical package R; specifically, we used the Student’s t-test, x2-test and Mann-Whitney test. Results: Concentrations of hs-CRP, IL-1β, IL-6 and TNF-α were lower in the control group than in the periodontal disease group. The concentrations of each protein (control group vs. periodontal disease group) were as follows: hs-CRP (0.5 ± 0.6 vs. 2.5 ± 2.6, re- spectively), IL-1β (2.1 ± 2.2 vs. 7.0 ± 11.6, respec- tively), IL-6 (1.9 ± 1.6 vs. 3.7 ± 4.4, respectively) and TNF-α (64.6 ± 72.3 vs. 80.0 ± 73.1, respectively). The differences between the groups showed statistical sig- nificance at p < 0.05. Conclusions: Periodontal dis- ease was associated with increased circulating con- centrations of hs-CRP, IL-1β, IL-6 and TNF-α.Open Journal of Stomatology 03/2013; 2013(3):32-38. DOI:10.4236/ojst.2013.31007
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ABSTRACT: Adjunctive use of sub-antimicrobial dose doxycycline (SDD) is a mode of host modulation therapy for periodontitis. However, the potential of SDD for moderating serum inflammatory mediators has not been investigated extensively. This study evaluated the effects of intensive scaling and root planning (ITSRP) ± SDD on the serum levels of tumor necrosis factor-alpha (TNF-interleukin-6 (IL-6) and lipid profile in advanced periodontitis. Forty systemically healthy patients were randomly assigned into two groups to take either a placebo or an SDD adjunctive to ITSRP in a double-blind controlled clinical trial. At baseline and after 4 weeks, we collected blood samples and recorded clinical indices. Statistically significant changes in TNF-and IL-6 serum levels did not occur in either group compared to baseline. A significant increase in high-density lipoprotein (HDL) cholesterol levels and a decrease in white blood cell counts were observed in the SDD group. Between groups, significantly greater improvements in pocket depth, clinical attachment level, mean number of pockets ≥ 7 mm and IL-6 alteration occurred in the SDD group. This study demonstrated the effectiveness of combining ITSRP with SDD in gaining periodontal attachment, IL-6 alteration and HDL cholesterol levels over ITSRP alone. Adjunctive use of SDD is likely to have a protective role against vascular events by mediating patient HDL levels. Further investigation among a high-risk population is recommended.African journal of microbiology research 01/2012; 6(Vol 6, No 2):355-360. DOI:10.5897/AJMR11.1006 · 0.54 Impact Factor