Clinical effects of supragingival plaque control on uncontrolled type 2 diabetes mellitus subjects with chronic periodontitis
Aim: To determine the clinical changes occurred in chronic periodontitis patients presenting uncontrolled type 2 diabetes mellitus after a supragingival plaque control period. Methods: Subjects presenting generalized chronic periodontitis were divided into two groups: Non-diabetics (n=20) – healthy subjects presenting chronic periodontitis; and Diabetics (n=14) – subjects with uncontrolled type 2 diabetes mellitus presenting chronic periodontitis. All subjects went through 28 days of supragingival plaque control - ST - (including prophylaxis, calculus removal, extraction of hopeless teeth and oral hygiene instructions) and were evaluated at baseline and after 28 days by the following parameters: Full-Mouth Plaque Score (FMPS) and Full-Mouth Bleeding Scores (FMBS), Periodontal Probing Depth (PPD), Gingival Recession (GR) and Clinical Attachment Level (CAL). ANOVA/Tukey’s test and Student’s t test were used for data analysis. Results: No statistically significant differences (p>0.05) between groups were observed at baseline for any parameter. Both groups presented a significant reduction in FMPS and FMBS after 28 days (p<0.05), but no statistically significant difference was found (p>0.05) between groups. Clinically, only the Non-diabetic group showed a significant improvement after ST, in PPD of initially deep pockets (p<0.05). However, no change in the clinical parameters was observed in the diabetic subjects (p>0.05). Conclusions: It may be concluded that uncontrolled diabetes mellitus reduces periodontal changes in the supragingival plaque control regimen of subjects presenting with chronic periodontitis.
2. Mealey BL. Periodontal disease and diabetes. A two-way street. J Am Dent Assoc. 2006; 137 (Suppl): 26S-31S
3. Mealey BL, Rose LF. Diabetes mellitus and inflammatory periodontal diseases. Curr Opin Endocrinol Diabetes Obes. 2008; 15: 135-41.
4. Vieira Ribeiro F, de Mendonça AC, Santos VR, Bastos MF, Figueiredo LC, Duarte PM. Cytokines and bone-related factors in systemically healthy patients with chronic periodontitis and patients with type 2 diabetes and chronic periodontitis. J Periodontol. 2011; 82: 1187-96.
5. Santos VR, Ribeiro FV, Lima JA, Napimoga MH, Bastos MF, Duarte PM. Cytokine levels in sites of chronic periodontitis of poorly controlled and well-controlled type 2 diabetic subjects. J Clin Periodontol. 2010; 37: 1049-58.
6. Shin DS, Park JW, Suh JY, Lee JM. The expressions of inflammatory factors and tissue inhibitor of matrix metalloproteinase-2 in human chronic periodontitis with type 2 diabetes mellitus. J Periodontal Implant Sci. 2010; 40: 33-8.
7. Duarte PM, de Oliveira MC, Tambeli CH, Parada CA, Casati MZ, Nociti FH-Jr. Overexpression of interleukin-1beta and interleukin-6 may play an important role in periodontal breakdown in type 2 diabetic patients. J Periodontal Res. 2007; 42: 377-81.
8. Listgarten MA, Mayo HE, Tremblay R. Development of dental plaque on epoxy resin crowns in man. A light and electron microscopic study. J Periodontol. 1975; 46: 10-26.
9. Hellström MK, Ramberg P, Krok L, Lindhe J. The effect of supragingival plaque control on the subgingival microflora in human periodontitis. J Clin Periodontol. 1996; 23: 934-40.
10. Westfelt E, Rylander H, Dahlén G, Lindhe J. The effect of supragingival plaque control on the progression of advanced periodontal disease. J Clin Periodontol. 1998; 25: 536-41.
11. Ribeiro Edel P, Bittencourt S, Nociti-Júnior FH, Sallum EA, Sallum AW, Casati MZ. The effect of one session of supragingival plaque control on clinical and biochemical parameters of chronic periodontitis. J Appl Oral Sci. 2005; 13: 275-9.
12. Kho P, Smales FC, Hardie JM. The effect of supragingival plaque control on the subgingivalmicroflora. J Clin Periodontol. 1985; 12: 676-86. 13. Beltrami M, Bickel M, Baehni PC. The effect of supragingival plaque control on the composition of the subgingival microflora in human periodontitis. J Clin Periodontol. 1987; 14: 161-4.
14. McNabb H, Mombelli A, Lang NP. Supragingival cleaning 3 times a week. The microbiological effects in moderately deep pockets. J Clin Periodontol. 1992; 19: 348-56.
15. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999; 4: 1-6.
16. Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975; 25: 229-35.
17. Mühlemann HR, Son S. Gingival sulcus bleeding—a leading symptom in initial gingivitis. Helv Odontol Acta. 1971; 15: 107-13
18. Katz PP, Wirthlin MR Jr, Szpunar SM, Selby JV, Sepe SJ, Showstack JA. Epidemiology and prevention of periodontal disease in individuals with diabetes. Diabetes Care. 1991; 14: 375-85.
19. Yuan K, Chang CJ, Hsu PC, Sun HS, Tseng CC, Wang JR. Detection of putative periodontal pathogens in non-insulin-dependent diabetes mellitus and non-diabetes mellitus by polymerase chain reaction. J Periodontal Res. 2001; 36: 18-24.
20. Tervonen T, Oliver RC, Wol LF, Bereuter J, Anderson LA, Aeppli DM. Prevalence of periodontal pathogens with varying metabolic control of diabetes mellitus. J Clin Periodontol. 1994; 21: 375-9.
21. Sbordone L, Ramaglia L, Barone A, Ciaglia RN, Tenore A, Iacono VJ. Periodontal status and selected cultivable anaerobic microflora of insulindependent juvenile diabetics. J Periodontol. 1995; 66: 452-61.
22. Zambon JJ, Reynolds H, Fisher JG, Shlossman M, Dunford R, Genco RJ. Microbiological and immunological studies of adult periodontitis in patients with noninsulin-dependent diabetes mellitus. J Periodontol. 1988; 59: 23-31.
23. Ficara AJ, Levin MP, Grower MF, Kramer GD. A comparison of the glucose and protein content of gingival fluid from diabetics and non diabetics. J Periodontal Res. 1975; 10: 171-5.
24. Hintao J, Teanpaisan R, Chongsuvivatwong V, Ratarasan C, Dahlen G. The microbiological profiles of saliva, supragingival and subgingival plaque and dental caries in adults with and without type 2 diabetes mellitus. Oral Microbiol Immunol. 2007; 22: 175-81.
25. Nogueira Moreira A, Luna Davila G, Bianchini H, Alonso C, Piovano S. Effect of supragingival plaque control on subgingival microflora and gingivoperiodontal tissues. Acta Odontol Latinoam. 2000; 13: 73-86.
26. Gomes SC, Piccinin FB, Susin C, Oppermann RV, Marcantonio RA. Effect of supragingival plaque control in smokers and never-smokers: 6- month evaluation of patients with periodontitis. J Periodontol. 2007; 78: 1515-21.
27. Gomes SC, Nonnenmacher C, Susin C, Oppermann RV, Mutters R, Marcantonio RA. The effect of a supragingival plaque-control regimen on the subgingival microbiota in smokers and never-smokers: evaluation by real-time polymerase chain reaction. J Periodontol. 2008; 79: 2297-304.
28. Meulman TB, Casarin RC, Peruzzo DC, Giorgetti AP, Barbagallo A, Casati MZ, et al. Impact of supragingival therapy on subgingival microbial profile in smokers versus non-smokers with severe chronic periodontitis. J Oral Microbiol. 2012; 4: doi: 10.3402/jom.v4i0.e8640.
29. Nassarawin NA. Effect of smoking on the response to nonsurgical periodontal therapy. East Mediterr Health J. 2010; 16: 162-5.
30. Kudva P, Tabasum ST, Garg N. Evaluation of clinical and metabolic changes after non-surgical periodontal treatment of type 2 diabetes mellitus patients: a clinico biochemical study. J Indian Soc Periodontol. 2010; 14: 257-62.
- All content of the journal, except where identified, is licensed under a Creative Commons attribution-type BY. The online journal is free and open access.