Efficacy of Curcumin Gel on Zinc, Magnesium, Copper, IL-1ß, and TNF-α in Chronic Periodontitis Patients.

Curcumin exhibits antibacterial, antioxidant, and anti-inflammatory effects and has been suggested as a treatment for inflammatory diseases. The study is aimed at evaluating the effect of curcumin gel on serum levels of micronutrients (zinc, copper, and magnesium) and proinflammatory cytokines (IL-1ß and TNF-α) in chronic periodontitis patients. Ninety subjects with an age of 25-54 were included in this study. From the total number, 30 subjects with healthy periodontium (control group) (mean age = 37.30 ± 7.08) were employed for the sole purpose of obtaining the normal mean values of clinical, chemical, and immunological parameters, and 60 with chronic periodontitis (mean age = 36.73 ± 6.22) were divided randomly into 2 groups, of which each group included 30 subjects. Group A received scaling and root planing SRP and curcumin gel injection covered by Coe pack for 7 days, and group B received SRP alone covered by Coe pack. Clinical parameters (plaque index, gingival index, bleeding on probing, pocket depth, and clinical attachment loss measurements) and blood samples were collected before and after 1 month of treatment to measure serum levels of zinc, copper, magnesium, IL-1ß, and TNF-α. The results showed significant micronutrient alteration and increase of proinflammatory cytokines in the chronic periodontitis group as compared to healthy control (P ≤ 0.05), and curcumin gel had a significant effect on the reduction of IL-1ß, TNF-α, copper, and clinical parameters (P ≤ 0.05) and increase of zinc and magnesium levels after 1 month as compared to baseline (P ≤ 0.05), nearly the same pattern for group B but with nonsignificant differences for Zn (P > 0.05). In conclusion, curcumin gel resulted in a more significant reduction in clinical parameters, inflammatory mediators, and copper and increase of zinc and magnesium levels as compared to SRP alone.

Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis.

BACKGROUND: Glycemic control is vital in the care of type 2 diabetes mellitus (T2DM) and is significantly associated with the incidence of clinical complications. This Bayesian network analysis was conducted with an aim of evaluating the efficacy of scaling and root planning (SRP) and SRP + adjuvant treatments in improving glycemic control in chronic periodontitis (CP) and T2DM patients, and to guide clinical practice. METHODS: We searched the Pubmed, Embase, Cochrane Library and Web of Science databases up to 4 May 2018 for randomized controlled trials (RCTs). This was at least three months of the duration of study that involved patients with periodontitis and T2DM without other systemic diseases given SRP. Patients in the control group did not receive treatment or SRP combination with adjuvant therapy. Outcomes were given as HbA1c% and levels fasting plasma glucose (FPG). Random-effects meta-analysis and Bayesian network meta-analysis were conducted to pool RCT data. Cochrane's risk of bias tool was used to assess the risk of bias. RESULTS: Fourteen RCTs were included. Most were unclear or with high risk of bias. Compared to patients who did not receive treatment, patients who received periodontal treatments showed improved HbA1c% level, including SRP (the mean difference (MD) -0.399 95% CrI 0.088 to 0.79), SRP + antibiotic (MD 0.62, 95% CrI 0.18 to 1.11), SRP + photodynamic therapy (aPDT) + doxycycline (Doxy) (MD 1.082 95% CrI 0.13 to 2.077) and SRP + laser (MD 0.66 95% CrI 0.1037, 1.33). Among the different treatments, SRP + aPDT + Doxy ranked best. Regarding fasting plasma glucose (FPG), SRP did not show advantage over no treatment (MD 4.91 95% CI - 1.95 to 11.78) and SRP with adjuvant treatments were not better than SRP alone (MD -0.28 95% CI -8.66, 8.11). CONCLUSION: The results of this meta-analysis seem to support that periodontal treatment with aPDT + Doxy possesses the best efficacy in lowering HbA1c% of non-smoking CP without severe T2DM complications. However, longer-term well-executed, multi-center trails are required to corroborate the results.

The effects of melatonin supplementation in adjunct with non-surgical periodontal therapy on periodontal status, serum melatonin and inflammatory markers in type 2 diabetes mellitus patients with chronic periodontitis: a double-blind, placebo-controlled trial.

BACKGROUND: Diabetes mellitus (DM) and periodontitis are two common chronic diseases with bidirectional relationship. Oxidative stress plays a key role in the pathogenesis of these two diseases. The aim of this study was to investigate the effects of melatonin supplementation in adjunct with non-surgical periodontal therapy on periodontal status, serum melatonin and inflammatory markers in type 2 DM patients with chronic periodontitis (CP). MATERIALS AND METHODS: In this double-blind clinical trial study, 50 type 2 DM patients with CP were randomly allocated to the intervention and control groups. The intervention and control groups received either 6 mg melatonin or placebo (2 tablets) once a day. Serum levels of melatonin, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), hs-C-reactive protein (hs-CRP), clinical attachment loss (CAL), pocket depth (PD), bleeding on probing (BOP) and plaque index were evaluated in all subjects pre- and post-intervention. RESULTS: Melatonin supplementation significantly increased the mean serum levels of melatonin after intervention. The mean changes of melatonin were significantly higher in intervention group compared with control group. IL-6 and hs-CRP levels were significantly (p = 0.008 and p = 0.017, respectively) reduced in the intervention group. The mean changes of IL-6 were significantly lower in the intervention group compared with the control group (p = 0.04). In the intervention group, PD and CAL were significantly decreased after intervention (p < 0.001). There were significant differences in the mean change of PD and CAL between the intervention and control groups after intervention (p < 0.001). CONCLUSIONS: Melatonin supplementation in adjunct with non-surgical periodontal therapy might improve inflammatory and periodontal status in T2DM with CP.

Novel PAradigm to improve Inflammatory burden in end stage Renal disease (rePAIR): study protocol for a randomized controlled trial.

BACKGROUND: Given the importance of inflammation as a predictor of poor outcomes in End Stage Renal Disease (ESRD), reductions in inflammatory biomarkers have been proposed as a critical target in this population. This study targets chronic periodontitis, an oral inflammatory disease of microbial etiology causing persistent inflammation in ESRD. Unlike the previously reported episodic periodontal interventions, we propose to control periodontal inflammation with a continuous maintenance and oral health behavior modifications. We hypothesize that this strategy will improve systemic inflammation and oxidative stress, oral health and quality of life within the 6-month observation period. METHODS: The rePAIR (novel PAradigm to improve Inflammatory burden in ESRD) study is a pilot and feasibility, parallel-arm, and randomized controlled clinical trial that will recruit 72 ESRD subjects with periodontitis in a model of computerized block randomization. This trial aims to compare the effect of standard-of-care vs. repeated non-surgical periodontal therapy on systemic and oral inflammatory burden. This trial will recruit ESRD adult patients with periodontitis older than 21 years old with a minimum of 12 teeth and no history of periodontal treatment within a year. The trial will examine serum C-reactive protein (CRP) (primary outcome) as a biomarker of inflammation as well as interleukin-6 (IL-6), F2 isofurans and F2 isoprostanes (secondary outcomes) and compare their difference between groups from baseline to 6 months. The trial will also compare the difference between groups in patient-centered and clinical oral outcomes from baseline to 6 months. DISCUSSION: The trial follows a rigorous and transparent study design capturing elements such as pre-specified eligibility criteria, pre-specified primary and secondary outcomes, detailed intervention description to allow replication, intervention random allocation and concealment, blinding in outcome assessment, appropriate sample size calculations, explanation of interim analysis, as per CONSORT Guidelines. Further, gender diversity is secured not only at recruitment but also throughout the trial and during the analysis. Therefore, treatment response outcomes will be examined per gender category. In order to manage anticipated problems, the protocol has included alternative approaches. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03241511 . Registered on 7 August 2017.

Periodontal Therapy with 0.25%Lemongrass Oil Mouthwash in Reducing Risk of Cardiovascular Diseases: A 3-Arm Prospective Parallel Experimental Study.

BACKGROUND: Periodontal disease is associated with cardiovascular diseases because of its role in host immune-inflammatory response. Serum lipids are the commonest risk factors between periodontal disease and cardiovascular diseases. MATERIALS AND METHOD: A double blinded randomised clinical trial was carried out among 45 subjects with generalised severe periodontitis. They were divided into 3-groups of 15 subjects each. Group A: 0.25% lemongrass oil mouthwash, Group B: 0.12% chlorhexidine mouthwash and Group C: Oral prophylaxis only Group. Oral examinations like assessment of Probing Pocket Depth and Clinical Attachment Loss and Bio-chemical tests like assessment of C-Reactive Protein, Total Cholesterol, High Density Lipid, Low Density Lipid and triglycerides were conducted at baseline followed by oral prophylaxis at the same visit. Reassessment of the above mentioned parameters were done after 3 months of intervention. Data so collected were subjected for statistical analysis using SPSS ver. 20.0. RESULTS: A statistically significant reduction in C-Reactive Protein, Probing Pocket Depth, Clinical Attachment Loss, Total Cholesterol and Low Density Lipid level in 0.25% lemongrass oil mouthwash group was found. On comparing a statistically significant difference was observed for the post intervention scores of Probing Pocket Depth and Clinical Attachment Loss only; for Group A v/s C and Group B v/s C. CONCLUSION: 0.25% Lemongrass oil mouthwash was found to be a good herbal alternative; both in the treatment of chronic periodontitis and reduction in the level of serum markers of Cardio Vascular Diseasess.

Additional effects of homeopathy on chronic periodontitis: a 1-year follow-up randomized clinical trial.

BACKGROUND AND OBJECTIVE: The aim of this study was test the hypothesis that homeopathy (H) enhances the effects of scaling and root planing (SRP) in patients with chronic periodontitis (CP). MATERIALS AND METHODS: 50 patients with CP were randomly allocated to one of two treatment groups: SRP (C-G) or SRP + H (H-G). Assessments were made at baseline and after 3 and 12 months of treatments. The local and systemic responses to the treatments were evaluated by clinical and serologic parameters, respectively. RESULTS: Both groups displayed significant improvements, however, using clinical attachment gain and reductions in HDL, LDL and Total Cholesterol, Triglycerides, Glucose and Uric acid, from baseline to 1 year, as criteria for treatment success, H-G performed significantly better than C-G. CONCLUSION: The findings of this 1-year follow-up randomized clinical trial suggest that homeopathic medicines, as an adjunctive to SRP, can provide significant local and systemic improvements for CP patients.

Vitamin E supplementation, superoxide dismutase status, and outcome of scaling and root planing in patients with chronic periodontitis: a randomized clinical trial.

BACKGROUND: This study investigates the levels of superoxide dismutase (SOD) activity in serum and saliva of patients with chronic periodontitis (CP). In addition, the outcome of scaling and root planing (SRP) with and without vitamin E supplementation is evaluated in terms of changes in periodontal parameters and SOD activity in patients with CP. METHODS: Serum and salivary SOD activity in 38 patients with CP were compared with those of 22 systemically and periodontally healthy individuals (control group). At periodontal examination, serum and saliva samples were obtained. Patients with CP were randomly divided into treatment groups 1 (TG-1) and 2 (TG-2). SRP was performed for both groups, and TG-2 also received 200 mg (300 IU) vitamin E every other day. Periodontal parameters and SOD activity were evaluated after 3 months. SOD activity was determined using an SOD assay and enzyme-linked immunosorbent assay reader at 450 nm. RESULTS: SOD activity in both serum (P <0.05) and saliva (P <0.001) was lower in patients with CP compared with controls. After 3 months of follow-up, SOD activity improved in both treatment groups; however, the improvement in TG-2 was higher than in TG-1, along with more improvement in periodontal parameters. Serum SOD levels in TG-2 increased even above the level of the control group. CONCLUSIONS: Systemic and local SOD levels are lowered in CP. Adjunctive vitamin E supplementation improves periodontal healing as well as antioxidant defense.

The impact of non-surgical periodontal treatment on serum levels of long chain-polyunsaturated fatty acids: a pilot randomized clinical trial.

BACKGROUND AND OBJECTIVE: Our group recently found higher levels of serum long chain-polyunsaturated fatty acids (LC-PUFAs) in patients with chronic periodontitis compared to controls. However, the effect of periodontal treatment on LC-PUFA serum levels has not been investigated. The primary aim of the present study was to investigate the impact of periodontal treatment on LC-PUFA serum levels. A secondary aim was to assess the effect of dietary ω-3 supplementation on clinical outcome. MATERIAL AND METHODS: The test group was composed of 10 patients with generalized chronic periodontitis (mean age 44 ± 6.4 years) treated with scaling and root planing associated with 4 mo of ω-3 supplementation eicosapetaenoic acid (EPA) plus docosahexaenoic acid (DHA), 3 g/d. The placebo group was composed of 11 patients (47.9 ± 10.5 years) that received scaling and root planing plus placebo. The periodontal examination included probing depth, clinical attachment level, bleeding on probing and visible plaque index. Docosapentaenoic acid (DPA), EPA, DHA and arachidonic acid (AA) were detected using gas chromatograph. RESULTS: In the placebo group, all LC-PUFAs levels reduced significantly (DHA, DPA and AA, p = 0.004; EPA, p = 0.008). In the test group, only DPA and AA showed a significant reduction (p = 0.005). Moreover, a significant decrease in the ratios AA/EPA and AA/DHA (p = 0.005) was observed in the test group. CONCLUSION: Non-surgical periodontal treatment reduced significantly the serum levels of all analyzed LC-PUFAs except those presented in the supplementation. The ω-3 dietary supplementation had no effect on clinical outcome of treatment.

Additional benefits of homeopathy in the treatment of chronic periodontitis: a randomized clinical trial.

BACKGROUND AND OBJECTIVE: Homeopathic medicine (HM) in the treatment of Chronic Periodontitis (CP) aims to restore the vital energy balance of the patient allowing the body to heal itself. Thus, the aim of this study was to evaluate the additional benefits of HM as an adjunctive to conventional periodontal treatment (CPT). MATERIALS AND METHODS: After sample size calculation, sixty individuals of both genders, and ages varying between 35 and 70 years old, 40 with chronic periodontitis (CP group - CPG) and 20 without CP (Healthy Group - HG) participated in this "Single-Blind Randomized Controlled Clinical Trial". The CP patients were divided into two groups: one was submitted only to CPT (CP Control Group - CPT-C) and the other group was submitted to CPT and HM, according to the similia principle (CP Test Group - CPTT). Assessments were made at baseline and after 90 days of treatments. The local and systemic responses to the treatments were evaluated by clinical and laboratory parameters, respectively. Data were analyzed by parametric and nonparametric tests. The level of significance was 5%. RESULTS: At baseline, CP patients presented higher values of LDL cholesterol and blood glucose than HG individuals. After the treatment, all the systemic parameters evaluated decreased in CP patients, except LDL and HDL Cholesterol in CPT-C, and HDL Cholesterol in CPT-T. There was a statistical gain in clinical attachment level only in CPT-T (+0.51 mm) after 90 days; however, there was a reduction in probing depth, in the level of visible plaque and in the bleeding on probing, in both CP groups (CPT-C and CPT-T) after 90 days. CONCLUSION: The findings of this 3-month follow-up study concluded that H M, as an adjunctive to CPT, can provide additional benefits in the treatment of CP.

Serum levels of long-chain polyunsaturated fatty acids in patients with periodontal disease.

BACKGROUND: Long-chain polyunsaturated fatty acids omega-3 and omega-6 (LC-PUFA n-3 and n-6) can function as important inflammatory modulators and also have a strong effect in the proresolving inflammatory processes. The aim of the authors is to analyze the serum levels of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and arachidonic acid (AA) in patients with generalized chronic periodontitis (GCP) and compare these results with serum levels of patients with gingivitis only. METHODS: Twenty-one patients with untreated GCP (mean age: 46.0 ± 8.8 years) and 16 patients with gingivitis only (mean age: 31.5 ± 7.5 years) were investigated. The clinical examination included probing depth (PD), clinical attachment level, bleeding on probing, and plaque index. Blood samples were analyzed for the presence of DHA, EPA, DPA, and AA using gas chromatography. RESULTS: Significantly higher levels of DHA, DPA, EPA, and AA were observed in patients with GCP when compared with patients with gingivitis (P = 0.007, P = 0.004, P = 0.033, and P = 0.001, respectively). The differences were still significant even after the adjustments for age and sex. The PD showed a significant positive correlation with DHA (r = 0.5; P = 0.003), DPA (r = 0.6; P <0.001), and AA (r = 0.6; P <0.001). CONCLUSION: The present findings suggest that serum levels of LC-PUFA n-3 and n-6 may be affected by the severity of periodontal disease.

Total antioxidant capacity of venous blood, blood plasma, and serum of patients with periodontitis, and the effect of Traumeel S on these characteristics.

INTRODUCTION: Periodontal diseases are among the most common chronic infections in humans. Chronic low-level bacteremia and a septicemic inflammatory response have been suggested as a pathogenetic link between periodontal disease and atherosclerosis, diabetes and other systemic diseases. All this significantly increases the relevance of the search for the means for treatment and prevention of periodontal diseases. The aim of the present study was to evaluate blood count and the antioxidant capacity of venous blood, blood plasma, and serum in patients with periodontitis and control subjects with healthy periodontal tissues, and to investigate the effect of the homeopathic medication Traumeel S on the antioxidant capacity of venous blood, plasma, and serum. MATERIAL AND METHODS: The study was performed using venous blood of 21 individuals with chronic periodontitis and 22 healthy subjects. Reduction properties of venous blood, blood plasma, and serum were investigated using the method of reduction of nitroblue tetrazolium, proposed by Demehin et al. RESULTS: The data showed that there was no significant difference in venous blood hemoglobin levels or erythrocyte counts between the groups, while significantly higher leukocyte counts were observed in the periodontitis group (P<0.05). The antioxidant capacity of blood plasma was significantly higher in the periodontitis group than it was in the controls (P<0.05). Meanwhile, the antioxidant capacity of serum was significantly lower in the periodontitis group as compared with controls (P<0.05). The preparation Traumeel S had no effect on the antioxidant capacity of venous blood or blood plasma in the studied groups. CONCLUSIONS: Compared to healthy individuals, the antioxidant capacity of blood plasma in patients with periodontitis was higher, while the antioxidant capacity of serum was lower. The homeopathic medication Traumeel S had no effect on the antioxidant capacity of venous blood, blood plasma, or serum. Our findings concerning the elevated leukocyte counts in venous blood of patients with periodontitis confirm the presumption that periodontal diseases cause low-grade systemic inflammation induced by the host response to periodontal bacteria.

The effect of subantimicrobial-dose-doxycycline periodontal therapy on serum biomarkers of systemic inflammation: a randomized, double-masked, placebo-controlled clinical trial.

BACKGROUND: Periodontitis has been reported to be associated with coronary artery disease (CAD). Research is needed to determine if therapies that improve periodontal health also reduce systemic measures of inflammation associated with both diseases. METHODS: The study registrar randomly assigned 128 eligible postmenopausal women with chronic periodontitis to a twice-daily regimen of subantimicrobial-dose-doxycycline (SDD) or placebo tablets for two years as an adjunct to periodontal maintenance therapy. Through a supplement to the main trial, in which they investigated alveolar bone and clinical attachment level changes, the authors assayed inflammatory mediators and lipid profiles in baseline, one-year and two-year serum samples. The authors analyzed the data by using generalized estimating equations. RESULTS: In the intent-to-treat analysis across two years, SDD treatment reduced median high-sensitivity C-reactive protein (hs-CRP) by 18 percent (primary outcome; P = .02) and reduced serum matrix metalloproteinase (MMP)-9 (92 kilodalton gelatinase; difference in mean scanning units, -28.44; P < .001), with no significant effect on serum lipids. However, in women more than five years postmenopausal, SDD elevated the level of high-density lipoprotein (HDL) cholesterol (difference in means [milligrams per deciliter], 5.99; P = .01). CONCLUSION: A two-year SDD regimen in postmenopausal women significantly reduced the serum inflammatory biomarkers hs-CRP and MMP-9 and, among women more than five years postmenopausal, increased the HDL cholesterol level. CLINICAL IMPLICATIONS: SDD significantly reduced the systemic inflammatory biomarkers hs-CRP and MMP-9. More research is needed to determine whether SDD has a role in managing the care of patients at risk of developing CAD.