Impact of gingivitis treatment for diabetic patients on quality of life related to periodontal objective parameters: A randomized controlled clinical trial.

OBJECTIVES: Patients with diabetes have a poor oral health-related quality of life (OHRQoL). It is not clear if this situation could be changed with effective periodontal treatment. This study examined both patients with diabetes and systemically healthy individuals to discover the impact of a gingivitis treatment protocol on OHRQoL and its relation to objective periodontal parameters. DESIGN: After ultrasonic debridement, patients were randomly assigned to an essential-oils (EO) or placebo mouthwash group. At baseline and 3 months, OHRQoL was assessed with the Oral Health and Quality of Life-United Kingdom questionnaire (OHQoL-UK) along with clinical, halitometric, microbiological and inflammatory objective parameters. The primary outcome was a change in OHQoL-UK scores. A factor analysis was performed and the impact of the extracted quality of life factor (QLF) and its interactions with diabetes, treatment, and time on the objective parameters, were tested by multiple linear regression models (p < 0.05). Chi-Square test compared questionnaire-answering profiles (p<0.05). RESULTS: Combined treatment with EO provided OHQoL improvements in both systemic conditions. Positive effect of oral health status on quality of life increased in EO groups but not in placebo groups. Question I (self-confidence) showed the greatest factorial weight, while Question A (food intake) showed the lowest factorial weight. All patients who showed OHRQoL improvements and used the EO rinse showed the lowest plaque and gingival indices and lower levels of bacteria and volatile sulfur compounds. CONCLUSIONS: OHRQoL positively changed overtime. Most effective treatment protocols would provide better improvements in OHRQoL which is related to periodontal objective measures.

Clinical, microbial, and immune responses observed in patients with diabetes after treatment for gingivitis: a three-month randomized clinical trial.

BACKGROUND: Although patients with diabetes are frequently affected by periodontitis, only a few investigations have focused on gingivitis in this at-risk population. This randomized placebo-controlled clinical trial compared the response to a gingivitis treatment protocol that combined mechanical procedures and daily use of an essential oil (EO) mouthrinse between patients with and without diabetes. METHODS: The whole-mouth periodontal probing depth (PD), gingival index (GI), and plaque index (PI) were monitored in gingivitis cases among systemically healthy patients (n = 60) or those with diabetes (n = 60) at baseline and 3 months after treatment. Levels of Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, and total bacterial load were determined by a real-time polymerase chain reaction in intrasulci plaque samples. The volume of gingival crevicular fluid (GCF) was quantified, and interleukin-1ß (IL-1ß) levels were determined in GCF samples. After a full-mouth ultrasonic debridement, patients were randomly assigned to an EO or a placebo rinse for 90 days (40 mL/day). The data were analyzed through repeated-measures analysis of variance and multiple comparisons Tukey tests (P <0.05). RESULTS: GI was more severe in the diabetes group. Diabetes impaired GI and reduced GCF volume. PD, bacterial levels, and IL-1ß improved similarly in both systemic conditions. The adjunctive use of EO provided greater reductions of PI, GI, total bacterial load, T. forsythia, A. actinomycetemcomitans, and GCF volume. CONCLUSIONS: Response to gingivitis treatment in patients with diabetes can slightly differ from that in patients without diabetes. Daily use of an EO mouthrinse after ultrasonic debridement benefited patients with and without diabetes.

Níveis comparativos pré- e pós-tratamento de CSV, carga bacteriana total subgengival e sangramento gengival / Pre-and post-treatment comparative levels of VSC, subgingival total bacterial load and gingival bleeding

O objetivo deste ensaio clínico randomizado de 3 meses de duração foi avaliar os efeitos da combinação de procedimentos mecânicos e químicos sobre os níveis de sangramento gengival, Compostos Sulfurados Voláteis (CSV) e carga total bacteriana de pacientes com gengivite. Sessenta voluntários sistemicamente saudáveis com gengivite foram divididos em dois grupos: raspagem profissional associada ao uso diário de óleos essenciais (20ml/2x/dia) ou solução placebo (20ml/2x/dia). Todos os participantes receberam instruções de higiene bucal. Índice de sangramento gengival, carga bacteriana total subgengival (PCR em tempo real) e concentrações de CSV (dosador portátil Halimeter) foram mensurados antes e 90 dias após o tratamento gengival. Os dados foram comparados estatisticamente pelos teste t-Student e teste t-pareado (p < 0,05). Resultados: Finalizaram o estudo 27 indivíduos no grupo teste e 25 no grupo placebo. A carga bacteriana total e o IG reduziram mais evidentemente no grupo teste do que no grupo placebo. No grupo teste os valores médios de CSV reduziram de 94,62ppb (inicial) para 62,19ppb (3 meses) enquanto no grupo placebo eles se mantiveram estáveis entre as mensurações inicial (93,46ppb) e de 3 meses (95,00ppb). Conclusões: o tratamento gengival seguido de 90 dias de uso de solução de óleos essenciais acarretou melhora dos parâmetros monitorados, IG, carga total bacteriana e CSV.

The aim of this 3-month randomized clinical study was to evaluate the effects of the combination of mechanical and chemical procedures over the levels of gingival bleeding, VSC and total bacterial load in patients with gingivitis. Sixty systemically healthy individuals with gingivitis were randomized in two groups: professional debridement along with the daily use of essential oils (20ml/2x/day) or of a placebo solution (20ml/2x/day). All participants received oral hygiene instructions. Gingival Index, total bacterial load (real time PCR) and VSC concentration (portable Halimeter) were measured at baseline and at 90 days after gingival treatment. Data were statistically compared by Student-t test and paired-t test (p < 0.05). Results: Twenty-seven individuals finished the study in the test group and 25 in the placebo group. Total bacterial load and GI were greatest reduced in the test group than in the placebo group. Mean VSC values in the test group were reduced from 94,62ppb (at baseline) to 62,19ppb (3 months) while in the placebo group measures continued stable between baseline (93,46ppb) and (95,00ppb) 3-month examinations. Conclusions: Gingival treatment followed by the use of essential oils for 90 days lead to an improvement in the monitored parameters, GI, total bacterial load and VSC.