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    Short-term effects of non-surgical periodontal therapy on clinical measures of impaired glucose tolerance in people with prediabetes and chronic periodontitis. Giblin Lori J,Boyd Linda D,Rainchuso Lori,Chadbourne Dianne Journal of dental hygiene : JDH PURPOSE:Diabetes and periodontal disease are conditions considered to be biologically linked. Prediabetes is a condition in which individuals have blood glucose levels, impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) or glycated hemoglobin (A1C) levels higher than normal but not high enough to be classified as diabetes. Few human studies address the relationship between periodontitis and prediabetes or clarify an association between periodontitis and prediabetes. The purpose of this pilot study was to examine the impact of non-surgical periodontal therapy (NSPT) on clinical measures of glycemic control in prediabetes. METHODS:Prediabetes measures of IFG, IGT, A1C and periodontal measures of pocket depth (PD), clinical attachment level (CAL), plaque index (PI) and gingival index (GI) were taken at baseline and 3 months in 12 subjects with prediabetes and chronic slight to moderate periodontitis. Blood samples were taken from each subject following an 8 hour fast. This study controlled for changes in medications, body-mass index, physical activity and diet. RESULTS:Comparison of mean prediabetes and periodontal measures from baseline and post-treatment at 3 months demonstrated clinical improvement for both periodontal and prediabetes measures. A mean reduction in PD of 0.27 (p=0.003), CAL of 0.32 (p=0.050) and A1C of 0.19 (p=0.015) reached statistical significance. CONCLUSION:This pilot study suggests NSPT improves A1C and periodontal measures at 3 months. The robustness of measures is limited due to the small sample size and lack of a control group. Further larger scale studies using a randomized control design would be informative.
    Periodontal Bacteria and Prediabetes Prevalence in ORIGINS: The Oral Infections, Glucose Intolerance, and Insulin Resistance Study. Demmer R T,Jacobs D R,Singh R,Zuk A,Rosenbaum M,Papapanou P N,Desvarieux M Journal of dental research Periodontitis and type 2 diabetes mellitus are known to be associated. The relationship between periodontal microbiota and early diabetes risk has not been studied. We investigated the association between periodontal bacteria and prediabetes prevalence among diabetes-free adults. ORIGINS (the Oral Infections, Glucose Intolerance and Insulin Resistance Study) cross sectionally enrolled 300 diabetes-free adults aged 20 to 55 y (mean ± SD, 34 ± 10 y; 77% female). Prediabetes was defined as follows: 1) hemoglobin A1c values ranging from 5.7% to 6.4% or 2) fasting plasma glucose ranging from 100 to 125 mg/dL. In 1,188 subgingival plaque samples, 11 bacterial species were assessed at baseline, including Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, and Actinomyces naeslundii. Full-mouth clinical periodontal examinations were performed, and participants were defined as having no/mild periodontitis vs. moderate/severe periodontitis per the definition of the Centers for Disease Control and Prevention / American Academy of Periodontology. Modified Poisson regression evaluated prediabetes prevalence across bacterial tertiles. Prevalence ratios and 95% confidence intervals for third vs. first tertiles are presented. All analyses were adjusted for cardiometabolic risk factors. All results presented currently arise from the baseline cross section. Prediabetes prevalence was 18%, and 58% of participants had moderate/severe periodontitis. Prevalence ratios (95% confidence intervals) summarizing associations between bacterial levels and prediabetes were as follows: A. actinomycetemcomitans, 2.48 (1.34, 4.58), P = 0.004; P. gingivalis, 3.41 (1.78, 6.58), P = 0.0003; T. denticola, 1.99 (0.992, 4.00), P = 0.052; T. forsythia, 1.95 (1.0, 3.84), P = 0.05; A. naeslundii, 0.46 (0.25, 0.85), P = 0.01. The prevalence ratio for prediabetes among participants with moderate/severe vs. no/mild periodontitis was 1.47 (0.78, 2.74), P = 0.23. Higher colonization levels of specific periodontal microbiota are associated with higher prediabetes prevalence among diabetes-free adults. 10.1177/0022034515590369
    Influence of T2DM and prediabetes on blood DC subsets and function in subjects with periodontitis. Rabelo Mariana de Sousa,El-Awady Ahmed,Moura Foz Adriana,Hisse Gomes Giovane,Rajendran Mythilpriya,Meghil Mohamed M,Lowry Scott,Romito Giuseppe Alexandre,Cutler Christopher W,Susin Cristiano Oral diseases OBJECTIVE:To compare the myeloid and plasmacytoid DC counts and maturation status among subjects with/without generalized periodontitis (GP) and type 2 diabetes mellitus (T2DM). METHODS:The frequency and maturation status of myeloid and plasmacytoid blood DCs were analyzed by flow cytometry in four groups of 15 subjects: healthy controls, T2DM with generalized CP (T2DM + GP), prediabetes with GP (PD + GP), and normoglycemics with GP (NG + GP). RT-PCR was used to determine levels of Porphyromonas gingivalis in the oral biofilms and within panDCs. The role of exogenous glucose effects on differentiation and apoptosis of healthy human MoDCs was explored in vitro. RESULTS:Relative to controls and to NG + GP, T2DM + GP showed significantly lower CD1c + and CD303 + DC counts, while CD141 + DCs were lower in T2DM + GP relative to controls. Blood DC maturation required for mobilization and immune responsiveness was not observed. A statistically significant trend was observed for P. gingivalis levels in the biofilms of groups as follows: controls <NG+GP < PD+GP < T2DM+GP. Moreover, significantly higher P. gingivalis levels were observed in blood DCs of NG + GP than controls, whereas no differences were observed between controls and PD + GP/T2DM + GP. In vitro differentiation of MoDCs was significantly decreased, and apoptosis was increased by physiologically relevant glucose levels. CONCLUSION:Type 2 diabetes mellitus appears to inhibit important DC immune homeostatic functions, including expansion and bacterial scavenging, which might be mediated by hyperglycemia. 10.1111/odi.13200
    Mediation analysis of systemic inflammation on the association between periodontitis and glycaemic status. Torrungruang Kitti,Ongphiphadhanakul Boonsong,Jitpakdeebordin Supawadee,Sarujikumjornwatana Somchai Journal of clinical periodontology AIM:This cross-sectional study investigated the associations between periodontitis, systemic inflammation and glycaemic status. MATERIALS AND METHODS:The participants were divided into three groups: normoglycaemia, impaired fasting glucose (IFG) and diabetes. Multinomial logistic regression was used to examine the associations between periodontitis severity and glycaemic status, adjusting for potential confounders. Mediation analysis of four systemic inflammatory biomarkers, C-reactive protein (CRP), white blood cell count (WBC), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), was performed. RESULTS:This study comprised 2,036 participants, aged 39-66 years. Severe periodontitis was associated with IFG and diabetes with odds ratios of 1.6 (95% confidence interval [CI]: 1.1-2.4, p = .023) and 2.4 (95% CI: 1.3-4.5, p = .006), respectively. The CRP, WBC and PLR were associated with both periodontitis severity and glycaemic status (p < .05). In contrast, the NLR was associated with periodontitis severity (p < .05) but not glycaemic status (p > .05). The CRP, WBC and PLR mediated 8%, 13% and 6%, respectively, of the association between severe periodontitis and diabetes. Similar proportions mediated were observed for the periodontitis-IFG association. CONCLUSIONS:Our findings support the role of systemic inflammation as mediators of the associations between periodontitis and IFG or diabetes. 10.1111/jcpe.12884
    Effect of Periodontal Treatment on HbA1c among Patients with Prediabetes. Kocher T,Holtfreter B,Petersmann A,Eickholz P,Hoffmann T,Kaner D,Kim T S,Meyle J,Schlagenhauf U,Doering S,Gravemeier M,Prior K,Rathmann W,Harks I,Ehmke B,Koch R Journal of dental research Evidence is limited regarding whether periodontal treatment improves hemoglobin A1c (HbA1c) among people with prediabetes and periodontal disease, and it is unknown whether improvement of metabolic status persists >3 mo. In an exploratory post hoc analysis of the multicenter randomized controlled trial "Antibiotika und Parodontitis" (Antibiotics and Periodontitis)-a prospective, stratified, double-blind study-we assessed whether nonsurgical periodontal treatment with or without an adjunctive systemic antibiotic treatment affects HbA1c and high-sensitivity C-reactive protein (hsCRP) levels among periodontitis patients with normal HbA1c (≤5.7%, n = 218), prediabetes (5.7% < HbA1c < 6.5%, n = 101), or unknown diabetes (HbA1c ≥ 6.5%, n = 8) over a period of 27.5 mo. Nonsurgical periodontal treatment reduced mean pocket probing depth by >1 mm in both groups. In the normal HbA1c group, HbA1c values remained unchanged at 5.0% (95% CI, 4.9% to 6.1%) during the observation period. Among periodontitis patients with prediabetes, HbA1c decreased from 5.9% (95% CI, 5.9% to 6.0%) to 5.4% (95% CI, 5.3% to 5.5%) at 15.5 mo and increased to 5.6% (95% CI, 5.4% to 5.7%) after 27.5 mo. At 27.5 mo, 46% of periodontitis patients with prediabetes had normal HbA1c levels, whereas 47.9% remained unchanged and 6.3% progressed to diabetes. Median hsCRP values were reduced in the normal HbA1c and prediabetes groups from 1.2 and 1.4 mg/L to 0.7 and 0.7 mg/L, respectively. Nonsurgical periodontal treatment may improve blood glucose values among periodontitis patients with prediabetes (ClinicalTrials.gov NCT00707369). 10.1177/0022034518804185
    Cross-sectional associations of impaired glucose metabolism measures with bleeding on probing and periodontitis. Pérez Cynthia M,Muñoz Francisco,Andriankaja Oelisoa M,Ritchie Christine S,Martínez Sasha,Vergara José,Vivaldi José,López Lydia,Campos Maribel,Joshipura Kaumudi J Journal of clinical periodontology AIM:This study assessed the associations of pre-diabetes and insulin resistance with bleeding on probing (BOP) and periodontitis among adults. MATERIALS AND METHODS:We included 1191 Hispanic adults aged 40-65 years, free of diabetes, enrolled in San Juan Overweight Adults Longitudinal Study. Pre-diabetes was defined as impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or impaired glycated haemoglobin. Impaired one-hour plasma glucose (1hPG) was defined as levels >155 mg/dl. Insulin resistance was defined using the study population-specific 75th percentile (HOMA-IR ≥ 3.13). High BOP was defined as percentage of teeth with bleeding ≥30%. Periodontitis was defined according to the CDC/AAP definition. RESULTS:After multivariable adjustment for age, gender, education, smoking status, alcohol consumption, physical activity, obesity, HDL-C, and plaque index, pre-diabetes with and without 1hPG, IFG, impaired 1hPG, IGT, and HOMA-IR were significantly associated with high BOP; pre-diabetes, IFG, and impaired 1hPG were significantly associated with severe periodontitis. Most of these associations remained significant when the analyses were restricted to non-smokers. CONCLUSIONS:This study suggests associations between pre-diabetes and insulin resistance with BOP and periodontitis. Given the high prevalence of impaired glucose metabolism and periodontitis, the assessment of the temporal sequence of these associations is of utmost importance. 10.1111/jcpe.12662
    [Research progress in the relationship between prediabetes mellitus and periodontitis]. Zhonghua kou qiang yi xue za zhi = Zhonghua kouqiang yixue zazhi = Chinese journal of stomatology Prediabetes mellitus (Pre-DM) is an intermediate state of hyperglycemia between normal blood glucose homeostasis and type 2 diabetes mellitus (T2DM). More than half of adults in China suffer from Pre-DM. Periodontitis is a chronic inflammatory disease mainly caused by microorganisms in dental plaque. It shares common risk factors and interacts with non-communicable diseases such as diabetes mellitus. Pre-DM may increase the risk of periodontitis, and the latter may also influence the development and progress of diabetes. Oxidative stress, systemic inflammation and intestinal flora are the main mechanisms by which Pre-DM and periodontitis interconnect with each other. This article mainly reviews the relationship between Pre-DM and periodontitis and potential related mechanisms, providing a new basis for the prevention and treatment of both. 10.3760/cma.j.cn112144-20220328-00140
    Periodontal findings in individuals with newly identified pre-diabetes or diabetes mellitus. Lamster Ira B,Cheng Bin,Burkett Sandra,Lalla Evanthia Journal of clinical periodontology AIM:To assess the periodontal status and number of missing teeth in patients with newly identified pre-diabetes or diabetes mellitus. METHODS:A total of 1097 subjects with previously undiagnosed diabetes were available for study, and were categorized into normoglycaemic, potentially pre-diabetes or potentially diabetes groups based on a point-of-care (POC) HbA1c test. RESULTS:In fully adjusted models, significant differences were observed between all groups for the per cent of teeth with at least one site with a probing depth of ≥5 mm. For bleeding on probing, there were significant differences between diabetes and pre-diabetes (p = 0.001), and between diabetes and normoglycaemic groups (p = 0.002). For missing teeth, there were significant differences between the pre-diabetes and normoglycaemic groups (p = 0.034), and the diabetes and normoglycaemic groups (p = 0.004). CONCLUSIONS:Individuals with previously unidentified pre-diabetes demonstrate a level of periodontal destruction between that observed for normoglycaemic individuals and persons with diabetes. These data emphasize the association of oral findings to dysglycaemia, and suggest that periodontal disease and tooth loss can be early complications of diabetes mellitus. 10.1111/jcpe.12307
    Pre-diabetes and well-controlled diabetes are not associated with periodontal disease: the SHIP Trend Study. Kowall Bernd,Holtfreter Birte,Völzke Henry,Schipf Sabine,Mundt Torsten,Rathmann Wolfgang,Kocher Thomas Journal of clinical periodontology AIM:To examine associations of pre-diabetes and well-controlled diabetes with periodontitis. MATERIALS AND METHODS:The Study of Health in Pomerania (SHIP)-Trend is a cross-sectional survey in North-Eastern Germany including 3086 participants (49.4% men; age 20-82 years). Clinical attachment loss (CAL) and periodontal probing depth (PPD) were assessed applying a random half-mouth protocol. The number of teeth was determined. Pre-diabetes comprised impaired fasting glucose and impaired glucose tolerance. Previously known diabetes was defined as well controlled if glycated haemoglobin (HbA1c) was <7.0%. Participants were categorized as follows: normal glucose tolerance (NGT), pre-diabetes, newly detected type 2 diabetes (T2DM), known T2DM with HbA1c<7.0% and known T2DM with HbA1c≥7.0%. RESULTS:Pre-diabetes was neither associated with mean CAL and PPD in multivariable adjusted linear regression models nor with edentulism (OR = 1.09 (95%-CI: 0.69-1.71)) and number of teeth (OR = 0.96 (95%-CI: 0.75-1.22), lowest quartile versus higher quartiles) in logistic regression models. Associations with mean CAL and edentulism were stronger in poorly controlled previously known diabetes than in well-controlled previously known diabetes (for edentulism: OR = 2.19 (95%-CI: 1.18-4.05), and OR = 1.40 (95%-CI: 0.82-2.38), respectively, for comparison with NGT). CONCLUSIONS:Periodontitis and edentulism were associated with poorly controlled T2DM, but not with pre-diabetes and well-controlled diabetes. 10.1111/jcpe.12391