Mejía GEG, Guerrero ÁF, Todd JM, Téllez JH, Salazar LSA, Torres BJM, Lara CJR

Language: Spanish
References: 0
Page: 511-517
PDF size: 320.81 Kb.

ABSTRACT

Objective: Evaluate effect of non surgical periodontal therapy against a control group with metabolic, inflammatory and periodontal markers in patients with Diabetes Mellitus Type 2.
Introduction: Local and systemic factors have been implicated in the modulation of the inflammatory response of the host. Of the Systemic factors, diabetic patients had established that they have two times more the risk of increasing the periodontal disease (PD) compare with non diabetic patients. Diabetes mellitus type 2 (DM2) is a multifactorial disease that involves genetic factors and environmental in its etiology. It is believe that this factors reduce the insuline sensitivity. Obesity is the strongest risk factor that cause insuline sensitivity to go low. Patients suffering of DM2 are known for its increased susceptibility to certain kind of infections, and once the infection is established oral infection is creates systemic disease. Infection cause apoptosis of fibroblasts and osteoblasts, this contributes to higher loss of hard and soft tissue which happened on diabetic individuals. Since PD is linked with destructive effects of inflammatory mediators, the dm2 can create the effects trough irregulation of cytokines. Low glycolic control its related significantly with high production of cytokines and high levels of these in crevicular gingival liquid. The continous secretion of cytokines, including IL1, IL6, IL8 and TNF alfa, as well as prostanglandine E2, by the host molecules followed by stimulation of periodontogenes and its products, is a critic determinant of the periodontal tissues destruction. Metabolic alterations associated to diabetes can give origin to high levels of cytokine (TNF-alfa), formation of final products of the advanced glucolisis (AGEs) and high levels of protein c reactive activation.
Methods: Patients selected from the posgrade periodoncy clinic in the Universidad Autónoma de Tamaulipas, México were included in the experimental, longitudinal, prospective and control study from January to April 2008. The inclusion criteria was patients of both genres with PD and dm2 under medical supervision and with or without previous periodontal treatment. The clinical parameters evaluated were: probe depth, insertion lost, bleeding probe and dentbacterial plaque index, using a automatic periodontal probe (Florida Probe, Gainesville, FL, USA) and a periodontal probe of the North Carolina University of 15mm, Body mass index was also measured. Each of the patients got lab tested, of three different markers: Glucoside Hemoglobine, TNF alfa and Ultrasensitive PCR. The total of patients was divided in two groups: experimental and control. The experimental group had perdiotontal therapy phase 1, the control group didn't got periodontal therapy, just paulative therapy. After healing time of phase 1 (three weeks), second check up was made and second lab tests, also the body mass index, comparing at the end both results.
Results: The study evidenced the relation between the markers of glicemic control and inflammatory with the periodontal therapy phase 1 in patients with dm2 of 30 to 90 years old of both genders.
Discussion: The severity of the chronic PD is associated with the levels of TNF alfa in plasma on DM2 subjects. The levels of TNF alfa have been associated with the insuline resistance. There are a couple of explanations for the association between PCR and the increase in the probe depth. Recent studies show that high values of PCR in patients with periodontitis have clinic significance because the Hearth American association implemented the use of pcr and ldl-c has a risk predictor for the coronary disease.
Conclusion: The reduction of periodontal inflammation helps decrease the inflammatory mediators in the serum, which associates to insuline resistance, improving the glycolic control. Levels of pcr increase in the artery hypertension and diabetes, which can be influenced by smoking, diet and body mass index. Because the dm2 is associated with cytokines high levels, particularly in response of the bacteria products, it has been suggested that the risk increase and the severity of pd associated, can be because of the response causing inflammation. It is possible that the improve in the insuline resistance is mediated by the reduction of the TNF alfa. The periodontal treatment seems to reduce the levels of TNF alfa circulating in diabetic patients with periodontal disease.