Effect of Non-surgical Periodontal Therapy on Metabolic Control of Type 2 Diabetics : Second Report Change of Inflammatory Mediators

Abstract

The aim of this study was to evaluate the clinical and microbiological effect of non-surgical periodontal therapy on metabolic control of Type 2 diabetics. The first report showed that there were significantly effective changes in the clinical and microbiological evaluation after non-surgical periodontal therapy in Type 2 diabetics and non-diaferences in the levels of HbA_1C and glucose level of Type 2 diabetics. Therefore, to evaluate the effect of non-surgical therapy on inflammatory mediators, serum CRP, IL6 and TNF-αwere measured. Nine Type 2 diabetic patients (2 females and 7 males, 47-69 years, mean age 57.6 years) with moderate to advanced periodontitis and 9 matched healthy control patients (5 females and 4 males, 45-59 years, mean age 52.0 years) were selected. Serum CRP, IL-6 and TNF-α concentration were measured at baseline and three months after non-surgical periodontal therapy. Serum high-sensitive CRP was measured by using nephelometry, IL-6 and TNF-α were determined by sensitive enzyme-linked immunosorbent assay (ELISA). The serum concentration of CRP decreased from 5.02±7.38 mg/ml to 0.96±0.94 mg/ml (p=0.038) in Type 2 diabetics. Serum CRP concentration of non-diabetics was 0.43±0.27 mg/ml at baseline, and 1.01±0.99 mg/ml after non-surgical periodontal therapy. Serum IL-6 concentration decreased from 3.89±4.31 pg/ml to 1.84±1.51pg/ml (p=0.086) in Type 2 diabetics. Serum IL-6 concentration of non-diabetics was 1.22±1.44 pg/ml at baseline and 2.81±1.70 pg/ml after non-surgical periodontal therapy. Though serum TNF-α concentration was 0.99±0.86 pg/ml at baseline and 1.39±1.52 pg/ml in Type 2 diabetics after non-surgical periodontal therapy, serum TNF-α concentration of non-diabetics was 2.19±1.27 pg/ml at baseline and 3.74±3.81 pg/ml after non-surgical periodontal therapy. There were significant differences in the changes of serum CRP concentration and serum IL-6 concentration tended to decrease after non-surgical periodontal therapy, though there was no significant decrease in the change of serum TNF-α concentration after non-surgical periodontal therapy in Type 2 diabetics. There was a lower level of serum TNF-α in Type 2 diabetics than non-diabetics at baseline. It is reported that decrease of serum TNF-α concentration induce to improve in the insulin-resistance. These results suggest that improvement of periodontal inflammatory tissue induce to decrease of acute general inflammatory response, and helps to improve metabolic control of Type 2 diabetics who have been cured by internal medical therapy and diatary care.