To determine whether presence of periodontal disease and diabetes mellitus influence the life prognosis in 80-year-old subjects, oral and medical examinations were conducted in 697 residents of Fukuoka Prefecture of Japan who were 80 years old in 1997, and the dates and causes of death among these residents were determined 5 years and 12 years later. We analyzed the all-cause death, pneumonia death, cardiovascular-disease death and cancer death rates between the subjects with mild periodontal disease (no. of teeth with a probing depth ≥4 mm = 0-4; n = 526) and those with severe periodontal disease (no. of teeth with a probing depth ≥4 mm ≥5; n = 169), and also between the 77 diabetic patients (history of diabetes mellitus and/or random blood sugar levels ≥200 mg/dl) and 620 non-diabetic subjects. The relative risk of pneumonia death in the severe periodontal disease group was 2.28 times higher at the 12-year follow-up as compared to that in the mild periodontal disease group. On the other hand, the relative risks of cardiovascular-disease death and cancer death were not affected by the severity of the periodontal disease. The relative risks of pneumonia death and all-cause death determined at the 12-year follow-up were higher in the diabetic patients than in the non-diabetic subjects. When we analyzed four other subject groups (mild periodontal disease+non-diabetic, mild periodontal disease+diabetic, severe periodontal disease+non-diabetic, and severe periodontal disease+diabetic), the relative risk of pneumonia death at the 12-year follow-up was 2.90 times higher in the severe periodontal disease+non-diabetic group, 5.93 times higher in the mild periodontal disease+diabetic group, and 6.20 times higher in the severe periodontal disease+diabetic group as compared to that in the mild periodontal disease+non-diabetic group. The relative risks of all-cause death in the mild periodontal disease+diabetic group and severe periodontal disease+diabetic group were 2.24 times higher and 2.21 times higher, respectively, as compared to the relative risk in the mild periodontal disease+non-diabetic group. In the 80-year-old study population, it appeared that severe periodontal disease and diabetes mellitus independently increased the risk of pneumonia death, but when diabetes mellitus was present concomitantly with severe periodontal disease, the risk of pneumonia death appeared to be further increased.
Alpha-lipoic acid (ALA) is a known anti-inflammatory agent that can be used as a pharmacological agent in adjunctive therapy to inhibit the recurrence of periodontitis. This study investigated the inflammatory regulation effect of pre-administered ALA on human gingival fibroblasts (HGFs) stimulated with Escherichia coli-derived lipopolysaccharide (LPS). HGFs were administered ALA and then stimulated with LPS. Western blot analysis was used to investigate activation of the nuclear factor-kappa B (NF-κB) signaling pathway. Analysis of NF-κB p65 nuclear translocation was performed using an immunofluorescence, assay and inflammatory cytokine (TNF-α, IL-1β, IL-6, and IL-8) secretion analysis was conducted using an enzyme-linked immunosorbent assay. NF-κB signaling pathway expression was increased by LPS stimulation. However, increased NF-κB signaling pathway expression was down-regulated by ALA pre-administration. Further, NF-κB p65 was translocated to the nucleus by LPS stimulation. However, NF-κB p65 translocation was inhibited by ALA pre-administration. The secretion of TNF-α, IL-1β, IL-6, and IL-8 was increased by LPS stimulation but down-regulated by ALA pre-administration. The results of this study demonstrated that ALA regulated the secretion of inflammatory cytokines via regulation of NF-κB signaling pathway activation in HGFs, which suggests that ALA has the potential to regulate periodontal tissue inflammation.
This is a case report of a rheumatoid arthritis (RA) patient with generalized severe chronic periodontitis who was treated in cooperation with an internist, with resultant improvement of both the periodontitis and rheumatoid arthritis.
The patient was a 42-year-old female, who presented to us with a history of gingival bleeding and swelling in the region of the right molar teeth. Generalized swelling was observed and the average probing depth (PD) was 5.1 mm, the percentage of sites with PD ≥4 mm was 75.6%, the percentage of sites with bleeding on probing (BOP) was 82.2%, and the plaque control record (PCR) was 80.4%. Dental X-ray images indicated severe horizontal and vertical bone resorption. Based on the results of the examinations, the patient was diagnosed as having generalized severe chronic periodontitis. According to the patient's medical history, the initial diagnosis of RA had been made 10 years ago, and the patient had received treatment with adrenocorticosteroids for nine years.
As part of the initial periodontal therapy, after the plaque control had improved, scaling and root planing (SRP) were performed. The blood reports were sent to an internist, and the progression of the rheumatic symptoms was monitored with the cooperation of the physician. Periodontal surgery was performed to stabilize the periodontal tissue, after which the treatment stage was changed to supportive periodontal therapy (SPT).
After SPT for two years and six months, satisfactory results were obtained, as follows: average PD, 2.6 mm; percentage of sites with PD ≥4 mm, 6.0%; percentage of sites with BOP, 8.7%; PCR score, 15%. At the time of the patient's first visit to our clinic, her daily life was constrained by chronic joint pains throughout her body. As the periodontal health improved, the patient also reported reduction of the joint pains. Nevertheless, since the stabilization of the RA symptoms could not be confirmed from the results of the blood test for rheumatoid factor (RF), there was no correlation between the RF titer in the blood and the periodontal tissue stabilization.
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