Advanced glycation end products (AGEs) influence periodontal disease onset and progression by denaturing proteins in the periodontal tissues and inducing inflammation. Therefore, inhibiting both AGE formation itself and the AGE-induced inflammation would be effective for preventing periodontal disease. This study aimed to find anti-inflammatory ingredients in oral-care products that also exhibit AGE formation inhibitory effect. We evaluated in vitro the AGE formation inhibitory effects of five ingredients with known anti-inflammatory effects in oral-care products: allantoin (ALA), 6-aminohexanoic acid, dipotassium glycyrrhizinate (GKII), lysozyme chloride, and azulene sulfonate sodium hydrate (AZU). Furthermore, in order to assess the implications of the antiglycation effect of these ingredients in periodontal disease, human gingival fibroblasts (HGFs) were treated with AGEs formed in the presence or absence of each ingredient, and the IL-6 expression level in the culture supernatant was analyzed by enzyme-linked immunosorbent assays. Our results showed that ALA, GKII, and AZU inhibited AGE formation in vitro. In addition, compared with bovine serum albumin (BSA) incubated with glyceraldehyde only (i.e. glyceraldehyde-derived AGE), BSA incubated with glyceraldehyde in the presence of each component inhibited IL-6 production from HGFs in vitro, suggesting that these components may prevent gingival inflammation by preventing the formation of AGE. Our in vitro results suggest the possibility that these oral-care product ingredients can help prevent periodontal disease by two distinctive functions-antiglycation and anti-inflammation.
We report the case of a patient with severe aggressive periodontitis and intellectual disability who underwent intensive non-surgical periodontal therapy under general anesthesia and received oral home-care support. The patient was a 25-year-old woman who visited our clinic with the chief complaint of swollen gums. Periodontal examination revealed dental plaque deposits and deep periodontal pockets, with easy bleeding, in all the teeth. Although the patient had difficulty brushing her own teeth because of intellectual disability, she was not only instructed on the method of brushing but was also supervised by caregivers. We assessed that usual dental treatment would be difficult, because she refused probing. Periodontal treatment combined with full-mouth scaling and root planing (SRP) was undertaken under general anesthesia, with antimicrobial therapy. Thereafter, the patient's periodontal condition stabilized, and we moved to monthly supportive periodontal therapy (SPT). During the SPT period, we continued to provide oral self-care support to the patient and brushing instructions to the caregivers. The results showed that both the instructions provided to both patient and the caregivers led to brushing habits and plaque control, and the periodontal condition improved. Furthermore, we found that the patient also adapted to the dental treatment at the same time as the periodontal condition improved. Currently, about 3 years have passed since the start of the SPT, and the periodontal condition remains stable.
This case suggests that oral home-care support, non-surgical periodontal therapy, and short-term SPT are effective for the control of severe aggressive periodontitis and adaptation to dental treatment of patients with intellectual disability.