https://orcid.org/0000-0002-3348-3382
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ABSTRACT
Aim: The current study aimed at analyzing the effect of non-surgical periodontal treatment accompanied by systemic antibiotics on salivary enzyme activities, periodontal parameters, and glycemic control in type−2 diabetic (T2D) patients with chronic periodontitis.
Methods: The study included 125 type−2 diabetic patients with chronic periodontitis who had good glycemic control (T2Dc), 125 type−2 diabetics who had bad glycemic control (T2Dpc). The 125 T2Dpc were divided randomly into two groups. The first one enrolled 63 T2Dpc and received a non-surgical periodontal treatment (T2Dpc + NST). The second group enrolled 62 T2Dpc and received the non-surgical treatment accompanied by systemic antibiotics (T2Dpc+NST+A). HbA1c, periodontal indices, and salivary enzyme activities were assessed for all groups. The Glycated hemoglobin (HbA1c) was assessed. The Salivary alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransaminase (ALT), lactate dehydrogenase (LDH), and creatine kinase (CK) activities were measured.
Results: The T2Dpc were characterized by the highest probing depth (PPD) and clinical attachment loss (CAL) periodontal scores, as well as ALP, AST, and ALT enzymatic activities. However, BOP did not differ significantly between T2Dc and T2Dpc. Whereas the rest of clinical parameters PI, GI, and OHI-S did not significantly differ between groups. The Pearson’s analysis revealed three correlations between ALP-PPD, ALP-CAL, and ALP-BOP (bleeding on probing) in both T2Dc and T2Dpc (P < 0.05). Interestingly, a significant decrease in periodontal indices, salivary enzyme activities, and HbA1c was recorded in T2Dpc+NST+A group.
Conclusion: The increase in ALP, AST, and ALT activities reflects the impact of uncontrolled T2D on periodontal tissue alteration. The ALP activity increase was associated with the severity of periodontal status in diabetic patients. In comparison to non-surgical treatment alone, the adjunct use of systemic antibiotics improves periodontal state, enzyme activity, and glycemic control.
Abbreviations list
| A | = | Antibiotics |
| ALP | = | Alkaline phosphatase |
| ALT | = | Alanine aminotransaminase |
| AST | = | Aspartate aminotransferase |
| BOP | = | Bleeding on probing |
| CAL | = | Clinical attachment loss |
| CK | = | Creatine kinase |
| GI | = | Gingival index |
| HbA1c | = | Glycated hemoglobin |
| LDH | = | Lactate dehydrogenase |
| NST | = | Non-surgical treatment |
| OHI-S | = | Oral hygiene index- simplified |
| PI | = | Plaque index |
| PPD | = | Periodontal probing depth |
| T2Dc | = | Adequately glycemic controlled type 2 diabetic patients with chronic periodontitis |
| T2Dpc | = | Poorly glycemic controlled type 2 diabetic patients with chronic periodontitis |
Acknowledgments
The authors are grateful for the cooperation of the study participants. The authors especially acknowledge the head of the Biochemistry Department and LR12SP11, in Sahloul University Hospital, and the excellent technical team assistance for their valuable contribution.
Disclosure statement
No potential conflict of interest was reported by the authors.
Author contributions
Marwa Mrag and Yosra Ayed contributed to the study concepts. The study design was done by Dr Asma Kassab. Data acquisition was performed by Aishah Alhodhodi and Yassine Khalij. Marwa Mrag and Shadia A. Elsayed contributed to data analyses and interpretation. Asma Kassab contributed to the manuscript preparation and manuscript editing and reviewing. All authors read and approved the final manuscript.