The Effect Of Oral Hygiene Instruction On Type2Diabetes Mellitus Patients With Chronic Periodontitis

Diabetes mellitus is one of the most common metabolic disorders characterized by hyperglycemia, mainly divided into two types. Type2diabetes mellitus usually called non-insulin-dependent-diabetes mellitus (NIDDM). which is caused by progressive damage of insulin secretion under insulin resistance,is the main type of diabetes. Diabetes has become the third disease of disability rate and fatality rate second only to cancer and cardiovascular disease in China.Periodontal disease is caused by the destruction of the interaction between bacterial infection and host response of the teeth’s support tissue (periodontal tissue).In our country, the incidence of periodontitis is approximate80percent to90percent in adults,which is the main cause of adult tooth lost.Recent studies found that periodontitis not only affect periodontal tissue, but also is an important potential risk factor for certain systemic disease or abnormality (such as cardiovascular disease, diabetes, preterm delivery and low birth weight and respiratory infections, etc.). With the deepening of research, periodontitis has been considered the sixth complication of diabetes, both two-way relationship is also of concern.That diabetes affect periodontitis possible biological mechanism is of diabetes in patients with sustained high blood sugar state, resulting in the accumulation of advanced glycation end products (AGEs) in the tissue, and produce large amounts of inflammatory factors (TNF,IL-1, IL-6, etc) through AGE-RAGE pathway to increase the immune response, resulting in impaired immune cell function, increased vascular permeability, and a series of changes, aggravating periodontal inflammatory reaction.On the other hand periodontitis will make to promote the body’s secretion of inflammatory mediators (eg TNF-alpha, IL-6, IL-1), release of inflammatory mediators into the blood can affect fat metabolism and glucose metabolism, eventually leading to insulin resistance. Therefore, periodontitis may contribute to insulin resistance, is not conducive to blood sugar control.The impact of diabetes on periodontitis has been widely recognized, control blood sugar levels can help to control periodontitise. It is controversial that periodontitis clinical interventions cauld affect the metabolic control of diabetes, most studies on periodontitis clinical intervention are with the direction of the initial periodontal therapy, but with oral hygiene instructions on diabetic patients is uncommonreported. This study investigated the oral hygiene instruction on type2diabetes mellitus patients with chronic periodontitis with periodontitis control, the level of blood glucose and lipid metabolism as well as serum levels of inflammatory markers.Objectives:1.To establish periodontitis clinical database information, questionnaire and biological sample library of China’s Han with type2diabetes.2.To observe the effect of oral hygiene instruction on periodontal tissue inflammatory, glucose metabolism level, lipid metabolism level and serum inflammatory markers in patients with type2diabetes.Methods:1.Subjects collection From March of2008to December of2009, total of31type2diabetes patients with chronic periodontitis were collected from five diabetes centers in Guangzhou. Inclusion criteria:diagnosed as type2diabetes over one year, free of serious complications, and chronic periodontitis. Exclusion criteria:systemic diseases other than type2diabetes such as coronary heart disease; active infections other than periodontitis; pregnancy, breast-feeding or plan to become pregnant during treatment; acute periodontal abscess; refused to participate in this study; intake of antibiotics in the previous4weeks; periodontal treatment within the last six months. The written informed consent was obtained from all the included subjects.2.Oral hygiene instructionAt baseline detailed oral hygiene instruction is taken to the study population, including:the relationship between periodontal disease and diabetes; hazards and related risk factors of periodontal disease; the daily maintenance of oral hygiene and brushing. Thereafter, respectively, in6weeks,3months,6months,12months and18months of referral observed intermediate evaluation.3. Periodontal treatment interventionAt18months returned visit.the study population received non-surgical periodontal treatment, including scaling and root planning when necessary.6weeks after treatment, referral for final evaluation. Throughout the observation period, patients try not to use any antibiotics, still accept the treatment of endocrinologists, was informed and required to maintain the existing lifestyle and eating habits.4. Clinical data collectionAt baseline and every return visit, the periodontal index (including periodontal pocket depth PD, plaque index PLI, bleeding index BOP, AL attachment loss), sugar metabolism (fasting plasma glucose FPG and glycated hemoglobin HbAlc), lipid metabolism (total cholesterol, TG, high density lipoprotein HDL, low density lipoprotein LDL, triglycerides TC), inflammatory cytokines (tumor necrosis factor TNF-α and high sensitivity C-reactive protein CRP), were all examined and recorded.5. Statistical analysisAll the data were analyzed using SPSS13.0statistical software, Bilateral level at P<0.05was selected. The differences of the test parameters between different visit points before non-surgical periodontal treatment were analyzed with ANOVA, when the test of sphericity was not been satisfied, Greenhouse-Gerisser method was used. Inner-group comparison after the treatment was analyzed using paired-samples t test. Missing data were treated with the LOCF (Last observation forward) method.Results1. Periodontal indexThe average PD pre-treatment over time change was not significant (F=1.637. P=0.203) and decreased significantly after treatment (t=5.070, P=0.000). The average AL statistically significant upward trend over time (F=6.492, P=0.003), after periodontal treatment change was not significant (t=-1.276, P=0.212). Average PLI declined after oral hygiene instruction, after the3months time to return to the baseline level; again decreased after periodontal treatment, but no significant (pre-treatment:F=2.382, P=0.087; after treatment:t=0.835, P=0.410). The average BOP improved in the initial stages, but increased after the3months with statistically significant (F=3.257,P=0.022)2. The level of glucose metabolismFPG before treatment and after treatment were declined without statistically significant over time (pre-treatment:F=1.096, P=0.352; after treatment:t=0.060, P=0.952). No significant change of mean HbAlc before treatment over time (F=2.445,P=0.072), and a statistically significant rise after treatment (t=-2.362, P=0.025), Changes showed a seasonal cycle changes.3. Lipid metabolism levelTG,TC,HDL-C and LDL-C decreased pre-treatment with statistically significant over time(PTG=0.043, PTC=0.001, PHDL=0.000, PLDL=0.040). After treatment are different degrees of increased.4. Serum inflammatory factors hsCRP decline over time was no significant (pre-treatment:F=0.451,P=0.676; after treatment:t=1.968, P=0.058). TNF-a before treatment over time decline was no significant (F=2.048, P=0.160),but statistically significant rise after treatment (t=-2.295, P=0.029)Conclusion1. Oral hygiene instruction can affect oral hygiene habits, short-term improvement of gingival bleeding status, and to achieve the best results in the3months; but can not provide more effective help on periodontal retreat.2. Still can not believe that the oral hygiene instruction can significantly improve glycemic control and lipid metabolism in patients with diabetes.3. Although there was no sufficient evident to support that OHI can improve CRP level in diabetic patients, the non-surgical periodontal treatment may reduce serum CRP levels.,but whether it will continue to decline need to be further observed.4. The impact of periodontitis on serum TNF concentrations in patients with type2diabetes is very limited and still can not believe that the oral hygiene instruction and periodontal therapy on serum TNF concentrations in patients with type2diabetes had a significantly lower.