Effects Of Non-surgical Periodontal Therapy On Microecology And Metabolism In Periodontal Patients Complicated With Or Without Type ? Diabetes Mellitus

Background and ObjectiveChronic periodontitis is listed as the sixth syndromes of diabetes.Epidemiological investigations have found that the risk of periodontitis in patients with diabetes is significantly higher than that in non-diabetics.The continuously increasing diabetic population poses serious challenges for the treatment of periodontal diseases."Non-surgical periodontal therapy,as an effective method for the treatment of periodontitis at present,has solved the problems of numerous patients with periodontitis,but its therapeutic effect on people with systemic diseases such as type ? diabetes mellitus is still controversial.This project intends to explore the effects of non-surgical periodontal therapy on clinical,immunological,inflammatory and metabolic indicators of periodontitis patients with or without type ? diabetes mellitus,explore the differences in oral microecological diversity among different populations,and further study the changes of oral microecology in periodontitis patients with type ? diabetes mellitus at post-therapy to provide a reference for clinical treatment.MethodsFrom March 2018 to February 2019,43 volunteers were recruited at the Stomatological Hospital of Shandong University and Qilu Hospital of Shandong University,including 13 healthy volunteers(H group),14 patients with chronic periodontitis(CP group)and 16 chronic periodontitis patients with type II diabetes mellitus(CP+T2DM group).The researchers introduced the detailed information about the study to the subjects,and the participants signed the relevant informed consent.The demographic characteristics of patients,periodontal measurements including plaque index(PLI),sulcus bleeding index(SBI),probe of bleeding(BOP),periodontal probe depth(PD),clinical attachment level(CAL),and metabolic indicators of fasting blood glucose(FBG),glycated hemoglobin(GHbA1c)were recorded,the plaque of subgingival,saliva and dorsal tongue,as well as gingival crevicular fluid(GCF)and blood were collected at the same time.The above information was collected and recorded again in details at 1.5-and 3-month follow-up.The 16S rDNA sequencing technology and bioinformatics technology were used to detect and analysis the obtained microorganisms of plaque,and the immune and inflammatory indicators(Interleukin-1?,IL-6,IL-8,C-reactive protein,tumor necrosis factor-?,monocyte chemotactic protein-1,platelet activating factor,human?-denfensin-3)of the collected GCF and blood were detected by enzyme-linked immunoassay(ELISA).Results1.There were significant differences in periodontal measurements,local inflammatory indicators,and blood glucose metabolic indicators between H group and disease groups at baseline(P<0.05).The periodontal indicators in H group was significantly better than that in the disease groups(P<0.05),The local inflammation indexes in disease groups was significantly higher than that in H group(P<0.05).No significant difference was found in serum inflammatory indexes(P>0.05).The blood glucose level in CP+T2DM group was significantly higher than H group and CP group(P<0.05).2.There were significant differences in the flora of different niches in the same population.Overall,the microbial abundance of subgingival plaque in the same population was significantly higher than that of saliva and dorsal tongue.At baseline,the composition of the bacterial complex in subgingival plaque was different from that of saliva and dorsal tongue.3.The bacterial composition at phylum level between H group and the disease groups was similar,but the microorganisms of the disease groups and H group were significantly different at the species level.There was a significant difference in red complex of subgingival plaque between H group and disease groups,especially the discrepancy in the abundance of Porphyromonas gingivalis(P.gingivalis)(P<0.05).4.Non-surgical periodontal therapy significantly improved the clinical periodontal indicators and reduced the local inflammatory indicators of disease groups(P<0.05),but the effect of therapy on the systemic inflammation indicators was not significant in CP patients(P>0.05).In addition,the blood glucose level improved significantly in CP+T2DM group at post-therapy(P<0.05).5.Non-surgical periodontal therapy significantly reduced the burden of subgingival plaque in CP patients,and significantly decreased the abundance of suspected pathogenic bacteria,mainly P.gingivalis.6.After 1.5 months of non-surgical periodontal therapy,the subgingival species abundance of disease groups signifi cantly decreased than that at baseline.The abundance of species rebounded at 3 months post-therapy,while remained lower than that at baseline.ConclusionsNon-surgical periodontal therapy could significantly improve periodontal parameters,reduce the level of local inflammation and improve the metabolic indicators,alter plaque microecology,decrease the abundance of suspicious pathogenic bacteria in subgingival plaque.