Gt. Smith et al., SHORT-TERM RESPONSES TO PERIODONTAL THERAPY IN INSULIN-DEPENDENT DIABETIC-PATIENTS, Journal of periodontology, 67(8), 1996, pp. 794-802
THIS INVESTIGATION STUDIED RELATIVE CHANGES in periodontal conditions
of 18 insulin-dependent diabetic patients. Measures of gingival inflam
mation, crevicular fluid aspartate aminotransferase (AST) levels, prob
ing depth and attachment levels, the presence of three periodontal pat
hogens (Porphyromonas gingivalis, Bacteroides forsythus, and Actinobac
illus actinomycetemcomitans) and serum an ti be cly titers to these ba
cteria, and blood sugar levels (glycosylated hemoglobin, HbAlc) were s
tudied before and 2 months after non-surgical debridement. Antibody ti
ters to the same bacteria were also studied in sera from 18 sex- and a
ge-matched periodontally healthy and non-diabetic subjects, Periodonta
l conditions showed significant improvement. The mean probing depth at
4 of the worst sites selected in each patient decreased from 5.7 mm t
o 4.8 mm (P < 0.0001). The mean full width probing depth changed from
2.9 mm (s.d. +/- 0.2) to 2.5 mm (s.d. +/- 0.3). A mean gain of 0.4 mm
attachment level was recorded (P < 0.0001), The mean AST value decreas
ed from 1009 mu IU to 518 mu IU (P < 0.006), Minimal differences in me
an glycosylated hemoglobin values (HbAlc) were noticed before and afte
r treatment. A. actinomycetemcomitans was never detected, P. gingivali
s was present at 7% of the sites both before and after treatment. B. f
orsythus was found at 29% or sites (50% of patients) before and at 36%
of sites (61% of patients) after treatment. Positive associations wer
e found between the presence of B. forsythus and AST values, gingival
index, probing depth, and attachment level (P < 0.05). Baseline serum
Ige titers to P. gingivalis were significantly lower in thr patients w
ith diabetes (9.5 ELISA units vs. 28.5 ELISA units in the healthy cont
rols). IgG titers to B. forsythus did not differ between diabetic and
non-diabetic subjects. No changes in IgG titers occurred after treatme
nt. Clinical improvements after mechanical non-surgical therapy in pat
ients with insulin-dependent diabetes mellitus were modest after 2 mon
ths. Treatment did not eliminate B. forsythus and P. gingivalis and di
d not affect IgG titer responses. More intense therapy, and longer fol
low-up times, may be necessary to see more pronounced clinical and sys
temic effects.