SHORT-TERM RESPONSES TO PERIODONTAL THERAPY IN INSULIN-DEPENDENT DIABETIC-PATIENTS

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.