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VOLUME 20 , ISSUE 2 ( February, 2019 ) > List of Articles

ORIGINAL RESEARCH

Effect of Initial Periodontal Therapy on Serum Nitric Oxide Levels in Chronic Periodontitis Patients with or without Type 2 Diabetes Mellitus

S Gayathri, PR Arunima, K Jaya Kumar

Keywords : Chronic periodontitis, Initial periodontal therapy, Serum NO, T2DM

Citation Information : Gayathri S, Arunima P, Kumar KJ. Effect of Initial Periodontal Therapy on Serum Nitric Oxide Levels in Chronic Periodontitis Patients with or without Type 2 Diabetes Mellitus. J Contemp Dent Pract 2019; 20 (2):197-203.

DOI: 10.5005/jp-journals-10024-2497

License: CC BY-NC 4.0

Published Online: 01-02-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim: To evaluate the effect of initial periodontal therapy on serum NO levels in chronic periodontitis (CP) patients with or without type 2 diabetes mellitus (T2DM) Materials and methods: A total of 90 subjects (group I-30 healthy controls, group I-30 CP and group III-30 CP with T2DM) participated in this study. Groups II and III subjects received initial periodontal therapy. Clinical periodontal parameters (OHI-S, GI, PPD, and CAL) and serum NO levels were evaluated at baseline and 4 weeks after initial periodontal therapy. Serum NO levels were determined by the Spectrophotometric assay based on the Griess colorimetric reaction. Results: Four weeks after initial periodontal therapy both groups II and III exhibited improvement in clinical periodontal parameters (OHI-S, GI, PPD, CAL) and reduction in serum levels of NO from its baseline values (Baseline-Group II: 3.64 ± 0.53, 1.93 ± 0.30, 3.29 ± 0.42, 3.60 ± 0.42, 89.21 ± 1.46 respectively, group III: 3.66 ± 0.44, 2.03 ± 1.32, 3.57 ± 0.40, 3.65 ± 0.45, 85.54 ± 1.54 respectively. Post-treatment-Group II: 1.73 ± 0.42, 1.27 ± 0.23, 3.16 ± 0.46, 3.47 ± 0.58, 70.91 ± 1.68 respectively, group III: 2.39 ± 0.49, 1.71 ± 0.33, 3.44 ± 0.42, 3.61 ± 0.48, 68.69 ± 1.17 respectively). However, statistically significant differences were observed only with OHI-(S) and serum NO values in both groups II and III (p < 0.05). When the baseline values of groups II and III were compared the differences were non-significant except for GI (p < 0.05). However, when the post-treatment clinical periodontal parameters and serum NO level of groups II and III were compared, statistically significant differences (p < 0.05) were observed except for PPD and CAL between the groups. Conclusion: NO can be utilized as a good indicator of the inflammatory status of the periodontium. Initial periodontal therapy is effective in reducing serum levels of NO in CP patients with or without T2DM. Clinical significance: A bidirectional relationship exists between periodontal disease and diabetes mellitus. NO is found to play a significant role in the pathobiology of both CP and T2DM. Initial periodontal therapy seems to be beneficial in reducing serum NO levels along with periodontal parameters in CP patients with or without T2DM. However further studies are warranted to enhance our knowledge about the role of NO in periodontal diseases in the course of diabetes.


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  1. Kendall HK, Marshall RI, Bartold PM. Nitric oxide and tissue destruction. Oral Dis 2001;7(1):2-10.
  2. Moncada S, Herman AG, Vanhoutte P. Endothelium-derived relaxing factor is identified as nitric oxide. TIPS 1987; 8(10):365-368.
  3. Nathan C. Nitric oxide as a secretory product of mammalian cell. FASEB J 1992;6:3051-3064.
  4. Moncada S, Palmer RM, Higgs EA. Nitric oxide: physiology, pathophysiology, and pharmacology. Pharmacol Rev 1991; 43(2):109-142.
  5. Kröncke KD, Fehsel K, Kolb-Bachofen V. Nitric oxide: cytotoxicity versus cytoprotection-how, why, when, and where? Nitric Oxide 1997;1(2):107-120.
  6. Kim YS, Pi SH, Lee YM, Lee SI, Kim EC. The anti-inflammatory role of heme oxygenase-1 in lipopolysaccharide and cytokine-stimulated inducible nitric oxide synthase and nitric oxide production in human periodontal ligament cells. J Periodontol. 2009;80(12):2045-2055.
  7. Batista AC, Silva TA, Chun JH, Lara VS. Nitric oxide synthesis and severity of human periodontal disease. Oral Dis. 2002;8(5):254-260.
  8. Matejka M, Partyka L, Ulm C, Solar P, Sinzinger H. Nitric oxide synthesis is increased in periodontal disease. J Periodontal Res 1998; 33(8):517-518.
  9. Aurer A, Aleksic J, Ivic-Kardum M, Aurer J, Culo F. Nitric oxide synthesis is decreased in periodontitis. J Clin Periodontol 2001; 28(6):565-568.
  10. Reher VG, Zenobio EG, Costa FO, Reher P, Soares RV. Nitric oxide levels in saliva increase with severity of chronic periodontitis. J Oral Sci 2007; 49(4):271-276.
  11. Ozer L, Elgun S, Ozdemir B, Pervane B, Ozmeric N Argininenitric oxide-polyamine metabolism in periodontal disease. J Periodontol 2011;82(2):320-328.
  12. Parwani SR, Chitnis PJ, Parwani RN. Salivary nitric oxide levels in inflammatory periodontal disease–A case-control and interventional study. Int J Dent Hyg 2012;10(1):67-73.
  13. Menaka KB, Ramesh A, Thomas B & Kumari NS. Estimation of nitric oxide as an inflammatory marker in periodontitis. Journal of Indian Society of Periodontology 2009; 13(2):75-78.
  14. Andrukhov O, Haririan H, Bertl K, Rausch WD, Bantleon HP, Moritz A, et al. Nitric oxide production, systemic inflammation and lipid metabolism in periodontitis patients: possible gender aspect. J Clin Periodontol 2013;40(10):916-923.
  15. Wattamwar PP, Kolte RA, Kolte AP, Shah KK. Influence of interventional nonsurgical periodontal treatment on levels of salivary and serum nitric oxide in smokers and non-smokers with chronic periodontitis. Journal of Indian Society of Periodontology 2016;20(6):592-596.
  16. American Diabetes Association Diagnosis and classification of diabetes mellitus. Diabetes Care 2012;35 (Suppl 1):S64-S71.
  17. Brownlee M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes 2005; 54(6):1615-1625.
  18. Ruderman NB, Williamson JR, Brownlee M. Glucose and diabetic vascular disease. FASEB J 1992; 6: 2905-2914.
  19. Pacher P, Beckman JS, Liaudet L. Nitric oxide and peroxynitrite in health and disease. Physiol. Rev 2007; 87(1):315-424.
  20. Nassar H, Kantarci A, and Van Dyke TE. Diabetic periodontitis: a model for activated innate immunity and impaired resolution of inflammation. Periodontol 2000 2007;43(1): 233-244.
  21. Pacher P, Obrosova IG, Mabley JG and Szabó C. Role of Nitrosative Stress and Peroxynitrite in the Pathogenesis of Diabetic Complications. Emerging New Therapeutical Strategies. Curr Med Chem 2005;12(3):267-275.
  22. Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: a two-way relationship. Ann Periodontol 1998; 3(1):51-61.
  23. Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K. et al. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012;55(1):21-31.
  24. Loe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 1993 16(1):329-334.
  25. Armitage GC. Development of a classi.cation system for periodontal diseases and Conditions. Ann Periodontol 1999; 4(1):1-6.
  26. Pan Z, Guzeldemir E, Toygar HU, Bal N and Bulut S. Nitric oxide synthase in gingival tissues of patients with chronic periodontitis and with and without diabetes. J Periodontol 2010;81(1):109-110.
  27. Cortas N, Wakid N. Determination of inorganic nitrate in serum and urine by a kinetic cadmium- reduction method. Clin Chem 1990;36(8):1440-1443.
  28. Bryan NS, Grisham MB. Methods to detect Nitric Oxide and its Metabolites in Biological Samples. Free Radic Biol Med 2007; 43(5):645-657.
  29. Shlossman M, Knowler WC, Pettitt DJ, Genco RJ. Type 2 diabetes mellitus and periodontal disease. J Am Dent Assoc 1990;121(4):532-536.
  30. Kiran M, Arpak N, Unsal E, Erdogan MF. The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus. J Clin Periodontol 2005;32(3):266-272.
  31. Garcia R. Periodontal treatment could improve glycaemic control in diabetic patients. Evid Based Dent 2009; 10(1): 20-21.
  32. Promsudthi A, Pimapansri S, Deerochanawong C, Kanchanavasita W. The effect of periodontal therapy on uncontrolled type 2 diabetes mellitus in older subjects. Oral Dis 2005; 11(5):293-298.
  33. Cirino G, Distrutti E, Wallace JL. Nitric oxide and inflammation. Inflamm Allergy Drug Targets. 2006 Apr; 5(2):115-119.
  34. Lohinai ZM, Szabo C. Role of nitric oxide in physiology and pathophysiology of periodontal tissues Med Sci Monit 1998; 4(6):1089-1095.
  35. Mian AI, Aranke M, Bryan NS. Nitric Oxide and its Metabolites in the Critical Phase of Illness: Rapid Biomarkers in the Making. Open Biochem J. 2013;7:24-32.
  36. Ghasemi A, Zahediasl S. Is nitric oxide a hormone? Iranian Biomed J 2011;15(3):59-65.
  37. Szabo C. Multiple pathways of peroxynitrite cytotoxicity. Toxicol Lett 2003;140-141:105-112.
  38. Taskiran D, Stefanovic-Racic M, Georgescu H, Evans C. Nitric oxide mediates suppression of cartilage proteoglycan synthesis by interleukin-1. Biochem Biophys Res Commun 1994;15; 200(1);142-148.
  39. Brennan PA, Thomas GJ, Langdon JD. The role of nitric oxide in oral diseases. Arch Oral Biol 2003;48(2):93-100.
  40. Güllü C, Ozmeric N, Tokman B, Elgün S, Balos K. Effectiveness of scaling and root planing versus modified Widman flap on nitric oxide synthase and arginase activity in patients with chronic periodontitis. J Periodontal Res. 2005 Apr;40(2):168-175.
  41. Herrera BS, Martins-Porto R, Maia-Dantas A, Campi P, Spolidorio LC, Costa SKP, et al. iNOS-Derived Nitric Oxide Stimulates Osteoclast Activity and Alveolar Bone Loss in Ligature-Induced Periodontitis in Rats. J Periodontol 2011;82(11):1608-1615.
  42. Salvemini D, Seibert K, Masferrer JL, Misko TP, Currie MG. Endogenous nitric oxide enhances prostaglandin production in a model of renal inflammation;J Clin Invest 1994;93(5): 1940-1947.
  43. Burke T. Nitric oxide and its role in health and diabetes; Available at www.photonicenergetics.com:1-21.
  44. Goldin A, Beckman JA, Schmidt AM, Creager MA. Advanced glycation end products: sparking the development of diabetic vascular injury. Circulation 2006; 114(6):597-605.
  45. Mahfouz MH, Emara IA, Shouman MS, Ezz MK; Asymmetrical dimethylarginine (ADMA) and nitric oxide as potential cardiovascular risk factors in type 2 diabetes mellitus. African Journal of Biochemistry Research 2009; 3(8):293-301.
  46. Chan NN, Chan JC. Asymmetric dimethylarginine (ADMA): a potential link between endothelial dysfunction and cardiovascular diseases in insulin resistance syndrome? Diabetologia 2002;45(12):1609-1616.
  47. Novak MJ, Potter RM, Blodgett J, Ebersole JL. Periodontal disease in Hispanic Americans with type 2 diabetes. J Periodontol 2008;79(4):629-636.
  48. Mealey BL. Periodontal disease and diabetes: A two-way street. JADA 2006; 137 Suppl.:26s-31s.
  49. Schmidt AM, Weidman E, Lalla E, Yan SD, Hori O, Cao R, et al. Advanced end products (AGEs) induce oxidant stress in the gingiva: A potential mechanism underlying accelerated periodontal disease associated with diabetes. J Periodontal Res 1996; 31(7):508-515.
  50. Rodrigues DC, Taba MJ, Novaes AB, Souza SL, Grisi MF. Effect of non-surgical periodontal therapy on glycemic control in patients with type 2 diabetes mellitus. J Periodontol. 2003;74(9):1361-1367.
  51. Koromantzos PA, Makrilakis K, Dereka X, Katsilambros N, Vrotsos IA, Madianos PN. A randomized- controlled trial on the effect of non-surgical periodontal therapy in patients with type 2 diabetes. Part I: Effect on periodontal status and glycaemic control. J Clin Periodontol 2011;38(2):142-147.
  52. Arrington H. Inducible Nitric Oxide Synthase and Periodontal Inflammation:A Preclinical Canine Study-Thesis 2007:1-98.
  53. Leitao RFC, Ribeiro RA, Chaves HV, Rocha FAC, Lima V, Brito GAC. Nitric oxide synthase inhibition prevents alveolar bone resorption in experimental periodontitis in rats. J Periodontol 2005;76(6):956-963.
  54. Zingarelli B, Southan GJ, Gilad E, O'Connor M, Salzman AL, Szabo C. The inhibitory effects of mercaptoalkylguanidines on cyclo-oxygenase activity. Br J Pharmaco. 1997; 120(3):357- 366.
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