Aim and objective: To evaluate the effect of nonsurgical periodontal therapy on periodontal parameters, serum C-reactive protein (CRP) level, total leukocyte count (TLC), and differential leukocyte count (DLC) in normolipidemic patients with generalized chronic periodontitis. Materials and methods: A total of 60 subjects (38 males and 22 females) between 20 and 55 years of age were included in this study. Twenty subjects with generalized chronic gingivitis were assigned group I. Forty subjects with generalized chronic periodontitis were randomly divided into test groups, i.e., group II (n = 20) and control group, i.e., group III (n = 20). At baseline, clinical parameters (plaque and gingival indices, clinical attachment loss) were recorded and blood collected for lipid profile test, TLC, DLC, and CRP estimation. Patients with lipid values in the normal range continued the study. Groups I and II were provided nonsurgical periodontal therapy. Follow-up clinical examination and blood examination were done for CRP level, TLC, and DLC after 1 and 2 months. Results: A significant improvement in the clinical parameters was evident following scaling and root planning in group II as compared to group III. A decrease in serum CRP and TLC count was also observed, but the difference was not significant. Moreover, a reduction was observed in neutrophils, monocytes, eosinophils post therapeutically in group II but the decrease was significant only for monocyte count. Conclusion: Based on the findings of the study, it can be concluded that nonsurgical periodontal therapy can reduce the inflammatory component. Clinical significance: Periodontal diseases comprise a wide range of inflammatory conditions affecting the supporting structures of teeth. Effect of nonsurgical periodontal therapy on chronic periodontitis can be evaluated by measuring the CRP and leukocyte concentration.
Noack B, Genco RJ, Trevisan M, et al. Periodontal infections contribute to elevated systemic C-reactive protein level. J Periodontol 2001;72(9):1221-1227. DOI: 10.1902/jop.2000.72.9.1221.
Radafshar G, Shad B, Ariamajd E, et al. Effect of intensive nonsurgical treatment on the level of serum inflammatory markers in advanced periodontitis. J Dent Tehran Uni Med Sci 2010;7(1):24-30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184718/
Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection. Front Immunol 2018;9:754. DOI: 10.3389/fimmu.2018.00754.
Baumeister D, Akhtar R, Ciufolini S, et al. Childhood trauma and adulthood inflammation: a meta-analysis of peripheral C-reactive protein, inetleukin-6 and tumour necrosis factor-ƒ¿. Mol Psychiatry 2016;21(5):642-649. DOI: 10.1038/mp.2015.67.
Ramamoorthy RD, Nallasamy VK, Reddy R, et al. A review of C-reactive protein: a diagnostic indicator in periodontal medicine. J Pharm Bioallied Sci 2012;4(Suppl 2):s422.s426. DOI: 10.4103/0975-7406.100318.
Slade GD, Ghezzi EM, Heiss G, et al. Relationship between periodontal disease and C reactive protein among adults in the atherosclerosis risk in communities study. Arch Intern Med 2003;163(10):1172-1179. DOI: 10.1001/archinte.163.10.1172.
Patil VA, Desai MH. Effect of periodontal therapy on serum C-reactive protein levels in patients with gingivitis and chronic periodontitis: a clinicobiochemical study. J Contemp Dent Pract 2013;14(2):233-237. DOI: 10.5005/jp-journals-10024-1305.
Christan C, Dietrich T, Hagewald S, et al. White blood cell count in generalized aggressive periodontitis after non-surgical therapy. J Clin Periodontol 2002;29:201-206. DOI: 10.1034/j.1600- 051x.2002.290303.x.
Ana P, Draginja K, Dimitrije M, et al. The markers of systemic inflammation in patients with chronic periodontitis: leukocytes, C-reactive protein and Fibrinogen. J Prev Med 2013;1(3):43–49. DOI: 10.12691/jpm-1-3-6.
Loos BG, Craandijk J, Hoek FJ, et al. Elevation of systemic markers related to cardiovascular diseases in the peripheral blood of periodontitis patients. J Periodontol 2000;71:1528–1534. DOI: 10.1902/jop.2000.71.10.1528.
Perry DA, Schmid MO, Takei HN. Phase I periodontal therapy. In: Newman MG, Takei H, Klokkevoid P, et al., editors. Carranza's clinical periodontology, 10th ed. St Louis, Missouri: Saunders; 2006. pp. 722–727.
Lofthus JE, Waki MY, Jolkovsky DL, et al. Bacteremia following subgingival irrigation and scaling and root planing. J Periodontol 1991;62(10):602–607. DOI: 10.1902/jop.1918.104.22.1682.
Waki MY, Jolkovsky DL, Otomo-Corgel J, et al. Effects of subgingival irrigation on bacteremia following scaling and root planing. J Periodontol 1990;61(7):405–411. DOI: 10.1902/jop.1922.214.171.1245.
Ebersole JL, Cappelli D. Acute-phase reactants in infections and inflammatory diseases. Periodontology 2000;23:19–49. DOI: 10.1034/j.1600-0757.2000.2230103.x.
Peter S. Essentials of preventive and community dentistry, 4th ed. New Delhi: Arya Medi Publishing House Pvt. Ltd.; 2009, pp. 322–324.
Rebelo MAB, de Queiroz AC. Gingival indices: state of art, gingival diseases - their aetiology, prevention and treatment. London: In Tech; 2011. Available from: http://www.intechopen.com/books/gingival-diseases-their-aetiology-prevention-and-treatment/gingival-indices-state-of-art
Pitiphat W, Savetsilp W, Wara, et al. C-reactive protein associated with periodontitis in a Thai population. J Clin Periodontol 2008;35(2): 120–125. DOI: 10.1111/j.1600-051X.2007.01179.x.
Rai B, Kharb S, Jain R, et al. Periodontitis, C-reactive protein and peripheral blood links with cardiovascular disease. Adv Med Sci 2010;3(3):76–79.
Anitha G, Nagaraj M, Jayashree A. Comparative evaluation of levels of C-reactive protein and PMN in periodontitis patients related to cardiovascular disease. J Indian Soc Periodontol 2013;17(3):330–332. DOI: 10.4103/0972-124X.115657.
Mani A, Vadvadgi V, Anar the R, et al. A clinical study on dental air force home dental cleaning system on adult chronic periodontitis patients and its assessment to C-reactive protein levels. Int J Exp Dent Sci 2012;1(1):14–18. DOI: 10.5005/jp-journals-10029-1003. link.gale.com/apps/doc/A235407128/HRCA?u=anon~55dc8558&sid=HRCA&xid=b10349d1.
George AK, Janam P. The short term effect of non-surgical periodontal therapy on the circulating levels of interleukin-6 and C-reactive protein in patients with chronic periodontitis. J Indian Soc Periodontol 2013;17(1):36–41. DOI: 10.4103/0972- 124X.107472.
Ritam SNT, Jyoti RR. Effect of periodontal treatment on plasma fibrinogen, serum C-reactive protein and total White blood cell count in periodontitis patients - a prospective interventional trial. Rom J Intern Med 2013;51(1):45–51. DOI: 10.1016/j.sdentj.2018.12.001
Pabolu CM, Mutthineni RB, Chintala S, et al. Evaluation of the effect of one stage versus two stage full mouth disinfection on C-reactive protein and leukocyte count in patients with chronic periodontitis. J Indian Soc Periodontol 2013;17(4):466–471. DOI: 10.4103/0972- 124X.118318.
Luthra S, Grover HS, Singh A, et al. Comparative evaluation of C-reactive protein and complete blood count in chronic periodontitis patients following phase I therapy: a serological and hematological study. J Indian Soc Periodontol 2019;23(6):525–533. DOI: 10.4103/jisp. jisp_639_18.
Ide M, McPartlin D, Coward PY, et al. Effect of treatment of chronic periodontitis on levels of serum markers of acute-phase inflammatory and vascular responses. J Clin Periodontol 2003;30:334–340. DOI: 10.1034/j.1600-051x.2003.00282.x.
Yamazaki K, Honda T, Oda T, et al. Effect of periodontal treatment on the C-reactive protein and pro-inflammatory cytokine levels in Japanese periodontal patients. J Periodont Res 2005;40(1):53–58. DOI: 10.1111/j.1600-0765.2004.00772.x.
Ushida Y, Koshy G, Kawashima Y, et al. Changes in serum interleukin-6, C-reactive protein and thrombomodulin levels under periodontal ultrasonic debridement. J Clin Periodontol 2008;35(11):969–975. DOI: 10.1111/j.1600-051X.2008.01316.x.
Ioannidou E, Malekzadeh T, Dongari-Bagtzoglou A. Effect of periodontal treatment on serum C - reactive protein Levels: a systematic review and meta-analysis. J Periodontol 2006;77(10):1635–1642. DOI: 10.1902/jop.2006.050443.
Kamil W, Al Habashneh R, Khader Y, et al. Effects of non-surgical periodontal therapy on C-reactive protein and serum lipids in Jordanian adults with advanced periodontitis. J Periodont Res 2011;46(5):616–621. DOI: 10.1111/j.1600-0765.2011.01380.x.
Mattila K, Vesanen M, Valtonen V, et al. Effect of treating periodontitis on C-reactive protein levels: a pilot study. BMC Infect Dis 2002;2:30. DOI: 10.1186/1471-2334-2-30.
Banthia R, Jain P, Banthia P, et al. Effect of phase-I periodontal therapy on pro-coagulant state in chronic periodontitis patients – a clinical and haematological study. J Ir Dent Assoc 2013;59(4):183–188. https://pubmed.ncbi.nlm.nih.gov/24156210/
Siddeshappa ST, Nagdeve S, Yeltiwar RK, et al. Evaluation of various hematological parameters in patients with periodontitis after nonsurgical therapy at different intervals. J Indian Soc Periodontol 2016;20:180–183. DOI: 10.4103/0972-124X.175172.
Mohan M, Jhingran R, Bains VK, et al. Impact of scaling and root planning on C-reactive protein levels in gingival crevicular fluid and serum in chronic periodontitis patients with or without diabetes mellitus. J Periodontal Implant Sci 2014;44(4):158–168. DOI: 10.5051/jpis.2014.44.4.158.