EFFECT OF NON-SURGICAL THERAPY ON SALIVARY NITRIC OXIDE AND LIPID PEROXIDATION LEVELS IN TYPE II DIABETIC AND NON DIABETIC PATIENTS WITH PERIODONTAL DISEASE
Objective: Reactive oxygen species have been identified as potential factors causing periodontal tissue destruction. Elevated levels of these in patients with chronic periodontitis and diabetes may aggravate the oxidative stress burden thereby accelerating the tissue damage associated with diabetes. The present study aimed to assess the effect of diabetes and periodontal disease on the oxidative stress markers and the effect of non-surgical therapy on these markers.
Methods: A total of 50 participants were divided into four groups based on the selection criteria. In addition to clinical parameters and biochemical parameters (salivary nitric oxide [NO] and malondialdehyde [MDA] levels) were assessed using spectrophotometric method at baseline and 3 months after non-surgical periodontal therapy.
Result: There was a statistically significant difference in the clinical parameters as well as NO and MDA levels in patients with type 2 diabetes and chronic periodontitis than other three groups at baseline and at 3 months after non- surgical periodontal therapy.
Conclusion: Diabetes mellitus and periodontitis have a compounding effect on the oxidative stress. Periodontal therapy is essential for diabetic patients as it can lower the levels of oxidative damage.
2. Loe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 1993;16:329-34.
3. Chapple IL, Matthews JB. The role of reactive oxygen and antioxidant species in periodontal tissue destruction. Periodontol 2000 2007;43:160-32.
4. Allen EM, Matthews JB, Connor RO, Oâ€™Halloran D, Chapple IL. Periodontitis and type II diabetes: Is oxidative stress the mechanistic link? Scott Med J 2009;54:41-7.
5. Pan Z, Guzeldemir E, Toygar HU, Bal N, Bulut S. Nitric oxide synthase in gingival tissues of patients with chronic periodontitis and with and without diabetes. J Periodontal 2010;81:109-20.
6. Khalili J, Biloklytska HF. Salivary malondialdehyde levels in clinically healthy and periodontal diseased individuals. Oral Dis 2008;14:754-60.
7. Reher VG, Zenobio EG, Costa FO, Reher P, Soares RV. Nitric oxide levels in saliva increase with severity of periodontitis. J Oral Sci 2007;49:271-6.
8. Tsai CC, Chen HS, Chen SL, Ho YP, Ho KY, Wu YM, et al. Lipid peroxidation: A possible role in the production and progression of chronic periodontitis. J Periodontal Res 2005;40:378-84.
9. Aydin A, Orhan H, Sayal A, Ã–zata M, Åžahin G, IÅŸÄ±mer A. Oxidative stress and nitric oxide related parameters in Type II diabetes mellitus: Effects of glycemic control. Clin Biochem 2001;34:65-70.
10. Halliwell B. Reactive oxygen species in living systems: Source, biochemistry and role in human diseases. Am J Med 1991;91:14S-22S.
11. Brennan PA, Thomas GJ, Langdon JD. The role if nitric oxide in oral diseases. Arch Oral Biol 2003;48:93-100.
12. Lohinai Z, Benedek P, Feher E, GyÃ¶rfi A, Rosivall L, Fazekas Ã, et al. Protective effects of mercaptoethylguanidine, a selective inhibitor of inducible nitric oxide synthase, in ligature-induced periodontitis in the rat. Br J Pharmacol 1998;123:353-60.
13. Deepa J, Aleykutty NA, Jyoti H. Effect of combination of two plant extracts on diabetes mellitus. Int J Pharm Pharm Sci 2018;10:49-52.
14. Lohinai Z, Stachlewitz R, Virag L, SzÃ©kely AD, HaskÃ³ G, SzabÃ³ C. Evidence for reactive nitrogen species formation in the gingivomucosal tissue. J Dent Res 2001;80:470-5.
15. Daghigh F, Borghaei RC, Thornton RD, Bee JH. Human gingival fibroblasts produce nitric oxide in response to pro inflammatory cytokines. J Periodontol 2002;73:392-400.
16. Sosroseno W, Barid I, Herminajeng E, Susilowati H. Nitric oxide production by a murine macrophage cell line (RAW264.7) stimulated with lipopolysaccharide from Actinobacillusactinomycetemcomitans. Oral Microbiol Immunol 2002;17:72-8.
17. Kim SJ, Ha MS, Choi EY, Choi JI, Choi IS. Prevotella intermedia lipopolysaccharide stimulates release of nitric oxide by inducing expression of inducible nitric oxide synthase. J Periodont Res 2004;39:424-1.
18. Matejka M, Partyka L, Ulm C, Solar P, Sinzlnger H. Nitric oxide synthesis is increased in periodontal disease. J Periodont Res 1998;33:517-8.
19. Kendall HK, Haase HR, Li H, Xiao Y, Bartold PM. Nitric oxide synthase type-II is synthesized by human gingival tissue and cultured human gingival fibroblasts. J Periodont Res 2000;35:194-200.
20. Lappin DF, Kjeldsen M, Sander L, Kinane DF. Inducible nitric oxide synthase expression in periodontitis. J Periodont Res 2000;35:369-73.
21. Hirose M, Ishihara K, Saito A, Nakagawa T, Yamada S, Okuda K. Expression of cytokines and inducible nitric oxide synthase in inflamed gingival tissue. J Periodontol 2001;72:590-7.
22. Batista A, Silva TA, Chun JH, Lara VS. Nitric oxide synthesis and severity of human periodontal disease. Oral Dis 2002;8:254-60.
23. Bartold PM, Wiebkin OW, Thonard JC. The effect of oxygen-derived free radicals on gingival proteoglycans and hyaluronic acid. J Periodont Res 1984;19:390-400.
24. Tervonen T, Oliver RC. Long-term control of diabetes mellitus and periodontitis. J Clin Periodontol 1993;20:431-5.
25. Girotti AW. Mechanisms of lipid peroxidation. J Free Rad Biol Med 1985;1:87-95.
26. Varani J, Fligiel SEG, Till GO, Kunkel RG, Ryan US, Ward PA. Pulmonary endothelial cell killing by human neutrophils: Possible involvement of hydroxyl radical. Lab Invest 1985;53:656-63.
27. Liberman TO, Baltimore O. Activation of interleukin-6 gene expression through NF-Æ™B transcription factor. Mol Cell Biol 1990;22:2327-34.
28. Poli G, Parola M. Oxidative damage and fibrogenesis. Free Rad Biol Med 1997;22:287-305.
29. Hemnani T, Parihar MS. Reactive oxygen species and oxidative DNA damage. Indian J Physiol Pharmacol 1998;42:440-52.
30. Del Rio D, Stewart AJ, Pellegrini N. A review of recent studies on malondialdehyde as toxic molecule and biological marker of oxidative stress. Nutr Metab Cardiovas Dis 2005;15:316-8.
31. TrickoviÄ‡-JanjiÄ‡ O, CvetkoviÄ‡ T, ApostoloviÄ‡ M. Analysis of enzyme activity and the level of malondialdehyde in the saliva of children with gingivitis. Vojnosanit Pregl 2009;66:892-6.
32. Akalm FA, Baltacioglu E, Alver A, Karabulut E. Lipid peroxidation levels and total oxidant status in serum, saliva and gingival crevicular fluid in patients with chronic periodontitis. J Clin Periodontol 2007;34:558-65.
33. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature 2001;414:813-20.
34. Green K, Brand, MD, Murphy MP. Prevention of mitochondrial oxidative damage as a therapeutic strategy in diabetes. Diabetes Care 2004;53:s110-7.
35. Mohanty P, Hanouda W, Garg R, Aljada A, Ghanim H, Dandona P. Glucose challenge stimulates reactive oxygen species (ROS) generation by leucocytes. J Clin Endo Metab 2000;85:2970-3.
36. Quagliaro L, Piconi L, Assaloni R, Martinelli L, Motz E, Ceriello A. Intermittent high glucose enhances apoptosis related to oxidative stress in human umbilical vein endothelial cells: The role of Protein Kinase C and NAD(P)HOxidase activation. Diabetes 2003;52:2795-04.
37. Gillery P, Monboisse JC, Maquart FX, Borel JP. Glycation of proteins as a source of superoxide. Diabet Metab 1998;14:25-30.
38. Freita JP, Filipe PM, Guerra Rodrigo F. Lipid peroxidation in type 2 normolipidemic diabetic patients. Diabetes Res Clin Pract 1997;36:71-5.
39. Skaleric U, Gaspirc B, McCartney-Francis N, Masera A, Wahl SM. Proinflammatory and antimicrobial nitric oxide in gingival fluid of diabetic patients with periodontal disease. Infect Immun 2006;74:7010-3.
40. Al-Rawi NH. Oxidative stress, antioxidant status and lipid profile in the saliva of type 2 diabetes. Diab Vasc Dis Res 2011;8:22-8.
41. Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: A two-way relationship. Ann Periodontol 1998;3:51-61.
42. Fredriksson MI, Gustaffson AK, Bergstrom KG, Asman BE. Constitutionally hyperreactive neutrophils in periodontitis. J Periodontol 2003;74:219-24.
43. Brock GR, Matthews JB, Butterworth CJ, Chapple IL. Local and systemic antioxidant capacity in periodontitis and health. J Clin Periodontol 2004;31:515-21.
44. Iacopino AM. Diabetic periodontitis: A possible lipid-induced defect in tissue repair through alteration of macrophage phenotypes and function. Oral Dis 1995;1:214-29.
45. Lee TI, Sun MF, Wen YR, Kuo PL, Liu CF. Elevated nitric oxide levels inhibit malondialdehyde production in patients with diabetes mellitus in Taiwan. Nutr Metab Cardiovas Dis 2005;15:452-3.
46. Miller LS, Manwell MA, Newbold D, Reding ME, Rasheed A, Blodgett J, et al. The relationship between reduction in periodontal inflammation and diabetes control: A report of 9 cases. J Periodontol 1992;63:843-8.
47. Wei D, Zhang XL, Wang YZ, Yang CX, Chen G. Lipid peroxidation levels, total oxidant status and superoxide dismutase in serum, saliva and gingival crevicular fluid in chronic periodontitis patients before and after periodontal therapy. Aust Dent J 2010;55:70-8.
48. Sonoki K, Nakashima S, Takata Y, Naito T, Fujisawa K, Ootsubo T, et al. Decreased lipid peroxidation following periodontal therapy in type 2 diabetic patients. J Periodontol 2006;77:1907-13.
49. Grossi SG, Skrepcinski FB, DeCaro T, Robertson DC, Ho AW, Dunford RG, et al. Treatment of periodontal disease in diabetes reduces glycated hemoglobin. J Periodontol 1997;68:713-9.
50. Christgau M, Palitzsch KD, Schmalz G, Kreiner U, Frenzel S. Healing response to non-surgical periodontal therapy in patients with diabetes mellitus: Clinical, microbiological and immunologic results. J Clin Periodontol 1998;25:112-24.
51. Stewart JE, Wager KA, Friedlander AH, Zadeh HH. The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus. J Clin Periodontol 2001;28:306-10.
52. Kiran M, Arpak N, Unsal E, ErdoÄŸan MF. The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus. J Clin Periodontol 2005;32:266-72.
53. Rodrigues DC, TabaJr M, NovaesJr AB, Souza SL, Grisi MF. Effect of non-surgical periodontal therapy on glycemic control in patients with type 2 diabetes mellitus. J Periodontol 2003;74:1361-7.
54. Teeuw WJ, Gerdes VE, Loos BG. Effect of periodontal treatment on glycemic control of diabetic patients: A systematic review and meta-analysis. Diabetes Care 2010;33:421-7.
55. Dussa KN, Sahay RK, Sundararajan P, Ardhanarao MV. Adaptation of diabetes knowledge questionnaire for south Asian countries context. Int J Pharm Pharm Sci 2017;9:252-6.
56. Gullu C, Ozmeric N, Tokman B, ElgÃ¼n S, Balos K. Effectiveness of scaling and root planning versus modified Widman flap on nitric oxide synthase and arginase activity in patients with chronic periodontitis. J Periodont Res 2005;40:168-75.
57. Ozer L, Elgun S, Ozdemir B, Pervane B, Ozmeric N. Arginine-nitric oxide-polyamine metabolism in periodontal disease. J Periodontol 2011;82:320-8.
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