Comparative evaluation of C-reactive protein and complete blood count in chronic periodontitis patients following Phase I therapy: A serological and hematological study

Abstract

Background:Periodontitis is an example of persistent low-grade disease. The primary cause for the disease is anaerobic gram-negative bacteria thriving in a protective biofilm in subgingival periodontal pockets. The treatment of this infection is removal of these deposits by mechanical instrumentation (Phase I therapy). This can help achieve reduction of the bacterial load thus suppressing localized inflammation. Phase I therapy or mechanical debridement of the subgingival area causes a severe transient bacteremia along with some damage to the surrounding soft tissue, resulting in a systemic inflammatory response being elicited. The objective of the current study was to comparatively assess periodontal parameters, serum C-reactive protein (CRP) levels, and transitory alterations in hematological parameters; in 30-systemically healthy patients having chronic periodontitis, before and after Phase I therapy.Materials and Method:The individuals underwent an intensive session of mechanotherapy with ultrasonic scalers. Blood samples were taken before treatment and at 1, 7, and 30 days after treatment to assess the parameters.Results:There was a clear recuperation in periodontal parameters as well as marked improvement in the values of CRP and complete blood count (CBC) by 30 days after transient alterations occurring initially.Conclusion:Phase I (mechanotherapy) – the first step in treatment of periodontitis leads to transient bacteremia by systemic dispersal of bacteria harbored in dental plaque. This produces an acute-phase response resulting in variations in the levels of CRP and the CBC counts. After a month, both periodontal and hematological parameters show marked improvement, thus establishing periodontal health and decreasing the risk of inadvertent cardiovascular or thromboembolic episode.

Does non-surgical periodontal treatment influence on rheumatoid arthritis? A systematic review and meta-analysis

“…What can be seen in all these analyses is that the group that received periodontal treatment showed significant improvement in periodontal parameters, the PD reduced significantly ( Al-Katma et al, 2007 , Ortiz et al, 2009 , Pinho et al, 2009 , Erciyas et al, 2013 , Okada et al, 2013 , Khare et al, 2016 , Zhao et al, 2018 ), there was a significant gain in CAL ( Al-Katma et al, 2007 , Erciyas et al, 2013 , Okada et al, 2013 , Khare et al, 2016 ), and a significant decrease in BOP posttreatment ( Al-Katma et al, 2007 , Ortiz et al, 2009 , Erciyas et al, 2013 , Okada et al, 2013 , Khare et al, 2016 , Zhao et al, 2018 ). The reduction in PD and improvements in CALs can be attributed to the decreased size of inflammatory components after periodontal therapy, this decrease in inflammation in patients with chronic periodontitis according to Luthra et al, 2019 can be observed 30 days after non-surgical periodontal therapy.…”

Invasive dental treatment and acute vascular events: A systematic review and meta‐analysis

“…This treatment could involve tooth extractions and/or intensive sessions of dental cleaning. A transient impairment of endothelial function (Tonetti et al, 2007), acute inflammation (D'Aiuto et al, 2007; Habbab et al, 2019), increased leukocyte counts (Luthra et al, 2019), and short‐lived bacteraemia (Kinane et al, 2005) are commonly observed within 24 h of intensive treatment of periodontitis (D'Aiuto, Nibali, et al, 2004; Luthra et al, 2019). Similar acute changes plus a rise in serum levels of high‐sensitivity cardiac troponin T, fibrinogen, and endotoxin activity have been reported in patients with established cardiac problems undergoing dental extractions (Habbab et al, 2019).…”

“…This association, however, remains controversial (Chen et al, 2018). Current evidence confirms that IDTs result in a weeklong acute inflammatory response (D'Aiuto, Nibali, et al, 2004;Luthra et al, 2019) with transient impairment of vascular function (Tonetti et al, 2007) and the creation of a pro-thrombotic state (D'Aiuto et al, 2007). While it is now accepted that the risk of distant vascular infections (i.e., endocarditis) is negligible except in some limited circumstances (Cahill et al, 2017), some evidence indicates that IDTs could result in an increased risk of acute vascular events (AVEs) in the first 4 weeks post treatment (Minassian et al, 2010).…”

Avaliação da influência da doença periodontal sobre os níveis séricos de proteína C reativa

“…Em um outro estudo, os níveis séricos de PCR nos grupos com periodontite e gengivite foram significantemente maiores que no grupo controle (indivíduos com periodonto saudável), havendo uma redução significativa desses valores após a terapia periodontal (Patil & Desai, 2013). Em concordância, no estudo de De Souza, Okawa, Silva, e Araújo (2017) Em um estudo conduzido por Luthra et al (2019), 30 indivíduos com periodontite crônica foram submetidos à terapia periodontal com ultrassom, sendo coletadas amostras de sangue antes do tratamento e 1, 7 e 30 dias após o tratamento. Observou-se um aumento significativo nos valores de PCR 1 dia após o tratamento periodontal, os quais permaneceram notavelmente mais altos 1 semana após o procedimento.…”

“…A terapia periodontal não cirúrgica é o primeiro passo no procedimento de tratamento, com o objetivo de eliminar fatores etiológicos das doenças gengivais e periodontais, cessando a progressão da doença (Luthra, Grover, Singh, Lall & Masamatti, 2019). Não obstante, cabe salientar que evidências atestam que a periodontite pode ocasionar um quadro infeccioso capaz de aumentar a síntese hepática da PCR, ratificando uma relevante contribuição da terapia periodontal.…”