Effect of Non-Surgical Therapy on Salivary Nitric Oxide and Lipid Peroxidation Levels in Type Ii Diabetic and Non Diabetic Patients With Periodontal Disease

Abstract

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.

Evaluation of Lipid Peroxidation in the Saliva of Diabetes Mellitus Type 2 Patients with Periodontal Disease

“…For example, Tsai et al [ 45 ] reported a significant reduction in salivary LP concentration one month after initial therapy, and Wei et al [ 46 ] found a statistically significant reduction in MDA, which declined to the control level four months after nonsurgical therapy completion. Our results related to the DM2 group are also in agreement with those obtained by Latha et al [ 41 ], who concluded that a significant decrease in MDA after periodontal treatment suggests that, even in periodontitis patients with DM2, the total antioxidant capacity appears to be restored to the control level by successful nonsurgical therapy.…”

“…Our findings are likely driven by the relatively good metabolic control of our participants with diabetes (mean HbA1c = 7.23%), as the results reported by other authors show that poor metabolic control in DM2 patients is associated with higher levels of salivary and GCF oxidative stress [ 22 , 40 ]. Latha et al [ 41 ] and Trivedi et al [ 23 ] also noted similar LP levels in periodontitis patients with and without DM. Further, the correlation analysis showed a significant positive correlation between LP and PPD ( p = 0.044) but not HbA1c ( p = 0.577), which is expected, given that saliva represents a more localized oral environment.…”

Oxidative stress‐related biomarkers in chronic periodontitis patients with or without type 2 diabetes: A systematic review and meta‐analysis

“…As for iNOS/NO levels, two studies 31,32 provided data on iNOS levels in CP patients with or without type 2 diabetes, and both showed higher levels of iNOS were obtained in periodontitis participants than type 2 diabetes than CP group. Besides, there are also two articles compared the NO levels between the two groups, one of which concluded higher NO levels in DMCP groups 29 but the other claimed no significant difference between the two groups. 33…”

“…Similarly, although LPO increased MDA levels during tissue destruction, no correlation between the degree of inflammation and MDA levels was found in studies. 29,53 A review from Del et al attributes that to the insensitivity of the most used assays for MDA and excessive interference from MDA-related species or interference from an overestimation of stress analysis conditions, and that more accurate assays have now been recommended for adoption in future studies. 54 Another common oxide is NO, which acts as a physiological and pathophysiological mediator in vivo.…”

“…33 In contrast, Latha et al obtained the exact opposite conclusion when comparing salivary NO levels in DMCP and CP patients crosssectionally. 29 Therefore, we did not perform a meta-analysis of NO under the coexistence of type 2 diabetes and periodontitis. NO is synthesized by iNOS, and we found that the DMCP group had higher iNOS values than the CP control group which are consistent with previous studies.…”