Low Levels of Tumor Necrosis Factor-α will Prevent Periodontitis Exacerbation in Type 2 Diabetes Mellitus

Abstract

Objectives Diabetes mellitus (DM) is a major risk factor for periodontitis. Susceptibility to periodontitis increases approximately three times in people with DM. There is a clear relationship between the degree of hyperglycemia and the severity of periodontitis. This study aimed to analyze the reduction of tumor necrosis factor-α (TNF-α) in diabetics who came for periodontitis examination to prevent exacerbations. Materials and Methods This was an analytic observational study using a cross-sectional approach at health centers in Surabaya, Indonesia. Measurement of periodontal status used the community periodontal index of treatment needs by measuring bleeding at probing and pocket depth. TNF-α was measured using enzyme-linked immunosorbent assay, and behavior and lifestyle using a questionnaire. Statistical Analysis The Kolmogorov–Smirnov test was performed to identify data normality (p < 0.05). A nonparametric test was used to measure the degree of association between different characteristics and the incidence of periodontitis in type 2 DM patients with and without periodontitis. Spearman's test was done to examine the correlation between TNF-α level and severity of periodontitis in diabetics. The significant level was at p <0.05. Results There was a correlation between age, predisposing factors, reinforcing factors, drug consumption, and TNF-α levels in patients with type 2 DM and the incidence of periodontitis. Conclusions Poor glycemic control can induce oxidative stress on the gingiva, thereby aggravating damage to periodontal tissue. An important factor in preventing periodontitis for type 2 DM patients is controlling blood sugar levels through regular consumption of drugs and regular maintenance of oral cavity health. Knowledge is a predisposing factor that affects adherence of people with type 2 DM to consuming drugs regularly, which can be strengthened by family support. These will ultimately play a role in reducing TNF-α levels.

Oral Manifestations: A Reliable Indicator for Undiagnosed Diabetes Mellitus Patients

“…27,28 This is due to the fact that status of periodontal disease in uncontrolled diabetic patients is influenced by glycemic control, increased production of advanced glycated end-products, and poor glycemic control cause oxidative stress to the gingiva, which in turn lead to periodontal disease. 29,30 The risk of halitosis (bad breath) increases with elevated levels of HbA1c 31 In the present study, around 88% of prediabetic and 97% of diabetic patients presented with halitosis which is in accordance with studies done by Choi and Al-Zahrani et al showing a strong association between halitosis and elevated levels of HbA1c. 31,32 Xerostomia is regarded as one of the most prevalent signs of DM.…”

“… 27 28 This is due to the fact that status of periodontal disease in uncontrolled diabetic patients is influenced by glycemic control, increased production of advanced glycated end-products, and poor glycemic control cause oxidative stress to the gingiva, which in turn lead to periodontal disease. 29 30 …”

Effect of Lipopolysaccharide-Induced Apical Periodontitis in Diabetes Mellitus Rats on Periapical Inflammation

“…13 TNF-a is strongly correlated to the incidence and exacerbation of periodontitis in diabetes mellitus. 30 TNF-a is a major cytokine released by activated macrophages, monocytes, and T lymphocytes which affect growth regulation, immune response, survival, differentiation, and physiological functions of different cells together with the production of other enzymes, mediators, and cytokines. TNF-a production to increase disease progression is triggered by endotoxins.…”