Might smoking assuage the pro‐inflammatory effect of diabetes in periodontal sites?

Abstract

ObjectivesThis study evaluated the effects of type 2 diabetes mellitus (DM), smoking, and these two factors combined on gingival crevicular fluid levels and ratios of pro‐/anti‐inflammatory cytokines. Associations between cytokines with each other and with key periodontal pathogens in periodontal sites under the challenge of one or both of these risk factors were also assessed.MethodsA total of 102 subjects with periodontitis were included in this cross‐sectional study and assigned to one of the following groups: non‐diabetic non‐smokers (control group, n = 25), non‐smokers with DM (DM group, n = 30), non‐diabetic smokers (S group, n = 26), and smokers with DM (S + DM group, n = 21). The levels of 13 pro‐inflammatory (IFN‐γ, TNF‐α, MIP‐1α, GM‐CSF, IL‐1β, IL‐2, IL‐6, IL‐7, IL‐8, IL‐12, IL‐17, IL‐21, and IL‐23) and 5 anti‐inflammatory (IL‐4, IL‐5, IL‐10, IL‐13, and TGF‐β) cytokines were assessed in healthy and diseased sites, using multiplex immunoassay. Ratios of pro‐/anti‐inflammatory cytokines were obtained in all possible permutations. The levels of 7 key periodontal pathogens were evaluated by qPCR.ResultsOverall, the ratios of pro‐/anti‐inflammatory cytokines were higher in healthy and diseased sites of the DM group and in healthy sites of the S + DM group, and lower in diseased sites of the S group, compared with the control (p < .05). The proportion of the pro‐inflammatory cytokines in relation to the 18 cytokines studied was higher in the DM group and lower in the S group, whereas the proportion of the anti‐inflammatory cytokines was lower in both diabetic groups and higher in the S group, compared to the control (p < .05). A cluster of six common cytokines (IL‐4, IL‐5, IL‐12, IL‐13, IL‐21, and IL‐23) was observed in the diseased sites of all groups studied. Eight common cytokines (IL‐4, IL‐5, IL‐12, IL‐13, IL‐17, IL‐21, IL‐23, and IFN‐γ) grouped closely in the healthy sites of both diabetic groups. Significant associations between pathogens and cytokines occurred mainly in the diseased sites of the S + DM group (p < .05).ConclusionDiabetes mellitus induced an overall pro‐inflammatory state, while smoking mainly stimulated immunosuppression in periodontal sites. When the two risk factors overlapped, smoking seemed to partially assuage the hyperinflammatory effect of DM.

Diabetes Mellitus and Periodontitis Share Intracellular Disorders as the Main Meeting Point

“…M1-type macrophage [8][9][10], neutrophils [11][12][13][14], and polymorphonuclear cells (PMN) [15] usually have their function upregulated, and dendritic cells are reduced or immature [16]. Consequently, pro-inflammatory cytokines such as IL-1β, IL-17, IL-6, TNFα, INFγ used to be higher and IL-10 reduced [17][18][19][20][21]. This scenario favors the great tissue destruction observed in periodontal tissues, micro and macrovascular lesions, lipid profile alterations (high low-density lipoprotein (LDL) and triglycerides) and difficulty in glycemic control [22][23][24][25].…”

The impact of smoking on periodontitis patients’ GCF/serum cytokine profile both before and after periodontal therapy: a meta-analysis

“…We included studies reporting cytokines by both methods, which is consistent with other meta-analyses [ 64 , 65 ]. For studies reporting the quantity of cytokines by both the concentration and total amounts [ 41 , 49 – 51 ], we adopted the data reported by concentration rather than the total amounts because the concentration is the reporting method adopted by most studies. Moreover, reporting results by concentration eliminated the influence of the GCF volume on the level of cytokines.…”

“…A total of fifteen studies were included in our manuscript, including eight cross-sectional studies and seven prospective cohort studies [20,28,[40][41][42][43][44][45][46][47][48][49][50][51][52]. Their study characteristics are described in Additional file 2: Table S1.…”

Periodontal Disease in an Ageing Population: Key Considerations in Diagnosis and Management for the Dental Healthcare Professional

“…42 Smoking has been found to alter the response to periodontal disease in patients with other systemic conditions such as diabetes. 43 If considering tooth replacement options such as dental implants, it is important to note that smoking is known to impair healing and result in a higher rate of implant failure. 44,45 For older patients who have been smoking for many years, it is important to make them aware that there is evidence, from longitudinal studies with follow up periods of 4-32 years, to suggest that if they stop smoking their risk of periodontitis incidence or progression is similar that of never-smokers.…”