Salivary tumor necrosis factor-alpha levels in periodontitis associated with diabetes mellitus after low level laser therapy as an adjunct to scaling and root planning

Abstract

Context: Tumor necrosis factor-alpha (TNF-α) has been shown to play a critical role in the pathogenesis of periodontitis and diabetes. Nonsurgical periodontal therapy was shown to reduce inflammation and improves glycemic status. Recently, adjunctive low level laser therapy (LLLT) has been shown to alter the inflammatory process. Aim: To evaluate and compare the alteration in TNF-α levels before and after treatment in patients with periodontitis with and without type 2 diabetes mellitus (T2DM). Settings and Design: Randomised clinico-biochemical study was carried out for 8 weeks from September 2019 to December 2020. Materials and Methods: Sixty-four participants were divided into Groups A (periodontitis) and B (periodontitis associated with T2DM), based on probing depth ≥5 mm, clinical attachment level ≥2 mm, and history of T2DM. Later were subdivided into A1, A2, B1, B2, based on assigned treatments. Clinical periodontal parameters and salivary TNF-α levels were evaluated and compared at baseline to 8 weeks. Statistical Analysis: Multiple group comparisons were done using analysis of variance, intra group comparisons were made using t -tests. Results: Comparison of periodontal parameters and salivary TNF-α levels from baseline to 8 weeks showed statistically significant difference ( P < 0.05) in all groups, indicating a positive effect of scaling and root planing (SRP) and adjunctive LLLT. Conclusion: Both SRP and SRP with adjunctive LLLT effectively altered TNF-α levels, correlating reduced periodontal inflammation.

Diabetes in spotlight: current knowledge and perspectives of photobiomodulation utilization

“…Regarding diabetes chronic periodontitis, three teams each published 2-3 studies: Chava et al. ( 34 , 35 ), Haaki et al. ( 36 , 37 ), and Obradovic et al.…”

“…Among studies that examined the gingival index, plaque index, and clinical attachment level, 75% reported improvements in at least one of these parameters. Four studies reported negative results: one had the highest fluence ( 144 ), one had the highest exposure frequency [once a day for 8 weeks ( 35 )], one had poorly described illumination parameters and a wavelength beyond the infrared range ( 142 ), and one had four PBM exposure sites ( 148 ), whereas most studies reported one to two exposure sites. Finally, the ideal parameters could involve a single exposure or exposure over 2 to 3 days, on one to two sites in direct contact with gingival tissue or intra-pocket, with a fluence of 1 to a few J/cm², continuous or pulsed laser illumination, and a wavelength range of 650 to 1064 nm.…”

“…Regarding diabetic neuropathies, two teams each published three studies: Burke et al (28)(29)(30), and Arun G et al (31)(32)(33). Regarding diabetes chronic periodontitis, three teams each published 2-3 studies: Chava et al (34,35), Haaki et al (36,37), and Obradovic et al (38)(39)(40). Regarding performance and functionality during or after exercise in patient with diabetes .…”

Effect of Subgingival Scaling and Root Planing-assisted Occlusal Adjustment Scheme on Periodontitis

“…Currently, periodontitis is mainly treated by subgingival scaling and root planing (SRP), which removes tartar and plaque from the root surface within periodontal tissues through subgingival ultrasonic instruments 3) . SRP can relieve inflammation and promote tissue healing by destroying and removing the subgingival plaque biofilm and establishing a biocompatible root 4) . However, SRP alone has poor efficacy since occlusal traumas occur in most patients with periodontitis due to an excessive occlusal force or an abnormal lateral occlusal force, thus exacerbating periodontal destruction.…”