Assessment of Inflammatory and Metabolic Parameters at a Medical College in Patients with Chronic Periodontitis.

Research Report.

SUMMARY:

Periodontal disease is an inflammatory and/or infectious disease of the tissues surrounding and supporting the teeth. Periodontal disease can consist of gingivitis (reversible gingival inflammation) and periodontitis (gingivitis with gingival recession accompanied by loss of clinical attachment and alveolar bone).
Evidence exists indicating that periodontal disease could be an important risk factor for several common systemic conditions. Studies in Nepal and abroad have consistently reported that patients with certain systemic diseases like diabetes have poorer periodontal health. Researchers have also suggested that there is a bidirectional relationship between diabetes and periodontitis. This means that both the periodontal health/disease as well as diabetes mellitus (DM) influence the course of disease or treatment outcome of the other. Numerous studies have reported that periodontal diseases adversely affect certain other systemic conditions besides DM, like cardiovascular disease (CVD), rheumatoid arthritis, pregnancy outcomes, tuberculosis, pneumococcal pneumonia, inflammatory bowel disease, etc. It has also been observed by many researchers that the treatment of periodontal diseases leads to better glycemic control and improvement in systemic biomarkers. One easy way to assess the systemic status is by assessing the various inflammatory and metabolic systemic biomarkers like: C-reactive protein (CRP), glycated hemoglobin (HbA1c), total leukocyte count (TLC), and differential leukocyte count (DLC) in patients with periodontitis.
Various studies have been done internationally but not much literature exist in context to Nepal, and the reports are not always consistent. Hence, this study aims to see whether the various inflammatory and metabolic marker levels are actually affected by periodontal status in a sample of Nepalese population.
This analytical cross-sectional study is being conducted at dental outpatient (OPD) departments of Kathmandu Medical College (KMC) among 315 individuals with varying severity of periodontal disease. A written informed consent is signed before enrolling the participants in the study by convenience sampling. Relevant data are filled in the “Proforma” prepared for the research. The data is being collected by a single examiner, the principal investigator, by history taking and clinical examination before any periodontal therapy. The basic demographic information: age and gender; smoking status; various metabolic parameters: HbA1c, body mass index (BMI); systemic biomarkers: CRP, TLC, DLC; and oroclinical parameters: periodontal probing depth (PPD); clinical attachment level (CAL), plaque index (PI), and gingival index (GI) are recorded. Chronic periodontitis is categorized as: Slight (1-2 mm CAL), Moderate (34 mm CAL), and Severe (≥5 mm CAL).
All data is entered in Microsoft Excel Sheet and analyzed. For complicated statistical analysis, Statistical Package for the Social Sciences (SPSS) version 23 is used. Confidentiality of the participants is maintained to the utmost. Qualitative data is presented as frequencies and percentages. Quantitative data is presented as means and standard deviation and analyzed. The level of significance will set at p <0.05 for any statistical tests.

Keywords: body mass index; chronic periodontitis; inflammatory parameters; metabolic parameters; smoking status.