Effects of Periodontal Therapy in Patients with Metabolic Syndrome

Objectives: Metabolic syndrome (MetS) consists of a cluster of clinical and biological abnormalities that are affected by insulin resistance and promote cardiovascular diseases (CVD). Periodontitis has been associated with an increase in C-Reactive Protein (CRP) levels and increase risk of atherogenesis and hyperglycemia. Both periodontitis and MetS are associated with systemic inflammation and insulin resistance, and these two diseases might be linked through a common pathophysiological pathway. The objective of this trial was to evaluate the impact of periodontal treatment on the systemic markers of inflammation of patients with MetS and severe periodontitis, and therefore to evaluate the effect on their cardiometabolic risk.
Methods: A parallel-arm, double blind, randomized clinical trial with a 6-months follow-up was conducted on patients with MetS and severe periodontitis. Participants were randomly allocated to either an Intensive Periodontal Treatment group (IPT; n=20), consisting on scaling and root planing (SRP) and azithromycin (500 mg every 24h for 3 days); or to a Minimal Periodontal Treatment (MPT; n=19) group, consisiting on professional plaque removal and placebo capsules. Blood samples were collected prior, 3 and 6 months after therapy; being analyzed for CRP, total cholesterol, triglycerides, HbA1c, α-1 antitrypsin and fibrinogen.
Results: At 6 months, the periodontal parameters significantly improved in both groups, although the improvement was more pronounced in the IPT. Statistically significant differences were found in favour of group IPT for the change in CRP (Change in CRP= -0,22±0,13 mg/dl and 0,14±0,09 mg/dl for IPT and MPT groups respectively; p=0.038), as well as a tendency for HbA1c (Change in HbA1c=-0.7±0.48% and 0.36±0.20% for IPT and MPT groups respectively; p=0.056). No significant differences were found between groups or visits for total cholesterol, triglycerides, α-1 antitrypsin and fibrinogen.
Conclusions: Periodontal treatment consisting on SRP and azithromycin prescription significantly reduced CRP and HbA1c levels after 6 months in patients with MetS and severe periodontitis.