Locally administered metronidazole as an adjunct to conventional periodontal therapy in diabetic patients

Periodontitits is considered the sixth complications of diabetes, and recently, treatment of periodontal infection was shown to improve the glycemic control of diabetic patients. Scaling and root planing [Sc/Rp] alone may fail to eliminate periodontal pathogens especially in inaccessible areas. Since not all diabetics can tolearte surgical intervention, the use of an adjunctive therapy is advisable. The purpose of this study was to determine the clinical and microbial response to local application of metronidatole as an adjunct to scaling and root planing in diabetics. The study utilized a total of 60 patients [20 non-diabetics, 20 type I and 20 type II diabetics] with generalized severe periodontitis. Each individual was provided four treatment modalities, one in each quadrant. These were: 1] Sc/Rp plus application of placbo; 2] Sc/Rp plus application of 25% metronidazole gel [Elyzol]; 3] Sc/Rp plus irrigation with 2% chlorehexidine gluconate [CHX] and 4] Sc/Rp plus Elyzol and CHX irrigation. Among diabetics, the results showed no significant change in probing depth [PPD] when Sc/Rp was the only treatment. Whereas, all the three groups showed a significant reduction in PPD after application of Elyzol with/without CHX irrigation. The treatment modality consisting of Elyzol plus CHX irrigation was the most effective in all groups. Based on these results, we concluded that local delivery of metronidazole/CHX as an adjunct to Sc/Rp may improve periodontal health among diabetics

Comparison between prostaglandin in gingival inflammation in diabetics and non-diabetics

In this study, the level of prostaglandin in gingival tissue extract obtained form diabetic and non-diabetic individuals suffering from severe gingival inflammation was estimated using prostagl and ins radioimmunoassay technique. The patients were classified into 3 groups [non-diabetics, non-insulin dependent diabetic patients and insulin-dependent diabetic patients], all had the same degree of gingival inflammation as assessed clinically by [GI] and histopathologically. All patients were subjected to full mouth debridement one month prior to any procedure. Tissue biopsies were obtained for histopathological examinations and for measuring level of PG in tissue extract. The results demonstrated a highly significant increase in PGs in diabetic patients comparing with non-diabetics, also clinical evaluations revealed a significant increase in gingival bleeding in diabetics. Chronic hyperglycemia may be responsible for exaggerated production of PGs and for microvascular changes of gingival tissue

Estimation of proteolytic activity of subgingival microflora of diabetic and non-diabetic individuals

The purpose of this study was to estimate the proteolytic activity of subgingival microflora of diabetic and non-diabetic individividuals as an attempt to clarify the role of these enzymes which are produced by some Gram + ve and Gram - ve bacteria in the pathogenesis of periodontal tissue destruction in patients suffering from diabetes mellitus. Clinical indices and microbiological parameters were determined of 39 adult patients their age ranged from 35-65, 18 diabetic [non-insuline dependent diabetes mellitus] and 21 non-diabetics. The clinical results demonstrated the significant increase in all gingival clinical parameters in diabetics comparing with the non-diabetics. Microbiologically, staphylococcus aureus, micrococcus sp., Gram - ve bacilli and yeasts showed higher percentage of isolates in diabetic patients than in non-diabetic patients. Thus diabetic status may, not only affect the clinical aspect of the gingival tissue of the diabetic patients, but may also modify microbial plaque activities