The effect of periodontal terapy on gingival crevicular fluid (GCF) and serum oxidative stress and inflammatory markers in patients with type 2 di̇abetes and chronic periodontitis

There is a bidirectional relationship between diabetes mellitus (DM) and chronic periodontitis with its clinical and immunological aspects. It is known that DM adversely affects host response in the pathogenesis of chronic periodontitis. Glycolized polymorphonuclear leukocytes (PMNL) release higher than average reactive oxygen derivatives (ROS). This leads to oxidative stress by disrupting the balance between oxidant and antioxidant levels. Therefore, another factor triggering tissue destruction in type 2 diabetes mellitus and periodontal diseases may be increased local and systemic oxidative stress. The aim of this study was to evaluate the effects of non-surgical periodontal treatment on cytokine and oxidative stress levels in gingival crevicular fluid (GCF) and serum in patients with type 2 diabetes and chronic periodontitis. The study consisted of 16 systemically healty patients with chronic periodontitis (CP), 15 patients with well controlled type 2 diabetes and chronic periodontitis (CP + CDM) and 14 patients with uncontrolled type 2 diabetic and chronic periodontitis (CP + UCDM). In our patients, clinical parameters, HbA1c, CRP, fibrinogen (FIB) were measured before and 3 months after non-surgical periodontal treatment and IL-4, IL-17, total oxidant level (TOL), total antioxidant level (TAL) in gingival crevicular fluid (GCF) and serum were compared and evaluated statistically. Clinical parameters were significantly decreased in all groups 3 months after treatment (p <0,005). In the comparison between the groups, the initial CRP value in CP was significantly lower than the diabetic groups (p <0,05). Although HbA1c and CRP decreased after treatment in all groups, it was not significant (p> 0,05). Although there was a decrease in IL-4 levels in GCF after treatment in all groups, it was found statistically significant only in CP and CP+UCDM groups. There was a decrease in IL-4 levels in serum after periodontal treatment in all groups, it was statistically significant only in the CP group (p<0,05). IL- 17 level in GCF decreased significantly in CP+UCDM after trearment (p<0,05). Initial serum TAL were significantly lower in the CP +UCDM group than the other two groups (p <0,05). Serum TOL were significantly decreased and serum TAL were significantly increased 3 months after the non-surgical periodontal treatment in the CP + UCDM group (p <0,05). In conclusion, it is seen that systemic inflammation increases when chronic periodontitis and type 2 diabetes disease coexist. Periodontal treatment has been found to contribute to glycemic control by reducing oxidative stress and inflammation in uncontrolled diabetes patients. Key Words: Chronic Periodontitis, Diabetes Mellitus, Oxidative Stress, Cytokine