The effect of locally delivered Andrographis paniculata gel as an adjunct therapy for periodontitis in well-controlled type 2 diabetes mellitus patients
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Abstract
Objective: To compare clinical results for the group using a locally delivered Andrographis paniculata gel as an adjunct to scaling and root planing (SRP) with those obtained for the group receiving only SRP for periodontal treatment in well-controlled type 2 diabetes mellitus patients.
Materials and Methods: Thirty-two type 2 diabetes patients with periodontitis were included in this split-mouth single-blinded randomized clinical trial. At the start of the study, these patients had a hemoglobin A1c (HbA1c) less than 7%, at least two single-rooted teeth of the same type located on different quadrants of the same dental arch, an initial probing depth (PD) ≥ 5 mm. with bleeding on probing (BOP), radiographic alveolar bone loss, and a periodontal pocket depth that did not differ by > 1 mm. The teeth were randomly assigned to the experimental (SRP and AP gel) and control (SRP only) groups. PD, clinical attachment level (CAL), gingival index (GI), plaque index (PI), and BOP were recorded at the baseline and at the 3-month follow-up.
Results: After treatment, both groups exhibited improved periodontal parameters. In the experimental group, PD, CAL, GI, and BOP significantly improved in comparison with the control group at the 3-month follow-up (P < 0.05).
Conclusion: Application of locally delivered AP gel as an adjunct enhanced SRP clinical outcomes for periodontal therapy in well-controlled type 2 diabetes mellitus patients.
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References
Hallmonn WC, editor. The American Academy of Periodontology. Periodontal literature reviews: a summary of current knowledge. Chicago: The academy, 1996.
Marsh PD, Moter A, Devine DA. Dental plaque biofilms: communities, conflict, and control. Periodontol 2000 2011; 55: 16-35.
American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2017. Diabetes Care 2017; 40: S11-S24.
Stöhr J, Barbaresko J, Neuenschwander M, Schlesinger S. Bidirectional association between periodontal disease and diabetes mellitus: a systematic review and meta-analysis of cohort studies. Sci Rep 2021; 11 :13686.
Sanz M, Ceriello A, Buysschaert M, Chapple I, Demmer RT, Graziani F, et al. Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology. J Clin Periodontol 2018; 45: 138-49.
Simpson TC, Clarkson JE, Worthington HV, MacDonald L, Weldon JC, Needleman I, et al. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev 2022; 4: CD004714.
Cobb CM. Non-surgical pocket therapy: mechanical. Ann Periodontol 1996; 1: 443-90.
Graziani F, Karapetsa D, Alonso B, Herrera D. Nonsurgical and surgical treatment of periodontitis: how many options for one disease? Periodontol 2000 2017; 75: 152-88.
Adriaens PA, Edwards CA, De Boever JA, Loesche WJ. Ultrastructural observations on bacterial invasion in cementum and radicular dentin of periodontally diseased human teeth. J Periodontol 1988; 59: 493-503.
Greenstein G, Polson A. The role of local drug delivery in the management of periodontal diseases: a comprehensive review. J Periodontol 1998; 69: 507-20.
Eid Abdelmagyd HA, Ram Shetty DS, Musa Musleh Al-Ahmari DM. Herbal medicine as adjunct in periodontal therapies - A review of clinical trials in past decade. J Oral Biol Craniofac Res 2019; 9: 212-7. doi: 10.1016/j.jobcr.2019.05.001.
Rovai ES, Souto ML, Ganhito JA, Holzhausen M, Chambrone L, Pannuti CM. Efficacy of local antimicrobials in the non-surgical treatment of periodontitis patients with diabetes: a systematic review. J Periodontol
; 87: 1406-17.
Pradeep AR, Garg V, Raju A, Singh P. Adjunctive local delivery of Aloe Vera gel in patients with type 2 diabetes and chronic periodontitis: a randomized controlled clinical trial. J Periodontol 2016; 87: 268-74.
National Drug Committee. National List of Essential Drugs 1999 (List of herbal medicine products). Bangkok: Agricultural Cooperative Community of Thailand Publishing, 1999.
Sheeja K, Shihab PK, Kuttan G. Antioxidant and anti-inflammatory activities of the plant Andrographis paniculata Nees. Immunopharmacol Immunotoxicol 2006; 28: 129-40.
Puri A, Saxena R, Saxena RP, Saxena KC, Srivastana V, Tandon JS. Immunostimulant agents from Andrographis paniculata. J Nat Prod 1993; 56: 995-9.
Dedhia J, Mukharjee E, Luke AM, Mathew S, Pawar AM. Efficacy of Andrographis paniculata compared to Azadirachta indica, Curcuma longa, and sodium hypochlorite when used as root canal irrigants against Candida albicans and Staphylococcus aureus: An in vitro antimicrobial study. J Conserv Dent 2018; 21: 642-45.
Amornchat C, Kraivaphan P, Kraivaphan V, Triratana T. The antibacterial activity of Andrographis paniculata crude extracts on oral bacteria. J Dent Assoc Thai 1991; 41: 178-85.
Keerthika N, Suganya S, Murugesan K, Gowtham V. Effect of aqueous extract of Andrographis Paniculata on inhibition of adhesion of Candida Albicans to denture acrylic resin: An in-vitro study. J Prosth Dent 2020; 15: 8-14. ISSN No:2582-0362
Thawornrungroj S, Kuphasuka Y, Petmitr S, Srisatjaluk RK, Kitkumthorn N. The application of Andrographis paniculata gel as an adjunct in the treatment of chronic periodontitis: clinical and microbiological effects. NU Journal 2011; 19: 38-49.
Kasetsuwan J, Sirirat M, Srichan R. Clinical effects of Andrographis paniculata gel as an adjunctive treatment in periodontitis: 3-month study. M Dent J 2013; 33:168-75.
Kuphasuk Y, Prommas C. The clinical result of subgingivally delivered Andrographis paniculata gel versus 10% doxycycline gel in the treatment of supportive periodontal therapy patients. M Dent J 2020; 40: 69-76. pISSN, eISSN 0125-5614.
American Diabetes Association. 3. Comprehensive medical evaluation and assessment of comorbidities: standards of medical care in diabetes-2017. Diabetes Care 2017; 40: S25-S32.
Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J 1975; 25: 229-35.
Löe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963; 21: 533-51.
Silness J, Löe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964; 22: 121-35.
Komwatchara T. The development of Andrographis paniculata extract gel for microbial inhibition in adult periodontitis. [M.S. Thesis in Pharmacy. Faculty of Graduate Studies, Mahidol University]. Bangkok: Mahidol University; 1996.
Aekplakorn W, Chariyalertsak S, Kessomboon P, Assanangkornchai S, Taneepanichskul S, Putwatana P. Prevalence of diabetes and relationship with socioeconomic status in the Thai population: National Health Examination Survey, 2004-2014. J Diabetes Res 2018; 2018: 1654530.
Fukai K, Takaesu Y, Maki Y. Gender differences in oral health behavior and general health habits in an adult population. Bull Tokyo Dent Coll 1999; 40: 187-93.
Tomasi C, Leyland AH, Wennström JL. Factors influencing the outcome of non-surgical periodontal treatment: a multilevel approach. J Clin Periodontol 2007; 34: 682-90.
Preshaw PM, Bissett SM. Periodontitis: oral complication of diabetes. Endocrinol Metab Clin North Am 2013; 42:
-67.
Sima C and Glogauer M. Neutrophil dysfunction and host susceptibility to periodontal inflammation: Current
state of knowledge. Curr Oral Health Rep 2014; 1: 95-103.
Golub LM, Schneir M, Ramamurthy NS. Enhanced collagenase activity in diabetic rat gingiva: in vitro and in vivo evidence. J Dent Res 1978; 57: 520-5.
Lalla E, Lamster IB, Stern DM, Schmidt AM. Receptor for advanced glycation end products, inflammation, and accelerated periodontal disease in diabetes: mechanisms and insights into therapeutic modalities. Ann Periodontol 2001: 6; 113-8.
Thorstensson H, Dahlén G, Hugoson A. Some suspected periodontopathogens and serum antibody response in adult long-duration insulin-dependent diabetics. J Clin Periodontol 1995; 22: 449-58
Aemaimanan P, Amimanan P, Taweechaisupapong S. Quantification of key periodontal pathogens in insulin-dependent type 2 diabetic and non-diabetic patients with generalized chronic periodontitis. Anaerobe 2013; 22: 64-8.
How KY, Song KP, Chan KG. Porphyromonas gingivalis: An overview of periodontopathic pathogen below the gum line. Front Microbiol 2016; 7: 53.
Al-Bayaty FH, Abdulla MA, Abu Hassan MI, Ali HM. Effect of Andrographis paniculata leaf extract on wound healing in rats. Nat Prod Res 2012; 26: 423-9.
Christgau M, Palitzsch KD, Schmalz G, Kreiner U, Frenzel S. Healing response to non-surgical periodontal therapy in patients with diabetes mellitus: clinical, microbiological, and immunologic results. J Clin Periodontol 1998; 25: 112-24.
Kadahl WB, Kalkwarf KL, Patil KD, Molvar MP, Dyer JK. Long-term evaluation of periodontal therapy: II. Incidence of sites breaking down. J Periodontol 1996; 67: 103-8.
Santos VR, Lima JA, De Mendonça AC, Braz Maximo MB, Faveri M, Duarte PM. Effectiveness of full-mouth and partial-mouth scaling and root planing in treating chronic periodontitis in subjects with type 2 diabetes. J Periodontol 2009; 80 :1237- 45.
Skaleric U, Schara R, Medvescek M, Hanlon A, Doherty F, Lessem J. Periodontal treatment by Arestin and its effects on glycemic control in type 1 diabetes patients. J Int Acad Periodontol 2004; 6: 160-5.