Effect of advanced periodontal self-care in patients with early-stage periodontal diseases on endothelial function: An open-label, randomized controlled trial

PLoS One. 2021 Sep 23;16(9):e0257247. doi: 10.1371/journal.pone.0257247. eCollection 2021.

Abstract

Although a significant association between periodontal disease and atherosclerotic cardiovascular disease has been reported, their cause-to-effect relationship remains controversial. This randomized controlled clinical trial aimed to investigate the effect of advanced self-care on atherosclerotic cardiovascular disease-related vascular function markers flow-mediated brachial artery dilatation (FMD) and serum asymmetric dimethylarginine (ADMA) level in patients with early-stage periodontal disease. The study was designed as a parallel group, 3-month follow-up, open-label, randomized controlled trial. The control group received standard care for periodontal diseases, whereas the test group additionally applied disinfectant using a custom-fabricated prescription tray for advanced self-care twice a day. Overall, 110 patients provided data for FMD and serum ADMA level. No significant improvements in FMD were observed in the control (mean increase, -0.1%; 95% confidence interval [CI], -1.0-0.8; P = 0.805) or test (mean increase, -0.3%; 95% CI, -1.1-0.4; P = 0.398) group. No significant changes in serum ADMA levels were observed (mean reduction, 0.01 μmol/L; 95% CI, -0.00-0.02; P = 0.366 and mean reduction, 0.00 μmol/L; 95% CI, -0.01-0.01; P = 0.349, respectively). No significant between-group differences were found in FMD (mean difference, -0.2%; 95% CI, -1.4-0.9; p = 0.708) or serum ADMA levels (mean difference, 0.01 nmol/L; 95% CI, -0.00-0.03; p = 0.122). Significant improvements in the average probing pocket depth were observed in the control and test groups. The bleeding on probing score in the test group was significantly reduced, while that in the control group was reduced, although not significantly. Periodontal care for a 3-month duration did not provide better endothelial function although improvements of periodontal status in patients with early-stage periodontal diseases. This trial is registered in UMIN Clinical Trials Registry (www.umin.ac.jp/ctr/; ID: UMIN000023395).

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Arginine / analogs & derivatives
  • Arginine / blood
  • Atherosclerosis / complications
  • Atherosclerosis / prevention & control*
  • Biomarkers / blood
  • Brachial Artery / pathology
  • Dilatation, Pathologic
  • Endothelium, Vascular / drug effects
  • Female
  • Follow-Up Studies
  • Humans
  • Japan
  • Male
  • Mandible / physiology
  • Maxilla / physiology
  • Middle Aged
  • Oral Hygiene / methods*
  • Periodontal Diseases / prevention & control*
  • Periodontal Diseases / therapy*
  • Self Care*
  • Treatment Outcome
  • Young Adult

Substances

  • Biomarkers
  • N,N-dimethylarginine
  • Arginine

Grants and funding

This work was supported by the Japan Society for the Promotion of Science (JSPS) [Grant numbers 16K20704 (MA), 17K12031 (AO), 17K11688 (KM), 18K09926 (NH), 19K10471 (TM), 19K19339 (RO)] and the SECOM Science and Technology Foundation [Grant number 2018.09.10 No. 1 (NH)]. Japan Society for the Promotion of Science: https://www.jsps.go.jp/ SECOM Science and Technology Foundation: https://www.secomzaidan.jp/ The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.