|Year : 2014 | Volume
| Issue : 1 | Page : 24-26
Comparative evaluation of hemoglobin level in anemic patients with chronic periodontitis before and after treatment
Mranali K Shetty1, Bijju Thomas2, A Veena Shetty3
1 Department of Periodontics, Manipal College of Dental Sciences mangalore, Manipal University, Mangalore, Karnataka, India
2 Department of Periodontics, A. B. Shetty Memorial Institute of Dental Sciences, Nitte University, Mangalore, Karnataka, India
3 Department of Microbiology, KSHEGDE Medical Academy, Nitte University, Mangalore, Karnataka, India
|Date of Web Publication||21-Jun-2014|
Mranali K Shetty
Department of Periodontics, Manipal College of Dental Sciences mangalore, Manipal University, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Anemia can be caused by various chronic diseases, one of which could be chronic periodontitis. Treatment of chronic periodontitis has shown to improve hematological values. This study aimed at assessing effect of periodontal therapy on hemoglobin levels in patients with chronic periodontitis. Materials and Methods: This was a case-control study consist of 40 anemic subjects with hemoglobin levels of ≤8 g/dl. The sample size comprised of 20 periodontally healthy subjects and 20 subjects with chronic periodontitis. Blood samples were collected before and after therapy for hemoglobin assessment and all the patients were subjected to periodontal therapy. The values were subjected to statistical analysis. Results: The study showed that there was an improvement in hemoglobin level for the test group after periodontal therapy, which was statistically significant. Conclusion: The phase I periodontal treatment helped in improvement of the hemoglobin level in chronic periodontitis group.
Clinical Relevance to Interdisciplinary Dentistry
- Many systemic diseases have been implicated as risk indicators or risk factors in oral diseases.
- To understand the pathogenesis of the systemic diseases to oral diseases is important for the dental clinicians (endodontists, periodontists, prosthodontists) to draw comprehensive treatment plan for the patient.
- This article explains the influence of anemia of chronic disease on the outcome of periodontal treatment.
Keywords: Hemoglobin, periodontitis, root planning and scaling
|How to cite this article:|
Shetty MK, Thomas B, Shetty A V. Comparative evaluation of hemoglobin level in anemic patients with chronic periodontitis before and after treatment. J Interdiscip Dentistry 2014;4:24-6
|How to cite this URL:|
Shetty MK, Thomas B, Shetty A V. Comparative evaluation of hemoglobin level in anemic patients with chronic periodontitis before and after treatment. J Interdiscip Dentistry [serial online] 2014 [cited 2020 Jul 11];4:24-6. Available from: http://www.jidonline.com/text.asp?2014/4/1/24/135000
| Introduction|| |
Periodontitis is a chronic inflammatory disease caused by Gram-negative anaerobic bacteria. Certain systemic conditions may initiate or progress gingivitis and periodontitis. The converse side of the relationship between systemic health and oral health has also been demonstrated. This means that there may be potential effects of periodontal disease on a wide range of organ systems.  The changes in immune response offers an explanation of the mechanisms for the interactions between periodontal infection and a variety of systemic disorders.  This leads to the production of cytokines, most notably tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-1 and IL-6.  Such inflammatory cytokines can depress erythropoietin production leading to the development of anemia. , Hutter et al.  have concluded that periodontitis, like other chronic conditions, lead to anemia. Hence, the purpose of this study is to assess the effect of periodontal therapy on anemia.
This study aimed at assessing effect of periodontal therapy on hemoglobin levels in subjects with chronic periodontitis.
| Materials and methods|| |
Subjects reporting to the outpatient Department of Periodontics were selected for the study. The research protocol was submitted to the Institutional Ethical Committee and Review Board. After ethical approval, all subjects were verbally informed about the study, and written informed consent was obtained. A total of 40 subjects between the age group of 30 and 55 years are included in the study. Patients with hemoglobin levels ≤8 g/dl were included in the study.
- Group A: Includes 20 subjects as controls
- Group B: Includes 20 subjects diagnosed with chronic generalized periodontitis.
Inclusion criteria for Group A
Confirmed anemic patients who had healthy periodontium with a clinical probing sulcus depth of 2-3 mm.
Inclusion criteria for Group B
Confirmed anemic patients with chronic generalized periodontitis with a probing pocket depth of ≥5 mm, presence of bleeding on probing, loss of attachment of ≥2 mm, and gingival index score of ≥1 mm.
- History of any systemic diseases other than anemia
- Female patients
- Patient who have been on any long-term medication 3 months preceding the study
- Present and past smokers
- Patients who have undergone periodontal treatment 6 months prior to the study
- Patients who have <16 remaining teeth in the mouth.
- Medical and dental history was taken
- Modified sulcular bleeding index (Mombelli et al. in 1987)
- Pocket depth (≥5 mm)
- Loss of attachment of ≥3 mm (based on AAP 1999 classification).
Under aseptic conditions 2 ml of venous blood was drawn from ante-cubital fossa and sent for investigation of hemoglobin levels. Probing pocket depth and loss of attachment were recorded at base line using mouth mirror, Williams graduated periodontal probe. Thorough phase I therapy was carried out for both groups, which included scaling and root planning. Patients were given oral hygiene instructions that included brushing technique and use of mouth rinse.
Patients were recalled after 3 months. Probing pocket depth and loss of attachment were recorded. Blood samples were collected again for assessing hemoglobin levels. The values were subjected to statistical analysis using paired and unpaired t-test.
| Results|| |
A total of 40 anemic subjects, 20 periodontally healthy and 20 with chronic generalized moderate to severe periodontitis were included in this study.
After undergoing phase I periodontal therapy, patients in the chronic periodontitis group showed an improvement in hemoglobin levels, which was statistically significant [Figure 2].
When comparing the hemoglobin values of periodontally healthy patients before and after phase I, statistically significant difference was not found [Figure 1].
|Figure 1: Descriptive statistics of control and periodontitis group before and after treatment|
Click here to view
|Figure 2: Comparison of hemoglobin level before and after treatment in study subjects|
Click here to view
When control and test group were compared for hemoglobin values before and after therapy, test group showed statistically significant difference.
| Discussion|| |
The relation between anemia and periodontitis has been explored in the latter half of 20 th century. Chawla et al.  suggested anemia as an important factor in the causation or pathogenesis of periodontal disease. Seigel  have reported a depression in the number of erythrocytes apparently secondary to the presence of periodontal disease, since arrest or cure of these pathological processes in individual cases resulted in the elevation of erythrocyte count to normal or high normal levels. Chronic periodontal disease as a possible contributing factor or cause of mild anemia was also indicated. Thomas et al.  showed that periodontitis patient have a lower hematocrit, lower number of erythrocytes, lower hemoglobin levels and higher erythrocyte sedimentation rates. Whereas, the studies by Wakai et al.  and Havemose-Poulsen et al.  failed to show any association between hemoglobin levels and periodontal status. In particular IL-1, IL-6, and TNF have been implicate the cytokines responsible for suppressing erythropoiesis.  Pro-inflammatory cytokines such as TNF-α, IL-Iβ, interferon-I, and PGE2 are found in high concentrations in inflamed tissues. The various cytokines can enter the blood circulation and affect distant sites and organs. The same inflammatory cytokines have been found to be central in the pathogenesis of anemia of chronic disease. , The present study showed an improvement in the hemoglobin levels in anemic patients with chronic periodontitis. This was in accordance with the study done by Nupur et al.
Agarwal  showed that treatment of periodontitis lead to an improvement in hematocrit and other related blood parameters in chronic generalized periodontitis patients with anemia. A study conducted by Pradeep and Anuj  concluded that chronic periodontitis may tend toward anemia and provides evidence that nonsurgical periodontal treatment can improve the anemic status of patients with chronic periodontitis, and that improvement in hematologic parameters was greater in female subjects which is in agreement with our study.
| Conclusion|| |
The present study showed that periodontitis, like other chronic conditions, may increase the anemic state by lowering the hemoglobin levels in chronic periodontitis, but later the hemoglobin levels could have improved due to phase I periodontal therapy which was statistically significant.
| References|| |
|1.||Newman M, Takei H, Klokkevold P, Carranza F. Clinical Periodontology. 10 th ed. St .Louis , Missouri: W. B. Saunders; 2006. |
|2.||Mealey BL, Klokkevold PR. Periodontal medicine. In: Newman MG, Takei HH, Carranza FA, editors. Carranza′s Clinical Periodontology. 9 th ed. Philadelphia: Saunders; 2002. p. 229-44. |
|3.||Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med 2005;352:1011-23. |
|4.||Faquin WC, Schneider TJ, Goldberg MA. Effect of inflammatory cytokines on hypoxia-induced erythropoietin production. Blood 1992;79:1987-94. |
|5.||Raja KB, O Latunde-Dada G, Peters TJ, McKie AT, Simpson RJ. Role of interleukin-6 in hypoxic regulation of intestinal iron absorption. Br J Haematol 2005;131:656-62. |
|6.||Hutter JW, van der Velden U, Varoufaki A, Huffels RA, Hoek FJ, Loos BG. Lower numbers of erythrocytes and lower levels of hemoglobin in periodontitis patients compared to control subjects. J Clin Periodontol 2001;28:930-6. |
|7.||Chawla TN, Kapoor KK, Teotia SP, Singh NK. Anaemia and periodontal disease - A correlative study. J Indian Dent Assoc 1971;43:67-78. |
|8.||Seigel EH. Total erythrocyte, leucocyte and differential white cell counts of blood in chronic periodontal disease. J Dent Res 1945;24:270. |
|9.||Thomas B, Ramesh A, Rithesh K. Relationship between periodontitis and erythrocyte count. J Indian Soc Periodontol 2006;10:288-91. |
|10.||Wakai K, Kawamura T, Umemura O, Hara Y, Machida J, Anno T, et al. Associations of medical status and physical fitness with periodontal disease. J Clin Periodontol 1999;26:664-72. |
|11.||Havemose-Poulsen A, Westergaard J, Stoltze K, Skjødt H, Danneskiold-Samsøe B, Locht H, et al. Periodontal and hematological characteristics associated with aggressive periodontitis, juvenile idiopathic arthritis, and rheumatoid arthritis. J Periodontol 2006;77:280-8. |
|12.||Fuchs D, Hausen A, Reibnegger G, Werner ER, Werner-Felmayer G, Dierich MP, et al. Immune activation and the anaemia associated with chronic inflammatory disorders. Eur J Haematol 1991;46:65-70. |
|13.||Greer J, Rodgers G, Joersfer J, Paraskevas F. Wintrobes C linical Haematology. 11 th ed. Philadelphia, USA: Lippincott Williams and Wilkins; 2004. |
|14.||Agarwal N, Kumar VS, Gujjari SA. Effect of periodontal therapy on hemoglobin and erythrocyte levels in chronic generalized periodontitis patients: An interventional study. J Indian Soc Periodontol 2009;13:6-11. |
|15.||Pradeep AR, Anuj S. Anemia of chronic disease and chronic periodontitis: Does periodontal therapy have an effect on anemic status? J Periodontol 2011;82:388-94. |
[Figure 1], [Figure 2]