|Year : 2017 | Volume
| Issue : 2 | Page : 109-113
Effect of scaling and root planing on blood counts in patients with chronic generalized periodontitis
Devinder Singh Kalsi, Anchal Sood, Simran Mundi, Vikrant Sharma
Department of Periodontics, Baba Jaswant Singh Dental College, Ludhiana, Punjab, India
|Date of Web Publication||26-May-2017|
Devinder Singh Kalsi
Department of Periodontics, Baba Jaswant Singh Dental College, Ludhiana, Punjab
Source of Support: None, Conflict of Interest: None
Background: Many systemic diseases have been implicated as risk factors in periodontal disease. Studies suggest that periodontal infection can adversely affect systemic health; by inference periodontal disease will also have an effect on blood values, but the data available is not conclusive. Aim: This clinical study was designed to evaluate the effect of treatment of plaque induced periodontitis on commonly assessed blood parameters. Materials and Method: 37 males and 31 females aged between 20 and 50 years in good general health but suffering from plaque induced chronic periodontitis were selected for the study. The selected patients were assessed for ESR, TLC, PMN count, lymphocyte count from DLC, HB, BT and their periodontal condition before the start of the study. SCRP was carried out and patients were reassessed for the same clinical and hematological parameters 21 days after the periodontal therapy (SCRP). Results: A highly significant reduction in the counts of PMNs and the values of ESI was seen after SCRP. Furthermore a significant reduction in TLC, lymphocytes count, and BT and a non significant decrease in Hb were also observed. Conclusion: SCRP done in patients of chronic periodontitis has a considerable affect on the assessed blood parameters.
Keywords: Lymphocyte count, periodontal disease, total leukocyte count
|How to cite this article:|
Kalsi DS, Sood A, Mundi S, Sharma V. Effect of scaling and root planing on blood counts in patients with chronic generalized periodontitis. Indian J Dent Sci 2017;9:109-13
|How to cite this URL:|
Kalsi DS, Sood A, Mundi S, Sharma V. Effect of scaling and root planing on blood counts in patients with chronic generalized periodontitis. Indian J Dent Sci [serial online] 2017 [cited 2019 Dec 5];9:109-13. Available from: http://www.ijds.in/text.asp?2017/9/2/109/207097
| Introduction|| |
For decades, blood has been used as a diagnostic body fluid for assessing the status of various infections and systemic diseases. For the past many years, plaque-induced chronic periodontitis, through several studies, has been linked to various systemic diseases, disorders, and conditions and is known to change the cellular and molecular components of blood. It is already known that systemic effects of periodontal diseases are known to be caused by bacteremia arising from diseased periodontal tissues and the resultant inflammatory response. It is exhibited in blood as an increase in total leukocyte count (TLC), PMN and lymphocyte count, and erythrocyte sedimentation rate (ESR) values. Mechanical debridement is the cornerstone for plaque control and treatment of infective-inflammatory periodontal diseases, so much so that scaling and root planing (SCRP) are common basic first-line treatments for practically all periodontal diseases. They are used both as initial- and maintenance-phase therapies. It is well known now that the initiation and progression of gingivitis and periodontitis may be affected by certain systemic diseases and conditions, and the relationship between systemic health and oral health has been demonstrated in many studies. Lainson was one of the first authors to report anemia as a cause of periodontitis. It is now becoming increasingly clear that a reverse relationship also exists, i.e., periodontal disease adversely affects systemic health also. This means that there may be potential effect of periodontal diseases on a wide range of organ systems including blood. Many authors have concluded that periodontal diseases can lead to adverse changes in commonly assessed blood parameters (i.e., hemoglobin [Hb], white blood cell, PMN and lymphocyte count from differential leukocyte count [DLC], and ESR) although some other authors have not found such a correlation., Seigel reported a decrease in the number of erythrocytes secondary to the presence of periodontal disease.
It is a known fact that these blood values are commonly assessed for knowing the status of systemic health and disease both by dental and medical doctors in several oral and systemic diseases and conditions. If indeed, periodontal disease, one of the most common diseases afflicting humanity, can cause alterations in the blood counts, this fact must be well known to treating physicians and dentists as they may be assessing systemic condition and disease of their patients through blood values while looking for and treating systemic ailments whereas these values might have actually been altered by periodontal disease alone or periodontal disease in combination with systemic disorders.
Conclusive evidence of interrelationship between these blood values and infective-inflammatory periodontal disease must, therefore, be available and known to all for the overall good of our patients. In the absence of conclusive data on interrelationships between SCRP and its effect on blood parameters, the present clinical study was designed to research and evaluate the effect of infective-inflammatory periodontal disease and its treatment on commonly assessed blood parameters such as ESR, TLC, polymorphonuclear leucocyte count (PMN) and lymphocyte count from DLC, Hb, and bleeding time (BT).
| Materials and Methods|| |
The present study was conducted after taking the due clearance from the Ethical Committee of Baba Jaswant Singh Dental College and obtaining informed consent from the participants selected for the study. Sixty-eight patients; 37 males and 31 females, in good general health and with no history of chronic disease or episode of ill health at least 8 weeks before start of this study, aged between 20 and 50 years but suffering from generalized chronic plaque-induced periodontitis, visiting the Department of Periodontology, Baba Jaswant Singh Dental College Hospital and Research Institute, Ludhiana, were selected for the study. The patients who had undergone antimicrobial therapy due to any reason in the past 6 months were excluded from the study, also patients who were smokers and females who were either pregnant or were <1 year postpartum were excluded from the study. The females included in this study were in the intervening periods of their menstrual cycle. Of these, eight patients did not complete the study. Therefore, results obtained from sixty patients were compiled and assessed for this study. Patients chosen for the study had at least 24 teeth present in the mouth, generalized pockets >3 mm deep, a CPITN score of 2 or more, were nonsmokers, and otherwise systemically healthy. They remained in good general health till at least 4 weeks from the start of the study. The selected patients were assessed for their ESR by Westergren method, TLC, polymorph count (PMN) and lymphocyte count from DLC, Hb, and BT and their periodontal condition before the start of the study. This formed the baseline visit and full mouth SCRP was then carried out in this visit. Patients were then reassessed for the clinical and hematological parameters 21 days after the periodontal treatment (SCRP) was completed. The above-mentioned blood tests were carried out at the clinical laboratory of Baba Jaswant Singh Dental College Hospital and Research Institute, Ludhiana. The data were collected for all participants and tabulated and statistically analyzed for the difference in individual blood parameters using paired t-test with a level of significance 0.05.
| Results|| |
The data for sixty patients are tabulated in [Table 1]. It shows the total sum of the counts of various blood parameters, their averages, and the change in the pre- and posttreatment readings. The [Graph 1] and [Graph 2] are a pictorial representation of the pre- and post-SCRP readings of blood parameters and the difference in them. The mean value of ESR at the baseline visit was 13.05 mm/h and was reduced to 8.7 mm/h 3 weeks after SCRP showing a reduction of 4.35 mm/h which is statistically highly significant. Further, the total average value of TLC for sixty patients at baseline visit was 6455/mm 3 which decreased to 6040/mm 3 3 weeks after SCRP showing a reduction of 415/mm 3 which is statistically significant [Table 1].
Similarly, the average number of PMNs before and after SCRP was 4168. 25/mm 3 and 3676.2/mm 3, respectively, showing a decrease of 440.63/mm 3. This reduction in the PMN count is statistically highly significant. The average number of lymphocytes before and after SCRP was 2184.1 and 2183.65/mm 3, respectively, showing a decrease of 0.45/mm 3 which is a statistically nonsignificant reduction. The average of Hb before SCRP was 12.80 g% and 12.71 g% after 3 weeks. The reduction in the value of Hb (0.95 g%) is statistically significant. The average value of BT at baseline visit was 1.90 s and reduced to 1.81 s after 3 weeks. The reduction in the BT was 0.09 s which is statistically significant [Table 1].
| Discussion|| |
Periodontal disease is considered to be a mixed infection wherein pathogens act directly or indirectly to cause destruction of tooth-supporting structures. The main etiological factor is the accumulation of microbial plaque in the dentogingival area. The host reacts to this bacterial challenge by activating its defense mechanisms in an attempt to localize and eventually eliminate the pathogens. Defenses against infection comprise a wide range of physical, chemical, and microbiologic barriers that prevent pathogens from invading the tissues of the body. The primary function of the immune system of the mouth is to protect the teeth, gingival, and the oral mucosa against infection. Saliva, gingival crevicular fluid, and the epithelial cells of the oral mucosa provide the first line of defense for the tissues of the oral cavity and in particular the periodontium. If these primary defenses are breached, then the cellular and molecular elements of the innate immune response are activated. Recognition of pathogenic microorganisms and recruitment of effector cells (e.g., neutrophils and lymphocytes) and molecules (e.g., the complement system) are central to effective innate immunity.
The assessed parameters (ESR, TLC, count of PMNs and lymphocytes from DLC, Hb, and BT) are commonly evaluated indicators of systemic health and disease and can show alterations due to oral infectious diseases (e.g., chronic periodontitis). Health officials may err in reaching a diagnosis of patient's systemic health status if role of oral infections is not factored in during assessment of patient's systemic health/disease state, when evaluating patients with altered test values of ESR, PMN count, lymphocyte count, TLC, Hb, and BT. The present study was, therefore, designed and carried out to evaluate the effect of SCRP on blood values of ESR, TLC, count of PMNs and lymphocytes from DLC, Hb, and BT in plaque-induced chronic periodontitis patients having good general health. The interrelationship between treatment of chronic periodontitis and various blood values has been explored, but conclusive evidence still eludes us.
The ESR is a method of monitoring the progress of treatment of diseases, of which inflammation is a major component. The ESR is the rate at which the red blood cells sediment in a period of 1 h. Although it is a nonspecific measure of severity of inflammation, it is still a commonly relied upon hematological test both by physicians and dental surgeons. There are two methods of evaluating the ESR - Wintrobe method and Westergren method. The Westergren method was applied in our study. The normal range of ESR by Westergren method is 0–22 mm/h for men and 0–29 mm/h for women. A higher ESR indicates a greater inflammatory process, whereas a decreased/normal ESR is correlated with a lesser active/no inflammatory disease. Determination of ESR is helpful in assessing the progress of patients treated for chronic inflammatory disorders. It has also been shown that patients suffering from plaque-induced chronic generalized periodontitis have higher ESR.,, Our study shows a highly significant decrease in ESR in periodontitis patients after periodontal treatment which is in agreement with the results of another study  [Table 1].
The TLC is an important component of the complete blood count. Increased number of leukocytes in the blood is often an indicator of infectious disease. The normal TLC is usually between 4000 and 11,000/mm 3 of blood. Our present study shows a significant decrease in TLC after SCRP which is in agreement with several other studies.,,,, After phase I therapy, reduction in TLC and ESR can be attributed to reduction in infection and infection-induced inflammation in plaque-induced periodontitis.
Polymorphs are cells of acute inflammation, and plaque-induced periodontitis is an infective-inflammatory disease. The normal polymorph count ranges from 2500 to 7000/mm 3. Our study shows a decrease in an average of polymorph count from 4168.25/mm 3 to 3676.2/mm 3 [Table 1]. Results of the present study are also in agreement with other studies that showed a significant decrease in TLC and polymorph count.,,,,
Lymphocytes are cells of chronic inflammation. Their numbers are elevated in chronic infective-inflammatory diseases such as chronic generalized plaque-induced periodontitis. Normally, the lymphocytes range from 1700 to 3500/mm 3 of blood. Our study shows a decrease in an average of lymphocytes from 2184.1/mm 3 to 2183.65/mm 3 after 18–21 days of SCRP which is a nonsignificant (P = 0.49) decrease [Table 1]. This slight decrease in lymphocytes is observed in our study which may be attributable to the decrease in the level of infective-inflammatory periodontal disease following Phase I therapy (SCRP).
Hb concentration measurement is another most commonly performed blood test. The association between Hb concentration and periodontitis has been studied in the past. Lainson was one of the first authors who reported anemia as a cause of periodontitis. Rai and Kharb, in a 10-week intervention study, found an increase in Hb after SCRP in patients with severe periodontitis. A study in the past has reported an increase in Hb level implies that anemia associated with periodontitis is of normochromic types. This is, however, not in agreement with our study which shows a significant and unexplained decrease in an average of Hb from 12.805 g% to 12.71 g% [Table 1]. The results of our study are in accordance with Havemose who failed to show any association between Hb and periodontitis patients.
Test for BT is done to assess platelet function and the body's ability to form a platelet plug at the site of injury. According to Duke's method, the normal BT ranges from 1 to 3 min. Platelets play a significant role in controlling bleeding. BT is commonly evaluated before surgery and in several hemorrhagic disorders such as dengue. Our study shows a significant reduction in BT after SCRP; however, the reason for this is unclear.
The results of this study show that the plaque-induced chronic periodontitis and its treatment do have an effect on the evaluated blood parameters even though their altered values remained within the normal range. During the course of the study, some cases showed a very large variation in the blood parameters evaluated in this study although such extreme variants got subdued when averaging of these values was done, and results were tabulated, and the conclusions were drawn and recommendations were given on the basis of such average values. If these observations are universally true, the results of this study will serve as useful information to treating dentists and physicians in perplexing situations wherein they do not find reasons for elevated blood values, especially ESR, TLC, and PMN counts. Results of this study suggest that in several situations, these counts (especially ESR, TLC, and PMN) may be altered solely as an after effect of infective-inflammatory periodontal disease or a combination of infective-inflammatory periodontal disease and infective and/or inflammatory systemic disease rather than solely due to a systemic ailment, usually being looked for by the medical doctors or dentists.
| Conclusion|| |
The present study was aimed at evaluating the effect of SCRP on various blood parameters, i.e., ESR, TLC, count of PMNs and lymphocytes from DLC, Hb, and BT. Our study shows a highly significant reduction in the counts of PMNs and the value of ESR after SCRP (Phase I therapy) in plaque-induced chronic generalized periodontitis patients. Furthermore, there is a significant reduction in TLC, lymphocytes count, and BT and an insignificant decrease in Hb. Thus, it can be inferred that there is an effect of periodontal disease and its treatment on these commonly assessed blood parameters.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Loos BG. Systemic markers of inflammation in periodontitis. J Periodontol 2005;76 11 Suppl: 2106-15.
Li X, Kolltveit KM, Tronstad L, Olsen I. Systemic diseases caused by oral infection. Clin Microbiol Rev 2000;13:547-58.
Lainson PA, Brady PP, Fraleigh CM. Anemia, a systemic cause of periodontal disease? J Periodontol 1968;39:35-8.
Newman M, Takei H, Klokkevold P. Carranza's Clinical Periodontology. 10th
ed. St. Louis: W.B. Saunders; 2006.
Gokhale SR, Sumanth S, Padhye AM. Evaluation of blood parameters in patients with chronic periodontitis for signs of anemia. J Periodontol 2010;81:1202-6.
Yamamoto T, Tsuneishi M, Furuta M, Ekuni D, Morita M, Hirata Y. Relationship between decrease of erythrocyte count and progression of periodontal disease in a rural Japanese population. J Periodontol 2011;82:106-13.
Seigel EH. Total erythrocyte, leucocyte and differential white cell counts of blood in chronic periodontal disease. J Dent Res 1945;24:270.
Cutress TW, Ainamo J, Sardo-Infirri J. The community periodontal index of treatment needs (CPITN) procedure for population groups and individuals. Int Dent J 1987;37:222-33.
Landi L, Amar S, Polins AS, Van Dyke TE. Host mechanisms in the pathogenesis of periodontal disease. Curr Opin Periodontol 1997;4:3-10.
Czerkinsky C, Anjuere F, McGhee JR, George-Chandy A, Holmgren J, Kieny MP, et al.
Mucosal immunity and tolerance: Relevance to vaccine development. Immunol Rev 1999;170:197-222.
Preshaw PM, Taylor JJ. Periodontal pathogenesis. In: Preshaw PM, editor. Carranza's Clinical Periodontology. 11th
ed. Missouri: Elsevier Saunders; 2012.
Merchant A. Whether periodontitis cause anemia cannot be determined. J Evid Based Dent Pract 2002;2:239-40.
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.
Thomas B, Ramesh A, Ritesh K. Relationship between periodontitis and erythrocytes count. J Indian Soc Periodontol 2006;10:288-91.
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.
] [Full text]
Fredriksson MI, Figueredo CM, Gustafsson A, Bergström KG, Asman BE. Effect of periodontitis and smoking on blood leukocytes and acute-phase proteins. J Periodontol 1999;70:1355-60.
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.
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.
Christan C, Dietrich T, Hägewald S, Kage A, Bernimoulin JP. White blood cell count in generalized aggressive periodontitis after non-surgical therapy. J Clin Periodontol 2002;29:201-6.
Loos BG, Craandijk J, Hoek FJ, Wertheim-van Dillen PM, van der Velden U. Elevation of systemic markers related to cardiovascular diseases in the peripheral blood of periodontitis patients. J Periodontol 2000;71:1528-34.
Rai B, Kharb S. Effect of scaling and root planning in periodontitis on peripheral blood. Internet J Dent Sci 2007;6:1.
Li X, Kolltveit KM, Mohan H. Textbook of Pathology. 5th
ed. Mumbai: Jaypee Brothers Medical Publications (P); 2005.
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.
Duke WW. The relation of blood platelets to hemorrhagic disease. Description of a method for determining the bleeding time and the coagulation time and report of three cases of hemorrhagic disease relieved by blood transfusion. J Am Med Assoc 1910;55:1185-92.