title: A randomized controlled trial of intensive periodontal therapy on metabolic and inflammatory markers in patients With ESRD: results of an exploratory study.
abstract: BACKGROUND
  Periodontitis is a novel risk factor for inflammation and cardiovascular disease in the dialysis population. Limited information exists about the impact of periodontal therapy in patients receiving dialysis.
  
  
  METHODS
  Randomized controlled trial to assess feasibility and gather preliminary data.
  
  
  METHODS
  Dialysis patients with moderate/severe chronic periodontitis.
  
  
  METHODS
  Intensive treatment, consisting of scaling and root planing, extraction of hopeless teeth, and placement of local-delivery antibiotics, was performed at the baseline visit for treatment-group patients and after study completion for control-group patients.
  
  
  RESULTS
  Outcomes were feasibility (screening, recruitment, enrollment, adverse events, and study withdrawal/completion), clinical periodontal parameters (probing depth, clinical attachment level, bleeding on probing, gingival index, and plaque index), and serum albumin and interleukin 6 levels at 3 and 6 months postintervention.
  
  
  RESULTS
  342 dialysis patients were approached for participation: 53 were randomly assigned, with 26 participants assigned to immediate treatment and 27 assigned to a control arm for treatment after 6 months. 51 patients completed baseline appointments; 46 were available for 3-month follow-up, 45 were available for 6-month follow-up examinations, and 43 completed all visits. At 3 months, there was a statistically significant improvement for the treatment group compared to the control group for 3 periodontal parameters: mean probing depth (P = 0.008), extent of probing depth ≥4 mm (P = 0.02), and extent of gingival index ≥1 (P = 0.01). However, by 6 months, the difference between groups was no longer present for any variable except probing depth ≥4 mm (P = 0.04). There was no significant difference between groups for serum albumin or high-sensitivity interleukin 6 level at any time when adjusted for body mass index, diabetic status, and plaque index.
  
  
  CONCLUSIONS
  Small sample size and relatively healthy population, imbalance in diabetes.
  
  
  CONCLUSIONS
  This small trial demonstrates successful cooperation between dentists and nephrologists and successful recruitment, treatment, and retention of dialysis patients with periodontitis. Larger studies with longer follow-up are needed to determine whether treatment can improve markers of inflammation and morbidity.
authors.affiliation: Department of Periodontics, University of Texas School of Dentistry at Houston, Houston, TX, USA. meggan.wehmeyer@gmail.com
authors.forename: Meggan M H
authors.initials: MM
authors.lastname: Wehmeyer
authors.forename: Abhijit V
authors.initials: AV
authors.lastname: Kshirsagar
authors.forename: Silvana P
authors.initials: SP
authors.lastname: Barros
authors.forename: James D
authors.initials: JD
authors.lastname: Beck
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Moss
authors.forename: John S
authors.initials: JS
authors.lastname: Preisser
authors.forename: Steven
authors.initials: S
authors.lastname: Offenbacher
mesh_terms: D002908:Chronic Disease; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010518:Periodontitis / Q000097:blood* / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index
chemical_list: D015850:Interleukin-6; D012709:Serum Albumin