title: Evaluation of nonsurgical periodontal therapy in chronic periodontitis patients with anemia by estimating hematological parameters and high-sensitivity C-reactive protein levels.
abstract: BACKGROUND
  Periodontal tissues mount an immune inflammatory response to bacteria and their products. Certain inflammatory cytokines produced during periodontal inflammation increase the production of acute phase proteins like high‑sensitivity C‑reactive protein (hs‑CRP) and can depress erythropoietin production leading to the development of anemia.
  
  
  OBJECTIVE
  The aim of this study is to investigate the efficacy of nonsurgical periodontal therapy on red blood cell (RBC) parameters and hs-CRP in chronic periodontitis patients with anemia.
  
  
  METHODS
  This is a longitudinal, interventional study with 6-month follow-up. A total of 30 subjects with anemia and chronic periodontitis with age group of 33-55 years were selected by screening hemoglobin (Hb) levels and examining periodontal findings. The clinical parameters plaque index (PI), gingival index (GI), probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at baseline. Laboratory blood investigations were performed to evaluate RBC count, Hb, packed cell volume (PCV), erythrocyte sedimentation rate (ESR) and red cell indices, hs-CRP at baseline. Nonsurgical periodontal therapy was performed for all patients. Patients were recalled after 6 months. The clinical and hematological parameters were re-evaluated to analyze the changes after nonsurgical periodontal therapy.
  
  
  RESULTS
  The results showed that there was a significant increase in Hb levels, RBC count and PCV from baseline to 6 months after nonsurgical periodontal therapy. There is significant decrease in levels of ESR and hs-CRP levels after nonsurgical periodontal therapy indicating resolution of periodontal inflammation. There is a significant decrease in PPD, scores of PI and GI and significant increase in CAL gain. Minimal changes in mean corpuscular volume, mean corpuscular hemoglobin (MCH) and MCH concentration indicated that the lower values of red cell parameters are not due to any vitamin and mineral deficiencies, but secondary to the chronic inflammatory changes associated with chronic periodontal disease.
  
  
  CONCLUSIONS
  The present study strengthens the hypothesis that chronic periodontitis may lead to anemia and provides evidence that nonsurgical periodontal therapy can improve the anemic status and reduce levels of hs-CRP in patients with chronic periodontitis.
authors.affiliation: Department of Periodontics, St Joseph Dental College, Duggirala, Eluru, Andhra Pradesh, India.
authors.forename: S V V S
authors.initials: SV
authors.lastname: Musalaiah
authors.affiliation: Department of Periodontics, St Joseph Dental College, Duggirala, Eluru, Andhra Pradesh, India.
authors.forename: M
authors.initials: M
authors.lastname: Anupama
authors.affiliation: Department of Periodontics, St Joseph Dental College, Duggirala, Eluru, Andhra Pradesh, India.
authors.forename: M
authors.initials: M
authors.lastname: Nagasree
authors.affiliation: Department of Prosthodontics, St Joseph Dental College, Duggirala, Eluru, Andhra Pradesh, India.
authors.forename: Ch Murali
authors.initials: ChM
authors.lastname: Krishna
authors.affiliation: Department of Periodontics, St Joseph Dental College, Duggirala, Eluru, Andhra Pradesh, India.
authors.forename: Aravind
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Periodontics, St Joseph Dental College, Duggirala, Eluru, Andhra Pradesh, India.
authors.forename: P Mohan
authors.initials: PM
authors.lastname: Kumar
keywords: Anemia; C-reactive protein; chronic periodontitis; non-surgical periodontal therapy