Effect of a training program on periodontal health status in diabetic patients

Schulze A2, Busse M1

General Outpatient Ambulance1 and Sports Dentistry2 of the Institute of Sports Medicine, University of Leipzig
(1Director: Prof. M.W. Busse, MD, PhD) (2Head: A. Schulze, DDS)

Summary

Schulze A, Busse M. Effect of a training program on periodontal health status in diabetic patients. Clinical Sports Medicine International (CSMI) 2008, 2: 16-19

Purpose: Since systemic inflammation appears to be a major factor of diabetes, periodontitis may be considered a representative site of this general immunological disorder. Diabetes is associated with increased prevalence, severity, and progression of periodontal diseases. The prevalence of diabetes is more than twice as high in patients with periodontitis compared to healthy subjects. Periodontal disease may contribute to systemic inflammation and worsening insulin resistance and glycemic control due to the generation of inflammatory cytokines. Physical exercise may be helpful to increase insulin sensitivity and to improve glucose metabolism. Further moderate endurance exercise may improve resistance against infectious diseases. The aim of this study was to determine the effects of physical exercise on periodontal inflammation in diabetics with periodontal diseases.

Methods: 14 good controlled type 2 diabetics were examined before and after 6 months of moderate recreational training 2 times a week. A self-reported oral hygiene and health questionnaire was completed. All subjects had a clinical dental examination, including plaque index and gingivitis index, probing depth, clinical attachment loss and Periodontal Screening Index.

Results: There were no significant changes in weight and HbA1c. Overall dental hygiene was not changed. Insignificantly improved values were found for clinical attachment loss and loss of insertion. The periodontal screening index (PSI) was significantly decreased by 8%. The periodontal bleeding index 3 (PBI) was significantly reduced to 39% of pre-training score values. The number of probing pocket depth sites >5 mm or >6mm was highly significantly reduced to 61% or 23%, respectively. The gingival index (GI) was highly significantly reduced to 61%.

Conclusions: A six months rehabilitative exercise training had only minor effects on body weight and HbA1c values. Unexpectedly the major effects were related to a relevant improvement of indices of periodontal inflammation. The results may indicate that a consequent training regimen in diabetics may improve the systemic inflammatory status of the patients. It is known that physical training improves the immune status including cellular defense of the gingival tissues. Diabetes reduces the local gingival defense and enhances the severity of periodontal disease. It appears that chronic physical exercise may act as an antagonist against these undesirable effects.

Key words: diabetes, periodontal disease, inflammation, rehabilitative training, physical exercise, sports