Evaluation of Non-surgical Periodontal Therapy in Patients With Rheumatoid Arthritis
Condition: Rheumatoid Arthritis; Periodontitis
MeSH terms: Arthritis; Arthritis, Rheumatoid; Periodontitis
Study type: Interventional

Summary: 
      Some clinical and epidemiological studies have revealed a high prevalence of periodontitis
      and tooth loss in patients with rheumatoid arthritis. The aim of this study was to evaluate
      the efficacy of periodontal scaling and oral hygiene instruction for patients with mild
      chronic periodontitis and rheumatoid arthritis through clinical periodontal parameters and
      laboratory tests for CRP (C- reactive protein) and ESR (erythrocyte sedimentation rate).
    

Detailed description: 
      This longitudinal study was approved by the Research Committee of the Santos Metropolitan
      University, and all individuals had access to the terms of consent. A total of 56 individuals
      with rheumatoid arthritis were assessed, and the investigators selected 12 women with a mean
      age of 45.38 who had been diagnosed with rheumatoid arthritis (RA) and who also had mild
      chronic periodontitis (PD). All of the patients were referred from the outpatient specialty
      medicals service and the rheumatologist's specialty outpatient clinic of the Metropolitan
      University of Santos diagnosed and evaluated individuals in the test group and the control
      group. The control group was composed of individuals who initiated periodontal treatment, did
      not have any systemic involvement, and had probing depth compatible with the individuals in
      the test group. The criteria for participation in the study included not having any dental
      procedure performed in the last six months, not having used antibiotic medication in the last
      six months, except for the use of drugs that could alter salivary flow (antidepressants,
      anxiolytics, antihistamines, and diuretics among others), not smoking, and not wearing
      braces.

      The main parameters for the diagnosis of RA include counting the number of painful joints and
      the number of swollen joints, inflammatory activity (ESR and PCR), assessment of pain
      intensity, and assessment of joint mobility and functional capacity. Before the start of
      periodontal treatment, these tests were performed, and blood tests (ESR and PCR) were
      requested and evaluated by the rheumatologist in charge. The healthy subjects (control group)
      also underwent blood tests.

      Upon completion of amamneses, periodontal clinical examinations were performed by a
      previously trained and calibrated periodontist, and in the sample studied, 10% were examined
      twice for each of the clinical criteria in order to obtain the intra-examiner reliability as
      measured by Kappa statistics (0.87).

      The investigators observed the clinical parameters of periodontal probing depth (PD) in six
      points per tooth, and plaque index (PI) and gingival index (GI), conducted dichotomously for
      cheeks, buccal, mesial, distal and lingual/ palatal. All of the participants received
      radiographic, periapical, dental examinations in order to check the height level of the
      cortical bone.

      Subjects received oral hygiene devices and underwent therapy for full mouth disinfection, and
      patients followed the protocol of holding two sessions with an interval of less than 24 hours
      between sessions. At the beginning of each session, oral hygiene instructions were given to
      each subject individually and the investigators tried to teach patients the correct way of
      using a brush and floss. The treatment was performed by scraping by a single periodontist who
      was blinded to the participants and the data obtained in clinical trials.

      Each participant received seven doses of the individually-based mouthwash chlorhexidine
      0.12%, to be used within seven calendar days after execution of the first session of the
      proposed therapy, and patients were told to always use it after brushing the last thing at
      night and then to wait 30 minutes to receive the maximum effectiveness of the chlorhexidine.
      After the procedures for dental scaling and root planing, 90 days passed before reassessment
      and new periodontal clinical and laboratory (ESR and PCR) tests were performed. Then the
      participants were referred to clinics operating in the college of Dentistry UNIMES as needed.

      After tabulating the clinical and laboratory data for the participants included in this
      study, the data were subjected to statistical analysis. For this, the investigator used the
      software SPSS 13.0 and 5.0 bioestat. In all analytical situations a significance level of 95%
      should be adopted (α ≤.05). For each cluster of analytical interest, the characteristic
      distribution of the sample was tested and among the selected statistical tests being used
      were the statistical tests ANOVA with two factors (factor "health condition" - healthy or
      rheumatoid factor and "periodontal treatment" - Immediate evaluation or after periodontal
      treatment) and the Tukey's test.
    

Intervention name(s): Non-surgical Periodontal Therapy
Intervention type(s): Procedure
Other intervention name(s): periodontal scaling
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment