"OZONIOTHERAPY ADJUVANT TO NON-SURGICAL PERIODONTAL THERAPY IN INDIVIDUALS WITH PERIODONTITIS ASSOCIATED WITH TYPE 2 DIABETES MELLITUS"
"Type 2 diabetes mellitus; periodontitis; ozonetherapy; non-surgical periodontal therapy"
"Diabetes mellitus and periodontitis are two immunoinflammatory diseases that maintain a bidirectional relationship in which the chronic state of one can activate and maintain the progression of the other. Periodontitis is characterized by dysbiosis of the oral microbiotaand mediated by immune system events, while diabetes mellitus is a group of systemic disorders characterized by hyperglycemia resulting from defect in insulin secretion and/or action. The non surgicalapproachofscalingandrootplaningisthe“goldstandard”treatmentof periodontitis, but this therapy often does not produce the desired clinical results, especially in individuals with immunoinflammatory alterations and at risk of recurrence of oral disease, such as diabetes. Ozone therapy combined with periodontal treatment has been studied mainly for its antimicrobial effect; but ozone also has a biomodulation capacity, such as antioxidant, anti- inflammatory and antihypoxic effects, which represent an additional benefit for individuals with diabetes. Despite this, only two studies evaluated the effect of adjuvant ozone therapy to periodontal treatment in this group of patients. A review of the literature was carried out and, in the face of little direct evidence, the effects of ozone on molecular mechanisms and signaling pathways reported in other situations or diseases, but also present in periodontitis and diabetes, were reviewed too. Based on this literature review, a never-before-tested protocol was proposed combining the 3 forms of ozone application (water, gas, and oil) adjuvant to periodontal therapy and was used in seven patients with type 2 diabetes. Periodontal clinical data (bleeding index on probing, probing depth and clinical attachment level), biochemicals (glycated hemoglobin and C-reactive protein) were evaluated, in addition to microbiological analysis of some samples (real-time PCR). After 30 days of treatment, patients showed satisfactory periodontal results and also improved glycemic control, suggesting that ozone therapy can be a powerful tool in periodontal therapy of patients with type 2 diabetes and deserves to be further investigated and compared with non-surgical periodontal therapy only."