Effect of essential oils as adjutants on the treatment of subjects with periodontitis: assessment of metabolic variables as effect modifiers

Abstract

Background and objectives: The increasing scientific data indicate on a double cause-effect relationship between periodontitis (PD) and cardiovascular disease (CVD), including metabolic syndrome (MetS). Such interaction can be mediated by inflammation mediators, but also by the effect of bacteria for which the periodontium may represent an entry into the circulation. Several plant extracts have a beneficial effect on periodontal disease progression thought different mechanisms. Such component also may improve different MetSrelated parameters including lipids, that further may influence the general inflammatory status, as well as PD. Furthermore, a direct anti-inflammatory effect on the periodontium is not excluded. The present thesis aimed to analyze the effect of a nutraceutical composed of several plant extracts in subjects with PD and different levels of risk for the MetS. Specifically, it has been evaluated: 1) if the responses of some periodontal clinical variables were more effective in subjects treated with the extract compared to controls; 2) if the effect on MetS-related variables in the subjects treated with the extract could be more favourable compared to controls; and 3) to evaluate the effect of selected plant extracts on inflammatory markers and determine if those were associated with a worse periodontal condition, and specific periodontal variables. Some parts of the study, which aimed to assess inflammatory markers were not completed due to COVID-19 pandemic. Materials and Methods: The clinical study was a randomized, controlled, double-blinded clinical trial. 62 patients were divided in 2 groups: 1) test group who received the extract in form of irrigation solutions in the periodontal pockets during regular periodontal treatment. They have continued at home during the follow-up period, taking the essential oils (EOs) as a rinse twice per day, and as a spray when regular toothbrush could not be performed (n = 30); 2) control group patients that followed the same protocol, but using regular irrigation and a placebo spray at home (n = 32). Periodontal clinical variables of all participants were gathered, a blood sample was drawn from each subject. Results: Some periodontal variables achieved the statistically significant differences between 2 groups: BP5T0, BP6T0, NBOLT0, BOLTOTT0, PISIMT0, SPIM3MT0 and BP6T1, while there were no differences in assessed cardiometabolic variables, except glycemia that decreased significantly in both groups. A slight increase in systolic, diastolic blood pressure and pulse were observed in the test group, as well as a slight decrease in body weight, body mass index and waist circumference. On the other hand, in the control group body weight, body mass index, systolic blood pressure, pulse and waist circumference increased, while diastolic blood pressure decreased. Conclusions: The preliminary results obtained indicate that nutraceutical based on EOs as an adjuvant therapeutic agent for periodontal treatment might have some beneficial effect on PD variables when used as an irrigation solution or mouthwash. It might be associated with improvements in some MetS-related variable, and this could have a protective effect against periodontal disease progression, but also CVD. Future long-lasting studies are required to confirm these encouraging preliminary data and elucidate the underlying mechanisms.