# Effect of Non-surgical Periodontal Therapy on Levels of Ghrelin and Tumor Necrosis Factor-Alpha (TNF-α) in the Gingival Crevicular Fluid of Healthy and Periodontitis Patients With and Without Type 2 Diabetes Mellitus: A Clinico-Biochemical Study

## TL;DR

This study examines how non-surgical periodontal therapy affects ghrelin and TNF-α levels in people with and without diabetes.

## Contribution

The study introduces a novel analysis of ghrelin and TNF-α as potential biomarkers for periodontitis treatment response in T2DM patients.

## Key findings

- Baseline GCF levels of ghrelin and TNF-α differed significantly among healthy, periodontitis, and periodontitis with T2DM groups.
- Non-surgical periodontal therapy significantly reduced ghrelin and TNF-α levels in all groups, with the greatest reduction in T2DM patients.
- Ghrelin and TNF-α may serve as useful biomarkers for evaluating periodontal disease severity and treatment outcomes.

## Abstract

Purpose: Periodontitis, a chronic inflammatory disease, is closely associated with type 2 diabetes mellitus (T2DM). Ghrelin, a stomach-derived peptide hormone, may influence periodontal health by modulating inflammation through its receptor growth hormone secretagogue receptor (GHS-R1a), notably by inhibiting lipopolysaccharide (LPS)-induced tumor necrosis factor-alpha (TNF-α) production in oral epithelial cells.

Aim: To compare and correlate the gingival crevicular fluid (GCF) ghrelin and TNF-α levels in healthy individuals and stage III grade B periodontitis patients with and without T2DM before and three months after non-surgical periodontal therapy (NSPT).

Materials and methods: Ninety subjects were segregated into three groups: Group I (healthy), Group II (Stage III Grade B periodontitis), and Group III (periodontitis with controlled T2DM). Clinical parameters such as plaque index (PI), gingival index (GI), bleeding on probing (BoP), probing pocket depth (PPD), and interdental clinical attachment loss (ICAL) were recorded along with GCF samples which were collected and analysed at baseline and at the end of three months post NSPT.

Results: Baseline GCF levels of ghrelin and TNF-α differed significantly among the three groups. Three months after NSPT, all the groups exhibited a significant reduction in ghrelin and TNF-α levels in GCF, with the greatest reduction observed in Group III.

Conclusion: Our findings suggest that ghrelin and TNF-α levels may serve as useful biomarkers for evaluating periodontal disease severity and treatment response, especially in patients with T2DM. The study also confirms the effectiveness of NSPT in reducing inflammation, highlighting its critical role in managing periodontitis among individuals with systemic conditions like T2DM.