Effect Of Calcium Supplementation As An Adjunct To Scaling And Root Planing In The Treatment Of Chronic Periodontitis
Allour Vaishnavi1, Arvina Rajasekar2*
1 Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai- 77, India.
2 Senior Lecturer, Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences [SIMATS],
Saveetha University, Chennai- 77, India.
*Corresponding Author
Dr. Arvina Rajasekar,
Senior Lecturer, Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences [SIMATS], Saveetha University, Chennai-
77, India.
Tel: +91 9486442309
E-mail: arvinar.sdc@saveetha.com
Received: September 13, 2021; Accepted: September 22, 2021; Published: September 23, 2021
Citation:Allour Vaishnavi, Arvina Rajasekar. Effect Of Calcium Supplementation As An Adjunct To Scaling And Root Planing In The Treatment Of Chronic Periodontitis. Int J Dentistry Oral Sci. 2021;8(9):4588-4592. doi: dx.doi.org/10.19070/2377-8075-21000934
Copyright: Dr. Arvina Rajasekar©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: Periodontal diseases are one of the most common diseases in the oral cavity. It has long been recognized that
patients in periodontal maintenance programs taking calcium supplementation had better periodontal health compared to
patients not taking supplementation.
Aim: To evaluate the effect of calcium supplementation as an adjunct to scaling and root planing in the treatment of chronic
periodontitis.
Materials and Methods: The study was performed as a randomised controlled trial. A total of 22 patients were selected
randomly, comprising two groups, 11 in each, with generalised chronic periodontitis. Both the groups underwent scaling and
root planing. The first group was asked to take a placebo and the second group was advised calcium supplements for 3 weeks.
The pocket depth and gingival index scores were calculated after scaling and root planing (baseline) . Then subsequently after
3 weeks, the pocket depth and gingival index were re assessed. Data was analyzed using SPSS software, Version 23. Unpaired
t-test was done to compare the difference in pocket depth and gingival index between the two groups.
Results: The group 1 was found to have a mean gingival index value of 2.89±0.02 at baseline and 2.20±0.01 after 3 weeks.
The gingival index was measured to be 2.92±0.03 at baseline in group 2 and post 3 weeks the gingival index value reported
to be 1.50±0.03. The difference in gingival index scores between both the groups was found to be statistically significant
(p=0.002). The mean pocket depth of the individuals who underwent only scaling and root planing were found to have a
score of 5±0.05 at baseline and 3±0.01 post 3 weeks. In group 2 the pocket depth was measured to be 4±0.02 at baseline and
2±0.03 post 3 weeks. The difference in pocket depth between both the groups was statistically significant, (p=0.000).
Conclusion: The present study reveals that the calcium supplementation given as an adjunct to scaling and root planing was
more effective compared to scaling and root planing alone in the management of chronic periodontitis.
2.Introduction
3.Materials and Methods
3.Results
4.Discussion
5.Conclusion
5.References
Keywords
Calcium; Chronic Periodontitis; Pocket Depth; Scaling and Root Planing; Innovative Technique.
Introduction
Periodontitis is an inflammatory disease of the supporting tissues
of the teeth caused by a group of specific microorganisms. If it is
left untreated, it leads to the destruction of both soft tissues and
hard tissues resulting in increased pocket depth, clinical attachment
loss, recession, mobility, bone loss, pathologic migration of
the teeth and tooth loss [1-7]. It is a multifactorial disease. Even
though plaque is the primary etiology, the disease is aggravated by
a variety of risk factors including age, systemic diseases, gender,
genetic factors, smoking, stress, hormones[8-11].
Periodontitis is one of the most common diseases in the oral cavity.
In the management of periodontitis, scaling and root planing
is one of the most effective methods. To help in faster healing of
the periodontitis many adjuncts such as herbal agents, therapeutic
agents like tetracycline, minocycline and other antibiotics. These
adjuncts aid in the destruction of microorganisms and help in
speedy recovery of periodontium to its normal state [3, 12-16].
Calcium is thought to be potentially influencing risk of periodontal
disease through three mechanisms: maintenance of oral bone
health, anti-inflammatory activity and antimicrobial activity [17].
Vitamin D is essential for consumption of calcium from the gut
and re-absorption of calcium from kidneys and bone formation
in order to maintain adequate plasma calcium concentrations for
calcium homeostasis, bone mineralisation and immunity [18].
There is biologic surmise that multiple actions of calcium are potentially
appealing for the management of chronic periodontitis,
whose pathogenesis is based on bacterial driven inflammation[19,
20]. It is speculated that the status of calcium could modify the
risk of periodontitis by preventing alveolar bone loss or by mediation
of the host's immune response to infection [21, 22]. Thus,
there is evidence pointing to the potential role of calcium intake
on dental health; however, there are controversies regarding the
role of calcium supplementation in chronic periodontitis and its
management [23, 24]. Definition regarding the use of optimum
levels of calcium for maintenance of bone health has been a matter
of debate [25-27].
Our team has extensive knowledge and research experience that
has translate into high quality publications [28-47]. Literature evidence
reveals only minimal studies have assessed the management
of chronic periodontitis with calcium supplementation[48-53]
Therefore, the aim of this article was to assess the effect of calcium
supplementation as an adjunct to scaling and root planing
in the management of chronic periodontitis among the patients
reported to Saveetha Dental College and Hospitals, Chennai.
Materials and Methods
Study Population:
The present randomized clinical trial was carried out from June
2020 to December 2020 in the Department of Periodontics,
Saveetha Dental College and Hospitals, Chennai, India. A total of
22 patients with generalised chronic periodontitis were enrolled.
The ethical clearance was obtained from the Institutional Ethical
Committee and a written informed consent was obtained from all
the study participants.
Inclusion Criteria:
Patients who were systemically healthy, presence of at least 20
teeth, probing depth of 4-5 mm, presence of bleeding on probing
(BOP) in at least 30% of the sites were included in the study.
Exclusion Criteria:
Smokers, pregnant or lactating mothers, patients under long term
medications, systemically compromised patients were excluded
from the study.
Study Design:
The sample size was taken to be 22, with 11 participants in each
group Group 1, [Scaling and root planing plus placebo], Group 2,
[Scaling and root planing plus calcium supplementation]. Participants
were assigned to the groups by a person not involved in the
study. All the subjects were assigned into group 1 and group 2 via
the simple lottery method. The participants in group 1 were asked
to take the placebo for three weeks and group 2 were instructed
to take the Calcium supplementation for three weeks.
Clinical Parameters:
• Loe and Silness Gingival Index (GI)
• Pocket Depth
Before recording the clinical parameters, thorough scaling and
root planing was done using ultrasonic scalers. Both the parameters
were then recorded (baseline). Then the respective groups
were asked to intake placebo and Calcium supplements (500mg/
day) for 3 weeks and the same index and pocket depth was recorded
post 3 weeks.
Statistical Analysis:
The data was analyzed using Statistical Package for Social Sciences
(SPSS Software, Version 23.0). Descriptive and inferential
statistics were done for data summarization and presentation.
Unpaired t-test was used to compare the mean values of pocket
depth and gingival index between the groups. The analysed data
were interpreted as graphs and tabulations.
Results
In the present study 22 periodontitis patients were enrolled. 11
patients were enrolled in group 1 (scaling and root planing), while
the remaining 11 patients were enrolled in group 2 (scaling, root
planing and Calcium supplements). The study was carried out as
a randomized clinical trial. The pocket depth and gingival index
of both the groups were compared at baseline and after 3 weeks.
It was observed that there was a significant reduction in the
pocket depth and gingival index scores of both the groups post
3 weeks. The group in which only scaling and root planing was
done was found to have a mean gingival index value of 2.89±0.02
at baseline and 2.20±0.01 after 3 weeks. The gingival index was
measured to be 2.92±0.03 at baseline in the group which took
Calcium supplements in adjunct to scaling and root planing and
post 3 weeks the gingival index value reported to be 1.50±0.03.
The difference in gingival index scores between both the groups
was found to be statistically significant (p=0.002). [Fig.1, Table.1].
The mean pocket depth of the individuals who underwent only
scaling and root planing were found to have a score of 5±0.05 at
baseline and 3±0.01 post 3 weeks. However in the group which
used the Calcium supplements as adjunct to scaling and root planing
the pocket depth was measured to be 4±0.02 at baseline and
2±0.03 post 3 weeks. The difference in pocket depth between
both the groups was statistically significant, (p=0.000). [Fig.2, Table.
1].
Table 1. Comparison of mean gingival index score and pocket depth between the study groups using unpaired t-test.
Figure 1. Comparison of difference between scaling and root planing alone versus scaling and root planing with Calcium supplementation in terms of gingival index scores. X-axis depicts the modality of treatment adopted in the study: scaling and root planing, scaling root planing with calcium supplement. The Y-axis depicts the mean gingival index value. Blue bar depicts the preoperative gingival index scores; green bar depicts the postoperative gingival index scores. The reduction in gingival index score was higher in the group which had taken Calcium supplements as adjunct compared to the group in which only scaling and root planing was done. The difference was found to be statistically significant with the p value of 0.002 (unpaired t-test).
Figure 2. Comparison of difference between scaling and root planing alone versus scaling and root planing with Calcium supplementation in terms of pocket depth. X-axis depicts the modality of treatment adopted in the study: scaling and root planing, scaling root planing with calcium supplement. The Y-axis depicts the mean pocket depth. Blue bar depicts the preoperative pocket depth measured, green bar depicts the postoperative pocket depth measured. The reduction in pocket depth in the group which had taken calcium supplements as adjunct was higher to that compared to the group in which only scaling and root planing was done. The difference was found to be statistically significant with the p value of 0.000 (unpaired t-test).
Discussion
The present study assessed the effect of calcium supplementation
as an adjunct to scaling and root planing in the treatment of
chronic periodontitis.
In the present study, all the clinical parameters assessed in both
groups showed that both interventions were effective in restoring
periodontal health.
However, when compared with patients who received scaling and
root planing alone, patients who received calcium supplementation
along with scaling and root planing showed drastic improvement
in terms of probing pocket depth and gingival index.
Garcia et al.,[48]conducted a study to assess the effects of vitamin
D and calcium supplementation on chronic periodontitis. In that
study, it was observed calcium and vitamin D have positive effects
on periodontal health. Similar results were obtained in the present
study. But the difference is that in the previous study, higher doses
of calcium supplementation were given for a longer time period.
The study of Hiremath et al.,[49] evaluated the anti-inflammatory
effect of calcium on gingivitis at various doses which revealed
that there was a dose-dependent anti-inflammatory effect of
calcium on gingivitis and concluded that calcium was a safe and
effective anti-inflammatory agent in doses 500 mg. But in their
study, clinical parameters like gingival index, oral hygiene index
simplified, plaque index were considered. But in this study, we
have included subjects with generalized chronic periodontitis and
analysed the effect of calcium on gingival and periodontal parameters.
However, improvement in gingival health was similar to the
previous study.
Milley et al.,[50] conducted a cross-sectional study and assessed
the influence of vitamin D and calcium supplementation on
chronic periodontitis and observed that there was better periodontal
health after taking calcium and vitamin D supplementation.
In their study, clinical parameters like probing depth, bleeding
on probing, gingival index, furcation involvement, attachment
loss and alveolar crest height were considered. But in the present
study, gingival index and probing pocket depth alone were taken
and proved that calcium supplementation gives a better periodontal
health.
Keiko Tanaka et al.,[51] investigated the relationship between
calcium intake and the prevalence of periodontal disease and
concluded that higher calcium intake may be inversely associated
with the prevalence of periodontal disease. Hildebolt et al.,[52]
studied the effect of vitamin D and/or calcium supplementation
on periodontitis and concluded that calcium supplementation and
vitamin D have a beneficial effect on clinical parameters of periodontitis
as a complementary therapy. The results of the present
study were in agreement with the previous studies.
Even though we found that calcium supplementation along with
scaling and root planing significantly reduces the clinical parameters
like gingival index and probing pocket depth, when compared
to scaling to root planing alone, these results cannot be
generalised since this study was conducted among a small population
with short term follow-up. Therefore, more randomized
controlled clinical trials with long term follow-up are warranted
to confirm this finding.
Conclusion
The present study reveals that the calcium supplementation given
as an adjunct to scaling and root planing was more effective compared
to scaling and root planing alone in the management of
chronic periodontitis.
Acknowledgement
The authors would like to acknowledge the help rendered by
Saveetha Dental College and Hospitals, Saveetha Institute of
Medical and Technical Sciences, Saveetha University, Chennai.
Source of Funding
The present project was sponsored by
• Saveetha Institute of Medical and Technical Sciences,
• Saveetha Dental College and Hospitals,
• Saveetha University,
• RK Tax Consultancy, Andhra Pradesh.
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