|Year : 2014 | Volume
| Issue : 3 | Page : 194-198
A clinical and microbiological study to evaluate the effect of dietary supplement of coenzyme Q10 in nonsurgical treatment outcome of chronic periodontitis patients after phase 1 periodontal therapy
Department of Periodontology and Oral Implantology, Rural Dental College, Pravara Institute of Medical Sciences, Loni, Tehsil - Rahata, Ahmednagar, Maharashtra, India
|Date of Web Publication||24-Sep-2014|
Dr. Rajiv Saini
Department of Periodontology and Oral Implantology, Rural Dental College, Pravara Institute of Medical Sciences, Loni, Tehsil - Rahata, Ahmednagar - 413 736, Maharashtra
Source of Support: None, Conflict of Interest: None
Aim: The present study was aimed to evaluate the effect of dietary supplement of coenzyme Q10 (CoQ10) in nonsurgical treatment outcome of chronic periodontitis patients after phase 1 periodontal therapy. Materials and Methods: A total of 50 generalized chronic periodontitis patient between the aged ranges between 18 and 55 years were enrolled in the study and divided into two categories (A and B). Clinical and microbiological parameters were recorded prior to phase 1 therapy; and subjects were put on conventional oral hygiene regime. The subjects under group B were incorporated with CoQ10 as nutritional dietary supplement (TDS). Results: The results of this study showed that there was significant decrease in clinical and microbiological parameters from baseline to 4 months in both groups (P < 0.01). The subjects under group B incorporated with dietary supplement of CoQ10 showed a highly significant reduction to all the parameters when compared to subjects under group A. Conclusion: Long-term regular intake of nutritional dietary supplement of CoQ10 is more beneficial in nonsurgical treatment outcome of periodontal disease.
Keywords: Coenzyme Q10, periodontitis, ubiquinone
|How to cite this article:|
Saini R. A clinical and microbiological study to evaluate the effect of dietary supplement of coenzyme Q10 in nonsurgical treatment outcome of chronic periodontitis patients after phase 1 periodontal therapy. Eur J Gen Dent 2014;3:194-8
|How to cite this URL:|
Saini R. A clinical and microbiological study to evaluate the effect of dietary supplement of coenzyme Q10 in nonsurgical treatment outcome of chronic periodontitis patients after phase 1 periodontal therapy. Eur J Gen Dent [serial online] 2014 [cited 2020 Jun 6];3:194-8. Available from: http://www.ejgd.org/text.asp?2014/3/3/194/141669
| Introduction|| |
Periodontitis is a destructive inflammatory disease of the supporting tissues of the teeth and is caused by specific microorganisms or a group of specific microorganisms resulting in progressive destruction of periodontal ligament and alveolar bone with periodontal pocket formation, gingival recession or both.  Periodontitis is initiated by oral biofilm formation if untreated progress to gingivitis further leading to periodontal disease. The link between periodontal disease and systemic diseases has been scientifically proven over last two decades. The principle reason for this oral-systemic connection is dissemination of locally produced pro-inflammatory mediators such as C-reactive protein, interleukins-1 beta (IL-1β) and IL-6 and tumor necrosis factor alpha.  Similarly, systemic health, diet and nutrition also impact on oral health, in particular gingival and periodontal diseases. A person's diet can exert a topical or a systemic effect on the body and its tissues. Coenzyme Q10 (CoQ10 or ubiquinone) is a naturally occurring quinine and is one of the most significant lipid antioxidants, which prevents the generation of free radicals and modifications of proteins, lipids, and DNA. Antioxidants, such as CoQ10, can neutralize free radicals and may reduce or even help prevent some of the damage they cause. CoQ10 improves energy, augments the immune system, and acts as an antioxidant.  In many disease conditions connected with increased generation and the action of reactive oxygen species (ROS), the concentration of CoQ10 in the human body decreases ,, and the deficiency of CoQ10 leads to the dysfunction of the respiratory chain, which is due to the insufficient production of highly energetic compounds, which decrease the efficiency of cells. Periodontal disease is associated with an increased production of ROS which, if not buffered sufficiently, cause damage to the host cells and tissues.  Hence, an attempt has been made in the present study to assess and compare the effects of dietary supplement of CoQ10 in nonsurgical treatment outcome of chronic periodontitis patients after phase 1 periodontal therapy.
| Materials and Methods|| |
The present study was conducted in the Department of Periodontology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India. The research protocol was approved by the University Research and Ethical Committee. Verbal and written informed consent was obtained from all subjects prior to their voluntarily enrollment in the study.
The subjects enrolled in this study were selected from the Outpatient Department of Periodontology, Rural Dental College and Hospital, Loni, Ahmednagar, Maharashtra, India. The study included a total of 50 subjects with chronic periodontitis as illustrated in [Table 1]. All the 50 subjects were grouped into two categories and each group was comprised of 25 subjects each as illustrated in [Table 2]. Exclusion criteria for the patient enrolled in the study were: (1) Presence of any systemic neurological disorder (e.g. epilepsy or schizophrenia), (2) presence of a disease with possible effects on the immune system (e.g. chronic infections or cancer), (3) patient who have received antibiotics or nonsteroidal anti-inflammatory drug (like ibuprofen) in past 9-11 weeks, (4) patients who have received periodontal treatment in past 6 months, (5) pregnant and lactating mother, (6) patient with artificial prosthesis, (7) patients who smokes or consumes tobacco in any form, (8) patients suffering with arthritis, (9) patient with any type of heart disease (myocardial infarction, coronary heart disease, etc.), (10) female patient using intrauterine birth control devices or birth control pills, (11) obese individuals (30 and above range as per WHO body mass index cut-off for weight categories for Asians), (12) presence of diabetes mellitus (13) participants not willing to participate in the study.
|Table 1: Age and sex wise distribution of the cases in both groups (A and B)|
Click here to view
|Table 2: Distribution of chronic periodontitis patients in study groups (A and B)|
Click here to view
After the enrollment of the subjects in the study, phase 1 therapy (scaling and root planning) was done by similar Electro Medical Systems ultrasonic scaler by the same operator to all the 50 subjects at first visit (baseline) only. After phase 1 therapy, subjects under both the groups were advised to brush twice a day for 5 min by modified bass method (technique demonstrated to each subject) and similar medium bristle toothbrush and toothpaste is provided to each of the subjects during the study course. After phase 1 therapy, subjects under group B were further advised to take a nutritional supplement of CoQ10 (Oxyfresh ® Company) TDS for 4 months. Recall visits were scheduled for all the subjects belonging to both groups (A and B) on 2 nd and 4 th month and no phase 1 therapy (scaling and root planning) was done at the recall visits. All the clinical and microbiological parameters of 50 subjects enrolled in a clinical trial were recorded at the base line, 2 nd and 4 th month.
Clinical parameters protocol
Clinical parameters of periodontal disease that were evaluated were gingival index (GI), plaque index (PI) and clinical attachment loss (CAL).
The teeth selected as index teeth were 16, 12, 24, 32, 36 and 44. The tissues surrounding each tooth were divided into four gingival scoring units: Disto-facial papilla, facial gingival margin, mesio-facial papilla and the entire lingual gingival margin. A blunt instrument such as a periodontal probe was used to assess the bleeding tendency of the tissues. The index for each index tooth was recorded and then calculated by dividing total number of index teeth examined. This provided the GI for the individual.
All teeth were examined on four surfaces (i.e. mesiobuccal, buccal, distobuccal and lingual/palatal) after using a disclosing agent.
Clinical attachment loss
The clinical attachment level was examined with William's graduated probe. Clinical attachment level represents distance from cementoenamel junction to the base of the gingival sulcus or periodontal pocket. Average CAL of the person is calculated by dividing the total clinical attachment level by the number of teeth examined. Chronic periodontitis is sub classified as mild or slight, moderate and severe periodontitis based on CAL according to American Academy of Periodontology 1999 classification of periodontal diseases. If gingival recession is present then, loss of attachment is calculated by the distance between the cement enamel and gingival margin to be added to pocket depth.
Subgingival plaque samples were collected for specific bacterial examination that is, Aggregatibacter actinomycetemcomitans (Aa), Fusobacterium nucleatum (Fn), Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi). Subgingival plaque samples were then collected from the sample sites using the standardized paper point (Dentsply) ® which were inserted to the depth of the periodontal pocket until resistance was felt. The paper points were retained for 20 s in the collection sites. The samples site selected was maxillary first molar in all the cases to maintain the standard protocol. After 20 s the paper point was removed from the sample site and immediately transferred into Robertson's cooked meat transport (RCM) in a test tube for specific bacterial culturing. In the laboratory, the RCM was subjected to vortex homogenization for 60 s before incubated anaerobically (Gas pack system) for 2-3 days.
| Results|| |
Distribution of mean and standard deviation values of all the clinical and microbiological parameters of both the groups (A and B) were illustrated in [Table 3] and [Table 4]. After applying Student's Paired t-test, there was a highly significant decrease in clinical and microbiological parameters from baseline to months in groups A and B (i.e. P < 0.01). It was observed that group B showed more significant decrease as compared to the group A (i.e. P < 0.01) as illustrated in [Table 5] and [Table 6]. Also by applying Student's unpaired t-test there was a highly significant difference between mean values of all clinical and microbiological parameters in the group A versus B (i.e. P < 0.01). It was concluded that the mean clinical and microbiological parameters in group B showed a larger decrease than group B (P < 0. 01) as shown in [Figure 1] and [Figure 2] (A vs. B). By applying two-way ANOVA (Tukey-Kramer multiple comparison tests) test there was a significant difference between groups A and B when compared together in respect to clinical and microbiological parameters (P < 0.05). The percentage decrease in clinical parameters (GI, PI, CAL and probing depth) from baseline to 4 th month in group B was 10.22%, 13.39%, 17.38% and 9.79% when compared to group A, that is, 3.01%, 5.41 and, 4.25% and 3.78%. The percentage decrease in microbiological parameters (Aa, Fn, Pg and Pi) from base line to 4 th month in group B was 24.12%, 17.94%, 19.68% and 21.31% as compared to group A, that is, 22.62%, 16.33%, 12.03% and 18.16%. This statistical significant increase in the percentage of group B when compared to group A attributed to the effect of dietary supplement of CoQ10.
|Table 3: Distribution of mean and SD values of clinical parameter in groups (A and B)|
Click here to view
|Table 4: Distribution of mean and SD values of microbiological parameter in groups (A and B)|
Click here to view
|Table 5: Comparison of mean values of clinical parameters in group A and group B at 4 months|
Click here to view
|Table 6: Comparison of mean values of microbiological parameters in group A and group B at 4 months|
Click here to view
|Figure 1: Comparison of mean values of clinical parameters in group A and group B at 4 months|
Click here to view
|Figure 2: Comparison of mean values of microbiological parameters in group A and group B at 4 months|
Click here to view
| Discusion|| |
A deficiency of CoQ10 at its enzyme sites in the gingival tissue may exist independently of and/or because of periodontal disease.  If a deficiency of CoQ10 existed in the gingival tissue for nutritional causes and independently of periodontal disease, then the advent of periodontal disease could enhance the gingival deficiency of CoQ10. In such patients, oral dental treatment and oral hygiene could correct the plaque and calculus, but not that part of the deficiency of CoQ10 due to systemic cause; therapy with CoQ10 can be included with the oral hygiene for an improved treatment of this type of periodontal disease.  The specific activity of succinic dehydrogenase CoQ10 reductase in gingival tissues from patients with periodontal disease against normal periodontal tissues has been evaluated using biopsies, which showed a deficiency of CoQ10 in patients with periodontal disease. On exogenous CoQ10 administration, an increase in the specific activity of this mitochondrial enzyme was found in deficient patients. ,,, This study proved that when CoQ10 (Oxyfresh ® Company) dietary supplement was incorporated in the treatment regime (TDS) of periodontitis patients after phase 1 therapy statistical noticeable improvements in clinical and microbiological parameters were noted as compared to patients without dietary supplement of CoQ10 (Oxyfresh ® Company) as illustrated in [Figure 1] and [Figure 2]. Similar to our study, previous studies had also shown that oral administration of CoQ10 increases the concentration of CoQ10 in the diseased gingiva and effectively suppresses advanced periodontal inflammation ,, and periodontal microorganisms. The possible hypothesis associated to this clinical and microbiological improvement is that CoQ10 nutritional supplement synergizes the effect and acting as potent antioxidant to counter the free ROS released during the active phase of periodontal inflammation. The other hypothesis is that healing and repair of periodontal tissues requires efficient energy production, which depends in a part on an adequate supply of CoQ10.  Our results were supported by previous study  thus concluding that CoQ10 regular dietary supplement should be considered as an adjunct with phase 1 periodontal therapy for the nonsurgical treatment of chronic periodontitis patients in current periodontal practice. However, long-term multicentric studies with more subjects will further help in understanding the potential effects of CoQ10 in treatment modality of periodontal disease.
| References|| |
Saini R, Saini S, Saini SR. Periodontitis: A risk for delivery of premature labor and low birth weight infants. J Nat Sci Biol Med 2011;2:50-2.
Saini R. Dental Air Force home dental cleaning system: A revolutionary oral hygiene device to prevent systemic diseases caused by periodontal infection. Int J Med Res Health Sci 2013;2:431-8.
Saini R. Coenzyme Q10: The essential nutrient. J Pharm Bioallied Sci 2011;3:466-7.
Saini R. Vitamins and periodontitis. J Pharm Bioallied Sci 2011;3:170.
Battino M, Ferreiro MS, Bompadre S, Leone L, Mosca F, Bullon P. Elevated hydroperoxide levels and antioxidant patterns in Papillon-Lefèvre syndrome. J Periodontol 2001;72:1760-6.
Battino M, Bullon P, Wilson M, Newman H. Oxidative injury and inflammatory periodontal diseases: The challenge of anti-oxidants to free radicals and reactive oxygen species. Crit Rev Oral Biol Med 1999;10:458-76.
Saini R, Saini S, Sharma S. Antioxidants accelerates cellular health. Int J Green Pharm 2010;3:212.
Prakash S, Sunitha J, Hans M. Role of coenzyme Q (10) as an antioxidant and bioenergizer in periodontal diseases. Indian J Pharmacol 2010;42:334-7.
Nakamura R, Littarru GP, Folkers K, Wilkinson EG. Deficiency of coenzyme Q in gingiva of patients with periodontal disease. Int J Vitam Nutr Res 1973;43:84-92.
Littarru GP, Nakamura R, Ho L, Folkers K, Kuzell WC. Deficiency of coenzyme Q 10 in gingival tissue from patients with periodontal disease. Proc Natl Acad Sci U S A 1971;68:2332-5.
Wilkinson EG, Arnold RM, Folkers K, Hansen I, Kishi H. Bioenergetics in clinical medicine. II. Adjunctive treatment with coenzyme Q in periodontal therapy. Res Commun Chem Pathol Pharmacol 1975;12:111-23.
Nakamura R, Littarru GP, Folkers K, Wilkinson EG. Study of CoQ10-enzymes in gingiva from patients with periodontal disease and evidence for a deficiency of coenzyme Q10. Proc Natl Acad Sci U S A 1974;71:1456-60.
Shizukuishi S, Hanioka T, Tsunemitsu A, Fukunaga Y, Kishi T, Sato N. Clinical effect of coenzyme 10 on periodontal disease; evaluation of oxygen utilization in gingiva by tissue reflectance spectrophotometry. In: Shizukuishi S, Hanioka T, Tsunemitsu A, editors. Biomedical and Clinical Aspects of Coenzyme Q. Vol. 5. Amsterdam: Elsevier; 1986. p. 359-68.
McRee JT, Hanioka T, Shizukuishi S, Folkers K. Therapy with Coenzyme Q10 for patients with periodontal disease. 1. Effect of Coenzyme Q10 on subgingival micro-organisms. J Dent Health 1993;43:659-66.
AR Gaby. The role of CoQ10 in clinical medicine: Part 1. Altern Med Rev 1996;1:11-7.
Wilkinson EG, Arnold RM, Folkers K. Bioenergetics in clinical medicine. VI. adjunctive treatment of periodontal disease with coenzyme Q10. Res Commun Chem Pathol Pharmacol 1976;14:715-9.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]