Original Article

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Comparative evaluation of hemoglobin level

in anemic patients with chronic periodontitis
before and after treatment
Mranali K. Shetty, Bijju Thomas1, A. Veena Shetty2
Departments of Periodontics, Manipal College of Dental Sciences mangalore, Manipal University, 1A. B. Shetty
Memorial Institute of Dental Sciences, 2Department of Microbiology, KSHEGDE Medical Academy, Nitte University,
Mangalore, Karnataka, India

Address for correspondence: Dr. Mranali K. Shetty, E-mail: mranalialva@gmail.com

ABSTRACT
Background: Anemia can be caused by various chronic diseases, one of which could be chronic periodontitis. Treatment of
chronic periodontitis has shown to improve hematological values. This study aimed at assessing effect of periodontal therapy
on hemoglobin levels in patients with chronic periodontitis. Materials and Methods: This was a case-control study consist of
40 anemic subjects with hemoglobin levels of 8 g/dl. The sample size comprised of 20 periodontally healthy subjects and 20
subjects with chronic periodontitis. Blood samples were collected before and after therapy for hemoglobin assessment and all the
patients were subjected to periodontal therapy. The values were subjected to statistical analysis. Results: The study showed that
there was an improvement in hemoglobin level for the test group after periodontal therapy, which was statistically significant.
Conclusion: The phase I periodontal treatment helped in improvement of the hemoglobin level in chronic periodontitis group.

CLINICAL RELEVANCE TO INTERDISCIPLINARY DENTISTRY

Many systemic diseases have been implicated as risk indicators or risk factors in oral diseases.
To understand the pathogenesis of the systemic diseases to oral diseases is important for the dental clinicians (endodontists,
periodontists, prosthodontists) to draw comprehensive treatment plan for the patient.
This article explains the influence of anemia of chronic disease on the outcome of periodontal treatment.
Key words: Hemoglobin, periodontitis, root planning and scaling

INTRODUCTION

eriodontitis is a chronic inflammatory disease

caused by Gram-negative anaerobic bacteria.
Certain systemic conditions may initiate or progress
gingivitis and periodontitis. The converse side of the
relationship between systemic health and oral health
has also been demonstrated. This means that there
may be potential effects of periodontal disease on a
wide range of organ systems.[1] The changes in immune
response offers an explanation of the mechanisms
for the interactions between periodontal infection
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DOI:
10.4103/2229-5194.135000

24

and a variety of systemic disorders.[2] This leads to

the production of cytokines, most notably tumor
necrosis factor-alpha (TNF-) and interleukin (IL)-1
and IL-6.[3] Such inflammatory cytokines can depress
erythropoietin production leading to the development
of anemia.[4,5] Hutter et al.[6] have concluded that
periodontitis, like other chronic conditions, lead to
anemia. Hence, the purpose of this study is to assess
the effect of periodontal therapy on anemia.
Aim
This study aimed at assessing effect of periodontal
therapy on hemoglobin levels in subjects with chronic
periodontitis.

MATERIALS AND METHODS

Subjects reporting to the outpatient Department
of Periodontics were selected for the study. The
Journal of Interdisciplinary Dentistry / Jan-Apr 2014 / Vol-4 / Issue-1

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Shetty, et al.: Hemoglobin level in healthy and chronic periodontitis

research protocol was submitted to the Institutional Ethical

Committee and Review Board. After ethical approval,
all subjects were verbally informed about the study,
and written informed consent was obtained. A total of
40 subjects between the age group of 30 and 55 years
are included in the study. Patients with hemoglobin
levels 8 g/dl were included in the study.
Group A: Includes 20 subjects as controls
Group B: Includes 20 subjects diagnosed with chronic
generalized periodontitis.
Inclusion criteria for Group A
Confirmed anemic patients who had healthy periodontium
with a clinical probing sulcus depth of 2-3 mm.
Inclusion criteria for Group B
Confirmed anemic patients with chronic generalized
periodontitis with a probing pocket depth of 5 mm,
presence of bleeding on probing, loss of attachment
of 2 mm, and gingival index score of 1 mm.

levels. The values were subjected to statistical analysis

using paired and unpaired t-test.

RESULTS
A total of 40 anemic subjects, 20 periodontally healthy
and 20 with chronic generalized moderate to severe
periodontitis were included in this study.
After undergoing phase I periodontal therapy, patients in
the chronic periodontitis group showed an improvement
in hemoglobin levels, which was statistically significant
[Figure 2].
When comparing the hemoglobin values of periodontally
healthy patients before and after phase I, statistically
significant difference was not found [Figure 1].
When control and test group were compared for
hemoglobin values before and after therapy, test group
showed statistically significant difference.

Exclusion criteria

History of any systemic diseases other than anemia

Female patients
Patient who have been on any long-term medication
3 months preceding the study
Present and past smokers
Patients who have undergone periodontal treatment
6 months prior to the study
Patients who have <16 remaining teeth in the mouth.

Clinical recordings

Medical and dental history was taken

Modified sulcular bleeding index (Mombelli et al. in
1987)
Pocket depth (5 mm)
Loss of attachment of 3 mm (based on AAP 1999
classification).

Methodology
Under aseptic conditions 2 ml of venous blood was
drawn from ante-cubital fossa and sent for investigation
of hemoglobin levels. Probing pocket depth and loss
of attachment were recorded at base line using mouth
mirror, Williams graduated periodontal probe. Thorough
phase I therapy was carried out for both groups, which
included scaling and root planning. Patients were given
oral hygiene instructions that included brushing technique
and use of mouth rinse.
Patients were recalled after 3 months. Probing pocket
depth and loss of attachment were recorded. Blood
samples were collected again for assessing hemoglobin
Journal of Interdisciplinary Dentistry / Jan-Apr 2014 / Vol-4 / Issue-1

DISCUSSION
The relation between anemia and periodontitis has been
explored in the latter half of 20th century. Chawla et al.[7]
suggested anemia as an important factor in the causation
or pathogenesis of periodontal disease. Seigel[8] have
reported a depression in the number of erythrocytes
apparently secondary to the presence of periodontal
disease, since arrest or cure of these pathological processes
in individual cases resulted in the elevation of erythrocyte
count to normal or high normal levels. Chronic periodontal
disease as a possible contributing factor or cause of mild
anemia was also indicated. Thomas et al.[9] showed that
periodontitis patient have a lower hematocrit, lower number
of erythrocytes, lower hemoglobin levels and higher
erythrocyte sedimentation rates. Whereas, the studies by
Wakai et al.[10] and Havemose-Poulsen et al.[11] failed to show
any association between hemoglobin levels and periodontal
status. In particular IL-1, IL-6, and TNF have been implicate
the cytokines responsible for suppressing erythropoiesis.
[12]
Pro-inflammatory cytokines such as TNF-, IL-I,
interferon-I, and PGE2 are found in high concentrations in
inflamed tissues. The various cytokines can enter the blood
circulation and affect distant sites and organs. The same
inflammatory cytokines have been found to be central in the
pathogenesis of anemia of chronic disease.[13,3] The present
study showed an improvement in the hemoglobin levels
in anemic patients with chronic periodontitis. This was in
accordance with the study done by Nupur et al.
Agarwal[14] showed that treatment of periodontitis lead
to an improvement in hematocrit and other related
25

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Shetty, et al.: Hemoglobin level in healthy and chronic periodontitis

Figure 1: Descriptive statistics of control and periodontitis group before and after treatment

Figure 2: Comparison of hemoglobin level before and after treatment in study subjects

blood parameters in chronic generalized periodontitis

patients with anemia. A study conducted by Pradeep and
Anuj[15] concluded that chronic periodontitis may tend
toward anemia and provides evidence that nonsurgical
periodontal treatment can improve the anemic status of
patients with chronic periodontitis, and that improvement
in hematologic parameters was greater in female subjects
which is in agreement with our study.

6.

7.
8.
9.

CONCLUSION
The present study showed that periodontitis, like other
chronic conditions, may increase the anemic state by
lowering the hemoglobin levels in chronic periodontitis,
but later the hemoglobin levels could have improved
due to phase I periodontal therapy which was statistically
significant.

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How to cite this article: Shetty MK, Thomas B, Shetty AV. Comparative
evaluation of hemoglobin level in anemic patients with chronic periodontitis
before and after treatment. J Interdiscip Dentistry 2014;4:24-6.
Source of Support: Nil, Conflict of Interest: None declared.

Journal of Interdisciplinary Dentistry / Jan-Apr 2014 / Vol-4 / Issue-1