Abstract
Chronic periodontitis is a common inflammatory disease that affects the gums and the tissues around the teeth. It is characterized by long-term inflammation of the gums and the breakdown of the parts of the teeth that support them, especially the bone. Insulin resistance and high blood glucose levels are two signs of type II diabetes, which is a metabolic disorder. A lot of studies have looked into the link between vitamin D levels and gum health. Some data suggests that keeping enough vitamin D levels may lower the likelihood and severity of periodontal disease, even though the results did not always the same.
There were 60 people who took part. There were two groups of patients. The first group had 30 cases of chronic periodontitis and type II diabetes, while the second group had 30 healthy periodontally persons who served as a control group. We took samples of human blood to find out how much vitamin D and glycated hemoglobin were in them. The periodontitis group had much lower levels of vitamin D in their blood than the healthy group. The results showed that there was a strong negative link between Vitamin D and periodontal indicators, HbA1c, and RBS.

Keywords :Vit D3 ,Periodontitis, Type II diabetic

Introduction

A chronic metabolic disease called diabetes mellitus is characterized by elevated blood glucose levels brought on by insufficiencies in either insulin action or production, or both. Diabetes mellitus is categorized into two principal types: Type 1 and Type 2. Type 1 diabetes is an autoimmune disorder wherein the immune system attacks and destroys the insulin-producing beta cells in the pancreas (Ahmed and Goldstein, 2006).
In contrast, Type 2 diabetes is mostly associated with insulin resistance, marked by the body’s cells failing to respond appropriately to insulin, along with inadequate insulin secretion. Complications of diabetes include cardiovascular issues, neuropathy, nephropathy, and retinopathy (Pickup and Williams, 2003).

Management approaches aim to control blood sugar levels, stop issues from happening, and improve quality of life as a whole. To take good care of your diabetes, you need to make changes to your lifestyle, like eating a balanced diet, getting regular exercise, and keeping your weight in check. Insulin and oral antidiabetic drugs are two common types of drugs used to control blood sugar levels (Reinehr,2013).
Vitamin D is a fat-soluble ketosteroid that is important for keeping your health and well-being in general. Vitamin D is made in the skin when it is exposed to ultraviolet B (UVB) sunlight or when it is eaten. It doesn’t do anything in the body until it is hydroxylated in the liver and kidneys, which makes its active metabolites (Holick, 2004).

The primary function of vitamin D is to regulate calcium and phosphorus metabolism, facilitating their absorption in the intestine and supporting their utilization in bone mineralization. Besides its traditional role in bone health, vitamin D is linked to other physiological activities, such as immune function, cardiovascular health, and gene expression modification (Holick, 2013). Vitamin D insufficiency results in clinical repercussions include musculoskeletal disorders, such as rickets in children and osteomalacia in adults, along with an increased risk of fractures and compromised immune function. Addressing vitamin D deficiency often involves supplementation, dietary modifications, and careful sun exposure (Zittermann, 2003).
Chronic periodontitis is a prevalent inflammatory condition affecting the supportive structures of the teeth, characterized by the progressive degradation of periodontal tissues. This presentation provides a comprehensive analysis of chronic periodontitis, including its origin, pathophysiology, and several treatment options. The pathogenesis of chronic periodontitis is complex, involving the interplay of microbial, host, and environmental factors. Dental plaque, predominantly composed of pathogenic bacteria, is essential for initiating and maintaining the inflammatory response. Host characteristics, like as genetics, systemic health, and immune response, affect individual susceptibility to chronic periodontitis. Furthermore, environmental factors, including lifestyle choices and dental hygiene practices, influence disease progression (Horst et al., 2005).

The research objectives focused on examining the effects of Vitamin D on the health of persons with Type 2 Diabetes Mellitus. The effects of Vitamin D have also been examined in persons with chronic periodontitis. The examined link between patients with Type 2 Diabetes Mellitus suffering from chronic periodontitis and the influence of Vitamin D on both illnesses.

Material and Methods

Collection of Samples:

Participants

The study received approval from the medical ethics committee of the Iraqi Ministry of Health. In this research, a total of 60 participants were enlisted. These individuals were divided into two groups: the first group is 30 cases with both chronic periodontitis (CP) and diabetes type II, and the second group is 30 periodontally healthy and used as a control group. Diabetes patients included in the study were explicitly chosen from those treated at Ramadi Teaching Hospital in Iraq. They were diagnosed with Type II DM by a physician specialist. Periodontally healthy persons as a control group were selected from Al-Maarif University College (AUC), Ramadi, Iraq. To ensure that a comparable percentage of cases fit into the categories determined by the selection variable (age and sex in this research), groups were chosen from an established age range (30-60) and sex; males made up about 50% of the cases and controls.

Blood sample collection

The serum of (n=60) participants was stored at -20◦C. The blood was obtained from the participants via venipuncture and incubated in a water bath for 10 minutes until clotted, then centrifuged ( 10 min( at 3000 rpm. The serum was transferred into Eppendorf tubes after labeling each tube. Tubes were stored in a deep freezer until analysis. Samples were incubated at room temperature until they thawed naturally during the experiment.

Principle tests of mindray (CLIA)

The CLIA immunoassay operates on the principle of magnetic particles, which facilitate the separation of immune complexes with a specific antigen or antibody. The detection system employs flash chemiluminescence utilizing acridinium ester, with the intensity of the light flash quantified in relative light units (RLU). Chemiluminescence is predicated on the reaction between nitric oxide (NO) and ozone. The chemical oxidation of NO by ozone generates nitrogen dioxide in an excited state, and the subsequent relaxation from this state results in a characteristic light emitted (chemiluminescence) that is proportional to the concentration of NO.

Clinical periodontal examination

A single-trained dentist performed periodontal indices checks in all subjects. Clinical measures, including plaque index (PI), gingival bleeding index (GBI), clinical attachment loss (CAL), and probing pocket depth (PPD) were assessed. All probing measures were performed manually using a millimeter periodontal probe (Williams Periodontal Probe PW; Hu-FriedyR, Chicago, IL, USA).

Statistical data analysis
Percentages and frequencies were employed to delineate categorical variables, while the chi-square statistic was utilized for comparison. An independent-sample t-test was employed to compare the mean and standard deviation ( standard deviation ) of continuously and regularly distributed data. The variables were presented as the mean accompanied by the interquartile range. The coefficient of Pearson correlation was employed for the relationship analysis. When P<0.05, differences were considered statistically significant. All analyses were conducted using IBM SPSS

Results and Discussion

Sample collection:

Descriptive and t-test analysis result

Throughout the study, the variables (age, Sex, Vitamin D, and Glycated hemoglobin HbA1c) for patients with diabetes type 2 infected with chronic periodontitis were examined for descriptive analysis for sex table and figure (1). In addition to found mean and standard deviation. A t-test was used to compare the mean and standard deviation of the data in table and figure (2), and if the p-value was less than or equal to 0.05, then a measure of significant differences between the two groups was taken.The total participant of study was 40 cases for patient and in same for controls. The frequency of male was (20) with percentage (50%) and the same thing for female for both group (Patients and controls) and the result showed in table 1 and figure1.

                  Table 1 :showed the Frequency and percentage for sex of the study

Figure 1: Showed the frequency and percentage of sex for the study

The results showed that the mean age for the patients with diabetes type 2 infected with chronic periodontitis was 46 year, while for the controls group was 39.3 year. The results also showed that the mean of glycated haemoglobin (HbA1c) for patients was 8.96% with standard Deviation SD (1.66), while the mean of glycated haemoglobin for controls group was 4.42% with SD (0.76), and there was a significant difference (p-value = 0.0001). The result indicated an increase of glycated haemoglobin in patients due to increasing accumulation of glucose molecular in red blood cell during 120 days and this consider as a diagnosis and monitoring for diabetes mellitus.

The current study showed that the concentration of vitamin D (normal = 30-50 ng/ml) in patients was abnormal with decreasing in a mean concentration 20.56 ng/ml with SD (6.1), while the mean of concentration of vitamin D in controls group was in normal range 41.62 ng/ml with SD (12.5), significant differences were found between the two group for blood haemoglobin (p-value = 0.0001).

Table 2: showed the Mean ± SD with probability for study parameter

Figure 2: Showed the Mean and Probability of study parameter

It is a well-established fact that Vitamin D possesses bone-protective properties and immune-modulating effects; thus, it was expected that serum 25(OH)D levels would be inversely associated with the severity of infection in the periodontium (Vieth, 2011; Bikle, 2011).
The Nordic nutrition recommendations indicate that serum 25(OH)D levels of 30 ng/ml are sufficient for dental health, as stated by the US National Institutes of Health in 2014.Abreu et al. (2016) advocated a threshold of ≥20 ng/ml as sufficient for bone and general health.
Our findings corroborate the results provided by Abreu et al. (2016) and Laky et al. (2016), indicating a substantial association between low Vitamin D levels and periodontitis, as our study also revealed diminished total Vitamin D levels.

Person correlation between study parameters

The correlation test between the variables (Pearson’s test) was conducted to find the relationship between the variables and the effect of each other on patients with diabetes mellitus infected with chronic periodontitis.

Table (3) showed the correlation between variables patients group. The result showed no relation between age and Glycated haemoglobin and vitamin D concentration with r = -0.013 and -0.234 respectively with non- significant differences (P-value > 0.05),this indicates that as age do not effect on these two parameters

Table 3: showed the person’s correlation for the study variables

          Vit. D3 levels are significant correlated with Periodontitis indices

Pearson correlation coefficient was observed, and the clinical periodontal measurements scores: Plaque Index (PI), Gingival Bleeding Index (GBI), probing pocket depth (PPD), and clinical attachment level (CAL), HbA1c, and RBS revealed a statistically significant negative correlation with serums vitamin D levels (p <0.01), as shown in Table 4.

Table 4: Spearman correlation  between periodontal , glycaemic parameters, and vit. D

The mean age for the patients with diabetes type 2 infected with chronic periodontitis was 46 years, while for the control group, it was 39.3 years.The mean of glycated haemoglobin (HbA1c) for patients was (8.96±1.66), while the mean of glycated haemoglobin for the control group was (4.42±0.76), and there was a significant difference (P- value = 0.0001).The concentration of vitamin D (normal = 30-50 ng/ml) in patients was abnormal, with decreasing in mean concentration (20.56±6.1), while the mean concentration of vitamin D in the control group was (41.62±12.5), with significant differences were found between the two groups for blood haemoglobin (p-value = 0.0001).Pearson’s correlation coefficient was observed between vitamin D and the clinical periodontal measurements scores: (PI), (GBI), (PPD), (CAL), HbA1c, and RBS revealed a statistically significant negative correlation with serums vitamin D levels (P <0.01).

Conclusions :

The correlation coefficient calculated by Pearson’s indicated a statistically significant negative association between serum vitamin D levels and clinical periodontal measurement scores: Plaque Index (PI), Gingival Bleeding Index (GBI), Probing Pocket Depth (PPD), CAL, HbA1c, and Random Blood Sugar (RBS) (p < 0.01).

Acknowledgment

Non .

Conflicts Interest

Non.

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