Effect of Non-surgical Periodontal Therapy Along With Myo-inositol on High Sensitivity C-reactive Protein and Insulin Resistance in Polycystic Ovary Syndrome Women Having Chronic Periodontitis: A Randomized Controlled Trial

Polycystic Ovary Syndrome(PCOS) is a genetically complex endocrine disorder of uncertain etiology and a common cause of hyperandrogenism, anovulatory infertility, menstrual dysfunction, hirsutism, alopecia and acne. It was first reported by Stein and Leventhal in 1935. It affects 6-8% of women of reproductive age. Accordingly PCOS might be viewed as a gender specific form of metabolic syndrome.

According to Androgen Excess Society(AES) /2006 criteria PCOS was defined by the presence of hyperandrogenism (clinical and/or biochemical),Oligo or anovulation, Polycystic ovarian morphology(PCOM)- at least one ovary with 1)12 or more follicles (2-9 mm in diameter) or 2) Ovarian volume >10 ml. Patients with PCOS are at higher risk of developing cardiovascular risk factors that is diabetes, insulin resistance, visceral obesity and a state of low grade inflammation.Therefore, PCOS may represent a model for studying the complex interaction among these Cardiovascular risk factors,especially chronic inflammation and insulin resistance.

Visceral obesity,insulin resistance and hyperinsulinemia are prevalent co-morbidities of PCOS which promotes androgen excess.Insulin resistance in PCOS is due to a post-receptor defect in insulin receptor mediated cells which leads to induce a decrease in glucose transporters. Therefore, reduction of insulin secretion and/or improvement of its action at target tissues offer the possibility of improving the effects of androgen excess by correction of the reproductive dysfunction and preventing metabolic derangements from becoming entrenched.

For this purpose many insulin-sensitizing agents like metformin have been tried as a treatment modality of metabolic as well as reproductive dysfunction in PCOS.Myo-inositol (MI) is a naturally occurring substance produced in the human body that belongs to the vitamin B complex group.PCOS has been linked to a deficiency in myo-inositol. MI can be synthesized by the body from food, but when the investigators are already deficient, the lack of MI can impact the ability of the body to be sensitive to insulin. MI plays an important role as the structural basis for a number of secondary messengers including synthesis of phosphatidylinositol 3-kinase (PI 3-kinase), a key messenger to improve insulin sensitivity and thereby reducing insulin resistance Supplying extra MI appears to temporarily correct the impaired insulin pathways and reduce the signs and symptoms of insulin resistance.

Periodontal diseases, including gingivitis are common chronic infectious diseases characterized by a gingival inflammatory response against predominantly pathogenic microorganisms that colonize the subgingival area and cause local and systemic elevations of proinflammatory cytokines, such as tumor necrosis factor-a and interleukin-6 resulting in loss of connective tissue attachment, alveolar bone resorption which can result in tooth loss. It is well established that patients suffering from periodontitis present with a low grade systemic inflammatory state when compared with healthy subjects.Increased concentrations of inflammatory biomarkers in both gingival tissues and serum such as C-reactive protein and interleukin have been reported.