Effect of nonsurgical periodontal treatment on glycosylated hemoglobin in diabetic patients: a systematic review

Effectiveness of periodontal treatment to improve glycemic control: an umbrella review

AIM

The aim of the present umbrella review was to systematically assess existing evidence on the effect of non-surgical periodontal therapy, both per se' and with adjuvants, on glycemic control in patients with type 2 diabetes and periodontitis and to combine quantitative data with a meta-analysis.

MATERIALS AND METHODS

A detailed study protocol was registered on PROSPERO (CRD42021222279). Four electronic databases (Medline via Pubmed, EMBASE, Cochrane Database of Systematic Reviews and Scielo) were searched independently and in duplicate to identify potentially eligible systematic reviews up to March 2022. Two pre-calibrated independent reviewers performed study selection, data extraction and quality assessment with two checklists (AMSTAR 2 and PRISMA). Moreover, general characteristics of primary studies included in each systematic review were abstracted, and JADAD scale was used to assess the risk of bias for included randomized controlled trials. Data from the individual studies included in each meta-analysis were analyzed, using both fixed and random effect model. The statistical heterogeneity was calculated using the Q test and the I² index. The publication bias was evaluated using a funnel plot and Egger's linear regression method.

RESULTS

Sixteen systematic reviews, published between 2010 and 2021, were included for qualitative synthesis. From these systematic reviews, a total of 27 studies were included in the meta-analysis: all of them were randomized clinical trials, except 1 controlled clinical study. A statistically significant mean difference of - 0.49% and of - 0.38% HbA1c reductions was seen respectively at 3- and 6-month post-treatment, favoring the treatment group (non-surgical periodontal therapy alone) compared to the control group (no treatment). The effect of periodontal treatment with the adjunctive use of antibiotics or laser on the glycemic control was not statistically significant compared to non-surgical periodontal therapy alone.

CONCLUSIONS

The findings of the present study, within its limitations, indicated that non-surgical treatment of periodontitis is an efficacious therapy for improving the glycemic control in type 2 diabetes mellitus patients, both at 3- and 6-month follow-up.

Efficacy of ILIB on periodontal clinical parameters and glycemic control in patients with periodontitis and type II diabetes-randomized clinical trial

Our study aimed to study the efficacy of ILIB on periodontal parameters and glycemic control in patients with periodontitis and type II diabetes. Twenty-one patients in a randomized clinical trial were divided into 2 groups: control group (CG), conventional periodontal therapy, and test group (TG), conventional periodontal treatment associated with 10 laser applications by the ILIB-Modified (ILIB-M) technique. Fasting blood glucose levels and glycated hemoglobin (HbA1c), visible plaque index (VPI), gingival bleeding index (GBI), and periodontal clinical parameters were evaluated at baseline and after 4 months (T₄). Regarding periodontal parameters, the intragroup analysis showed a statistically significant reduction (p < 0.05) between baseline and T₄, for the VPI, GBI, BOP, PD, and CAL indexes. However, in the intergroup analysis, no statistically significant improvements (p > 0.05) were observed between the TG and CG for the VPI, GBI, BOP, PD, and CAL indexes. Regarding HbA1C and fasting blood glucose values, no statistically significant improvements were observed in intergroup and intragroup analyses (p > 0.05). The Modified ILIB did not improve the periodontal clinical parameters and glycemic control in patients with type II diabetes.

Clinical efficacy of scaling and root planing with and without metronidazole on glycemic control: three-arm randomized controlled trial

BACKGROUND

Treating periodontitis through non-surgical periodontal therapy (NSPT) may improve glycemic control in type-2 Diabetes Mellitus (T2DM) patients. However, the evidence to maintain this improvement beyond four months is insufficient. Hence, this trial was conducted to assess clinical efficacy of NSPT on glycemic control in T2DM patients.

METHODS

This three-arm randomized controlled trial recruited 150 known T2DM participants (35-65 years), suffering from moderate to severe periodontitis, having HbA1c level ≥ 6.5% at baseline. Participants were followed up at 3 and 6 months. Intervention for test group-1 included scaling and root planing (SRP) with metronidazole (MET) and oral hygiene instructions (OHI). Test group-2 was intervened with SRP + OHI and control group with OHI only. Stata v. 14 was used to observe inter and intragroup mean changes in glycemic [glycated hemoglobin (HbA1c), fasting blood glucose (FBG)] and periodontal variables [bleeding on probing (BOP), periodontal pocket depth (PPD), clinical attachment loss (CAL)] using ANOVA and RMANOVA. Proportion of change in outcome variable (HbA1c) was assessed between treatment groups using chi-square test. Change was considered significant at p-value ≤ 0.05.

RESULTS

A significant reduction was observed in BOP, PPD, CAL, HbA1c and FBG over time [p < 0.05]. Significant reductions were observed in same variables in both test groups in comparison to control arm [p < 0.05]. No change between the two test groups was observed [p > 0.05].

CONCLUSION

Scaling and root planing improves glycemic control of T2DM patients independently of the use of MET. Therefore, SRP after every 6 months may be suggested and included as a part of overall diabetes management for patients suffering from T2DM. Clinical trial registration NCT 03,343,366 [Date of Registration: 17/11/2017].

Periodontal Treatment Protocol for Decompensated Diabetes Patients

Background: Decompensated diabetes is associated with a higher prevalence and severity of periodontitis and poorer response to periodontal therapy. It is conceivable that periodontal therapy may cause systemic and local complications in this type of patients. The aim of the present study was to identify and describe the best available evidence for the treatment of periodontitis in decompensated diabetics.

Material and methods: An expert committee including participants from different areas gathered to discuss and develop a treatment guideline under the guidance of the Cochrane Associate Center, Faculty of Dentistry, University of Chile. In total, four research questions were prepared. The questions prepared related to decompensated diabetic patients (glycated hemoglobin >8) were, (1) Does the exposure to periodontal treatment increase the risk of infectious or systemic complications? (2) Does the antibiotic treatment or prophylaxis, compared to not giving it, reduce infectious complications? (3) Does the exposure to periodontal treatment, compared to no treatment, reduce the glycated hemoglobin levels (HbA1c)? Last question was related to diabetic patients, (4) Does the exposure to a higher level of HbA1c, compared to stable levels, increase the risk of infectious complications? Based on these questions, a search strategy was developed using MEDLINE and EPISTEMONIKOS. Only systematic reviews were considered.

Results: For question 1, the search yielded 12 records in EPISTEMONIKOS and 23 in MEDLINE. None of these studies addressed the question. For question 2, the search yielded 58 records in EPISTEMONIKOS and 11 in MEDLINE. None of these studies addressed the question. For question 3, the search yielded 16 records in EPISTEMONIKOS and 11 in MEDLINE. Thirteen addressed the question. For question 4, the search yielded 7 records in EPISTEMONIKOS and 9 in MEDLINE. One addressed the question.

Conclusions: In decompensated diabetic patients, there is lack of scientific information about risk of infectious or systemic complications as a result of periodontal treatment and about the impact of antibiotic treatment or prophylaxis on reduction if infectious complications. A defined HbA1c threshold for dental and periodontal treatment in diabetic patients has yet to be determined. Finally, periodontal treatment does have an impact on HbA1c levels.

Correlation between diabetes mellitus and number of restored, carious lesions and missing teeth: A retrospective radiographic evaluation

Aim

This study aimed to evaluate the prevalence of carious, restored, and missing teeth among diabetic and non-diabetic patients who visited dental clinics in Dammam, Saudi Arabia.

Method

This retrospective study was conducted between April and November 2018. The data collection procedure was conducted in two steps: (1) review of patient records for the demographic variables and (2) screening of digital panoramic radiographs (OPGs). The patients who visited the restorative and prosthetic clinics in the period of 2016–2017 were included in the study.

Results

A total of 1186 patient records and OPGs were reviewed to extract the data. The average age of the patients in the study sample was 40.96 (±16.29). The sample included 751 (63.3%) female and 435 (36.7%) male patients. Among the patients, 192 (16.2%) had diabetes mellitus and 994 (83.8%) were non-diabetic. The average numbers of fixed partial dentures and missing teeth were significantly high among diabetic patients (P < 0.001). Conversely, the average numbers of carious lesions and restored teeth were higher among the non-diabetic patients. Only the number of restored teeth was found to be significant (P < 0.001).

Conclusion

The diabetic patients were found to be at high risk of losing teeth compared with the non-diabetic patients. The prevalence of fixed partial dentures was also higher among diabetic patients. The oral health status of dental patients with diabetes needs urgent attention to prevent these patients from having teeth loss, and it can be done by improving their oral health.

Does Nonsurgical Periodontal Treatment Improve Systemic Health?

Clinicians frequently stress the importance of maintaining good oral health for multiple reasons, including its link to systemic health. Because periodontal treatment reduces inflammation in oral tissues, some hypothesize it may positively affect systemic outcomes by reducing inflammation in the body. A significant number of systematic reviews (SRs) and meta-analyses (MAs) have evaluated the effect of periodontal treatment on systemic outcomes. However, inconsistent findings and questionable methodological rigor make drawing conclusions difficult. We conducted a systematic review of reviews that studied the effect of nonsurgical periodontal treatment on systemic disease outcomes. We report on outcomes evaluated, categorizing them as biomarkers, and surrogate or clinical endpoints. In addition, we used A MeaSurement Tool to Access systematic Reviews 2 (AMSTAR 2) to evaluate the methodological quality of the reviews. Of the 52 studies included in our review, 21 focused on diabetes, 15 on adverse birth outcomes, 8 on cardiovascular disease, 3 each on obesity and rheumatoid arthritis, and 2 on chronic kidney disease. Across all studies, surrogate endpoints predominated as outcomes, followed by biomarkers and, rarely, actual disease endpoints. Ninety-two percent of studies had "low" or "critically low" AMSTAR 2 confidence ratings. Criteria not met most frequently included advance registration of the protocol, justification for excluding individual studies, risk of bias from individual studies being included in the review, and appropriateness of meta-analytical methods. There is a dearth of robust evidence on whether nonsurgical periodontal treatment improves systemic disease outcomes. Future reviews should adhere more closely to methodological guidelines for conducting and reporting SRs/MAs than has been the case to date. Beyond improved reviews, additional rigorous research on whether periodontal treatment affects systemic health is needed. We highlight the potential of large-scale databases containing matched medical and dental record data to inform and complement future clinical research studying the effect of periodontal treatment on systemic outcomes.

Periodontal Medicine: 100 Years of Progress

Periodontal medicine is a term used to describe how periodontal infection/inflammation may impact extraoral health. Periodontitis has been linked to over 50 systemic diseases and conditions. As part of the Journal of Dental Research's Centennial Celebration, this narrative review discusses periodontal medicine research done over the past 100 y, with particular focus on the effects of periodontal disease on 3 pathological conditions: cardiovascular disease, diabetes mellitus, and adverse pregnancy outcomes. We selected 29 total studies that were the "first" of their kind, as they provided novel observations or contributed to shifting paradigms as well as important studies that made strong contributions to progress in understanding relationships to the systemic conditions. These studies were organized in an overview timeline and broken down into timelines by topic: cardiovascular disease (n = 10), diabetes (n = 12), and adverse pregnancy outcomes (n = 7). Overall, the majority of cross-sectional, case-control, and longitudinal studies have revealed positive associations between poor periodontal status and cardiovascular disease, diabetes metabolic control, and a number of adverse pregnancy outcomes, and these associations are upheld in systematic reviews. Findings from randomized controlled trials testing the effects of periodontal therapy on systemic health outcomes were conflicting and inconsistent. While there has been a great deal of progress, we highlight lessons learned and make comments and suggestions on a number of key aspects, including the heterogeneity of case definitions of periodontal disease across studies, accounting for features of the periodontal phenotype that are most relevant to the biological link between periodontitis and systemic outcomes, the role of other comorbid inflammatory conditions, selection of study participants, and timing and intensity of the periodontal intervention.

The effect of periodontal and prosthodontic therapy on glycemic control in patients with diabetes

PURPOSE

To evaluate the effect of periodontal and prosthodontic therapy on glycated hemoglobin A(HbA1c) level in patients with diabetes.

MATERIALS AND METHODS

This is a retrospective study of 70 patients suffering from diabetes who visited the Kyungpook National University Hospital between January 2016 and May 2018. Patients underwent medical evaluation for their routine check-up, which includes laboratory test for HbA1c levels. Among the 70 patients, 35 patients also visited Kyungpook National University Dental Hospital during the same period to receive periodontal and prosthodontic therapy, while the other 35 patients did not receive such therapy. The HbA1c levels were compared before and after periodontal and prosthodontic therapy. Comparisons between groups and within groups were performed using independent t-test.

RESULTS

The HbA1c levels in the group who have received periodontal and prosthodontic therapy decreased from 7.2 to 6.7 (P=.001). The HbA1c levels in the control group decreased from 7.2 to 7.1 (P=.580). The difference in changes between the two patient groups was statistically significant (P=.011).

CONCLUSION

Periodontal and prosthodontic therapy can be effective on glycemic control in patients with diabetes.

[The impact of periodontal therapy on the diabetes control: A systematic review]

PURPOSE

The bidirectional relationship between diabetes and periodontal disease has been established. Diabetes is a risk factor for periodontal disease while periodontal disease is a complication of diabetes. The objective of this systematic review is to determine whether the administration of periodontal therapy compared to the absence of this treatment would have an impact on the diabetes control in diabetic patients with periodontitis.

METHODS

A literature search was conducted on four databases (PubMed, Science direct, Scopus, Cochrane) to identify randomized clinical trials investigating the effect of periodontal therapy on levels of glycated hemoglobin and fasting plasma glucose for diabetic patients diagnosed with periodontitis. The quality assessment and the risk of bias of the included studies were carried out according to the Cochrane RoB tool.

RESULTS

Fourteen studies met the criteria and were included in this systematic review. Thirteen of these studies reported that periodontal therapy reduces glycated hemoglobin levels three months after periodontal therapy. Nine of these studies investigated the effect of periodontal therapy on fasting plasma glucose levels, five of which reported statistically significant differences of blood glucose levels between diabetics who received periodontal therapy and diabetics who did not receive treatment periodontal.

CONCLUSION

The results of this systematic review indicate that periodontal therapy can contribute to diabetes control in diabetic patients with periodontitis.

The burden of Diabetes, Its Oral Complications and Their Prevention and Management

BACKGROUND

Diabetes mellitus (DM), chronic disease, is a public health problem that affects 8.5% adult population worldwide. The number of adults with DM has risen sharply from 108 million in 1980 to 422 million in 2014. In 2012, 1.5 million individuals died because of DM and an additional 2.2 million deaths occurred because of high blood glucose level resulting in cardiovascular and other systemic diseases. DM brings huge economic loss to patients, their families, and healthcare systems. Globally, the cost of DM was US$1•31 trillion in 2015.

AIM

This review article utilised the prevalence data of diabetes mellitus from the World Health Organization and International Diabetes Federation to provide a comprehensive picture of the disease in different parts of the world.

METHODS

Electronic databases such as Google Scholar, Medline via PubMed, Scopus, and Web of Science were used to search the literature. The library resources of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia were used to retrieve studies on the topics of the present review.

RESULTS

Systemic complications of DM include heart attack, kidney disease, limb loss, blindness, and peripheral nerve damage. More than 90% of diabetic patients were found to have oral manifestations. It is known that DM severely damages oral tissues causing periodontal disease, tooth loss, xerostomia, caries, burning mouth disorder, taste and salivary gland dysfunction, delayed wound healing, lichen planus, geographic tongue, and candidiasis. The evidence is mounting about a strong bidirectional relationship between DM and periodontal disease. Unfortunately, many diabetic patients are unaware of the association between DM and oral health, and only a small percentage of them visit the dentist for routine dental check-ups. Changes in lifestyles (control of blood glucose levels and self-care practices), regular dental check-ups with emphasis on periodontal assessment, and reinforcement of oral health instructions can effectively prevent oral complications of DM. Scaling and root planning are effective in improving glycemic control among diabetic patients.

CONCLUSION

Dental professionals should be part of the multidisciplinary team that helps individuals with diabetes.

Evidence summary: The relationship between oral diseases and diabetes

Introduction This paper is the third of four rapid reviews undertaken to explore the relationships between oral health and general medical conditions in order to support teams within Public Health England, health practitioners and policymakers.Aims This review aimed to explore the nature of the association between poor oral health and diabetes when found in the same individuals or populations, having reviewed the most contemporary evidence in the field.Methods The reviews were undertaken by four groups each comprising consultant clinicians from medicine and dentistry, trainees, public health and academics. The methodology involved a streamlined rapid review process and synthesis of the findings.Results The results identified a number of systematic reviews of low to high quality suggesting that diabetes is associated with periodontal disease, tooth loss, and oral cancer in particular, and that the management of oral diseases, most notably periodontal care, has a short-term beneficial influence on metabolic outcomes related to diabetes; however, there is no evidence that this is sustained over the long-term and reduces the prevalence of the long-term complications.Conclusion Current evidence, of mixed quality, suggests a number of associations between oral diseases and diabetes mellitus (diabetes). Further high quality research is required in this field.

Oral manifestations of Diabetes Mellitus. A systematic review

BACKGROUND

Diabetes Mellitus has become a global epidemic and presents many complications, usually proportional to the degree and duration of hyperglycemia. The aim of this systematic review was to investigate the different oral manifestations associated with Diabetes Mellitus.

MATERIAL AND METHODS

A MEDLINE search for "Diabetes Mellitus and oral manifestations" was performed. A further search was conducted for "diabetes" and its individual oral manifestation. Inclusion criteria were as follows: human clinical studies with a minimum of 30 patients; studies published in relevant scientific journals between January 1998 and January 2016. Nineteen studies fulfilled the inclusion criteria and were analyzed, assessing the strength of scientific evidence according to recommendations made by the Centre for Evidence-Based Medicine, Oxford (OCEBM), which permits adequate assessment of prevalence studies.

RESULTS

A total 3,712 patients (2,084 diabetics) were included in the studies reviewed. Of the 19 studies analyzed, 4 were longitudinal studies and 15 cross-sectional studies. Periodontal disease, periapical lesions, xerostomia and taste disturbance were more prevalent among diabetic patients. An association between diabetes and caries and mucosal lesions proved positive in 5 out of 10 studies.

CONCLUSIONS

Despite multiple oral manifestations associated with DM, awareness of the associations between diabetes, oral health, and general health is inadequate. It is necessary for doctors and dentists to be aware of the various oral manifestations of diabetes in order to make an early diagnosis.

Changes in diabetes medications in the Diabetes and Periodontal Therapy Trial and their effect on hemoglobin A1c (HbA1c)

OBJECTIVE

Evaluate the effect of medications and medication changes during the Diabetes and Periodontal Therapy Trial (DPTT) on the primary study outcome, namely, change in hemoglobin A1c (HbA1c) at 6months following baseline.

METHODS

The DPTT set strict criteria for changes in diabetes medications. Medication change was defined as: change in dose of any 1 oral hypoglycemic agent by more than two-fold, change in dose of insulin of >10% and/or addition or subtraction of an oral hypoglycemic agent, insulin or non-insulin injectable agents. Comparisons between the treatment (non- surgical periodontal therapy) and control (no therapy) groups used t-tests for continuous variables and chi-square tests for categorical variables, including DPTT defined diabetes medication changes between baseline (BL) and 3month visits and 3- and 6-month visits. Changes in HbA1c were compared across the four medication change categories using ANOVA models, overall and for each treatment group separately.

RESULTS

Baseline medication use was similar between the treatment groups (p>0.40), as were medication changes between BL- 3month visits and 3 and 6month visits (p=0.58). Participants with higher BL HbA1c (>8%) and those taking insulin at BL were more likely to have a change in medication (p=0.03).

CONCLUSIONS

The DPTT had the most rigorous definition of medication changes and medication monitoring of any trial in this field to date. The absence of a significant difference in medication changes between treatment groups may suggest that such changes did not play a role in the negative outcome of the DPTT.

Correlation between periodontal disease management and metabolic control of type 2 diabetes mellitus. A systematic literature review

Background

Diabetes and periodontal disease share common features in terms of inflammatory responses. Current scientific evidence suggests that treatment of periodontal disease might contribute to glycemic control. The objective of the study is a review of the last three years.

Material and Methods

A literature search was performed in the MEDLINE (PubMed), Cochrane, and Scopus databases, for articles published between 01-01-2013 and 30-06-2015, applying the key terms “periodontal disease” AND “diabetes mellitus”. The review analyzed clinical trials of humans published in English and Spanish.

Results

Thirteen clinical trials were reviewed, representing a total of 1,912 patients. Three of them had samples of <40 patients, making a total of 108 patients and the remaining ten samples had >40 patients, representing a total of 1,804. Only one article achieved a Jadad score of five. Seven articles (998 patients, 52.3% total), presented a statistically significant decrease in HbA1c (p< 0.05) as a result of periodontal treatment. In the six remaining articles (representing 914 patients, 47.8% of the total), the decrease in HbA1c was not significant. Patient follow-up varied between 3 to 12 months. In three articles, the follow-up was of 3, 4, and 9 months, in two 6 and 12 months.

Conclusions

The majority of clinical trials showed that radicular curettage and smoothing, whether associated with antibiotics or not, can improve periodontal conditions in patients with diabetes mellitus. However, few studies suggest that this periodontal treatment improves metabolic control. However, there is no clear evidence of a relation between periodontal treatment and improved glycemic control in patients with type 2 diabetes mellitus.

Key words:Diabetes, periodontal disease, HbA1c, metabolic control.