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Lin SY, Sun JS, Lin IP, Hung MC, Chang JZC. Efficacy of adjunctive local periodontal treatment for type 2 diabetes mellitus patients with periodontitis: A systematic review and network meta-analysis. J Dent 2024; 148:105212. [PMID: 38936456 DOI: 10.1016/j.jdent.2024.105212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVES To investigate the effectiveness of different adjunctive local treatments combined with non-surgical periodontal therapy (NSPT) to reduce pocket depth (PD), gain clinical attachment level (CAL), and/or reduce glycated hemoglobin (HbA1c) in individuals with both type 2 diabetes mellitus (T2DM) and periodontitis in a systematic review and network meta-analysis. DATA SOURCES Publications were searched in Cochrane databases, EMBASE, Google Scholar, MEDLINE, PubMed, opengrey.eu, and www. CLINICALTRIALS gov up to May 29, 2024 with no language restriction. STUDY SELECTION Only randomized controlled trials (RCTs) were included. Network meta-analysis utilized frequentist models. DATA The network meta-analysis of 30 RCTs involving 1224 patients revealed that, in short-term (2-3 months) and medium-term (4-6 months), adjunctive local treatment involving statins or metformin significantly outperformed scaling and root planning (SRP) with/without additional interventions such as photodynamic and laser therapies (PDT/LT), phytotherapy, doxycycline, bisphosphonates, antibiotics, antiseptics, or placebo for reducing PD and/or gaining CAL. In the long-term (>6 months), statins yielded the most significant additional PD reduction and CAL gain, followed by antibiotics, compared to SRP with antiseptics or placebo. Only PDT/LT demonstrated significantly greater HbA1c reduction in the short term compared to SRP with/without statins, antiseptics, or placebo. CONCLUSION This study moderately supports that adding metformin or statins locally to NSPT may enhance PD reduction and CAL gain compared to SRP with/without placebo. CLINICAL SIGNIFICANCE Clinicians are guided to optimize adjunctive therapies, enhancing the health of patients with type 2 diabetes and periodontitis. A strategic approach is proposed to tackle systemic and oral health challenges simultaneously.
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Affiliation(s)
- Shih-Ying Lin
- Department of Dentistry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Orthopedic Surgery, En Chu Kong Hospital, Taipei, Taiwan
| | - I-Ping Lin
- Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Chih Hung
- Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenny Zwei-Chieng Chang
- Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan; School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Janson TM, Ramenzoni LL, Hatz CR, Schlagenhauf U, Attin T, Schmidlin PR. Limosilactobacillus reuteri supernatant attenuates inflammatory responses of human gingival fibroblasts to LPS but not to elevated glucose levels. J Periodontal Res 2024. [PMID: 38764133 DOI: 10.1111/jre.13290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/04/2024] [Accepted: 05/05/2024] [Indexed: 05/21/2024]
Abstract
AIM We investigated the in vitro effect of Limosilactobacillus reuteri DSM 17938 supernatant on the inflammatory response of human gingival fibroblasts (HGF) challenged by lipopolysaccharide (LPS) or elevated glucose levels. METHODS HGF were exposed to LPS (1 μg/mL), glucose (5, 12 mM or 25 mM), and dilutions of supernatant prepared from L. reuteri DSM 17938 (0.5 × 107, 1.0 × 107, 2.5 × 107, and 5.0 × 107 CFU/mL). After 24 h cell viability and levels of cytokines (IL-1β, IL-6 and IL-8) and TLR-2 were determined. RESULTS None of the tested L. reuteri (DSM 17938) supernatant concentrations reduced the viability of HGF. Supernatant concentrations (2.5 × 107 and 5 × 107 CFU/mL) significantly (p < .05) decreased the production of IL-1β, IL-6, IL-8, and TLR-2 in the presence of LPS. In contrast, inflammatory markers were not reduced by L. reuteri supernatant in the presence of glucose. Glucose concentrations of 12 mM and 24 mM still lead to an elevated production of the investigated biochemical mediators. CONCLUSION While L. reuteri (DSM 17938) supernatant attenuates the inflammatory response of HGF to LPS in a dose-dependent manner, elevated glucose levels suppress this action. These in vitro results support the overall anti-inflammatory efficacy of L. reuteri supplementation in plaque-associated periodontal inflammations.
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Affiliation(s)
- T M Janson
- Division of Periodontology and Peri-implant Diseases, Clinic of Conservative and Preventive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - L L Ramenzoni
- Division of Periodontology and Peri-implant Diseases, Clinic of Conservative and Preventive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - C R Hatz
- Division of Periodontology and Peri-implant Diseases, Clinic of Conservative and Preventive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - U Schlagenhauf
- Division of Periodontology and Peri-implant Diseases, Clinic of Conservative and Preventive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
- Department of Conservative Dentistry and Periodontology, Center for Oral Health, University Hospital Wuerzburg, Wuerzburg, Germany
| | - T Attin
- Division of Periodontology and Peri-implant Diseases, Clinic of Conservative and Preventive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - P R Schmidlin
- Division of Periodontology and Peri-implant Diseases, Clinic of Conservative and Preventive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
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Ananda N, Suniarti DF, Bachtiar EW. The antimicrobial effect of Limosilactobacillus reuteri as probiotic on oral bacteria: A scoping review. F1000Res 2024; 12:1495. [PMID: 38434653 PMCID: PMC10905032 DOI: 10.12688/f1000research.139697.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
Dysbiosis among oral microbial community in the oral cavity can lead to several oral diseases. Probiotic therapy is known to correct these imbalances. Limosilactobacillus reuteri is one of the most studied strains of probiotics and can control oral microbiota through reuterin, a wide-spectrum antimicrobial agent. The objective of this review was to evaluate the effect of the antimicrobial activity of Limosilactobacillus reuteri on the oral bacteria of humans. This review used PubMed, Scopus, EMBASE, ScienceDirect, and Google Scholar databases as bibliographic resources. Studies with matching keywords were analyzed and screened with PRISMA-ScR recommendations. Sixteen articles were selected for this review, which included a total of 832 patients. Based on this review, Limosilactobacillus reuteri has a strong antibacterial effect against Streptococcus mutans in healthy individuals but is not effective against Lactobacillus. Additionally, it has a significant antibacterial effect against Porphiromonas gingivalis in patients with periodontitis, although its effectiveness is not stable in patients with peri-implant infections. Furthermore, Limosilactobacillus reuterihas varying results against other bacteria, indicating the need for further extensive research to ensure its efficacy.
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Affiliation(s)
- Nissia Ananda
- Dental Department, Universitas Indonesia Hospital, Universitas Indonesia, Depok, West Java, 16424, Indonesia
| | - Dewi Fatma Suniarti
- Department of Oral Biology, Oral Science Research Center, Faculty of Dentistry, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Endang Winiati Bachtiar
- Department of Oral Biology, Oral Science Research Center, Faculty of Dentistry, Universitas Indonesia, Jakarta, 10430, Indonesia
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Chen S, Zhang Y. Mechanism and application of Lactobacillus in type 2 diabetes-associated periodontitis. Front Public Health 2023; 11:1248518. [PMID: 38098816 PMCID: PMC10720667 DOI: 10.3389/fpubh.2023.1248518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) accelerates the progression of periodontitis through diverse pathways. Abnormal immune responses, excessive activation of inflammation, increased levels of advanced glycation end products, and oxidative stress have defined roles in the pathophysiological process of T2DM-associated periodontitis. Furthermore, in the periodontium of diabetic individuals, there are high levels of advanced glycation end-products and glucose. Meanwhile, progress in microbiomics has revealed that dysbacteriosis caused by T2DM also contributes to the progression of periodontitis. Lactobacillus, owing to its fine-tuning function in the local microbiota, has sparked tremendous interest in this field. Accumulating research on Lactobacillus has detailed its beneficial role in both diabetes and oral diseases. In this study, we summarize the newly discovered mechanisms underlying Lactobacillus-mediated improvement of T2DM-associated periodontitis and propose the application of Lactobacillus in the clinic.
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Affiliation(s)
- Sisi Chen
- Chongqing Three Gorges Medical College, Chongqing, China
- Chongqing Medical University, Chongqing, China
| | - Yuhan Zhang
- Chongqing Three Gorges Medical College, Chongqing, China
- Chongqing Medical University, Chongqing, China
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Thankappan P, Gopalakrishnan D, Manandhar S. Emerging role of photodynamic therapy as an adjunct to nonsurgical periodontal therapy on periodontal status and glycemic control in patients with type 2 diabetes: A clinical study. J Indian Soc Periodontol 2023; 27:508-514. [PMID: 37781335 PMCID: PMC10538516 DOI: 10.4103/jisp.jisp_7_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 10/03/2023] Open
Abstract
Background Periodontal disease is considered to be the sixth most common complication of diabetes mellitus (DM). Antibiotics (systemic and local) enhance the outcome of conventional mechanical debridement but frequent use of antimicrobials may develop resistance to microorganisms. To overcome this complicacy, the current study assessed the effectiveness of photodynamic therapy (PDT) in chronic periodontitis patients with type 2 diabetes when used as a combination therapy to standard periodontal therapy by assessing the various clinical and glycemic parameters. Materials and Methods A total of 16 known cases of chronic Periodontitis patients who were suffering from type 2 DM were allocated into two groups. The test group (n = 8) was treated with standard scaling and root planing (SRP) along with PDT while the control group was treated with SRP alone. Various clinical parameters assessed were plaque index, gingival index, pocket probing depth, clinical attachment level, and Glycated hemoglobin level at baseline and 90 days after therapy. Results At the end of the study, both the groups showed improvements with regard to all clinical and glycemic parameters compared to baseline. However, the test group presented statistically significant favorable results (all P < 0.05). Conclusion Conventional periodontal treatment aided with PDT proved to be a beneficial therapeutic measure and effective alternative in patients with chronic periodontitis with diabetes when compared with standard periodontal therapy alone.
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Affiliation(s)
- Prasanth Thankappan
- Department of Periodontology, Dr. D. Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Dharmarajan Gopalakrishnan
- Department of Periodontology, Dr. D. Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Sumita Manandhar
- Department of Periodontology, Armed Forces Medical Colleges, Pune, Maharashtra, India
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Silva PGBD, Guimarães L, Oliveira F, Miranda LO, Esteves RP. The effect of antimicrobial photodynamic therapy adjunct to non-surgical periodontal therapy on the treatment of periodontitis in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis. Photodiagnosis Photodyn Ther 2023; 42:103573. [PMID: 37062511 DOI: 10.1016/j.pdpdt.2023.103573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND The purpose of the present systematic review and meta-analysis was to assess the impact of antimicrobial photodynamic therapy adjunct to non-surgical periodontal treatment on individuals with type 2 diabetes mellitus. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were carried out in six databases without restriction regarding publication year. Studies comparing periodontal clinical parameters among individuals submitted to non-surgical periodontal therapy associated with antimicrobial photodynamic therapy and a control group of individuals submitted to only non-surgical periodontal treatment were included. Study selection, data extraction, and risk of bias assessment (RoB 2.0) were performed by two review authors. Meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided. RESULTS Two hundred and five studies were identified and 11 studies were included. The meta-analysis demonstrated that antimicrobial photodynamic therapy adjunctive to periodontal therapy, in individuals with diabetes, resulted in a greater reduction of bleeding on probing at 6 months and in probing depth at 3 and 6 months in comparison to periodontal treatment alone (p<0.05). The included studies exhibited low risk of bias. CONCLUSION Antimicrobial photodynamic therapy adjunct to periodontal therapy contributes to the improvement of periodontal clinical parameter bleeding on probing and probing depth in individuals with type 2 diabetes mellitus.
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Affiliation(s)
- Pierre Geraldo Braz da Silva
- Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, School of Dentistry, Federal University de Minas Gerais. Antônio Carlos Avenue 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil, zip code 31270-901
| | - Lucas Guimarães
- Department of Child and Adolescent Oral Health, School of Dentistry, Federal University of Minas Gerais. Antônio Carlos Avenue 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil, zip code 31270-901
| | - Fernando Oliveira
- Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, School of Dentistry, Federal University de Minas Gerais. Antônio Carlos Avenue 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil, zip code 31270-901
| | - Luís Otávio Miranda
- Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, School of Dentistry, Federal University de Minas Gerais. Antônio Carlos Avenue 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil, zip code 31270-901
| | - Rafael Paschoal Esteves
- Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, School of Dentistry, Federal University de Minas Gerais. Antônio Carlos Avenue 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil, zip code 31270-901.
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Zhou K, Xie J, Su Y, Fang J. Lactobacillus reuteri for chronic periodontitis: focus on underlying mechanisms and future perspectives. Biotechnol Genet Eng Rev 2023:1-28. [PMID: 36856460 DOI: 10.1080/02648725.2023.2183617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023]
Abstract
Chronic periodontitis is a common oral disorder caused by pathogenic bacteria. Despite the wide use of antibiotics as the conventional adjunctive treatment, the challenges of increased antibiotic resistance and limited therapeutic effect receive considerable attention and the developments of alternative treatments gain increasing consideration. Growing evidence showed that Lactobacillus reuteri (LR) may represent a promising alternative adjunct for chronic periodontitis. It can attenuate inflammation and reduce tissue disruption. LR-assisted treatment has been shown to be effective and relatively safe in multiple clinical trials, and accumulating evidence suggests its significant biological roles. In the current review, we focus on capturing the underlying mechanisms of LR involved in chronic periodontitis, thereby representing a scientific foundation for LR-assisted therapy. Furthermore, we point out the challenges and future directions for further clinical trials to improve the clinical applicability for LR.
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Affiliation(s)
- Keyi Zhou
- Department of Pediatric Dentistry, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, PR China
| | - Jiaman Xie
- Department of Pediatric Dentistry, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, PR China
| | - Yuan Su
- Department of Periodontology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, PR China
| | - Jingxian Fang
- Department of Pediatric Dentistry, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, PR China
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Rossi R, Rispoli L, Lopez MA, Netti A, Petrini M, Piattelli A. Photodynamic Therapy by Mean of 5-Aminolevulinic Acid for the Management of Periodontitis and Peri-Implantitis: A Retrospective Analysis of 20 Patients. Antibiotics (Basel) 2022; 11:antibiotics11091267. [PMID: 36140046 PMCID: PMC9495362 DOI: 10.3390/antibiotics11091267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Periodontitis and peri-implantitis are common in the population worldwide. Periodontal diseases affect approximately 50% of adults, while mucositis affects 80% of patients with implants, turning into peri-implantitis at a rate varying from 28 to 58%. If standardized treatments for all degrees and variety of periodontal diseases are known and codified, a consensus on the treatment of peri-implantitis still has to be found. Photodynamic therapy (PDT) has been used successfully in the medical field and was recently introduced as supportive therapy in dentistry. This paper reviews the results on 20 patients, 10 affected by periodontal disease (grades II to III) and 10 by peri-implantitis. Application of 5% 5-aminolevulinic acid gel (ALAD), as a support of causal therapy, in periodontal pockets and areas of peri-implantitis favored the maintenance of severely compromised teeth and significantly improved compromised implant conditions. Between baseline and 6 months, all teeth and implants remained functional. All patients confirmed that the scaling and root planning (SRP)+ALAD-PDT was not painful, and all perceived a benefit after the treatment at all timing points. For periodontal patients, a significant decrease in PPD after 3 (p < 0.001) and 6 months after SRP+ALAD-PDT respect baseline values were observed. For the implant patients, the SRP+ALAD-PDT was correlated to a decrease in PPD and BOP, and a slight increase in the number of exposed threads. However, the results were statistically significant only for PPD (p < 0.001).
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Affiliation(s)
| | - Lorena Rispoli
- Department of Periodontology, Humanitas Dental Center, Humanitas Research Hospital, Rozzano, 20089 Milano, Italy
| | - Michele Antonio Lopez
- Department of Head and Neck and Sensory Organs, Division of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica Sacro Cuore, 00168 Rome, Italy
- Correspondence: ; Tel./Fax: +39-06-3015-4079
| | - Andrea Netti
- Department of Head and Neck and Sensory Organs, Division of Oral Surgery and Implantology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Morena Petrini
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66013 Chieti, Italy
| | - Adriano Piattelli
- School of Dentistry, Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
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Simpson TC, Clarkson JE, Worthington HV, MacDonald L, Weldon JC, Needleman I, Iheozor-Ejiofor Z, Wild SH, Qureshi A, Walker A, Patel VA, Boyers D, Twigg J. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev 2022; 4:CD004714. [PMID: 35420698 PMCID: PMC9009294 DOI: 10.1002/14651858.cd004714.pub4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Glycaemic control is a key component in diabetes mellitus (diabetes) management. Periodontitis is the inflammation and destruction of the underlying supporting tissues of the teeth. Some studies have suggested a bidirectional relationship between glycaemic control and periodontitis. Treatment for periodontitis involves subgingival instrumentation, which is the professional removal of plaque, calculus, and debris from below the gumline using hand or ultrasonic instruments. This is known variously as scaling and root planing, mechanical debridement, or non-surgical periodontal treatment. Subgingival instrumentation is sometimes accompanied by local or systemic antimicrobials, and occasionally by surgical intervention to cut away gum tissue when periodontitis is severe. This review is part one of an update of a review published in 2010 and first updated in 2015, and evaluates periodontal treatment versus no intervention or usual care. OBJECTIVES: To investigate the effects of periodontal treatment on glycaemic control in people with diabetes mellitus and periodontitis. SEARCH METHODS An information specialist searched six bibliographic databases up to 7 September 2021 and additional search methods were used to identify published, unpublished, and ongoing studies. SELECTION CRITERIA: We searched for randomised controlled trials (RCTs) of people with type 1 or type 2 diabetes mellitus and a diagnosis of periodontitis that compared subgingival instrumentation (sometimes with surgical treatment or adjunctive antimicrobial therapy or both) to no active intervention or 'usual care' (oral hygiene instruction, education or support interventions, and/or supragingival scaling (also known as PMPR, professional mechanical plaque removal)). To be included, the RCTs had to have lasted at least 3 months and have measured HbA1c (glycated haemoglobin). DATA COLLECTION AND ANALYSIS At least two review authors independently examined the titles and abstracts retrieved by the search, selected the included trials, extracted data from included trials, and assessed included trials for risk of bias. Where necessary and possible, we attempted to contact study authors. Our primary outcome was blood glucose levels measured as glycated (glycosylated) haemoglobin assay (HbA1c), which can be reported as a percentage of total haemoglobin or as millimoles per mole (mmol/mol). Our secondary outcomes included adverse effects, periodontal indices (bleeding on probing, clinical attachment level, gingival index, plaque index, and probing pocket depth), quality of life, cost implications, and diabetic complications. MAIN RESULTS We included 35 studies, which randomised 3249 participants to periodontal treatment or control. All studies used a parallel-RCT design and followed up participants for between 3 and 12 months. The studies focused on people with type 2 diabetes, other than one study that included participants with type 1 or type 2 diabetes. Most studies were mixed in terms of whether metabolic control of participants at baseline was good, fair, or poor. Most studies were carried out in secondary care. We assessed two studies as being at low risk of bias, 14 studies at high risk of bias, and the risk of bias in 19 studies was unclear. We undertook a sensitivity analysis for our primary outcome based on studies at low risk of bias and this supported the main findings. Moderate-certainty evidence from 30 studies (2443 analysed participants) showed an absolute reduction in HbA1c of 0.43% (4.7 mmol/mol) 3 to 4 months after treatment of periodontitis (95% confidence interval (CI) -0.59% to -0.28%; -6.4 mmol/mol to -3.0 mmol/mol). Similarly, after 6 months, we found an absolute reduction in HbA1c of 0.30% (3.3 mmol/mol) (95% CI -0.52% to -0.08%; -5.7 mmol/mol to -0.9 mmol/mol; 12 studies, 1457 participants), and after 12 months, an absolute reduction of 0.50% (5.4 mmol/mol) (95% CI -0.55% to -0.45%; -6.0 mmol/mol to -4.9 mmol/mol; 1 study, 264 participants). Studies that measured adverse effects generally reported that no or only mild harms occurred, and any serious adverse events were similar in intervention and control arms. However, adverse effects of periodontal treatments were not evaluated in most studies. AUTHORS' CONCLUSIONS Our 2022 update of this review has doubled the number of included studies and participants, which has led to a change in our conclusions about the primary outcome of glycaemic control and in our level of certainty in this conclusion. We now have moderate-certainty evidence that periodontal treatment using subgingival instrumentation improves glycaemic control in people with both periodontitis and diabetes by a clinically significant amount when compared to no treatment or usual care. Further trials evaluating periodontal treatment versus no treatment/usual care are unlikely to change the overall conclusion reached in this review.
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Affiliation(s)
- Terry C Simpson
- Edinburgh Dental Institute, University of Edinburgh, Edinburgh, UK
| | - Janet E Clarkson
- School of Dentistry, University of Dundee, Dundee, UK
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Laura MacDonald
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Jo C Weldon
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Ian Needleman
- Unit of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, London, UK
| | | | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ambrina Qureshi
- Department of Community Dentistry, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Veena A Patel
- Orthodontic Department, Leeds Dental Institute, Leeds, UK
| | | | - Joshua Twigg
- School of Dentistry, University of Leeds, Leeds, UK
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Gheisary Z, Mahmood R, Harri shivanantham A, Liu J, Lieffers JRL, Papagerakis P, Papagerakis S. The Clinical, Microbiological, and Immunological Effects of Probiotic Supplementation on Prevention and Treatment of Periodontal Diseases: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14051036. [PMID: 35268009 PMCID: PMC8912513 DOI: 10.3390/nu14051036] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Periodontal diseases are a global health concern. They are multi-stage, progressive inflammatory diseases triggered by the inflammation of the gums in response to periodontopathogens and may lead to the destruction of tooth-supporting structures, tooth loss, and systemic health problems. This systematic review and meta-analysis evaluated the effects of probiotic supplementation on the prevention and treatment of periodontal disease based on the assessment of clinical, microbiological, and immunological outcomes. (2) Methods: This study was registered under PROSPERO (CRD42021249120). Six databases were searched: PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, and Dentistry and Oral Science Source. The meta-analysis assessed the effects of probiotic supplementation on the prevention and treatment of periodontal diseases and reported them using Hedge’s g standardized mean difference (SMD). (3) Results: Of the 1883 articles initially identified, 64 randomized clinical trials were included in this study. The results of this meta-analysis indicated statistically significant improvements after probiotic supplementation in the majority of the clinical outcomes in periodontal disease patients, including the plaque index (SMD = 0.557, 95% CI: 0.228, 0.885), gingival index, SMD = 0.920, 95% CI: 0.426, 1.414), probing pocket depth (SMD = 0.578, 95% CI: 0.365, 0.790), clinical attachment level (SMD = 0.413, 95% CI: 0.262, 0.563), bleeding on probing (SMD = 0.841, 95% CI: 0.479, 1.20), gingival crevicular fluid volume (SMD = 0.568, 95% CI: 0.235, 0.902), reduction in the subgingival periodontopathogen count of P. gingivalis (SMD = 0.402, 95% CI: 0.120, 0.685), F. nucleatum (SMD = 0.392, 95% CI: 0.127, 0.658), and T. forsythia (SMD = 0.341, 95% CI: 0.050, 0.633), and immunological markers MMP-8 (SMD = 0.819, 95% CI: 0.417, 1.221) and IL-6 (SMD = 0.361, 95% CI: 0.079, 0.644). (4) Conclusions: The results of this study suggest that probiotic supplementation improves clinical parameters, and reduces the periodontopathogen load and pro-inflammatory markers in periodontal disease patients. However, we were unable to assess the preventive role of probiotic supplementation due to the paucity of studies. Further clinical studies are needed to determine the efficacy of probiotic supplementation in the prevention of periodontal diseases.
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Affiliation(s)
- Zohre Gheisary
- Laboratory of Oral, Head and Neck Cancer—Personalized Diagnostics and Therapeutics, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada; (Z.G.); (R.M.); (A.H.s.)
| | - Razi Mahmood
- Laboratory of Oral, Head and Neck Cancer—Personalized Diagnostics and Therapeutics, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada; (Z.G.); (R.M.); (A.H.s.)
| | - Aparna Harri shivanantham
- Laboratory of Oral, Head and Neck Cancer—Personalized Diagnostics and Therapeutics, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada; (Z.G.); (R.M.); (A.H.s.)
| | - Juxin Liu
- Department of Mathematics and Statistics, College of Arts and Science, University of Saskatchewan, 106 Wiggins Road, Saskatoon, SK S7N 5E6, Canada;
| | - Jessica R. L. Lieffers
- College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada;
| | - Petros Papagerakis
- Laboratory of Precision Oral Health and Chronobiology, College of Dentistry, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada;
| | - Silvana Papagerakis
- Laboratory of Oral, Head and Neck Cancer—Personalized Diagnostics and Therapeutics, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada; (Z.G.); (R.M.); (A.H.s.)
- Correspondence: ; Tel.: +1-3069661960
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11
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Sang-Ngoen T, Czumbel LM, Sadaeng W, Mikó A, Németh DI, Mátrai P, Hegyi P, Tóth B, Csupor D, Kiss I, Szabó A, Gerber G, Varga G, Kerémi B. Orally Administered Probiotics Decrease Aggregatibacter actinomycetemcomitans but Not Other Periodontal Pathogenic Bacteria Counts in the Oral Cavity: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:682656. [PMID: 34447307 PMCID: PMC8383782 DOI: 10.3389/fphar.2021.682656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/01/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: At the initial part of the gastrointestinal tract, multiple tissues serve the normal function of food delivery. Periodontal structures are integral elements of these. When they deteriorate, it is extremely challenging to regenerate and reconstruct them. The conventional intervention for periodontal disease is scaling and root planning with the aim of reducing pathogenic bacteria. However, periodontal pathogens can rapidly recolonize treated areas. Probiotics have been proposed as novel tools for managing oral health by suppressing pathogenic bacteria through their anti-inflammatory effect, but the available data are controversial. Aim: Therefore, we performed a meta-analysis to study the effect of probiotics on periodontal pathogenic bacteria. Methods: The study was registered in PROSPERO under registration number CRD42018094903. A comprehensive literature search from four electronic databases (PubMed, Cochrane CENTRAL, Embase, and Web of Science) yielded nine eligible records for statistical analysis. Studies measuring bacterial counts in saliva and supra- and subgingival plaque were included. Bacterial counts were analyzed using standard mean difference (SMD) and by a random effects model with the DerSimonian-Laird estimation. Results: The results showed a significant decrease in the overall count of Aggregatibacter actinomycetemcomitans in the probiotic-treated group compared to the control at 4 weeks (SMD: -0.28; 95% CI: -0.56--0.01; p = 0.045) but not later. Analyzing the bacterial counts in subgroups, namely, in saliva and supra- and subgingival plaque, separately, yielded no significant difference. Probiotics had no significant effect on the overall count of Porphyromonas gingivalis at 4 weeks (SMD: -0.02; 95% CI: -0.35-0.31; p = 0.914) or later. Subgroup analysis also revealed no significant difference between treatment and control groups nor did probiotics significantly decrease the overall and subgroup bacterial counts of Prevotella intermedia, Tannerella forsythia, and Fusobacterium nucleatum. Conclusion: Our data support the beneficial effect of probiotics in reducing A. actinomycetemcomitans counts, but not of other key periodontal pathogenic bacteria in periodontal disease patients. However, due to the complex mechanism associated with periodontal disease and the limitations of the available studies, there is a further need for well-designed randomized clinical trials to assess the efficacy of probiotics.
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Affiliation(s)
| | | | - Wuttapon Sadaeng
- Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - Alexandra Mikó
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Dávid István Németh
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Mátrai
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Barbara Tóth
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Dezső Csupor
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - István Kiss
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Andrea Szabó
- Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Gábor Gerber
- Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| | - Gábor Varga
- Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - Beáta Kerémi
- Department of Oral Biology, Semmelweis University, Budapest, Hungary
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