1
|
Elnour MA, Mirghani H. Periodontitis treatment (surgical and nonsurgical) effects on glycemic control: A review and meta-analysis. Ann Afr Med 2023; 22:131-135. [PMID: 37026192 DOI: 10.4103/aam.aam_53_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Background Periodontitis is the sixth most prevalent chronic disease. Literature suggests a relationship between diabetes and periodontitis and when coexist may aggravate each other deleterious consequences. Therefore, we aimed to assess the effects of periodontitis treatment on glycemic control. Materials and Methods A systematic literature search was conducted in PubMed, Cochrane Library, and the first 100 articles in Google Scholar from January 2011 to October 2021. The terms periodontitis, periodontal treatment, diabetes mellitus, nonsurgical treatment, glycated hemoglobin (HbA1c) were used, with the Protean "AND" and "OR." The titles, abstracts, and references of the included studies were screened. Any discrepancy was solved by an agreement between researchers. Out of 1059 studies retrieved, 320 stands after the removal of duplication, from them, 31 full texts were screened and only 11 studies were included in the final meta-analysis. Results In the present meta-analysis, 11 studies (1469 patients included) were pooled, and the overall effect showed that periodontitis treatment improved the HbA1c, odd ratio, -0.024, 95% confidence interval, -0.42-.06, P value, 0.009, Chi-square, 52.99. However, substantial heterogeneity was observed, P value, < 0.001, I2 for heterogeneity 81%. Conclusion Periodontitis treatment improved the HbA1c among patients with diabetes and poor glycemic control. Screening of this common disease is important in diabetes holistic care.
Collapse
|
2
|
Di Domenico GL, Minoli M, Discepoli N, Ambrosi A, de Sanctis M. Effectiveness of periodontal treatment to improve glycemic control: an umbrella review. Acta Diabetol 2023; 60:101-113. [PMID: 36261746 DOI: 10.1007/s00592-022-01991-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/03/2022] [Indexed: 01/10/2023]
Abstract
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.
Collapse
Affiliation(s)
| | - Margherita Minoli
- Department of Periodontology, Università Vita-Salute San Raffaele, Milan, Italy
| | - Nicola Discepoli
- Unit of Periodontics, Department of Medical Biotechnologies, Università degli Studi di Siena, Siena, Italy
| | - Alessandro Ambrosi
- Faculty of Medicine and Surgery, Università Vita-Salute San Raffaele, Milan, Italy
| | - Massimo de Sanctis
- Department of Periodontology, Università Vita-Salute San Raffaele, Milan, Italy
| |
Collapse
|
3
|
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: 30] [Impact Index Per Article: 15.0] [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.
Collapse
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
| |
Collapse
|
4
|
Esteves Lima RP, Atanazio ARS, Costa FO, Cunha FA, Abreu LG. IMPACT OF NON-SURGICAL PERIODONTAL TREATMENT ON SERUM TNF-α LEVELS IN INDIVIDUALS WITH TYPE 2 DIABETES: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2021; 21:101546. [PMID: 34391555 DOI: 10.1016/j.jebdp.2021.101546] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/28/2021] [Accepted: 03/13/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The objective of this systematic review and meta-analysis was to search for scientific evidence on the impact of non-surgical periodontal therapy on tumor necrosis factor alpha (TNF-α) in type 2 diabetics. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement has been followed. The study was registered (CRD42020192790) in the International prospective register of systematic reviews. Searches were conducted in five databases. Restrictions on publication date were not imposed in anyway. The studies reporting the serum TNF-α levels of individuals with type 2 diabetes mellitus (DM) before and after non-surgical periodontal therapy were included. Studies' selection, extraction of data and risk of bias assessment were performed in duplicate. Consensus was achieved. Meta-analysis was carried out. The 95% confidence interval and odds ratio were provided. RESULTS Six hundred and twenty-three references were retrieved and eighteen studies were included. Meta-analysis demonstrated that the serum levels of TNF-α in individuals with type 2 DM decreased six months after non-surgical periodontal therapy (mean difference = -1.90, confidence interval = -3.05--0.74). Included studies presented low risk of bias. CONCLUSION Non-surgical periodontal therapy has an impact on serum TNF-α levels at six months in type 2 DM patients.
Collapse
Affiliation(s)
- Rafael Paschoal Esteves Lima
- Division of Periodontology, The Dental School, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil.
| | - Andressa Rafaela Silva Atanazio
- Division of Periodontology, The Dental School, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Fernando Oliveira Costa
- Division of Periodontology, The Dental School, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Fabiano Araújo Cunha
- Division of Periodontology, The Dental School, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Guimarães Abreu
- Division of Pediatric Dentistry, The Dental School, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
5
|
Machado V, Escalda C, Proença L, Mendes JJ, Botelho J. Is There a Bidirectional Association between Polycystic Ovarian Syndrome and Periodontitis? A Systematic Review and Meta-analysis. J Clin Med 2020; 9:jcm9061961. [PMID: 32585861 PMCID: PMC7355910 DOI: 10.3390/jcm9061961] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) has reproductive and metabolic properties that may be linked to periodontitis (PD). This study aimed to update and render a robust critical assessment on all evidence linking PCOS and PD, and appraising a hypothetical bidirectional association. Five databases (PubMed, Scholar, EMBASE, Web of Science and CENTRAL) were searched up to May 2020. Case-control and cohort studies on the association of PCOS and PD were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses of standardized mean difference (SMD) and risk ratio (RR) were performed. We followed Strength of Recommendation Taxonomy (SORT) to appraise the strength and quality of the evidence. Twelve case-controls fulfilled the inclusion criteria (876 with PCOS and 48170 healthy controls), all scored as having a low risk of bias. Meta-analysis revealed that PCOS females have 28% more risk towards PD, and PD females have 46% more risk to have PCOS. PCOS females with PD had higher gum bleeding, periodontal pocket depth and clinical attachment loss than non-PCOS females with PD. Populations with undefined periodontal status contribute to underestimated results. On the basis of the available evidence, it is possible to assume a bidirectional link between PCOS and PD. That is, PCOS increases by 28% the risk of having PD and in the same fashion, PD increases by 46% the risk of having PCOS. Furthermore, women with PCOS were associated with worsening clinical characteristics and inflammation of PD. These findings suggest that PCOS and PD may be linked. Hence, further prospective and clinical trial studies with nonsurgical periodontal therapy are necessary to clarify the existence of an increased risk of PCOS in women with PD and vice-versa.
Collapse
Affiliation(s)
- Vanessa Machado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal; (C.E.); (J.J.M.); (J.B.)
- Correspondence:
| | - Cláudia Escalda
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal; (C.E.); (J.J.M.); (J.B.)
| | - Luís Proença
- Quantitative Methods for Health Research (MQIS), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal;
| | - José João Mendes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal; (C.E.); (J.J.M.); (J.B.)
| | - João Botelho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal; (C.E.); (J.J.M.); (J.B.)
| |
Collapse
|
6
|
Pérez-Sayáns M, Blanco-Carrión A, García-García A, Chamorro-Petronacci CM, Ortega KL, Suárez-Quintanilla J. Alveolar bone loss, platelet and glycosylated haemoglobin levels in 239 patients. A clinical study. Med Oral Patol Oral Cir Bucal 2020; 25:e318-e325. [PMID: 32134896 PMCID: PMC7211374 DOI: 10.4317/medoral.23181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background The relation between periodontal disease and systemic pathologies is still not widespread among general practitioners. The aim of our study is to evaluate whether or not periodontal radiological diagnosis can aid the detection of blood alterations associated with acquired systemic diseases.
Material and Methods This is a cross sectional study. All of the participants underwent a panoramic radiograph and a complete blood test. Morphological bone loss was considered as positive in those patients who showed radiographically more than 1 tooth with bone loss greater than or equal to the middle third of the root. The statistical analysis was performed by comparing the variables using the ANOVA or U-Mann-Whitney tests for independent samples with normal conditions. The correlation coefficient was analysed using the Pearson test.
Results 239 patients were included in our study (96 men and 143 women) with an average age of 64.40 years. 59.04% of the patients were determined as morphological bone loss positive and had on average 4 teeth less than negative patients (p <0.0001). Also the average platelet levels in positive patients were lower (p = 0.024) and mean levels of HBA1c (p = 0.009) were higher.
Conclusions Morphological bone loss parameter can be useful both for dentists and general practitioners to refer, subsequently, to periodontal specialist. Key words:Periodontal diseases, blood chemical analysis, blood platelets, alkaline phosphatase, glycosylated haemoglobin A, alveolar bone loss.
Collapse
Affiliation(s)
- M Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit Faculty of Medicine and Dentistry Santiago de Compostela University Entrerríos s/n, Santiago de Compostela C.P. 15782, Spain
| | | | | | | | | | | |
Collapse
|
7
|
Baeza M, Morales A, Cisterna C, Cavalla F, Jara G, Isamitt Y, Pino P, Gamonal J. Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis. J Appl Oral Sci 2020; 28:e20190248. [PMID: 31939522 PMCID: PMC6919200 DOI: 10.1590/1678-7757-2019-0248] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/29/2019] [Accepted: 09/19/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The evidence is inconclusive regarding the effect of periodontal treatment on glycemic control and systemic inflammation in patients with type 2 diabetes (T2D) and periodontitis. To evaluate the effect of scaling and root planing (SRP) on the metabolic control and systemic inflammation of patients with type 2 diabetes (T2D). METHODOLOGY A literature search was conducted using the MEDLINE database via PubMed and the Cochrane Central Register of Controlled Trials, from their oldest records up to July 2018. Only randomized clinical trials (RCT) were considered eligible for evaluating the effect of periodontal treatment on markers of metabolic control [glycated hemoglobin (HbA1C)] and systemic inflammation [C-reactive protein (CRP)] in patients with T2D. The quality of the studies was evaluated using the Cochrane Collaboration risk assessment tool. Meta-analyses were performed for HbA1c and CRP using random effects models. The size of the overall intervention effect was estimated by calculating the weighted average of the differences in means (DM) between the groups in each study. Heterogeneity was assessed using the Q-statistic method (x2 and I²). The level of significance was established at p<0.05. RESULTS Nine RCT were included. SRP was effective in reducing HbA1c [DM=0.56 (0.36-0.75); p<0.01] and CRP [DM=1.89 (1.70-2.08); p<0.01]. No heterogeneity was detected (I2=0%, p>0.05). CONCLUSIONS SRP has an impact on metabolic control and reduction of systemic inflammation of patients with T2D.
Collapse
Affiliation(s)
- Mauricio Baeza
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
- Universidad de Chile, Facultad de Medicina, Escuela de Salud Pública, Santiago, Chile
| | - Alicia Morales
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiología y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
| | - Carlos Cisterna
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
| | - Franco Cavalla
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
| | - Gisela Jara
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiología y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
| | - Yuri Isamitt
- Universidad de Chile, Facultad de Odontología, Departamento de Prótesis, Santiago, Chile
| | - Paulina Pino
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiología y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
| | - Jorge Gamonal
- Universidad de Chile, Facultad de Odontología, Departamento de Odontología Conservadora, Santiago, Chile
- Universidad de Chile, Facultad de Odontología, Centro de Epidemiología y Vigilancia de las Enfermedades Orales (CEVEO), Santiago, Chile
| |
Collapse
|
8
|
El-Makaky Y, Shalaby HK. The effects of non-surgical periodontal therapy on glycemic control in diabetic patients: A randomized controlled trial. Oral Dis 2019; 26:822-829. [PMID: 31834660 DOI: 10.1111/odi.13256] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/12/2019] [Accepted: 12/07/2019] [Indexed: 12/16/2022]
Abstract
AIM The present study aimed to monitor the clinical outcomes and the metabolic response of periodontal therapy (non-surgical) in patients with periodontitis (chronic) and uncontrolled diabetes (type 2). METHODS Eighty-eight subjects with periodontitis (chronic) and uncontrolled diabetes (type 2) were enrolled in this controlled trial and allocated randomly to the test group (44 patients were received immediate periodontal therapy) or the control group (44 patients were received delayed periodontal therapy). The metabolic and clinical evaluations were conducted at baseline and 3 months. This included clinical attachment level, glycated hemoglobin (HbA1c), bleeding on probing, visible plaque, and pocket depth. The periodontal therapy in this study consists of one-stage scaling and root planning, a combination of systemic antibiotics (amoxicillin 500 mg and metronidazole 400 mg), and oral hygiene instructions. RESULTS Regarding clinical and metabolic parameters at baseline, no statistically significant differences were displayed between the two groups. However, at 3-month follow-up period the patients within the test group demonstrated significantly better clinical and metabolic outcomes than patients in the control group. CONCLUSION The non-surgical periodontal treatment using a combination of metronidazole and amoxicillin significantly improved the metabolic outcome in addition to periodontal health in diabetic subjects with chronic periodontitis.
Collapse
Affiliation(s)
- Yasser El-Makaky
- Department of Periodontology, Faculty of Dentistry, Tanta University, Tanta, Egypt.,Department of Periodontology, College of Dentistry, Taibah University, Saudi Arabia
| | - Hany K Shalaby
- Department of Periodontology, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt
| |
Collapse
|
9
|
Srivastava MC, Srivastava R, Verma PK, Gautam A. Metabolic syndrome and periodontal disease: An overview for physicians. J Family Med Prim Care 2019; 8:3492-3495. [PMID: 31803642 PMCID: PMC6881921 DOI: 10.4103/jfmpc.jfmpc_866_19] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/08/2019] [Accepted: 10/21/2019] [Indexed: 01/26/2023] Open
Abstract
The metabolic syndrome (MetS) (also known as insulin resistance syndrome, syndrome X) is a cluster of factors associated with increased risk of developing coronary heart disease or type 2 diabetes mellitus. Several studies in the past have reviewed an association between MetS and periodontitis. Periodontal disease is considered an infectious and chronic inflammatory disease, and it has been considered to be a potential risk in cardiovascular and respiratory diseases and diabetes, and has implications in adverse pregnancy outcomes, osteoporosis, and so on. These systemic disorders have been documented as capable of affecting the periodontium or treatment of periodontal disease. Oral inflammatory lesions have different basic mechanisms concerning the possible association with systemic diseases. They concern local spread, metastatic spread, or immunologic cross-reactivity. In many studies, sometimes contrasting, periodontal pathogens have been evaluated in atheromatous plaques isolated from patients with chronic periodontitis. Oral inflammatory lesions have been shown unequivocally to contribute to elevated systemic inflammatory responses. In some studies, intensive periodontal therapy showed a significant reduction in c-reactive protein levels, interleukin-6, and low-density lipoprotein cholesterol after 2 months. The aim of this article is to reflect the association between MetS and periodontitis and to suggest an understanding to promote interprofessional practice; with proper oral care and plaque control, we can reduce the severity of MetS.
Collapse
Affiliation(s)
- Mahesh C Srivastava
- Department of Medicine, Prasad Institute of Medical Sciences, Banthara, Lucknow, Uttar Pradesh, India
| | - Ruchi Srivastava
- Department of Periodontology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Pushpendra Kumar Verma
- Department of Conservative Dentistry and Endodontics, Saraswati Dental College, Lucknow, Uttar Pradesh, India
| | - Anju Gautam
- Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| |
Collapse
|
10
|
Toda K, Mizutani K, Minami I, Ye M, Arakawa T, Mitsubayashi K, Ogawa Y, Araki K, Shinada K. Effects of oral health instructions on glycemic control and oral health status of periodontitis patients with type 2 diabetes mellitus: A preliminary observation. J Dent Sci 2019; 14:171-177. [PMID: 31210891 PMCID: PMC6562110 DOI: 10.1016/j.jds.2019.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/16/2019] [Indexed: 01/16/2023] Open
Affiliation(s)
- Kanako Toda
- Department of Educational System in Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Mizutani
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Isao Minami
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ming Ye
- Department of Biomedical Devices and Instrumentation, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Arakawa
- Department of Biomedical Devices and Instrumentation, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kohji Mitsubayashi
- Department of Biomedical Devices and Instrumentation, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshihiro Ogawa
- Department of Molecular and Cellular Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kouji Araki
- Department of Educational System in Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kayoko Shinada
- Department of Oral Health Care Science, Graduate School of Medical and Dental Sciences (Dentistry), Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
11
|
[The impact of periodontal therapy on the diabetes control: A systematic review]. Presse Med 2019; 48:4-18. [PMID: 30665791 DOI: 10.1016/j.lpm.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 11/23/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022] Open
Abstract
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.
Collapse
|
12
|
Jain A, Gupta J, Bansal D, Sood S, Gupta S, Jain A. Effect of scaling and root planing as monotherapy on glycemic control in patients of Type 2 diabetes with chronic periodontitis: A systematic review and meta-analysis. J Indian Soc Periodontol 2019; 23:303-310. [PMID: 31367125 PMCID: PMC6628769 DOI: 10.4103/jisp.jisp_417_18] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: There is enough evidence, which suggests that nonsurgical periodontal therapy (NSPT) improved the glycemic control in patients of Type 2 diabetes mellitus (T2DM) with chronic periodontitis (CP). This meta-analysis is aimed to explore the effect of NSPT, exclusively scaling and root planing (SRP) as monotherapy on glycemic control and periodontal parameters in patients of T2DM with CP. Materials and Methods: Two databases, MEDLINE and EMBASE, were searched from June 2006 to June 2016. Initially, 464 potentially relevant studies were evaluated. Randomized controlled trials with duration of ≥3 months, based on the treatment group managed with SRP without any supportive use of local drug delivery or systemic antibiotics, while the control group received no periodontal therapy, were selected. This resulted in six appropriate articles with a total of 812 patients of T2DM with CP. Alteration in glycated hemoglobin (HbA1c) was the primary outcome measure, whereas the changes in clinical attachment level (CAL) and probing pocket depth (PPD) were the secondary outcome measures. Results: SRP treatment resulted in a decrease in HbA1c by 0.26% (P = 0.17) at 3–4 months compared to the control group. Further, on subgroup analysis, SRP therapy revealed a decrease in PPD and CAL at 3–4 months, though statistically insignificant. Conclusion: SRP treatment leads to modest improvement in glycemic status and periodontal parameters in T2DM patients with CP at 3–4 months.
Collapse
Affiliation(s)
- Akanksha Jain
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, Punjab, India
| | - Jyoti Gupta
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, Punjab, India
| | - Dipika Bansal
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Mohali, Punjab, India
| | - Shaveta Sood
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, Punjab, India
| | - Shipra Gupta
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, Punjab, India
| | - Ashish Jain
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, Punjab, India
| |
Collapse
|
13
|
Abstract
About one in two adults in the United States has periodontal disease. Chronic periodontitis is an oral disease affecting the supporting structures of the teeth leading to progressive loss of the attachment apparatus and bone around teeth. It is characterized by gingival pocket formation and/or gingival recession. The disease is initiated by bacteria and their components like lipopolysaccharide and causes a heightened host inflammatory response. This cascade of inflammatory response ultimately leads to an increased osteoclastic activity and bone loss. Individuals with periodontitis have increased systemic levels of acute phase proteins, plasma antibody levels, coagulation factor, total white blood cell count, neutrophils, C reactive protein (CRP), and cytokines such as INF- gamma (Interferon gamma), TNF-α (Tumor necrosis Factor- Alpha), IL (Interleukin)-1β, IL-2 and IL-6. As periodontitis works on the same chronic inflammation model seen in systemic diseases, there is sufficient evidence to suggest a bi-directional link between the two. This article summarizes the established associations between periodontal disease and systemic health.
Collapse
|
14
|
Vergnes JN, Canceill T, Vinel A, Laurencin-Dalicieux S, Maupas-Schwalm F, Blasco-Baqué V, Hanaire H, Arrivé E, Rigalleau V, Nabet C, Sixou M, Gourdy P, Monsarrat P. The effects of periodontal treatment on diabetic patients: The DIAPERIO randomized controlled trial. J Clin Periodontol 2018; 45:1150-1163. [PMID: 30136741 DOI: 10.1111/jcpe.13003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 07/13/2018] [Accepted: 08/19/2018] [Indexed: 12/14/2022]
Abstract
AIM To assess whether periodontal treatment can lead to clinical, glycaemic control and quality of life improvements in metabolically unbalanced diabetic patients (type 1 or type 2) diagnosed with periodontitis. METHODS In this open-labelled randomized controlled trial, diabetic subjects (n = 91) were given "immediate" or "delayed" periodontal treatment (full-mouth non-surgical scaling and root planing, systemic antibiotics, and oral health instructions). The main outcome was the effect on glycated haemoglobin (HbA1C ) and fructosamine levels. The General Oral Health Assessment Index and the SF-36 index were used to assess quality of life (QoL). RESULTS Periodontal health significantly improved after periodontal treatment (p < 0.001). Periodontal treatment seemed to be safe but had no significant effects on glycaemic control based on HbA1C (adjusted mean difference with a 95% confidence interval (aMD) of 0.04 [-0.16;0.24]) and fructosamine levels (aMD 5.0 [-10.2;20.2]). There was no obvious evidence of improvement in general QoL after periodontal treatment. However, there was significant improvement in oral health-related QoL (aMD 7.0 [2.4;11.6], p = 0.003). CONCLUSION Although periodontal treatment showed no clinical effect on glycaemic control in this trial, important data were provided to support periodontal care among diabetic patients. Periodontal treatment is safe and improves oral health-related QoL in patients living with diabetes. ISRCTN15334496.
Collapse
Affiliation(s)
- Jean-Noel Vergnes
- The Department of Epidemiology and Public Health, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France.,The Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Thibault Canceill
- The Department of Oral Rehabilitation, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France
| | - Alexia Vinel
- The Department of Oral Surgery, Periodontology and Oral Biology, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France.,The Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1048, INSERM, UPS, Université de Toulouse, Toulouse, France
| | - Sara Laurencin-Dalicieux
- The Department of Oral Surgery, Periodontology and Oral Biology, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France.,INSERM U1043, Université Toulouse III CHU Purpan, Toulouse, France
| | - Françoise Maupas-Schwalm
- The Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1048, INSERM, UPS, Université de Toulouse, Toulouse, France.,The Department of Biochemistry and Molecular Biology, Faculty of Medicine-Rangueil (CHU de Toulouse), Paul Sabatier Toulouse-3, IFR-150, Toulouse, France
| | - Vincent Blasco-Baqué
- The Department of Oral Surgery, Periodontology and Oral Biology, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France.,The Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1048, INSERM, UPS, Université de Toulouse, Toulouse, France
| | - Hélène Hanaire
- The Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1048, INSERM, UPS, Université de Toulouse, Toulouse, France.,The Department of Diabetology - Metabolic Diseases - Nutrition, CHU of Toulouse, Toulouse, France
| | - Elise Arrivé
- Department of Dentistry and Oral health, Bordeaux University Hospital, Bordeaux, France.,Department of Odontology, University of Bordeaux, Bordeaux, France
| | | | - Cathy Nabet
- The Department of Epidemiology and Public Health, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France.,INSERM U1027, Paul Sabatier University, Toulouse, France
| | - Michel Sixou
- The Department of Epidemiology and Public Health, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France
| | - Pierre Gourdy
- The Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR1048, INSERM, UPS, Université de Toulouse, Toulouse, France.,The Department of Diabetology - Metabolic Diseases - Nutrition, CHU of Toulouse, Toulouse, France
| | - Paul Monsarrat
- The Department of Oral Rehabilitation, Faculty of Dentistry, Toulouse University Hospital (CHU de Toulouse), Paul Sabatier University, Toulouse, France.,STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, ENVT, Inserm U1031, UPS, Toulouse, France
| | | |
Collapse
|
15
|
Sabharwal A, Gomes-Filho IS, Stellrecht E, Scannapieco F. Role of periodontal therapy in management of common complex systemic diseases and conditions: An update. Periodontol 2000 2018; 78:212-226. [DOI: 10.1111/prd.12226] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Amarpreet Sabharwal
- Department of Oral Biology; School of Dental Medicine; University at Buffalo; The State University of New York; Buffalo NY USA
| | | | - Elizabeth Stellrecht
- Health Sciences Library; University at Buffalo; The State University of New York; Buffalo NY USA
| | - Frank A. Scannapieco
- Department of Oral Biology; School of Dental Medicine; University at Buffalo; The State University of New York; Buffalo NY USA
| |
Collapse
|
16
|
Kocher T, König J, Borgnakke WS, Pink C, Meisel P. Periodontal complications of hyperglycemia/diabetes mellitus: Epidemiologic complexity and clinical challenge. Periodontol 2000 2018; 78:59-97. [DOI: 10.1111/prd.12235] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Jörgen König
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Wenche Sylling Borgnakke
- Department of Periodontics and Oral Medicine; University of Michigan School of Dentistry; Ann Arbor Michigan
| | - Christiane Pink
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| | - Peter Meisel
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry; University Medicine Greifswald; Greifswald Germany
| |
Collapse
|
17
|
Mauri-Obradors E, Merlos A, Estrugo-Devesa A, Jané-Salas E, López-López J, Viñas M. Benefits of non-surgical periodontal treatment in patients with type 2 diabetes mellitus and chronic periodontitis: A randomized controlled trial. J Clin Periodontol 2018; 45:345-353. [DOI: 10.1111/jcpe.12858] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 12/11/2022]
Affiliation(s)
| | - Alexandra Merlos
- Department of Pathology and Experimental Therapeutics; Medical School; IDIBELL-University of Barcelona; Barcelona Spain
| | | | - Enric Jané-Salas
- Department of Dentistry; Dental School; University of Barcelona; Barcelona Spain
- Oral Medicine Unit; Department of Dentistry; Faculty of Medicine and Health Sciences (Dental School) and Dental Hospital Barcelona University (University of Barcelona) and Health and Masticatory System Group (Bellvitge Biomedical Research, Institute) IDIBELL; Barcelona Spain
| | - José López-López
- Department of Dentistry; Dental School; University of Barcelona; Barcelona Spain
- Oral Medicine Unit; Department of Dentistry; Faculty of Medicine and Health Sciences (Dental School) and Dental Hospital Barcelona University (University of Barcelona) and Health and Masticatory System Group (Bellvitge Biomedical Research, Institute) IDIBELL; Barcelona Spain
| | - Miguel Viñas
- Department of Pathology and Experimental Therapeutics; Medical School; IDIBELL-University of Barcelona; Barcelona Spain
| |
Collapse
|
18
|
Madianos PN, Koromantzos PA. An update of the evidence on the potential impact of periodontal therapy on diabetes outcomes. J Clin Periodontol 2017; 45:188-195. [DOI: 10.1111/jcpe.12836] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Phoebus N. Madianos
- Department of Periodontology; School of Dentistry; National and Kapodistrian University of Athens; Athens Greece
| | - Panagiotis A. Koromantzos
- Department of Periodontology; School of Dentistry; National and Kapodistrian University of Athens; Athens Greece
| |
Collapse
|
19
|
Wang S, Liu J, Zhang J, Lin J, Yang S, Yao J, Du M. Glycemic control and adipokines after periodontal therapy in patients with Type 2 diabetes and chronic periodontitis. Braz Oral Res 2017; 31:e90. [PMID: 29185604 DOI: 10.1590/1807-3107bor-2017.vol31.0090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/25/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | | | | | | | - Jiangwu Yao
- Xiamen Stomatological Research Institute, China
| | | |
Collapse
|
20
|
Goel K, Pradhan S, Bhattarai MD. Effects of nonsurgical periodontal therapy in patients with moderately controlled type 2 diabetes mellitus and chronic periodontitis in Nepalese population. Clin Cosmet Investig Dent 2017; 9:73-80. [PMID: 28761379 PMCID: PMC5522660 DOI: 10.2147/ccide.s138338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives Despite several investigations, evidence is still controversial regarding the effect of periodontal treatment on diabetes. This study evaluates and compares the effect on glycemic control and periodontal status with or without nonsurgical periodontal therapy in patients with type 2 diabetes mellitus and chronic periodontitis in a Nepalese population. Materials and methods A total of 82 patients attending the diabetes clinic and fulfilling enrollment criteria with moderate to severe periodontitis were selected. They were assigned in an alternative sequence, into test and control group. Both groups were instructed to continue with their medical treatment without modifications. Scaling and root surface debridement were performed in the test group whereas the control group received oral hygiene instructions with no treatment during the 3-month study period. Results There were 41 participants in each group with the mean age of 50.66±7.70 and 53.80±9.16 years, average diabetes duration of 6.32±4.21 and 6.24±4.00 years, mean body mass index of 24.78±1.85 and 24.6±1.79 kg/m2, and glycated hemoglobin (HbA1c) level of 6.71±0.50% and 6.80±0.45%, in the test and control group, respectively. After 3 months, there was significant reduction in HbA1c levels in the test group compared to the control group (p=0.029). Clinical periodontal parameters of gingival index, probing depth (PD), and clinical attachment level (CAL) significantly improved in the test group (p<0.001) with PD reduction by 0.9 mm and gain in CAL by 0.3 mm compared to the control group (p>0.001) who showed an increase by 0.05 mm. Conclusion This study showed that nonsurgical periodontal therapy may have a beneficial effect on HbA1c level in moderately controlled type 2 diabetic patients.
Collapse
Affiliation(s)
- Khushboo Goel
- Department of Periodontology and Oral Implantology, College of Dental Surgery, B.P. Koirala Institute of Health Sciences, Dharan
| | - Shaili Pradhan
- Department of Dental Surgery, Periodontics Unit, Bir Hospital
| | | |
Collapse
|
21
|
Deepti, Tewari S, Narula SC, Singhal SR, Sharma RK. Effect of Non-Surgical Periodontal Therapy Along With Myo-Inositol on High-Sensitivity C-Reactive Protein and Insulin Resistance in Women With Polycystic Ovary Syndrome and Chronic Periodontitis: A Randomized Controlled Trial. J Periodontol 2017; 88:999-1011. [PMID: 28598285 DOI: 10.1902/jop.2017.170121] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The purpose of this study is to evaluate the effect of non-surgical periodontal therapy and medical treatment on the level of a serologic marker of inflammation (high-sensitivity C-reactive protein [hsCRP]) and insulin resistance (homeostatic model assessment [HOMA]) in women with polycystic ovary syndrome (PCOS) and chronic periodontitis (CP). METHODS Women with PCOS and CP (n = 60) were randomly divided into two groups. The test group was treated with scaling and root planing (SRP) and myo-inositol (MI). The control group was treated with MI and given oral hygiene instructions. Anthropometric, metabolic, and periodontal parameters were assessed at baseline and re-evaluated at 3 and 6 months. All parameters of both groups at 6 months were compared with 25 systemically and periodontally healthy females (group A). RESULTS Periodontal parameters were significantly improved in the test group compared with the control group at 3- and 6-month follow-up (P <0.001). A statistically significant reduction was observed in hsCRP and HOMA in both groups at 3- and 6-month follow-up (P <0.05). However, significantly more improvement in hsCRP (P <0.05) and a statistically comparable reduction in HOMA (P >0.05) was observed in the test group compared with the control group at 3 and 6 months. Both the test and control group showed significant consistent improvement in metabolic parameters at 3- and 6-month follow-up, which was further comparable to group A. CONCLUSION SRP together with medical treatment results in a greater reduction of systemic inflammatory burden compared with medical treatment alone in management of women with PCOS and CP.
Collapse
Affiliation(s)
- Deepti
- Department of Periodontics and Oral Implantology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Shikha Tewari
- Department of Periodontics and Oral Implantology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Satish Chander Narula
- Department of Periodontics and Oral Implantology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Savita Rani Singhal
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rajinder Kumar Sharma
- Department of Periodontics and Oral Implantology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| |
Collapse
|
22
|
Teshome A, Yitayeh A. The effect of periodontal therapy on glycemic control and fasting plasma glucose level in type 2 diabetic patients: systematic review and meta-analysis. BMC Oral Health 2016; 17:31. [PMID: 27473177 PMCID: PMC4967318 DOI: 10.1186/s12903-016-0249-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/12/2016] [Indexed: 12/14/2022] Open
Abstract
Background Diabetic mellitus and periodontal disease have bilateral associations. However, there is a dilemma on the effect of periodontal therapy on glycemic control and/or fasting plasma glucose level in type 2 diabetic patients with periodontitis. Therefore, this review aimed to assess the effectiveness of periodontal therapy versus no periodontal therapy on glycated hemoglobin (HbA1c) and fasting plasma glucose level in type 2 diabetic patients. Methods Article searching was done using four databases (MEDLINE, Cochrane library (CENTRAL), EMBASE and CINAHL) and a manual search (until December 2015). We included randomized controlled trials testing the effectiveness of periodontal therapy on glycated hemoglobin and fasting plasma glucose level in patients with type 2 Diabetes mellitus with periodontal disease. Studies published in English between 2005 and 2015 were included. Risk of bias was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases. Results After the article selection process, seven Randomized controlled trials involving 940 participants with a primary outcome of change in glycated hemoglobin and/or fasting plasma glucose and having a minimum of 3 months follow-up were included. There was a reduction of glycated hemoglobin 0.48(95 % CI: 0.18–0.78) after 3 months follow-up and 0.53 (95 % CI: 0.24–0.81) at the end of the intervention period. There was also a significant reduction of fasting plasma glucose level, 8.95 mg/dl (95 % CI: 4.30–13.61) in the intervention group after the end of the intervention. The pooled analysis showed that patients with adjunctive antibiotic therapy and mouth wash had effect size of 0.51(0.03, 1.00, p = 0.04) and it was 0.53 (95 % CI: 0.19, 0.87; p = 0.002) in patients without adjunctive therapy. The publication bias of the studies was 0.066 according to Egger’s test. Conclusion In this systematic review and meta-analysis, there is a significant reduction of Glycated hemoglobin and Fasting plasma glucose level on type 2 diabetic and periodontal patients with non-surgical periodontal therapy.
Collapse
Affiliation(s)
- Amare Teshome
- Department of Dentistry, College of Medicine and Health Sciences, University of Gondar, Gondar, P.O. Box 196, Ethiopia.
| | - Asmare Yitayeh
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
23
|
Pérez-Losada FL, Jané-Salas E, Sabater-Recolons MM, Estrugo-Devesa A, Segura-Egea JJ, López-López J. Correlation between periodontal disease management and metabolic control of type 2 diabetes mellitus. A systematic literature review. Med Oral Patol Oral Cir Bucal 2016; 21:e440-6. [PMID: 26827070 PMCID: PMC4920457 DOI: 10.4317/medoral.21048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/11/2015] [Indexed: 12/23/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- F-L Pérez-Losada
- Department of Odontostomatology, School of Dentistry, Pabellón de Gobierno, Bellvitge University Campus, C/Feixa LLarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain,
| | | | | | | | | | | |
Collapse
|
24
|
Botero JE, Rodríguez C, Agudelo-Suarez AA. Periodontal treatment and glycaemic control in patients with diabetes and periodontitis: an umbrella review. Aust Dent J 2016; 61:134-48. [DOI: 10.1111/adj.12413] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 12/28/2022]
Affiliation(s)
- JE Botero
- Faculty of Dentistry; Universidad de Antioquia; Medellín Colombia
| | - C Rodríguez
- Faculty of Dentistry; Universidad de Antioquia; Medellín Colombia
| | | |
Collapse
|
25
|
Gurav AN. Management of diabolical diabetes mellitus and periodontitis nexus: Are we doing enough? World J Diabetes 2016; 7:50-66. [PMID: 26962409 PMCID: PMC4766246 DOI: 10.4239/wjd.v7.i4.50] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/16/2015] [Accepted: 01/19/2016] [Indexed: 02/05/2023] Open
Abstract
Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease is bacterial biofilm, which accumulates on the teeth as dental plaque. In addition to the biofilm microorganisms, other factors such as environmental, systemic and genetic are also responsible in progression of periodontitis. Diabetes mellitus (DM) is metabolic disorder which has an impact on the global health. DM plays a crucial role in the pathogenesis of periodontitis. Periodontitis is declared as the “sixth” major complication of DM. Evidence based literature has depicted an enhanced incidence and severity of periodontitis in subjects with DM. A “two way” relationship has been purported between periodontitis and DM. Mutual management of both conditions is necessary. Periodontal therapy (PT) may assist to diminish the progression of DM and improve glycemic control. Various advanced technological facilities may be utilized for the purpose of patient education and disease management. The present paper clarifies the etio-pathogenesis of periodontitis, establishing it as a complication of DM and elaborating the various mechanisms involved in the pathogenesis. The role of PT in amelioration of DM and application of digital communication will be discussed. Overall, it is judicious to create an increased patient cognizance of the periodontitis-DM relationship. Conjunctive efforts must be undertaken by the medical and oral health care professionals for the management of periodontitis affected DM patients.
Collapse
|
26
|
Evaluation of the effects of platelet-rich fibrin on bone regeneration in diabetic rabbits. J Craniomaxillofac Surg 2016; 44:126-33. [DOI: 10.1016/j.jcms.2015.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/14/2015] [Accepted: 11/20/2015] [Indexed: 01/05/2023] Open
|
27
|
Simpson TC, Weldon JC, Worthington HV, Needleman I, Wild SH, Moles DR, Stevenson B, Furness S, Iheozor‐Ejiofor Z. Treatment of periodontal disease for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev 2015; 2015:CD004714. [PMID: 26545069 PMCID: PMC6486035 DOI: 10.1002/14651858.cd004714.pub3] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Glycaemic control is a key issue in the care of people with diabetes mellitus (DM). Periodontal disease is the inflammation and destruction of the underlying supporting tissues of the teeth. Some studies have suggested a bidirectional relationship between glycaemic control and periodontal disease. This review updates the previous version published in 2010. OBJECTIVES The objective is to investigate the effect of periodontal therapy on glycaemic control in people with diabetes mellitus. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 31 December 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2014, Issue 11), MEDLINE via OVID (1946 to 31 December 2014), EMBASE via OVID (1980 to 31 December 2014), LILACS via BIREME (1982 to 31 December 2014), and CINAHL via EBSCO (1937 to 31 December 2014). ZETOC (1993 to 31 December 2014) and Web of Knowledge (1990 to 31 December 2014) were searched for conference proceedings. Additionally, two periodontology journals were handsearched for completeness, Annals of Periodontology (1996 to 2003) and Periodontology 2000 (1993 to 2003). We searched the US National Institutes of Health Trials Registry (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) of people with type 1 or type 2 DM (T1DM/T2DM) with a diagnosis of periodontitis. Interventions included periodontal treatments such as mechanical debridement, surgical treatment and antimicrobial therapy. Two broad comparisons were proposed:1. periodontal therapy versus no active intervention/usual care;2. periodontal therapy versus alternative periodontal therapy. DATA COLLECTION AND ANALYSIS For this review update, 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.Our primary outcome was blood glucose levels measured as glycated (glycosylated) haemoglobin assay (HbA1c).Our secondary outcomes included adverse effects, periodontal indices (bleeding on probing (BOP), clinical attachment level (CAL), gingival index (GI), plaque index (PI) and probing pocket depth (PPD)), cost implications and diabetic complications. MAIN RESULTS We included 35 studies (including seven from the previous version of the review), which included 2565 participants in total. All studies used a parallel RCT design, and 33 studies (94%) only targeted T2DM patients. There was variation between studies with regards to included age groups (ages 18 to 80), duration of follow-up (3 to 12 months), use of antidiabetic therapy, and included participants' baseline HbA1c levels (from 5.5% to 13.1%).We assessed 29 studies (83%) as being at high risk of bias, two studies (6%) as being at low risk of bias, and four studies (11%) as unclear. Thirty-four of the studies provided data suitable for analysis under one or both of the two comparisons.Comparison 1: low quality evidence from 14 studies (1499 participants) comparing periodontal therapy with no active intervention/usual care demonstrated that mean HbA1c was 0.29% lower (95% confidence interval (CI) 0.48% to 0.10% lower) 3 to 4 months post-treatment, and 0.02% lower after 6 months (five studies, 826 participants; 95% CI 0.20% lower to 0.16% higher).Comparison 2: 21 studies (920 participants) compared different periodontal therapies with each other. There was only very low quality evidence for the multiple head-to-head comparisons, the majority of which were unsuitable to be pooled, and provided no clear evidence of a benefit for one periodontal intervention over another. We were able to pool the specific comparison between scaling and root planing (SRP) plus antimicrobial versus SRP and there was no consistent evidence that the addition of antimicrobials to SRP was of any benefit to delivering SRP alone (mean HbA1c 0.00% lower: 12 studies, 450 participants; 95% CI 0.22% lower to 0.22% higher) at 3-4 months post-treatment, or after 6 months (mean HbA1c 0.04% lower: five studies, 206 patients; 95% CI 0.41% lower to 0.32% higher).Less than half of the studies measured adverse effects. The evidence was insufficient to conclude whether any of the treatments were associated with harm. No other patient-reported outcomes (e.g. quality of life) were measured by the included studies, and neither were cost implications or diabetic complications.Studies showed varying degrees of success with regards to achieving periodontal health, with some showing high levels of residual inflammation following treatment. Statistically significant improvements were shown for all periodontal indices (BOP, CAL, GI, PI and PPD) at 3-4 and 6 months in comparison 1; however, this was less clear for individual comparisons within the broad category of comparison 2. AUTHORS' CONCLUSIONS There is low quality evidence that the treatment of periodontal disease by SRP does improve glycaemic control in people with diabetes, with a mean percentage reduction in HbA1c of 0.29% at 3-4 months; however, there is insufficient evidence to demonstrate that this is maintained after 4 months.There was no evidence to support that one periodontal therapy was more effective than another in improving glycaemic control in people with diabetes mellitus.In clinical practice, ongoing professional periodontal treatment will be required to maintain clinical improvements beyond 6 months. Further research is required to determine whether adjunctive drug therapies should be used with periodontal treatment. Future RCTs should evaluate this, provide longer follow-up periods, and consider the inclusion of a third 'no treatment' control arm.Larger, well conducted and clearly reported studies are needed in order to understand the potential of periodontal treatment to improve glycaemic control among people with diabetes mellitus. In addition, it will be important in future studies that the intervention is effective in reducing periodontal inflammation and maintaining it at lowered levels throughout the period of observation.
Collapse
Affiliation(s)
- Terry C Simpson
- University of EdinburghEdinburgh Dental InstituteLauriston PlaceEdinburghScotlandUKEH3 8HA
| | - Jo C Weldon
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Helen V Worthington
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Ian Needleman
- UCL Eastman Dental InstituteUnit of Periodontology and International Centre for Evidence‐Based Oral Health256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Sarah H Wild
- Public Health Sciences, University of EdinburghCentre for Public Health and Primary Care ResearchTeviot PlaceEdinburghUKEH8 9AG
| | - David R Moles
- Peninsula Dental SchoolOral Health Services ResearchThe John Bull Building, Tamar Science Park, Research WayPlymouthUKPL6 8BU
| | - Brian Stevenson
- University of Dundee Dental Hospital and SchoolDepartment of Restorative DentistryPark PlaceDundeeTaysideUKDD1 4HN
| | - Susan Furness
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | | | | |
Collapse
|
28
|
Llambés F, Arias-Herrera S, Caffesse R. Relationship between diabetes and periodontal infection. World J Diabetes 2015; 6:927-935. [PMID: 26185600 PMCID: PMC4499526 DOI: 10.4239/wjd.v6.i7.927] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/23/2014] [Accepted: 03/20/2015] [Indexed: 02/05/2023] Open
Abstract
Periodontal disease is a high prevalent disease. In the United States 47.2% of adults ≥ 30 years old have been diagnosed with some type of periodontitis. Longitudinal studies have demonstrated a two-way relationship between diabetes and periodontitis, with more severe periodontal tissue destruction in diabetic patients and poorer glycemic control in diabetic subjects with periodontal disease. Periodontal treatment can be successful in diabetic patients. Short term effects of periodontal treatment are similar in diabetic patients and healthy population but, more recurrence of periodontal disease can be expected in no well controlled diabetic individuals. However, effects of periodontitis and its treatment on diabetes metabolic control are not clearly defined and results of the studies remain controversial.
Collapse
|
29
|
Li Q, Hao S, Fang J, Xie J, Kong XH, Yang JX. Effect of non-surgical periodontal treatment on glycemic control of patients with diabetes: a meta-analysis of randomized controlled trials. Trials 2015; 16:291. [PMID: 26137892 PMCID: PMC4490675 DOI: 10.1186/s13063-015-0810-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 06/17/2015] [Indexed: 01/27/2023] Open
Abstract
Objective The present study aimed at investigating whether non-surgical periodontal treatment can reduce the Haemoglobin A1c (HbA1c) % level in type 2 diabetic patients. Methods A search of the literature on English publications was performed in Cochrane Central, Medline, ISI Web of Knowledge and EMBASE (until 06 February 2014). An RCT was selected if the subject was type 2 diabetic patients diagnosed with chronic periodontitis, and compared HbA1c% change after non-surgical periodontal treatment alone for at least three months of the study duration. Weighted mean difference for pooled data and large sample size strata were calculated. Heterogeneity and publication bias were explored. Results After the study selection process, only 9 RCTs were suitable. Compared to the control group, the pooled analysis (n=1082) showed −0.27 % (95 % CI:-0.46 % to −0.07 %, p= 0.007) absolute difference in HbA1c % with treatment while studies with sufficient sample size had HbA1c % change of −0.014 % (95 % CI:-0.18 % to 0.16 %, p= 0.87). Publication bias was marginally significant with Egger’s teat (p=0.045) but not with Begg’s test (p=0.72). Conclusion The moderate reduction in HbA1c after the non-surgical therapy in patients with type 2 diabetes is consistent with previous systematic reviews. However, more large scale and high-quality RCTs are necessitated to confirm these results. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0810-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Quan Li
- Center of Stomatology, the Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Soochow, 215004, P. R. China.
| | - Sha Hao
- Department of Integrated Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. .,Department of Medical Oncology, JingmenTraditional Chinese Medicine Hospital, Jingmen, 448000, China.
| | - Jie Fang
- Center of Stomatology, the Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Soochow, 215004, P. R. China.
| | - Jing Xie
- Department of Stomatology, the First Affiliated Hospital of Wenzhou Medical College, No.2 Fuxue Road, Wenzhou, China.
| | - Xiang-Hui Kong
- Department of Cardiology, the People's Hospital of Jingmen, Jingmen, 448000, China.
| | - Jian-Xin Yang
- Center of Stomatology, the Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Soochow, 215004, P. R. China.
| |
Collapse
|
30
|
Schjetlein AL, Jørgensen ME, Lauritzen T, Pedersen ML. Periodontal status among patients with diabetes in Nuuk, Greenland. Int J Circumpolar Health 2014; 73:26093. [PMID: 25498562 PMCID: PMC4265130 DOI: 10.3402/ijch.v73.26093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 10/30/2014] [Accepted: 11/01/2014] [Indexed: 01/30/2023] Open
Abstract
Background Diabetes is becoming more common in the Greenlandic population. Patients with diabetes are more prone to periodontal disease. Periodontal status may have an effect on metabolic control. Objective The aim of this study was to estimate the prevalence of periodontitis amongst patients with diabetes in Nuuk, Greenland, and secondly, to observe if dental care was associated with improved periodontal status and metabolic control. Study design Observational cross-sectional study and a pilot study of a dental care intervention. Methods Sixty-two Greenlandic patients with diabetes were included in the study. Data were collected from the Electronic Medical Records (EMR), in addition to a telephone interview. Patients were offered 3 dental examinations with a 3-month interval. The dental examinations consisted of a full-mouth assessment of number of remaining teeth and assessment of periodontal status. Patients received scaling and root planing, together with information and instructions on oral hygiene. Information on glycated haemoglobin (HbA1C) values was collected from the EMR at each dental examination. Results In this study, 21.0% (13/62) of patients with diabetes had periodontitis. About 42% had less than 20 teeth. The association between diabetes and periodontitis was known by 20 out of the 62 patients. Over half of the patients had been to a dental examination within the last year. The prevalence of periodontitis decreased significantly from 21.0 to 0% (p<0.001) after 3 dental examinations. No change in HbA1C levels was observed (p=0.440). Conclusion Periodontitis was common among patients with diabetes in Nuuk. Dental health status based on Periodontal Screening Index (PSI) and bleeding on probing (BOP) seemed to improve after dental health care, indicating a need for increased awareness among patients and health care professionals. HbA1C levels were not improved among the patients.
Collapse
Affiliation(s)
| | - Marit Eika Jørgensen
- Steno Diabetes Center, Gentofte, Denmark; Centre for Health Research in Greenland, Southern Denmark University, Odense, Denmark
| | - Torsten Lauritzen
- Section of General Practice, Department of Public Health, Aarhus University, Arhus, Denmark
| | - Michael Lynge Pedersen
- Queen Ingrid Health Care Centre, Nuuk, Greenland; Greenland Centre for Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
| |
Collapse
|
31
|
Al-Nowaiser AM, Al-Zoman H, Baskaradoss JK, Robert AA, Al-Zoman KH, Al-Sohail AM, Al-Suwyed AS, Ciancio SG, Al-Mubarak SA. Evaluation of adjunctive systemic doxycycline with non-surgical periodontal therapy within type 2 diabetic patients. Saudi Med J 2014; 35:1203-9. [PMID: 25316464 PMCID: PMC4362117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the effects of systemic doxycycline on clinical and microbiological parameters of diabetic subjects with chronic periodontitis. METHODS This 9-month multi-center, randomized, parallel, single-blinded study was conducted from different hospitals in Riyadh, Saudi Arabia between April 2010 and December 2010. A total of 76 diabetic subjects with chronic periodontitis were randomized into 2 groups: control group (CG) received only scaling and root planing (SRP), and the treatment group (TG) receiving systemic doxycycline during the reevaluation visit 45 days after the completion of SRP. Probing pocket depth, clinical attachment level, gingival index, plaque index, and bleeding on probing were collected at baseline, 45 days after SRP, and one, 3, and 6 months after the use of systemic doxycycline. Microbiological analysis comprised the detection of Tannerella forsythia (Tf), Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Prevotella intermedia (Pi) by polymerase chain reaction method. RESULTS Sixty-eight (33 CG and 35 TG) subjects completed the study. Greater reduction in the population of Tf, Pg, and Pi were observed in TG compared with CG in the first month after the administration of systemic doxycycline. The TG showed a significant improvement in gingival index scores compared with the CG (p<0.05) by the end of the first and 6 months after the administration of doxycycline. CONCLUSION Adjunct systemic doxycycline can be associated with a reduction of Tf, Pg, and Pi in the first month after the administration of doxycycline with an improvement in the GI.
Collapse
Affiliation(s)
- Abeer M. Al-Nowaiser
- From the Department of Preventive Dental Sciences (Al-Nowaiser), King Abdulaziz University, College of Dentistry (Al-Zoman H), King Saud University, the Department of Endocrinology and Diabetes (Robert), Diabetes Treatment Center, Prince Sultan Military Medical City, the Dental Department (Al-Zoman K, Al-Mubarak), King Faisal Specialist Hospital & Research Center, the Prince Abdulrahman Bin Abdulaziz Institute for Higher Dental Studies (Al-Sohail), the Dental Department (Al-Suwyed), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, the Department of Dental Public Health (Baskaradoss), School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, and the Department of Periodontics and Endodontics (Ciancio), School of Dental Medicine, State University of New York at Buffalo, Buffalo, New York, United States of America.
| | - Hamad Al-Zoman
- From the Department of Preventive Dental Sciences (Al-Nowaiser), King Abdulaziz University, College of Dentistry (Al-Zoman H), King Saud University, the Department of Endocrinology and Diabetes (Robert), Diabetes Treatment Center, Prince Sultan Military Medical City, the Dental Department (Al-Zoman K, Al-Mubarak), King Faisal Specialist Hospital & Research Center, the Prince Abdulrahman Bin Abdulaziz Institute for Higher Dental Studies (Al-Sohail), the Dental Department (Al-Suwyed), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, the Department of Dental Public Health (Baskaradoss), School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, and the Department of Periodontics and Endodontics (Ciancio), School of Dental Medicine, State University of New York at Buffalo, Buffalo, New York, United States of America.
| | - Jagan K. Baskaradoss
- From the Department of Preventive Dental Sciences (Al-Nowaiser), King Abdulaziz University, College of Dentistry (Al-Zoman H), King Saud University, the Department of Endocrinology and Diabetes (Robert), Diabetes Treatment Center, Prince Sultan Military Medical City, the Dental Department (Al-Zoman K, Al-Mubarak), King Faisal Specialist Hospital & Research Center, the Prince Abdulrahman Bin Abdulaziz Institute for Higher Dental Studies (Al-Sohail), the Dental Department (Al-Suwyed), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, the Department of Dental Public Health (Baskaradoss), School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, and the Department of Periodontics and Endodontics (Ciancio), School of Dental Medicine, State University of New York at Buffalo, Buffalo, New York, United States of America.
| | - Asirvatham A. Robert
- From the Department of Preventive Dental Sciences (Al-Nowaiser), King Abdulaziz University, College of Dentistry (Al-Zoman H), King Saud University, the Department of Endocrinology and Diabetes (Robert), Diabetes Treatment Center, Prince Sultan Military Medical City, the Dental Department (Al-Zoman K, Al-Mubarak), King Faisal Specialist Hospital & Research Center, the Prince Abdulrahman Bin Abdulaziz Institute for Higher Dental Studies (Al-Sohail), the Dental Department (Al-Suwyed), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, the Department of Dental Public Health (Baskaradoss), School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, and the Department of Periodontics and Endodontics (Ciancio), School of Dental Medicine, State University of New York at Buffalo, Buffalo, New York, United States of America.
| | - Khalid H. Al-Zoman
- From the Department of Preventive Dental Sciences (Al-Nowaiser), King Abdulaziz University, College of Dentistry (Al-Zoman H), King Saud University, the Department of Endocrinology and Diabetes (Robert), Diabetes Treatment Center, Prince Sultan Military Medical City, the Dental Department (Al-Zoman K, Al-Mubarak), King Faisal Specialist Hospital & Research Center, the Prince Abdulrahman Bin Abdulaziz Institute for Higher Dental Studies (Al-Sohail), the Dental Department (Al-Suwyed), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, the Department of Dental Public Health (Baskaradoss), School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, and the Department of Periodontics and Endodontics (Ciancio), School of Dental Medicine, State University of New York at Buffalo, Buffalo, New York, United States of America.
| | - Abdulaziz M. Al-Sohail
- From the Department of Preventive Dental Sciences (Al-Nowaiser), King Abdulaziz University, College of Dentistry (Al-Zoman H), King Saud University, the Department of Endocrinology and Diabetes (Robert), Diabetes Treatment Center, Prince Sultan Military Medical City, the Dental Department (Al-Zoman K, Al-Mubarak), King Faisal Specialist Hospital & Research Center, the Prince Abdulrahman Bin Abdulaziz Institute for Higher Dental Studies (Al-Sohail), the Dental Department (Al-Suwyed), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, the Department of Dental Public Health (Baskaradoss), School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, and the Department of Periodontics and Endodontics (Ciancio), School of Dental Medicine, State University of New York at Buffalo, Buffalo, New York, United States of America.
| | - Abdulaziz S. Al-Suwyed
- From the Department of Preventive Dental Sciences (Al-Nowaiser), King Abdulaziz University, College of Dentistry (Al-Zoman H), King Saud University, the Department of Endocrinology and Diabetes (Robert), Diabetes Treatment Center, Prince Sultan Military Medical City, the Dental Department (Al-Zoman K, Al-Mubarak), King Faisal Specialist Hospital & Research Center, the Prince Abdulrahman Bin Abdulaziz Institute for Higher Dental Studies (Al-Sohail), the Dental Department (Al-Suwyed), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, the Department of Dental Public Health (Baskaradoss), School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, and the Department of Periodontics and Endodontics (Ciancio), School of Dental Medicine, State University of New York at Buffalo, Buffalo, New York, United States of America.
| | - Sebastian G. Ciancio
- From the Department of Preventive Dental Sciences (Al-Nowaiser), King Abdulaziz University, College of Dentistry (Al-Zoman H), King Saud University, the Department of Endocrinology and Diabetes (Robert), Diabetes Treatment Center, Prince Sultan Military Medical City, the Dental Department (Al-Zoman K, Al-Mubarak), King Faisal Specialist Hospital & Research Center, the Prince Abdulrahman Bin Abdulaziz Institute for Higher Dental Studies (Al-Sohail), the Dental Department (Al-Suwyed), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, the Department of Dental Public Health (Baskaradoss), School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, and the Department of Periodontics and Endodontics (Ciancio), School of Dental Medicine, State University of New York at Buffalo, Buffalo, New York, United States of America.
| | - Sultan A. Al-Mubarak
- From the Department of Preventive Dental Sciences (Al-Nowaiser), King Abdulaziz University, College of Dentistry (Al-Zoman H), King Saud University, the Department of Endocrinology and Diabetes (Robert), Diabetes Treatment Center, Prince Sultan Military Medical City, the Dental Department (Al-Zoman K, Al-Mubarak), King Faisal Specialist Hospital & Research Center, the Prince Abdulrahman Bin Abdulaziz Institute for Higher Dental Studies (Al-Sohail), the Dental Department (Al-Suwyed), King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, the Department of Dental Public Health (Baskaradoss), School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, and the Department of Periodontics and Endodontics (Ciancio), School of Dental Medicine, State University of New York at Buffalo, Buffalo, New York, United States of America.,Address correspondence and reprint request to: Dr. Sultan A. Al-Mubarak, Senior Clinical Scientist and Consultant, Dental Department, King Faisal Specialist Hospital & Research Center, PO Box 3354, Riyadh 11211, Kingdom of Saudi Arabia. E-mail:
| |
Collapse
|