Effect of Periodontal Treatment on Glycemic Control of Diabetic Patients: A Systematic Review and Meta-Analysis

Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands.
Diabetes care (Impact Factor: 8.42). 02/2010; 33(2):421-7. DOI: 10.2337/dc09-1378
Source: PubMed


There is growing evidence that periodontitis may affect general health. This study was assigned to explore the robustness of observations that periodontal therapy leads to the improvement of glycemic control in diabetic patients.
A literature search (until March 2009) was carried out using two databases (MEDLINE and the Cochrane Library) with language restriction to English. Selection of publications was based on 1) original investigations, 2) controlled periodontal intervention studies where the diabetic control group received no periodontal treatment, and 3) study duration of > or =3 months.
Screening of the initial 639 identified studies and reference checking resulted in five suitable articles. A total of 371 patients were included in this analysis with periodontitis as predictor and the actual absolute change in A1C (DeltaA1C) as the outcome. The duration of follow-up was 3-9 months. All studies described a research population of type 2 diabetic patients in whom glycemic control improved after periodontal therapy compared with the control group (range DeltaA1C: Delta-1.17 up to Delta-0.05%). The studies in a meta-analysis demonstrated a weighted mean difference of DeltaA1C before and after therapy of -0.40% (95% CI -0.77 to -0.04%, P = 0.03) favoring periodontal intervention in type 2 diabetic patients. Nevertheless, this improvement in %A1C must be interpreted with care due to limited robustness as evidenced by heterogeneity among studies (59.5%, P = 0.04).
The present meta-analysis suggests that periodontal treatment leads to an improvement of glycemic control in type 2 diabetic patients for at least 3 months.

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Available from: Wijnand J Teeuw,
    • "Thus, periodontal treatment such as scaling and root planing was suggested to improve glycaemic control . Indeed, these interventions reduced glycated haemoglobin (HbA1c) in type 2 diabetes patients by roughly 0.4%, as reported in recent meta-analyses (Teeuw et al. 2010, Engebretson & Kocher 2013, Wang et al. 2014). However, little is known about associations between periodontitis and moderate glycaemic disorders such as pre-diabetes and well-controlled diabetes. "
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    ABSTRACT: AimTo examine associations of prediabetes and well controlled diabetes with periodontitis.Materials and methodsThe Study of Health in Pomerania (SHIP)-Trend is a cross-sectional survey in North-Eastern Germany including 3,086 participants (49.4% men; age 20–82 years). Clinical attachment loss (CAL) and periodontal probing depth (PPD) were assessed applying a random half-mouth protocol. The number of teeth was determined. Prediabetes comprised impaired fasting glucose and impaired glucose tolerance. Previously known diabetes was defined as well controlled if glycated hemoglobin (HbA1c) was <7.0%. Participants were categorized as follows: normal glucose tolerance (NGT), prediabetes, newly detected type 2 diabetes (T2DM), known T2DM with HbA1c<7.0%, known T2DM with HbA1c≥7.0%.ResultsPrediabetes was neither associated with mean CAL and PPD in multivariable adjusted linear regression models nor with edentulism (OR=1.09 (95%-CI: 0.69-1.71)) and number of teeth (OR=0.96 (95%-CI: 0.75-1.22), lowest quartile versus higher quartiles) in logistic regression models. Associations with mean CAL and edentulism were stronger in poorly controlled previously known diabetes than in well controlled previously known diabetes (for edentulism: OR=2.19 (95%-CI: 1.18-4.05), and OR=1.40 (95%-CI: 0.82-2.38), respectively, for comparison with NGT).Conclusions Periodontitis and edentulism were associated with poorly controlled T2DM, but not with prediabetes and well controlled diabetes.This article is protected by copyright. All rights reserved.
    Journal Of Clinical Periodontology 03/2015; 42(5). DOI:10.1111/jcpe.12391 · 4.01 Impact Factor
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    • "Metabolic changes occurring in DM and related pathological status may influence the reparative capacity of periodontal tissues. It has been suggested that hyperglycemia and resultant advanced glycation end product (AGE) formation, which is one of the several pathways that leads to the classic microvascular and macrovascular complications of DM, are also involved in the pathophysiology of periodontitis in diabetic subjects (Mealey & Rose 2008, Teeuw et al. 2010). The mechanisms of diabetes-mediated effects on periodontal wound healing and osseous repair have been examined in several studies; however, there is still a lack of preclinical investigation to validate the dynamic changes in the local environment and repair patterns , and molecular events during periodontal defect healing in diabetes (Chang et al. 2012). "
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    ABSTRACT: AimTo evaluate the effects of fibroblast growth factor (FGF) -2 on the healing of surgical periodontal defects in rats with streptozotocin-induced early diabetes.Materials and Methods Fifty Wistar rats were assigned to streptozotocin-induced diabetes or non-diabetes group. Periodontal defects were surgically created at maxillary first molars. Defects were treated with hydroxypropyl cellulose (HPC) or FGF-2 with HPC. Defect fill was evaluated by micro-computed tomography. Histological and immunohistochemical analyses were performed.ResultsCompared to vehicle alone, FGF-2 treatment yielded significantly greater bone volume and trabecular thickness in diabetes group. Diabetes group displayed reduced new bone formation and significantly longer epithelial downgrowth compared to non-diabetes group. In diabetes group, FGF-2 treatment increased PCNA-positive cells and new bone formation after 2 weeks and suppressed epithelial downgrowth, but new cementum formation was minimal even after 4 weeks. In diabetes group, overexpression of vascular endothelial growth factor was evident in cells within connective tissue, and no significant enhancement was observed by FGF-2 treatment. FGF-2 increased the expression of α-smooth muscle actin in diabetes group.Conclusions Treatment of surgical periodontal defect in early diabetic rats with the single application of FGF-2 provided beneficial effects on new bone formation via increasing cell proliferation and regulating angiogenesis.This article is protected by copyright. All rights reserved.
    Journal Of Clinical Periodontology 01/2015; 42(1):62-71. DOI:10.1111/jcpe.12324 · 4.01 Impact Factor
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    • "Intervention trials have suggested that there was an improvement in glycaemic control in people with type 2 diabetes following non-surgical periodontal therapy [22]. However, a recent meta-analysis of intervention studies suggests that more evidence is required to confirm the effects of periodontal therapy on the metabolic control of people with type 2 diabetes [23]. The aim of this study was to determine the effect of NSPT as compared to thorough OHI on the metabolic control as well as systemic inflammatory marker, hs C-reactive protein (hs-CRP), among a population of type 2 diabetes afflicted with moderate to severe chronic periodontitis. "
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    ABSTRACT: 40 subjects with type 2 diabetes and moderate to severe CP were randomly distributed to groups receiving either NSPT or OHI. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, 2- and 3-months intervals. 40 subjects with type 2 diabetes and moderate to severe CP were randomly distributed to groups receiving either NSPT or OHI. Periodontal parameters, glycosylated haemoglobin (HbA1c) and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline, 2- and 3-months intervals. 15 subjects from NSPT group and 17 from OHI group completed the study. The difference in plaque index (PI) between NSPT and OHI groups were significant at 2 months recall (p = 0.013). There was no significant difference between NSPT and OHI group for all other clinical periodontal parameters, HbA1c and CRP levels. At 3 months post-therapy, periodontal parameters improved significantly in both groups with sites with probing pocket depth (PPD) < 4 mm reported as 98 ± 1.8% in NSPT group and 92 ± 14.9% in OHI group. Mean PPD and mean probing attachment loss (PAL) within the NSPT group reduced significantly from baseline (2.56 ± 0.57 mm, 3.35 ± 0.83 mm) to final visit (1.94 ± 0.26 mm, 2.92 ± 0.72 mm) (p = 0.003, p < 0.001). For OHI group, improvements in mean PPD and mean PAL were also seen from baseline (2.29 ± 0.69 mm, 2.79 ± 0.96 mm) to final visit (2.09 ± 0.72 mm, 2.62 ± 0.97 mm) (p < 0.001 for both). Similarly, HbA1c levels decreased in both groups with NSPT group recording statistically significant reduction (p = 0.038). Participants who demonstrated ≥ 50% reduction in PPD showed significant reductions of HbA1c and hs-CRP levels (p = 0.004 and p = 0.012). NSPT significantly reduced PI at 2 months post-therapy as compared to OHI. Both NSPT and OHI demonstrated improvements in other clinical parameters as well as HbA1c and CRP levels. Trial registration ClinicalTrials.gov: NCT01951547.
    BMC Oral Health 06/2014; 14(1):79. DOI:10.1186/1472-6831-14-79 · 1.13 Impact Factor
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