Treatment of periodontal disease for glycaemic control in people with diabetes

Simpson TC, Needleman I, Wild SH, Moles DR, Mills EJ

Published Online:

May 12, 2010

Long-term control of blood sugar levels is considered to be of critical importance in preventing complications associated with diabetes. Research evidence has suggested that treating gum disease in people with diabetes may assist in lowering blood sugar levels. The aim of this review was to investigate the relationship of treating gum disease on blood sugar control in people with diabetes and suggest a future strategy for research and medical/dental practice. The evidence gathered suggested that there may be small but significant improvement in blood sugar control from treating pre-existing gum disease in people with Type 2 diabetes mellitus.

Abstract (click to read)

Background:

Glycaemic control is a key issue in the care of people with diabetes mellitus (DM). Some studies have suggested a bidirectional relationship between glycaemic control and periodontal disease.

Objectives:

To investigate the relationship between periodontal therapy and glycaemic control in people with diabetes and to identify the appropriate future strategy for this question.

Search strategy:

A comprehensive approach was adopted employing handsearching; searching of electronic databases including the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE, CINAHL, ZETOC, ISI Web of Knowledge and LILACS; contact with appropriate non-English language healthcare professionals; authors and organisations. The final date for searching for studies was 24th March 2010.

Selection criteria:

This review studied randomised controlled trials of people with Type 1 or 2 diabetes mellitus (DM) with a diagnosis of periodontitis. Suitable interventions included mechanical periodontal therapy with or without adjunctives and oral hygiene education.

Data collection and analysis:

The titles and abstracts of 690 papers were examined by two review authors independently. Ultimately, seven studies were included and 19 excluded after full text scrutiny. All trials were assessed for risk of bias.

Main results:

Three studies had results pooled into a meta-analysis. The effect for the mean percentage difference in HbA1c for scaling/root planing and oral hygiene (+/- antibiotic therapy) versus no treatment/usual treatment after 3/4 months was -0.40% (95% confidence interval (CI) fixed effect -0.78% to -0.01%), representing a statistically significant reduction in HbA1c (P = 0.04) for scaling/root planing. One study was assessed as being at low risk of bias with the other two at moderate to high risk of bias. A subgroup analysis examined studies without adjunctive antibiotics -0.80% (one study: 95% CI -1.73% to 0.13%; P = 0.09), with adjunctive antibiotics in the test group -0.36% (one study: 95% CI -0.83% to 0.11%; P = 0.14), and with antibiotics in both test and control groups after 3/4 months -0.15% (one study: 95% CI -1.04% to 0.74%; P = 0.74).

Authors' conclusions:

There is some evidence of improvement in metabolic control in people with diabetes, after treating periodontal disease. There are few studies available and individually these lacked the power to detect a significant effect. Most of the participants in the study had poorly controlled Type 2 DM with little data from randomised trials on the effects on people with Type 1 DM.

Improving periodontal health is an important objective in itself. However, in order to understand the potential of this treatment to improve glycaemic control among people with diabetes, larger, carefully conducted and reported studies are needed.

This record should be cited as:

Simpson TC, Needleman I, Wild SH, Moles DR, Mills EJ. Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database of Systematic Reviews 2010, Issue 5. Art. No.: CD004714. DOI: 10.1002/14651858.CD004714.pub2

Assessed as up to date:

March 24, 2010

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Primary Review Group:

Oral Health Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective is treatment of periodontal disease for glycaemic control in people with diabetes mellitus (DM)?

Bottom line:

Compared with no treatment or usual treatment, there was a small but significant reduction in HbA1c after 3–4 months of treating periodontitis (scaling/root planing and oral hygiene ± antibiotic therapy) in people with type 2 DM.

Caveat:

Only seven studies met the inclusion criteria for the review, and individually these lacked the power to detect a significant effect. Only three studies were suitable to include in a meta-analysis, and two of these were assessed as being at moderate to high risk of bias. Most of the participants in the studies had poorly controlled type 2 DM, with little data from trials on the effects on people with type 1 DM.

Context:

Long-term glycaemic control is of critical importance in preventing complications associated with DM. Research evidence has suggested the chronic inflammation and infection that results from periodontal disease could have an adverse effect on glycaemic control in people with DM, which in turn could lead to worsening gum disease.

Cochrane Systematic Review:

Simpson TC et al. Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Reviews 2010, Issue 5. Article No. CD004714. DOI: 10.1002/14651858. CD004714.pub2. This review contains 7 studies involving 490 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Dentistry & oral health > Periodontal disease > Treatment

Endocrine & metabolic > Diabetes > Type 2

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Independent high-quality evidence for health care decision making

Treatment of periodontal disease for glycaemic control in people with diabetes

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