Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta‐analysis

Abstract

Context The effect of periodontal therapy on diabetes outcomes has not been established. Objective This update examines the effect of periodontal treatment on diabetes outcomes. Data Sources Literature since October 2009 using MEDLINE. Study eligibility criteria Published RCTs including periodontal therapy for diabetic subjects, a metabolic outcome, an untreated control group, and follow up of 3 months. Data Extraction Predefined data fields, including study quality indicators were used. Data Synthesis A search revealed 56 publications of which 9 met inclusion criteria. Mean change of HbA1c from baseline was compared across treatment groups. Pooled analysis was based on random effects models. Results A meta analysis indicated a mean treatment effect of −0.36% HbA1c (CI −0.54, − 0.19) compared to no treatment after periodontal therapy (p<0.0001). Heterogeneity tests revealed only minimal evidence of publication bias (I2 =9%). Limitations Small sample size and high risk of bias remain problematic for studies of this type. Periodontal therapy varied considerably. Conclusion The modest reduction in HbA1c observed as a result of periodontal therapy in subjects with type 2 diabetes is consistent with previous systematic reviews. Despite this finding, multi-center trials of sufficient sample size are lacking.

Effects of periodontal treatment on the medical status of patients with type 2 diabetes mellitus: a pilot study

“…It is known that diabetic patients have an increased risk of periodontitis, and that, once established, their periodontitis is more severe [2]. On the other hand, both direct and indirect evidence supports the concept that periodontal infection adversely affects glycemic control in people with diabetes [3]. …”

Impact of periodontal disease on outcomes in diabetes

“…The prevalence of POD among adults 30 years or older in the NHANES was 47% [3]. The prevalence of POD among patients with DM is higher than in the general population [1, 4-7]. In non-diabetic patients, there is some association between POD and osteoporosis [24].…”

“…The prevalence of periodontal disease (POD) among adults 30 years or older in the National Health and Nutrition Examination Survey (NHANES) is 47% [3]. A higher prevalence of POD is seen among patients with DM [1, 4-7]. Systemic inflammation is a common finding among patients with DM and POD [7-9].…”

“…Inflammation has been implicated in the pathogenesis of both cardiovascular disease (CVD) [10-12] and bone disease [13, 14]. There is existing evidence that links POD to adverse CVD outcomes [4, 7-9]. Patients with POD have been reported to have higher levels of bone turnover markers [14].…”

“…In addition, those patients with DM have an increased risk for fractures [15]. In spite of these findings, evidence supporting improved DM control and reduction in DM complications including osteoporosis after both surgical and non-surgical treatment of POD in patients with DM is mixed [4, 7, 16]. This may be partly responsible for the lack of specific guidelines and weak emphasis on prevention and treatment of POD in the clinical care of patients with DM [17, 18].…”