Effect of nonsurgical periodontal therapy verses oral hygiene instructions on Type 2 diabetes subjects with chronic periodontitis: a randomised clinical trial

Abstract

Background40 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.Methods40 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.Results15 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).ConclusionNSPT 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 registrationClinicalTrials.gov: NCT01951547.

Benefits of non‐surgical periodontal treatment in patients with type 2 diabetes mellitus and chronic periodontitis: A randomized controlled trial

“…This result suggests that differences in PPD do not influence the effects of periodontal treatment. Significant improvements in the periodontal parameters of the CG, by the mere act of proper plaque removal by the patients themselves, were observed in other studies, but these improvements were not as quick or extensive as in the respective treated groups (Lee et al., ; Raman, Taiyeb‐Ali, Chan, Chinna, & Vaithilingam, ). In fact, Raman et al.…”

“…In fact, Raman et al. () found no significant differences between treated and control patients with respect to any of the evaluated periodontal parameters, nor in their HbA1c or C‐reactive protein levels assessed during months 2 or 3 of the study; however, changes in the plaque index at 2 months post‐treatment were attributable to calculus removal (in TG), which reduced the amount of plaque retention. Correa et al.…”

Non‐surgical periodontal therapy reduces salivary adipocytokines in chronic periodontitis patients with and without obesity

“…Although the role of SRP in reducing periodontal inflammation is well acknowledged, studies have shown that SRP, when performed with adjunct therapies (eg bisphosphonates, application of lasers, and photodynamic therapy), is more effective in reducing periodontal inflammation in systemically healthy and immunocompromised individuals compared with SRP alone. Moreover, studies have also reported that SRP helps reduce hyperglycemia in diabetic patients . Whether SRP has an influence on obesity remains unknown and requires further investigation.…”

Effects of Periodontal Treatment on Glycated Hemoglobin A Levels in Patients with Type 2 Diabetes: A Meta-Analysis of Randomized Clinical Trials

“…Raman et al 40) showed that the HbA1c level significantly decreased in the experimental group at 3 months relative to the level during the early research period (p=0.038).…”

“…Raman et al 40) , 32 patients; Wu et al 42) , 46 patients; and that by Mizuno et al 43) , 37 patients. Although these sample sizes were statistically calculated, they are close to the minimum number of patients required, and these studies note the small sample sizes as their limitation.…”