Effectiveness of periodontal treatment to improve glycemic control: an umbrella review

Domenico, Giovanna Laura Di; Minoli, Margherita; Discepoli, Nicola; Ambrosi, Alessandro; Sanctis, Massimo de

doi:10.1007/s00592-022-01991-z

Cited by 9 publications

(6 citation statements)

References 73 publications

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“…In other studies [30], the statistically significant reduction in HbA1c levels at 3 or 4 months after periodontal treatment was not maintained over time and ceased to be significant at 6 months after treatment. In line with this study, in a recent review [31], the authors found significant reductions in HbA1c levels at 3 and 6 months after NSPT, but the levels decreased over time, from 0.49% at 3 months to 0.38% at 6 months.…”

Section: Primary Outcomesupporting

confidence: 81%

Nonsurgical Periodontal Care for Diabetes Patients: A Case-Control Study

María José,

Arturo,

Marta

et al. 2024

Preprint

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Background: Diabetes mellitus (DM) and periodontitis are two chronic diseases that are interconnected. The coexistence of these conditions leads to increased severity of periodontitis and challenges in controlling blood glucose levels in diabetic patients. Objectives: The aim of this study was to evaluate both the influence of periodontal disease and its treatment in patients with DM in terms of a reduction in glycosylated hemoglobin levels at 3 and 6 months after treatment. Methods: A sequential, nonprobabilistic, controlled, prospective and longitudinal case−control study was carried out at the University Dental Clinic of the Morales Meseguer Hospital in Murcia, Spain. Thirty diabetic patients were divided into two groups: patients with periodontitis (test group) and patients without periodontitis (control group). The periodontal and endocrine-metabolic variables were measured at baseline and at 3 and 6 months after periodontal treatment for both groups. Results: Statistically significant differences were found at 3 and 6 months after periodontal treatment with respect to HbA1c levels in the group of periodontal patients. However, these differences were not observed in the control group. Conclusion: The presence of periodontal disease increased HbA1c levels in patients with DM. Nonsurgical periodontal treatment significantly decreased the degree of periodontal inflammation and the HbA1c level at 3 and 6 months after treatment.

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Section: Primary Outcomesupporting

confidence: 81%

Nonsurgical Periodontal Care for Diabetes Patients: A Case-Control Study

María José,

Arturo,

Marta

et al. 2024

Preprint

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“…The mechanism of periodontitis affecting glycemic control in diabetes mellitus involves periodontal pathogens destroying the balance of intestinal microbiota, the spread of inflammatory mediators exacerbating systemic inflammation and metabolic damage, periodontal pathogens entering the blood causing bacteremia ( 30 , 258 – 261 ), and periodontal pathogens reducing insulin production ( 262 ) or insulin resistance ( 263 ). Periodontal treatment can improve glycemic control of diabetes, but the evidence is still insufficient, and more clinical data are needed ( 25 – 29 ). New research showed that there was a direct relationship between the enhanced glycolysis of macrophages induced by hyperglycemia and training immunity ( 263 ), which may provide a theoretical basis for the two-way relationship between diabetes and periodontitis, and this new research field needs more exploration.…”

Section: Conclusion and Perspectivementioning

confidence: 99%

“…On the other hand, periodontitis patients exhibit poor glycemia control, a further risk of insulin resistance, and a higher prevalence of diabetes-related complications ( 10 , 21 – 24 ). Many studies have attested that periodontal therapy can reduce the load of periodontal inflammation, which in turn has a positive effect on blood glycated hemoglobin levels ( 25 – 29 ). Therefore, it is necessary to screen patients with diabetes for periodontitis and vice versa ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Diabetes mellitus promotes susceptibility to periodontitis—novel insight into the molecular mechanisms

Zhao,

Xie,

Gao

et al. 2023

Front. Endocrinol.

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Diabetes mellitus is a main risk factor for periodontitis, but until now, the underlying molecular mechanisms remain unclear. Diabetes can increase the pathogenicity of the periodontal microbiota and the inflammatory/host immune response of the periodontium. Hyperglycemia induces reactive oxygen species (ROS) production and enhances oxidative stress (OS), exacerbating periodontal tissue destruction. Furthermore, the alveolar bone resorption damage and the epigenetic changes in periodontal tissue induced by diabetes may also contribute to periodontitis. We will review the latest clinical data on the evidence of diabetes promoting the susceptibility of periodontitis from epidemiological, molecular mechanistic, and potential therapeutic targets and discuss the possible molecular mechanistic targets, focusing in particular on novel data on inflammatory/host immune response and OS. Understanding the intertwined pathogenesis of diabetes mellitus and periodontitis can explain the cross-interference between endocrine metabolic and inflammatory diseases better, provide a theoretical basis for new systemic holistic treatment, and promote interprofessional collaboration between endocrine physicians and dentists.

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“…A recent meta‐analysis of 30 randomized controlled trials (RCTs) showed that periodontal therapy yielded a HbA1c% level reduction of 0.43% (95% CI 0.28–0.59) (Simpson et al, 2022). While evidence that periodontal treatment can positively impact HbA1c levels in individuals with type T2DM is well established (Di Domenico et al, 2023), it is still unclear which periodontal treatment modality is the most effective. Most meta‐analyses have either combined all treatment effects or have explored few pairwise comparisons using traditional meta‐analytic methods (Abduljabbar et al, 2017; Donos et al, 2020; Oliveira et al, 2023; Rovai et al, 2016; Zhao et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

The efficacy of combining adjuvants with non‐surgical periodontal therapy in individuals with type 2 diabetes: A Bayesian network meta‐analysis

Zanatta,

Antoniazzi,

Oliveira

et al. 2024

J Clinic Periodontology

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AimThis Bayesian network meta‐analysis of randomized controlled trials assessed the effect of adjuvant periodontal treatment in both periodontal and HbA1c outcomes in adult individuals with type 2 diabetes (T2DM).Materials and MethodsA systematic search was done up to February 2023 comparing sub‐gingival debridement (SD) in combination with local or systemic adjuvant treatment with SD alone for individuals with T2DM. The primary outcomes were changes in absolute HbA1c levels and full‐mouth probing depth reported at 3‐ to 6‐month post‐treatment.ResultsSeventy‐two eligible publications evaluating 27 adjuvant treatments were retrieved. The combination of SD and systemic antibiotic metronidazole or SD and antioxidant alpha lipoic acid provided, respectively, 1.4% (95% credible interval [CrI] 0.48; 2.20) and 2.4% (95% CrI 1.50; 3.30) more significant improvement on HbA1c levels, and 0.89 mm (95% CrI 0.23; 1.50) and 0.92 mm (95% CrI 0.02; 0.92) greater periodontal probing depth reductions. Other adjuvant treatments provided added benefit to the periodontal outcomes without discernible effects on HbA1c.ConclusionsAdjuvant use of metronidazole or alpha lipoic acid was the best adjunct option to provide clinically meaningful HbA1c levels and probing depth reductions. However, no strong recommendation can be drawn due to the scarcity of studies for each adjuvant treatment and the low certainty of the resultant evidence.

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Effectiveness of periodontal treatment to improve glycemic control: an umbrella review

Cited by 9 publications

References 73 publications

Nonsurgical Periodontal Care for Diabetes Patients: A Case-Control Study

Nonsurgical Periodontal Care for Diabetes Patients: A Case-Control Study

Diabetes mellitus promotes susceptibility to periodontitis—novel insight into the molecular mechanisms

The efficacy of combining adjuvants with non‐surgical periodontal therapy in individuals with type 2 diabetes: A Bayesian network meta‐analysis

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