Abstract
Data sources
The Cochrane Oral Health Group's Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), Medline, EMBASE, CINAHL, ZETOC, ISIWeb of Knowledge and LILACS databases were searched together with hand searches of the journals Annals of Periodontology (1996 to 2003) and Periodontology 2000 (1993 to 2003).There were no language restrictions.
Study selection
This review included 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 extraction and synthesis
The titles and abstracts of all identified papers were examined by two review authors’ independently. All included trials were assessed for risk of bias. Data were collated in evidence tables, grouped according to research design and assessed for possible meta-analysis on the basis of homogeneity of main characteristics.
Results
Seven studies were included and 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).
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 and there was 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.
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Authors and Affiliations
Additional information
Address for correspondence: Luisa Fernandez Mauleffinch, Review Group Co-ordinator, Cochrane Oral Health Group, MANDEC, School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK. E-mail: luisa.fernandez@manchester.ac.uk
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.
This paper is based on a Cochrane Review published in the Cochrane Library 2010, issue 5 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the Cochrane Library should be consulted for the most recent version of the review.
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Vergnes, JN. Treating periodontal disease may improve metabolic control in diabetics. Evid Based Dent 11, 73–74 (2010). https://doi.org/10.1038/sj.ebd.6400734
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DOI: https://doi.org/10.1038/sj.ebd.6400734
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