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A SYSTEMATIC REVIEW AND META-ANALYSIS
Year : 2023  |  Volume : 22  |  Issue : 2  |  Page : 131-135  

Periodontitis treatment (surgical and nonsurgical) effects on glycemic control: A review and meta-analysis


Department of Internal Medicine, Faculty of Medicine, University of Tabuk, KSA

Date of Submission29-Mar-2022
Date of Decision30-Jul-2022
Date of Acceptance27-Sep-2022
Date of Web Publication4-Apr-2023

Correspondence Address:
Mohammed Adam Ahmed Elnour
Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Tabuk
KSA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aam.aam_53_22

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   Abstract 


Background: Periodontitis is the sixth most prevalent chronic disease. Literature suggests a relationship between diabetes and periodontitis and when coexist may aggravate each other deleterious consequences. Therefore, we aimed to assess the effects of periodontitis treatment on glycemic control. Materials and Methods: A systematic literature search was conducted in PubMed, Cochrane Library, and the first 100 articles in Google Scholar from January 2011 to October 2021. The terms periodontitis, periodontal treatment, diabetes mellitus, nonsurgical treatment, glycated hemoglobin (HbA1c) were used, with the Protean “AND” and “OR.” The titles, abstracts, and references of the included studies were screened. Any discrepancy was solved by an agreement between researchers. Out of 1059 studies retrieved, 320 stands after the removal of duplication, from them, 31 full texts were screened and only 11 studies were included in the final meta-analysis. Results: In the present meta-analysis, 11 studies (1469 patients included) were pooled, and the overall effect showed that periodontitis treatment improved the HbA1c, odd ratio, −0.024, 95% confidence interval, −0.42−.06, P value, 0.009, Chi-square, 52.99. However, substantial heterogeneity was observed, P value, < 0.001, I2 for heterogeneity 81%. Conclusion: Periodontitis treatment improved the HbA1c among patients with diabetes and poor glycemic control. Screening of this common disease is important in diabetes holistic care.

   Abstract in French 

Résumé
Contexte: La parodontite est la sixième maladie chronique la plus répandue. La littérature suggère une relation entre le diabète et la parodontite et lorsqu'ils coexistent peuvent aggraver les uns les autres des conséquences délétères. Par conséquent, nous avons cherché à évaluer les effets du traitement de la parodontite sur le contrôle glycémique. Matériels et méthodes: Une recherche documentaire systématique a été menée dans PubMed, Cochrane Library et les 100 premières articles dans Google Scholar de janvier 2011 à octobre 2021. Les termes parodontite, traitement parodontal, diabète sucré, non chirurgical traitement, l'hémoglobine glyquée (HbA1c) a été utilisée. Avec le protéiforme “ ET “ et “ OU “. Les titres, résumés et références des documents inclus études ont été passées au crible. Toute divergence a été résolue par un accord entre les chercheurs. Sur 1059 études récupérées, 320 stands après la suppression des doublons, parmi eux, 31 textes intégraux ont été passés au crible et seules 11 études ont été incluses dans la méta-analyse finale. Résultats: Dans le présente méta-analyse, 11 études (1469 patients inclus) ont été regroupées et l'effet global a montré que le traitement de la parodontite améliorait l'HbA1c, rapport des cotes, −0,024, intervalle de confiance à 95 %, −0,42−0,06, valeur P, 0,009, Chi-carré, 52,99. Cependant, une grande hétérogénéité a été observé, valeur P, < 0,001, I2 pour l'hétérogénéité 81%. Conclusion: Le traitement de la parodontite a amélioré l'HbA1c chez les patients diabétiques et un mauvais contrôle glycémique. Le dépistage de cette maladie courante est important dans les soins holistiques du diabète.
Mots-clés: Diabète sucré, contrôle glycémique, parodontite

Keywords: Diabetes mellitus, glycemic control, periodontitis


How to cite this article:
Elnour MA, Mirghani HO. Periodontitis treatment (surgical and nonsurgical) effects on glycemic control: A review and meta-analysis. Ann Afr Med 2023;22:131-5

How to cite this URL:
Elnour MA, Mirghani HO. Periodontitis treatment (surgical and nonsurgical) effects on glycemic control: A review and meta-analysis. Ann Afr Med [serial online] 2023 [cited 2023 Jun 2];22:131-5. Available from: https://www.annalsafrmed.org/text.asp?2023/22/2/131/373570




   Introduction Top


Diabetes mellitus is reaching an epidemic, currently, 9.2% of the world population suffers from this chronic disease with high morbidity and mortality.[1] The disease is expected to jump to 700 million by 2045.[2]

Periodontitis is the inflammation of the deep tissue supporting the teeth that may lead to gingivitis, loss of bone, and ultimately tooth loss, and sixth most prevalent chronic disease. More than half of the world population are affected by apical periodontitis at the tooth level.[3] Periodontitis negatively affects chewing, nutritional status, and quality of life.[4] Literature suggests a relationship between diabetes and periodontitis and when coexist may aggravate each other deleterious consequences.[5] Periodontitis is considered the six chronic complications of diabetes mellitus.[6]

Reports of the association between diabetes mellitus and periodontitis are conflicting.[7],[8] Therefore, we aimed to assess the effects of periodontitis treatment on glycemic control.


   Materials and Methods Top


Eligibility criteria according to PICOS

This systematic review and meta-analysis were conducted to assess the effect of periodontitis treatment on glycemic control among patients with type 2 diabetes. Studies were included if they were randomized controlled studies. Prospective or retrospective cohorts, case–control studies, and animal studies were not approached. The search was limited to the English language due to the researcher's language background. Only studies reporting the effects of nonsurgical periodontal treatment on glycated hemoglobin (HbA1c) were eligible. Studies assessing the addition of doxycycline, photodynamic therapy, and Diode laser were excluded due to the possible effects on plasma glucose and HbA1c.

Periodontitis definition

Periodontitis is defined as moderate-to-severe chronic periodontitis.

Periodontitis treatment

The treatment received was full-mouth scaling and root planning.

Outcome measures

The outcome measure was HbA1c.

Literature search and data extraction

A systematic literature search was conducted in PubMed, Cochrane Library, and the first 100 articles in Google Scholar from January 2011 to October 2021. Two reviewers searched the databases for relevant articles. The terms periodontitis, periodontal treatment, diabetes mellitus, nonsurgical treatment, and HbA1c were used, with the Protean “AND” and “OR.” The titles, abstracts, and references of the included studies were screened. Any discrepancy was resolved by consensus between the two researchers. Out of 1059 studies retrieved, 320 stands after the removal of duplication, from them, 31 full texts were screened and only 11 studies were included in the final meta-analysis. A datasheet was used to extract the author's name, year, and country of publication, the study type, number of participants if matched for age, duration of diabetes, and sex. The HbA1c at baseline and after periodontitis treatment was also recorded. A modified Cochrane risk of bias assessed the quality of the included studies.[7] The risk of bias was assessed on randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases [Table 1], [Table 2], [Table 3] and [Figure 1].[9]
Table 1: Basic character of patients with diabetes and periodontitis

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Table 2: Periodontitis management and glycemic control

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Table 3: The quality of the included trials according to Cochrane risk of bias assessment tool

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Figure 1: Periodontitis treatment and glycemic control

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Statistical analysis

The most recent version of the RevMan (Cochrane, 5.4, September 2020) system was used. The data from 11 randomized trials were entered manually and a comparison was generated. The fixed effect was applied because no significant heterogeneity was observed. A P of < 0.05 was considered statistically significant.


   Results Top


In the present meta-analysis, 11 studies (1469 patients included) were pooled.[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20] Four studies were from Europe, four from Asia, two published in the USA, and one from Australia. The studies were conducted among patients with uncontrolled type 2 diabetes (matched for age and sex) and a follow-up duration from 3 months to 12 months the overall effect showed that periodontitis treatment improved the HbA1c, odd ratio, −0.024, 95% confidence interval, −0.42 − 0.06, P value, 0.009. However, substantial heterogeneity was observed, P value, < 0.001, I2 for heterogeneity, 81% [Figure 2].
Figure 2: Periodontitis treatment effect on the glycated hemoglobin (HbA1c)

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   Discussion Top


In the present meta-analysis, periodontitis treatment was effective in reducing the HbA1c among patients with type 2 diabetes and treatment follow-up duration from 3 months to 12 months. Similarly, a meta-analysis including nine randomized trials carried on patients with type 2 diabetes found that scaling and root planing improved inflammation and HbA1c.[21] A meta-analysis published in the United Kingdom among patients with type 1 and type 2 diabetes (35 studies included) and reported an inconclusive result regarding periodontitis treatment and glycemic control. However, a high risk of bias was observed in the included studies.[22] Supporting the results of a previous study including five trials on type 2 diabetes.[23] Another meta-analysis included seven randomized controlled trials (RCTs) and showed better glycemic control with scaling and root planning.[24] A study showed that the effects of periodontal treatment on glycemic control are short-term only and not a robot after 6 months.[25] On the other hand, Wang et al.[26] investigated the effects of nonsurgical periodontitis treatment (four trials were pooled) and showed no effect of periodontal treatment. It is interesting to note that systemic markers of inflammation reduced significantly among obese/overweight patients with diabetes compared to their counterparts with normal weight.[27] The current study's strength is that we include a good number of RCTs. However, the heterogeneity is a big limitation of the study.


   Conclusion Top


The present meta-analysis showed a slight association between periodontal treatment and glycemic control among patients with uncontrolled diabetes. Early detection and treatment of periodontitis are recommended to improve glycemic control. Further, longer studies are needed to assess the long term on glycemic control.

Consent

This study was not registered with Cochrane or any RCT or systematic review database.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Teo ZL, Tham YC, Yu M, Chee ML, Rim TH, Cheung N, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045: Systematic review and meta-analysis. Ophthalmology 2021;128:1580-91.  Back to cited text no. 1
    
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Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the international diabetes federation diabetes atlas, 9th edition. Diabetes Res Clin Pract 2019;157:107843.  Back to cited text no. 2
    
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Wu CZ, Yuan YH, Liu HH, Li SS, Zhang BW, Chen W, et al. Epidemiologic relationship between periodontitis and type 2 diabetes mellitus. BMC Oral Health 2020;20:204.  Back to cited text no. 3
    
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Tibúrcio-Machado CS, Michelon C, Zanatta FB, Gomes MS, Marin JA, Bier CA. The global prevalence of apical periodontitis: A systematic review and meta-analysis. Int Endod J 2021;54:712-35.  Back to cited text no. 4
    
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Kebede TG, Pink C, Rathmann W, Kowall B, Völzke H, Petersmann A, et al. Does periodontitis affect diabetes incidence and haemoglobin A1c change? An 11-year follow-up study. Diabetes Metab 2018;44:243-9.  Back to cited text no. 5
    
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Pepelassi E, Xynogala I, Perrea D, Pantopoulou A, Agrogiannis G, Vrotsos I. The effect of experimental periodontitis, experimental diabetes and their combination on the serum levels of adiponectin, leptin, IL-6, IL-18, MCP-1, RANTES and sICAM-1 in rats. J Int Acad Periodontol 2020;22:1-10.  Back to cited text no. 6
    
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Joshipura KJ, Muñoz-Torres FJ, Dye BA, Leroux BG, Ramírez-Vick M, Pérez CM. Longitudinal association between periodontitis and development of diabetes. Diabetes Res Clin Pract 2018;141:284-93.  Back to cited text no. 7
    
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Sanz M, Ceriello A, Buysschaert M, Chapple I, Demmer RT, Graziani F, et al. Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the international diabetes federation and the European federation of periodontology. J Clin Periodontol 2018;45:138-49.  Back to cited text no. 8
    
9.
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.  Back to cited text no. 9
    
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D'Aiuto F, Gkranias N, Bhowruth D, Khan T, Orlandi M, Suvan J, et al. Systemic effects of periodontitis treatment in patients with type 2 diabetes: A 12 month, single-centre, investigator-masked, randomised trial. Lancet Diabetes Endocrinol 2018;6:954-65.  Back to cited text no. 10
    
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Das AC, Das SJ, Panda S, Sharma D, Taschieri S, Fabbro MD. Adjunctive effect of doxycycline with conventional periodontal therapy on glycemic level for chronic periodontitis with type 2 diabetes mellitus subjects. J Contemp Dent Pract 2019;20:1417-23.  Back to cited text no. 11
    
12.
Engebretson SP, Hyman LG, Michalowicz BS, Schoenfeld ER, Gelato MC, Hou W, et al. The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: A randomized clinical trial. JAMA 2013;310:2523-32.  Back to cited text no. 12
    
13.
Gay IC, Tran DT, Cavender AC, Weltman R, Chang J, Luckenbach E, et al. The effect of periodontal therapy on glycaemic control in a Hispanic population with type 2 diabetes: A randomized controlled trial. J Clin Periodontol 2014;41:673-80.  Back to cited text no. 13
    
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Kapellas K, Mejia G, Bartold PM, Skilton MR, Maple-Brown LJ, Slade GD, et al. Periodontal therapy and glycaemic control among individuals with type 2 diabetes: Reflections from the PerioCardio study. Int J Dent Hyg 2017;15:e42-51.  Back to cited text no. 14
    
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Kaur PK, Narula SC, Rajput R, K Sharma R, Tewari S. Periodontal and glycemic effects of nonsurgical periodontal therapy in patients with type 2 diabetes stratified by baseline HbA1c. J Oral Sci 2015;57:201-11.  Back to cited text no. 15
    
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Koromantzos PA, Makrilakis K, Dereka X, Katsilambros N, Vrotsos IA, Madianos PN. A randomized, controlled trial on the effect of non-surgical periodontal therapy in patients with type 2 diabetes. Part I: Effect on periodontal status and glycaemic control. J Clin Periodontol 2011;38:142-7.  Back to cited text no. 16
    
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Moeintaghavi A, Arab HR, Bozorgnia Y, Kianoush K, Alizadeh M. Non-surgical periodontal therapy affects metabolic control in diabetics: A randomized controlled clinical trial. Aust Dent J 2012;57:31-7.  Back to cited text no. 17
    
18.
Sun WL, Chen LL, Zhang SZ, Wu YM, Ren YZ, Qin GM. Inflammatory cytokines, adiponectin, insulin resistance and metabolic control after periodontal intervention in patients with type 2 diabetes and chronic periodontitis. Intern Med 2011;50:1569-74.  Back to cited text no. 18
    
19.
Vergnes JN, Canceill T, Vinel A, Laurencin-Dalicieux S, Maupas-Schwalm F, Blasco-Baqué V, et al. The effects of periodontal treatment on diabetic patients: The DIAPERIO randomized controlled trial. J Clin Periodontol 2018;45:1150-63.  Back to cited text no. 19
    
20.
Wang S, Liu J, Zhang J, Lin J, Yang S, Yao J, et al. Glycemic control and adipokines after periodontal therapy in patients with Type 2 diabetes and chronic periodontitis. Braz Oral Res 2017;31:e90.  Back to cited text no. 20
    
21.
Baeza M, Morales A, Cisterna C, Cavalla F, Jara G, Isamitt Y, et al. Effect of periodontal treatment in patients with periodontitis and diabetes: Systematic review and meta-analysis. J Appl Oral Sci 2020;28:e20190248.  Back to cited text no. 21
    
22.
Simpson TC, Weldon JC, Worthington HV, Needleman I, Wild SH, Moles DR, et al. Treatment of periodontal disease for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev 2015;2015:CD004714.  Back to cited text no. 22
    
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Teeuw WJ, Gerdes VE, Loos BG. Effect of periodontal treatment on glycemic control of diabetic patients: A systematic review and meta-analysis. Diabetes Care 2010;33:421-7.  Back to cited text no. 23
    
24.
Teshome A, Yitayeh A. The effect of periodontal therapy on glycemic control and fasting plasma glucose level in type 2 diabetic patients: Systematic review and meta-analysis. BMC Oral Health 2016;17:31.  Back to cited text no. 24
    
25.
Wang X, Han X, Guo X, Luo X, Wang D. The effect of periodontal treatment on hemoglobin A1c levels of diabetic patients: A systematic review and meta-analysis. PLoS One 2014;9:e108412.  Back to cited text no. 25
    
26.
Wang TF, Jen IA, Chou C, Lei YP. Effects of periodontal therapy on metabolic control in patients with type 2 diabetes mellitus and periodontal disease: A meta-analysis. Medicine (Baltimore) 2014;93:e292.  Back to cited text no. 26
    
27.
Papageorgiou SN, Reichert C, Jäger A, Deschner J. Effect of overweight/obesity on response to periodontal treatment: Systematic review and a meta-analysis. J Clin Periodontol 2015;42:247-61.  Back to cited text no. 27
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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