Dentists Can Play a Key Role in Management of Diabetes

Patients with type 2 diabetes and periodontitis may experience significant improvements in glycemic control if they have their gum disease properly treated, the results of a Spanish randomized controlled trial suggest.

Comparing thorough periodontal treatment with superficial plaque and calculus removal, the researchers found that patients who underwent intensive gum management experienced significant improvements in fasting plasma glucose (FPG) and HbA_1c, despite already receiving diabetes treatment.

The study demonstrates "that the nonsurgical treatment of periodontitis improves glycemic status and levels of glycated hemoglobin, and therefore proves the great importance of oral health in these patients," said coauthor José López-López, MD, PhD, from the Dental School at the University of Barcelona, Spain, in a press release.

The research was recently published online in the Journal of Clinical Periodontology, by Miquel Viñas, PhD, Department of Pathology and Experimental Therapeutics, IDIBELL-University of Barcelona, Spain, and colleagues.

It follows Dutch findings indicating that patients with severe periodontitis may have undiagnosed type 2 diabetes, as reported by Medscape Medical News. That analysis of 300 dental patients revealed HbA_1c levels increased significantly with increased severity of periodontitis, and severe periodontitis was linked to a doubling of the risk of suspected diabetes.

Dr Viñas said the current study shows that there is a relationship, not only from diabetes to periodontal disease, but also "the other way round."

"Dentists play a critical role in the management of diabetes patients, identifying those at high risk of diabetes and helping them to control their periodontal disease and therefore their metabolic status," he and his colleagues assert.

Spanish Study: Patients Had Diabetes for 10 Years on Average

Although previous studies have suggested that periodontal treatment could be linked to improved glycemic control, there has not been enough evidence to demonstrate a causal relationship.

The Spanish researchers conducted a randomized clinical trial to examine the impact of nonsurgical periodontal treatment on glycemic control in 90 patients previously diagnosed with type 2 diabetes and who had generalized chronic periodontitis.

Specifically, patients were randomized to treatment, comprising scaling and root planing using ultrasound and Gracey curettes, or to a control group, who underwent supragingival removal of plaque and calculus using ultrasound. Both groups also received oral hygiene instruction.

A full periodontal assessment, including plaque index (PI), gingival index (GI), and probed pocket depth, was carried out at baseline and after 3 and 6 months. HbA_1c and FPG were determined up to 30 days before baseline and at 6 months, as were bacterial counts.

Mean age of participants was 61 years, and mean duration of diabetes was around 10 years. Approximately 45% of patients were receiving oral hypoglycemic agents, and around 40% were taking these agents alongside insulin.

There were no significant differences between the treatment and control groups in terms of age, sex, duration of diabetes, body mass index, daily brushing, and mouthwash habits.

There were, however, significant differences in smoking history (P = .002), with the patients in the treatment group substantially more likely to be current smokers and less likely to be former smokers or having never smoked than control patients.

The authors note that a worse response to periodontal therapy in smokers than nonsmokers has previously been reported, but they still had a significant difference between groups in spite of the fact there were more smokers in the treatment group.

Significant Improvements in FPG and HbA_1c With Intensive Treatment

Patients in the treatment group experienced significant improvements in PI and GI at 3 and 6 months (P = .000), while the changes in the control group were minimal and not significant (P = .487).

At baseline, both HbA_1c and FPG levels were similar in the treatment and control groups.

FPG levels decreased by a significant 18.61 mg/dL in the treatment group at 6 months (P = .022), while they increased by 16.25 mg/dL in the control group, with a significant difference between the groups (P = .019).

The researchers also note that patients in the treatment group had a significantly greater improvement in HbA_1c compared with the control group, at –0.51% vs –0.06% (P = .023).

Some, but not all, patients experienced marked reductions in bacterial counts. However, this was not associated with changes in glycemic control, leading the researchers to observe "even if treatment had no effect on bacterial counts, it leads to an improvement in the clinical condition of the patient."

The team concludes, "Periodontal evaluation is essential for individuals with diabetes, who should be aware of their increased risk of periodontal disease. Periodontal therapy could lead to cost savings in patients with type 2 diabetes, thanks to its effect on the metabolic control of these patients."

The study was partially funded by research grants from SEPA and the University of Barcelona. The authors have reported no relevant financial relationships.

J Clin Periodontol. Published online January 19, 2018. Abstract

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