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The Reason to Urge Your Patients to Follow Proper Oral Care Routine

Mar 31, 2018
 

Study shows that good periodontal health is necessary to achieve a favorable glycemic status.

Diabetologia reported on a two-way link between periodontitis and diabetes a few years ago as a result of a systematic review conducted by P. Preshaw and colleagues. Not only did they report the risk of periodontitis to be increased with uncontrolled diabetes, but they describe the HbA1c improvements with proper periodontal therapy. Providing patients with information about the risks of periodontitis at the time of diabetes diagnosis, and delivering a prompt peritonitis diagnosis are fundamental to preventing irreversible tissue loss that is commonly seen with periodontal disease.  But, what occurs when patients already have periodontitis? To uncover whether non-surgical oral therapy can lead to HbA1c improvement in patients who have both diabetes and generalized chronic periodontitis, Elisabet Mauri-Obradors et al. conducted a randomized controlled, single-blind trial.

The study in question included individuals who were diagnosed with T2D for at least a year and a half prior to study inclusion if they also had generalized chronic periodontitis. Treatment with antibiotics for longer than 10 days during the last 3 months preceding the study, previous non-surgical periodontitis treatment, and pregnancy were among the exclusion criteria of the 6-month-long trial. Both participants and the dentists were aware of the treatment, while the principal examiner was blinded. Patients were randomized into two groups: treatment group and control group.  A total of 90 patients were enrolled in the study: 42 individuals in the treatment group who received scaling and root planning using ultrasound and Gracey curettes, and 48 subjects in the control group who received supragingival removal of plaque and calculus with ultrasound. Regardless of the treatment arm, all subjects were advised to follow a modified Bass technique for oral care. Subjects received a full dental examination at baseline, then at 3 and 6 months following the commencement of study. HbA1c, fasting glucose levels, periodontal index, gingival index, and probed pocked depth were measured at each of the follow-up appointments.

At the end of 6 months, individuals who were in the treatment group of the trial had a significant improvement in all periodontal parameters than what was seen at baseline. This was not the case with the control group. More importantly, subjects in the treatment arm had a statistically significant improvement in periodontal (PI) and gingival index (GI), p-value of 00001; improvement in PI and GI in control group was not statistically significant, p-value of 0.487.   When assessing the change in HbA1c levels, individuals who received the treatment for periodontitis had a statistically significant decrease of A1c by approximately 0.51%, while the reduction was 0.06% in control group, p-value of 0.023 favoring the treatment arm. After completing the correlation analysis, the benefit in A1c level was found not to be related to age, height, weight, duration of diabetes, or differences in PI, GI, or probed pocket depth (PPD). After 6 months of treatment, fasting plasma glucose levels improved in individuals in the treatment arm as well; these subjects had a decrease of FBG levels by ~18.71 mg/dL.

Mauri-Obradors and colleagues concluded that by following non-surgical procedures for treatment of generalized chronic peritonitis fasting plasma glucose and HbA1c levels can be optimized. Since the same effect was not seen in subjects who did not receive the non-surgical procedures, authors argue that these changes were not controlled with lifestyle changes or uses of medication treatments. As previously mentioned, periodontal evaluation and education of risks are essential for patients with diabetes in order to control their metabolic status and prevent tissue loss that occurs with the disease. Therefore, routine oral health practices should be encouraged in all patients with diabetes, and a closer partnership of care between primary care providers and dentists are necessary to minimize the risk of periodontal disease and in instances where the disease is already present to improve the outcomes of patients.

Practice Pearls:

  • Non-surgical treatment of periodontitis leads to improved oral health and will decrease the tissue loss in patients with diabetes.
  • Proper oral health leads to decrease HbA1c levels by approximately 0.51%.
  • Patients had a decrease in fasting plasma glucose levels by 18.71 mg/dL following non-surgical treatment of periodontitis.

References:

Elisabet Mauri-Obrados, Alexandra Merlos, Albert Estrugo-Devesa, et al. “Benefits of non- surgical periodontal treatment in patients with type 2 diabetes mellitus and chronic periodontitis: A randomized controlled trial.” Journal of Clinical Periodontry.  2018. http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12858/abstract.  Accessed Feb 2018.

  1. Preshaw, A. Alba, D. Hererra, et al. “Periodontitis and Diabetes: A Two-way Relationship.” Diabetologia. 2012. https://link.springer.com/article/10.1007%2Fs00125-011-2342-y. Accessed Feb 2018.

Lamija Zimic, PharmD(c), University of South Florida, College of Pharmacy