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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
Mohammed Adam Ahmed Elnour, Hyder Osman Mirghani
Department of Internal Medicine, Faculty of Medicine, University of Tabuk, KSA
Correspondence Address:
Mohammed Adam Ahmed Elnour
Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Tabuk
KSA
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/aam.aam_53_22
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
Introduction 
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 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 3: The quality of the included trials according to Cochrane risk of bias assessment toolStatistical 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 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) Discussion 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 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 
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