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Basic, Nonsurgical Care for Periodontal Disease May Not Be Enough for Patients with Diabetes

Posted on December 18, 2013

For persons with type 2 diabetes and chronic periodontitis, nonsurgical periodontal treatment did not result in improved glycemic control, according to a study appearing in the December 18 issue of JAMA.

Emerging evidence implicates inflammation in the development of type 2 diabetes. Chronic periodontitis, a destructive inflammatory disorder of the soft and hard tissues supporting the teeth, is a major cause of tooth loss in adults. Nearly half of the US population older than 30 years is estimated to have chronic periodontitis, according to background information in the article. Individuals with diabetes are at greater risk for chronic periodontitis. Well-controlled diabetes is associated with less severe chronic periodontitis and a lower risk for progression of periodontitis, suggesting that level of glycemia is an important mediator of the relationship between diabetes and risk of chronic periodontitis. Limited evidence suggests that periodontal therapy may improve glycemic control.

Steven P. Engebretson, DMD, MS, of New York University, New York, and colleagues examined whether nonsurgical periodontal therapy, compared with no therapy, reduces levels of glycated hemoglobin (HbAlc) levels in persons with type 2 diabetes and moderate to advanced chronic periodontitis. The trial included 514 participants who were enrolled between November 2009 and March 2012 from diabetes and dental clinics and communities affiliated with 5 academic medical centers. The treatment group (n = 257) received scaling and root planing plus an oral rinse at baseline and supportive periodontal therapy at 3 and 6 months. The control group (n = 257) received no treatment for 6 months.

The researchers found that levels of HbAlc did not change between baseline and the 3-month or 6-month visits in either the treatment or the control group, and the target 6-month reduction of HbAlc level of 0.6% or greater was not achieved. There were no differences in HbAlc levels across centers.

Periodontal measures improved in the treatment group compared with the control group at 6 months.

"This multicenter randomized clinical trial of nonsurgical periodontal treatment for participants with type 2 diabetes and chronic periodontitis did not demonstrate a benefit for measures of glycemic control. Although periodontal treatment improved clinical measures of chronic periodontitis in patients with diabetes, the findings do not support the use of nonsurgical periodontal treatment for the purpose of lowering levels of HbAlc," the authors conclude.

Despite these results, the American Academy of Periodontology (AAP) continues to encourage patients with diabetes to maintain periodontal health and receive appropriate treatment for any periodontal disease.

Dr. Stuart J. Froum, DDS, President of the AAP and clinical professor and Director of Clinical Research in the Department of Periodontics and Implant Dentistry at New York University Dental Center, says the findings should not dismiss an association between periodontal disease and diabetes. "As a number of population studies suggest, there is indeed a relationship between diabetes and periodontal disease. While this study specifically focuses on basic nonsurgical periodontal care, some cases of periodontal disease require more intensive treatment. There is evidence that more intensive periodontal therapies can be effective in glycemic control."

According to the AAP, patients with diabetes should receive an annual comprehensive periodontal evaluation which includes a thorough assessment of periodontal health and any risk factors for disease. "Every patient requires an individualized treatment plan," says Dr. Froum. "For patients with diabetes, this may include either nonsurgical periodontal care or more advanced treatment. I encourage all patients living with diabetes to talk with their dental professional about their unique periodontal health."