J Clin Periodontol. 2018;45:345–353. wileyonlinelibrary.com/journal/jcpe
|
345 © 2017 John Wiley & Sons A/S.
Published by John Wiley & Sons Ltd
Accepted: 1 December 2017
DOI: 10.1111/jcpe.12858
RANDOMIZED CLINICAL TRIAL
Benefits of non-surgical periodontal treatment in patients
with type 2 diabetes mellitus and chronic periodontitis: A
randomized controlled trial
Elisabet Mauri-Obradors
1
| Alexandra Merlos
2
| Albert Estrugo-Devesa
1
| Enric
Jané-Salas
1,3
| José López-López
1,3
| Miguel Viñas
2
1
Department of Dentistry, Dental
School, University of Barcelona, Barcelona,
Spain
2
Department of Pathology and Experimental
Therapeutics, Medical School, IDIBELL-
University of Barcelona, Barcelona, Spain
3
Oral Medicine Unit, Department of
Dentistry, Faculty of Medicine and Health
Sciences (Dental School) and Dental Hospital
Barcelona University (University of Barcelona)
and Health and Masticatory System Group
(Bellvitge Biomedical Research, Institute)
IDIBELL, Barcelona, Spain
Correspondence
José López López, Oral Medicine Unit,
Department of Dentistry, Pabellón de
Gobierno, and Faculty of Medicine and Health
Sciences (Dentistry) Campus of Bellvitge,
Barcelona, Spain.
Emails: 18575jll@gmail.com, jl.lopez@ub.edu
Funding information
No external funding, apart from the support
of the authors’ institution, was available for
this study.
Abstract
Background: Periodontitis and diabetes are highly prevalent conditions whose asso-
ciation has long been recognized.
Objective: To evaluate the effect of non-surgical periodontal treatment on serum
HbA1c (haemoglobin A1c or glycated haemoglobin) levels in patients with type 2
diabetes.
Research Design and Methods: This was a 6-month, single-masked, randomized clini-
cal trial based on 90 patients (HbA1c: 7.7% (61 mmol/mol) ± 1.13%) who were ran-
domly assigned to either the treatment group (oral hygiene instructions + scaling and
root planing using ultrasound and Gracey curettes) or the control group (oral hygiene
instructions + supragingival removal of plaque and calculus using ultrasound). Pocket
depth, gingival index, and plaque index were assessed at baseline and after 3 and
6 months together with determinations of fasting plasma glucose, HbA1c, and
bacterial counts.
Results: Treatment significantly improved the periodontal and metabolic parameters
(p < .05), whereas in the control group no improvement was observed. These results
were consistent with the bacteriological results in most but not all cases.
Conclusion: Non-surgical periodontal treatment resulted in a better glycaemic status
of type 2 diabetes patients and demonstrated the importance of oral health in their
general health.
KEYWORDS
glycosylated haemoglobin, PCR, periodontal disease, scaling and root planing, type 2 diabetes
mellitus
1 | INTRODUCTION
Inflammatory periodontal diseases are the most common chronic
inflammatory condition, with up to 90% of the world’s population
affected. The association of periodontitis with diabetes mellitus has
been largely recognized (Pihlstrom, Michalowicz, & Johnson, 2005;
Preshaw et al., 2012).
Inflammation of the periodontium starts by the formation of a
subgingival biofilm, being major risk factors smoking and diabetes
(Preshaw et al., 2012). The increased risk of periodontitis for diabetic
patients depends on the glycaemic control, as in other complications.
Thus, patients with well-controlled glycated haemoglobin (HbA1c;
~7% (53 mmol/mol)) have a risk of periodontitis low increasing expo-
nentially as glycaemic control declines (Al-Khabbaz, 2014).