What is the effect of periodontal treatment (such as mechanical periodontal therapy or oral hygiene education) compared with no treatment or usual treatment on glycemic control in people with diabetes?
TYPE OF REVIEW
This is a Cochrane review of seven randomized controlled trials and contains a meta-analysis of the pooled results of three of the trials.
RELEVANCE FOR NURSING
Periodontitis, which occurs when the underlying supportive tissues of the teeth are inflamed or destroyed, may have an effect on the blood glucose levels of people with diabetes. Patient education regarding diabetes self-management should include information on gum disease prevention and oral hygiene practices, as well as the importance of seeking treatment if signs or symptoms of periodontal disease are present.
It is important for people with diabetes to be aware that preventing or reducing inflammation caused by bacteria in the mouth can influence blood glucose levels. Evidence suggests that treating periodontal disease can decrease blood glucose levels, which will have a positive impact on glycemic control. Therefore nurses should include preventing or treating gum disease when they engage in education of patients with diabetes.
CHARACTERISTICS OF THE EVIDENCE
The authors completed a comprehensive literature search for randomized controlled trials of people (16 years or older) with type 1 or type 2 diabetes who were undergoing treatment for periodontitis. They searched English and foreign language databases for relevant studies, contacted health care organizations for their recommendations, and searched relevant journals. From the 690 studies they found, only seven met the inclusion criteria. Of these, three were included in a meta-analysis. Interventions included mechanical periodontal therapy (scaling and root planing, for example), with or without adjunctive antibiotics, and oral hygiene education.
The glycated hemoglobin (HbA1c) level is a good indicator of glycemic control. After three or four months, scaling and root planing plus oral hygiene (with or without antibiotic therapy), compared with no treatment or usual treatment, showed a mean percent difference in HbA1c of -0.40% (95% confidence interval, fixed effect -0.78% to -0.01%), which was statistically significant (P = 0.04).
BEST PRACTICE RECOMMENDATIONS
Despite the fact that available data is extremely limited, there is some evidence that after being treated for periodontal disease, people with diabetes show an improvement in glycemic control. However, the vast majority of studies in this review involved people with poorly controlled type 2 diabetes.
People with diabetes should be given information about periodontal disease and treatment, and health professionals should routinely suggest oral assessments as part of diabetes management. If periodontal disease is identified, patients with diabetes should be referred to a trained oral health professional for treatment.
There is a need for randomized controlled trials to investigate the effects of treatment of periodontal disease in people with type 1 diabetes. In addition, large, rigorously conducted and reported studies are needed to fully understand the potential of periodontal treatment on improving glycemic control.
Simpson TC, et al. Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database Syst Rev 2010(5):CD004714.