Does nonsurgical periodontal therapy improve glycemic control?

Area of Science:

• Periodontology
• Endocrinology
• Evidence-based dentistry

Background:

• Periodontal disease is prevalent in diabetic patients and can negatively impact glycemic control.
• Nonsurgical periodontal therapy (NSPT) aims to reduce periodontal inflammation and may influence systemic health outcomes.
• The efficacy of NSPT, with or without adjunctive therapies, on glycemic control requires comprehensive evaluation.

Purpose of the Study:

• To systematically review and synthesize evidence on the effectiveness of nonsurgical periodontal therapy in improving glycemic control in diabetic patients.
• To assess the impact of adjunctive therapies (antibiotics, laser) combined with NSPT on HbA1c levels.
• To evaluate the quality of existing systematic reviews and meta-analyses on this topic.

Main Methods:

• Comprehensive literature search of databases including Medline, EMBASE, Cochrane, and Scielo, supplemented by grey literature.
• Inclusion of systematic reviews that analyzed randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing NSPT alone versus no treatment or NSPT with adjunctive therapies.
• Data extraction and quality assessment using AMSTAR 2 and PRISMA checklists; risk of bias assessment for RCTs using JADAD scale; heterogeneity assessed by Q test and I2 Index; meta-analysis using fixed and random models.

Main Results:

• Sixteen systematic reviews, encompassing 30 meta-analyses, were included in the qualitative synthesis.
• Nonsurgical periodontal therapy demonstrated a statistically significant reduction in HbA1c by -0.49% at 3 months (p=0.0041) and -0.38% at 6 months (p=0.0851) compared to control groups.
• Adjunctive therapies, including antibiotics and lasers, did not show statistically significant improvements in HbA1c compared to NSPT alone at 3 or 6 months.

Conclusions:

• Nonsurgical periodontal therapy is an effective intervention for improving glycemic control in diabetic patients, as evidenced by HbA1c reduction.
• Current evidence suggests that adjunctive therapies such as antibiotics or lasers do not provide statistically significant additional benefits when used with NSPT.
• These findings underscore the importance of NSPT in managing diabetes and highlight the need for further research into optimal adjunctive treatment strategies.