The Effects of Non-surgical Periodontal Treatment on Glycemic Control, Oxidative Stress Balance and Quality of Life in Patients with Type 2 Diabetes: A Randomized Clinical Trial

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2017 Nov 18

PMID 29145468

Citations 23

Authors

Hirofumi Mizuno

Daisuke Ekuni

Takayuki Maruyama

Kota Kataoka

Toshiki Yoneda

Daiki Fukuhara

Yoshio Sugiura

Takaaki Tomofuji

Jun Wada

Manabu Morita

Affiliations

Soon will be listed here.

Abstract

Aim: The purpose of this study was to investigate the effects of non-surgical periodontal treatment on hemoglobinA1c (HbA1c) levels, oxidative stress balance and quality of life (QOL) in patients with type 2 diabetes mellitus (T2DM) compared to no periodontal treatment (simple oral hygiene instructions only).

Methods: The design was a 6-month, single-masked, single center, randomized clinical trial. Patients had both T2DM and chronic periodontitis. Forty participants were enrolled between April 2014 and March 2016 at the Nephrology, Diabetology and Endocrinology Department of Okayama University Hospital. The periodontal treatment group (n = 20) received non-surgical periodontal therapy, including scaling and root planing plus oral hygiene instructions, and consecutive supportive periodontal therapy at 3 and 6 months. The control group (n = 17) received only oral hygiene instructions without treatment during the experimental period. The primary study outcome was the change in HbA1c levels from baseline to 3 months. Secondary outcomes included changes in oxidative stress balance (Oxidative-INDEX), the Diabetes Therapy-Related QOL and clinical periodontal parameters from baseline to 3 months and baseline to 6 months.

Results: Changes in HbA1c in the periodontal treatment group were not significantly different with those in the control group at 3 and 6 months. Systemic oxidative stress balance and QOL significantly improved in the periodontal treatment group compared to the control group at 3 months. In the subgroup analysis (moderately poor control of diabetes), the decrease in HbA1c levels in the periodontal treatment group was greater than that in the control group at 3 months but not significant.

Conclusions: In T2DM patients, non-surgical periodontal treatment improved systemic oxidative stress balance and QOL, but did not decrease HbA1c levels at 3 months follow-up.

Trial Registration: Current Controlled Trials UMIN-ICDR UMIN 000013278 (Registered April 1, 2014).

Citing Articles

The role of periodontal treatment on the reduction of hemoglobinA1c, comparing with existing medication therapy: a systematic review and meta-analysis.

Umezaki Y, Yamashita A, Nishimura F, Naito T Front Clin Diabetes Healthc. 2025; 6:1541145.

PMID: 40070580 PMC: 11893427. DOI: 10.3389/fcdhc.2025.1541145.

Does Non-surgical Periodontal Therapy With Adjunct Antimicrobial Photodynamic Therapy Help Reduce Periodontal Inflammation and Haemoglobin A1c Levels in Patients With Type-2 Diabetes Mellitus? A Systematic Review and Meta-analysis.

BinShabaib M Oral Health Prev Dent. 2024; 22:479-486.

PMID: 39286965 PMC: 11619874. DOI: 10.3290/j.ohpd.b5750814.

Improvement of post-periodontitis-therapy inflammatory state in diabetics: a meta-analysis of randomized controlled trials.

Barbirato D, Nogueira N, Guimaraes T, Zajdenverg L, Sansone C Clin Oral Investig. 2024; 28(9):514.

PMID: 39235621 DOI: 10.1007/s00784-024-05905-x.

Systemic antibiotics adjuvants to scaling and root planing in type 2 diabetic and periodontitis individuals: Systematic review with network meta-analysis.

Wu S, Wu C, Lin L, Chen Y, Huang H, Lai Y Jpn Dent Sci Rev. 2023; 59:167-178.

PMID: 38152384 PMC: 10751746. DOI: 10.1016/j.jdsr.2023.06.001.

Systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of non-surgical periodontal treatment in patients with concurrent systemic conditions.

Joseph P, Prabhakar P, Holtfreter B, Pink C, Suvan J, Kocher T Clin Oral Investig. 2023; 28(1):21.

PMID: 38147183 PMC: 10751251. DOI: 10.1007/s00784-023-05392-6.

References

Reddy P, Ambati M, Koduganti R . Systemic lycopene as an adjunct to scaling and root planing in chronic periodontitis patients with type 2 diabetes mellitus. J Int Soc Prev Community Dent. 2015; 5(Suppl 1):S25-31. PMC: 4428016. DOI: 10.4103/2231-0762.156520. View

Miranda T, Feres M, Perez-Chaparro P, Faveri M, Figueiredo L, Tamashiro N . Metronidazole and amoxicillin as adjuncts to scaling and root planing for the treatment of type 2 diabetic subjects with periodontitis: 1-year outcomes of a randomized placebo-controlled clinical trial. J Clin Periodontol. 2014; 41(9):890-9. DOI: 10.1111/jcpe.12282. View

Kiran M, Arpak N, Unsal E, Erdogan M . The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus. J Clin Periodontol. 2005; 32(3):266-72. DOI: 10.1111/j.1600-051X.2005.00658.x. View

Engebretson S, Kocher T . Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta-analysis. J Periodontol. 2013; 84(4 Suppl):S153-69. PMC: 4100543. DOI: 10.1902/jop.2013.1340017. View

Simpson T, Needleman I, Wild S, Moles D, Mills E . Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database Syst Rev. 2010; (5):CD004714. DOI: 10.1002/14651858.CD004714.pub2. View

Santos C, Lira-Junior R, Fischer R, Santos A, Oliveira B . Systemic Antibiotics in Periodontal Treatment of Diabetic Patients: A Systematic Review. PLoS One. 2015; 10(12):e0145262. PMC: 4687852. DOI: 10.1371/journal.pone.0145262. View

OLeary T, Drake R, Naylor J . The plaque control record. J Periodontol. 1972; 43(1):38. DOI: 10.1902/jop.1972.43.1.38. View

Santos V, Lima J, Miranda T, Goncalves T, Figueiredo L, Faveri M . Full-mouth disinfection as a therapeutic protocol for type-2 diabetic subjects with chronic periodontitis: twelve-month clinical outcomes: a randomized controlled clinical trial. J Clin Periodontol. 2013; 40(2):155-62. DOI: 10.1111/jcpe.12040. View

Terao M, Takaki A, Maruyama T, Oe H, Yasunaka T, Tamaki N . Serum Oxidative/anti-oxidative Stress Balance Is Dysregulated in Potentially Pulmonary Hypertensive Patients with Liver Cirrhosis: A Case Control Study. Intern Med. 2015; 54(22):2815-26. DOI: 10.2169/internalmedicine.54.4889. View

10.

Kisa K, Kawabata H, Itou T, Nishimoto N, Maezawa M . Survey of patient and physician satisfaction regarding patient-centered outpatient consultations in Japan. Intern Med. 2011; 50(13):1403-8. DOI: 10.2169/internalmedicine.50.5107. View

11.

. 3. Foundations of Care and Comprehensive Medical Evaluation. Diabetes Care. 2015; 39 Suppl 1:S23-35. DOI: 10.2337/dc16-S006. View

12.

Eke P, Page R, Wei L, Thornton-Evans G, Genco R . Update of the case definitions for population-based surveillance of periodontitis. J Periodontol. 2012; 83(12):1449-54. PMC: 6005373. DOI: 10.1902/jop.2012.110664. View

13.

Su H, Gornitsky M, Velly A, Yu H, Benarroch M, Schipper H . Salivary DNA, lipid, and protein oxidation in nonsmokers with periodontal disease. Free Radic Biol Med. 2009; 46(7):914-21. DOI: 10.1016/j.freeradbiomed.2009.01.008. View

14.

Engebretson S, Gelato M, Hyman L, Michalowicz B, Schoenfeld E . Design features of the Diabetes and Periodontal Therapy Trial (DPTT): a multicenter randomized single-masked clinical trial testing the effect of nonsurgical periodontal therapy on glycosylated hemoglobin (HbA1c) levels in subjects with type 2.... Contemp Clin Trials. 2013; 36(2):515-26. PMC: 3885354. DOI: 10.1016/j.cct.2013.09.010. View

15.

Telgi R, Tandon V, Tangade P, Tirth A, Kumar S, Yadav V . Efficacy of nonsurgical periodontal therapy on glycaemic control in type II diabetic patients: a randomized controlled clinical trial. J Periodontal Implant Sci. 2013; 43(4):177-82. PMC: 3769596. DOI: 10.5051/jpis.2013.43.4.177. View

16.

Kowluru R, Tang J, Kern T . Abnormalities of retinal metabolism in diabetes and experimental galactosemia. VII. Effect of long-term administration of antioxidants on the development of retinopathy. Diabetes. 2001; 50(8):1938-42. DOI: 10.2337/diabetes.50.8.1938. View

17.

Casanova L, Hughes F, Preshaw P . Diabetes and periodontal disease: a two-way relationship. Br Dent J. 2014; 217(8):433-7. DOI: 10.1038/sj.bdj.2014.907. View

18.

Urakawa H, Katsuki A, Sumida Y, Gabazza E, Murashima S, Morioka K . Oxidative stress is associated with adiposity and insulin resistance in men. J Clin Endocrinol Metab. 2003; 88(10):4673-6. DOI: 10.1210/jc.2003-030202. View

19.

Nezu S, Okamoto N, Morikawa M, Saeki K, Obayashi K, Tomioka K . Health-related quality of life (HRQOL) decreases independently of chronic conditions and geriatric syndromes in older adults with diabetes: the Fujiwara-kyo Study. J Epidemiol. 2014; 24(4):259-66. PMC: 4074629. DOI: 10.2188/jea.je20130131. View

20.

Le Lay S, Simard G, Martinez M, Andriantsitohaina R . Oxidative stress and metabolic pathologies: from an adipocentric point of view. Oxid Med Cell Longev. 2014; 2014:908539. PMC: 4131099. DOI: 10.1155/2014/908539. View