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
(Journal of Clinical Periodontology; doi: 10.1111/jcpe.12282)
Tamires Szeremeske Miranda, Magda Feres, Paula Juliana Perez-Chaparro, Marcelo Faveri, Luciene Cristina Figueiredo, Neila Sumie Tamashiro, Marta Ferreira Bastos, Poliana Mendes Duarte
Cleaning below the gumline is used to treat periodontitis, a disease that damages the tissues supporting teeth. Researchers wanted to know whether adding antibiotics could improve results for people with type 2 diabetes.
This randomised trial enrolled 58 adults with type 2 diabetes and widespread periodontitis. Participants received professional cleaning below the gums, plus either amoxicillin and metronidazole or placebo tablets. The researchers checked gum health, selected bacteria and blood glucose over one year.
Both groups improved. The antibiotic group had greater reductions in pocket depth and fewer remaining deep pockets. About 76% met the study’s definition of a lower risk of future progression, compared with 22% in the comparison group. This classification was based on gum measurements; it was not proof that future tooth loss had been prevented. Several disease-associated bacteria also decreased more with antibiotics. Neither treatment produced a statistically clear improvement in HbA1c, the blood test reflecting average glucose levels.
Antibiotics may offer additional gum benefits for selected patients, but this study does not show that they improve diabetes management. A dentist needs to weigh the likely benefit against side effects and antibiotic resistance. Having diabetes alone is not a reason to assume antibiotics are necessary.
The most useful comparison is the difference between the treatment groups, rather than improvement within just one group. Results also depend on who took part, the comparison care and how long people were followed. A statistically uncertain difference does not prove two approaches are identical. Equally, a clear difference in a measurement may not show a lasting benefit for tooth retention or general health. These findings need to be considered alongside other trials and your individual clinical needs when discussing treatment choices.
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Periodontitis is the 6th most prevalent condition globally
Periodontitis and diabetes are bidirectionally linked
Diabetic complications are increased if you have both diseases
Successful periodontal treatment can improve blood glucose control
Periodontitis is the 6th most prevalent condition globally
Periodontitis and diabetes are bidirectionally linked
Diabetic complications are increased if you have both diseases
Successful periodontal treatment can improve blood glucose control
