Use of adjuncts in periodontal treatment for patients with diabetes

Background + Aims

• Type 2 diabetes mellitus (T2DM) is a global health challenge, with an estimated 592 million cases projected by 2035. It is closely associated with inflammatory diseases such as periodontitis.
• Periodontitis is a chronic immune-inflammatory condition associated with a dysbiotic (unbalanced) biofilm which exacerbates systemic inflammation and can impair glycaemic control.
• It is thought that management of periodontitis is vital for people living with diabetes to maintain stable blood glucose levels.
• Antibiotics such as doxycycline, known for their wide spectrum and low cost, have been studied for their role in enhancing periodontal therapy. They also exhibit anti-collagenolytic properties, potentially improving metabolic markers. The indiscriminate use of antibiotics raises concerns about bacterial resistance, warranting cautious evaluation of their benefits.
• This study aimed to assess the impact of systemic doxycycline as an adjunct to scaling and root planing (SRP) on clinical, microbiological, and immunological outcomes in people with well-managed T2DM and periodontitis.

Materials + Methods

• A double-blinded randomised controlled trial (RCT) was conducted over 6 months with 66 participants divided into two groups:
  • Test Group: SRP + systemic doxycycline (200 mg loading dose, 100 mg/day for 20 days)
  • Control Group: SRP + placebo
• Eligibility criteria included:
  • Aged >30 years old
  • T2DM patients with HbA1c <7.5%
  • Moderate to advanced periodontitis (probing pocket depth (PPD) >5mm, clinical attachment loss (CAL) >3mm, bone loss >10% in >30% of teeth)
  • Non-smokers
  • Compliant with oral hygiene
• Clinical parameters assessed included:
  • PPD
  • CAL
  • Bleeding on probing (BOP)
• Microbial sampling involved “checkerboard” DNA-DNA hybridisation for 15 bacterial species.
• Gingival crevicular fluid (GCF) samples were tested for MMP-8 levels
• HbA1c was evaluated at baseline, 3- and 6-months
• Statistical analysis used non-parametric tests to assess changes and compare between groups

Results

• Both groups showed improvements in periodontal parameters post-treatment, but no significant differences were observed between them at any time point.
• A minor benefit was seen in the test group, with fewer sites showing PPD >5 mm with BOP at 6-months.
• Reduced bacterial counts in both groups, with no consistent differences between test and control groups.
• MMP-8 levels decreased significantly in both groups by three months. Further reductions at 6-months were observed only in the test group.
• No changes in HbA1c levels were noted in either group.
• Both treatments were well-tolerated, with minor side effects reported.

Limitations