Impact of periodontal treatment on diabetes management

Background + Aims

• Periodontitis is a common complication for individuals living with type 2 diabetes, especially those with poor glycaemic management.
• Short-term full-mouth scaling and root planing (FMSRP) within 24 hours has been proposed to prevent bacterial translocation, but its long-term effects remain unclear.
• The full-mouth disinfection (FMD) protocol involves the adjunctive use of chlorhexidine (CHX) during and after FMSRP to reduce microbial recolonisation and enhance periodontal health.
• This study aimed to evaluate the clinical and glycaemic effects of FMD compared to FMSRP alone in people with poorly managed type 2 diabetes and generalised chronic periodontitis.
• Researchers hypothesised that FMD would provide superior periodontal and glycaemic outcomes over 12 months.

Materials + Methods

• Single-blinded, parallel-design, randomised controlled clinical trial.
• 38 individuals were included:
  • Aged 37–75 years
  • With type 2 diabetes
  • With generalised chronic periodontitis.
• Exclusion criteria included:
  • Recent periodontal therapy, systemic antibiotic use, smoking, and severe diabetic complications.
• Groups:
  • FMD group: Received FMSRP within 24 hours, CHX rinses, and subgingival gel application for 60 days.
  • Control group: Received FMSRP with placebo rinses and gels.
  • Both groups received supportive therapy, including plaque control and oral hygiene reinforcement, at 3, 6, and 9 months.
• Clinical parameters measured: Probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP), and plaque index at baseline, 3, 6, and 12 months.
• Glycaemic parameters measured:
  • Glycated haemoglobin (HbA1c)
  • Fasting plasma glucose (FPG).
• Primary outcome assessed changes in CAL at sites with deep PPD (≥7mm).
• Statistical analysis assessed differences between groups and time points.

Results

• Both groups showed significant improvements in all periodontal parameters (BoP, PD, CAL) over 12 months.
• No significant differences were observed between the FMD and control groups for:
  • CAL gains at deep PD sites.
  • Reductions in BoP, PD, and plaque levels.
• Glycaemic management (HbA1c and FPG levels) remained stable in both groups without significant changes or differences.
• Adverse effects, such as dry mouth and taste alterations, were reported by some participants but were mild and self-limiting.
• Supportive therapies contributed to sustained improvements in periodontal outcomes across both groups.
• The hypothesis that FMD would yield superior clinical outcomes was rejected.

Limitations