Cochrane · intervention · CD004714
Treatment of periodontitis for glycaemic control in people with diabetes mellitus
Simpson, TC, Clarkson, JE, Worthington, HV, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
10
current version
GRADE rated
1
No studies
2
Included studies
35
as reported
No studies 2 · 20%Ungraded 7 · 70%Very low 0 · 0%Low 0 · 0%Moderate 1 · 10%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | People with diabetes mellitus (type 1 or type 2) and periodontitis, at least 16 years of age; periodontitis accepted on trialist statement (including chronic/adult periodontitis); excluded if >10% gestational diabetes or metabolic syndrome | 35 studies, 3249 randomised participants; almost all Type 2 DM (one study Type 1 or 2); mixed good/fair/poor metabolic control; mostly secondary care; follow-up 3-12 months |
| Intervention | Subgingival instrumentation (scaling and root planing / mechanical debridement); optionally with surgical periodontitis treatment (flap surgery/gingivectomy), antimicrobial therapy (local or systemic), other drug therapy, other novel interventions, supragingival scaling (PMPR), oral hygiene instruction/education | Subgingival instrumentation (20 studies); subgingival instrumentation plus antimicrobials (11 studies); subgingival instrumentation plus antimicrobial mouthrinse (3 studies) |
| Comparison | No (or delayed) treatment or usual care (oral hygiene instruction or supragingival scaling with or without OHI) | No active intervention/usual care (oral hygiene instruction, support, and/or supragingival plaque removal) |
| Outcomes | Primary: glycaemic control measured by HbA1c (% or mmol/mol). Secondary: clinical attachment level; probing pocket depth; bleeding on probing; gingival indices; plaque indices; adverse effects; quality of life (e.g. OHIP-14); diabetic complications; cost implications | HbA1c (n=2443, 30 studies at 3-4mo; n=1457, 12 studies at 6mo; n=264, 1 study at 12mo); CAL (18 studies); PPD (21 studies); BOP (14 studies); PI (18 studies, SMD); GI (12 studies, SMD); adverse effects (narrative); quality of life (3 studies); cost/diabetic complications (no included-study data) |
| Study designs | Randomised controlled trials (RCTs); excluded split-mouth and cross-over; follow-up >=90 days | RCT, parallel group (n=35) |
| Timing | At least 3 months (90 days) after completion of treatment course | 3-4 months; 6 months; 12 months |
Search date: 2021-09. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; CINAHL EBSCO; LILACS BIREME; Web of Science (conference proceedings); ZETOC (conference proceedings); ClinicalTrials.gov; WHO ICTRP
Questions and results
Current version onlyPeriodontal treatment (subgingival instrumentation, with or without antimicrobials/surgery) vs No active intervention/usual care
Population: People with diabetes mellitus (type 1 or type 2, mostly type 2) and periodontitis, at least 16 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quality of life indicators 3-4 months | Three studies measured QoL. Vergnes 2018: overall GOHAI adjusted MD 7.0 (95% CI 2.4 to 11.6), 79 participants (better oral health-related QoL); no clear change in general SF-36 QoL. D'Aiuto 2018 ADDQoL better in… | 3 studies | Ungraded |
Bleeding on probing (BOP) 3-4 months | MD -15.56 [-21.77, -9.36] -15.56 [-21.77, -9.36] percentage of sites | 14 studies | Ungraded |
Probing pocket depth (PPD/PD) 3-4 months | MD -0.56 [-0.72, -0.40] -0.56 [-0.72, -0.40] mm | 21 studies | Ungraded |
Gingival index (GI) 3-4 months | SMD -1.75 [-2.27, -1.24] -1.75 [-2.27, -1.24] standard deviations | 12 studies | Ungraded |
HbA1c (glycated haemoglobin), change 3-4 months | MD -0.43 [-0.59, -0.28] -0.43 [-0.59, -0.28] % HbA1c (percentage points) | 30 studies · 2443 participants | Moderate Downgraded: risk of bias |
Plaque index (PI) / oral hygiene 3-4 months | SMD -2.05 [-2.57, -1.53] -2.05 [-2.57, -1.53] standard deviations | 18 studies | Ungraded |
Diabetic complications 3-4 months | Included studies did not report data on diabetic complications (some reported medication changes only) | 0 studies | No studies |
Adverse effects of treatment 3-4 months | SoF comment: insufficient evidence to determine whether SRP for glycaemic control is associated with any harms; most studies did not evaluate adverse effects. Where reported (e.g. D'Aiuto 2018) serious adverse events… | NR | Ungraded |
Clinical attachment level (CAL) 3-4 months | MD -0.48 [-0.65, -0.31] -0.48 [-0.65, -0.31] mm | 18 studies | Ungraded |
Cost implications 3-4 months | Included studies did not report cost data. A brief economic commentary drew on four external economic evaluations (Smits 2020, Nasseh 2017, Choi 2020, Soloweij-Wedderburn 2017) suggesting potential cost… | 0 studies | No studies |
Periodontal therapy (scaling and root planing, with or without antimicrobials) vs No active intervention/usual care
Population: People with diabetes mellitus (type 1 or type 2, mostly type 2) and periodontitis, at least 16 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects of treatment 3-4 months | Twenty studies (57%) did not report adverse effects; 8 reported no adverse events; minor events reported by Jones 2007 (doxycycline GI upset; chlorhexidine taste change/staining), Miranda 2014, Santos 2013.… | NR | Ungraded |
Bleeding on probing (BOP) 3-4 months | MD -0.16 [-0.21, -0.10] -0.16 [-0.21, -0.10] proportion of sites | 4 studies | Ungraded |
Diabetic complications 3-4 months | No included studies reported data relating to diabetic complications | 0 studies | No studies |
Quality of life indicators 3-4 months | No included studies reported data relating to quality of life | 0 studies | No studies |
Cost implications 3-4 months | No included studies reported data relating to cost implications | 0 studies | No studies |
Plaque index (PI) / oral hygiene 3-4 months | MD -0.57 [-0.79, -0.35] -0.57 [-0.79, -0.35] index units | 7 studies | Ungraded |
HbA1c (glycated haemoglobin), change 3-4 months | MD -0.29 [-0.48, -0.10] -0.29 [-0.48, -0.10] % HbA1c (percentage points) | 14 studies · 1499 participants | Low Downgraded: risk of bias, inconsistency |
Clinical attachment level (CAL) 3-4 months | MD -0.25 [-0.45, -0.05] -0.25 [-0.45, -0.05] mm | 8 studies | Ungraded |
Probing pocket depth (PPD/PD) 3-4 months | MD -0.40 [-0.62, -0.18] -0.40 [-0.62, -0.18] mm | 9 studies | Ungraded |
Gingival index (GI) 3-4 months | MD -0.54 [-0.80, -0.27] -0.54 [-0.80, -0.27] index units | 4 studies | Ungraded |
Scaling/root planing plus adjunctive antimicrobial vs Scaling/root planing alone
Population: People with diabetes mellitus (type 1 or type 2, mostly type 2) and periodontitis, at least 16 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical attachment level (CAL) 3-4 months · SRP plus antimicrobial versus SRP | MD -0.23 [-0.48, 0.03] -0.23 [-0.48, 0.03] mm | 7 studies | Ungraded |
Bleeding on probing (BOP) 3-4 months · SRP plus antimicrobial versus SRP | MD 0.01 [-0.03, 0.05] 0.01 [-0.03, 0.05] proportion of sites | 6 studies | Ungraded |
HbA1c (glycated haemoglobin), change 3-4 months · SRP plus antimicrobial versus SRP | MD 0.00 [-0.22, 0.22] 0.00 [-0.22, 0.22] % HbA1c (percentage points) | 12 studies · 450 participants | Very low Downgraded: risk of bias, imprecision |
Plaque index (PI) / oral hygiene 3-4 months · SRP plus antimicrobial versus SRP | MD 0.02 [-0.02, 0.06] 0.02 [-0.02, 0.06] index units | 7 studies | Ungraded |
Gingival index (GI) 3-4 months · SRP plus antimicrobial versus SRP | MD 0.09 [-0.03, 0.21] 0.09 [-0.03, 0.21] index units | 3 studies | Ungraded |
Probing pocket depth (PPD/PD) 3-4 months · SRP plus antimicrobial versus SRP | MD -0.11 [-0.28, 0.05] -0.11 [-0.28, 0.05] mm | 9 studies | Ungraded |
Adverse effects of treatment 3-4 months | SoF 2 comment: insufficient evidence to determine whether more intensive periodontal therapy (extra treatment combination in intervention groups) is associated with any harms | NR | Ungraded |
Scaling/root planing and oral hygiene (with or without adjunctive antibiotics) vs No treatment/usual treatment
Population: People with diabetes mellitus (Type 1 or Type 2, mostly Type 2) and periodontitis, at least 16 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quality of life indicators 3-4 months | Not reported by any included study | 0 studies | No studies |
Diabetic complications 3-4 months | No diabetic complications outcome data; studies reported only narrative changes in antidiabetic/insulin therapy | 0 studies | No studies |
Fructosamine (percentage change from baseline) 3-4 months | No included trials examined fructosamine as an outcome and therefore no comparisons were possible | 0 studies | No studies |
HbA1c (glycated haemoglobin), change 3-4 months | MD -0.40 [-0.78, -0.01] -0.40 [-0.78, -0.01] % HbA1c (percentage points) | 3 studies · 244 participants | Low Downgraded: risk of bias, indirectness |
Clinical attachment level (CAL) 3-4 months | MD -0.07 [-0.64, 0.49] -0.07 [-0.64, 0.49] mm | 2 studies · 90 participants | Low Downgraded: risk of bias |
Adverse effects of treatment 3-4 months | Only Jones 2007 detailed adverse effects: chlorhexidine (taste disturbance 15%, tooth staining 13.6%, sore mouth/tongue irritation 5%, swelling/breathlessness in a few) and doxycycline (diarrhoea 7.1%, abdominal pain… | 1 study | Ungraded |
Cost implications 3-4 months | Not reported by any included study | 0 studies | No studies |
Probing depth (PD/PPD) 3-4 months | MD -0.39 [-0.64, -0.15] -0.39 [-0.64, -0.15] mm | 2 studies · 90 participants | Low Downgraded: risk of bias |
Gingival index (GI) 3-4 months | Gingival index reported narratively in 2 studies; Al-Mubarak 2002 test 2.09 to 0.69 vs control 2.19 to 1.15; Kiran 2005 test 0.94 to 0.26 vs control 0.87 to 0.84; no pooled estimate | 2 studies | Ungraded |
Bleeding on probing (BOP) 3-4 months | MD -20.21 [-27.84, -12.58] -20.21 [-27.84, -12.58] percentage of sites | 2 studies · 90 participants | Low Downgraded: risk of bias |
Plaque index (PI) / oral hygiene 3-4 months | Plaque index reported narratively in 3 studies (Al-Mubarak 2002 test 2.45 to 0.86; Kiran 2005 test 1.60 to 0.29; Yun 2007 test 3.23 to 1.57), with smaller reductions in controls; no pooled estimate | 3 studies | Ungraded |
Scaling/root planing plus adjunctive antimicrobial (antibiotic) vs Scaling/root planing alone
Population: People with diabetes mellitus (Type 1 or Type 2, mostly Type 2) and periodontitis, at least 16 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
HbA1c (glycated haemoglobin), change 3-4 months · SRP plus antimicrobial versus SRP | Rodrigues 2003 (full-mouth SRP + amoxicillin/clavulanic vs full-mouth SRP alone): HbA1c test 9.5% to 9.2% vs control 8.8% to 7.6% over 3 months; between-group difference reported significant favouring the SRP-alone… | 1 study | Ungraded |
Mechanical periodontal therapy plus oral irrigation vs Mechanical periodontal therapy alone
Population: People with diabetes mellitus (Type 1 or Type 2, mostly Type 2) and periodontitis, at least 16 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
HbA1c (glycated haemoglobin), change 3 months | Al-Mubarak 2002: HbA1c test 8.06% to 7.7% vs control 8.5% to 8.3% over 3 months; no statistically significant difference between groups (P > 0.05) | 1 study · 52 participants | Ungraded |
Scaling/root planing plus alendronate (10 mg/day) vs Scaling/root planing plus placebo
Population: People with diabetes mellitus (Type 1 or Type 2, mostly Type 2) and periodontitis, at least 16 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
HbA1c (glycated haemoglobin), change 6 months | Rocha 2001: HbA1c alendronate 11.9% to 9.4% vs placebo 13.1% to 10.8% over 6 months; between-group difference not statistically significant (P = 0.78) | 1 study · 40 participants | Ungraded |
Periodontal therapy (oral hygiene instruction, mechanical debridement/scaling, antiseptics, antimicrobial therapy) vs No treatment or placebo
Population: People with diabetes mellitus (Type 1 or Type 2) and periodontal disease, at least 16 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Diabetic complications ≥90 days post-treatment (planned) | Protocol only; planned outcome, no results reported | NR | No studies |
Any adverse effects of treatment ≥90 days post-treatment (planned) | Protocol only; planned outcome, no results reported | NR | No studies |
Bleeding ≥90 days post-treatment (planned) | Protocol only; planned outcome, no results reported | NR | No studies |
Changes in periodontal attachment levels ≥90 days post-treatment (planned) | Protocol only; planned outcome, no results reported | NR | No studies |
Quality of life indicators ≥90 days post-treatment (planned) | Protocol only; planned outcome, no results reported | NR | No studies |
Fructosamine (percentage change from baseline; primary) ≥90 days post-treatment (planned) | Protocol only; planned outcome, no results reported | NR | No studies |
Gingival inflammation ≥90 days post-treatment (planned) | Protocol only; planned outcome, no results reported | NR | No studies |
Oral hygiene ≥90 days post-treatment (planned) | Protocol only; planned outcome, no results reported | NR | No studies |
Cost implications ≥90 days post-treatment (planned) | Protocol only; planned outcome, no results reported | NR | No studies |
HbA1c (absolute percentage change from baseline; primary) ≥90 days post-treatment (planned) | Protocol only; planned outcome, no results reported | NR | No studies |