RESUMO
Background: There is a bidirectional link between diabetes and periodontal disease. Control of active periodontal infection is an essential requisite to maintain optimal oral and systemic health in diabetic patients. The purpose of this study was to evaluate the efficacy of subgingival irrigation and powered toothbrush as home care maintenance protocol in type 2 diabetic patients with active periodontal disease compared to routine oral hygiene. Materials and Methods: Forty (n = 40) diabetic (HbA1c >7%) patients were enrolled in this parallel, examiner-blind, interventional clinical trial. Patients were randomized into two groups: Group A (sonic toothbrush and irrigation with water twice daily) or Group B (manual toothbrush and mouth rinsing with 0.12% Chlorhexidine gluconate (CHX) twice daily)). All patients received Phase I therapybefore the start of the study. Clinical parameters (plaque index [PI], gingival index [GI], oral hygiene index [OHI], pocket depth [PD], clinical attachment level [CAL], and bleeding index [BI]) were assessed at baseline, 1, 2, and 4 months. Levels of C-reactive protein (CRP), HbA1c, and interleukin (IL)-1 ß were assessed at baseline and 4 months only. Verbal and written instructions were provided to each subject specific to their intervention allocation. Descriptive, parametric, and nonparametric analyses were used where appropriate. Results: Sixteen (n = 16) patients in Group A and fifteen (n = 15) patients in Group B completed the 4-month study. Both groups showed a significant difference in BI, PD, CAL, and HbA1c from baseline to 4 months. There were no differences within groups for OHI, GI, or PI and CRP, IL-1 ß. The results are based on an underpowered study due to the drop out of 9 patients reducing the number below the needed 19 patients per group based on the power analysis. Conclusion: Results from this study provide information for future studies on self-care regimens for individuals living with Type 2 diabetes.
RESUMO
DATA SOURCES: The authors searched Medline via Pubmed, EMBASE, Cochrane Database of Systematic Reviews and Scielo. Additionally, grey literature was also searched with no restrictions regarding date of publication and journal up to March 2022. The search was conducted by two pre-calibrated independent reviewers using AMSTAR 2 and PRISMA checklists. Both MeSH terms, relevant free text and their combinations were utilised to conduct the search. STUDY SELECTION: The authors screened the articles on the basis of their titles and abstracts. Duplicates were removed. Full-text publications were evaluated. Any disagreement was resolved by discussion amongst themselves or with a third reviewer. Only the systematic reviews that included RCTs and CCTs were included involving the articles comparing nonsurgical periodontal treatment alone vs no treatment or nonsurgical periodontal treatment with adjunctive therapeutic modality (antibiotics, laser) vs no treatment or nonsurgical periodontal therapy alone. PICO method was used to define the inclusion criteria and changes in glycated haemoglobin post-intervention 3 months was taken as primary outcome. All the articles with the use of adjunctive therapy other than antibiotics (local or systemic) or laser were excluded. The selection was restricted to English only. DATA EXTRACTION AND SYNTHESIS: Data extraction was performed by two reviewers. For each systematic review and each study, mean and standard deviation of glycated hemoglobin level at each follow-up, number of patients both in intervention and control group, type of diabetes, design of study, follow-up period, number of comparisons in meta-analysis, quality assessment of systematic review was assessed by 16 items AMSTAR 2 (Assessment of Multiple Systematic Reviews) and 27 itemed PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) checklist. JADAD scale was used to assess the risk of bias for included RCTs. Q test was used to calculate statistical heterogeneity and percentage of variation by I2 Index. Both Fixed (Mantel-Haenszel [Peto] test) and random (Dersimonian-Laird test) models were used to estimate individual study. Funnel plot and Egger's linear regression methods were used to evaluate publication bias. RESULTS: Following initial electronic and hand search, 1062 articles were screened for title and abstract and 112 articles were considered for full text eligibility. Finally, 16 systematic reviews were considered for qualitative synthesis of results. 16 systematic reviews described 30 unique meta-analyses. Publication bias was assessed in nine out of 16 systematic reviews. Compared to control or non-treatment group, nonsurgical periodontal therapy resulted in statistically significant mean difference of -0.49% HBA1c reduction at 3 months (p = 0.0041), -0.38% (p = 0.0851). The effect of periodontal therapy with antibiotics compared to NSPT alone was not statistically significant (CI -0.32-0.06, 3 months; CI -0.31-0.53, 6 month). The effect of NSPT and laser vs NSPT for HbA1c was not statistically significant (CI -0.73-0.17, 3-4 month). CONCLUSIONS: Based on included systematic reviews and limitations within the study, nonsurgical periodontal therapy is an effective treatment modality in glycaemic control in diabetic patients in terms of HbA1c reduction both at 3 months and 6 months follow-up. The adjunctive therapies like antibiotic administration whether local or systemic and use of lasers with NSPT does not show statistically significant differences as compared to NSPT alone. However, these findings are based on analysis of available literature based on systematic reviews on this subject.
