Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Nov 6;2015(11):CD004714.
doi: 10.1002/14651858.CD004714.pub3.

Treatment of periodontal disease for glycaemic control in people with diabetes mellitus

Terry C Simpson  1 , Jo C Weldon, Helen V Worthington, Ian Needleman, Sarah H Wild, David R Moles, Brian Stevenson, Susan Furness, Zipporah Iheozor-Ejiofor
Affiliations
Review

Treatment of periodontal disease for glycaemic control in people with diabetes mellitus

Terry C Simpson et al. Cochrane Database Syst Rev. .

Update in

  • Treatment of periodontitis for glycaemic control in people with diabetes mellitus.
    Simpson TC, Clarkson JE, Worthington HV, MacDonald L, Weldon JC, Needleman I, Iheozor-Ejiofor Z, Wild SH, Qureshi A, Walker A, Patel VA, Boyers D, Twigg J. Simpson TC, et al. Cochrane Database Syst Rev. 2022 Apr 14;4(4):CD004714. doi: 10.1002/14651858.CD004714.pub4. Cochrane Database Syst Rev. 2022. PMID: 35420698 Free PMC article. Review.

Abstract

Background: Glycaemic control is a key issue in the care of people with diabetes mellitus (DM). Periodontal disease is the inflammation and destruction of the underlying supporting tissues of the teeth. Some studies have suggested a bidirectional relationship between glycaemic control and periodontal disease. This review updates the previous version published in 2010.

Objectives: The objective is to investigate the effect of periodontal therapy on glycaemic control in people with diabetes mellitus.

Search methods: We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 31 December 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2014, Issue 11), MEDLINE via OVID (1946 to 31 December 2014), EMBASE via OVID (1980 to 31 December 2014), LILACS via BIREME (1982 to 31 December 2014), and CINAHL via EBSCO (1937 to 31 December 2014). ZETOC (1993 to 31 December 2014) and Web of Knowledge (1990 to 31 December 2014) were searched for conference proceedings. Additionally, two periodontology journals were handsearched for completeness, Annals of Periodontology (1996 to 2003) and Periodontology 2000 (1993 to 2003). We searched the US National Institutes of Health Trials Registry (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

Selection criteria: We searched for randomised controlled trials (RCTs) of people with type 1 or type 2 DM (T1DM/T2DM) with a diagnosis of periodontitis. Interventions included periodontal treatments such as mechanical debridement, surgical treatment and antimicrobial therapy. Two broad comparisons were proposed:1. periodontal therapy versus no active intervention/usual care;2. periodontal therapy versus alternative periodontal therapy.

Data collection and analysis: For this review update, at least two review authors independently examined the titles and abstracts retrieved by the search, selected the included trials, extracted data from included trials and assessed included trials for risk of bias.Our primary outcome was blood glucose levels measured as glycated (glycosylated) haemoglobin assay (HbA1c).Our secondary outcomes included adverse effects, periodontal indices (bleeding on probing (BOP), clinical attachment level (CAL), gingival index (GI), plaque index (PI) and probing pocket depth (PPD)), cost implications and diabetic complications.

Main results: We included 35 studies (including seven from the previous version of the review), which included 2565 participants in total. All studies used a parallel RCT design, and 33 studies (94%) only targeted T2DM patients. There was variation between studies with regards to included age groups (ages 18 to 80), duration of follow-up (3 to 12 months), use of antidiabetic therapy, and included participants' baseline HbA1c levels (from 5.5% to 13.1%).We assessed 29 studies (83%) as being at high risk of bias, two studies (6%) as being at low risk of bias, and four studies (11%) as unclear. Thirty-four of the studies provided data suitable for analysis under one or both of the two comparisons.Comparison 1: low quality evidence from 14 studies (1499 participants) comparing periodontal therapy with no active intervention/usual care demonstrated that mean HbA1c was 0.29% lower (95% confidence interval (CI) 0.48% to 0.10% lower) 3 to 4 months post-treatment, and 0.02% lower after 6 months (five studies, 826 participants; 95% CI 0.20% lower to 0.16% higher).Comparison 2: 21 studies (920 participants) compared different periodontal therapies with each other. There was only very low quality evidence for the multiple head-to-head comparisons, the majority of which were unsuitable to be pooled, and provided no clear evidence of a benefit for one periodontal intervention over another. We were able to pool the specific comparison between scaling and root planing (SRP) plus antimicrobial versus SRP and there was no consistent evidence that the addition of antimicrobials to SRP was of any benefit to delivering SRP alone (mean HbA1c 0.00% lower: 12 studies, 450 participants; 95% CI 0.22% lower to 0.22% higher) at 3-4 months post-treatment, or after 6 months (mean HbA1c 0.04% lower: five studies, 206 patients; 95% CI 0.41% lower to 0.32% higher).Less than half of the studies measured adverse effects. The evidence was insufficient to conclude whether any of the treatments were associated with harm. No other patient-reported outcomes (e.g. quality of life) were measured by the included studies, and neither were cost implications or diabetic complications.Studies showed varying degrees of success with regards to achieving periodontal health, with some showing high levels of residual inflammation following treatment. Statistically significant improvements were shown for all periodontal indices (BOP, CAL, GI, PI and PPD) at 3-4 and 6 months in comparison 1; however, this was less clear for individual comparisons within the broad category of comparison 2.

Authors' conclusions: There is low quality evidence that the treatment of periodontal disease by SRP does improve glycaemic control in people with diabetes, with a mean percentage reduction in HbA1c of 0.29% at 3-4 months; however, there is insufficient evidence to demonstrate that this is maintained after 4 months.There was no evidence to support that one periodontal therapy was more effective than another in improving glycaemic control in people with diabetes mellitus.In clinical practice, ongoing professional periodontal treatment will be required to maintain clinical improvements beyond 6 months. Further research is required to determine whether adjunctive drug therapies should be used with periodontal treatment. Future RCTs should evaluate this, provide longer follow-up periods, and consider the inclusion of a third 'no treatment' control arm.Larger, well conducted and clearly reported studies are needed in order to understand the potential of periodontal treatment to improve glycaemic control among people with diabetes mellitus. In addition, it will be important in future studies that the intervention is effective in reducing periodontal inflammation and maintaining it at lowered levels throughout the period of observation.

PubMed Disclaimer

Conflict of interest statement

Terry C Simpson (TS): none known. Jo Weldon (JW): none known. JW is salaried member of staff of the Cochrane Oral Health Group. Helen V Worthington (HW): none known. HW is Co‐ordinating Editor of the Cochrane Oral Health Group. Ian Needleman (IN): none known. IN is an Editor with the Cochrane Oral Health Group. Sarah H Wild (SW): none known. David R Moles (DM): none known. Brian Stevenson (BS): none known. Susan Furness (SF): none known. SF is an Editor with the Cochrane Oral Health Group. Zipporah Iheozor‐Ejiofor (ZIE): none known. ZIE is salaried member of staff and an Editor with the Cochrane Oral Health Group.

Figures

1
1
Review update: study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
4
4
Funnel plot of comparison: 1 Periodontal therapy versus no active intervention/usual care, outcome: 1.1 HbA1c at 3‐4 months
5
5
Funnel plot of comparison: 2 Periodontal therapy versus alternative periodontal therapy, outcome: 2.1 HbA1c at 3‐4 months
1.1
1.1. Analysis
Comparison 1 Periodontal therapy versus no active intervention/usual care, Outcome 1 HbA1c at 3‐4 months.
1.2
1.2. Analysis
Comparison 1 Periodontal therapy versus no active intervention/usual care, Outcome 2 HbA1c at 6 months.
2.1
2.1. Analysis
Comparison 2 Periodontal therapy versus alternative periodontal therapy, Outcome 1 HbA1c at 3‐4 months.
2.2
2.2. Analysis
Comparison 2 Periodontal therapy versus alternative periodontal therapy, Outcome 2 HbA1c at 6 months.
See this image and copyright information in PMC

Update of

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Al‐Zahrani 2009 {published and unpublished data}
    1. Al‐Zahrani MS, Bamshmous SO, Alhassani AA, Al‐Sherbini MM. Short‐term effects of photodynamic therapy on periodontal status and glycemic control of patients with diabetes. Journal of Periodontology 2009;80:1568‐73. - PubMed
Calbacho 2004 {published and unpublished data}
    1. Calbacho V, Carrasco E, Wilckens M, Barboza P, Grant C, Aguirre M, et al. Evaluation of influence of conventional therapy in diabetics type 2. Journal of Dental Research 2004;84((Spec Iss B) Chilean section):65739.
Chen 2012 {published data only}
    1. Chen L, Luo G, Xuan D, Wei B, Liu F, Li J, et al. Effects of non‐surgical periodontal treatment on clinical response, serum inflammatory parameters, and metabolic control in patients with type 2 diabetes: a randomized study. Journal of Periodontology 2012;83(4):435‐43. - PubMed
    1. Chen L, Wei B, Li J, Liu F, Xuan D, Xie B, et al. Association of periodontal parameters with metabolic level and systemic inflammatory markers in patients with type 2 diabetes. Journal of Periodontology 2010;81(3):364‐71. - PubMed
Engebretson 2011 {published data only}
    1. Engebretson SP, Hey‐Hadavi J. Sub‐antimicrobial doxycycline for periodontitis reduces hemoglobin A1c in subjects with type 2 diabetes: a pilot study. Pharmacological Research 2011; Vol. 64, issue 6:624‐9. - PMC - PubMed
Engebretson 2013 {published data only}
    1. Engebretson S, Gelato M, Hyman L, Michalowicz BS, Schoenfeld E. Design features of the Diabetes and Periodontal Therapy Trial (DPTT): a multicenter randomized single‐masked clinical trial testing the effect of nonsurgical periodontal therapy on glycosylated hemoglobin (HbA1c) levels in subjects with type 2 diabetes and chronic periodontitis. Contemporary Clinical Trials 2013;36(2):515‐26. - PMC - PubMed
    1. Engebretson S, Michaelowicz B, Seaquist ER, Reddy M, Lewis CE, Oates T, et al. The Diabetes and Periodontal Therapy Trial (DPTT). Journal of Dental Research 2012;91(Suppl A (AADR 41st Annual Meeting; Tampa, Florida)):Abstract No 568.
    1. Engebretson SP, Hyman LG, Michalowicz BS, Schoenfeld ER, Gelato MC, Hou W, et al. The effect of nonsurgical periodontal therapy on hemoglobin A1c levels in persons with type 2 diabetes and chronic periodontitis: a randomized clinical trial. JAMA 2013;310(23):2523‐32. - PMC - PubMed
    1. Michalowicz BS, Hyman L, Hou W, Oates TW Jr, Reddy M, Paquette DW, et al. Factors associated with the clinical response to nonsurgical periodontal therapy in people with type 2 diabetes mellitus. Journal of the American Dental Association 2014;145(12):1227‐39. - PubMed
Gay 2014 {published data only}
    1. Gay IC, Tran DT, Cavender AC, Weltman R, Chang J, Luckenbach E, et al. The effect of periodontal therapy on glycaemic control in a Hispanic population with type 2 diabetes: a randomized controlled trial. Journal of Clinical Periodontology 2014;41(7):673‐80. - PMC - PubMed
Gilowski 2012 {published and unpublished data}
    1. Gilowski L, Kondzielnik P, Wiench R, Plocica I, Strojek K, Krzeminski TF. Efficacy of short‐term adjunctive subantimicrobial dose doxycycline in diabetic patients‐‐randomized study. Oral Diseases 2012; Vol. 18, issue 8:763‐70. - PubMed
Grossi 1997 {published and unpublished data}
    1. Grossi SG, Skrepinski FB, DeCaro T, Robertson DC, Ho AW, Dunford RG, et al. Treatment of periodontal disease in diabetics reduces glycated hemoglobin. Journal of Periodontology 1997;68(8):713‐9. - PubMed
    1. Skrepinski F, Grossi S, Ho A, Dunford R, Genco RJ, DeCaro T, et al. A model of treatment of periodontal disease in native Americans with NIDDM. Journal of Periodontology 1996;67:71‐2.
Haerian Ardakani 2014 {published data only}
    1. Haerian Ardakani A, Asadi Y, Afkhami Ardakani M, Nooorelahi M, Sooratgar A. Effect of topical tetracycline gel with non surgical periodontal therapy on Hba1c and lipid profile in type 2 diabetic patients: a clinico‐biochemical study. Journal of Shahid Sadoughi University of Medical Sciences 2014;22(4):1387‐95.
Jones 2007 {published and unpublished data}
    1. Jones JA, Miller DR, Wehler CJ, Rich S, Krall E, Christiansen CL, et al. Study design, recruitment, and baseline characteristics: the Department of Veterans Affairs Dental Diabetes Study. Journal of Clinical Periodontology 2007;34(1):40‐5. [PUBMED: 17040483] - PubMed
    1. Jones JA, Miller DR, Wehler CJ, Rich SE, Krall‐Kaye EA, McCoy LC, et al. Does periodontal care improve glycemic control? The Department of Veterans Affairs Dental Diabetes Study. Journal of Clinical Periodontology 2007;34(1):46‐52. - PubMed
    1. McCoy LC, Wehler CJ, Rich SE, Garcia RI, Miller DR, Jones JA. Adverse events associated with chlorhexidine use: results from the Department of Veterans Affairs Dental Diabetes Study. Journal of the American Dental Association 2008;139(2):178‐83. [PUBMED: 18245686] - PubMed
Katagiri 2009 {published and unpublished data}
    1. Katagiri S, Nitta H, Nagasawa T, Uchimura I, Izumiyama H, Inagaki K, et al. Multi‐center intervention study on glycohemoglobin (HbA1c) and serum, high‐sensitivity CRP (hs‐CRP) after local anti‐infectious periodontal treatment in type 2 diabetic patients with periodontal disease. Diabetes Research and Clinical Practice 2009;83(3):308‐15. - PubMed
Kiran 2005 {published and unpublished data}
    1. Kiran M, Arpak N, Unsal E, Erdogan MF. The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus. Journal of Clinical Periodontology 2005;32(3):266‐72. - PubMed
Koromantzos 2011 {published and unpublished data}
    1. Koromantzos PA, Makrilakis K, Dereka X, Katsilambros N, Vrotsos IA, Madianos PN. A randomized, controlled trial on the effect of non‐surgical periodontal therapy in patients with type 2 diabetes. Part I: effect on periodontal status and glycaemic control. Journal of Clinical Periodontology 2011;38(2):142‐7. - PubMed
    1. Koromantzos PA, Makrilakis K, Dereka X, Offenbacher S, Katsilambros N, Vrotsos IA, et al. Effect of non‐surgical periodontal therapy on C‐reactive protein, oxidative stress, and matrix metalloproteinase (MMP)‐9 and MMP‐2 levels in patients with type 2 diabetes: a randomized controlled study. Journal of Periodontology 2012; Vol. 83, issue 1:3‐10. - PubMed
Kothiwale 2013 {published and unpublished data}
    1. Kothiwale SV, Kothiwale VA, Bhargava PV. Effect of non‐invasive periodontal therapy on glycaemic control in type 2 diabetes mellitus patients ‐ a randomized control trial. Diabetes 2013;62(Suppl 1):Abstract No A229.
Li 2011 {published data only}
    1. Li Z, Sha YQ, Zhang BX, Zhu L, Kang J. [Effect of community periodontal care intervention on periodontal health and glycemic control in type 2 diabetic patients with chronic periodontitis]. [Chinese]. Beijing da Xue Xue Bao (Yi Xue Ban/Journal of Peking University. Health Sciences) 2011;43(2):285‐9. - PubMed
Llambés 2008 {published and unpublished data}
    1. Llambés F, Silvestre FJ, Hernandez‐Mijares A, Guiha R, Caffesse R. Effect of non‐surgical periodontal treatment with or without doxycycline on the periodontium of type 1 diabetic patients. Journal of Clinical Periodontology 2005;32(8):915‐20. [PUBMED: 15998278] - PubMed
    1. Llambés F, Silvestre FJ, Hernandez‐Mijares A, Guiha R, Caffesse R. The effect of periodontal treatment on metabolic control of type 1 diabetes mellitus. Clinical Oral Investigations 2008;12(4):337‐43. - PubMed
Macedo 2014 {published data only}
    1. Macedo G, Arthur B, Novaes J, Sergio L, Souza S, Mario T, et al. Additional effects of a PDT on nonsurgical periodontal treatment with doxycycline in type II diabetes: a randomized, controlled clinical trial. Lasers in Medical Science 2014;29:881‐6. [DOI: 10.1007/s10103-013-1285-6] - DOI - PubMed
Madden 2008 {published data only}
    1. Madden TE, Herriges B, Boyd LD, Laughlin G, Chiodo G, Rosenstein D. Alterations in HbA1c following minimal or enhanced non‐surgical, non‐antibiotic treatment of gingivitis or mild periodontitis in type 2 diabetic patients: a pilot trial. The Journal of Contemporary Dental Practice 2008;9(5):9‐16. - PubMed
Miranda 2014 {published and unpublished data}
    1. Miranda TS, Feres M, Perez‐Chaparro PJ, Faveri M, Figueiredo LC, Tamashiro NS, et al. 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 2014;41(9):890‐9. - PubMed
Moeintaghavi 2012 {published data only}
    1. Moeintaghavi A, Arab HR, Bozorgnia Y, Kianoush K, Alizadeh M. Non‐surgical periodontal therapy affects metabolic control in diabetics: a randomized controlled clinical trial. Australian Dental Journal 2012; Vol. 57, issue 1:31‐7. - PubMed
NCT00801164 {published and unpublished data}
    1. NCT00801164. Exploratory study of iocide oral rinse in a diabetic population (diabetes). clinicaltrials.gov/show/NCT00801164 (2012).
O'Connell 2008 {published data only}
    1. O'Connell PA, Taba M, Nomizo A, Foss Freitas MC, Suaid FA, Uyemura SA, et al. Effects of periodontal therapy on glycemic control and inflammatory markers. Journal of Periodontology 2008;79(5):774‐83. - PubMed
Pradeep 2013 {published data only}
    1. Pradeep AR, Rao NS, Bajaj P, Kumari M. Efficacy of subgingivally delivered simvastatin in the treatment of patients with type 2 diabetes and chronic periodontitis: A randomized double‐masked controlled clinical trial. Journal of Periodontology 2013;84(1):24‐31. - PubMed
Raman 2014 {published data only}
    1. Raman RP, Taiyeb‐Ali TB, Chan SP, Chinna K, Vaithilingam RD. Effect of nonsurgical periodontal therapy versus oral hygiene instructions on Type 2 diabetes subjects with chronic periodontitis: a randomised clinical trial. BMC Oral Health 2014;14(1):2‐19. - PMC - PubMed
Rocha 2001 {published data only}
    1. Rocha M, Nava LE, Vazquez de la Torre C, Sanchez‐Marin F, Garay‐Sevilla ME, Malacara JM. Clinical and radiological improvement of periodontal disease in patients with type 2 diabetes mellitus treated with alendronate: a randomized, placebo‐controlled trial. Journal of Periodontology 2001;72(2):204‐9. - PubMed
Rodrigues 2003 {published and unpublished data}
    1. Rodrigues DC, Taba MJ, Novaes AB, Souza SL, Grisi MF. Effect of non‐surgical periodontal therapy on glycemic control in patients with type 2 diabetes mellitus. Journal of Periodontology 2003;74(9):1361‐7. - PubMed
Santos 2009 {published and unpublished data}
    1. Santos VR, Lima JA, Mendonca AC, Maximo MBB, Faveri M, Duarte PM. Effectiveness of full‐mouth and partial‐mouth scaling and root planing in treating chronic periodontitis in subjects with type 2 diabetes. Journal of Periodontology 2009;80:1237‐53. - PubMed
Santos 2012 {published and unpublished data}
    1. Santos VR, Ribeiro FV, Lima JA, Miranda TS, Feres M, Bastos MF, et al. Partial‐ and full‐mouth scaling and root planing in type 2 diabetic subjects: a 12‐month follow‐up of clinical parameters and levels of cytokines and osteoclastogenesis‐related factors. Journal of Periodontal Research 2012;47(1):45‐54. - PubMed
Santos 2013 {published data only}
    1. Santos VR, Lima JA, Miranda TS, Gonçalves TE, Figueiredo LC, Faveri M. Full‐mouth disinfection as a therapeutic protocol for type‐2 diabetic subjects with chronic periodontitis: Twelve‐month clinical outcomes. A randomized controlled clinical trial. Journal of Clinical Periodontology 2013;40(2):155‐62. - PubMed
Singh 2008 {published data only}
    1. Singh S, Kumar V, Kumar S, Subbappa A. The effect of periodontal therapy on the improvement of glycaemic control in patients with type 2 diabetes mellitus: A randomized controlled clinical trial. International Journal of Diabetes in Developing Countries 2008;28(2):38‐44. - PMC - PubMed
Skaleric 2004 {published and unpublished data}
    1. Skaleric U, Schara R, Medvescek M, Hanlon A, Doherty F, Lessem J. Periodontal treatment by Arestin and its effects on glycemic control in type 1 diabetes patients. Journal of the International Academy of Periodontology 2004; Vol. 6:160‐5. - PubMed
Sun 2011 {published data only}
    1. Sun WL, Chen LL, Zhang SZ, Wu YM, Ren YZ, Qin GM. Inflammatory cytokines, adiponectin, insulin resistance and metabolic control after periodontal intervention in patients with type 2 diabetes and chronic periodontitis. Internal Medicine 2011; Vol. 50, issue 15:1569‐74. - PubMed
Tsalikis 2014 {published data only}
    1. Tsalikis L, Sakellari D, Dagalis P, Boura P, Konstantinidis A. Effects of doxycycline on clinical, microbiological and immunological parameters in well‐controlled diabetes type‐2 patients with periodontal disease: a randomized, controlled clinical trial. Journal of Clinical Periodontology 2014;41(10):972‐80. - PubMed
Yun 2007 {published and unpublished data}
    1. Yun F, Firkova EI, Jun‐Qi L, Xun H. Effect of non‐surgical periodontal therapy on patients with type 2 diabetes mellitus. Folia Medica 2007;49(1‐2):32‐6. - PubMed
Zhang 2013 {published data only}
    1. Zhang H, Li C, Shang S, Luo Z. Scaling and root planing with enhanced root planing on healthcare for type 2 diabetes mellitus: A randomized controlled clinical trial. Journal of Dental Sciences 2013;8(3):272‐80.

References to studies excluded from this review

Albrecht 1988 {published data only}
    1. Albrecht M, Banoczy J, Gyenes V, Ember G, Rigo O, Valkovics M, et al. Treatment of gingivitis and periodontal diseases with insadol in diabetics. Fogorvosi Szemle 1988;81:65‐71. - PubMed
Al‐Mubarak 2002 {published data only}
    1. Al‐Mubarak S, Ciancio S, Aljada A, Mohanty P, Ross C, Dandona P. Comparative evaluation of adjunctive oral irrigation in diabetics. Journal of Clinical Periodontology 2002;29(4):295‐300. - PubMed
Cinar 2014 {published data only}
    1. Cinar AB, Schou L. Impact of empowerment on toothbrushing and diabetes management. Oral Health & Preventive Dentistry 2014;12(4):337‐44. - PubMed
Gorbacheva 2010 {published data only}
    1. Gorbacheva IA, Orekhova LY, Shestakova LA, Musayeva RS, Silina AS. Alternative pathogenetic approach to the treatment of periodontal inflammatory diseases in diabetic patients with polyorganic disorders. Azerbaidzhanskii Meditsinskii Zhurnal (Azerbaijan Medical Journal) 2010;(3):81‐7.
Hagiwara 2002 {published and unpublished data}
    1. Hagiwara S, Ogasawara Y, Tanaka A. Effect of non‐surgical periodontal therapy on diabetic metabolic control. Journal of Dental Research 2002;81(Suppl 1):Abstract No 1551.
Khader 2010 {published data only}
    1. Khader YS, Al Habashneh R, Al Malalheh M, Bataineh A. The effect of full‐mouth tooth extraction on glycemic control among patients with type 2 diabetes requiring extraction of all remaining teeth: a randomized clinical trial. Journal of Periodontal Research 2010; Vol. 45, issue 6:741‐7. - PubMed
Llambés 2012 {published data only}
    1. Llambés F, Silvestre FJ, Hernández‐Mijares A, Guiha R, Bautista D, Caffesse R. Efect of periodontal disease and non surgical periodontal treatment on C‐reactive protein. Evaluation of type 1 diabetic patients. Medicina Oral, Patología Oral y Cirugía Bucal 2012;17(4):e562‐8. - PMC - PubMed
Mansouri 2006 {published and unpublished data}
    1. Mansouri SS, Esteghamati A, Yousefi Y. Evaluation of first phase non‐surgical periodontal therapy on diabetes control. Iranian Journal of Diabetes and Lipid Disorders 2006;6:E13.
Munenaga 2013 {published data only}
    1. Munenaga Y, Hiroshima Study G, Yamashina T, Tanaka J, Nishimura F. Improvement of glycated hemoglobin in Japanese subjects with type 2 diabetes by resolution of periodontal inflammation using adjunct topical antibiotics: Results from the Hiroshima Study. Diabetes Research and Clinical Practice 2013;100(1):53‐60. - PubMed
NCT01255254 {published data only}
    1. NCT01255254. The effect of oral hygiene and full mouth scaling on metabolic control in patients with Type II diabetes. clinicaltrials.gov/show/NCT01255254 (2010).
Promsudthi 2005 {published data only}
    1. Promsudthi A, Pimapansri S, Deerochanawong C, Kanchanavasita W. The effect of periodontal therapy on uncontrolled type 2 diabetes mellitus in older subjects. Oral Diseases 2005;11(5):293‐8. - PubMed
Taylor 2011 {published data only}
    1. Taylor GW, Borgnakke WS. Relationship of periodontal infection to diabetes: glycemic control, complications and occurrence. Journal of Dental Health (Japanese Society for Oral Health) 2011;61(Suppl):170‐7.

References to studies awaiting assessment

Al‐Mubarak 2010 {published data only}
    1. Al Mubarak S, Abou Rass M, Alsuwyed A, Al‐Zoman K, Al Sohail A, Sobki S, et al. A new paradigm between mechanical scaling and root planing combined with adjunctive chemotherapy for glycated hemoglobin improvement in diabetics. International Journal of Diabetes Mellitus 2010;2(3):158‐64.
Botero 2013 {published data only}
    1. Botero JE, Yepes FL, Ochoa SP, Hincapie JP, Roldan N, Ospina CA, et al. Effects of periodontal non‐surgical therapy plus azithromycin on glycemic control in patients with diabetes: a randomized clinical trial. Journal of Periodontal Research 2013;48(6):706‐12. - PubMed
    1. Hincapié JP, Castrillón CA, Yepes FL, Roldan N, Becerra MA, Moreno SM, et al. Microbiological effects of periodontal therapy plus azithromycin in patients with diabetes: results from a randomized clinical trial. Acta Odontológica Latinoamericana 2014;27(2):89‐95. - PubMed
Chee 2006 {published data only}
    1. Chee HK, Lim LP, Tay F, Thai AC, Sum CF. Non‐surgical periodontal therapy and serum lipid levels in patients with diabetes mellitus. Annals of the Royal Australasian College of Dental Surgeons 2006;18:46. - PubMed
    1. Chee HK, Lim LP, Tay F, Thai AC, Sum CF. Non‐surgical periodontal treatment and lipid levels in diabetic patients. Annals of the Royal Australasian College of Dental Surgeons 2008;19:183. - PubMed
Lin 2012 {published and unpublished data}
    1. Lin SJ, Tu YK, Tsai SC, Lai SM, Lu HK. Non‐surgical periodontal therapy with and without subgingival minocycline administration in patients with poorly controlled type II diabetes: a randomized controlled clinical trial. Clinical Oral Investigations 2012;16(2):599‐609. - PubMed
Nassar 2014 {published data only}
    1. Nassar PO, Poleto R, Salvador CS, Felipetti FA, Nassar CA. One‐stage full‐mouth disinfection and basic periodontal treatment in patients with diabetes mellitus. Journal of Public Health 2014;22(1):81‐6.

References to ongoing studies

ACTRN12605000260628 {published and unpublished data}
    1. ACTRN12605000260628. Assessment of diabetes after periodontal treatment. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12605000260628 (2005).
ACTRN12605000340639 {published and unpublished data}
    1. ACTRN12605000340639. RMI adult oral health programme. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12605000340639 (2005).
IRCT2014082417587N7 {published data only}
    1. IRCT2014082417587N7. The effect of non‐surgical periodontal therapy plus doxycycline on HbA1c in patients with type 2 diabetes mellitus (DM). www.irct.ir/searchresult.php?keyword=&id=17587&number=7&prt=7287&total=1... (2014).
ISRCTN15334496 {published and unpublished data}
    1. Vergnes JN, Arrivé E, Gourdy P, Hanaire H, Rigalleau V, Gin H, et al. Periodontal treatment to improve glycaemic control in diabetic patients: study protocol of the randomized, controlled DIAPERIO trial. Trials 2009;10:65. - PMC - PubMed
ISRCTN83229304 {published and unpublished data}
    1. ISRCTN83229304. Periodontitis and type 2 diabetes mellitus. www.isrctn.com/ISRCTN83229304 (2010).
NCT00016835 {published data only}
    1. NCT00016835. Treating periodontal infection: effects on glycemic control. clinicaltrials.gov/show/NCT00016835 (2001).
NCT01291875 {published data only}
    1. NCT01291875. Periodontal treatment and metabolic control in Type 2 diabetic patients. clinicaltrials.gov/ct2/show/NCT01291875 (2011).
NCT01881074 {published data only}
    1. NCT01881074. The influence of periodontal treatment on gingival inflammatory response of the Type II diabetic patient. clinicaltrials.gov/ct2/show/NCT01881074 (2012).
NCT01901926 {published data only}
    1. NCT01901926. Impact of non surgical periodontal treatment on glycemic control in Type II diabetics. clinicaltrials.gov/ct2/show/NCT01901926 (2012).
NCT01904422 {published data only}
    1. NCT01904422. Evaluation of the effectiveness of intensive periodontal treatment as compared to conventional periodontal treatment on the level of glycosylated hemoglobin in patients with decompensated type 2 diabetes mellitus: randomized clinical trial. clinicaltrials.gov/ct2/show/NCT01904422 (2013).
NCT01964833 {published and unpublished data}
    1. NCT01964833. Combination of photodynamic therapy and periodontal treatment in patients with type 2 diabetes mellitus: randomized, double‐blind clinical trial. clinicaltrials.gov/ct2/show/NCT01964833 (2013).
U1111‐1124‐3635 {published data only}
    1. U1111‐1124‐3635. Influence of periodontal treatment in periodontitis and diabetes control. www.ensaiosclinicos.gov.br/rg/RBR‐8dfrpt/ (2012).

Additional references

Alam 2009
    1. Alam R, Sturt J, Lall R, Winkley K. An updated meta‐analysis to assess the effectiveness of psychological interventions delivered by psychological specialists and generalist clinicians on glycaemic control and on psychological status. Patient Education and Counseling 2009;75(1):25‐36. - PubMed
Armitage 1999
    1. Armitage GC. Development of a classification system for periodontal diseases and conditions. Annals of Periodontology 1999;4(1):1‐6. - PubMed
Begg 1994
    1. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50(4):1088‐101. - PubMed
Berlin 1997
    1. Berlin JA. Does blinding of readers affect the results of meta‐analyses? University of Pennsylvania Meta‐analysis Blinding Study Group. Lancet 1997;350(9072):185‐6. - PubMed
Bonito 2004
    1. Bonito AJ, Lohr KN, Lux L, Sutton S, Jackman A, Whitener L, et al. Effectiveness of antimicrobial adjuncts to scaling and root‐planing therapy for periodontitis. United States Agency for Healthcare Research and Quality: Evidence Report/Technology Assessment (Summary) 2004;88:1‐4. - PMC - PubMed
Borgnakke 2014
    1. Borgnakke WS, Chapple ILC, Genco RJ, Armitage G, Bartold PM, D'Aiuto F, et al. The multi‐center randomized controlled trial (RCT) published by the Journal of the American Medical Association (JAMA) on the effect of periodontal therapy on glycated hemoglobin (HbA1c) has fundamental problems. Journal of Evidence‐Based Dental Practice 2014;14(3):127‐32. - PMC - PubMed
Buchwald 2013
    1. Buchwald S, Kocher T, Biffar R, Harb A, Holtfreter B, Meisel P. Tooth loss and periodontitis by socio‐economic status and inflammation in a longitudinal population‐based study. Journal of Clinical Periodontology 2013;40(3):203‐11. - PubMed
Bunn 1981
    1. Bunn HF. Evaluation of glycosylated hemoglobin diabetic patients. Diabetes 1981;30(7):613‐7. - PubMed
Chew 2015
    1. Chew BH, Sherina MS, Hassan NH. Association of diabetes‐related distress, depression, medication adherence, and health‐related quality of life with glycated hemoglobin, blood pressure, and lipids in adult patients with type 2 diabetes: a cross‐sectional study. Therapeutics and Clinical Risk Management 2015;11:669‐81. - PMC - PubMed
Darré 2008
    1. Darré L, Vergnes JN, Gourdy P, Sixou M. Efficacy of periodontal treatment on glycaemic control in diabetic patients: A meta‐analysis of interventional studies. Diabetes & Metabolism 2008;34(5):497‐506. - PubMed
DCCT 1993
    1. Diabetes Control and Complications Trial Research Group (DCCT). The effect of intensive treatment of diabetes on the development and progression of long‐term complications in insulin‐dependent diabetes mellitus. The New England Journal of Medicine 1993;329(14):977‐86. - PubMed
Egger 1997
    1. Egger M, Davey‐Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109):629‐34. - PMC - PubMed
Engebretson 2013a
    1. Engebretson S, Kocher T. Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta‐analysis. Journal of Clinical Periodontology 2013;40(Suppl 14):S153‐63. - PubMed
Firatli 1997
    1. Firatli E. The relationship between clinical periodontal status and insulin dependent diabetes mellitus. Results after 5 years. Journal of Periodontology 1997;68(2):136‐40. - PubMed
Florkowski 2003
    1. Florkowski C. HbA1c standardisation issues: should New Zealand follow the DCCT or the IFCC position?. The New Zealand Medical Journal 2003;116(1171):U395. - PubMed
Franco 2012
    1. Franco RS. Measurement of red cell lifespan and aging. Transfusion Medicine and Hemotherapy 2012;39(5):302‐7. - PMC - PubMed
Goldstein 2004
    1. Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan D, Peterson CM, et al. Tests of glycaemia in diabetes. Diabetes Care 2004;27(7):1761‐73. - PubMed
GRADEpro [Computer program]
    1. McMaster University. GRADEpro. Version 3.6.1. McMaster University, 2014.
Grossi 1998
    1. Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: a two‐way relationship. Annals of Periodontology 1998;3(1):51‐61. - PubMed
Hanas 2010
    1. Hanas R, John G, International HBA1c Consensus Committee. 2010 consensus statement on the worldwide standardization of the hemoglobin A1C measurement. Diabetes Care 2010;33(8):1903‐4. - PMC - PubMed
Hex 2012
    1. Hex N, Bartlett C, Wright D, Taylor M, Varley D. Estimating the current and future costs of type 1 and type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabetic Medicine 2012;29(7):855‐62. - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
International Diabetes Federation 2013
    1. International Diabetes Federation. IDF Diabetes Atlas. 6th Edition. Brussels, Belgium: International Diabetes Federation, 2013. [ISBN 2‐930229‐85‐3]
Khaw 2001
    1. Khaw KT, Wareham N, Luben R, Bingham S, Oakes S, Welch A, et al. Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of european prospective investigation of cancer and nutrition (EPIC‐Norfolk). BMJ 2001;322(7277):15‐8. - PMC - PubMed
Kornman 2014
    1. Kornman KS. Commentary: Periodontitis severity and progression are modified by various host and environmental factors. Journal of Periodontology 2014;85(12):1642‐5. - PubMed
Kowall 2015
    1. Kowall B, Holtfreter B, Völzke H, Scipfe S, Mundt T, Rathmann W, et al. Pre‐diabetes and well‐controlled are not associated with periodontal disease: the SHIP Trend Study. Journal of Clinical Periodontology 2015;42(5):422‐30. - PubMed
McCambridge 2014
    1. McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. Journal of Clinical Epidemiology 2014;67(3):267‐77. - PMC - PubMed
Milward 2003
    1. Milward MR, Chapple IL. Classification of periodontal diseases: Where were we? Where are we now? Where are we going?. Dental Update 2003;30(1):37‐44. - PubMed
Page 1998
    1. Page RC. The pathobiology of periodontal diseases may affect systemic diseases: inversion of a paradigm. Annals of Periodontology 1998;3(1):108‐20. - PubMed
Papapanou 1996
    1. Papapanou PN. Periodontal diseases: epidemiology. Annals of Periodontology 1996;1(1):1‐36. - PubMed
Peter 2007
    1. Peter S. Essentials Of Preventive and Community Dentistry. 3rd Edition. New Delhi: Arya (Medi) Publishing House, 2007.
Preshaw 2012
    1. Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, et al. Periodontitis and diabetes: a two‐way relationship. Diabetologia 2012;55(1):21‐31. - PMC - PubMed
Rabi 2006
    1. Rabi DM, Edwards AL, Southern DA, Svenson LW, Sargious PM, Norton P, et al. Association of socio‐economic status with diabetes prevalence and utilization of diabetes care services. BMC Health Services Research 2006;3(6):124. - PMC - PubMed
RevMan 2014 [Computer program]
    1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Sandberg 2000
    1. Sandberg GE, Sundberg HE, Fjellstrom CA, Wikblad KF. Type 2 diabetes and oral health: a comparison between diabetic and non‐diabetic subjects. Diabetes Reseach and Clinical Practice 2000;50(1):27‐34. - PubMed
Seppälä 1993
    1. Seppälä B, Seppälä M, Ainamo J. A longitudinal study on insulin‐dependent diabetes mellitus and periodontal disease. Journal of Clinical Periodontology 1993;20(3):161‐5. - PubMed
Seuring 2015
    1. Seuring T, Archangelidi O, Suhrcke M. The economic costs of type 2 diabetes: a global systematic review. PharmacoEconomics 2015;33(8):811‐31. - PMC - PubMed
Sgolastra 2013
    1. Sgolastra F, Severino M, Pietropaoli D, Gatto R, Monaco A. Effectiveness of periodontal treatment to improve metabolic control in patients with chronic periodontitis and type 2 diabetes: a meta‐analysis of randomized clinical trials. Journal of Periodontology 2013;84(7):958‐73. - PubMed
Stewart 2001
    1. Stewart JE, Wager KA, Friedlander AH, Zadeh HH. The effect of periodontal treatment on glycaemic control in patients with type 2 diabetes mellitus. Journal of Clinical Periodontolgy 2001;28(4):306‐10. - PubMed
Stratton 2000
    1. Stratton IM, Adler AI, Neil HA, Mathews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321(7258):405‐12. - PMC - PubMed
Taylor 2001
    1. Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiological perspective. Annals of Periodontology 2001;6(1):99‐112. - PubMed
Teeuw 2010
    1. Teeuw WJ, Gerdes VEA, Loos BG. Effect of periodontal treatment on glycemic control of diabetic patients. Diabetes Care 2010;33(2):421‐7. - PMC - PubMed
UKPDS 1998
    1. United Kingdom Prospective Diabetes Study 33 (UKPDS). Intensive blood‐glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998;352(9131):837‐53. - PubMed
WHO 2013
    1. World Health Organization. Global action plan for the prevention and control of noncommunicable diseases (NCDs) 2013‐2020. www.who.int/nmh/events/ncd_action_plan/en/.
WHO 2014
    1. World Health Organization. Global status report on noncommunicable diseases 2014. www.who.int/nmh/publications/ncd‐status‐report‐2014/en/.
WHO 2015
    1. World Health Organization. Diabetes: Fact sheet N° 312. www.who.int/mediacentre/factsheets/fs312/en/ (January 2015).
Worthington 2015
    1. Worthington H, Clarkson J, Weldon J. Priority oral health research identification for clinical decision‐making. Evidence‐based Dentistry 2015;16(3):69‐71. - PubMed

References to other published versions of this review

Simpson 2004
    1. Simpson T, Needleman I, Wild SH, Moles DR, Mills EJ. Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database of Systematic Reviews 2004, Issue 2. [DOI: 10.1002/14651858.CD004714] - DOI - PubMed
Simpson 2010
    1. Simpson TC, Needleman I, Wild SH, Moles DR, Mills EJ. Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database of Systematic Reviews 2010, Issue 5. [DOI: 10.1002/14651858.CD004714.pub2] - DOI - PubMed

Substances