|Year : 2010 | Volume
| Issue : 1 | Page : 20-23
Assessment of the effects of scaling and root planing on blood glucose levels in type II diabetes patients: A pilot study
Uzma Rieyazulhuq Shaikh, Ravi V Shirahatti
Department of Community Dentistry, Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune, India
|Date of Web Publication||18-Nov-2011|
Ravi V Shirahatti
Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune
Source of Support: Indian Council of Medical Research,
New Delhi, Conflict of Interest: None
| Abstract|| |
Aim: To study the effect of the scaling and root planing of some blood glucose levels in Type II Diabetes patients. Study Population and Methods: The clinical study was conducted in 15 Type II diabetic patients of Dr. D Y Patil Dental College and Hospital, Pimpri, Pune. All the participants underwent a baseline examination for periodontal status using the community periodontal index of treatment needs and also estimation of fasting and post-prandial blood sugar levels. The participants received the intervention of scaling and root planing, as also routine oral hygiene instructions, and were recalled after one month for a final periodontal examination and blood sugar level investigation. The significance of difference between the means of the baseline and the final examination was tested using the paired 't' test. Results and Conclusion: There was no significant change in the fasting and post-prandial blood glucose levels in patients treated with scaling and root planing.
Keywords: Clinical trial, Dental hygiene, Diabetes, Periodontitis
|How to cite this article:|
Shaikh UR, Shirahatti RV. Assessment of the effects of scaling and root planing on blood glucose levels in type II diabetes patients: A pilot study. J Int Clin Dent Res Organ 2010;2:20-3
|How to cite this URL:|
Shaikh UR, Shirahatti RV. Assessment of the effects of scaling and root planing on blood glucose levels in type II diabetes patients: A pilot study. J Int Clin Dent Res Organ [serial online] 2010 [cited 2020 Mar 31];2:20-3. Available from: http://www.jicdro.org/text.asp?2010/2/1/20/89989
| Introduction|| |
Diabetes is one of the leading chronic diseases affecting the human population including the people of the Indian sub-continent. The relationship between oral health and systemic illnesses has been one of the major areas that need research in dentistry.  The relationship between periodontal disease and diabetes has been an area of investigation in the current dental literature.  In recent years, research has demonstrated that the relationship between periodontal disease and diabetes is not unidirectional. Not only does diabetes affect the periodontium, but periodontal infection can adversely impact glycemic control in diabetes. Severe periodontitis has been considered a risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus.  A large number of studies and reviews indicate the influence of periodontal disease and its treatment on glycemic control. ,,,,,,,,,,,,,,,,,, These studies lead to the hypothesis that successful management of periodontal infection in diabetics will lead to a better control of glucose metabolism.
There is a need to know whether the periodontal treatment that decreases the bacterial challenge and the resulting inflammatory periodontal destruction can improve glycemia in diabetic patients. There is a relative paucity of data in the Indian subcontinent on this important area of concern. The research findings in this significant area could support and expand our understanding of the diagnosis, treatment, and prevention of periodontal infection in diabetic patients. Hence, the present study was designed with the aim of investigating the effect of scaling and root planing on the blood glucose levels in Type II diabetes patients.
| Materials and Methods|| |
Study setting: The study was conducted in Dr. D Y Patil Dental College and Hospital, Pimpri, Pune. The known Type II diabetic patients from the Outpatient Department of the college were invited to participate in the study. The study was explained to the participants and informed consent was duly taken from the volunteers on the consent form. The investigators also approached the institutional Ethics Committee for ethical clearance, and the clearance was obtained before the start of the study.
Study design: The study design was a clinical study with before-after comparison. A total of 15 participants were selected for the study and constituted the total sample size.
Selection criteria: The patients with a history of Non-Insulin Dependent Diabetes Mellitus for at least the past three months, as confirmed by the physician, and who required oral prophylaxis were included in the study. Patients suffering from any other chronic infections, prolonged illnesses, and those diagnosed with diabetes within the past three months were excluded.
Baseline examination: All the participants underwent a baseline examination. The baseline examination included the examination for periodontal status, using Community Periodontal Index of Treatment Needs (CPITN),  using a pre-determined Proforma. The baseline investigation also included the estimation of fasting and post-prandial blood sugar levels. The blood sugar levels were estimated using a glucometer (Glucocheck, ASPEN DIAGNOSTICS, Delhi) according to the instruction manual of the product. As per the selection criteria, all the participants required periodontal treatment, as determined by the treatment need component of the CPITN index.
Intervention and follow-up: The study participants received the intervention of scaling and root planing and the routine oral hygiene instructions. All the participants were recalled after one month for the final periodontal examination and investigations for the Fasting and Post-prandial blood sugar levels, using a glucometer similar to the baseline reading.
Statistical analysis: The significance of the difference between the means of the baseline and the final examination was tested using the paired 't' test. A probability value of < 0.05 was considered to be statistically significant.
| Results|| |
Distribution of study participants according to age, gender, and years of being diagnosed as diabetics showed that the participants had the mean age of 48.6 years. Distribution of the study participants according to CPITN needs showed that all the participants in the intervention required scaling and root planning, with the presence of either Calculus or periodontal pockets [Table 1]. The baseline blood glucose levels compared with the final examination showed that there was no statistically significant change in the blood sugar levels between the baseline and follow-up examinations [Table 2].
|Table 1: Distribution of study participants according to age, gender, years of being diagnosed as diabetics, and the periodontal status|
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|Table 2: Blood Glucose level of participants before and after the study (n = 15)|
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| Discussion|| |
Diabetes mellitus is a prevalent chronic disease of adults and children in India. Type 2 diabetes is the most prevalent type of diabetes in India, affecting approximately 90 to 95% of the people with diabetes. Periodontal diseases, including gingivitis and severe periodontitis, are also common chronic infections in our population. The effect of periodontal treatment on diabetes has thus been studied in the current investigation.
The main results of the study, summarized in [Table 2], show that both the study groups did not show any statistically significant changes when the baseline blood glucose levels were compared with the final examination. Moreover, no significant improvement in glycemic control after periodontal therapy was observed by many other authors, like Jones et al. who observed 'no significant benefit' after periodontal therapy, even after four months of follow-up. Also in another study by Promsudthi et al. an improved periodontal status of the treatment group did not result in a statistically significant reduction in the level of fasting plasma glucose and HbA1c. Similar results have also been observed by Rodrigues et al. Such a result could also be due to the inadequateness of scaling and root planing in actually improving the periodontal condition, as reported by Smith et al. In this study, conventional treatment did not eliminate the micro-organisms like B. forsythus and
P. gingivalis and did not affect IgG titer responses. Also a recent meta-analysis of the interventional studies on the rearch question, "Does periodontal treatment improve glycemic control in diabetic patients?" by Janket et al. reported that in the meta-analysis of 10 intervention studies, none showed any statistically significant improvement in glycemic control after periodontal therapy. A more intense therapy and longer follow-up times may be necessary to see more pronounced clinical and systemic effects as indicated by the authors of the aforementioned studies.
In contrast to our results, the studies by Grossi et al. Stewart et al. and Navarro-Sanchez et al. showed that the clinical or immunological improvements in the periodontal condition were accompanied by a significant improvement in glycemic control.
This apparent 'no improvement' or 'slight worsening' of glycemic control after treatment, as observed in our study, may be due to the transient bacteremia commonly observed after routine scaling and root planing procedures, which may upregulate the serum TNF-alpha level, which in turn suppresses the insulin action, as suggested in a review by Nishimura et al. This type of response, as observed in the present study, needs further investigation and elucidation.
Possibly a longitudinal study with a prospective cohort study design with a larger sample size, similar to the National Health and Nutrition Examination Survey (NHANES) survey reported by Taylor et al. or the Gila River Indian Community study reported by the same author  would be a better study design to address the research question of whether periodontal treatment could improve the glycemic control or indeed have no influence on it.
| Acknowledgments|| |
The authors are indebted to the research grant by the Indian Council of Medical Research. New Delhi. The authors do not have any commercial interest in the materials used in the study.
| References|| |
|1.||Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005;83:661-9. |
|2.||Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: An epidemiologic perspective. Ann Periodontol 2001;6:99-112. |
|3.||Taylor GW, Loesche WJ, Terpenning MS. Impact of oral diseases on systemic health in the elderly: Diabetes mellitus and aspiration pneumonia. J Public Health Dent 2000;60:313-20. |
|4.||Miller LS, Manwell MA, Newbold D, Reding ME, Rasheed A, Blodgett J, et al. The relationship between reduction in periodontal inflammation and diabetes control: A report of 9 cases. J Periodontol. 1992;63:843-8. |
|5.||Taylor GW, Burt BA, Becker MP, Genco RJ, Shlossman M, Knowler WC, et al. Severe Periodontitis and Risk for Poor Glycemic Control in Patients with Non-Insulin-Dependent Diabetes Mellitus. J Periodontol 1996;67:1085-93. |
|6.||Aldridge JP, Lester V, Watts TL, Collins A, Viberti G, Wilson RF. Single-blind studies of the effects of improved periodontal health on metabolic control in type 1 diabetes mellitus. J Clin Periodontol. 1995;22:271-5. |
|7.||Smith GT, Greenbaum CJ, Johnson BD, Persson GR. Short-term responses to periodontal therapy in insulin-dependent diabetic patients. J Periodontol 1996;67:794-802. |
|8.||Grossi SG, Skrepcinski FB, DeCaro T, Robertson DC, Ho AW, Dunford RG, et al. Treatment of periodontal disease in diabetics reduces glycated hemoglobin. J Periodontol 1997;68:713-9. |
|9.||Stewart JE, Wager KA, Friedlander AH, Zadeh HH. The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus. J Clin Periodontol 2001;28:306-10. |
|10.||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. J Periodontol 2003;74:1361-7. |
|11.||Promsudthi A, Pimapansri S, Deerochanawong C, Kanchanavasita W. The effect of periodontal therapy on uncontrolled type 2 diabetes mellitus in older subjects. Oral Dis 2005;11:293-8. |
|12.||Schara R, Medvescek M, Skaleric U. Periodontal disease and diabetes metabolic control: A full-mouth disinfection approach. J Int Acad Periodontol 2006;8:61-6. |
|13.||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. J Clin Periodontol 2007;34:46-52. |
|14.||Navarro-Sanchez AB, Faria-Almeida R, Bascones-Martinez A. Effect of non-surgical periodontal therapy on clinical and immunological response and glycaemic control in type 2 diabetic patients with moderate periodontitis. J Clin Periodontol 2007;34:835-43. |
|15.||Nishimura F, Kono T, Fujimoto C, Iwamoto Y, Murayama Y. Negative effects of chronic inflammatory periodontal disease on diabetes mellitus. J Int Acad Periodontol 2000;2:49-55. |
|16.||Grossi SG. Treatment of periodontal disease and control of diabetes: An assessment of the evidence and need for future research. Ann Periodontol 2001;6:138-45. |
|17.||Taylor GW. Exploring interrelationships between diabetes and periodontal disease in African Americans. Compend Contin Educ Dent 2001;22:42-8. |
|18.||Matthews DC, The relationship between diabetes and periodontal disease. J Can Dent Assoc 2002;68:161-4. |
|19.||Mealey BL, Rethman MP. Periodontal disease and diabetes mellitus. Bidirectional relationship. Dent Today 2003;22:107-13. |
|20.||Janket SJ, Wightman A, Baird AE, Van Dyke TE, Jones JA. Does periodontal treatment improve glycemic control in diabetic patients? A meta-analysis of intervention studies. J Dent Res 2005;84:1154-9. |
|21.||Herring ME, Shah SK. Periodontal disease and control of diabetes mellitus. J Am Osteopath Assoc 2006;106:416-21. |
|22.||Mealey BL. Periodontal disease and diabetes. A two-way street. J Am Dent Assoc 2006;137:26S-31S. |
|23.||Cutress TW, Ainamo J, Sardo-Infirri J. The community periodontal index of treatment needs (CPITN) procedure for population groups and individuals. Int Dent J 1987;37:222-33. |
[Table 1], [Table 2]