Efficacy of non-surgical treatment accompanied by professional toothbrushing in the treatment of chronic periodontitis in patients with type 2 diabetes mellitus: a randomized controlled clinical trial

Abstract

Purpose: The present study aimed to evaluate the clinical benefit of additional toothbrushing accompanying non-surgical periodontal treatment on oral and general health in patients with type 2 diabetes mellitus (T2DM).

Methods: We conducted a doubled-blind randomized controlled trial in 60 T2DM patients between June 2013 and June 2014. The patients were randomly assigned to the scaling and root planing (SRP) group; the scaling and root planing with additional toothbrushing (SRPAT) group, in which additional toothbrushing was performed by toothpick methods; or the control group. Microbiological and oral examinations were performed for up to 12 weeks following treatment. Non-surgical treatment was conducted in the experimental groups. The SRP group received scaling and root planing and the SRPAT group received additional toothbrushing with the Watanabe method once a week from the first visit through the fifth visit. The primary outcomes were changes in haemoglobin A1c (or glycated haemoglobin; HbA1c) levels, serum endotoxin levels, and interleukin-1 beta levels. Periodontal health status was measured by periodontal pocket depth, the calculus index, and bleeding on probing (BOP).

Results: Both the SRP and SRPAT groups showed improvements in periodontal health and HbA1c, but the SRPAT group showed significantly less BOP than the SRP group. Furthermore, only the SRPAT group showed a statistically significant decrease in serum endotoxin levels.

Conclusions: Non-surgical periodontal treatment was effective in improving HbA1c and serum endotoxin levels in T2DM patients. Furthermore, non-surgical treatment with additional tooth brushing had a more favourable effect on gingival bleeding management.Trial RegistrationClinical Research Information Service Identifier: KCT000416.

Keywords: Diabetes mellitus; Glycated hemoglobin A; Interleukins; Periodontitis; Toothbrushing.

Figure 1. Flowchart of the participants through the study (CONSORT flow diagram).

CTR: control, SRP: scaling and root planning, SRPAT: scaling and root planing with additional toothbrushing.

Figure 2. Changes in systemic health status after each treatment (baseline and after 12 weeks).

HbA1c, IL-1β, and endotoxin levels in the serum were analysed. P values were calculated by repeated-measures analysis of variance with use of the Bonferroni-Holm adjustment for multiple comparisons. SRP: scaling and root planing, SRPAT: scaling and root planing with additional toothbrushing, CTR: control, HbA1c: haemoglobin A1c, IL-1β: interleukin-1 beta. ^a)Significant difference from the control group (P<0.025).

Figure 3. Changes in oral health status after each treatment (baseline and after 12 weeks).

PD, BOP, and CI decreased significantly. P value were calculated by repeated-measures analysis of variance with use of the Bonferroni-Holm adjustment for multiple comparisons. PD: pocket depth, BOP: bleeding on probing, CI: calculus index, SRP: scaling and root planing, SRPAT: scaling and root planing with additional toothbrushing, CTR: control. ^a)Significant difference from the control group (P<0.025). ^b)Significant difference from the SRP group (P<0.025).