Methods: Enrolled were poorly controlled diabetics with HbA1c elevated above 7.0 percent but less than 13.11, with periodontal inflammation. The authors compared changes in HbA1c from blood of 42 subjects randomized (balanced by gender only) to standard or enhanced periodontal therapy regimes. Scaling, root planing, polishing and oral hygiene instructions were provided at a six month interval in the standard care group, but at two month intervals, along with twice daily rinsing with 0.12% chlorhexidine mouthrinse for the enhanced care group. Repeated clinical periodontal measurements were obtained by a calibrated dentist blinded to the group assignment. Statistics included means, Mann-Whitney and Student T tests, and mixed between-within subjects ANOVA. During the 8 month study, 15 subjects underwent physician-advised diabetic medication change and consequently, their data were analyzed separately.
Results: Mean GI, PI, PD, CI improved in all subjects, but mean CAL remained unchanged. At six months, HbA1c reduction was as great as 3.7 in the enhanced group, and 1.6 in controls. A statistically significant mean reduction of 0.6 was experienced by 27 subjects (no medication change) with baseline HbA1c >9.0, with no difference between the groups. Mean HbA1c decreased 1.38 among enhanced-care, medication-change subjects with baseline HbA1c >9.0, compared to 1.10 in controls. Overall, periodontal treatment provided half as great reduction in HbA1c as did medication change.
Conclusions: Short-term non-surgical, periodontal treatments resulted in modest improvements in HbA1c. Greater reductions in HbA1c were achieved with enhanced regimes and when periodontal therapy was combined with diabetic medication changes.
This study was funded by the Medical Research Foundation of Oregon (USA).