Nonsurgical Treatment for Periodontal Disease May Not Be Enough for Patients with Diabetes

American Academy of Periodontology encourages dental professionals to continue to provide personalized care for patients with diabetes

A recent study published in the Journal of the American Medical Association (JAMA) found that nonsurgical treatment of periodontal disease does not improve glycemic control in patients with type 2 diabetes. Despite these results, the American Academy of Periodontology (AAP) continues to encourage clinicians to conduct annual comprehensive periodontal evaluations on patients and guide treatment and care based on provided outcomes.

Dr. Stuart J. Froum, DDS, President of the AAP and clinical professor and Director of Clinical Research in the Department of Periodontics and Implant Dentistry at New York University Dental Center, says the findings should not dismiss an association between periodontal disease and diabetes. “As a number of population studies suggest, there is indeed a relationship between diabetes and periodontal disease. While this study specifically focuses on basic nonsurgical periodontal care, some cases of periodontal disease require more intensive treatment. There is evidence that more intensive periodontal therapies can be effective in glycemic control.”

The study examined the impact of nonsurgical periodontal therapy on over 500 subjects with both type 2 diabetes and moderate to advanced chronic periodontitis. The subjects’ glycated hemoglobin (HbA1c) levels were assessed at three and six month intervals. Researchers found that compared to those who did not receive treatment, subjects that underwent nonsurgical periodontal therapy showed no difference in hemoglobin levels, suggesting no difference in glycemic control.

“It is important to note that the nonsurgical therapy employed in this study did not eradicate periodontal disease, which may be why researchers did not see an effect on glycemic control,” points out Dr. Froum. “A major indicator of periodontal disease – bleeding on probing – decreased only 19 percent, suggesting that the nonsurgical therapy was not successful in controlling moderate to advanced periodontal disease. The failure to eliminate periodontal disease may be why glycemic control was not impacted.”

Regardless, Dr. Froum is optimistic that this study may lead to a better understanding of the relationship between diabetes and periodontal disease. “I’m excited to see research that continues to explore the association between these two chronic, and highly prevalent, diseases. These findings are simply one piece of a complex puzzle and open the door for further investigation. “

According to the Centers for Disease Control and Prevention (CDC) and the AAP, nearly half of U.S. adults aged 30 or older have periodontal disease. As a result, the AAP recommends that all patients receive a comprehensive periodontal evaluation on an annual basis which includes a thorough assessment of periodontal health and any risk factors for disease. “Every patient requires an individualized treatment plan,” says Dr. Froum. “For patients with diabetes, this may include either nonsurgical periodontal care or more advanced treatment. Despite the lack of causal evidence, your patients should still be informed that maintaining periodontal health plays a larger role in systemic health.”

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About the American Academy of Periodontology:
The American Academy of Periodontology (AAP) is the professional organization for periodontists – specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,300 members world-wide.