Gum disease is a common chronic or persisting condition that can get worse over time. It involves inflammation of the gums, which surround and support the teeth, causing swollen and painful gums and in severe cases loss of the bone (alveolar) that supports the teeth. Clinical investigations have shown that there might be a link or association between chronic, ongoing gum disease and heart and blood vessel disease (cardiovascular disease). Some investigators believe that the treatment for gum disease, which gets rid of bacteria and infection and controls inflammation, might prevent the occurrence or recurrence.
Periodontal disease is a disease of the supporting tissues of the teeth that may affect the gums, periodontal ligament membrane, and bone around the tooth socket. It has been linked with infections, which some researchers believe could lead to or have an impact on a number of conditions, including problems in pregnancy. Periodontal disease is common in women of reproductive age, and gum conditions tend to worsen during pregnancy due to hormonal changes. The treatment involves bringing plaque on the teeth down to minimal levels, to reduce and resolve inflammation of the gums. It could involve counselling on oral hygiene measures, removing the plaque and calculus by using hand instruments (e.g. scale and polish) or ultrasound equipment (e.g. mechanical debridement), sometimes alongside the use of antibiotics or antiseptic mouthwashes or gels. If the nonsurgical treatment is not successful, surgery is sometimes required. This review assessed studies where pregnant women with gum disease were treated using a combination of techniques, with or without antibiotics. Continue reading
Gum disease treatment is used to reduce swelling and infection from gum disease. Keeping blood sugar levels under control is a key issue for people with diabetes, and some clinical research suggests a relationship exists between gum disease treatment and glycaemic control. As a result, it is important to discover if gum disease treatment does improve glycaemic control to encourage better use of clinical resources.
There is a broad range of gum disease treatments available for treating patients with diabetes. This review considered:
1. Does gum disease treatment improve blood sugar control in people with diabetes?
2. Does one type of gum disease treatment have a bigger effect than another in improving blood sugar control?
Gum disease or periodontitis is a chronic inflammatory disease that causes damage to the soft tissue and bone around the teeth. Mild periodontitis is common in adults with severe periodontitis occurring in up to 20% of the population. Non-surgical treatments based on the mechanical removal of bacteria from infected root surfaces are used in order to arrest and control the loss of the bone and tissue that support the tooth in adults suffering from chronic gum disease. These treatments can be carried out in a different area of the mouth in separate sessions over a period of several weeks (SRP), which is the conventional method, or alternatively, can be done within 24 hours in one or two sessions, which is termed ‘full-mouth scaling’ (FMS). When an antiseptic agent (such as chlorhexidine for example) is added to the full-mouth scaling the intervention is called ‘full-mouth disinfection’ (FMD). The rationale for full-mouth approaches is that they may reduce the likelihood of re-infection in already treated sites. This review is an update of one originally published in 2008, and considers the effectiveness of full mouth treatments. Continue reading
Did you know? There are now a range of Cochrane podcasts available on the Cochrane Library.
The latest Oral Health Group podcast is by the University of Manchester’s Lucy O’Malley, who gives the lowdown on her review: Primary school interventions for preventing caries. Follow the link to listen in and hear the findings!
Other available Oral Health Group podcasts include:
- Nicola Parkin on: Extraction of baby canine teeth for correcting poorly aligned adult canine teeth in children
- Terry Simpson on Treatment of periodontal disease for glycaemic control in people with diabetes
- Anne-Marie Glenny on Comparison between different concentrations of fluoride toothpaste for preventing tooth decay in children and adolescent
- Raphael Freitas de Souza on Interventions for cleaning dentures in adults
- Trent Outhouse on Mouthrinses for the treatment of halitosis
This week is National Diabetes Week. Did you know that looking after your gums may help to reduce your blood sugar levels if you are diabetic? Read more about our Review of the Month for June.
What was the research?
A systematic review of the evidence to find out whether treating gum disease in people with diabetes helps to lower blood sugar levels. The review looked at several different types of intervention to treat periodontal disease in diabetic patients.
- Scaling (cleaning between the gums and teeth)
- Subgingival curettage and gingivectomy (removal of inflamed or diseased gum tissue)
- Flap surgery (cleaning the tooth roots and repairing bone damage)
- Antiseptic mouthrinses, gels and toothpastes
- Treatment with drugs such as antibiotics
- Training people in oral hygiene measures.
Who conducted the research?
The research was conducted by a team led by Terry C. Simpson from Edinburgh Dental Institute in the UK, on behalf of the Cochrane Oral Health Group. Ian Needleman, Sarah H. Wild, David R. Moles and Edward J. Mills were also on the team.
What evidence was included in the review?
Data was extracted from 7 randomised controlled trials. The trials looks at the intervention compared to no intervention, placebo or “usual care”. 460 participants were included across the 7 trials.
What did the evidence say?
The evidence suggests that there may be small but significant improvements in blood sugar control from treating pre-existing gum disease in people with Type 2 Diabetes Mellitus. There was little data on people with Type 1 Diabetes Mellitus. The studies looked at ultrasonic scaling, antibiotics, root planing, and oral hygiene measures.
How good was the evidence?
Although seven trials met the inclusion criteria, only 3 compared the intervention with no treatment or “usual care”. Only two of the seven trials was at low risk of bias. The few studies available lacked the power to detect a significant effect, and the quality of the evidence was generally low.
What are the implications for dentists and the general public?
Periodontal therapy in individuals with diabetes might help to improve the management of their condition, and an oral health assessment should be recommended as part of routine care for diabetes. If diagnosed, trained oral health professionals should manage the periodontitis. Communication between professionals is important so that patients become aware of the importance of periodontal disease management to controlling blood sugar levels.
What should researchers look at in the future?
Both periodontal disease and diabetes are prevalent, and further studies examining the link between the two should be a public health priority. More larger scale randomized controlled trials are necessary, as the studies in this review were too small to show a significant effect.
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. Art. No.: CD004714. DOI: 10.1002/14651858.CD004714.pub2.
The Cochrane Oral Health Group met for their monthly Editorial Meeting this week and have registered one new title as a result:
Antimicrobial photodynamic therapy for the treatment of periodontal and peri-implant diseases
The review will be led by Dr Pia Jervoe-Storm from Germany (University of Bonn), with the assistance of Soren Jepsen (University of Bonn) and Jorg Eberhard (Hannover Medical School). Cochrane Oral Health Group editors Helen Worthington and Ian Needleman will also join the team.
The review will look at antimicrobial photodynamic therapy compared to subgingival scaling and root planing in non-surgical periodontal therapy and treatment of peri-implant diseases. We look forward to receiving the protocol from this very experienced team!