Senior scholar, School of Dental Hygiene, College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Professor emerita of clinical dentistry, University of Southern California, Los Angeles, CA, USA; Director, National Center for Dental Hygiene Research and Practice.
Can J Dent Hyg. 2021 Feb 15;55(1):57-67. eCollection 2021 Feb.
Previous research has confirmed strong associations between periodontitis and diabetes mellitus (DM), supporting DM as a risk factor for periodontal disease and suggesting a bidirectional relationship. Causal relationships have not been confirmed.
The aim of this paper is to review the most current evidence of the nature of this relationship and examine whether non-surgical periodontal therapy (NSPT) significantly lowers glycemic (HbA1c) control.
The PICO question was, "For individuals with type 2 diabetes mellitus (T2DM) and periodontitis, will non-surgical periodontal therapy (NSPT), as compared to no treatment, improve the individual's glycemic control as measured by HbA1c." Only systematic reviews (SRs) with or without a meta-analysis (MA) of randomized controlled trials (RCTs) or umbrella reviews of SRs and MAs of RCTs published in the English language between 2007 and 2019 were included. Several databases were searched as per their protocols. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality.
Of 54 records retrieved, after elimination of duplicates and studies not meeting inclusion criteria, 5 SRs/MAs and 3 umbrella reviews of SRs/MAs were selected. All 5 SRs/MAs reported reductions in HbA1c levels 3 months following NSPT, but effect sizes were small and 2 were not statistically significant. The 3 umbrella reviews consistently reported small reductions in HbA1c, but high levels of heterogeneity and moderate to high risk of bias. The Bradford Hill criteria failed to support a causal relationship between periodontitis and T2DM.
Whether NSPT compared with no treatment in persons with T2DM improves the individual HbA1c remains unclear as does the exact nature of the relationship between periodontitis and T2DM.
本文旨在回顾目前关于这种关系本质的最相关证据，并探讨非手术性牙周治疗（NSPT）是否能显著降低血糖（HbA1c）控制水平。
我们提出的 PICO 问题是：“对于患有 2 型糖尿病（T2DM）和牙周炎的个体，与不治疗相比，非手术性牙周治疗（NSPT）是否会改善个体的血糖控制，以 HbA1c 衡量？”仅纳入了 2007 年至 2019 年间发表的包含或不包含随机对照试验（RCT）的系统评价（SR）和荟萃分析（MA），或包含 RCT 的 SR 和 MA 的伞状评价的研究。按照各自的方案，对多个数据库进行了检索。两位作者均使用 PRISMA 清单进行了质量评估。使用布拉德福·希尔标准来确定因果关系的证据。
在排除重复记录和不符合纳入标准的研究后，从 54 条记录中检索到 5 项 SR/MA 和 3 项包含 SR/MA 的伞状评价。所有 5 项 SR/MA 均报告了 NSPT 后 3 个月 HbA1c 水平降低，但效应量较小，其中 2 项无统计学意义。3 项伞状评价一致报告 HbA1c 有较小幅度降低，但存在高度异质性和中度至高度偏倚风险。布拉德福·希尔标准未能支持牙周炎与 T2DM 之间存在因果关系。
NSPT 是否与 T2DM 患者的不治疗相比能改善个体的 HbA1c 仍不清楚，牙周炎与 T2DM 之间的确切关系也不清楚。
