Last weekend, EFP and International Diabetes Federation (IDF) delegates, in partnership with Sunstar, had met in Madrid and had worked on guidelines for dentists, medical doctors and patients with periodontitis and/or diabetes. The EFP website features some key findings when reviewing the literature. In particular, it is claimed that,
evidence suggests that periodontitis patients have a higher chance of developing pre-diabetes and type-2 diabetes and that people with periodontitis and diabetes have more difficulty in keeping their blood-sugar levels under control. Furthermore, patients with both diseases are more likely to develop diabetic complications than people with diabetes without periodontitis.
Current evidence indicates that in people with diabetes, periodontal therapy accompanied by effective self-performed oral hygiene at home is both safe and effective – even in people with poorly controlled diabetes. Similarly, there is consistent evidence that periodontal therapy reduces blood-sugar levels in people with diabetes and periodontitis. (Emphasis added.)
A surge of systematic reviews with varying quality had been published before and, in particular, after the large-scale, multicenter, randomized trial by Engebretson et al. 2013 which could not reproduce results of numerous small-scale trials of often low quality. So, how could anyone serious claim consistency? I had reported on the numerous attempts to question Engebretson’s frustrating, at least for some, findings and attempts to explain the stunning non-significance here on this blog. Obesity is one possible reason. The above “consensus” does not mention that evidence exists that reductions in blood sugar levels must not be expected in obese diabetic patients. The vast majority of diabetics actually is. The workshop participants furthermore present guidelines including
providing oral-health education to all patients with diabetes and informing them that they have a greater risk of periodontal disease which, if left untreated, could have a negative impact on metabolic control and may also increase the risk of complications including cardiovascular and kidney disease.
Patients should also be advised […] that successful periodontal therapy can have a positive impact on their metabolic control and complications.
While oral hygiene improvement and proper periodontal treatment has benefits in itself, not only in patients with diabetes, lowering the risk of serious established diabetic complications, cardiovascular and kidney disease, has to be proven, not claimed. In particular not in guidelines. It has yet to be shown whether proper periodontal treatment lowers the numerous risks of chronic diseases such as cardiovascular, kidney, or metabolic diseases. So far, the vast majority of randomized trials were confined to non-surgical periodontal treatment. It is still not clear whether the limited effects of scaling and root planing, when furcation involvement and infrabony lesions prevent proper access, can even be achieved in diabetics with periodontal disease.
So, have our medical colleagues, experts in the diagnosis and treatment of diabetes, been misled by periodontist workshop participants who claim effects when no have actually been achieved?
To answer that question, we have to wait at least until the proceedings of the workshop are published.
26 February 2017 @ 9:51 am.