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.)
The EFP website has posted the other day a debate between Professors Lior Shapira of the Jerusalem Hebrew University and Andrea Mombelli, Geneva. Is it time to rethink on the use of antibiotics in the treatment of periodontitis? Well, it actually is. One cannot continue just emphasizing the undeniable (if short-term) effect of antibiotics reducing the need and extent of periodontal surgery when administered as an adjunct to non-surgical treatment (Mombelli) without having the much bigger picture (real global threats of antibiotic resistance development) in mind (Shapiro). I have written about recent respective clinical reports on (transient) effects of adjunct antibiotics numerous times on this blog, see, for example here, here and here. I never concealed my opinion. Biofilm infections are indeed different.
No wonder when our professional societies and academies want to promote it with the above images. The Facebook page of the German Society of Periodontology features the left image while the right supports a recent statement by the American Academy of Periodontology’s President, Dr. Wayne Aldredge, regarding the U.S. Departments of Agriculture and Health and Human Services recent decision to remove flossing from the federal 2015-2020 Dietary Guidelines, citing the gap in quality research.
Claims and denials of clinically relevant effects of, in particular, non-surgical periodontal treatment on markers of diabetic control have not only led to a surge of new randomized clinical trials and systematic reviews thereof. If anybody had hope that the current frenzy has found a happy end with the updated and very comprehensive Cochrane review by Simpson et al. (2015) (s)he has been mistaken. In the June issue of the Australian Dental Journal, Botero et al. (2016) report on an umbrella review in which they systematically reviewed all systematic reviews on the subject, be it with or without meta-analysis, published between 1995 and 2015. The paper has been accepted for publication on January 20, 2016. It has to be emphasized that using the term “umbrella review” is somewhat misleading. In a strict sense, an umbrella review assembles together several systematic reviews on the same condition in the presence of many treatments or many important outcomes.
In a previous post, I have expressed considerable concern about an assumed advertorial in our leading periodontal journal, JCP. Quintessence Publishing was about to launch their fourth installment of “3D” animated, short (each 15-17 min) movies all called Cell-to-Cell Communication, “Oral Health and General Health – The Links between Periodontitis, Atherosclerosis, and Diabetes.” Previous movies have been offered for purchase by QuintPub for a remarkable amount of around $100. Luckily, the new one can now be found on the EFP homepage and accessed by members and non-members for free.