Advertisement

Effects of a full-mouth disinfection protocol on the treatment of type-2 diabetic and non-diabetic subjects with mild-to-moderate periodontitis: one-year clinical outcomes

  • Mariana Linhares Almeida
  • Poliana Mendes Duarte
  • Eduardo Aleixo Figueira
  • Janaína Cavalcante Lemos
  • Cintia Mirela Guimarães Nobre
  • Tamires Szeremeske Miranda
  • Bruno César de Vasconcelos GurgelEmail author
Original Article
  • 6 Downloads

Abstract

Objectives

This study compared the clinical effects of a full-mouth disinfection (FMD) protocol for the treatment of mild-to-moderate periodontitis in type 2 diabetic and non-diabetic subjects for up to 1 year. Secondary aim was to evaluate the effects of this therapy on the salivary levels of periodontal pathogens between diabetics and non-diabetics.

Material and methods

Twenty-six type 2 diabetic subjects and 28 non-diabetic subjects with mild-to-moderate periodontitis received full-mouth scaling and root planing within 24 h, application of chlorhexidine digluconate (CHX) gel in pockets and tongue plus CHX rinses for 14 days. Clinical monitoring was performed at baseline, 3, 6, and 12 months post-therapy. Salivary levels of red complex bacterial species were evaluated at baseline, 6, and 12 months post-therapy by qPCR.

Results

Intention-to-treat analyses were performed for seven diabetics and three non-diabetics that did not return for the 12-month evaluation. Most clinical parameters improved significantly at 3, 6, and 12 months post-therapies for both groups (p < 0.05). Overall, there were no significant differences in clinical parameters between groups after therapy (p > 0.05). At 1 year, 39.3% and 50.0% of the non-diabetic and diabetic subjects, respectively, achieved the desired clinical endpoint for treatment (≤ 4 sites with probing depth ≥ 5 mm) (primary outcome variable) (p > 0.05). FMD did not promote changes in the salivary levels of pathogens in either of the groups (p > 0.05). Levels of T. forsythia were lower in diabetic than in non-diabetic subjects at 6 months post-therapy (p < 0.05).

Conclusions

Type 2 diabetic subjects and systemically healthy subjects with mild-to-moderate periodontitis responded similarly to the proposed FMD protocol for up to 1 year.

Clinical relevance

There is a general thought that diabetics do not answer as well as non-diabetics to periodontal treatments. However, this study showed that diabetics and non-diabetics respond equally to the FMD protocol.

Trial registration

ClinicalTrials.gov Identifier: NCT02643771.

Keywords

Chronic periodontitis Diabetes Scaling and root planing Chlorhexidine 

Notes

Funding

This study was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)- Finance Code 2305/2011.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee in Clinical Research of the Federal University of Rio Grande do Norte (CAAE: 0151.0.051.000-11) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Preshaw PM, Lalla E (2013) A review of the evidence for pathogenic mechanisms that may link periodontitis and diabetes. J Clin Periodontol 40(suppl 14):113–134Google Scholar
  2. 2.
    Sanz M, Ceriello A, Buysschaert M, Chapple I, Demmer RT, Graziani F, Herrera D, Jepsen S, Lione L, Madianos P, Mathur M, Montanya E, Shapira L, Tonetti M, Vegh D (2018) Scientific evidence on the links between periodontal diseases and diabetes: consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the international diabetes federation and the European Federation of Periodontology. J Clin Periodontol 45(2):138–149CrossRefGoogle Scholar
  3. 3.
    Graziani F, Gennai S, Solini A, Petrini M (2018) A systematic review and meta-analysis of epidemiologic observational evidence on the effect of periodontitis on diabetes an update of the EFP-AAP review. J Clin Periodontol 45(2):167–187CrossRefGoogle Scholar
  4. 4.
    Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS (2018) A new classification scheme for periodontal and peri-implant diseases and conditions - introduction and key changes from the 1999 classification. J Periodontol 89(Suppl 1):S1–S8Google Scholar
  5. 5.
    Lang NP, Tan WC, Krähenmann MA, Zwahlen M (2008) A systematic review of the effects of full-mouth debridement with and without antiseptics in patients with chronic periodontitis. J Clin Periodontol 35(Suppl 8):8–21CrossRefGoogle Scholar
  6. 6.
    Knapp S (2013) Diabetes and infection: is there a link?-a mini-review. Gerontology 59(2):99–104CrossRefGoogle Scholar
  7. 7.
    Grellmann AP, Sfreddo CS, Maier J, Lenzi TL, Zanatta FB (2016) Systemic antimicrobials adjuvant to periodontal therapy in diabetic subjects: a meta-analysis. J Clin Periodontol 43(3):250–260CrossRefGoogle Scholar
  8. 8.
    Rovai ES, Souto ML, Ganhito JA, Holzhausen M, Chambrone L, Pannuti CM (2016) Efficacy of local antimicrobials in the non-surgical treatment of patients with periodontitis and diabetes: a systematic review. J Periodontol 87(12):1406–1417CrossRefGoogle Scholar
  9. 9.
    Abduljabbar T, Vohra F, Javed F, Akram Z (2017) Antimicrobial photodynamic therapy adjuvant to non-surgical periodontal therapy in patients with diabetes mellitus: a meta-analysis. Photodiagn Photodyn Ther 17:138–146CrossRefGoogle Scholar
  10. 10.
    Santos VR, Ribeiro FV, Lima JA, Miranda TS, Feres M, Bastos MF, Duarte PM (2012) Partial- and full-mouth scaling and root planing in type 2 diabetic subjects: a 12-mo follow-up of clinical parameters and levels of cytokines and osteoclastogenesis-related factors. J Periodontal Res 47(1):45–54CrossRefGoogle Scholar
  11. 11.
    Santos VR, Lima JA, Miranda TS, Gonçalves TED, Figueiredo LC, Faveri M, Duarte PM (2013) Full-mouth disinfection as a therapeutic protocol for type-2 diabetic subjects with chronic periodontitis: twelve-month clinical outcomes: a randomized controlled clinical trial. J Clin Periodontol 40(2):155–162CrossRefGoogle Scholar
  12. 12.
    Schara R, Medvescek M, Skaleric U (2006) Periodontal disease and diabetes metabolic control: a full-mouth disinfection approach. J Int Acad Periodontol 8:61–66Google Scholar
  13. 13.
    Srirangarajan S, Setty R, Satyanarayan A, Shetty S (2016) Effect of full-mouth disinfection on insulin sensitivity in type 2 diabetes patients with and without chronic periodontitis. Quintessence Int 47(2):103–112Google Scholar
  14. 14.
    Taşdemir Z, Özsarı Taşdemir F, Koçyiğit İ, Yazıcı C, Gürgan CA (2016) The clinical and systemic effects of periodontal treatment in diabetic and non-diabetic obese patients. J Oral Sci 58(4):523–531CrossRefGoogle Scholar
  15. 15.
    Quirynen M, Bollen CM, Vandekerckhove BN, Dekeyser C, Papaioannou W, Eyssen H (1995) Full- vs. partial-mouth disinfection in the treatment of periodontal infections: short-term clinical and microbiological observations. J Dent Res 74:1459–1467CrossRefGoogle Scholar
  16. 16.
    Fang H, Han M, Li QL, Cao CY, Xia R, Zhang ZH (2015) Comparison of full-mouth disinfection and quadrant-wise scaling in the treatment of adult chronic periodontitis: a systematic review and meta-analysis. J Periodontal Res 51(4):417–430CrossRefGoogle Scholar
  17. 17.
    Eberhard J, Jepsen S, Jervøe-Storm PM, Needleman I, Worthington HV (2015) Full-mouth treatment modalities (within 24 hours) for chronic periodontitis in adults. Cochrane Database Syst Rev (17, 4):CD004622Google Scholar
  18. 18.
    Belstrøm D, Sembler-Møller ML, Grande MA, Kirkby N, Cotton SL, Paster BJ, Holmstrup P (2017) Microbial profile comparisons of saliva, pooled and site-specific subgingival samples in periodontitis patients. PLoS One 12(8):e0182992.  https://doi.org/10.1371/journal.pone.0182992 CrossRefGoogle Scholar
  19. 19.
    Feres M, Soares GMS, Mendes JAV, Silva MP, Faveri M, Teles R, Socransky SS, Figueiredo LC (2012) Metronidazole alone or with amoxicillin as adjuncts to non-surgical treatment of chronic periodontitis: a 1-year double-blinded, placebo-controlled, randomized clinical trial. J Clin Periodontol 39:1149–1158CrossRefGoogle Scholar
  20. 20.
    Armitage GC (1999) Development of a classification system for periodontal diseases and conditions. Ann Periodontol 4:1–6CrossRefGoogle Scholar
  21. 21.
    Eke PI, Page RC, Wei L, Thornton-Evans G, Genco RJ (2012) Update of the case definitions for population-based surveillance of periodontitis. J Periodontol 83:1449–1454CrossRefGoogle Scholar
  22. 22.
    American Diabetes Association (2019) 6. Glycemic targets: standards of medical Care in Diabetes-2019. Diabetes Care 42(Suppl 1):S61–S70CrossRefGoogle Scholar
  23. 23.
    Ainamo J, Bay I (1975) Problems and proposals for recording gingivitis and plaque. Int Dent J 25:229–235Google Scholar
  24. 24.
    Araujo MW, Hovey KM, Benedek JR et al (2003) Reproducibility of probing depth measurement using a constant-force electronic probe: analysis of inter- and intraexaminer variability. J Periodontol 74:1736–1740CrossRefGoogle Scholar
  25. 25.
    Sakai VT, Campos MR, Machado MA, Lauris JR, Greene AS, Santos CF (2007) Prevalence of four putative periodontopathic bacteria in saliva of a group of Brazilian children with mixed dentition: 1-year longitudinal study. Int J Paediatr Dent 17(3):192–199CrossRefGoogle Scholar
  26. 26.
    Dolezel J, Bartos J, Voglmayr H, Greilhuber J (2003) Nuclear DNA content and genome size of trout and human. Cytometry A 51(2):127–128CrossRefGoogle Scholar
  27. 27.
    Duarte PM, Feres M, Yassine LLS, Soares GMS, Miranda TS, Faveri M, Retamal-Valdes B, Figueiredo LC (2018) Clinical and microbiological effects of scaling and root planing, metronidazole and amoxicillin in the treatment of diabetic and non-diabetic subjects with periodontitis: a cohort study. J Clin Periodontol 45:1326–1335.  https://doi.org/10.1111/jcpe.12994 CrossRefGoogle Scholar
  28. 28.
    Spineli LM, Fleming PS, Pandis N (2015) Addressing missing participant outcome data in dental clinical trials. J Dent 43(6):605–618CrossRefGoogle Scholar
  29. 29.
    da Cruz GA, de Toledo S, Sallum EA et al (2008) Clinical and laboratory evaluations of non-surgical periodontal treatment in subjects with diabetes mellitus. J Periodontol 79(7):1150–1157CrossRefGoogle Scholar
  30. 30.
    Gonçalves D, Correa FO, Khalil NM, de Faria Oliveira OM, Orrico SR (2008) The effect of non-surgical periodontal therapy on peroxidase activity in diabetic patients: a case-control pilot study. J Clin Periodontol 35(9):799–806CrossRefGoogle Scholar
  31. 31.
    Correa FO, Gonçalves D, Figueredo CM, Gustafsson A, Orrico SR (2008) The short-term effectiveness of non-surgical treatment in reducing levels of interleukin-1beta and proteases in gingival crevicular fluid from patients with type 2 diabetes mellitus and chronic periodontitis. J Periodontol 79(11):2143–2150CrossRefGoogle Scholar
  32. 32.
    Quirynen M, Mongardini C, de Soete M, Pauwels M, Coucke W, van Eldere J, van Steenberghe D (2000) The rôle of chlorhexidine in the one-stage full-mouth disinfection treatment of patients with advanced adult periodontitis. Long-term clinical and microbiological observations. J Clin Periodontol 27:578–589CrossRefGoogle Scholar
  33. 33.
    Swierkot K, Nonnenmacher CI, Mutters R, Flores-de-Jacoby L, Mengel R (2009) One-stage full-mouth disinfection versus quadrant and full-mouth root planing. J Clin Periodontol 36:240–249CrossRefGoogle Scholar
  34. 34.
    Fonseca DC, Cortelli JR, Cortelli SC, Miranda Cota LO, Machado Costa LC, Moreira Castro MV, Oliveira Azevedo AM, Costa FO (2015) Clinical and microbiologic evaluation of scaling and root Planing per quadrant and one-stage full-mouth disinfection associated with azithromycin or chlorhexidine: a clinical randomized controlled trial. J Periodontol 86(12):1340–1351CrossRefGoogle Scholar
  35. 35.
    Tsourdi E, Barthel A, Rietzsch H, Reichel A, Bornstein SR (2013) Current aspects in the pathophysiology and treatment of chronic wounds in diabetes mellitus. Biomed Res Int 2013:385641.  https://doi.org/10.1155/2013/385641 CrossRefGoogle Scholar
  36. 36.
    Bollen CM, Mongardini C, Papaioannou W, Van Steenberghe D, Quirynen M (1998) The effect of a one-stage full-mouth disinfection on different intra-oral niches. Clinical and microbiological observations. J Clin Periodontol 25(1):56–66CrossRefGoogle Scholar
  37. 37.
    Quirynen M, Mongardini C, Pauwels M, Bollen CM, Van Eldere J, van Steenberghe D (1999) One stage full- versus partial-mouth disinfection in the treatment of chronic adult or generalized early-onset periodontitis. II Long-term impact on microbial load. J Periodontol 70(6):646–656CrossRefGoogle Scholar
  38. 38.
    Al-Rawi N, Al-Marzooq F (2017) The relation between Periodontopathogenic bacterial levels and Resistin in the saliva of obese type 2 diabetic patients. J Diabetes Res 2017:2643079.  https://doi.org/10.1155/2017/2643079 CrossRefGoogle Scholar
  39. 39.
    Ogawa T, Honda-Ogawa M, Ikebe K, Notomi Y, Iwamoto Y, Shirobayashi I, Hata S, Kibi M, Masayasu S, Sasaki S, Kawabata S, Maeda Y (2017) Characterizations of oral microbiota in elderly nursing home residents with diabetes. J Oral Sci 59(4):549–555CrossRefGoogle Scholar
  40. 40.
    Goodson JM, Hartman ML, Shi P, Hasturk H, Yaskell T, Vargas J, Song X, Cugini M, Barake R, Alsmadi O, al-Mutawa S, Ariga J, Soparkar P, Behbehani J, Behbehani K (2017) The salivary microbiome is altered in the presence of a high salivary glucose concentration. PLoS One 12(3):e0170437.  https://doi.org/10.1371/journal.pone.0170437 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Mariana Linhares Almeida
    • 1
    • 2
  • Poliana Mendes Duarte
    • 2
  • Eduardo Aleixo Figueira
    • 1
  • Janaína Cavalcante Lemos
    • 1
  • Cintia Mirela Guimarães Nobre
    • 1
  • Tamires Szeremeske Miranda
    • 2
  • Bruno César de Vasconcelos Gurgel
    • 1
    Email author
  1. 1.Department of DentistryFederal University of Rio Grande do NorteNatalBrazil
  2. 2.Department of Periodontology, Dental Research DivisionGuarulhos UniversitySão PauloBrazil

Personalised recommendations