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Clinical Oral Investigations
Published in: Clinical Oral Investigations 1/2020

01-01-2020 | Root Planing | Original Article

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

Authors: Mariana Linhares Almeida, Poliana Mendes Duarte, Eduardo Aleixo Figueira, Janaína Cavalcante Lemos, Cintia Mirela Guimarães Nobre, Tamires Szeremeske Miranda, Bruno César de Vasconcelos Gurgel

Published in: Clinical Oral Investigations | Issue 1/2020

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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.
Footnotes
1
Colgate Total® 12, Colgate Palmolive Co., São Paulo, SP, Brazil
 
2
North Carolina, Hu-Friedy, Chicago, IL, USA
 
3
LightCycler 2.0, Roche Diagnostics GmbH, Mannheim, Germany
 
4
MasterPure™, Epicenter, Madison, WI, USA
 
Literature
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):113–134
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):138–149CrossRef
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):167–187CrossRef
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–S8PubMed
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):8–21CrossRef
6.
Knapp S (2013) Diabetes and infection: is there a link?-a mini-review. Gerontology 59(2):99–104CrossRef
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):250–260CrossRef
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):1406–1417CrossRef
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 17:138–146CrossRef
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):45–54CrossRef
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):155–162CrossRef
12.
Schara R, Medvescek M, Skaleric U (2006) Periodontal disease and diabetes metabolic control: a full-mouth disinfection approach. J Int Acad Periodontol 8:61–66PubMed
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):103–112PubMed
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):523–531CrossRef
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 74:1459–1467CrossRef
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):417–430CrossRef
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):CD004622
18.
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 39:1149–1158CrossRef
20.
Armitage GC (1999) Development of a classification system for periodontal diseases and conditions. Ann Periodontol 4:1–6CrossRef
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 83:1449–1454CrossRef
22.
American Diabetes Association (2019) 6. Glycemic targets: standards of medical Care in Diabetes-2019. Diabetes Care 42(Suppl 1):S61–S70CrossRef
23.
Ainamo J, Bay I (1975) Problems and proposals for recording gingivitis and plaque. Int Dent J 25:229–235
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 74:1736–1740CrossRef
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):192–199CrossRef
26.
Dolezel J, Bartos J, Voglmayr H, Greilhuber J (2003) Nuclear DNA content and genome size of trout and human. Cytometry A 51(2):127–128CrossRef
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 CrossRefPubMed
28.
Spineli LM, Fleming PS, Pandis N (2015) Addressing missing participant outcome data in dental clinical trials. J Dent 43(6):605–618CrossRef
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):1150–1157CrossRef
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):799–806CrossRef
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):2143–2150CrossRef
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 27:578–589CrossRef
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 36:240–249CrossRef
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):1340–1351CrossRef
35.
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):56–66CrossRef
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):646–656CrossRef
38.
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):549–555CrossRef
40.
Metadata
Title
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
Authors
Mariana Linhares Almeida
Poliana Mendes Duarte
Eduardo Aleixo Figueira
Janaína Cavalcante Lemos
Cintia Mirela Guimarães Nobre
Tamires Szeremeske Miranda
Bruno César de Vasconcelos Gurgel
Publication date
01-01-2020
Publisher
Springer Berlin Heidelberg
Keyword
Root Planing
Published in
Clinical Oral Investigations / Issue 1/2020
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI
https://doi.org/10.1007/s00784-019-02927-8

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