Improvement of post-periodontitis-therapy inflammatory state in diabetics: a meta-analysis of randomized controlled trials.

Abstract

Objectives: This systematic review aimed to evaluate the impact of periodontal therapy on systemic biomarkers of inflammation and oxidative stress in patients with type 2 diabetes mellitus (T2DM) and periodontitis.

Materials and methods: An electronic search without restriction on dates or languages was performed in six electronic databases, protocol records and other sources until May 2024. To develop the search strategy, clinical question was formulated using the PICOD method. Eligibility criteria included randomized controlled trials on the effects of periodontitis-therapy on the inflammatory parameters of T2DM patients. Risk of bias and certainty of evidence were assessed by RoB2 and GRADE tools, respectively. The review protocol was registered in PROSPERO platform (CRD42020206295).

Results: Of 1,062 records screened, the authors determined that 14 studies enrolling 1223 participants proved eligible. Moderate-quality evidence suggested a positive effect of periodontitis-therapy on serum levels of c-reactive protein [0.39 (CI95%: 0.27-0.5)], even without the use of antibiotics [0.34 (CI95%: 0.22-0.46)], in T2DM patients. The significant reduction in C-reactive protein (CRP) among smokers in favor of periodontitis-therapy was greatest at six months of follow-up.

Conclusions: Non-surgical periodontal therapy improved short-term biomarkers of systemic inflammation in T2DM patients, with moderate evidence of improvement in serum levels of high sensitivity-CRP.

Clinical relevance: Systemic inflammation in T2DM patients can be reduced after non-surgical periodontal therapy, which also has the potential to reduce the risk of other important systemic outcomes, such as cardiovascular disease.