Use of adjunctive periodontal therapy for type 2 diabetics with gum disease

Using Metformin or statins may help treat patients with type 2 diabetes and periodontitis non-surgically, presenting a strategic approach to manage both systemic and oral health challenges simultaneously.

To study how diverse local treatments used alongside non-surgical periodontal therapy (NSPT) can reduce pocket depth (PD), increase clinical attachment level (CAL), and lower glycated haemoglobin (HbA1c) levels in individuals with both type 2 diabetes mellitus (T2DM) and periodontitis.

Thirty-two studies met the inclusion criteria. The quality assessment indicated that 58.04% of the studies had a low risk of bias (ROB), 22.32% had an unclear ROB, and 19.64% had a high ROB. Two trials were excluded from the meta-analysis due to incomplete data and non-responsiveness. 

This network meta-analysis of 30 RCTs with 1224 patients showed that short (i.e. 2 to 3 months) and medium-term (i.e. 4 to 6 months) therapies favored statins or Metformin over scaling and root planing (SRP) alone or with adjunctive therapies. Statins, followed by antibiotics showed the most noteworthy decreases in PD and gains in CAL in the long term (>6 months). Photodynamic and laser therapies were more effective in short-term HbA1c reduction than SRP with or without statins, antiseptics, or placebo.

This study provides moderate evidence suggesting that adding Metformin or statins to NSPT could potentially enhance reductions in PD and improvements in CAL, compared to treatments involving SRP with or without a placebo.