In February 2010 issue of Diabetes Care, Teeuw, Gerdes, and Loos (1) reported a systemic review and meta-analysis of the literature to determine if periodontal treatment improved the glycemic control of diabetic patients for at least three months. The authors identified five studies as meeting their review criteria and stipulated that periodontal treatment consisted of scaling and root planning, oral hygiene instruction, variable use of systemic or local antibiotics, and possibly surgical removal of deep residual periodontal lesions, all in an effort to ameliorate systemic inflammation, which abets insulin resistance.
As a contributing author of one of the five studies chosen for inclusion in the meta-analysis, it is important to note that glycemic control achieved in our study (2) resulted not only from our providing periodontal treatment, but also because we extracted numerous nonrestorable teeth. Specifically, we removed teeth having either excessive alveolar bone loss secondary to advanced periodontal disease (teeth that were often mobile and likely not be readily debrided by the patient) or periaprical infections (teeth with an osteolytic process at their apex arising from dental caries infecting the dental pulp and rendering them nonvital). Furthermore, in the study by Kiran et al. (3), which was also chosen for review by the authors, it was specifically noted that nine patients in the treatment group had nine teeth with periapical lesions, four of which were extracted and the other five were provided root-canal treatment.
Teeth having marked bone loss such that they are mobile because of advanced periodontitis, and teeth with periapical infections secondary to dental cares are known to cause significant local and systemic inflammation—reactions that may impair glycemic control. Patients with severely mobile teeth are best provided exodontia services, and those with nonvital teeth should be provided either extraction or endodontic (root-canal) therapy.
It is inappropriate of the authors to claim that the glycemic control obtained by the patients in two of the five studies under consideration was derived solely from periodontal treatment. It is highly likely that some of the patients in the studies by Stewart et al. and Kiran et al. had a greater burden of chronic dental infection/inflammation than persons in the other three studies.
Acknowledgments
No potential conflicts of interest relevant to this article were reported.
