title: The effect of periodontal therapy on glycemic control and fasting plasma glucose level in type 2 diabetic patients: systematic review and meta-analysis.
abstract: BACKGROUND
  Diabetic mellitus and periodontal disease have bilateral associations. However, there is a dilemma on the effect of periodontal therapy on glycemic control and/or fasting plasma glucose level in type 2 diabetic patients with periodontitis. Therefore, this review aimed to assess the effectiveness of periodontal therapy versus no periodontal therapy on glycated hemoglobin (HbA1c) and fasting plasma glucose level in type 2 diabetic patients.
  
  
  METHODS
  Article searching was done using four databases (MEDLINE, Cochrane library (CENTRAL), EMBASE and CINAHL) and a manual search (until December 2015). We included randomized controlled trials testing the effectiveness of periodontal therapy on glycated hemoglobin and fasting plasma glucose level in patients with type 2 Diabetes mellitus with periodontal disease. Studies published in English between 2005 and 2015 were included. Risk of bias was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases.
  
  
  RESULTS
  After the article selection process, seven Randomized controlled trials involving 940 participants with a primary outcome of change in glycated hemoglobin and/or fasting plasma glucose and having a minimum of 3 months follow-up were included. There was a reduction of glycated hemoglobin 0.48(95 % CI: 0.18-0.78) after 3 months follow-up and 0.53 (95 % CI: 0.24-0.81) at the end of the intervention period. There was also a significant reduction of fasting plasma glucose level, 8.95 mg/dl (95 % CI: 4.30-13.61) in the intervention group after the end of the intervention. The pooled analysis showed that patients with adjunctive antibiotic therapy and mouth wash had effect size of 0.51(0.03, 1.00, p = 0.04) and it was 0.53 (95 % CI: 0.19, 0.87; p = 0.002) in patients without adjunctive therapy. The publication bias of the studies was 0.066 according to Egger's test.
  
  
  CONCLUSIONS
  In this systematic review and meta-analysis, there is a significant reduction of Glycated hemoglobin and Fasting plasma glucose level on type 2 diabetic and periodontal patients with non-surgical periodontal therapy.
authors.affiliation: Department of Dentistry, College of Medicine and Health Sciences, University of Gondar, Gondar, P.O. Box 196, Ethiopia. teshomeamare78@yahoo.com.
authors.forename: Amare
authors.initials: A
authors.lastname: Teshome
authors.affiliation: Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
authors.forename: Asmare
authors.initials: A
authors.lastname: Yitayeh
mesh_terms: D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications; D005215:Fasting; D006442:Glycated Hemoglobin; D006801:Humans; D010510:Periodontal Diseases / Q000150:complications / Q000628:therapy*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Fasting plasma glucose; Glycemic control; HbA1c; Periodontal disease; Periodontal therapy; Scaling and root planning; Type 2 diabetic patients