Glycemic Control and Periodontal Health in Uncontrolled Diabetes and Periodontitis Using an Electric Toothbrush with a Smart Mobile Application: A Randomized Controlled Trial

Abstract

Background: Periodontitis and type II diabetes mellitus (T2DM) are both chronic inflammatory diseases and have been shown to have a bidirectional relationship. Periodontal inflammation can worsen glycemic control, while hyperglycemia can raise baseline inflammatory load and worsen periodontal tissue breakdown. Aim: To evaluate whether an electronic toothbrush with a smartphone application, used as an adjunct to scaling and root planing (ScRP), improves glycemic control and periodontal outcomes, compared to a manual toothbrush. Methods: Adults ≥35-year-old with stage II-III periodontitis and T2DM with HbA1c ≥7% were included for the study. Patients received ScRP and oral hygiene instruction, and frequent periodontal maintenance. Patients were randomized into either (1) manual toothbrush (control) or (2) electronic toothbrush with smartphone application (test) group. Patients receives periodontal maintenances at follow-ups visits at 3, 6, 9, and 12 months. Oral hygiene instruction and periodontal maintenance was provided at follow-up visits at 3, 6, 9, and 12 months. The primary outcome was HbA1c changes from baseline. Secondary outcomes included changes in probing pocket depth (PPD), residual deep pocket, bleeding on probing (BOP), plaque index (PI), and inflammatory biomarkers collected from gingival crevicular fluid (GCF). Results: 32 participants were enrolled; 23 were included in the final analysis (11 control, 12 test). The mean age was 62-year-old for both groups. HbA1c declined initially for both groups and then increased again at the end of 12-month follow-up. In the control group, the greatest mean HbA1c reduction of 0.51% was at 6 months. In the test group the greatest mean HbA1c reduction of 0.85% was at 3 months. Overall, HbA1c level changes did not demonstrate a statistically significant difference between the two groups over time. For periodontal clinical parameters, PPD reduction were significant across all time points for both control and test groups, however, no between-group differences were observed. End point parameter of residual deep pockets showed significant differences across all time points within-group and a significant difference at 9 months between two groups, favoring the test group. BOP showed statistically significant within-group reduction across all time points for test group but only significant at 2 and 6 months for control group. Between-group difference was statistically significant at 9 months, favoring the test group. PI showed no statistical significance between the two groups. GCF biomarker analyses were completed for 14 inflammatory biomarkers. Statistically significant between-group differences at the p .05 threshold were limited to TNFα, IL-2, IL-4, IL-5, and VEGF. Conclusions: Electronic toothbrush with smartphone application when used as adjunct to nonsurgical periodontal therapy with regular maintenance enhanced periodontal clinical outcomes. However, the effects on HbA1c are comparable between two groups.