Efficacy of a Smart Toothbrush on Glycemic Control in Patients with Type 2 Diabetes Mellitus and Chronic Periodontitis. A Prospective Randomized Controlled Clinical trial.

Abstract

Background: Periodontitis is the 11th most prevalent chronic disease globally, with a disease burden of approximately 1.1 billion people. Similarly, type 2 diabetes mellitus (T2DM) is a global health concern affecting 537 million adults worldwide. The bidirectional relationship between periodontal diseases and diabetes is well-established. Treatment and control of periodontal diseases improves diabetes outcomes. This study aims to investigate the efficacy of an electric toothbrush with mobile smart application as an adjunct to periodontal therapy on the improvement of glycemic control and oral health parameters in moderate to severe periodontitis patients with uncontrolled type 2 diabetes (T2DM). Methods: Forty (40) individuals diagnosed with uncontrolled type 2 diabetes mellitus (T2DM) and moderate to severe periodontal disease were included in this prospective randomized control clinical trial. Baseline periodontal parameters were measured (probing depths, bleeding on probing and plaque index), and gingival crevicular fluid and fasting blood were collected. Non-surgical periodontal therapy was performed on all enrolled patients. Twenty (20) patients were randomized into the control group and received oral hygiene instructions (OHI) with a standard manual toothbrush, while the other twenty (20) were randomized into the test group and received OHI with an electric smart toothbrush linked to a mobile device application. Clinical measurements were re- evaluated at eight weeks and at three, six, nine, and twelve months post non-surgical therapy. Results: HbA1c for the test group decreased from 8.6% at baseline to 7.6% at 12 months and for the control group from 7.9% to 7.7%; the difference was not statistically significant for either of the treatment groups. Both treatment groups demonstrated a 63% decrease in plaque accumulation which was significant when compared to baseline, but not significant between the groups at any time point. There was statistically significant reduction in the mean PPD (3.04 mm) for the test group between baseline and 12 months compared to the control group (1.89 mm). Additionally, 14.2% of controls and 16.7% of the test group achieved a clinical endpoint of £ 4 clinical sites with PPD £ 5mm. Conclusions: The preliminary results from the present RCT study suggest that a smart toothbrush with a mobile application to guide self-efficacy in oral home care is a valuable adjunct to non-surgical therapy in patients with periodontitis and poorly or uncontrolled diabetes. Completion of the study is required to drawn definitive conclusions.