Special mouthwashes and brushes can help treat gum disease in patients with diabetes

People with type 2 diabetes who are being treated for periodontitis may benefit from using an antimicrobial mouthwash and small brushes to clean between the teeth as part of their oral care routine at home.

That was a key finding in a recent study conducted by Patricia Diaz, DDS, Ph.D., SUNY Empire Innovation Professor at the University at Buffalo School of Dental Medicine and director of UB’s Microbiome Center. He published the results of the study he conducted with other researchers JDR Clinical & Translational Research.

Scaling and root planing (SRP) is the most commonly used treatment for the initial treatment of periodontitis or gum disease. However, specialized home rinses can also help patients.

“This study aimed to find the effects of an intensive chemical and mechanical anti-plaque regimen used at home, in addition to SRP, for the treatment of moderate to severe periodontitis,” says Diaz. “Our secondary objective was to compare the responses in people with type 2 diabetes and people who are not diabetic.”

People with diabetes who used the mouthwash showed a significantly greater reduction in periodontal inflammation compared to people with diabetes who received the control treatment.

“We’re not sure why exactly, but we suspect it’s because people with diabetes have an impaired therapeutic response,” says Diaz. “This oral care regimen removed oral bacteria and allowed for better healing.”

Meanwhile, non-diabetics did not benefit from the additional measures to remove oral bacteria.

While the dental industry has prescribed anti-plaque mouthwashes for periodontitis patients for years, Diaz notes that no previous studies have been designed specifically for diabetic patients.

A grant from Sunstar, the maker of several oral care, beauty and health products, funded the research. Robert J. Genco, SUNY Distinguished Professor of Oral Biology, Periodontology and Microbiology and founder of the UB Microbiome Center, spearheaded the research before his death in 2019.

“Dr. Genco was a pioneer in looking at the relationship between gum disease and systemic disease,” says Diaz. “He had a close working relationship with Sunstar.”

From 2017 to 2020, the research team recruited people in Western New York through newspaper ads and flyers, particularly encouraging people with type 2 diabetes to participate.

Of 361 subjects screened, 114 were selected to participate in the six-month trial. They were then divided into two groups. The test group received non-surgical periodontal treatment consisting of SRP under local anesthesia and instructions to use chlorhexidine gluconate mouthwash twice daily for three months, along with elastic proximal hair cleaners twice daily for six months. The other group received SRP and general oral hygiene instructions only.

Chlorhexidine is a powerful antimicrobial mouthwash with superior efficacy as an anti-slip and anti-gingival agent compared to other antimicrobial solutions. Practitioners are reluctant to use chlorhexidine for extended periods because of side effects, including tooth staining and taste disturbances, Diaz says.

Although subjects reported changes in their taste after three months, these disappeared after they stopped using the mouthwash, according to the report. Also, supragingival scaling resolved any staining resulting from the use of chlorhexidine.

This study also evaluated changes in blood glucose markers and C-reactive protein (CRP) after periodontal treatment. No changes were observed six months after any treatment in any of the blood biomarkers assessed.

Diaz says the researchers were surprised that people with diabetes responded so well to home treatments, but it also made sense.

“There’s a lot of talk about precision medicine, and this is one example,” says Diaz. “Previously, it was a one-size-fits-all approach, which is not ideal for treating gingivitis.”

While the findings are remarkable, more research is needed, Diaz says, adding that she is currently pursuing further study of the microbiome and how it affects diabetes.

“We need more definitive answers,” he says. “Current studies are evaluating how this oral care routine modified the oral microbiome to allow for better healing.”