Dental Therapy and Improved Glycemic Control in an Urban Free-Clinic

Objectives:  This study tested the feasibility of assessing the effects of dental treatment on diabetes glycemic control in patients of an urban free clinic project (FCP). The specific aim was to determine whether receiving routine dental procedures that may influence systemic inflammation (prophylaxis, debridement, scaling and root planing, extractions, endodontics) contributed to improvement in hemoglobin A1c (HbA1c).  

Method: We selected two groups of patients who had 2+ HbA1c values and were seen in a two-year period (2006-2008). The two groups were patients seen in both the medical and dental clinic and those seen only in the medical clinic. Analysis of changes in HbA1c, using independent and paired t-tests and regression with Generalized Estimating Equations considered a variety of scenarios for time intervals between the first HbA1c and first dental procedure (T1) and the last dental procedure and last HbA1c (T2).  

Result: We identified 15 patients seen in both the medical and dental clinics and 24 patients seen only in the medical clinic. A mean reduction in HbA1c occurred for both groups, with the reduction consistently greater for the group seen in both the dental and medical clinic. The between group change in HbA1c was not statistically different (P>0.5). However, using time intervals for T1 of 0-120 or 0-59 days and T2 time intervals of 30-180 or 60-180 days, we found a statistically significant HbA1c improvement of 0.8% or 0.93% (P<0.05), respectively, within patients who received dental procedures with potential anti-inflammatory effects. The HbA1c improvement for patients seen only in the medical clinic (0.4%) was not statistically significant. Not unexpectedly, the sample sizes markedly diminished as we restricted the time intervals.

Conclusion: Dental procedures that may influence systemic inflammation may have a benefit in improving glycemic control. This study provided important preliminary data to plan a larger, more definitive project.