Impact of risk factor control in patients with periodontitis

Research Topic:

Background + Aims

Periodontitis progression is influenced by common risk factors, including poor oral hygiene, smoking, and lifestyle habits. Interventions targeting these factors can improve treatment outcomes and periodontal health.
Behavioural changes such as smoking cessation, diabetes control, increased physical activity, healthier diets, and weight loss have shown to enhance periodontal health and quality of life.
Despite growing engagement by oral health professionals in counselling, implementing health behaviour change in periodontal care remains challenging.
Current evidence underscores the need for periodontal providers to integrate strategies for lifestyle modifications, including smoking cessation and dietary adjustments, into patient care.
The systematic review aimed to answer the question: What is the efficacy of health behaviour change interventions on smoking cessation, diabetes control, physical activity, dietary adjustments, and weight loss in improving periodontal outcomes?

Materials + Methods

This systematic review included 2 stages:
- Identifying recent guidelines for interventions targeting smoking cessation, diabetes control, physical exercise, dietary changes, and weight loss in the general population
- Evaluating studies assessing these interventions in patients with periodontitis.
Searches for studies were performed on 2 databases up to May 2019.
Supplementary hand-searching of recent articles in key periodontal journals.
Studies included:
- Randomised clinical trials (RCTs) and controlled clinical trials (CCTs) conducted in human subjects were included if they evaluated the impact of these interventions in periodontitis patients.
- Only English-language publications were included due to time constraints.
Animal studies, narrative reviews, case reports, and studies lacking intervention details were excluded.
3 reviewers independently screened titles, abstracts, and full texts, resolving disagreements by consensus.
Methodological quality was assessed using the Cochrane Collaboration’s risk of bias tool.
Data were extracted into evidence tables collaboratively and revalidated for accuracy.
The systematic approach aimed to provide evidence on the efficacy of lifestyle interventions in enhancing periodontal health outcomes.

Results

The systematic review explored the impact of risk factor control interventions on patients with periodontitis, focusing on six key areas: smoking cessation, diabetes control, physical exercise, dietary changes, carbohydrate reduction, and weight loss.
It identified 13 clinical guidelines and 25 studies that evaluated these interventions, providing insights into their efficacy and associated periodontal health benefits.
Smoking cessation:
- Included six studies on smoking cessation, based on well-established guidelines like those from the U.S. Department of Health and Human Services.
- Interventions ranged from brief advice to more intensive behavioural support.
- Quit rates varied, with 4% quitting at one year and up to 30% at two years.
- Studies consistently showed that those who engaged with smoking cessation experienced significant periodontal improvements, including greater probing depth (PD) reduction and less clinical attachment loss (CAL) compared to those who did not.
- Intensive interventions yielded better outcomes, underscoring the role of robust behavioural support.
Diabetes control:
- 3 studies evaluated diabetes control interventions, including lifestyle counselling, dietary modifications, and oral health education.
- The interventions, lasting from four weeks to six months, resulted in improved periodontal health markers such as gingival index (GI) and bleeding on probing (BOP).
- 1 RCT demonstrated significant reductions in PD and CAL after six months.
- These findings highlight the bidirectional benefits of managing diabetes for periodontal health, reinforcing the importance of integrated care.
Physical exercise:
- 2 studies investigated physical exercise interventions, which included yoga and structured physical activity programs.
- Both studies reported improvements in periodontal health, including reduced bleeding scores and PD.
- A 12-week yoga intervention showed reduced stress levels and enhanced periodontal parameters, linking stress reduction to improved outcomes.
- These findings suggest that physical activity, even in non-traditional forms like yoga, can positively influence periodontal health.
Dietary changes:
- 7 studies assessed dietary interventions aimed at promoting healthier eating habits.
- Interventions ranged from guided nutritional counselling to diet-specific modifications like high-fibre or fruit-rich diets.
- Most studies reported significant improvements in bleeding indices and PD.
- 1 study demonstrated reductions in gingival crevicular fluid inflammatory markers following dietary guidance.
- These results emphasise the role of nutrition in managing periodontitis, although more consistency in study design is needed for stronger conclusions.
Carbohydrate reduction:
- 2 studies specifically examined the effects of reducing dietary sugars.
- Both reported improvements in gingival health, with one study showing significant reductions in periodontal inflamed surface area. These benefits occurred despite no change in plaque levels, highlighting the systemic impact of dietary sugars on inflammation and periodontal disease.
Weight loss:
- 5 studies explored weight loss interventions through dietary and lifestyle modifications.
- Most showed significant improvements in PD and CAL, particularly in patients achieving substantial weight reductions.
- 1 study observed elevated serum adiponectin and reduced tumour necrosis factor-alpha levels after weight loss, correlating with periodontal improvements.
- Variations in intervention intensity and participant adherence influenced outcomes, indicating the challenges in maintaining long-term benefits.

Limitations

The evidence for most interventions beyond smoking cessation and dietary counselling was limited or inconclusive. Many studies lacked specificity, often addressing multiple overlapping risk factors (e.g., weight loss combined with dietary changes and physical exercise) rather than isolating single interventions. This complexity, while reflective of real-world scenarios, complicates direct attribution of periodontal outcomes to individual interventions.
The high heterogeneity in study designs, intervention protocols, and durations posed challenges for meta-analyses, limiting the ability to derive robust conclusions.
The quality of evidence was generally low, with many studies at moderate to high risk of bias.
Ethical constraints also restricted the design of randomised controlled trials (RCTs), particularly for interventions like smoking cessation.
Most studies included were conducted in controlled settings, making it difficult to extrapolate findings to diverse real-world periodontal practices.
Counselling interventions were not always well-documented, and the role of inter-professional collaboration (potentially critical for managing complex risk factors) was under-explored.
Guidelines often involved pharmacological or surgical components not directly implementable by dental professionals, requiring multidisciplinary approaches.

Conclusion

This systematic review underscores the effectiveness of smoking cessation and dietary counselling in improving periodontal outcomes, though evidence for other interventions, such as diabetes control, physical activity, carbohydrate reduction, and weight loss, remains limited.
The findings highlight the need for an interdisciplinary approach, involving collaboration among healthcare providers, to address overlapping risk factors and improve periodontal health.
Future research should prioritise isolated interventions, standardised protocols, and mechanisms of behaviour change to enhance evidence-based periodontal care and promote healthy lifestyles for optimal patient outcomes.

Read the full article Back to Research