Effectiveness of Antimicrobial Photodynamic Therapy Versus Doxycycline in the Treatment of Periodontitis on Glycaemic Control and Periodontal Parameters in Adults with Type 2 Diabetes Mellitus

BackgroundThis meta-analysis aimed to compare the efficacy of antimicrobial photodynamic therapy (aPDT) with systemic doxycycline, as adjunctive treatments to scaling and root planing (SRP) for treating periodontitis in patients with type 2 diabetes mellitus (T2DM). MethodsA search across electronic databases including PubMed, Scopus, CENTRAL, OVID EMBASE and OVID MEDLINE was carried out to identify relevant randomised controlled trials (RCTs), comparing aPDT or doxycycline combined with SRP, versus SRP alone. Data were pooled using random-effects models and indirect comparisons were retrieved using the Chi2 test for subgroup differences, to assess the impact of these treatments on glycated haemoglobin (HbA1c), probing depth (PD), and clinical attachment level (CAL). ResultsEight RCTs were included. aPDT with SRP showed a significant reduction in probing depth compared to doxycycline (MD = -0.55 mm, 95% CI: -1.03 to -0.07; p = 0.02). A significant difference between the two subgroups was found (p = 0.04), suggesting aPDT was more effective. No significant differences were found for HbA1c or CAL between the two interventions. ConclusionsThe findings suggest that aPDT may offer greater benefits for the treatment of periodontitis in T2DM patients. This suggests that aPDT could potentially be a non-antibiotic alternative to doxycycline. However, as neither treatment influenced HbA1c, clinicians should not rely on periodontal therapy for glycaemic control. Layperson summaryPeople with type 2 diabetes have a higher risk of getting gum disease because their bodies cant manage blood sugar levels well. When people with type 2 diabetes get gum disease, the swelling in their gums makes it even harder to control their blood sugar levels, making their diabetes worse. Type 2 diabetics sometimes dont respond well to regular gum treatments so dentists will also give them antibiotics to treat the gum disease. But when antibiotics are used too often, they can stop working. This is called antibiotic resistance and its a big problem in healthcare. Therefore, this study wanted to test if adding a special light therapy to regular gum treatments could replace using antibiotics. The results from this study found that the light therapy was better at healing parts of the gums compared to antibiotics. However, neither treatment made a big difference in blood sugar levels. This is important because it means that the light therapy could replace antibiotics for treating gum disease, reducing the problem of antibiotic resistance. However, more research is needed to see if these treatments could have any beneficial effect on blood sugar levels.