Age differences in the effects of multi-component periodontal treatments on oral and metabolic health among people with diabetes mellitus: A meta-epidemiological study

Objective: To explore the age differences in the effects of multi-component periodontal treatments on oral and metabolic indicators among individuals with periodontitis and diabetes.

Data: Trials reporting the effects of multi-component periodontal treatments on oral and metabolic indicators among participants aged 18 and above with periodontitis and diabetes were included.

Sources: Six databases (PubMed/Medline, Embase, CINHAL, Web of Science, Cochrane Library, and ProQuest) were searched from database inception to August 2022.

Study selection: Two reviewers selected the included studies independently. We used bivariate and multivariate meta-regression models to examine the association between age and treatment effect size. The primary outcomes were changes in probing depth (PD), clinical attachment level (CAL), and hemoglobin A1c (HbA1c).

Results: A total of 18,067 articles were identified in the database search. Of these, 115 trials (119 articles) met inclusion criteria. The mean age of participants was 58 years old, ranging from 35 to 73 years. The pooled evidence demonstrated that multi-component periodontal treatment significantly reduced PD (g=0.929 [0.689-1.169], I²=94.1%), CAL (g=0.879 [0.669-1.089], I²=92.1%), and HbA1c (g=0.603 [0.443-0.763], I²=87.5%). A significant decreasing trend was observed in the effect size for PD (P for trend = 0.020) and CAL (P for trend = 0.028) as age increases. Results from multivariate meta-regression showed that mean age was associated with a smaller effect size for PD (β=-0.123 [0.041], P = 0.004) and CAL (β=-0.159 [0.055], P = 0.006). Compared to their younger counterparts, the effect size for HbA1c was smaller among participants aged 55 and older (β=-0.792 [0.322], P = 0.017).

Conclusions: Multi-component periodontal treatments may be more effective in younger populations in terms of effects on PD, CAL, and HbA1c.

Clinical significance: Our study highlights the importance of early intervention and tailored treatment approaches. Clinicians should take into account the patient's age when developing periodontal treatment plans and may need to employ more aggressive or personalized strategies for older adults to achieve optimal outcomes.