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preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng18er3-lrg.png" alt="Cover of Periodontal treatment to improve diabetic control in children and young people with type 1 or type 2 diabetes" /></a></div><div class="bkr_bib"><h1 id="_NBK584539_"><span itemprop="name">Periodontal treatment to improve diabetic control in children and young people with type 1 or type 2 diabetes</span></h1><div class="subtitle">Evidence review C</div><p><i>NICE Guideline, No. 18</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2022 Jun</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-1385-5</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div></div><div class="bkr_clear"></div></div><div id="niceng18er3.s1"><h2 id="_niceng18er3_s1_">Evidence review on effectiveness of periodontal treatment to improve diabetic control in children and young people with type 1 or type 2 diabetes</h2><div id="niceng18er3.s1.1"><h3>1.1. Review question</h3><p>In children and young people with type 1 or type 2 diabetes, what is the effectiveness of periodontal treatment to improve diabetic control?</p><div id="niceng18er3.s1.1.1"><h4>1.1.1. Introduction</h4><p>Diabetes mellitus represents an extremely significant health problem as it plays a pivotal role in the etiopathogenesis of long-term complications. Suboptimal diabetes control, typically quantified by increased glycated haemoglobin (HbA1c), is a recognised risk factor for periodontitis.</p><p>Periodontitis is the sixth most common complication of diabetes that can manifest either as gingivitis or periodontitis. Gingivitis is the most prevalent inflammatory periodontitis among children and young people with diabetes, which can be treated with simple non-surgical periodontal interventions such as debridement of root surfaces to remove bacterial plaque, biofilms, and mineralised plaque. Periodontal inflammation if left untreated or inadequately controlled, does not only progress to periodontitis, but results in increased systemic inflammatory burden, further worsening the glycaemic status and perpetual promotion of associated complications of diabetes. Establishing the effectiveness of periodontal treatment on diabetic control is important to help to reduce the harms associated with hyperglycaemia and diabetes complications.</p><p>The aim of this review is to assess the effectiveness of periodontal treatment in improving diabetic control in children and young people with type 1 or type 2 diabetes.</p></div><div id="niceng18er3.s1.1.2"><h4>1.1.2. Summary of the protocol</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng18er3tab1"><a href="/books/NBK584539/table/niceng18er3.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng18er3tab1" rid-ob="figobniceng18er3tab1"><img class="small-thumb" src="/books/NBK584539/table/niceng18er3.tab1/?report=thumb" src-large="/books/NBK584539/table/niceng18er3.tab1/?report=previmg" alt="Table 1. PICO table." /></a><div class="icnblk_cntnt"><h4 id="niceng18er3.tab1"><a href="/books/NBK584539/table/niceng18er3.tab1/?report=objectonly" target="object" rid-ob="figobniceng18er3tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO table. </p></div></div></div><div id="niceng18er3.s1.1.3"><h4>1.1.3. Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in appendix A and the methods document.</p><p>Randomised controlled trials (RCTs), systematic reviews of RCTs, prospective and retrospective cohort studies, non-randomised controlled trials, controlled before-and-after studies and before-and-after studies were considered.</p><p>No studies were found that matched the inclusion criteria for the review.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng18er3.s1.1.4"><h4>1.1.4. Effectiveness evidence</h4><div id="niceng18er3.s1.1.4.1"><h5>1.1.4.1. Included studies</h5><p>A systematic literature search was conducted for this review on effectiveness of periodontal treatment in improving diabetic control in children and young people with type 1 or type 2 diabetes.</p><p>The search after deduplication returned a total of 2070 results (see <a href="#niceng18er3.appb">Appendix B</a> for the literature search strategy). Based on title and abstract screening against the review protocol, 21 potential references were ordered and reviewed against the inclusion criteria for full text screening.</p><p>Of the 21 references screened as full texts, no studies met the inclusion criteria specified in the review protocol for this question (<a href="#niceng18er3.appa">Appendix A</a>). The clinical evidence study selection is presented as a diagram in <a href="#niceng18er3.appd">Appendix D</a>.</p></div><div id="niceng18er3.s1.1.4.2"><h5>1.1.4.2. Excluded studies</h5><p>See <a href="#niceng18er3.appk">Appendix K</a> for excluded studies and reasons for exclusion.</p></div></div><div id="niceng18er3.s1.1.5"><h4>1.1.5. Summary of studies included in the effectiveness evidence</h4><p>Studies that met the inclusion criteria specified in the review protocol were not identified.</p></div><div id="niceng18er3.s1.1.6"><h4>1.1.6. Summary of the effectiveness evidence</h4><p>Studies that met the inclusion criteria specified in the review protocol were not found.</p></div><div id="niceng18er3.s1.1.7"><h4>1.1.7. Economic evidence</h4><div id="niceng18er3.s1.1.7.1"><h5>1.1.7.1. Included studies</h5><p>No relevant health economic studies were included.</p></div><div id="niceng18er3.s1.1.7.2"><h5>1.1.7.2. Excluded studies</h5><p>No economic studies relating to this review question were identified.</p><p>See the health economic study selection flow chart presented in <a href="#niceng18er3.apph">Appendix H</a>.</p></div></div><div id="niceng18er3.s1.1.8"><h4>1.1.8. Summary of included economic evidence</h4><p>There are no existing studies for this review question.</p></div><div id="niceng18er3.s1.1.9"><h4>1.1.9. Economic model</h4><p>No original economic modelling was completed for this review question.</p></div><div id="niceng18er3.s1.1.11"><h4>1.1.11. The committee’s discussion and interpretation of the evidence</h4><div id="niceng18er3.s1.1.11.1"><h5>1.1.11.1. The outcomes that matter most</h5><p>Based on the evidence from the periodontal treatment in improving diabetic control in adults with type 1 and type 2 diabetes, the committee agreed that HbA1c, Clinical Attachment Level (CAL), and Probing Pocket Depth (PPD) are important outcomes to assess the link and further progression of diabetes and periodontitis. The committee members also agreed that by monitoring closely these indices, delay in the progression of diabetes complications and periodontitis later in life could be achieved. This would consequently result in improved Quality of Life (QoL) which was considered a secondary outcome.</p><p>Adverse effects were thought to be less important as periodontitis is not common among children and young people. In rare cases when required, conventional non-surgical techniques such as subgingival instrumentation / scaling and root planing cause only minor discomfort and tooth sensitivity that normally resolve after a few days.</p></div><div id="niceng18er3.s1.1.11.2"><h5>1.1.11.2. The quality of the evidence</h5><p>No studies were identified for the present evidence review.</p><p>The committee members agreed to extrapolate from the findings of the effectiveness of periodontal treatment in improving diabetic control in adults with type 1 and type 2 diabetes when compared to no active intervention or usual care. Two important factors influenced their decision. Firstly, the well documented biological link between diabetes and periodontitis and the pathogenesis of diabetic-related complications was considered. Namely, research shows that hyperglycaemia and resultant advanced glycation end-product formation exaggerate immuno-inflammatory response to the bacterial challenge which initiate periodontitis. As a result of persistent hyperglycaemia, these advanced glycation end products accumulate in the plasma and tissue cells, causing more rapid periodontal tissue destruction and premature loss of the teeth. Because the degree of diabetes control ranges widely in children and young people, the susceptibility to gingival and periodontal inflammation may vary. Consequently, although not all gingivitis proceeds into a destructive periodontitis, the committee members thought that prevention of gingival inflammation should be emphasised, particularly in children and young with poorly controlled diabetes.</p><p>The second decision-making factor was the clinical evidence base for the adult population with diabetes which had consistent and adequate volume of effectiveness to justify the recommendations for children and young people with diabetes aimed at prevention and delay of the onset of periodontitis.</p><p>Also, to support decision making, the committee referred to several other documents: care standard (the <a href="https://www.england.nhs.uk/wp-content/uploads/2019/08/commissioning-standard-dental-care-for-people.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Commissioning Standard: Dental Care for People with Diabetes</a>), guideline (the NICE’s Guideline on <a href="http://file://nice.nhs.uk/Data/Clinical%20Practice/1-Guideline%20Development%20Team/3.%20Guidelines/3.%20In%20Development/Diabetes/3.%20Development/5.%20Evidence%20Reviews/5.%20Periodontal/2444%20Periodontal%20CYP/Oral%20health%20promotion:%20general%20dental%20practice" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Oral health promotion: general dental practice (NG30))</a> and consensus papers (<a href="https://www.bsperio.org.uk/assets/downloads/99_093010_prperiodiabetesworkshopfinal.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">the European Federation of Periodontology (EFP) and the International Diabetes Federation (IDF)</a> joint workshop).</p><p>The above evidence combined with the clinical knowledge and experience of the dental healthcare professionals co-opted to the committee was used as bases when drafting the recommendations for the effectiveness of periodontal treatment in children and young people with type 1 and type 2 diabetes.</p><p>The link to the effectiveness of periodontal treatment in adults with type 1 and type 2 diabetes review can be found <a href="http://file://nice.nhs.uk/Data/Clinical%20Practice/1-Guideline%20Development%20Team/3.%20Guidelines/3.%20In%20Development/Diabetes/3.%20Development/5.%20Evidence%20Reviews/5.%20Periodontal/Periodontal%20Adults/Evidence%20review%20X%20Periodontal%20adults%20v5.2.docx" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">here</a>.</p><p>The committee did not suggest any recommendations for future research as periodontitis is a rare condition among children and young people.</p></div><div id="niceng18er3.s1.1.11.3"><h5>1.1.11.3. Benefits and harms</h5><p>Studies that met the inclusion criteria specified in the review protocol were not found and the committee members acknowledged the identified gap in evidence regarding children and young people diagnosed with type 1 and type 2 diabetes and periodontitis. They noted that the possible explanation for the lack of evidence lies in the fact that periodontitis rarely develops in children and young people. Periodontitis among children and young people consists mainly of gingivitis, the mildest form of periodontitis. Gingivitis is a reversible and non-destructive form of periodontitis which is characterised by plaque build-up, gingival redness, swelling, bleeding, and absence of periodontal attachment loss. However, if left untreated, it may progress to cause exposure of the roots, mobility, and premature loss of the teeth.</p><p>The committee members acknowledged that children and young people with diabetes are at increased risk of developing periodontitis and stated that this should be routinely discussed during diabetes consultations alongside eye disease and diabetes related foot problems. Regular oral health reviews to monitor plaque formation and gingival inflammation was suggested.</p><p>Based on the evidence in adults, the committee agreed that successful periodontal treatment can have a positive impact on metabolic control in people with type 1 and type 2 diabetes. Namely, the pooled effect of periodontal treatment when compared to no active intervention or usual care demonstrated that the treatment of periodontitis via subgingival instrumentation/scaling and root planing improved all primary outcomes (HbA1c, CAL and PPD) in the adult population. The committee considered this indirect beneficial effect and agreed that if left unattended, gingivitis in children and young people with type 1 and type 2 diabetes may progress to periodontitis which would further exacerbate diabetes outcomes.</p><p>Further extrapolating from the benefits of periodontal treatment evident in the adult diabetic population, the committee acknowledged that early detection and treatment of periodontitis has the potential to improve quality of life in some aspects of living with diabetes in adulthood. Due to the negligible side effects of subgingival instrumentation/ scaling and root planing, no specific adverse events regarding the management of gingivitis were highlighted.</p><p>Overall, it was agreed that the benefits outweigh the possible minor side effects, and the prevention and monitoring of periodontitis should be recommended to improve diabetic control in children and young people in the long term. As essential to the success of prevention and treatment of periodontitis, maintaining good oral health hygiene and early diagnosis was emphasised.</p></div><div id="niceng18er3.s1.1.11.4"><h5>1.1.11.4. Cost effectiveness and resource use</h5><p>The committee noted that no relevant published economic evaluations were identified, and no additional economic analysis was undertaken for the cost-effectiveness of periodontal treatment among children and young people with type 1 or type 2 diabetes. This is due to the fact that periodontitis is extremely rare in people under the age of 18. Therefore, the committee based the recommendations on the cost-effectiveness evidence of periodontal treatments among adults with diabetes, along with their clinical knowledge and experience, and existing NICE guidance. The new recommendations are mainly about preventive measures and should have a minimal cost impact to the NHS in terms of extra healthcare professionals’ time. This may be offset by better health outcomes by improving the care and quality of life of children and young people who may develop periodontitis when they reach adulthood.</p></div><div id="niceng18er3.s1.1.11.5"><h5>1.1.11.5. Other factors the committee took into account</h5><p>The committee agreed that maintaining gingival health to help prevent or manage periodontitis in children and young people with diabetes requires promoting and supporting positive oral health behaviours and regular dental prophylaxis. The provision of continuous educational support to improve self-care by maintaining effective oral health hygiene and managing lifestyle risk factors, such as smoking, diet and optimal diabetes control are essential to the success of prevention and management of periodontitis.</p><p>The committee acknowledged that the terms used to refer to the non-surgical periodontal treatment such as scaling, polishing etc. are now historic terms and no longer used as per the new periodontal disease nomenclature. However, to increase acceptance among the target population, these terms have not been replaced according to the new terminology as these are still widely recognised by the public.</p><p>The committee wished to stress that although NHS dental services are free for all under 18 and for all under 19 and in fulltime education the increased risk and the needs of certain groups of children and young people with diabetes must be taken into account. The committee considered the needs of certain disadvantaged groups such as children and young people with physical disability, mental health related or learning disability. These groups may also have limitations with their dexterity which can cause difficulties in using interdental and interproximal brushes to maintain good oral hygiene and often do not engage during dental checks putting them into an increased risk of further progression towards periodontitis. Consideration for children and young people in secure settings was also given due to the limited access to interdental and/or interproximal brushes and other dental health care products for security reasons. In general, broader access to dental treatment and adequate personal oral hygiene products in combination with proactive engagement and enhanced educational support have the potential to reduce inequalities among disadvantaged groups.</p><p>Lastly, how the delivery of care for children and young people with diabetes is best integrated across healthcare settings was considered. Clear advice for the oral healthcare/ dental team, of what is expected of them regarding diabetes dental care of children and young people and clear pathways are necessary to enhance the quality of care across the continuum and improve service delivery. The committee members also discussed the uncertainty regarding the initial increase in referrals of children and young people with diabetes for oral health review following the publication of this guidelines, as this will potentially impact on the scarce NHS dental service. Current lack of access to NHS dentistry and gaps in periodontal services, the needs of the disadvantaged subpopulation and future provision of periodontal treatment was of a major concern, warranting a broader and more flexible access to dental/ oral care and services in general.</p></div></div><div id="niceng18er3.s1.1.12"><h4>1.1.12. Recommendations supported by this evidence review</h4><p>This review supports <a href="http://file://nice.nhs.uk/Data/Clinical%20Practice/1-Guideline%20Development%20Team/3.%20Guidelines/3.%20In%20Development/Diabetes/3.%20Development/9.%20Short%20Version/Periodontal/Diabetes%20in%20children%20and%20young%20people%20periodontal%20update%20v2%20.1%20edited%20.docx" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">recommendations 1.2.1, 1.2.111 to 1.2.113, 1.3.1, and 1.3.41 to 1.3.43 of the Diabetes (type 1 and type 2) in children and young people: diagnosis and management guideline</a>.</p></div><div id="niceng18er3.s1.1.13"><h4>1.1.13. References – included studies</h4><div id="niceng18er3.s1.1.13.1"><h5>1.1.13.1. Effectiveness</h5><p>References that met the inclusion criteria specified in the review protocol were not found.</p></div><div id="niceng18er3.s1.1.13.2"><h5>1.1.13.2. Economic</h5><p>No relevant studies have been included as part of the economic evidence review.</p></div><div id="niceng18er3.s1.1.13.3"><h5>1.1.13.3. Other</h5><p>No other studies were included in this review.</p></div></div></div></div><div id="apendixesappgroup1"><h2 id="_apendixesappgroup1_">Appendices</h2><div id="niceng18er3.appa"><h3>Appendix A. Review protocols</h3><p id="niceng18er3.appa.et1"><a href="/books/NBK584539/bin/niceng18er3-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for effectiveness of periodontal treatment in improving diabetic control in children and young people with type or type 2 diabetes.</a><span class="small"> (PDF, 219K)</span></p></div><div id="niceng18er3.appb"><h3>Appendix B. Methods</h3><div id="niceng18er3.appb.s1"><h4>Priority screening</h4><p>The review undertaken for this guideline made use of the priority screening functionality with the EPPI-reviewer systematic reviewing software. This uses a machine learning algorithm (specifically, an SGD classifier) to take information on features (1, 2 and 3 word blocks) in the titles and abstract of papers marked as being ‘includes’ or ‘excludes’ during the title and abstract screening process, and re-orders the remaining records from most likely to least likely to be an include, based on that algorithm. This re-ordering of the remaining records occurs every time 25 additional records have been screened. As the number of records for screening was relatively small (2070 articles), a stopping criterion was not used when conducting screening. Therefore, all records were screened. Twenty-one potential studies were assessed at full-text stage.</p></div><div id="niceng18er3.appa.s2"><h4>Evidence of effectiveness of interventions</h4><p>Evidence that met the inclusion criteria specified in the review protocol was not found.</p></div></div><div id="niceng18er3.appc"><h3>Appendix C. Literature search strategies</h3><p>Evidence review on effectiveness of periodontal treatment in improving diabetic control in children and young people with type 1 or type 2 diabetes.</p><div id="niceng18er3.appc.s1"><h4>Clinical literature search strategy</h4><p>The search of the following databases was conducted on 8th November 2021: Medline, Medline In Process, Medline E-pub Ahead of print, PsycINFO, Embase (all via the Ovid platform), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews (both via the both via the Wiley platform) and the Database of Abstracts of Reviews of Effect (via the CRD platform)</p><p>Intervention and population terms</p><p id="niceng18er3.appc.et1"><a href="/books/NBK584539/bin/niceng18er3-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (280K)</span></p></div></div><div id="niceng18er3.appd"><h3>Appendix D. Effectiveness evidence study selection</h3><p id="niceng18er3.appb.et1"><a href="/books/NBK584539/bin/niceng18er3-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">PRISMA diagram</a><span class="small"> (PDF, 142K)</span></p></div><div id="niceng18er3.appe"><h3>Appendix E. Effectiveness evidence</h3><p>Evidence that met the inclusion criteria specified in the review protocol was not found.</p></div><div id="niceng18er3.appf"><h3>Appendix F. Forest plots</h3><p>Evidence that met the inclusion criteria specified in the review protocol was not found, hence no data was available to generate forest plots.</p></div><div id="niceng18er3.appg"><h3>Appendix G. GRADE tables</h3><p>Studies that met the inclusion criteria specified in the review protocol were not found.</p></div><div id="niceng18er3.apph"><h3>Appendix H. Economic evidence study selection</h3><p id="niceng18er3.apph.et1"><a href="/books/NBK584539/bin/niceng18er3-apph-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (140K)</span></p></div><div id="niceng18er3.appi"><h3>Appendix I. Economic evidence tables</h3><p>There are no included studies in this review question.</p></div><div id="niceng18er3.appj"><h3>Appendix J. Health economic model</h3><p>There is no original modelling in this review question.</p></div><div id="niceng18er3.appk"><h3>Appendix K. Excluded studies</h3><p id="niceng18er3.appk.et1"><a href="/books/NBK584539/bin/niceng18er3-appk-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (150K)</span></p></div></div></div><div class="fm-sec"><div><p>Final version</p></div><div><p>Evidence reviews underpinning recommendations 1.2.1, 1.2.130 to 1.2.132, 1.3.1, and 1.3.58 to 1.3.60 and research recommendations in the NICE guideline</p><p>These evidence reviews were developed by the NICE Guideline Development Team</p></div><div><p><b>Disclaimer</b> The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div><div class="small"><span class="label">Bookshelf ID: NBK584539</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/36166588" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">36166588</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng18er3tab1"><div id="niceng18er3.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO table</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK584539/table/niceng18er3.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng18er3.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng18er3.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><td headers="hd_b_niceng18er3.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Children and young people with type 1 or type 2 diabetes and periodontitis:<ul><li class="half_rhythm"><div>Children under 5 years old</div></li><li class="half_rhythm"><div>School age children (6–12 years)</div></li><li class="half_rhythm"><div>Young people (>12 years)</div></li></ul></td></tr><tr><th id="hd_b_niceng18er3.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions</th><td headers="hd_b_niceng18er3.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>A non-surgical periodontal treatment such as subgingival instrumentation also known as scaling and root planing (SRP), which may include one or more of the following:<ul><li class="half_rhythm"><div>mechanical debridement which includes scaling and root planing</div></li><li class="half_rhythm"><div>subgingival curettage</div></li><li class="half_rhythm"><div>antimicrobial therapy (antibacterials and antibiotics), either locally applied (including mouth rinses, gels, or dentifrices) or systemically administered</div></li><li class="half_rhythm"><div>other drug therapy with a possible benefit of improving the periodontal condition of the participant</div></li><li class="half_rhythm"><div>other novel interventions to manage periodontitis</div></li></ul></p>
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<p>Studies combining periodontal treatment with usual care or with antimicrobial therapy (antibacterial and antibiotics) will be grouped for the purpose of the analysis.</p>
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</td></tr><tr><th id="hd_b_niceng18er3.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator</th><td headers="hd_b_niceng18er3.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Placebo</div></li><li class="half_rhythm"><div>Usual care (defined as supragingival prophylaxis which can include scaling only or/and polish, oral hygiene instruction; education or support sessions to improve self-help or self-awareness of oral hygiene.)</div></li></ul>
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</td></tr><tr><th id="hd_b_niceng18er3.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng18er3.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>All outcomes should be reported at least 90 days following the intervention. All outcomes will be sorted into 3 months, 6 months, 12 months following the intervention</p>
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<p>
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<b>Primary outcomes</b>
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<ul><li class="half_rhythm"><div>Change in HbA1c</div></li><li class="half_rhythm"><div>Change in clinical attachment level (CAL)</div></li><li class="half_rhythm"><div>Change in periodontal probing pocket depth (PPD)</div></li></ul>
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</p>
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<p>
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<b>Secondary outcomes</b>
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<ul><li class="half_rhythm"><div>Quality of life (measured by validated tools e.g., hospital anxiety and depression scale (HADS), oral health-related quality of life (OHRQoL), health-related quality of life (HRQoL))</div></li><li class="half_rhythm"><div>Adverse events</div></li></ul>
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</p>
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