LONDON, UK: Factors such as glucose metabolism, nutrition, oxidative stress and ageing drive periodontal progression. However, current periodontal treatments do not directly address the host’s metabolic inflammatory response, which is crucial for the management of periodontal disease. Although systemic metformin is widely used in the management of diabetes, the medication has never been used in periodontitis treatment management. Now, a new study has reported that metformin helps control inflammation and glucose levels in the mouth and body and could be used as an intervention to help prevent both oral and systemic disease.
Research suggests that approximately half of the adult population over 30 years have some form of periodontal disease, and the figure increases to 70% in adults over 65 years and older. The disease is strongly associated with systemic conditions such as diabetes and obesity, and some studies have shown that controlling glucose metabolism in patients may contribute to longevity and decrease the development of periodontal disease. Similarly, it has also been demonstrated that patients successfully treated for periodontal disease improve their glucose metabolism and cardiovascular health.
In the study, the researchers investigated the effects of metformin, which is currently used as a first-line agent for glycaemic control, as a pharmaceutical glucose metabolism modulator. The medication was chosen for its cost-effectiveness, safety and potential for repurposing and to promote longevity in patients.
The study found that metformin led to significant prevention of bone loss during induced periodontal disease and age-related bone loss in vivo in living mice. The researchers then tested the use of metformin in patients with periodontal disease without diabetes, the first clinical trial of its kind. To test the effectiveness of the medication, half of the participants received 850 mg of a placebo and the other half were given 850 mg of metformin. All participants underwent full-mouth non-surgical therapy. The researchers reviewed the patients at baseline, three days later and a week later. Periodontal reassessment was performed six and 12 weeks after full-mouth non-surgical therapy.
The trial showed improved clinical outcomes in the periodontal disease treatment and in the control of glucose levels and inflammation in both the mouth and body, even when high levels of bacteria were present. In light of the data, the researchers believe that using metformin for periodontal disease prevention could also help control weight gain and glucose levels.
“Our patients do not often have any tools to fight against gum disease other than brushing their teeth, but for the first time, we have a potential tool that can help not only with gum disease but overall health,” lead author Dr Vitor Neves, academic clinical lecturer and periodontics registrar at King’s College London, said in a press release. He added: “Metformin is readily available around the world and is cheap, therefore allowing the drug to be used as a preventive medicine for oral and systemic diseases that could be adopted on a global scale.” He explained that this would help many to age more healthily.
The study, titled “Repurposing metformin for periodontal disease management as a form of oral–systemic preventive medicine”, was published online on 10 October 2023 in the Journal of Translational Medicine.
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