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Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta‐analysis
Author(s) -
Teeuw Wijnand J.,
Slot Dagmar E.,
Susanto Hendri,
Gerdes Victor E. A.,
Abbas Frank,
D'Aiuto Francesco,
Kastelein John J. P.,
Loos Bruno G.
Publication year - 2014
Publication title -
journal of clinical periodontology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.456
H-Index - 151
eISSN - 1600-051X
pISSN - 0303-6979
DOI - 10.1111/jcpe.12171
Subject(s) - medicine , periodontitis , meta analysis , gastroenterology , clinical trial , diabetes mellitus , bleeding on probing , randomized controlled trial , endocrinology
Aim Systematic review and meta‐analyses to study the robustness of observations that treatment of periodontitis improves the atherosclerotic profile. Material and Methods Literature was searched in Medline‐PubMed, Cochrane CENTRAL and EMBASE, based on controlled periodontal intervention trials, including also a non‐intervention group. Data were extracted and meta‐analyses were performed. Results From 3928 screened studies, 25 trials met the eligibility criteria. These trials enrolled 1748 periodontitis patients. Seven trials enrolled periodontitis patients that were otherwise healthy, 18 trials recruited periodontal patients with various co‐morbidities, such as CVD or diabetes. None of the trials used hard clinical endpoints of CVD. However, improvement of endothelial function has been consistently reported. Meta‐analyses demonstrated significant weighted mean difference (WMD) for hsCRP (−0.50 mg/l, 95% CI:−0.78; −0.22), IL‐6 (−0.48 ng/l, 95% CI: −0.90; −0.06), TNF‐α (−0.75 pg/ml, 95% CI: −1.34; −0.17), fibrinogen (−0.47 g/l, 95% CI: −0.76; −0.17), total cholesterol (−0.11 mmol/l, 95% CI: −0.21; −0.01) and HDL‐C (0.04 mmol/l, 95% CI: 0.03; 0.06) favouring periodontal intervention. Importantly, periodontitis patients with co‐morbidity benefitted most from periodontal therapy; significant WMD were observed for levels of hsCRP (−0.71 mg/l, 95% CI: −1.05; −0.36), IL‐6 (−0.87 ng/l, 95% CI: −0.97; −0.78), triglycerides (−0.24 mmol/l, 95% CI: −0.26; −0.22), total cholesterol (−0.15 mmol/l, 95% CI: −0.29; −0.01), HDL‐C (0.05 mmol/l, 95% CI: 0.03; 0.06) and HbA 1c (−0.43%, 95% CI: −0.60; −0.25). Conclusions This systematic review and meta‐analyses demonstrate that periodontal treatment improves endothelial function and reduces biomarkers of atherosclerotic disease, especially in those already suffering from CVD and/or diabetes.