Conflict of interest and source of funding
Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis
Article first published online: 29 OCT 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Journal of Clinical Periodontology
Volume 41, Issue 1, pages 70–79, January 2014
How to Cite
Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis. J Clin Periodontol 2014; 41: 70–79. doi: 10.1111/jcpe.12171., , , , , , , .
The authors declare that they have no conflict of interests. The Department of Periodontology ACTA, the Netherlands is supported in part by a grant of the University of Amsterdam for its participation in the focal point of “Oral infections and inflammation.” Dr. H. Susanto is supported by the Bernouille Foundation of the University Medical Center Groningen, University of Groningen, the Netherlands. Dr. F. D'Aiuto holds a Clinical Senior Lectureship Award supported by the UK Clinical Research Collaboration and works at UCLH/UCL and received a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme.
- Issue published online: 12 DEC 2013
- Article first published online: 29 OCT 2013
- Accepted manuscript online: 30 SEP 2013 09:18AM EST
- Manuscript Accepted: 18 SEP 2013
- University of Amsterdam
- Bernouille Foundation of the University Medical Center Groningen
- University of Groningen
- UK Clinical Research Collaboration
- Department of Health NIHR Biomedical Research Centres funding scheme
- systematic review;
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.
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 HbA1c (−0.43%, 95% CI: −0.60; −0.25).
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.