Periodontal treatment for preventing cardiovascular disease in people with periodontitis

Periodontitis is one of the worlds commonest infections and studies have suggested links with cardiovascular diseases (CVD) which are responsible for killing the most people worldwide. There are two main reasons why they could be related; systemic inflammation increases when moderate/severe periodontitis is present, and treatment reduces this; bacteria involved with periodontal disease may invade damaged periodontal tissues and also the cardiovascular system potential causing damage.

The aim of this Cochrane review update was to investigate the effects of periodontal therapy for primary or secondary prevention of CVD in people with chronic periodontitis.

Methods

Searches were conducted in the Cochrane Oral Health’s Trials Register, CENTRAL, Medline, Embase, CINAH, OpenGrey, Chinese BioMedical Literature Database , China National Knowledge Infrastructure, VIP,US National Institutes of Health Trials Register , World Health Organization (WHO) Clinical Trials Registry Platform and Science paper Online databases. This search updated those of the previous version of the review with the analysis conducted using the same methodology as previously (Dental Elf – 10^th Jan 2020).

Results

No additional trials were identified since the last update (Dental Elf – 10^th Jan 2020)
2 studies reported in 6 publications were included.
Both studies were considered to be at high risk of bias.
One study (165 patients) focused on primary prevention [very low certainty evidence].
- It was not possible to determine if scaling and root planning plus amoxicillin and metronidazole could reduce incidence of all-cause death, Peto OR = 7.48 (95%CI; 0.15 to 376.98), or all CVD-related death, Peto OR = 7.48 (95%CI; 0.15 to 376.98).
- The possibility that scaling and root planning plus amoxicillin and metronidazole could increase cardiovascular events compared with supragingival scaling may increase cardiovascular events measured at 12-month follow-up could not be excluded, Peto OR = 7.77 (95%CI; 1.07 to 56.1

One pilot study (303 patients) focused on secondary prevention. Patients received scaling and root planning plus oral hygiene instruction (periodontal treatment) or oral hygiene instruction plus a copy of radiographs and recommendation to follow-up with a dentist (community care). Only data on 37 participants was available at 1 years follow up so the data was not robust enough to be included. The study did not evaluate all-cause death and all CVD-related death.

Conclusions

The authors concluded: –

For primary prevention of cardiovascular disease (CVD) in people diagnosed with periodontitis and metabolic syndrome, very low-certainty evidence was inconclusive about the effects of scaling and root planning plus antibiotics compared to supragingival scaling. There is no reliable evidence available regarding secondary prevention of CVD in people diagnosed with chronic periodontitis and CVD. Further trials are needed to reach conclusions about whether treatment for periodontal disease can help prevent occurrence or recurrence of CVD.

Comments

This review is the third update of one first version published in 2014 and no additional studies have been included since the last update published. One key inclusion criteria for this review is a minimum 12 months follow up and this was a main reasons for the exclusion of studies. The reviewers did note that two studies currently underway were planning to report cardiovascular-related deaths at 12-month follow-up so may provide additional information in the future. As in the previous version the authros highlight the need for further RCTs highlighting a number of issues that should be considered in the design of future studies.

Links

Primary Paper

Ye Z, Cao Y, Miao C, Liu W, Dong L, Lv Z, Iheozor-Ejiofor Z, Li C. Periodontal therapy for primary or secondary prevention of cardiovascular disease in people with periodontitis. Cochrane Database Syst Rev. 2022 Oct 4;10:CD009197. doi: 10.1002/14651858.CD009197.pub5. PMID: 36194420.

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