Cardiovascular disease (CVD) is common and one of the world’s biggest killers causing an estimated 17 million deaths per year. A number of risk factors are recognised including, Smoking, high blood pressure and hyperlipidaemia. There has also been considerable interest in the potential role of chronic infections in the aetiology of CVD and periodontitis is probably the most common. Numerous studies have shown an association between CVD and periodontal disease with other studies demonstration potential causative pathways.
The aim of this Cochrane review was to investigate the effects of periodontal therapy in preventing the occurrence of, and management or recurrence of, cardiovascular disease (CVD) in patients with chronic periodontitis.
Methods
Searches were conducted in the Cochrane Oral Health Group’s Trials Register the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, OpenGrey, the Chinese BioMedical Literature Database, the China National Knowledge Infrastructure and the VIP database, the US National Institutes of Health Trials Register, the World Health Organization (WHO) Clinical Trials Registry Platform and Science paper Online database with no restrictions on language or date.
Only randomised controlled trials (RCTs) and quasi-RCTs with follow-up times ≥ one year that aimed to test the effects of different periodontal therapies for patients with cardiovascular disease (CVD) were considered. Standard Cochrane methodological approaches were followed.
Results
- No studies were identified that assessed primary prevention of CVD in people with periodontitis
- Only 1 trial involving 303 patients that compared scaling and root planing (SRP) with community care up to 25 months was included. It was considered to be at high risk of bias
- No data on deaths (all-cause or CVD- related) were reported.
- There was insufficient evidence to determine the effect of SRP and community care in reducing the risk of CVD recurrence in patients with chronic periodontitis (risk ratio (RR) 0.72; 95% confidence interval (CI) 0.23 to 2.22; very low quality evidence).
- The effects of SRP compared with community care on high-sensitivity C-reactive protein (hs-CRP) (mean difference (MD) 0.62; -1.45 to 2.69), the number of patients with high hs-CRP (RR 0.77; 95% CI 0.32 to 1.85) and adverse events (RR 9.06; 95% CI 0.49 to 166.82) were also not statistically significant.
- The study did not assess modifiable cardiovascular risk factors, other blood test results, heart function parameters or revascularisation procedures.
Conclusions
We found very low quality evidence that was insufficient to support or refute whether periodontal therapy can prevent the recurrence of CVD in the long term in patients with chronic periodontitis. No evidence on primary prevention was found.
Commentary
This review is an update of the 2014 Cochrane review published in 2014 (Dental Elf – 1st Sept 2014). Unfortunately, no new studies were included in the review so the conclusions are unchanged. Given the considerable number of article relating to the relationship between periodontal disease and CVD highlighting the association and the potential biological mechanisms by which periodontal disease could impact on CVD is it disappointing that no high-quality trials have been conducted. The authors highlight a number of areas where research is needed.
Links
Primary Paper
Li C, Lv Z, Shi Z, Zhu Y, Wu Y, Li L, Iheozor-Ejiofor Z. Periodontal therapy for the management of cardiovascular disease in patients with chronic periodontitis. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD009197. DOI: 10.1002/14651858.CD009197.pub3.
Other references
Dental Elf – 1st Sept 2014
