Background
Methods
Protocol and registration
Information sources and search strategy
Electronic databases | Search strategy | Limits | Hits |
---|---|---|---|
Pubmed | (Periodontitis OR periodontal disease OR gum disease OR periodontal health OR periodontal therapy OR periodontal treatment OR root scaling OR periodontal debridement OR root planing OR oral hygiene) AND (chronic obstructive pulmonary disease OR chronic bronchitis OR emphysema OR COPD) | Publication Date 01/01/2000–31/03/2020 English language Human species | 185 |
Scopus | (Periodontitis OR periodontal disease OR gum disease OR periodontal health OR periodontal therapy OR periodontal treatment OR root scaling OR periodontal debridement OR root planing OR oral hygiene) AND (chronic obstructive pulmonary disease OR chronic bronchitis OR emphysema OR COPD) | Year 2000–2020 English language | 55 |
Virtual Health Library | (Periodontitis OR periodontal disease OR gum disease OR periodontal health OR periodontal therapy OR periodontal treatment OR root scaling OR periodontal debridement OR root planing OR oral hygiene) AND (chronic obstructive pulmonary disease OR chronic bronchitis OR emphysema OR COPD) | Year 2000–2020 English Language | 252 |
ScienceDirect | ("Periodontitis" OR "periodontal disease" OR "periodontal therapy" OR "periodontal treatment" OR "root scaling" OR "periodontal debridement" OR "root planing" OR "oral hygiene") AND ("chronic obstructive pulmonary disease") | Year 2000–2020 Article types Research articles | 386 |
Wiley Online Library | (Periodontitis OR periodontal disease OR gum disease OR periodontal health OR periodontal therapy OR periodontal treatment OR root scaling OR periodontal debridement OR root planing OR oral hygiene) AND (chronic obstructive pulmonary disease OR chronic bronchitis OR emphysema OR COPD) | Publication date 01/2000–03/2020 Publication type Journals | 213 |
Web of Science | (Periodontitis OR periodontal disease OR gum disease OR periodontal health OR periodontal therapy OR periodontal treatment OR root scaling OR periodontal debridement OR root planing OR oral hygiene) AND (chronic obstructive pulmonary disease OR chronic bronchitis OR emphysema OR COPD) | Publication Years 2000–2020 Document Types Article Language English | 161 |
Proquest Dissertation and Theses Global | (Periodontitis OR periodontal disease OR gum disease OR periodontal health OR periodontal therapy OR periodontal treatment OR root scaling OR periodontal debridement OR root planing OR oral hygiene) AND (chronic obstructive pulmonary disease OR chronic bronchitis OR emphysema OR COPD) | Publication Date 01/01/2020–31/03/20 Limit to Title and Abstract English Language | 124 |
Google Scholar | ("Periodontitis" OR "periodontal disease" OR "periodontal health" OR "periodontal therapy" OR "periodontal treatment" OR "root scaling" OR "root planing" OR "oral hygiene") AND ("COPD" OR "chronic obstructive pulmonary disease") | Limit to Title English language Publication Date 2000–2020 | 66 |
Eligibility criteria
Definitions, interventions and outcomes measures
Data management, study selection and data extraction
Risk of bias in individual studies
Risk of bias across studies
Summary measures and synthesis of results
Results
Study selection and characteristics
First author/year/Country [Ref.] | Study design | Study population | Study groups | Periodontal interventions | Outcomes/associations | Follow up period | Results |
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Das/2017/India [27] | Randomized controlled trial | 35 COPD patients with CP | Periodontal treatment, n = 17 No treatment, n = 18 | Mouth scaling and root planning with hand instruments versus no treatment | SGRQ | 1 year | Treatment group: improvement in the SGRQ “activity” subscore (53.68 ± 16.37 vs. 38.20 ± 13.18; p = 0.005) Control group: no change in SGRQ |
Madalli/2016/India [33] | Before-after treatment prospective cohort | 30 COPD patients with CP | N/A | Supragingival scaling | FEV1/FVC | 3–5 months | No significant improvement in FEV1/FVC |
Shen/2016/Taiwan [30] | Retrospective propensity-matched case–control | 11,124 COPD patients with CP | Periodontal treatment, n = 5562 No treatment, n = 5562 | Subgingival curettage and root planning and/or invasive periodontal flap surgery versus no treatment | ER visits for COPD exacerbation Hospitalizations for adverse respiratory events ICU admissions All-cause mortality | 5 years from inclusion Occurrence of an adverse respiratory event Death Withdrawal from the insurance system | ER visits per 100 person-years for COPD exacerbation: 2.54 ( treatment group) versus 2.88 (control group); adjusted IRR of 0.86 (95% CI 0.78–0.94; p < 0.001) Hospitalizations for adverse respiratory events per 100 person-years: 2.75 (treatment group) versus 3.65 (control group); adjusted IRR 0.74 (95% CI 0.69–0.80; p < 0.001) ICU admissions per 100 person-years: 0.66 (treatment group) versus 0.75 (control group); adjusted IRR 0.84 (95% CI 0.75–0.94; p < 0.01) All-cause mortality per 100 person-years: 1.81 (treatment group) versus 2.87 (control group); adjusted rate ratio 0.57 (95% CI 0.52–0.62; p < 0.001) |
Zhou/2014/China [29] | Randomized controlled trial | 30 moderate-to-severe COPD patients | Supragingival scaling, root planning and maintenance care (SRP group), n = 20 Supragingival scaling and maintenance care (scaling group), n = 20 No treatment (control group), n = 20 | SRP versus scaling versus no treatment | FEV1 (% predicted), FEV1/FVC Proportion of frequent exacerbations (≥ 2/year) | 2 years | Control group lung function compared to baseline Lower FEV1 at 2 years (56.3 ± 16.4 vs. 51.6 ± 18.4, p < 0.05) Lower FEV1/FVC at 1 and 2 years (0.55 ± 0.11 vs. 0.54 ± 0.11 vs. 0.53 ± 0.11; p < 0.05) SRP versus control group Higher FEV1 at 1 year (55.9 ± 16 vs. 53.6 ± 18.7; p < 0.05) and at 2 years (57.1 ± 19 vs. 51.6 ± 18.4; p < 0.05) Higher FEV1/FVC at 1 year (0.59 ± 0.09 vs. 0.54 ± 0.11; p < 0.05) and at 2 years (0.57 ± 0.10 vs. 0.53 ± 0.11; p < 0.05) Scaling versus control group: Higher FEV1 at 1 year (59.6 ± 17.1 vs. 53.6 ± 18.7, p < 0.005) Higher FEV1/FVC at 2 years (0.56 ± 0.11 vs. 0.53 ± 0.11, p < 0.05) Proportion of frequent exacerbations in SRP versus scaling versus control group 30% versus 15.8% versus 66.7%; p < 0.004 Adjusted OR for frequent exacerbations SRP group: 0.29, (95% CI 0.10–0.84; p = 0.02) Scaling group: 0.004 (95% CI 0.003–0.64; p = 0.02) No differences in lung function and exacerbations between the 2 treatment groups |
Kucukcoskun/2013/ Turkey [31] | Prospective case–control | 40 COPD patients with CP and ≥ 1 exacerbation in the previous year | Periodontal treatment, n = 20 No treatment, n = 20 | Full-mouth scaling and root planning with hand instruments and ultrasonic devices | Exacerbation frequency in 12 months Number of hospitalizations | 12 months | Exacerbation frequency per patient-year: 1.95 (treatment group) versus 3.25 (control group) Exacerbation frequency decreased in treatment group (3 ± 1.83 vs. 1.95 ± 1.46; p = 0.01) but remained unchanged in the control group (3.5 ± 4.62 vs. 3.25 ± 3.35; p = NS) Hospitalizations increased from 4/year to 7/year in the treatment group and from 10/year to 12/year in the control group |
Agado/2012/USA [28] | Randomized controlled trial | 30 COPD patients with CP | Periodontal debridement with ultrasonic device, n = 10 Periodontal debridement with hand instruments, n = 10 No treatment, n = 10 | Periodontal debridement | SGRQ-A 5-point Likert scale of health status self-perception 7-item illness questionnaire | 4–6 weeks | No improvement in SGRQ-A, health status self-perception and illness questionnaire post treatment |
Liu/2012/China [32] | Cross-sectional | 392 COPD patients | Frequent exacerbators (≥ 2 events/year), n = 183 Infrequent exacerbators (< 2 events/year), n = 209 | Supragingival scaling ≥ 1/year, n = 15 < 1/year, n = 377 | Correlation between periodontal/oral health and its treatment and frequency of COPD exacerbations | N/A | Risk factors for frequent exacerbations ≤ 25 remaining teeth (adjusted OR 1.69, 95% CI 1.03–2.77; p = 0.04) < 1 daily brushing frequency (adjusted OR 4.19, 95% CI 1.44–12.1; p = 0.008) |
Risk of bias within studies
Results of data synthesis
Quality of life
Lung function
COPD exacerbations
Secondary outcomes
Periodontal outcomes
Periodontal pathogens, hospitalizations, mortality and comorbidities.
Risk of bias across studies
Periodontal therapy compared to no periodontal therapy in patients with PD and COPD | |||
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Patient or population: patients with PD and COPD Setting: university clinics and Hospitals (India, Taiwan, China, Turkey and USA) Intervention: periodontal therapy Comparison: no periodontal therapy | |||
Outcome no. of participants (studies) | Impact | Certainty | What happens with periodontal therapy |
Exacerbations of COPD assessed with: exacerbation frequency No. of participants: 11,616 (4 studies) | In one study, acute exacerbation rate was 2.54 versus 2.88 per 100 person-years for emergency room use, [adjusted IRR = 0.86 (95% CI 0.78–0.94, p < 0,001)] and 1.36 versus 1.71 per 100 person-years for hospitalizatios, [adjusted IRR = 0.78 (95% CI 0.72–0.85, p < 0,001)] In another study, proportion of frequent exacerbations was statistical significantly (p < 0.004) lower in periodontal therapy group at 2-years follow up In the third study, frequency of exacerbations was 1.95 per patient-years compared to 3.25 in the control group (p = 0.01) In the last study, although supragingival scaling < 1time/year was associated with higher proportion of patients with frequent exacerbations, in the adjusted model no statistical significance was obtained (OR = 2.23, 95% CI: 0.58–8.59, p = 0.24) | ⨁⨁⨁◯ MODERATEa,b,c | Probably reduces frequency of exacerbations of COPD |
Quality of life assessed with: SGRQ follow up: range 4 weeks to 1 years No. of participants: 65 (2 studies) | In one study SGRQ domain scores were lower in study group at one year follow up(p < 0.05 only for activity domain score) In another study, SGRQ and illness Questionnaire responses showed no significant difference between groups | ⨁◯◯◯ VERY LOWc,d | Too heterogenous response to synthesize across studies |
Lung function assessed with: FEV1, FEV1/FVC follow up: range 3 months to 2 years No. of participants: 116 (2 studies) | In one study, although FEV1/FVC mean value increased, no statistical significance was obtained In another study, FEV1 increased statistical significantly in one year follow up for both periodontal therapy groups(p = 0.03), but only for SRP group in two years follow up. FEV1/FVC increased statistical significantly in two years follow up for both periodontal therapy groups(p = 0.02), but only for SRP group in one year follow up (p = 0.04) | ⨁◯◯◯ VERY LOWc,e | Too heterogenous response to synthesize across studies |