Cochrane · intervention · CD009197
Periodontal therapy for primary or secondary prevention of cardiovascular disease in people with periodontitis
Ye, Z, Cao, Y, Miao, C, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
11
current version
GRADE rated
7
No studies
2
Included studies
2
as reported
No studies 2 · 18.2%Ungraded 2 · 18.2%Very low 7 · 63.6%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | We considered trials with participants who met the following criteria, regardless of age, sex, race, social or economic status. 1. Diagnosis of at least moderate chronic periodontitis with pocketing greater than or equal to 4 mm. 2. Absence of any known genetic or congenital heart defects and aggressive periodontitis. 3. For primary prevention, no existing or previous diagnosis of CVD (including angina, myocardial infarction, stroke); for secondary prevention, an existing or previous diagnosis of CVD. 4. Absence of other sources of inflammation, such as pulpal infections and active caries. 5. No periodontal treatment within preceding six months (participants should have active disease and not be in a periodontal maintenance programme). We did not include participants for whom periodontal therapy was contraindicated (including pregnant or lactating women, people with severe systemic diseases other than CVD), or participants who were unable to complete assessments during the follow-up period. | We included two RCTs in this review. One primary prevention study, which was a parallel-arm, double-blind RCT of one-year duration, in 165 participants with metabolic syndrome and periodontitis. One secondary prevention study, which was a multi-centre, parallel-group, single-blind RCT, with 303 participants randomised into a periodontal therapy group or community care group. |
| Intervention | Experimental: periodontal therapy of subgingival scaling and root planing (SRP), or SRP in combination with systemic antibiotic or host modulation, with or without other active remedies. | Scaling and root planing plus antibiotics (n=83); Periodontal treatment (n=151) |
| Comparison | Control: maintenance therapy (supragingival scaling, antimicrobial rinses), or no periodontal treatment, with or without the same basic remedies as those in the intervention group. | Supragingival scaling (n=82); Community care (n=152) |
| Outcomes | Primary outcomes: 1. All-cause and CVD-related death. 2. All cardiovascular events (angina, myocardial infarction, stroke). Secondary outcomes: 1. Modifiable cardiovascular risk factors: blood pressure; lipids including cholesterol, triglycerides, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, high-density lipoprotein cholesterol. 2. Blood test results, including serum levels of high-sensitivity C-reactive protein (hs-CRP), apolipoprotein-A, apolipoprotein-B. 3. Heart function parameters (such as ejection fraction). 4. Revascularisation procedures. 5. Adverse events due to periodontal therapy (e.g. tooth sensitivity, mouth discomfort). | All-cause death (n=165); All CVD-related death (n=165); All cardiovascular events (n=468); Serum high-sensitivity C-reactive protein (n=37); Number of participants who had high CRP (n=37); Adverse events due to periodontal therapy (n=468) |
| Study designs | We included randomised controlled trials (RCT) that aimed to test the effects of different periodontal therapies for people diagnosed with chronic periodontitis, with or without cardiovascular disease (CVD), with follow-up times of at least one year. | NR |
| Timing | We considered only long-term outcomes, i.e. those measured at one year or more. | The participants were observed for 12 months in the primary prevention study and for between 6 and 25 months in the secondary prevention study. |
Search date: 2021-11. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; CINAHL EBSCO; OpenGrey; Chinese BioMedical Literature Database (CBM); China National Knowledge Infrastructure (CNKI); VIP; US National Institutes of Health Trials Register;…
Questions and results
Current version onlyScaling and root planing (SRP) plus antibiotics (amoxicillin and metronidazole) vs Supragingival scaling (plus placebo)
Population: People with periodontitis and metabolic syndrome (no CVD; primary prevention)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events due to periodontal therapy 12 months | Peto OR 0.14 [0.00, 6.90] | 1 study · 165 participants | Very low Downgraded: risk of bias, imprecision |
All CVD-related death 12 months | Peto OR 7.48 [0.15, 376.98] 12 per 1000 vs 71 per 1000 | 1 study · 165 participants | Very low Downgraded: risk of bias, imprecision |
All cardiovascular events 12 months | Peto OR 7.77 [1.07, 56.1] 49 per 1000 vs 237 per 1000 | 1 study · 165 participants | Very low Downgraded: risk of bias, imprecision |
All-cause death 12 months | Peto OR 7.48 [0.15, 376.98] 12 per 1000 vs 71 per 1000 | 1 study · 165 participants | Very low Downgraded: risk of bias, imprecision |
C-reactive protein (CRP) 12 months | beta coefficient -0.002 [-0.19, 0.20] | 1 study | Very low Downgraded: risk of bias, imprecision |
Fibrinogen 12 months | beta coefficient 10.9 [-12.0, 33.8] | 1 study | Very low Downgraded: risk of bias, imprecision |
Periodontal treatment: scaling and root planing (SRP) plus advice vs Community care: advice only
Population: People with cardiovascular disease and chronic periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All-cause death | SoF row 'All-cause death': Outcome not reported. Results 2.1.1: Not reported. | 0 studies | No studies |
All cardiovascular events 6 to 25 months | All cardiovascular events (Follow-up: 6 to 25 months): One study of 303 participants assessed this outcome; however, we considered data were unreliable as participants were followed up for different lengths of time,… | 1 study · 303 participants | Very low Downgraded: risk of bias |
All CVD-related death | SoF row 'All CVD-related death': Outcome not reported. Results 2.1.2: Not reported. | 0 studies | No studies |
Adverse events due to periodontal therapy 6 to 25 months | Adverse events: because of variable follow-up (6 to 25 months) and almost 90% loss to follow-up by one year, results were not considered useful for analysis; uncertain whether adverse events are more likely with either… | 1 study · 303 participants | Ungraded |
Serum high-sensitivity C-reactive protein (hs-CRP) 12 months | Serum hs-CRP tested at one year; as loss to follow-up was almost 90%, data not considered useful for analysis (no usable estimate). | 1 study · 37 participants | Ungraded |
Scaling and root planing (SRP) plus antibiotics (amoxicillin and metronidazole) vs Supragingival scaling (plus placebo)
Population: People with periodontitis and metabolic syndrome (no CVD; primary prevention)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All CVD-related death 12 months | Peto OR 7.48 [0.15, 376.98] 12 per 1000 vs 71 per 1000 | 1 study · 165 participants | Very low Downgraded: risk of bias, imprecision |
C-reactive protein (CRP) 12 months | beta coefficient -0.002 [-0.19, 0.20] | 1 study | Very low Downgraded: risk of bias, imprecision |
Fibrinogen 12 months | beta coefficient 10.9 [-12.0, 33.8] | 1 study | Very low Downgraded: risk of bias, imprecision |
All-cause death 12 months | Peto OR 7.48 [0.15, 376.98] 12 per 1000 vs 71 per 1000 | 1 study · 165 participants | Very low Downgraded: risk of bias, imprecision |
All cardiovascular events 12 months | Peto OR 7.77 [1.07, 56.1] 49 per 1000 vs 237 per 1000 | 1 study · 165 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events due to periodontal therapy 12 months | Peto OR 0.14 [0.00, 6.90] | 1 study · 165 participants | Very low Downgraded: risk of bias, imprecision |
Periodontal treatment: scaling and root planing (SRP) plus advice vs Community care: advice only
Population: People with cardiovascular disease and chronic periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Serum high-sensitivity C-reactive protein (hs-CRP) 12 months | Serum hs-CRP tested at one year; as loss to follow-up was almost 90%, data not considered useful for analysis (no usable estimate). | 1 study · 37 participants | Ungraded |
All CVD-related death | SoF row 'All CVD-related death': Outcome not reported. Results 2.1.2: Not reported. | 0 studies | No studies |
All cardiovascular events 6 to 25 months | All cardiovascular events (Follow-up: 6 to 25 months): One study of 303 participants assessed this outcome; however, we considered data were unreliable as participants were followed up for different lengths of time,… | 1 study · 303 participants | Very low Downgraded: risk of bias |
All-cause death | SoF row 'All-cause death': Outcome not reported. Results 2.1.1: Not reported. | 0 studies | No studies |
Adverse events due to periodontal therapy 6 to 25 months | Adverse events: because of variable follow-up (6 to 25 months) and almost 90% loss to follow-up by one year, results were not considered useful for analysis; uncertain whether adverse events are more likely with either… | 1 study · 303 participants | Ungraded |
Active periodontal therapy (scaling and root planing, alone or with systemic antibiotic or host modulation) vs Maintenance therapy (supragingival scaling, antimicrobial rinses), no periodontal treatment, or a different periodontal treatment
Population: People with chronic periodontitis and no CVD (primary prevention)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | No study addressing primary prevention was identified. | 0 studies | No studies |
Periodontal treatment: scaling and root planing (SRP) plus advice vs Community care: advice only
Population: Patients with cardiovascular disease and chronic periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events due to periodontal therapy 6 to 25 months | RR 9.06 [0.49, 166.82] | 1 study · 303 participants | Ungraded |
All cardiovascular events 6 to 25 months | RR 0.72 [0.23, 2.22] 46 per 1000 vs 33 per 1000 | 1 study · 303 participants | Very low Downgraded: risk of bias, imprecision |
Number of participants with high hs-CRP (>3 mg/l) 12 months | RR 0.77 [0.32, 1.85] | 1 study · 37 participants | Ungraded |
Serum high-sensitivity C-reactive protein (hs-CRP) 12 months | MD 0.62 [-1.45, 2.69] | 1 study · 37 participants | Ungraded |
All-cause death | SoF row 'All-cause and CVD-related death': Outcomes not reported. Results 2.1.1 All-cause death: Not reported. | 0 studies | No studies |
All CVD-related death | SoF row 'All-cause and CVD-related death': Outcomes not reported. Results 2.1.2 All CVD-related death: Not reported. | 0 studies | No studies |
Active periodontal therapy (scaling and root planing, alone or with systemic antibiotic or host modulation) vs Maintenance therapy (supragingival scaling, antimicrobial rinses), no periodontal treatment, or a different periodontal treatment
Population: People with chronic periodontitis and no CVD (primary prevention)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | No study addressing primary prevention was identified. | 0 studies | No studies |
Periodontal treatment: scaling and root planing (SRP) plus advice vs Community care: advice only
Population: Patients with cardiovascular disease and chronic periodontitis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events due to periodontal therapy 6 to 25 months | RR 9.06 [0.49, 166.82] | 1 study · 303 participants | Ungraded |
All CVD-related death | SoF row 'All-cause and CVD-related death': Outcomes not reported. Results 2.1.2 All CVD-related death: Not reported. | 0 studies | No studies |
Number of participants with high hs-CRP (>3 mg/l) 12 months | RR 0.77 [0.32, 1.85] | 1 study · 37 participants | Ungraded |
All-cause death | SoF row 'All-cause and CVD-related death': Outcomes not reported. Results 2.1.1 All-cause death: Not reported. | 0 studies | No studies |
All cardiovascular events 6 to 25 months | RR 0.72 [0.23, 2.22] 46 per 1000 vs 33 per 1000 | 1 study · 303 participants | Very low Downgraded: risk of bias, imprecision |
Serum high-sensitivity C-reactive protein (hs-CRP) 12 months | MD 0.62 [-1.45, 2.69] | 1 study · 37 participants | Ungraded |
Active periodontal therapy (scaling and root planing, alone or with systemic antibiotic or host modulation) vs Maintenance therapy (supragingival scaling, antimicrobial rinses), no periodontal treatment, or a different periodontal treatment
Population: People with chronic periodontitis and no CVD (primary prevention)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Protocol: primary prevention of CVD planned; no results at protocol stage. | 0 studies | No studies |
Active periodontal therapy (scaling and root planing, alone or with systemic antibiotic or host modulation) vs Maintenance therapy (supragingival scaling, antimicrobial rinses), no periodontal treatment, or a different periodontal treatment
Population: People with chronic periodontitis and existing or previous CVD (secondary prevention)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Protocol: secondary prevention of CVD planned; no results at protocol stage. | 0 studies | No studies |