Non-Cochrane · aetiology · PM41663384
Linking lungs and gums: a meta-analysis of periodontitis prevalence and severity in chronic obstructive pulmonary disease.
Sivaramakrishnan Gowri, Sridharan Kannan · BDJ open · 2026 · PubMed · doi:10.1038/s41405-026-00403-6
Findings
32 findings
| Population | ||||
|---|---|---|---|---|
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Prevalence of severe periodontitis COPD group with less than 50% smokers | Prevalence (proportion) 0.18 [0.07, 0.30] GRADE not reported 4 studies · 8027 participants |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Periodontitis prevalence (all categories combined) COPD group with more than 50% smokers | Prevalence (proportion) 0.44 [0.31, 0.57] GRADE not reported 9 studies · 7286 participants |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Periodontitis prevalence (all categories combined) Cohort studies | Prevalence (proportion) 0.37 [0.12, 0.63] GRADE not reported 4 studies · 3931 participants |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Prevalence of periodontitis (severity not specified) COPD group with more than 50% smokers | Prevalence (proportion) 0.59 [0.38, 0.80] GRADE not reported 6 studies · 3779 participants |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Prevalence of moderate periodontitis | Prevalence (proportion) 0.25 [0.16, 0.34] GRADE not reported 6 studies · 4204 participants |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Prevalence of severe periodontitis COPD group with more than 50% smokers | Prevalence (proportion) 0.34 [0.18, 0.50] GRADE not reported 4 studies · 2571 participants |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Periodontitis prevalence (all categories combined) Cross-sectional studies | Prevalence (proportion) 0.38 [0.28, 0.47] GRADE not reported 8 studies · 14378 participants |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Prevalence of severe periodontitis | Prevalence (proportion) 0.26 [0.15, 0.37] GRADE not reported 8 studies · 10598 participants |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Periodontitis prevalence (all categories combined) Trim-and-fill adjusted (6 studies imputed) | Prevalence (proportion) 0.22 [0.09, 0.34] GRADE not reported Studies not reported |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Prevalence of periodontitis (severity not specified) | Prevalence (proportion) 0.59 [0.38, 0.80] GRADE not reported 6 studies · 3779 participants |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Periodontitis prevalence (all categories combined) COPD group with less than 50% smokers | Prevalence (proportion) 0.19 [0.12, 0.26] GRADE not reported 4 studies · 11295 participants |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Prevalence of moderate periodontitis COPD group with less than 50% smokers | Prevalence (proportion) 0.21 [0.14, 0.27] GRADE not reported 3 studies · 3268 participants |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Prevalence of moderate periodontitis COPD group with more than 50% smokers | Prevalence (proportion) 0.30 [0.13, 0.46] GRADE not reported 3 studies · 936 participants |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Periodontitis prevalence (all categories combined) Case-control studies | Prevalence (proportion) 0.16 [0.11, 0.21] GRADE not reported 1 study · 272 participants |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Periodontitis prevalence (all categories combined) Leave-one-out sensitivity analysis | Leave-one-out sensitivity analysis demonstrated that the pooled prevalence ranged from 33% to 37% when each study was omitted one at a time GRADE not reported 13 studies |
| Patients with COPD | COPD (exposure group; single-group prevalence) | Not applicable (no comparator) | Periodontitis prevalence (all categories combined) | Prevalence (proportion) 0.35 [0.25, 0.45] GRADE not reported 13 studies · 18581 participants |
| Patients with COPD and participants without COPD | COPD | Without COPD | Odds of CAL > 3 mm (number of patients) | OR 2.45 [1.39, 4.33] GRADE not reported 7 studies · 25928 participants |
| Patients with COPD and participants without COPD | COPD | Without COPD | Periodontitis (odds in COPD vs non-COPD) Trim-and-fill adjusted (3 studies imputed) | OR 1.13 [0.66, 1.91] Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias 6 studies · 36197 participants |
| Patients with COPD and participants without COPD | COPD | Without COPD | Mean probing (pocket) depth (PD) | SMD 0.72 [0.12, 1.31] Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias 16 studies · 14845 participants |
| Patients with COPD and participants without COPD | COPD | Without COPD | Odds of PD > 5 mm (number of patients) | OR 1.60 [0.92, 2.76] GRADE not reported 4 studies · 9499 participants |
| Patients with COPD and participants without COPD | COPD | Without COPD | Periodontitis (odds in COPD vs non-COPD) Severe periodontitis | OR 1.13 [0.76, 1.68] GRADE not reported 2 studies · 11673 participants |
| Patients with COPD and participants without COPD | COPD | Without COPD | Mean clinical attachment loss (CAL) Trim-and-fill adjusted (2 studies imputed) | SMD 0.49 [0.12, 0.87] Low Downgraded: risk of bias, imprecision, inconsistency, publication bias 18 studies · 29271 participants |
| Patients with COPD and participants without COPD | COPD | Without COPD | Periodontitis (odds in COPD vs non-COPD) | OR 1.66 [1.11, 2.48] Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias 6 studies · 36197 participants |
| Patients with COPD and participants without COPD | COPD | Without COPD | Mean probing (pocket) depth (PD) Leave-one-out sensitivity analysis | Leave-one-out sensitivity analysis (Supplementary File 13) further supported this finding, consistently showing significantly greater mean PD in COPD patients when each study was omitted one at a time. GRADE not reported 16 studies |
| Patients with COPD and participants without COPD | COPD | Without COPD | Mean bleeding on probing (BOP) | SMD 1.49 [0.19, 2.79] Low Downgraded: risk of bias, inconsistency 3 studies · 258 participants |
| Patients with COPD and participants without COPD | COPD | Without COPD | Periodontitis (odds in COPD vs non-COPD) Periodontitis (severity not specified) | OR 2.03 [1.25, 3.28] GRADE not reported 4 studies · 12851 participants |
| Patients with COPD and participants without COPD | COPD | Without COPD | Periodontitis (odds in COPD vs non-COPD) Moderate periodontitis | OR 1.69 [0.42, 6.70] GRADE not reported 2 studies · 11673 participants |
| Patients with COPD and participants without COPD | COPD | Without COPD | Mean clinical attachment loss (CAL) Leave-one-out sensitivity analysis | Leave-one-out sensitivity analysis further supported this finding, consistently showing significantly greater mean CAL in COPD patients when each study was omitted one at a time. GRADE not reported 18 studies |
| Patients with COPD and participants without COPD | COPD | Without COPD | Mean clinical attachment loss (CAL) | SMD 0.68 [0.37, 0.98] Low Downgraded: risk of bias, imprecision, inconsistency, publication bias 18 studies · 29271 participants |
| Patients with COPD and participants without COPD | COPD | Without COPD | Periodontitis (odds in COPD vs non-COPD) Leave-one-out sensitivity analysis | Leave-one-out sensitivity analysis further confirmed this association, showing consistently elevated odds ranging from 1.4 to 1.7 when each study was omitted one at a time GRADE not reported 6 studies |
| Patients with COPD and participants without COPD | COPD | Without COPD | Mean probing (pocket) depth (PD) Trim-and-fill adjusted (3 studies imputed) | SMD 0.24 [-0.54, 1.01] Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias 16 studies · 14845 participants |
| Patients with COPD and participants without COPD | COPD | Without COPD | Odds of PD > 3 mm (number of patients) | OR 2.05 [1.62, 2.60] GRADE not reported 5 studies · 25233 participants |
Included primary studies 42
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Prasanna 2011 Causal relationship between periodontitis and chronic obstructive pulmonary disease. PMID:22368360 | 2011 | 1 other review | not stated | not extracted yet |
| Baldomero 2019 The relationship between oral health and COPD exacerbations. PMID:31114185 | 2019 | this review only | not stated | not extracted yet |
| Barros 2013 A cohort study of the impact of tooth loss and periodontal disease on respiratory events among COPD subjects: modulatory role of systemic… PMID:23950871 | 2013 | this review only | not stated | not extracted yet |
| Bergstrom 2013 Dental health in smokers with and without COPD. PMID:23544074 | 2013 | this review only | not stated | not extracted yet |
| Bomble 2020 Association of periodontal status with lung function in patients with and without chronic obstructive pulmonary disease visiting a medical… PMID:31983848 | 2020 | this review only | not stated | not extracted yet |
| Chrysanthakopoulos 2014 Association between indices of clinically-defined periodontitis and self-reported history of systemic medical conditions. PMID:25048420 | 2016 | this review only | not stated | not extracted yet |
| Chrysanthakopoulos 2020 Different pathways lead to mitochondrial fragmentation during apoptotic and excitotoxic cell death in primary neurons. PMID:20201108 | 2010 | this review only | not stated | not extracted yet |
| Chung 2016 Associations Between Periodontitis and Chronic Obstructive Pulmonary Disease: The 2010 to 2012 Korean National Health and Nutrition… PMID:26912338 | 2016 | this review only | not stated | not extracted yet |
| Deo 2009 Periodontitis as a potential risk factor for chronic obstructive pulmonary disease: a retrospective study. PMID:20139573 | 2009 | this review only | not stated | not extracted yet |
| Gupta 2020 Association between periodontal disease and chronic obstructive pulmonary disease: A case–control study DOI:10.4103/ijds.ijds_89_20 | 2020 | this review only | not stated | not extracted yet |
| Gupta 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Harland 2018 Periodontitis modifies the association between smoking and chronic obstructive pulmonary disease in Japanese men. PMID:29925707 | 2018 | this review only | not stated | not extracted yet |
| Henke 2016 Lung function and associations with multiple dimensions of dental health: a prospective observational cross-sectional study. PMID:27184138 | 2016 | this review only | not stated | not extracted yet |
| Hyman 2004 Cigarette smoking, periodontal disease: and chronic obstructive pulmonary disease. PMID:15025211 | 2004 | this review only | not stated | not extracted yet |
| Javaheri 2020 Periodontal Status, Its Treatment Needs, and Its Relationship with Airflow Limitation and Quality of Life in COPD Patients. PMID:33209078 | 2020 | this review only | not stated | not extracted yet |
| Jung 2020 Association between oral health status and chronic obstructive pulmonary disease in Korean adults. PMID:31802488 | 2020 | this review only | not stated | not extracted yet |
| Katancik 2005 Periodontitis and airway obstruction. PMID:16277589 | 2005 | this review only | not stated | not extracted yet |
| Kedlaya 2021 Comparative evaluation of serum cotinine levels in chronic periodontitis and chronic obstructive pulmonary disease. PMID:34667383 | 2021 | this review only | not stated | not extracted yet |
| Komerik 2005 Oral health in patients on inhaled corticosteroid treatment. PMID:16120117 | 2005 | this review only | not stated | not extracted yet |
| Kucukcoskun 2013 Initial periodontal treatment for prevention of chronic obstructive pulmonary disease exacerbations. PMID:23003917 | 2013 | this review only | not stated | not extracted yet |
| Ledic 2013 Periodontal disease increases risk for chronic obstructive pulmonary disease. PMID:24308240 | 2013 | this review only | not stated | not extracted yet |
| Liu 2012 Oral hygiene, periodontal health and chronic obstructive pulmonary disease exacerbations. PMID:22092913 | 2012 | this review only | not stated | not extracted yet |
| Liu 2023 Association between symptoms of severe periodontitis and post-bronchodilator lung function: results from the China pulmonary health study. PMID:37330486 | 2023 | this review only | not stated | not extracted yet |
| Lopez-de-Andres 2018 Is COPD associated with periodontal disease? A population-based study in Spain. PMID:30425473 | 2018 | this review only | not stated | not extracted yet |
| Offenbacher 2012 Obstructive airway disease and edentulism in the atherosclerosis risk in communities (ARIC) study. PMID:23253873 | 2012 | this review only | not stated | not extracted yet |
| Oztekin 2014 The association between periodontal disease and chronic obstructive pulmonary disease: a case control study. PMID:24378084 | 2014 | this review only | not stated | not extracted yet |
| Peter 2013 Association between periodontal disease and chronic obstructive pulmonary disease: a reality or just a dogma? PMID:23339345 | 2013 | this review only | not stated | not extracted yet |
| Raj 2018 The effect of 6 months or longer duration of chronic obstructive respiratory disease medication on the oral health parameters of adults. PMID:29603344 | 2018 | this review only | not stated | not extracted yet |
| Sanghavi 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Sapey 2019 The clinical and inflammatory relationships between periodontitis and chronic obstructive pulmonary disease. PMID:32567697 | 2020 | this review only | not stated | not extracted yet |
| Sathyanarayana 2023 Periodontal health status among chronic obstructive pulmonary disease with age- and gender-matched controls. PMID:37781331 | 2023 | this review only | not stated | not extracted yet |
| Scannapieco 2001 Potential associations between chronic respiratory disease and periodontal disease: analysis of National Health and Nutrition Examination… PMID:11210073 | 2001 | this review only | not stated | not extracted yet |
| Sepolia 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Si 2012 Association between periodontitis and chronic obstructive pulmonary disease in a Chinese population. PMID:22248220 | 2012 | this review only | not stated | not extracted yet |
| Subappa 2023 Unmasking the Silent Threat: Periodontal Health's Impact on COPD Severity and Hospitalization. PMID:38138940 | 2023 | this review only | not stated | not extracted yet |
| Takeuchi 2019 Periodontitis Is Associated with Chronic Obstructive Pulmonary Disease. PMID:30848974 | 2019 | this review only | not stated | not extracted yet |
| Tan 2019 Relationship among clinical periodontal, microbiologic parameters and lung function in participants with chronic obstructive pulmonary… PMID:30086190 | 2019 | this review only | not stated | not extracted yet |
| Tereshima 2016 The association between dental health and nutritional status in chronic obstructive pulmonary disease. PMID:27056058 | 2017 | this review only | not stated | not extracted yet |
| Wang 2009 Periodontal health, oral health behaviours, and chronic obstructive pulmonary disease. PMID:19614723 | 2009 | this review only | not stated | not extracted yet |
| Winning 2019 Periodontitis and airflow limitation in older Swedish individuals. PMID:32246489 | 2020 | this review only | not stated | not extracted yet |
| Yildirim 2013 Periodontal health and serum, saliva matrix metalloproteinases in patients with mild chronic obstructive pulmonary disease. PMID:22967248 | 2013 | this review only | not stated | not extracted yet |
| Zhou 2020 Periodontal Status and Microbiologic Pathogens in Patients with Chronic Obstructive Pulmonary Disease and Periodontitis: A Case-Control… PMID:32943860 | 2020 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Association between periodontal disease and chronic obstructive pulmonary disease: an umbrella review. (2026) | 1 | 0.01 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Participants with or without COPD for whom periodontal parameters (periodontitis prevalence, PD, BOP, CAL) were measured; clinical studies of patients with COPD with clear diagnostic criteria for COPD and periodontitis | Adults with COPD (n=41 studies; case groups) and non-COPD controls (n=13 prevalence studies, 18,581 COPD patients) |
| Intervention | Patients with COPD (exposure group) | COPD (41 studies; 13 prevalence, 6 odds of periodontitis, 4 BOP, 21 CAL, 19 PD) |
| Comparison | Patients without COPD, or no control group | Without COPD (controls) or no control group |
| Outcomes | Prevalence of periodontitis (primary); mean BOP, mean PD, mean CAL; number of patients with PD and CAL > 3 mm; number with PD > 5 mm | Periodontitis prevalence (13 studies, n=18,581); odds of periodontitis (6 studies); mean BOP (4); mean CAL (21); mean PD (19); CAL and PD > 3 mm and PD > 5 mm (14 studies) |
| Study designs | Observational studies (case-control, cohort, cross-sectional) and randomized and non-randomized clinical studies; peer-reviewed, any year | 41 observational studies (cross-sectional, case-control, cohort, national surveys); no randomized trials identified |
| Timing | Not specified | Not specified |