Non-Cochrane · aetiology · PM42728586
Grading the evidence for the association between periodontal disease and chronic non-communicable diseases: an umbrella review of meta-analyses of observational studies.
Liu Haozhu, Bai Xiao, Wang Yuanfang, et al. · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-09402-3
Findings
65 findings
| Population | ||||
|---|---|---|---|---|
| People in observational studies | Periodontal disease | No periodontal disease | Breast cancer | RR 1.22 [1.06, 1.40] GRADE not reported 11 studies · 173162 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Oral cancer Objective clinical/radiographic definition | OR 2.57 [1.49, 4.44] GRADE not reported 4 studies |
| People in observational studies | Periodontal disease | No periodontal disease | Helicobacter pylori Infection | OR 2.46 [2.01, 3.01] GRADE not reported 25 studies · 8638 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Hematopoietic and lymphatic cancers | RR 1.16 [1.04, 1.29] GRADE not reported 6 studies · 436893 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Depression | RR 1.07 [0.95, 1.21] GRADE not reported 5 studies · 29266 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Esophageal cancer | HR 1.4 [1.17, 1.67] GRADE not reported 7 studies · 6887075 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Liver cancer | HR 1.09 [1.04, 1.13] GRADE not reported 3 studies · 4624350 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Low birth weight | OR 2.39 [1.70, 3.38] GRADE not reported 14 studies · 10058 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Preterm birth | OR 1.58 [1.38, 1.81] GRADE not reported 15 studies · 13781 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Gestational diabetes mellitus | OR 1.84 [1.26, 2.69] GRADE not reported 11 studies · 2032 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Colorectal cancer | HR 1.21 [1.05, 1.39] GRADE not reported 11 studies · 5042335 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Overall gastrointestinal cancer | HR 1.31 [1.16, 1.49] GRADE not reported 19 studies · 17325562 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Prostate cancer | RR 1.17 [1.06, 1.29] GRADE not reported 7 studies · 470772 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Cognitive Impairment | RR 1.27 [1.11, 1.44] GRADE not reported 10 studies · 11080 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Oral cancer | OR 2.94 [2.13, 4.07] GRADE not reported 16 studies · 7149 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Myocardial infarction | OR 1.16 [1.06, 1.27] GRADE not reported 10 studies · 5369235 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Small for gestational age | OR 1.62 [0.86, 3.06] GRADE not reported 4 studies · 3319 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Age-related macular degeneration | RR 1.35 [1.07, 1.70] GRADE not reported 5 studies · 117245 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Head and neck cancer | OR 2.20 [1.19, 4.06] GRADE not reported 5 studies · 4509 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Urogenital cancer Objective clinical/radiographic definition | HR 1.27 [1.21, 1.32] GRADE not reported 7 studies |
| People in observational studies | Periodontal disease | No periodontal disease | Total cancer Objective clinical/radiographic definition | HR 1.14 [1.05, 1.24] GRADE not reported 9 studies |
| People in observational studies | Periodontal disease | No periodontal disease | Lung cancer | RR 1.52 [1.26, 1.83] GRADE not reported 7 studies · 108056 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Total cancer Non-objective, proxy-based or mixed/unclear definition | HR 1.14 [1.10, 1.18] GRADE not reported 4 studies |
| People in observational studies | Periodontal disease | No periodontal disease | Dementia | RR 1.22 [1.04, 1.42] GRADE not reported 8 studies · 3076684 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Cognitive decline | RR 3.01 [1.56, 5.79] GRADE not reported 6 studies · 1487 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Pancreatic cancer | HR 1.35 [1.00, 1.82] GRADE not reported 10 studies · 11002082 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Urogenital cancer | HR 1.24 [1.17, 1.31] GRADE not reported 11 studies · 406895 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Diabetes mellitus | RR 1.26 [1.12, 1.41] GRADE not reported 10 studies · 405840 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Total cancer | HR 1.14 [1.08, 1.20] GRADE not reported 12 studies · 1263064 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Biliary tract cancer | HR 1.13 [0.9, 1.42] GRADE not reported 3 studies · 4624350 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Oral cancer Non-objective, proxy-based or mixed/unclear definition | OR 3.21 [2.18, 4.71] GRADE not reported 5 studies |
| People in observational studies | Periodontal disease | No periodontal disease | Bladder cancer | HR 1.09 [0.95, 1.26] GRADE not reported 4 studies · 658499 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Acute coronary syndrome | OR 1.48 [1.35, 1.63] GRADE not reported 46 studies · 6806286 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Gastric cancer | HR 1.13 [1.01, 1.26] GRADE not reported 7 studies · 4986976 participants |
| People in observational studies | Periodontal disease | No periodontal disease | Urogenital cancer Non-objective, proxy-based or mixed/unclear definition | HR 1.18 [1.00, 1.38] GRADE not reported 4 studies |
| People in observational studies | Periodontal disease | No periodontal disease | Cardiovascular disease | RR 1.19 [1.14, 1.23] GRADE not reported 26 studies · 3335840 participants |
| People in observational studies | Periodontitis | No periodontitis | Postoperative complications | OR 4.72 [1.12, 19.82] GRADE not reported 3 studies · 400 participants |
| People in observational studies | Periodontitis | No periodontitis | Implant loss | RR 0.37 [0.10, 1.40] GRADE not reported 3 studies · 518 participants |
| People in observational studies | Periodontitis | No periodontitis | Alzheimer's disease | OR 1.79 [1.15, 2.78] GRADE not reported 3 studies · 791 participants |
| People in observational studies | Periodontitis | No periodontitis | Polycystic ovarian syndrome | RR 1.46 [1.29, 1.66] GRADE not reported 3 studies · 49056 participants |
| People in observational studies | Periodontitis | No periodontitis | Inflammatory bowel disease | RR 1.15 [0.98, 1.35] GRADE not reported 10 studies · 20673300 participants |
| People in observational studies | Periodontitis | No periodontitis | Chronic obstructive pulmonary disease | OR 1.78 [1.04, 3.04] GRADE not reported 4 studies · 4145 participants |
| People in observational studies | Periodontitis | No periodontitis | Crohn's disease | RR 1.34 [1.04, 1.73] GRADE not reported 6 studies · 10272588 participants |
| People in observational studies | Periodontitis | No periodontitis | Pneumonia | OR 3.21 [1.99, 5.17] GRADE not reported 3 studies · 666 participants |
| People in observational studies | Periodontitis | No periodontitis | Liver disease | RR 1.46 [0.94, 2.26] GRADE not reported 3 studies · 153947 participants |
| People in observational studies | Periodontitis | No periodontitis | Stroke | HR 1.81 [1.38, 2.38] GRADE not reported 13 studies · 34261 participants |
| People in observational studies | Periodontitis | No periodontitis | Heart failure | OR 1.66 [1.26, 2.18] GRADE not reported 3 studies · 22538 participants |
| People in observational studies | Periodontitis | No periodontitis | Non-alcoholic fatty liver disease | OR 1.04 [0.97, 1.12] GRADE not reported 7 studies · 192815 participants |
| People in observational studies | Periodontitis | No periodontitis | Peri-implantitis | RR 0.23 [0.11, 0.47] GRADE not reported 3 studies · 518 participants |
| People in observational studies | Periodontitis | No periodontitis | Asthma | OR 3.54 [2.47, 5.07] GRADE not reported 3 studies · 740 participants |
| People in observational studies | Periodontitis | No periodontitis | Peripheral vascular disease | OR 1.60 [1.41, 1.82] GRADE not reported 25 studies · 68398 participants |
| People in observational studies | Periodontitis | No periodontitis | Erectile dysfunction | OR 2.55 [1.70, 3.84] GRADE not reported 6 studies · 215008 participants |
| People in observational studies | Periodontitis | No periodontitis | Rheumatoid arthritis | RR 1.28 [1.06, 1.54] GRADE not reported 4 studies · 1618115 participants |
| People in observational studies | Periodontitis | No periodontitis | Obstructive sleep apnea | OR 2.17 [1.66, 2.83] GRADE not reported 9 studies · 30994 participants |
| People in observational studies | Periodontitis | No periodontitis | Melanoma | HR 1.21 [1.03, 1.42] GRADE not reported 3 studies · 87139 participants |
| People in observational studies | Periodontitis | No periodontitis | Dental caries | OR 1.63 [1.32, 2.01] GRADE not reported 6 studies · 39961 participants |
| People in observational studies | Periodontitis | No periodontitis | Ulcerative colitis | RR 1.00 [0.75, 1.34] GRADE not reported 6 studies · 10272588 participants |
| People in observational studies | Periodontitis | No periodontitis | Type 2 diabetes mellitus | OR 4.04 [2.48, 6.59] GRADE not reported 3 studies · 1668 participants |
| People in observational studies | Periodontitis | No periodontitis | Psoriasis | RR 1.54 [1.35, 1.75] GRADE not reported 5 studies · 312584 participants |
| People in observational studies | Periodontitis | No periodontitis | Osteoporosis | RR 1.40 [1.12, 1.76] GRADE not reported 4 studies · 2335104 participants |
| People in observational studies | Severe periodontitis | No severe periodontitis | Metabolic syndrome | OR 1.55 [1.33, 1.79] GRADE not reported 6 studies · 30687 participants |
| People in observational studies | Moderate periodontitis | No moderate periodontitis | Metabolic syndrome | OR 1.30 [1.13, 1.49] GRADE not reported 6 studies · 29785 participants |
| People in observational studies | Chronic periodontitis | No chronic periodontitis | Helicobacter pylori Infection in mouth | OR 1.87 [0.86, 4.10] GRADE not reported 4 studies · 816 participants |
| People in observational studies | Gingivitis | No gingivitis | Stroke | HR 1.93 [0.92, 4.06] GRADE not reported 6 studies · 18442 participants |
| General population (exposed versus unexposed; as defined in the representative meta-analysis) | Periodontitis | No periodontal disease (unexposed) | Obstructive sleep apnea Objective clinical/radiographic PD definition | OR 2.45 [1.72, 3.47] GRADE not reported 9 studies |
Included primary studies 66
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Chen 2021 matched by author and year (probable) | NR | 7 other reviews | not stated | not extracted yet |
| Machado 2020 Vascular lesions of the middle ear. PMID:202044 | 1977 | 3 other reviews | PM42728586-P40-O1 | not extracted yet |
| Tsimpiris 2023 Relaxation of smooth muscle following contraction elicited by sympathetic nerve stimulation in vivo. PMID:202357 | 1977 | 3 other reviews | PM42728586-P57-O1 | not extracted yet |
| Wang 2024 [Tumor induction in mice treated with hydrocortisone and innoculated with polyoma transformed hamster cells]. PMID:202419 | 1977 | 3 other reviews | Overall gastrointestinal cancer; Dental caries; Metabolic syndrome; Helicobacter pylori Infection in mouth; Stroke; PM42728586-P7-O1 | not extracted yet |
| Dewan 2024 Effect of isometric exercise on catecholamines in the coronary circulation. PMID:202452 | 1977 | 2 other reviews | PM42728586-P51-O1; PM42728586-P58-O1 | not extracted yet |
| Ma 2024 Serum lipids in angiographically assessed coronary atherosclerosis. PMID:202436 | 1978 | 2 other reviews | PM42728586-P25-O1 | not extracted yet |
| Wei 2021 Cyclic AMP and cyclic GMP accumulation in hamster pre-ovulatory follicles stimulated with LH and FSH. PMID:202132 | 1978 | 2 other reviews | PM42728586-P21-O1 | not extracted yet |
| Zhang 2025 Cell-mediated cytotoxicity: comparison of primary and secondary immune reactions after parainfluenza type 1 virus inoculation. PMID:202521 | 1978 | 2 other reviews | PM42728586-P34-O1; PM42728586-P35-O1; PM42728586-P36-O1 | not extracted yet |
| Bai 2023 [Nucléoside diphosphate kinase d'érythrocytes de boeuf. Caractéristiques cinétiques]. PMID:202338 | 1977 | 1 other review | PM42728586-P27-O1 | not extracted yet |
| Chen 2025 [The treatment of severe and recurrent nonspecific colpitis]. PMID:202550 | 1978 | 1 other review | PM42728586-P49-O1 | not extracted yet |
| Dibello 2024 Persistence of enteroviruses in sewage sludge. PMID:202416 | 1977 | 1 other review | PM42728586-P10-O1; PM42728586-P11-O1; PM42728586-P12-O1; PM42728586-P13-O1 | not extracted yet |
| Wang 2022 Rescue of host-dependent conditional lethal mutants of vaccinia and rabbitpox viruses by yaba virus. Brief report. PMID:202231 | 1977 | 1 other review | PM42728586-P19-O1 | not extracted yet |
| Xie 2018 [Cogenital goiter in a premature infant after amniography (author's transl)]. PMID:201835 | 1977 | 1 other review | PM42728586-P24-O1 | not extracted yet |
| Xu 2023 [Effect of cholesterol on membrane Na,K-activated adenosine triphosphatase]. PMID:202351 | 1977 | 1 other review | PM42728586-P50-O1 | not extracted yet |
| Zhang 2022 Electron microscopic studies on equine infectious anemia virus (EIAV). Brief report. PMID:202230 | 1977 | 1 other review | PM42728586-P16-O1; PM42728586-P17-O1; PM42728586-P18-O1 | not extracted yet |
| Arora 2009 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Arora 2010 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Babic 2015 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Chung 2016 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Chung 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Dizdar 2017 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Farook 2021 2-Hydroxyoestrogens. Chemistry, biogenesis, metabolism and physiological significance. PMID:202149 | 1977 | this review only | PM42728586-P48-O1 | not extracted yet |
| Filho 2020 The inhibitory effect of coli-endotoxin on alpha-adrenergic receptor functions in the lower urinary tract. An in vitro study in cats. PMID:202017 | 1977 | this review only | PM42728586-P37-O1; PM42728586-P38-O1; PM42728586-P39-O1 | not extracted yet |
| Gamsiz-Isik 2017 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Güven 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Heikkila 2018 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Hujoel 2003 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Kale 2018 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Kaliamoorthy 2022 The electron-transfer reaction between azurin and the cytochrome c oxidase from Pseudomonas aeruginosa. PMID:202254 | 1977 | this review only | PM42728586-P53-O1 | not extracted yet |
| Keller 2013 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Khodadadi 2022 Synthesis of glycosaminoglycans by human embryonic lung fibroblasts. Different distribution of heparan sulphate, chondroitin sulphate and… PMID:202253 | 1977 | this review only | PM42728586-P52-O1 | not extracted yet |
| Laprise 2016 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Larvin 2021 Grouping of patients with hyperparathyroidism by clinical signs, correlated to some biochemical findings. PMID:202128 | 1976 | this review only | PM42728586-P14-O1 | not extracted yet |
| Larvin 2023 A psychophysiological investigation of the short-term effects of clozapine upon sleep parameters of normal young adults. PMID:202346 | 1977 | this review only | PM42728586-P43-O1; PM42728586-P44-O1; PM42728586-P45-O1 | not extracted yet |
| Latorre 2018 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Li 2022 Properties of Aleutian disease virus assayed with feline kidney cells. PMID:202229 | 1977 | this review only | PM42728586-P15-O1 | not extracted yet |
| Loke 2015 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Lv 2020 Effects on nervous function in volunteers ingesting mevinphos for one month. PMID:202041 | 1977 | this review only | PM42728586-P30-O1 | not extracted yet |
| Ma 2020 Infectious disease syndromes attributable to cytomegalovirus and their significance among renal transplant recipients. PMID:202047 | 1977 | this review only | PM42728586-P46-O1 | not extracted yet |
| Martos 2025 Methadone blockade of 2-deoxyglucose-induced pancreatic secretion in the rat. PMID:202537 | 1978 | this review only | PM42728586-P26-O1 | not extracted yet |
| Michaud 2008 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Michaud 2016 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Michaud 2018 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Moergel 2013 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Moradi 2023 Incorporation of excess cholesterol by high density serum lipoproteins. PMID:202326 | 1978 | this review only | PM42728586-P8-O1 | not extracted yet |
| Moraes 2016 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Nwizu 2017 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Pico-Orozco 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Qin 2021 [Biological-economic study of the Clostridium perfringens cultivation processes. 1. Value of the phasic portrait in the prognosis of the… PMID:202118 | 1977 | this review only | PM42728586-P20-O1 | not extracted yet |
| Rodriguez 2022 [Occurrence of rota- and coronavirus as a cause of neonatal calf diarrhea in the Federal Republic of Germany]. PMID:202239 | 1977 | this review only | PM42728586-P28-O1 | not extracted yet |
| Romandini 2024 [Characteristics of mRNA metabolism in tumor cells. The hypothesis of the uncoupling of the processes of polyribosome formation and… PMID:202442 | 1977 | this review only | PM42728586-P31-O1 | not extracted yet |
| Rosenquist 2005 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Sales-Peres 2016 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Santos 2023 The mechanism of action of narcotic analgesics in the guinea-pig ileum. PMID:202356 | 1977 | this review only | PM42728586-P55-O1; PM42728586-P56-O1 | not extracted yet |
| Shao 2018 Supersensitivity in rat cerebral cortex: pre- and postsynaptic effects of 6-hydroxydopamine at noradrenergic synapses. PMID:201833 | 1977 | this review only | PM42728586-P22-O1 | not extracted yet |
| Shin 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Stacchi 2016 Sites of lipoprotein particles in normal rat hepatocytes. PMID:201645 | 1978 | this review only | PM42728586-P41-O1; PM42728586-P42-O1 | not extracted yet |
| Stöhr 2021 [Characterization of human reticulocytes]. PMID:202127 | 1977 | this review only | PM42728586-P9-O1 | not extracted yet |
| Tezal 2007 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Tezal 2009 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Ungprasert 2017 Methylprednisolone effects upon cytochrome oxidase activity during gingival wound healing in rats. PMID:201743 | 1977 | this review only | PM42728586-P32-O1 | not extracted yet |
| Urbina 2023 Confirming low levels of hexabromobiphenyl by gas-liquid chromatography of photolysis products. PMID:202355 | 1977 | this review only | PM42728586-P54-O1 | not extracted yet |
| Verma 2023 Effect of periodate oxidation on the properties of dopamine-beta-hydroxylase. PMID:202340 | 1977 | this review only | PM42728586-P29-O1 | not extracted yet |
| Wang 2019 Influence of structural changes in the imidazolidine ring of clonidine on hypotensive activity. PMID:201948 | 1978 | this review only | PM42728586-P47-O1 | not extracted yet |
| Wu 2020 Nelson's syndrome: case report and review of the literature. PMID:202034 | 1977 | this review only | PM42728586-P23-O1 | not extracted yet |
| Wu 2020 Viral immune complexes in systemic lupus erythematosus. C-type viral complex deposition at extrarenal sites. PMID:202072 | 1977 | this review only | PM42728586-P33-O1 | 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 question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Individuals in eligible populations without a prespecified age restriction (mostly adults) | General population; 123,680,092 participants with 1,483,017 cases across associations |
| Intervention | Periodontal disease (periodontitis, gingivitis or related periodontal conditions) as exposure | Periodontal disease, periodontitis (moderate, severe, chronic) or gingivitis |
| Comparison | No periodontal disease | No periodontal disease |
| Outcomes | Incidence or occurrence of chronic non-communicable diseases (mortality, recurrence and survival outcomes excluded) | 58 associations across nine disease categories: cancer (n=17), cardiovascular and cerebrovascular (n=7), metabolic (n=7), musculoskeletal (n=3), neuropsychiatric (n=5), gastrointestinal (n=6), perinatal (n=3), respiratory (n=4), other (n=6) |
| Study designs | Meta-analyses of observational studies; largest dataset retained for overlapping meta-analyses | 38 meta-analyses (n=38), 3 to 46 primary studies per association (median 6) |
| Timing | Database inception to 28 September 2025 | Meta-analyses published 2016 to 2025 |