An association between periodontitis and cardiovascular disease has been shown. There is also an indirect association as they share similar risk factors, eg, smoking and diabetes. Experimental studies have also demonstrated potential mechanisms by which periodontal pathogens could contribute to atheromatous formation and thrombosis. The aim of the review was to evaluate the effect of periodontal treatment in the primary and secondary prevention of cardiovascular disease (CVD) in patients with chronic periodontitis.
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 Sciencepaper Online database with no restrictions on language or date. Only randomised controlled trials (RCTs) and quasi-RCTs with follow-up times ≥ one year were considered. Standard Cochrane methodological approaches were followed.
- Only 1 trial involving 303 patients that compared scaling and root planing (SRP) with community care 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.
The authors concluded
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.
The review was only able to identify one trial that focused on the secondary prevention of CVD in patients with chronic periodontitis. The trial was considered to be at high risk of bias so the results should be interpreted with caution. We have previously looked at a review by Teeuw et al that focused on biomarkers of atherosclerotic disease (Dental Elf- 16th Dec 2013) that review included studies with shorter follow up periods ( 4-12 months), none of which reported hard clinical endpoints such as angina, myocardial infarction, stroke or death.
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 2014, Issue 8. Art. No.: CD009197. DOI: 10.1002/14651858.CD009197.pub2.
Cochrane Oral Health Group – Treating chronic gum disease can it prevent heart disease
Dental Elf – 16th Dec 2013 – Periodontal treatment improved several biomarkers of atherosclerotic disease
Hi @CochraneOHG today we blogged about your recent paper on Periodontitis and heart disease. Any thoughts? http://t.co/4WaN2dzFMD
Jury still out: Treating gum disease does not neces. help CVD. http://t.co/lU3OiYWEJp
A systematic review evaluating the effect of periodontal treatment in the prevention of cardiovascular disease. http://t.co/4WaN2dzFMD
1 trial comparing scaling and root planing with community care was included, with a potentially high risk of bias http://t.co/4WaN2dzFMD
Don’t miss: Can treating periodontitis help prevent heart disease? http://t.co/4WaN2dzFMD
The SR did not assess modifiable cardiovascular risk factors, other blood test results, or heart function parameters. http://t.co/4WaN2dzFMD
There is a paper to be published in the October issue of Hypertension next month which reports the effect of ns ScRP and changes in carotid IMT and pulse wave velocity + a host of biomarkers. Of course it doesn’t report on CV outcomes. Studies haven’t been done on this yet. Stay tuned.
these are surrogate markers. The recent ADA/AAOA guidelines on if antibiotic px is effective to prevent prosthetic joint infection following dental treatment made a strong case that surrogate markers are not to be used for causation. If it is not appropriate in that issue, then should not be used in PD/CVD issue. Plus CRP and CIMT are not considered strong risk factors for CVD, according to most recent list of definite cardiac risk factors from ACC.