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.

Methods

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.

Results

• 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.

Conclusions

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.

Commentary

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- 16^th 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.

Links

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 – 16^th Dec 2013 – Periodontal treatment improved several biomarkers of atherosclerotic disease