Periodontitis is associated with an increased risk of the development of systemic conditions, such as cardiovascular disease, hypertension, and cognitive decline. It’s been suggested that those with periodontitis may also be more likely to have multimorbidities, such as diabetes, obesity, and rheumatoid arthritis. As life expectancy increases, multimorbidity becomes a public health concern regarding proper care, management, and coordination among specialists and primary care physicians.1
A systematic review and meta-analysis aimed to “examine and quantify the long-term risk of immune-mediated systemic conditions in people with periodontitis compared to people without periodontitis.”1
The Study
Multiple databases were searched for studies that met the inclusion criteria. Inclusion criteria included:1
- Longitudinal retrospective/prospective cohort and randomized controlled trials
- Minimum of one-year follow-up
- Explicit mention of clinically or self-reported diagnosis or signs of periodontitis
- Clearly defined classification of metabolic, autoimmune, or inflammatory diseases
- Subjected to peer-review
Exclusion criteria included:1
- Cross-sectional, case series, case-control or experimental studies
- Populations with predefined systemic disease
- Protocols, abstracts, reviews, or conference proceedings
- Lack of validated or clear diagnosis of periodontitis
- Absent or unclear definition of disease
- Estimates of risk not attainable
In total, 27 longitudinal cohort studies were used for the systematic review and meta-analysis. The included studies were published between 2008 and 2022.1
The Results
Of the reviewed articles, systemic diseases, including metabolic syndrome, diabetes, osteoporosis, rheumatoid arthritis, inflammatory bowel disease, psoriasis, and Sjogren’s syndrome, were quantified risks to determine an association with periodontitis.1
The review indicated there is a 22% higher risk of incidence of diabetes in people with periodontitis. The risk of kidney disease was two-fold higher in people with periodontitis, while the risk of liver disease increased by 50%. Most notable is that there was a 112% increased risk of liver disease in people with severe periodontitis.1
Overall, the risk of kidney disease, liver disease, and metabolic syndrome was higher than the risk of diabetes in people with periodontitis.1
People with periodontitis also displayed a 40% increased risk of osteoporosis. Further, there was a 27% increased risk of rheumatoid arthritis, a 40% to 52% increased risk of psoriasis, and a 46% increased risk of Sjogren’s syndrome.1
The findings demonstrate a dose-response relationship between the severity of periodontitis and the risk of developing diabetes, aligning with recent research that identified a non-linear trend between community periodontal index scores and diabetes incidence.1
Previous studies have also noted a similar dose-response pattern between periodontitis and cardiovascular disease risk. The results from this study did not observe a dose-response relationship for other conditions. This may be attributed to the limited number of studies reporting periodontitis severity and the resulting variability in the data.1
It could be plausible from the results of multiple studies that periodontitis may not augment the risk of an individual condition but rather increase the risk of multiple diseases.1
Conclusion
This systematic review highlights the association between periodontitis and an increased risk of developing multiple chronic conditions, a relationship that carries significant clinical implications.1
In summary, the most reported disease outcome in the studies reviewed was diabetes. This review showed that individuals with moderate to severe periodontitis face an increased risk of developing diabetes. However, the effect of periodontal severity on the risk of other immune-mediated systemic conditions requires further investigation as research is scarce. Additional longitudinal studies with well-defined populations and rigorous study designs are needed to draw more definitive conclusions about the association between periodontitis severity and subsequent immune-mediated diseases.1
The authors conclude that dental professionals must be aware of this association and prioritize preventing and managing periodontitis to reduce the likelihood of associated systemic diseases. When exploring the incidence of systemic disease, researchers should also consider periodontitis as a possible risk factor. Emphasizing oral health self-management as part of public health initiatives could help alleviate the strain of multimorbidity on health care systems.1
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Reference
- Larvin, H., Kang, J., Aggarwal, V.R., et al. Periodontitis and Risk of Immune-Mediated Systemic Conditions: A Systematic Review and Meta-analysis. Community Dent Oral Epidemiol. 2023; 51(5): 705-717. https://onlinelibrary.wiley.com/doi/10.1111/cdoe.12812
