Periodontitis and risk of immune-mediated systemic conditions: A systematic review and meta-analysis

Abstract

Introduction: The aim of this review is to examine and quantify the long-term risk of immune-mediated systemic conditions in people with periodontitis compared to people without periodontitis. Methods: Medline, EMBASE and Cochrane databases were searched up to June 2022 using keywords and MeSH headings. The ‘Risk of Bias in Non-Randomised Studies of Interventions’ tool was used to assess bias. Cohort studies comparing incident metabolic/autoimmune/inflammatory diseases in periodontitis to healthy controls were included. Meta-analysis and meta-regression quantified risks and showed impact of periodontitis diagnosis type and severity. Results: The search retrieved 3354 studies; 166 studies were eligible for full-text screening, and 30 studies were included for review. Twenty-seven studies were eligible for meta-analysis. The risks of diabetes, rheumatoid arthritis (RA) and osteoporosis were increased in people with periodontitis compared to without periodontitis (diabetes—relative risk [RR]: 1.22, 95% CI: 1.13–1.33; RA—RR: 1.27, 95% CI: 1.07–1.52; osteoporosis—RR: 1.40, 95% CI: 1.12–1.75). Risk of diabetes showed gradient increase by periodontitis severity (moderate—RR = 1.20, 95% CI = 1.11–1.31; severe—RR = 1.34, 95% CI = 1.10–1.63). Conclusion: People with moderate-to-severe cases of periodontitis have the highest risk of developing diabetes, while the effect of periodontal severity on risk of other immune-mediated systemic conditions requires further investigation. More homologous evidence is required to form robust conclusions regarding periodontitis-multimorbidity associations.