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

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.