Treating chronic gum inflammation (periodontitis) to prevent heart and blood vessel (cardiovascular) disease

Wei Liu, Yubin Cao, Li Dong, Ye Zhu, Yafei Wu, Zongkai Lv, Zipporah Iheozor-Ejiofor, Chunjie Li

Review question

The main question addressed by this review was whether treatments for chronic periodontitis (gum inflammation) can prevent or manage cardiovascular (heart and blood vessel) diseases.

Background

Chronic periodontitis causes swollen and painful gums, and loss of the alveolar bone that supports the teeth. 'Chronic' is a label that means the disease has continued for some time without treatment. The term 'chronic periodontitis' is being phased out as there is a new system for categorising different types of gum disease, but we have used this term in our review because the studies we found were based on the old system.

There may be a link between periodontitis and cardiovascular diseases. The treatment for chronic periodontitis gets rid of bacteria and infection, and controls inflammation, and it is thought that this may help prevent the occurrence or recurrence of diseases of the heart and blood vessels. We wanted to find out whether periodontal therapy could help prevent death, or reduce the likelihood of having cardiovascular 'attacks' like a stroke or heart attack.

Study characteristics

We searched for scientific research studies known as 'randomised controlled trials', up to 17 September 2019. In this type of study, participants are assigned in a random way to an experimental or control group. People in the experimental group receive the treatment being tested, and people in the control group usually receive either no treatment, placebo (fake treatment), another type of treatment or routine care.

We found two studies to include in our review. One study assessed 165 participants who did not have cardiovascular diseases, but had metabolic syndrome (a combination of risk factors for cardiovascular disease, such as obesity, high blood pressure, and high blood sugar). The other study started off with 303 participants who had cardiovascular diseases, but after a year, only 37 participants were assessed and so we thought the results were not reliable enough to be used. Both studies had problems with their design, and we judged them to be at high risk of bias.

Key results

For people who have metabolic syndrome but no cardiovascular diseases, we were unable to determine whether treating chronic periodontitis, by removing the plaque and tartar ('scaling') from the roots of teeth and giving antibiotics, reduced the risk of dying or having cardiovascular attacks when compared with scaling the teeth from above the gumline only.

For people with cardiovascular diseases and chronic periodontitis, we found no reliable evidence about the effects of periodontal treatment.

Certainty of the evidence

We classified the evidence as 'very low certainty'. We are uncertain about the findings because there are only two small studies, at high risk of bias, with very imprecise results. Overall, we cannot draw any reliable conclusions from the findings. Further research is needed.

Read the full review.

Liu W, Cao Y, Dong L, Zhu Y, Wu Y, Lv Z, Iheozor-Ejiofor Z, Li C. Periodontal therapy for primary or secondary prevention of cardiovascular disease in people with periodontitis. Cochrane Database of Systematic Reviews 2019 , Issue 12 . Art. No.: CD009197. DOI: 10.1002/14651858.CD009197.pub4 .