Updated review: Periodontal therapy for primary or secondary prevention of cardiovascular disease in people with periodontitis

Zelin Ye, Yubin Cao, Cheng Miao, Wei Liu, Li Dong, Zongkai Lv, Zipporah Iheozor-Ejiofor, Chunjie Li

What is the review about?

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

What is periodontitis?

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 used this term in our review because the studies we found were based on the old system.

Is there an association between periodontitis and cardiovascular diseases?

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.

What did we do?

We searched the main electronic databases for scientific research studies known as 'randomised controlled trials', up to November 2021. 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.

What did we find?

We found two studies to include in our review. Both studies had problems with their design and we judged them to be at high risk of bias. 

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). 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.

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 be reliable enough to be used.

How reliable is 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. Further research is needed.

Where can I read the review?

The full review is available on the Cochrane Library here.