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. 2020 Feb 1;54(1):32-41.

An umbrella review of systematic reviews of the evidence of a causal relationship between periodontal disease and cardiovascular diseases: Position paper from the Canadian Dental Hygienists Association

Salme E Lavigne  1 , Jane L Forrest  2
Affiliations

An umbrella review of systematic reviews of the evidence of a causal relationship between periodontal disease and cardiovascular diseases: Position paper from the Canadian Dental Hygienists Association

Salme E Lavigne et al. Can J Dent Hyg. .

Abstract
in English, French

Previous position papers have confirmed associations between periodontal disease and cardiovascular disease. Causal associations have not been confirmed and have been the source of much confusion for oral health professionals and the public.

Aim: To investigate whether sufficient evidence exists for a causal relationship between periodontal disease and cardiovascular disease.

Methods: The PICO question was "For adults in good general health who are diagnosed with periodontal disease, will receiving non-surgical periodontal therapy (NSPT), as compared to not receiving NSPT, lower their risk for cardiovascular diseases?" Only systematic reviews (SRs) with or without meta-analyses (MAs) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic Reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality.

Results: Of 53 cardiovascular disease studies retrieved, 7 met the inclusion criteria, of which 6 contained MAs. Results were mixed for various periodontal interventions lowering the risk for cardiovascular outcomes. Only one SR used cardiovascular events as a direct outcome; the other 6 used various surrogate measures.

Conclusions: Bradford Hill criteria analysis failed to support a causal relationship between periodontal disease and cardiovascular disease.

Les énoncés de position précédents ont confirmé des liens entre la maladie parodontale et les maladies cardiovasculaires. Des associations causales n’ont pas été confirmées et ont été la source de beaucoup de confusion pour les professionnels de la santé buccodentaire et la population.

But: Étudier s’il y a suffisamment de preuves qu’un lien de causalité existe entre la maladie parodontale et les maladies cardiovasculaires.

Méthodologie: La question PICO était : « Les adultes en bonne santé générale, qui ont reçu un diagnostic de parodontite, auront-ils une réduction de leur risque de maladies cardiovasculaires s’ils reçoivent une thérapie parodontale non chirurgicale (TPNC), en comparaison à ne pas recevoir de thérapie parodontale non chirurgicale? » Seules les revues systématiques (RS) avec ou sans méta-analyse (MA) d’essais comparatifs randomisés publiés en anglais entre 2007 et 2019 ont été incluses. Les recherches de bases de données ont été effectuées, entre autres, dans PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, le registre de revues systématiques Cochrane et le registre d’essais cliniques. Des évaluations de la qualité ont été menées par les 2 auteurs à l’aide de la liste de vérification PRISMA. Les critères de Bradford Hill ont été utilisés pour déterminer la preuve de causalité.

Résultats: Dans les 53 études repérées sur la maladie cardiovasculaire, 7 répondaient aux critères d’inclusion, et parmi celles-ci, 6 comprenaient des MA. Les résultats en matière de diminution du risque d’effets cardiovasculaires étaient mixtes selon les différentes interventions parodontales effectuées. Une seule RS a utilisé les effets cardiovasculaires comme résultat direct, les 6 autres ont employé diverses mesures de remplacement.

Conclusions: L’analyse de critère de Bradford Hill n’a pas réussi à appuyer un lien de causalité entre la maladie parodontale et les maladies cardiovasculaires.

Keywords: cardiovascular diseases; meta-analysis; oral health; periodontal disease; periodontal treatment; periodontitis; stroke; systematic reviews.

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Conflict of interest statement

The authors have declared no conflicts of interest.

Figures

Figure 1.
Figure 1.
Cardiovascular search flow diagram
See this image and copyright information in PMC

References

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