The association of periodontal diseases and Sjogren's syndrome: A systematic review and meta-analysis

Abstract

Background: The relationship between periodontal diseases and Sjogren's syndrome were found inconsistent in current studies. Our objective is to clarify the relationship between periodontal diseases and Sjogren's syndrome.

Methods: A systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Electronic databases (EMBASE, PubMed, Web of Science, and Cochrane Library, from inceptions until 24 November 2021) were searched. The Newcastle-Ottawa Scale (NOS) and Agency for Healthcare Research and Quality (AHRQ) were applied to evaluate the quality of studies. Quality assessment of the certainty of evidence was performed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. When the output is the ratio, Odds ratio (OR) of periodontal diseases with Sjogren's syndrome were calculated. When the output is the mean, weighted mean difference (WMD) of periodontal diseases with Sjogren's syndrome was calculated. We conducted meta-analysis and estimated the pool sensitivity. Begg's test was used to test the possibility of publication bias. We also carried out meta-regression to clarify the source of heterogeneity (I2 > 50%). Finally, we performed a trial sequential analysis (TSA) to identify the false positive or false negative outcomes that might occur during repeated updates.

Results: 21 studies were included in this systematic review, with a total of 11435 subjects. Meta-analysis of 5 studies showed that there is a positive correlation between periodontitis and Sjogren's syndrome (OR = 2.12, 95% CI = 1.43-3.17; 5 studies, 6927 participants; low certainty of evidence). Meta-analysis of 16 studies showed that the periodontal condition of patients with Sjogren's syndrome was worse compared with the control group, and the scores of clinical periodontal parameters were relatively high.

Conclusion: Sjogren's syndrome patients seem to be more likely to be diagnosed with periodontal diseases. However, our results should be interpreted with caution considering the high heterogeneity.

Systematic review registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021261322].

Keywords: Sjogren’s syndrome; meta-analysis; observational study; periodontal disease; systematic review.

FIGURE 1

Flow diagram of study selection.

FIGURE 2

Forest plot for periodontal diseases in subjects with Sjogren’s syndrome (SS) and controls. OR, odds ratio; CI, confidence interval.

FIGURE 3

Forest plot for SS and clinical periodontal parameters scores (A). Clinical periodontal parameters scores bleeding on probing (BOP) (B). Clinical periodontal parameters scores plaque index (PI) (C). Clinical periodontal parameters scores gingival index (GI) (D). Clinical periodontal parameters scores probing pocket depth (PPD) (E). Clinical periodontal parameters scores clinical attachment level (CAL). WMD, weighted mean difference; CI, confidence interval.

FIGURE 4

Sensitivity analysis. The pooled ORs (WMDs) and 95% CIs were stable after the deletion of each study in the analysis of the association between SS and controls (A). The association between periodontal diseases and SS (B). Clinical periodontal parameters scores BOP (C). Clinical periodontal parameters scores PI (D). Clinical periodontal parameters scores GI (E). Clinical periodontal parameters scores PPD (F). Clinical periodontal parameters scores CAL. CI, confidence interval.

FIGURE 5

Begg’s funnel plot analysis to detect publication bias for the association between periodontal diseases and SS (A). Clinical periodontal parameters scores PI (B). Clinical periodontal parameters scores GI (C). Clinical periodontal parameters scores PPD. WMD, weighted mean difference.

FIGURE 6

Trial sequential analysis of trials in subjects with SS (A). The association between periodontal disease and SS (B). Clinical periodontal parameters scores BOP (C). Clinical periodontal parameters scores PI (D). Clinical periodontal parameters scores GI (E). Clinical periodontal parameters scores PPD (F). Clinical periodontal parameters scores CAL. RIS, required information size.