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

BACKGROUND There may be an association between periodontitis and cardiovascular disease (CVD); however, the evidence so far has been uncertain about whether periodontal therapy can help prevent CVD in people diagnosed with chronic periodontitis. This is the third update of a review originally published in 2014, and most recently updated in 2019. Although there is a new multidimensional staging and grading system for periodontitis, we have retained the label "chronic periodontitis" in this version of the review since available studies are based on the previous classification system. OBJECTIVES To investigate the effects of periodontal therapy for primary or secondary prevention of CVD in people with chronic periodontitis. SEARCH METHODS An information specialist searched five bibliographic databases up to 17 November2021. We also searched the Chinese BioMedical Literature Database, the China National Knowledge Infrastructure, the VIP database, and Sciencepaper Online to March 2022. SELECTION CRITERIA AND OUTCOMES We included randomised controlled trials (RCTs) that compared active periodontal therapy to no periodontal treatment or a different periodontal treatment. We included studies of participants with a diagnosis of chronic periodontitis, either with CVD (secondary prevention studies) or without CVD (primary prevention studies). Primary outcomes, measured after 12-months or more than 12 months of follow-up, included all-cause and CVD-related death and all cardiovascular events (angina, myocardial infarction, and stroke). Secondary outcomes included, among the others, modifiable cardiovascular risk factors (e.g., blood pressure, lipids including cholesterol, triglycerides, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, high density lipoprotein cholesterol), and adverse events due to periodontal therapy. Two review authors carried out the study identification, data extraction, and "risk of bias" assessment independently and in duplicate. We adopted a formal pilot-tested data extraction form, and used the Cochrane tool to assess the risk of bias in the studies. We used GRADE criteria to assess the certainty of the evidence. MAIN RESULTS There are no new completed RCTs on this topic since we published our last update in 2019. We included two RCTs in the review. One study focused on the primary prevention of CVD, and the other addressed secondary prevention. We evaluated both as being at high risk of bias. Our primary outcomes of interest were death (all-cause and CVD-related) and all cardiovascular events, measured at one-year follow-up or longer. For primary prevention of CVD in participants with periodontitis and metabolic syndrome, one study (165 participants) provided very low certainty evidence. There was only one death in the study; we were unable to determine whether scaling and root planing plus amoxicillin and metronidazole could reduce incidence of all-cause death, or CVD-related death. We could not exclude the possibility that scaling and root planing plus amoxicillin and metronidazole could crease cardiovascular events compared with supragingival scaling. For secondary prevention of CVD, one pilot study randomised 303 participants to receive scaling and root planing plus oral hygiene instruction (periodontal treatment) or oral hygiene instruction plus a copy of radiographs and recommendation to follow-up with a dentist ( community care). As cardiovascular events had been measured for different time periods of between 6 and months, and only 37 participants were available with at least oneyear follow-up, we did not consider the data to be sufficiently bust for inclusion in this review. The study did not evaluate all cause death and all CVD-related death. We are unable to draw any conclusions about the effects of periodontal therapy on secondary prevention of CVD.