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BMC Oral Health
Published in: BMC Oral Health 1/2021

Open Access 01-12-2021 | Rheumatoid Arthritis | Research article

Effects of non-surgical periodontal therapy on periodontal clinical data in periodontitis patients with rheumatoid arthritis: a meta-analysis

Authors: Yu Huang, Zheng Zhang, Youli Zheng, Zhulan Zhao, Yang Zhong, Qingyu Zhang, Degeng Xia, Ning Ma, Li Zhang

Published in: BMC Oral Health | Issue 1/2021

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Abstract

Backgrounds

To date, there is still no consensus about the clinical efficacy of non-surgical periodontal therapy in rheumatoid arthritis (RA) patients with periodontitis. Therefore, the aim of this study was to summarize clinical data regarding the efficacy of scaling and root planing (SRP) in patients with RA and periodontitis compared to non-RA periodontitis patients.

Methods

We selected randomized controlled trials (RCTs) that compared periodontal clinical data in RA as compared to non-RA periodontitis patients by searching Embase, PubMed and Cochrane Central Register of Controlled Trials and by manually retrieving from the earliest records to March 8, 2021. The overall effect size of plaque index (PI), gingival index (GI), attachment loss (AL), probing depth (PD) and bleeding on probing (BOP) were calculated by either a fixed or random-effect model, and subgroup analyses were conducted according to the different time points of follow-up. Two investigators extracted the data and assess the accuracy of the obtained results with 95% of Confidence Intervals (CI). Cochrane Collaboration's tool was responsible for the evaluation of the literature quality and the inter-study heterogeneity was evaluated by Q test and I2 statistic. Sensitivity analyses were applied for results with heterogeneity. Publication bias was determined by Begg's test, Egger's test and the trim-and-fill method.

Results

Seven RCTs including 212 patients eventually met the inclusion criteria for the study. As the primary results, the change of PD was not statistically significant and in the secondary results changes of PI, GI, AL and BOP were also not statistically significant in RA patients with periodontitis compared to non-RA periodontitis patients. In subgroup analysis, a larger BOP reduction at 3 months, PI and AL reduction at 6 months were observed in patients with RA and periodontitis group. The results of sensitivity analyses had no significant effect. No evidence of potential publication bias was tested. There were some limitations due to the small number of eligible RCTs.

Conclusions

SRP is equally effective in RA as compared to non-RA periodontitis patients. It suggests RA does not affect the clinical efficacy of non-surgical periodontal therapy. These results could serve evidence-based practice.
Appendix
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Literature
1.
2.
Socransky SS. Relationship of bacteria to the etiology of periodontal disease. J Dent Res. 1970;49(2):203–22.PubMedCrossRef
3.
Kassebaum NJ, Bernabe E, Dahiya M, Bhandari B, Murray CJL, Marcenes W. Global burden of severe periodontitis in 1990–2010: a systematic review and metaregression. J Dent Res. 2014;93(11):1045–53.PubMedPubMedCentralCrossRef
4.
Lundberg K, Wegner N, Yucel-Lindberg T, Venables PJ. Periodontitis in RA-the citrullinated enolase connection. Nat Rev Rheumatol. 2010;6(12):727–30.PubMedCrossRef
5.
Tsioufis C, Kasiakogias A, Thomopoulos C, Stefanadis C. Periodontitis and blood pressure: the concept of dental hypertension. Atherosclerosis. 2011;219(1):1–9.PubMedCrossRef
6.
Lalla E, Papapanou PN. Diabetes mellitus and periodontitis: a tale of two common interrelated diseases. Nat Rev Endocrinol. 2011;7(12):738–48.PubMedCrossRef
7.
Kebschull M, Demmer RT, Papapanou PN. “Gum bug, leave my heart alone!”–epidemiologic and mechanistic evidence linking periodontal infections and atherosclerosis. J Dent Res. 2010;89(9):879–902.PubMedPubMedCentralCrossRef
8.
Jepsen S, Suvan J, Deschner J. The association of periodontal diseases with metabolic syndrome and obesity. Periodontol 2000. 2020;83(1):125–53.PubMedCrossRef
9.
McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med. 2011;365(23):2205–19.PubMedCrossRef
10.
11.
Rutger PG. Rheumatoid arthritis and periodontitis—inflammatory and infectious connections. Review of the literature. J Oral Microbiol. 2012;4:11829.CrossRef
12.
Grasso MA, Comer AC, DiRenzo DD, Yesha Y, Rishe ND. Using big data to evaluate the association between periodontal disease and rheumatoid arthritis. AMIA Annu Symp Proc. 2015;2015:589–93.PubMedPubMedCentral
13.
Kjeldsen M, Holmstrup P, Bendtzen K. Marginal periodontitis and cytokines: a review of the literature. J Periodontol. 1993;64(11):1013–22.PubMedCrossRef
14.
Havemose-Poulsen A, Holmstrup P. Factors affecting IL-1-mediated collagen metabolism by fibroblasts and the pathogenesis of periodontal disease: a review of the literature. Crit Rev Oral Biol Med. 1997;8(2):217–36.PubMedCrossRef
15.
Brusca SB, Abramson SB, Scher JU. Microbiome and mucosal inflammation as extra-articular triggers for rheumatoid arthritis and autoimmunity. Curr Opin Rheumatol. 2014;26(1):101–7.PubMedPubMedCentralCrossRef
16.
Vahabi S, Rostamian A, Baniebrahimi G. Characteristics and relationship of periodontal disease with juvenile idiopathic and rheumatoid arthritis. Dent Res J (Isfahan). 2015;12(6):541–7.CrossRef
17.
Kaur S, White S, Bartold PM. Periodontal disease and rheumatoid arthritis: a systematic review. J Dent Res. 2013;92(5):399–408.PubMedCrossRef
18.
Kasser UR, Gleissner C, Dehne F, Michel A, Willershausen-Zonnchen B, Bolten WW. Risk for periodontal disease in patients with longstanding rheumatoid arthritis. Arthritis Rheum. 1997;40(12):2248–51.PubMedCrossRef
19.
Kaur S, Bright R, Proudman SM, Bartold PM. Does periodontal treatment influence clinical and biochemical measures for rheumatoid arthritis? A systematic review and meta-analysis. Semin Arthritis Rheum. 2014;44(2):113–22.PubMedCrossRef
20.
Ortiz P, Bissada NF, Palomo L, Han YW, Al-Zahrani MS, Panneerselvam A, et al. Periodontal therapy reduces the severity of active rheumatoid arthritis in patients treated with or without tumor necrosis factor inhibitors. J Periodontol. 2009;80(4):535–40.PubMedPubMedCentralCrossRef
21.
Panezai J, Ali A, Ghaffar A, Benchimol D, Altamash M, Klinge B, et al. Upregulation of circulating inflammatory biomarkers under the influence of periodontal disease in rheumatoid arthritis patients. Cytokine. 2020;131:155117.PubMedCrossRef
22.
Wen S, Beltran V, Chaparro A, Espinoza F, Pablo RJ. Association between chronic periodontitis and rheumatoid arthritis. A systematic review. Rev Med Chil. 2019;147(6):762–75.PubMedCrossRef
23.
Tang Q, Fu H, Qin B, Hu Z, Liu Y, Liang Y, et al. A possible link between rheumatoid arthritis and periodontitis: a systematic review and meta-analysis. Int J Periodont Restorat Dent. 2017;37(1):79–86.CrossRef
24.
Fuggle NR, Smith TO, Kaul A, Sofat N. Hand to Mouth: a systematic Review and meta-Analysis of the association between rheumatoid arthritis and periodontitis. Front Immunol. 2016, 7.
25.
Sun J, Zheng Y, Bian X, Ge H, Wang J, Zhang Z. Non-surgical periodontal treatment improves rheumatoid arthritis disease activity: a meta-analysis. Clin Oral Investig. 2021.
26.
Ferreira RdO, Silva RdB, Magno MB, Sousa Carvalho Almeida APCP, Fernandes Fagundes NC, Maia LC, et al. Does periodontitis represent a risk factor for rheumatoid arthritis? A systematic review and meta-analysis. Ther Adv Musculoskelet Dis. 2019, 11.
27.
Qiao Y, Wang Z, Li Y, Han Y, Zhou Y, Cao X. Rheumatoid arthritis risk in periodontitis patients: a systematic review and meta-analysis. Joint Bone Spine. 2020;87(6):556–64.PubMedCrossRef
28.
Hussain SB, Botelho J, Machado V, Zehra SA, Mendes JJ, Ciurtin C, et al. Is there a bidirectional association between rheumatoid arthritis and periodontitis? A systematic review and meta-analysis. Semin Arthritis Rheum. 2020;50(3):414–22.PubMedCrossRef
29.
Silvestre F-J, Silvestre-Rangil J, Bagan L, Bagan JV. Effect of nonsurgical periodontal treatment in patients with periodontitis and rheumatoid arthritis: a systematic review. Medicina Oral Patologia Oral Y Cirugia Bucal. 2016;21(3):E349–54.CrossRef
30.
Moher D, Liberati A, Tetzlaff J, Altman DG, Grp P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-W64.CrossRefPubMed
31.
Higgins JPT, Altman DG, Gotzsche PC, Jueni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. Bmj-British Medical Journal. 2011, 343:d5928.
32.
Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22(4):719–48.PubMed
33.
Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.PubMedCrossRef
34.
35.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.PubMedCrossRef
36.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical research ed). 1997;315(7109):629–34.CrossRef
37.
Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–63.PubMedCrossRef
38.
Al-Katma MK, Bissada NF, Bordeaux JM, Sue J, Askari AD. Control of periodontal infection reduces the severity of active rheumatoid arthritis. Jcr-J Clin Rheumatol. 2007;13(3):134–7.CrossRef
39.
Rodriguez-Lozano B, Gonzalez-Febles J, Luis Garnier-Rodriguez J, Dadlani S, Bustabad-Reyes S, Sanz M, et al. Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case-control study. Arthritis Res Ther. 2019;21:27.PubMedPubMedCentralCrossRef
40.
Cosgarea R, Tristiu R, Dumitru RB, Arweiler NB, Rednic S, Sirbu CI, et al. Effects of non-surgical periodontal therapy on periodontal laboratory and clinical data as well as on disease activity in patients with rheumatoid arthritis. Clin Oral Investig. 2019;23(1):141–51.PubMedCrossRef
41.
Erciyas K, Sezer U, Ustun K, Pehlivan Y, Kisacik B, Senyurt SZ, et al. Effects of periodontal therapy on disease activity and systemic inflammation in rheumatoid arthritis patients. Oral Dis. 2013;19(4):394–400.PubMedCrossRef
42.
Pinho Mde N, Oliveira RD, Novaes AB Jr, Voltarelli JC. Relationship between periodontitis and rheumatoid arthritis and the effect of non-surgical periodontal treatment. Braz Dent J. 2009;20(5):355–64.PubMedCrossRef
43.
Bıyıkoğlu B, Buduneli N, Aksu K, Nalbantsoy A, Lappin DF, Evrenosoğlu E, et al. Periodontal therapy in chronic periodontitis lowers gingival crevicular fluid interleukin-1beta and DAS28 in rheumatoid arthritis patients. Rheumatol Int. 2013;33(10):2607–16.PubMedCrossRef
44.
Roman-Torres CV, Neto JS, Souza MA, Schwartz-Filho HO, Brandt WC, Diniz RE. An evaluation of non-Surgical periodontal therapy in patients with rheumatoid arthritis. Open Dent J. 2015;9:150–3.PubMedPubMedCentralCrossRef
45.
Kurgan Ş, Fentoğlu Ö, Önder C, Serdar M, Eser F, Tatakis DN, et al. The effects of periodontal therapy on gingival crevicular fluid matrix metalloproteinase-8, interleukin-6 and prostaglandin E2 levels in patients with rheumatoid arthritis. J Periodontal Res. 2016;51(5):586–95.PubMedCrossRef
46.
Kurgan Ş, Önder C, Balcı N, Fentoğlu Ö, Eser F, Balseven M, et al. Gingival crevicular fluid tissue/blood vessel-type plasminogen activator and plasminogen activator inhibitor-2 levels in patients with rheumatoid arthritis: effects of nonsurgical periodontal therapy. J Periodontal Res. 2017;52(3):574–81.PubMedCrossRef
47.
Zhao X, Liu Z, Shu D, Xiong Y, He M, Xu S, et al. Association of periodontitis with rheumatoid arthritis and the effect of non-Surgical periodontal treatment on disease activity in patients with rheumatoid arthritis. Med Sci Monit. 2018;24:5802–10.PubMedPubMedCentralCrossRef
Metadata
Title
Effects of non-surgical periodontal therapy on periodontal clinical data in periodontitis patients with rheumatoid arthritis: a meta-analysis
Authors
Yu Huang
Zheng Zhang
Youli Zheng
Zhulan Zhao
Yang Zhong
Qingyu Zhang
Degeng Xia
Ning Ma
Li Zhang
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2021
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-021-01695-w

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