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He I, Poirier B, Jensen E, Kaur S, Hedges J, Jesudason S, Jamieson L, Sethi S. Demystifying the connection between periodontal disease and chronic kidney disease - An umbrella review. J Periodontal Res 2023; 58:874-892. [PMID: 37477165 DOI: 10.1111/jre.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/07/2023] [Accepted: 06/30/2023] [Indexed: 07/22/2023]
Abstract
Chronic kidney disease (CKD) and poor oral health are inter-related and their significant impact on each other is well established in the literature. Many systematic reviews and meta-analyses have demonstrated a strong relationship between CKD and periodontitis, where periodontal treatment has shown potential in improving CKD outcomes. However, the quality of the studies and heterogeneity of the results show variation. The aim of this umbrella review was to review the quality of the current systematic reviews on the relationship between CKD and oral health with an emphasis on periodontal disease and to generate clinically relevant guidelines to maintain periodontal health in patients with CKD. This umbrella review was conducted and reported in alignment with the Joanna Briggs Institute and the PRISMA 2020 guidelines. The review protocol was established prior to commencing the review and registered on JBI and PROSPERO (CRD42022335209). Search strings were established for PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and Dentistry & Oral Science Source up to April 2022. All systematic reviews and meta-analyses that considered the relationship between CKD and periodontitis or periodontal treatment were included. Of 371 studies identified through the systematic search, 18 systematic reviews met the inclusion criteria. Ten studies assessed the relationship between oral health status and CKD with a focus on periodontitis and CKD, five reviewed the impact of periodontal treatment on CKD outcomes, two included both relationship and effectiveness of periodontal treatment and one qualitatively reviewed oral health-related quality of life in patients with kidney failure. Findings indicate there is a bidirectional relationship between CKD and periodontal disease. In view of the heterogeneity of the existing literature on CKD and periodontal disease, specific recommendations for the management of periodontitis among patients with CKD are proposed for medical professionals, dental professionals, and aged care workers based on the evidence collated in this review.
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Affiliation(s)
- Isaac He
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Brianna Poirier
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Emilija Jensen
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Sushil Kaur
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Sneha Sethi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
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Satyanarayana D, Kulkarni S, Doshi D, Reddy MP, Khaled S, Srilatha A. Periodontal health status among chronic obstructive pulmonary disease with age- and gender-matched controls. J Indian Soc Periodontol 2023; 27:524-529. [PMID: 37781331 PMCID: PMC10538517 DOI: 10.4103/jisp.jisp_479_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/04/2023] [Accepted: 05/19/2023] [Indexed: 10/03/2023] Open
Abstract
Background Periodontal disease and chronic obstructive pulmonary disease (COPD) share a pathogenic mechanism that involves activating and using inflammatory cytokines and neutrophils, which generate pathological changes in various tissues with a chronic degenerative outcome. Aim the aim of this study was to assess and compare the periodontal health status among COPD patients with age- and gender-matched controls. Materials and Methods All the patients aged >30 years who were diagnosed with COPD by the physician were included as cases, while people who are apparently healthy and age and gender matched with cases were included as controls. Data on demographic details, socioeconomic status (Kuppuswamy scale), deleterious oral habits, and oral hygiene practices were obtained. The Simplified Oral Hygiene Index (OHI-S) and the WHO basic oral health survey proforma (1997) were used to obtain the data on oral hygiene and periodontal status respectively. Results Most cases had moderate COPD severity (58.25%). The overall mean OHI-S, CPI, and LOA were higher among cases (3.92 ± 0.95, 3.68 ± 0.60, and 2.33 ± 1.10, respectively) in comparison to controls. Further, among cases, the mean oral hygiene and periodontitis increased with increased severity of COPD. Although among both cases and controls, gender, tobacco use, and alcohol consumption influenced their periodontal status, significant odds of higher risk were seen only among cases. Further, subjects with COPD had higher odds of having poor oral hygiene, deeper pocket depths, and LOA. Conclusion A strong association between COPD and periodontitis was observed. The oral hygiene and periodontal disease worsened with the severity of COPD.
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Affiliation(s)
- Dantala Satyanarayana
- Department of Public Health Dentistry, MNR Dental College and Hospital, Sangareddy, Telangana, India
| | - Suhas Kulkarni
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Hospital, Hyderabad, Telangana, India
| | - Dolar Doshi
- Department of Public Health Dentistry, Government Dental College and Hospital, Hyderabad, Telangana, India
| | - Madupu Padma Reddy
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Hospital, Hyderabad, Telangana, India
| | - Sana Khaled
- Department of Oral and Maxillofacial Pathology, Sri Balaji Dental College, Hyderabad, Telangana, India
| | - Adepu Srilatha
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Hospital, Hyderabad, Telangana, India
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Lapo S, Leonardo C, Luigi B, Michele N, Sergio S, Calogero Lino C, Francesco C. Association between chronic kidney disease and periodontitis. A systematic review and metanalysis. Oral Dis 2021; 29:40-50. [PMID: 34726333 DOI: 10.1111/odi.14062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Aims of this SR were to assess the association of Periodontitis (PD) with Chronic Kidney Disease (CKD) and with different CKD stages. MATERIALS AND METHODS MEDLINE, Cochrane Central Register of Trials and EMBASE, up to April 4, 2021 were searched. RCTs, prospective and retrospective cohort studies, case-control studies and cross-sectional studies were considered. JBI's Critical Appraisal Tool for risk of bias assessment was used. The risk of PD was calculated using the Mantel-Haenszel odds ratios (MH-OR); weighted mean difference for clinical attachment level (CAL) and periodontal probing depth (PPD) were also evaluated. RESULTS Out of 1949 titles screened, 142 full texts were evaluated and 17 studies were included. CKD was associated to higher risk of PD (MH-OR = 2.36, [95% C.I. 1.25, 4.44]; p = 0.008), higher mean CAL (WMD = 0.41 mm [95% C.I. 0.22, 0.60]; p < 0.0001) and mean PPD (WMD = 0.25 mm [95% C.I. 0.03, 0.47]; p = 0.02) compared to healthy individuals. Severe CKD (stages 4-5 vs 2-3) resulted at higher risk of PD (MH-OR = 2.21, [95% C.I. 1.07, 4.54]; p = 0.03). Heterogeneity and risk of bias were high. CONCLUSIONS An association between PD and CKD was found. It could be appropriate to consider PD a frequent CKD comorbidity.
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Affiliation(s)
- Serni Lapo
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | | | - Barbato Luigi
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Nieri Michele
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Serni Sergio
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | | | - Cairo Francesco
- Department of Experimental and Clinical Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
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Dannewitz B, Sommerer C, Stölzel P, Baid‐Agrawal S, Nadal J, Bärthlein B, Wanner C, Eckardt K, Zeier M, Schlagenhauf U, Krane V, Jockel‐Schneider Y. Status of periodontal health in German patients suffering from chronic kidney disease—Data from the GCKD study. J Clin Periodontol 2019; 47:19-29. [DOI: 10.1111/jcpe.13208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 10/03/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Bettina Dannewitz
- Department of Periodontology Johann Wolfgang Goethe‐University Frankfurt Frankfurt Germany
- Private Dental Practice Weilburg Germany
| | - Claudia Sommerer
- Division of Nephrology Heidelberg University Hospital Heidelberg Germany
| | - Peggy Stölzel
- Division of Periodontology University Hospital of Würzburg Würzburg Germany
| | - Seema Baid‐Agrawal
- Department of Nephrology and Medical Intensive Care University Hospital Charité Berlin Germany
- Department of Nephrology and Transplant Center Sahlgrenska University Hospital University of Gothenburg Gothenburg Sweden
| | - Jennifer Nadal
- Department of Medical Biometry, Informatics, and Epidemiology (IMBIE) University Hospital Bonn Germany
| | - Barbara Bärthlein
- Chair of Medical Informatics University of Erlangen‐Nürnberg Erlangen Germany
| | - Christoph Wanner
- Department of Medicine 1 Division of Nephrology University of Würzburg Würzburg Germany
| | - Kai‐Uwe Eckardt
- Department of Nephrology and Medical Intensive Care University Hospital Charité Berlin Germany
- Department of Nephrology and Hypertension Friedrich‐Alexander‐University Erlangen‐Nürnberg (FAU) University Hospital Erlangen Erlangen Germany
| | - Martin Zeier
- Division of Nephrology Heidelberg University Hospital Heidelberg Germany
| | | | - Vera Krane
- Department of Medicine 1 Division of Nephrology University of Würzburg Würzburg Germany
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Zhao D, Khawaja AT, Jin L, Li KY, Tonetti M, Pelekos G. The directional and non-directional associations of periodontitis with chronic kidney disease: A systematic review and meta-analysis of observational studies. J Periodontal Res 2018; 53:682-704. [PMID: 29777531 DOI: 10.1111/jre.12565] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 12/11/2022]
Abstract
This systematic review aimed to assess the current evidence on the directional and non-directional associations of periodontitis with chronic kidney disease (CKD). Electronic search for observational studies on the association of periodontitis with CKD was performed in MEDLINE, EMBASE, PubMed, Open GREY and Cochrane library up to June 5, 2017. Two reviewers conducted study selection, data collection and assessment of methodological quality using the original and modified Newcastle-Ottawa Scale. Cohort, case-control and cross-sectional studies were included, which clearly defined periodontitis and CKD or reported acceptable clinical parameters of these 2 diseases in adults. Meta-analysis was employed to estimate the pooled odds ratio on the non-directional association and the incidence rate ratio (IRR) for the directional association. Among 2530 potential eligible articles, 47 were finally included. Most of them investigated a non-directional association of periodontitis with CKD, including 7 case-control studies and 38 cross-sectional studies; 24 studies had statistical analysis on the non-directional association and 75% of them reported significant results, which were supported further by the meta-analysis (random: odds ratio = 2.12, P < .001; χ2 = 25.74, I2 = 88.3%). None of the studies focused on the directional association of CKD (as the exposure) with periodontitis (as the outcome), whereas 2 retrospective cohort studies explored a directional association of periodontitis (as the exposure) with CKD (as the outcome) (random: IRR=2.10, P > .05; fixed: IRR=1.76, P < .05; χ2 = 4.65, I2 = 78.3%). Overall, the high heterogeneity of studies limits the significance of these results. There is substantial evidence on the non-directional association of periodontitis with CKD, while there are limited studies on the directional association. Well-designed prospective studies with longer follow-ups in representative communities are needed to clarify the directional association and enhance the quality of the evidence on this topic.
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Affiliation(s)
- D Zhao
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - A T Khawaja
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - L Jin
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - K-Y Li
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - M Tonetti
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - G Pelekos
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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Deschamps-Lenhardt S, Martin-Cabezas R, Hannedouche T, Huck O. Association between periodontitis and chronic kidney disease: Systematic review and meta-analysis. Oral Dis 2018; 25:385-402. [DOI: 10.1111/odi.12834] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/07/2017] [Accepted: 01/22/2018] [Indexed: 12/18/2022]
Affiliation(s)
- S Deschamps-Lenhardt
- Faculté de chirurgie-dentaire; Periodontology; Université de Strasbourg; Strasbourg France
- Pôle de médecine et chirurgie bucco-dentaire; Hôpitaux universitaires de Strasbourg; Strasbourg France
| | - R Martin-Cabezas
- Faculté de chirurgie-dentaire; Periodontology; Université de Strasbourg; Strasbourg France
- Pôle de médecine et chirurgie bucco-dentaire; Hôpitaux universitaires de Strasbourg; Strasbourg France
| | - T Hannedouche
- Faculté de Médecine; Université de Strasbourg et Service de néphrologie; Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - O Huck
- Faculté de chirurgie-dentaire; Periodontology; Université de Strasbourg; Strasbourg France
- Pôle de médecine et chirurgie bucco-dentaire; Hôpitaux universitaires de Strasbourg; Strasbourg France
- INSERM (French National Institute of Health and Medical Research); Regenerative Nanomedicine; UMR 1260; Fédération de Médecine Translationnelle de Strasbourg (FMTS); Strasbourg France
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Abstract
Periodontal diseases are the most common human diseases globally, with gingivitis affecting up to 90% and periodontitis affecting 50% of adults. Tooth enamel is the only nonshedding tissue in the human body. In the absence of proper oral hygiene measures, microbial biofilm (dental plaque) develops on the teeth to include more than 700 different bacterial species, along with viruses, fungi, archea, and parasites. With time, ecological imbalances promote the growth of selected commensal species that induce host inflammatory pathways resulting in tissue destruction, including ulceration of the periodontal epithelium.
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Affiliation(s)
- Wenche S Borgnakke
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 North University Avenue, Room# G049, Ann Arbor, MI 48109-1078, USA.
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Siribamrungwong M, Chinudomwong P. Periodontitis: Tip of the iceberg in chronic kidney disease. World J Clin Urol 2014; 3:295-303. [DOI: 10.5410/wjcu.v3.i3.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/02/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
The prevalence of chronic kidney disease (CKD) is constantly escalating not only in industrialized countries but throughout the world. It is of major significance because of to its high morbidity and mortality. Strategies to tackle this worldwide health problem include identification of its associated risk factors, comorbidities, and complications as well as proper management to handle all the pertinent issues. Periodontal disease, a treatable infectious state of the dental supporting tissues, is common in CKD patients. Its association with CKD is believed to be in a reciprocal or bidirectional fashion and has been massively studied. This paper, therefore, aims to review the recent evidence pertaining to the association between periodontal disease and a variety of renal illnesses. Most of the current evidence was collected from cross-sectional studies and clinical trials. There is substantial evidence indicating that periodontal disease contributes markedly to the chronic systemic inflammatory burden, leading to cardiovascular and cerebrovascular complications, the principal causes of death among chronic renal disease patients. Furthermore, several studies demonstrated that proper periodontal intervention could help improve systemic inflammation and even nutritional status among CKD patients, resulting in a better quality of life. Suggestions have been made that periodontal disease should be diagnosed early, and managed and controlled to, at least, eradicate a source of inflammation in this population. Awareness of such an important issue should be increased in the relevant medical personnel.
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Tabeta K, Yoshie H, Yamazaki K. Current evidence and biological plausibility linking periodontitis to atherosclerotic cardiovascular disease. JAPANESE DENTAL SCIENCE REVIEW 2014. [DOI: 10.1016/j.jdsr.2014.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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