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(Continued) PICOS question addressed by a SR
Overall certainty of the evidence Low.
R12.2: Expert consensus-based statement Supporting literature (Orlandi et al., 2021)
From evidence to recommendation — additional considerations
Quality of evidence Very Low — One feasibility RCT at high risk of bias Grade of recommendation GradeO — $ Statement: unclear, additional research needed Strength of consensus Consensus (2.4% of the group abstained due to potential CoI)
Acceptability Little is known about patient preferences in relation to the treat- ment of periodontitis, due to a paucity of patient-reported outcome data. Feasibility Little is known about the implementation of periodontal therapy that is targeted at reducing cardiovascular biomarkers or those targeted at lowering metabolic risk, predominantly because the primary purpose of periodontal treatment is to improve periodontal rather than sys- temic health outcomes. Treatment of periodontitis is routinely per- formed in many healthcare systems across the world, and therefore it is in itself feasible for those who can afford care or those able to gain access to care. There are, however, groups in society who struggle to access periodontal care for various reasons, some being cost (The Economist Intelligence Unit, 2021). Ethical considerations Evaluation of the efficacy of the treatment of periodontitis on sys- temic health outcomes is ethically challenging as it would entail com- parison with no treatment.
Background
Intervention
Treatment of periodontitis was exactly as described under R12.1.
Available evidence
Number and design of included studies One randomized controlled study (feasibility trial) reported data on the effect of the treatment of periodontitis in comparison with no/control treatment on “ hard ” outcomes or complications of systemic diseases, in patients with a non-communicable disease (Beck et al., 2008). “ Hard ” outcomes have been defined as “ patient-important endpoints that are definitive with respect to the disease process, and reflect how a patient feels, functions or survives ” (Institute of Medicine, 2010). Risk of bias The trial was considered at high risk of bias according to the RoB 2.0 tool. Effect sizes and their clinical relevance No statistically significant overall effect of periodontal therapy on car- diovascular events was observed.
Economic considerations Cost-effectiveness has not been evaluated in these studies.
Legal considerations Not applicable.
12.1.2 | Impact of periodontal treatment on systemic inflammation and cardio-metabolic risk in people with co-morbid systemic non-communicable disease (NCD)
Consistency Not applicable.
Balance of benefit and harm No evidence of harm was reported in this study.
R12.2. Does treatment of periodontitis impact upon “ hard ” outcomes or complications of systemic NCDs, in periodontitis patients with a co-morbid NCD?
Overall certainty of the evidence Low.
PICOS question addressed by a SR
From evidence to recommendation — additional considerations
R12.2: Expert consensus-based statement It is currently unclear if the treatment of periodontitis improves “ hard ” outcomes or complications of systemic NCDs in patients with periodontitis with a co-morbid NCD .
Acceptability Little is known about patient preferences in relation to treatment of periodontitis in patients with an NCD.
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