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Feasibility Little is known about the implementation of periodontal treatment in patients with NCDs, or where periodontal therapy is prioritized by those patients relative to other co-morbidities within their overall healthcare portfolio. Treatment of periodontitis is routinely performed in many healthcare systems across the world, and therefore it is in itself feasible, accepting the limitations outlined in R12.1. Ethical considerations Evaluation of the efficacy of the treatment of periodontitis on sys- temic health outcomes is ethically challenging as it entails comparison with no treatment or a delayed treatment group, where adverse out- comes may arise in periodontal health, irrespective of systemic health outcomes. Economic considerations Insufficient evidence exists on the cost-effectiveness of the treatment of periodontitis when evaluating hard outcomes of systemic disease and/or complications of systemic conditions.
no/control treatment on systemic health in patients with a non- communicable disease. Populations with type 2 diabetes, cardiovas- cular diseases, polycystic ovary syndrome, end-stage renal disease, multiple co-morbidities, rheumatoid arthritis, and chronic kidney disease were reported. Systemic outcomes evaluated included hs- CRP, TNF-alpha, IL-6, erythrocyte sedimentation rate (ESR), HbA1c, fasting plasma glucose (FPG), TC, HDL cholesterol, LDL cholesterol, TG, very low density lipoproteins (VLDL), FMD, BMI, SBP, DBP, pulse rate, serum creatinine (sCR) and albumin, at 6 months follow- up. Meta-analyses were conducted by systemic outcome for hs- CRP, FPG, TNF-alpha, IL-6, TC, HDL cholesterol, LDL cholesterol, TG, FMD, SBP, DBP and BMI, at 6-month follow-up, and for hs- CRP, IL-6, HbA1c, TC, HDL cholesterol, estimated glomerular filtra- tion rate (eGFR) and asymmetric dimethylarginine (ADMA), at 12-month follow-up. Risk of bias Of 33 trials, 6 were considered at high risk, 9 at moderate risk and 18 at low risk of bias according to the RoB 2.0 tool. Effect sizes and their clinical relevance Treatment of periodontitis demonstrated a statistically significant reduction in hs-CRP (0.47 mg/L, 95% CI [0.20; 0.74]), reduction in FPG (1.07 mmoL/L, 95% CI [0.25; 1.89]) and increase in FMD (0.31%, 95% CI [0.07; 0.55]), at 6-month follow-up. Consistency Fifteen of 16 clinical trials reported a reduction in serum hs-CRP but with high heterogeneity. Six out of eight studies reported a reduction in FPG but with high heterogeneity. Both of the studies investigating FMD as a primary outcome measure, reported an increase in FMD with low heterogeneity. No evidence of publication bias was observed. Meta-analyses on IL-6 (6 studies), TNF- α (4 studies) and HbA1c (14 studies) reported statistically non-significant reductions following treatment of periodontitis.
Legal considerations Not applicable.
R12.3. Does periodontal treatment impact on systemic inflammation, metabolic control and cardiovascular risk in periodontitis patients with a co-morbid NCD?
PICOS question addressed by a SR
R12.3: Evidence-based recommendation We suggest that treatment of periodontitis is performed to reduce systemic inflammation , to reduce cardiovascular risk profile and to improve metabolic control in patients with co-morbid NCD ; however , treatment protocols should include careful consideration of the general health status of the patient (e.g., quadrant vs. full-mouth approach) . Supporting literature (Orlandi et al., 2021) Quality of evidence Moderate — Six RCTs were considered at high risk of bias, nine at moderate risk and 18 at low risk of bias Grade of recommendation GradeB — " Strength of consensus Consensus (0% of the group abstained due to potential CoI)
Balance of benefit and harm No evidence of harm was reported in any studies.
Overall certainty of the evidence Moderate.
Background
From evidence to recommendation — additional considerations
Intervention
Acceptability Little is known about patient preferences in relation to treatment of periodontitis in people with a co-morbid systemic condition, due to the lack of studies addressing PROMs. Feasibility Little is known about implementation of protocols targeted at reducing systemic biomarkers of cardio-metabolic risk. Treatment of periodontitis
Treatment of periodontitis was exactly as described under R12.1.
Available evidence
Number and design of included studies Thirty-three randomized controlled trials reported data on the effect of the treatment of periodontitis in comparison with
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