Archive | 2021
Effects of Non-surgical Periodontal Therapy on Periodontal Clinical Data in Periodontitis Patients With Rheumatoid Arthritis: a Meta-analysis
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 I 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. © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Open Access *Correspondence: [email protected]; [email protected] Yu Huang, Zheng Zhang and Youli Zheng contributed equally to this work 1 Hospital of Stomatology, Jilin University, 1500th Qinghua Road, Changchun 130021, Jilin, China Full list of author information is available at the end of the article Page 2 of 11 Huang et al. BMC Oral Health (2021) 21:340 Background Periodontitis is a chronic inflammation of the periodontal tissues, with negative impact on both local and systemic health. It is well known that the inflammatory state gives rise to a multitude of damage of periodontal tissue, of which the most critical are in alveolar bone, as well as in periodontal ligament [1, 2]. In a comprehensive epidemiological report in 1990 and 2010 of severe periodontitis (SP), a global age-standardized rate of severe periodontitis was reported to be high around 11.2% [3]. It suggested a growing global health threat from severe periodontitis. In addition, many modifiable and non-modifiable risk factors, such as rheumatoid arthritis (RA), diabetes, obesity, high blood pressure, atherosclerosis and other cardiovascular diseases and so on, can modify the individual’s risk of developing periodontitis, as well as the response to periodontal therapy [4–8]. RA is a chronic autoimmune disorder and can ultimately lead to the irreversible damage to cartilage in joints and loss of function even, which is closely related to the production of autoantibodies, synovial inflammation and hyperplasia [9, 10]. The interplay between RA and periodontitis has long been studied, with evidence showing complex associations between these two distinct diseases [11, 12]. The pathogenesis of the two diseases are characterized by local destruction of hard and soft tissues as a consequence of inflammation [13, 14]. Additionally, there is strong evidence that people with RA have elevated risk for inflammation of periodontal ligament, respiratory mucosa and intestinal mucosa to some extent [15]. Studies among people with RA demonstrate significantly higher prevalence levels in patients with periodontitis [16–18]. To date, the mechanisms accounting for the aggravation of periodontitis by RA are not completely clarified. The representative of non-surgical periodontal therapy as scaling and root planing (SRP) has been considered as the traditional treatment regime in managing periodontitis. Conventional clinical indices and parameters of periodontal health, namely plaque index (PI), gingival index (GI), attachment loss (AL), probing depth (PD) combined with bleeding on probing (BOP), are usually calculated to determine the efficacy of SRP. In recent years, there have been several works discussing effects of periodontal treatment on RA markers [19–21]. In previous meta-analyses, Schilin Wen et al., Qingqin Tang et al. and Nicholas R Fuggle et al. evaluated the prevalence and periodontal parameters of periodontitis in RA patients [22–24]. Assessed by disease activity score, tender joint counts, swollen joint counts, visual analogical scale and C-reactive protein, a meta-analysis indicates that SRP could improve RA activity [25]. There were also meta-analyses examining the risk of periodontitis for RA [26, 27]. In a recent meta-analysis, the bidirectional relationship between periodontitis and RA was also analyzed [28]. Additionally, effect of SRP about the clinical activity and inflammatory markers in patients with periodontitis and RA was assessed in a systematic review[29]. However, to our knowledge, a comprehensive meta-analysis attempted to establish the clinical efficacy of SRP in terms of periodontitis parameters in periodontitis patients with RA has not yet emerged. In light of these considerations, meta-analysis is now imperative to assess the difference in the clinical efficacy of SRP between RA with periodontitis patients and non-RA periodontitis patients.