An umbrella review of systematic reviews of the evidence of a causal relationship between periodontal disease and cardiovascular diseases: Position paper from the Canadian Dental Hygienists Association.
Level 1 - systematic review of randomized trials
Systematic review of systematic reviews of randomized controlled trials
What was done
This umbrella review evaluated whether non-surgical periodontal therapy (NSPT) reduces cardiovascular disease risk in adults diagnosed with periodontal disease. The authors searched PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, the Cochrane Registry of Systematic Reviews, and ClinicalTrials.gov for English-language systematic reviews (with or without meta-analyses) of randomized controlled trials published between 2007 and 2019. Quality was assessed using the PRISMA checklist, and evidence for causality was evaluated using the Bradford Hill criteria.
What was found
From 53 retrieved studies, 7 systematic reviews met inclusion criteria, 6 of which included meta-analyses. No quantitative pooled effect estimates were reported in the abstract. Results across reviews were mixed regarding the effect of periodontal interventions on cardiovascular outcomes. Only 1 systematic review evaluated direct cardiovascular events, while the remaining 6 assessed surrogate markers. Overall, the Bradford Hill criteria analysis failed to support a causal relationship between periodontal disease and cardiovascular disease.
Why it matters
Although observational associations between gum disease and cardiovascular illness are widely cited, this review clarifies that interventional trial data do not support a causal link or prove that periodontal therapy prevents cardiovascular events.
Limits
The underlying evidence base predominantly relies on surrogate cardiovascular endpoints rather than hard clinical events (6 of 7 reviews). The abstract provides no quantitative data or risk estimates, searches were restricted to English-language reviews, and study quality was evaluated using a reporting checklist (PRISMA) rather than a dedicated risk-of-bias tool for systematic reviews.
Cited by
- partial Periodontal pathogens found in gum pockets can cause heart attacks, brain damage, stroke risk, and preterm birth in pregnancy.