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Linking lungs and gums: a meta-analysis of periodontitis prevalence and severity in chronic obstructive pulmonary
Gowri Sivaramakrishnan1, Kannan Sridharan2
1Bahrain Defence Force Royal Medical Services, Riffa, Bahrain. Gowri.sivaramakrishnan@gmail.com.
Aim:
Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disorder associated with chronic inflammation and airflow limitation. Periodontitis shares common risk factors with COPD, such as smoking. This meta-analysis evaluates the prevalence and severity of periodontitis in COPD patients by assessing periodontal parameters, including probing depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP).
Methods:
A systematic search of electronic databases identified clinical studies reporting periodontitis in COPD patients. Studies with clear diagnostic criteria for both conditions were included. Data extraction was conducted using RAYYAN software, and study quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was performed in R Studio, with heterogeneity assessed using the I² statistic. To assess the robustness of the findings, a leave-one-out sensitivity analysis was conducted for CAL and PD. Publication bias was examined using the Trim and Fill method. Additionally, stratified subgroup analyses were performed based on smoking status and study design to explore potential sources of heterogeneity. Certainty of evidence was assessed using GRADE.
Results:
A total of 41 studies were included. Periodontitis prevalence in COPD patients was 35%, significantly higher than in non-COPD controls. COPD patients exhibited greater periodontal destruction, with increased CAL (0.68 [0.37;0.98]) deeper PD (0.72 [0.12; 1.31]), and BOP (1.49 [0.19;2.79]). However, the certainty of this evidence was rated as low to very low.
Conclusion:
COPD patients have a higher prevalence of periodontitis and worse periodontal parameters. While our meta-analysis suggests an association, the overall certainty of evidence is low. These findings should therefore be interpreted with caution. Future high-quality prospective studies are essential to confirm this relationship and inform clinical practice.
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Symptoms of COPD can be classified as primary or systemic. Primary symptoms relate to reduced airflow, while systemic or extrapulmonary symptoms relate to COPD's broader impact on the body.
Primary Symptoms of COPD: