Does Periodontal Disease Influence Tuberculosis Outcomes? Insights from a Scoping Review

Background: Periodontitis and tuberculosis (TB) are common chronic infections disproportionately affecting disadvantaged groups. They share behavioural, environmental, and immunological risk factors. Emerging evidence suggests a bidirectional relationship, with TB patients often exhibiting poorer periodontal health and periodontal inflammation potentially exacerbating systemic TB. Objective: To comprehensively map and evaluate the existing evidence regarding the association between periodontal disease and TB outcomes, and to explore the potential influence of periodontal status on TB progression, treatment response, and overall disease outcomes through a scoping review. Methods: This scoping review examined human studies assessing periodontal status in TB patients, including observational studies, clinical trials, and reviews. Searches were conducted in PubMed, Scopus, and Google Scholar, complemented by reference screening. Two independent reviewers applied inclusion criteria, extracted data, and narratively synthesised the findings due to methodological diversity. Results: Out of 1,129 records screened, 8 studies met the inclusion criteria. The majority of observational studies demonstrated a significantly higher prevalence and severity of periodontitis in TB patients relative to controls, characterised by increased probing pocket depths and elevated bleeding on probing. Complementary evidence from recent reviews and microbiome analyses highlights shared inflammatory mediators, immune dysregulation, and alterations in oral microbial communities as potential mechanistic pathways underpinning the association between TB and periodontal tissue destruction. Conclusion: Current evidence supports a consistent but preliminary association between TB and deteriorated periodontal health, indicating complex bidirectional interactions rather than confirmed causality. Routine periodontal screening and oral health counselling integrated into TB management, along with heightened clinical vigilance for TB in unusual periodontal cases, may improve care. Further longitudinal and mechanistic studies are needed to clarify these relationships.