Journal Article

Periodontal status and chronic obstructive pulmonary disease (COPD) exacerbations: a systematic review

Kelly, Niamh, Irwin, Christopher, Lundy, Fionnuala T., Winning, Lewis, Linden, Gerard J., Linden, Dermot, McGarvey, Lorcan, El Karim, Ikhlas A.

2021

Overview

Background A growing body of evidence suggests a role for oral bacteria in lung infections. This systematic review aimed to analyse the association between poor periodontal status and the frequency of chronic obstructive pulmonary disease (COPD) exacerbations. Methods PubMed, Embase, Web of Science, CINAHL and Medline were searched for studies published until May 2020, with no language restriction. Studies reporting periodontal condition, or periodontal treatment outcomes, with data on the frequency of exacerbations of COPD, were identified. The primary outcome was the frequency of exacerbations and secondary outcomes included quality of life (QoL) and hospitalisation. Quality and risk of bias assessment were carried out using the Newcastle Ottawa Scale for observational studies, Robins-1 tool for non-randomised intervention studies and Cochrane risk of bias assessment (RoB-2) tool for randomised clinical trials. Studies were assessed for eligibility and quality by two assessors independently. Results Searches identified 532 records and 8 met the inclusion criteria. Included studies were three clinical trials, one prospective cohort study, one case–control, and three cross-sectional studies. A narrative synthesis was performed. The data from intervention studies showed reduction in the frequency of exacerbations following periodontal treatment. Data from observational studies suggest association of worse plaque scores and fewer teeth with exacerbation, but not pocket depth or clinical attachment loss. Better periodontal health was also associated with reduced frequency of COPD exacerbations, hospitalisations and improved quality of life in COPD patients. Due to the high heterogeneity no meta-analysis was performed. The quality of some of the included studies was low and there was evidence of a high risk of bias. Conclusion The data supports possible association between poor periodontal health, the frequency of exacerbations, hospitalisation and quality of life in COPD patients. The evidence is of moderate to low certainty and is limited by high risk of bias suggesting the need for well-designed and adequately powered randomised controlled trials, to inform future research and clinical practice. The PROSPERO registration number CRD42020180328.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Bacteria / Bias / Bronchopulmonary infection / Care and treatment / Chronic obstructive pulmonary disease / Clinical medicine / Clinical trials / Complications and side effects / COPD / Cross-Sectional Studies / Dental plaque / Dentistry / Diagnosis / Disease / Disease Progression / Exacerbation / Gum disease / Humans / Infections / Lung diseases / Lung diseases, Obstructive / Medicine / Meta-analysis / Obstructive lung disease / Oral and Maxillofacial Surgery / Oral bacteria / Oral health / Oral hygiene / Pathogens / Patient outcomes / Patients / Periodontal disease / Periodontitis / Pneumonia / Prospective Studies / Pulmonary Disease, Chronic Obstructive - complications / Quality of Life / Respiratory diseases / Systematic review