Periodontitis and circulating blood cell profiles: a systematic review and meta-analysis

Abstract

Background: Periodontitis is a chronic inflammatory disease with local and systemic implications. Evidence suggests consistent hematologic changes associated with periodontitis. Our aim was to critically appraise the available evidence on hemogram, leukogram and thrombogram alterations in otherwise healthy patients suffering from periodontitis when compared to controls. Methods: For this systematic review (SR), we searched MEDLINE, Web of Science, EMBASE and The Cochrane Library (CENTRAL) for studies published up to June 2020. Both observational and interventional studies with baseline standard hematologic levels were included. Outcomes of interest were baseline hemogram, leukogram and thrombogram values and the impact of periodontitis treatment on these outcomes. Upon risk of bias assessment, data extraction both qualitative and quantitative (standardised mean differences MD) analyses were performed. Random-effects meta-analyses were performed to provide pooled estimates. PRISMA guidelines were followed (PROSPERO reg: CRD42020164531).Findings: A total of 45 studies, 8 intervention and 37 case-control, were identified after the final search of 3012 titles. Following quality assessment, 43 articles were deemed as of low risk of bias whilst two manuscripts with moderate risk. Meta-analyses confirmed that periodontitis was associated with both white and red cells lineages. Severe chronic periodontitis was associated with greater White Blood Cells count (WBC) (SMD of 0.53, 95% CI 0.26-0.79) when compared to controls. Patients with periodontitis were associated with higher number of neutrophils (MD of 7.16%, 95% CI: 5.96-8.37) and lower Mean Platelet Volume (MD of 0.30 fL, 95% CI: 0.49 --0.10) than healthy participants. Nonsurgical periodontal treatment (NSPT) was associated with a decrease in WBC levels (WMD of 0.28 10 9 /L, 95% CI -0.47 --0.08) in patients suffering from chronic periodontitis.Interpretation: Periodontitis is associated with hematologic changes (SORT A recommendation). Higher WBC, neutrophils, erythrocyte sedimentation rate and lower MPV levels are the most common blood counts findings. The association between periodontitis and WBC could be causal in nature. Further research in assessing whether periodontitis causes circulating blood cells changes and identify the molecular mechanisms behind these associations are warranted.

Periodontal Health, Nutrition and Anthropometry in Professional Footballers: A Preliminary Study

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Periodontal inflammation mediates the link between homocysteine and high blood pressure

“…At this stage, this results only highlight a possible connection point, and the reader must bear in mind that they are solely hypothetical. Though, the invasion of periodontal bacteria through the ulcerated epithelium into the blood stream has been shown, with prospective hostile systemic consequences 40,41 .…”

Association of bacterial vaginosis with periodontitis in a cross-sectional American nationwide survey

“…Blood levels data included WBC count (10 9 /L), monocyte percentage (%), monocyte (10 9 /L), segmented neutrophils percentage (%), segmented neutrophils (10 9 /L), percentage of eosinophils (%), eosinophils (10 9 /L), percentage of basophils (%), basophils (10 9 /L), lymphocyte percentage (%), lymphocyte (10 9 /L), red blood cell (RBC) count (million cells/uL), hemoglobin (g/dL), hematocrit (%), mean cell volume (MCV) (fL), mean cell hemoglobin (MCH) (pg), mean cell hemoglobin concentration (MCHC) (g/dL), percentage of red cell distribution (RCD) width (%), percentage of platelet count (%), mean platelet volume (MPV) (fL), CRP (mg/dL). Overall, the markers expected to present association were WBC, Segmented neutrophils percentage, RBC, Hemoglobin, Hematocrit, MCV, MCH and MCHC according to Botelho 89 .…”