Periodontitis, Edentulism, and Risk of Mortality: A Systematic Review with Meta-analyses

Abstract

Periodontitis has been independently associated with the chronic noncommunicable diseases that most frequently lead to death worldwide. The aim of the present systematic review was to study whether people with periodontitis/edentulism are at increased risk of all-cause and cause-specific mortality as compared with those without periodontitis/edentulism. Cohort studies were included that 1) evaluated periodontitis or edentulism as exposures in relation to all-cause or cause-specific mortality as an outcome and 2) reported effect estimates as hazard ratios, risk ratios, or odds ratios with 95% CIs or crude numbers. Two review authors independently searched for eligible studies, screened the titles and abstracts, did full-text analysis, extracted the data from the published reports, and performed the risk-of-bias assessment. In case of disagreement, a third review author was consulted. Study results were summarized through random effects meta-analyses. A total of 57 studies were included, involving 48 cohorts and 5.71 million participants. Periodontitis was associated with increased risk of all-cause mortality (risk ratio, 1.46 [95% CI, 1.15 to 1.85]) and mortality due to cardiovascular diseases (1.47 [1.14 to 1.90]), cancer (1.38 [1.24 to 1.53]), coronary heart disease (2.58 [2.20 to 3.03]), cerebrovascular diseases (3.11 [2.42 to 3.98]), but not pneumonia (0.98 [0.69 to 1.38]). Edentulism (all types) was associated with increased risk of all-cause mortality (1.66 [1.46 to 1.88]) and mortality due to cardiovascular diseases (2.03 [1.50 to 2.74]), cancer (1.55 [1.24 to 1.94]), pneumonia (1.72 [1.07 to 2.78]), coronary heart disease (2.98 [2.43 to 3.65]), and cerebrovascular diseases (3.18 [2.24 to 4.51]). Periodontitis and its ultimate sequela (edentulism) are associated with an increased risk of all-cause and cause-specific mortality (PROSPERO CRD42018100095).

The Vital Importance of Gum Health

“…The calculated RR for edentulism and mortality, based on 29 studies and 4,981,158 subjects, showed the same trend as demonstrated for periodontitis, but with increased evidence of association and significant results also for pneumonia (Romandini et al 2021). The interpretation of these results is challenging because of the risk of bias related to the variable causes of edentulism: caries, periodontitis, and traumatic and iatrogenic causes (Cooper 2009).…”

“…The review and meta-analysis published by Romandini et al (2021) summarized the evidence of 57 studies, involving 5.71 million participants. A qualitative and quantitative analysis of data with the relative statistical analysis permitted the researchers to obtain strong and reliable evidence about the role of periodontitis and edentulism on increasing mortality.…”

“…Epidemiological evidence based on 19 studies and 640,446 subjects showed that periodontitis was significantly associated with increased risk of all-cause mortality and deaths due to CVDs, cancer, coronary heart disease (CHD), and cerebrovascular diseases, but not pneumonia. The relative risk (RR) of periodontal patients for mortality was 2.58 for CHD and 3.11 for cerebrovascular disease with respect to a population with periodontal health (Romandini et al 2021). These results were supported by also considering only high-quality studies: subjects with periodontitis had more than twice the risk of all-cause and CVD mortality.…”

“…These results were supported by also considering only high-quality studies: subjects with periodontitis had more than twice the risk of all-cause and CVD mortality. Epidemiological evidence, biological plausibility, and interventional studies supported the impact of periodontitis with mortality (Romandini et al 2021). Interestingly, this association seems not to be influenced by the severity of periodontitis but by age; in particular, this association was more evident in subjects younger than 65 y.…”

Dental Care Access and the Elderly: What Is the Role of Teledentistry? A Systematic Review

“…A high level of unmet oral health needs is very common among elderly people, suggesting that enhancing access to dental care is crucial [13]. Oral diseases could be also responsible for the triggering or promotion of inflammatory and infectious processes at a systemic level, potentially worsening the clinical picture of subjects with comorbidities [14].…”