The association of periodontal diseases and Sjogren’s syndrome: A systematic review and meta-analysis

Abstract

BackgroundThe relationship between periodontal diseases and Sjogren’s syndrome were found inconsistent in current studies. Our objective is to clarify the relationship between periodontal diseases and Sjogren’s syndrome.MethodsA systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Electronic databases (EMBASE, PubMed, Web of Science, and Cochrane Library, from inceptions until 24 November 2021) were searched. The Newcastle-Ottawa Scale (NOS) and Agency for Healthcare Research and Quality (AHRQ) were applied to evaluate the quality of studies. Quality assessment of the certainty of evidence was performed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. When the output is the ratio, Odds ratio (OR) of periodontal diseases with Sjogren’s syndrome were calculated. When the output is the mean, weighted mean difference (WMD) of periodontal diseases with Sjogren’s syndrome was calculated. We conducted meta-analysis and estimated the pool sensitivity. Begg’s test was used to test the possibility of publication bias. We also carried out meta-regression to clarify the source of heterogeneity (I2 > 50%). Finally, we performed a trial sequential analysis (TSA) to identify the false positive or false negative outcomes that might occur during repeated updates.Results21 studies were included in this systematic review, with a total of 11435 subjects. Meta-analysis of 5 studies showed that there is a positive correlation between periodontitis and Sjogren’s syndrome (OR = 2.12, 95% CI = 1.43–3.17; 5 studies, 6927 participants; low certainty of evidence). Meta-analysis of 16 studies showed that the periodontal condition of patients with Sjogren’s syndrome was worse compared with the control group, and the scores of clinical periodontal parameters were relatively high.ConclusionSjogren’s syndrome patients seem to be more likely to be diagnosed with periodontal diseases. However, our results should be interpreted with caution considering the high heterogeneity.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021261322].

Periodontitis and Sjogren’s syndrome: a bidirectional two-sample mendelian randomization study

“…However, there were also several studies in contrast with our results. Two systematic reviews with meta-analysis similarly reported that SS patients were more likely to suffer from PD or worse periodontal status, which was not in line with our results [ 23 , 25 ]. However, these two studies still did not examine the risk of developing SS among PD patients, and as kindly figured out by their authors, the reliability of these results was impaired by unsatisfied methodological quality of the primary studies in meta-analysis, high statistical heterogeneity with no explicit source, or selection and cofounding bias in observational studies.…”

“…Meanwhile, some key proinflammatory mediators that might drive a higher risk of PD are elevated in saliva extracted from patients with SS, such as IL-12, IL-6, and IL-17, indicating the possible existence of a shared etiopathogenesis among these two diseases [ 19 – 22 ]. Several recent meta-analyses also supported these findings [ 23 – 25 ]. However, there were also some studies reporting no link between PD and SS [ 26 , 27 ].…”

Efectos de Inducción Recíproca Entre Periodontitis e Hiposalivación. Revisión de la Literatura

“…La asociación entre el síndrome de Sjögren y las afecciones gingivoperiodontales ha sido convalidada de manera categórica por numerosos estudios. Como ejemplo de esto, un metaanálisis publicado en el 2023 demostró con claridad que los pacientes que padecen síndrome de Sjögren poseen índices periodontales y gingivales más elevados que aquellos sanos, debido a la disminución de la secreción salival, aumentando sus chances de desarrollar enfermedad periodontal (Yang et al, 2023).…”

Association between Sjögren’s Syndrome and Periodontitis: Epidemiological, Fundamental and Clinical Data: A Systematic Review

“…As highlighted by a recent meta-analysis on the subject, performed on 21 studies with a total of 11,435 participants, SS patients could have an increased risk of being diagnosed with periodontitis [ 88 ]. However, as reflected by our systematic review and the conclusion of Yang’s meta-analysis, the results are highly heterogenous, meaning that so far, no definitive conclusion could be drawn [ 88 ]. Our review has illustrated a variety of approaches to the matter of increased risk in SS patients for periodontitis, generating, at times, conflicting results.…”