Human Cytomegalovirus May Contribute to the Development of Periodontitis, but Not to Apical Periodontitis of Endodontic Origin

Article Title and Bibliographic Information: Association between human cytomegalovirus and periodontitis: A systematic review and meta-analysis. Botero JE, Rodríguez-Medina C, Jaramillo-Echeverry A, Contreras A. J Periodontal Res. 2020;55(4):551-558. Subjects or Study Selection The authors searched the literature, published in English, Spanish, and Portuguese, from inception to May 2019. It was searched using the Medical Subject Heading (MeSH) terms and keywords: (((human cytomegalovirus [Title/Abstract]) OR HCMV [Title/Abstract] OR herpesvirus [Title/Abstract]) AND periodontitis [Title/Abstract] AND (Humans [Mesh])) via MEDLINE, Scopus, and SciELO databases. The authors did not report the use of additional literature sources (eg, citation mining and/or gray literature). Two reviewers independently screened titles and abstracts to identify relevant articles, and a third reviewer was consulted in case of disagreement. Based on eligibility criteria, 32 studies were included for the qualitative and quantitative analyses, 26 on periodontitis and 6 on patients with apical periodontitis. Key Study Factor The authors conducted a systematic review and meta-analysis of case-control and cross-sectional studies on the associations of human cytomegalovirus (HCMV) with periodontitis, and with apical periodontitis of endodontic origin. Studies included populations consisted of periodontal and endodontic patients positive for the presence of HCMV in examined samples compared with patients with negative HCMV result. Main Outcome Measure The main outcome measure was the prevalence of HCMV infection analyzed by different laboratory methods (ie, variants of polymerase chain reaction [PCR] methods [single, nested, multiplex, hot starts, real-time], and loop-mediated isothermal amplification) in periodontitis and apical periodontitis samples compared with healthy controls. In addition, the authors performed quality assessment analyses of the included studies based on their risk of publication bias. Main Results The pooled analysis of 25 studies with 2385 subjects (1324 with periodontitis and 1061 without periodontitis) revealed significantly increased odds for periodontitis when subgingival HCMV was detected (odds ratio [OR] = 5.31; 95% confidence interval [CI] = 3.15-8.97; P < .00001). Heterogeneity test was 1.00, and the test for overall effect was Z = 6.26, which indicates a significant heterogeneity (I-2 67%; P < .00001). In contrast, results from 5 included studies (n = 317, 219 periapical lesions and 98 healthy control samples) revealed no significant odds for apical periodontitis when HCMV was detected (OR = 3.65; 95% CI = 0.49-27.1; P = .21). Heterogeneity test was 3.94, and the test for overall effect was Z = 1.26 (I-2 83%; P < .00001). The quality of the included studies was assessed by analyzing their risk of bias using the US National Institute of Health National Heart, Lung and Blood Institute quality assessment tool for case-control, cohort, and cross-sectional studies. Of 25 studies with periodontitis samples, 18 were considered to be of fair quality, 7 were of poor quality, and only one study was appraised as good quality. Of 6 studies with apical periodontitis samples, 2 were considered to be of fair quality and 4 were of poor quality. Significant publication bias was observed among the 25 included studies related to periodontitis (Egger's test t = 7.0479, df = 23, P < .0001). Conclusions HCMV is significantly more common in patients with periodontitis than in healthy control samples. However, there was no significant difference in the occurrence of HCMV in patients with apical periodontitis compared with healthy control samples