Treatment of Periodontitis and C-Reactive Protein: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

BACKGROUND: Systemic inflammation is implicated in the onset and progression of several chronic diseases. Periodontitis is a potential trigger of systemic inflammation. PURPOSE: To comprehensively appraise all the evidence on the effects of the treatment of periodontitis on systemic inflammation assessed by serum CRP levels. DATA SOURCES: Six electronic databases were searched up to 10th February 2022 to identify and select articles in English language only. STUDY SELECTION: 26 Randomised controlled clinical trials reporting changes amongst 2579 participants about CRP levels at 6 months or more after treatment. DATA EXTRACTION: Two reviewers independently extracted data and rated the quality of studies. Meta-analyses were performed using random and fixed effect models. RISK OF BIAS: Risk of bias (RoB 2.0 tool) and quality of evidence (GRADEpro GDT tool) analyses were completed. DATA SYNTHESIS: Treatment of periodontitis reduced CRP levels by 0·69mg/L (95% CI: -0.97; -0·40) after six months but limited evidence was retrieved from studies with longer follow-ups. Similar findings were observed in participants with other co-morbidities in addition to periodontitis. Greatest reductions were observed in participants with concentrations of CRP >3 mg/L at baseline. LIMITATIONS: High level of heterogeneity. CONCLUSION: Treatment of periodontitis reduces serum CRP levels (up to six months follow-up) to a degree equivalent to that observed after traditional lifestyle or drug interventions. This evidence supports a causal association between periodontitis and systemic inflammation