| KQ1: Patient-reported outcomes and complications | Quality of life | Mixed results (ranging from no statistically significant difference in OHRQoL or diabetes treatment-related QoL between groups at 3 months to better OHRQoL in periodontal tx group [6.05 vs 9.02 on the Oral Health Impact Profile-14; p<.05] at unclear timing among those with HbA1c ≥ 7%) | 2 fair-quality RCTs50,69 and 1 fair-quality case-control study58 |
| Functionality | No statistically significant difference in SF-36 between groups at 3 months | 1 fair-quality case-control study58 |
| Myocardial infarction | Mixed results (ranging from ↓ MI incidence in periodontal tx vs no tx group [HR = 0.92, 95% CI (0.85, 0.99)] over max of 3 yrs to no projected difference in annual incidence of MI between groups) | 1 fair-quality retrospective cohort study53 and 1 computer-based simulation model study63 |
| Heart failure | ↓ Heart failure incidence in periodontal tx vs no tx group (HR = 0.60, 95% CI [0.45, 0.80]) over max of 3 yrs | 1 fair-quality retrospective cohort study53 |
| Stroke | Mixed results (ranging from no projected or measured difference in stroke incidence over max of 3 yrs groups to ↓ rates of stroke in periodontal tx vs no tx group [0.88%/yr vs 1.08%/yr; p<.001] over max of 10 yrs) | 1 fair-quality retrospective cohort study,53 1 poor-quality retrospective cohort study,55 and 1 computer-based simulation model study63 |
| CVD events | Expanded periodontal coverage projected to be associated with 7.3% (95% CI [−20.3 to −0.3%]) reduction in annual incidence of CVD events | 1 computer-based simulation model study63 |
| Diabetes-related complications | Expanded periodontal coverage projected to be associated with 20.5% (95% CI [−31.2, −9.1%]) reduced nephropathy incidence, 17.7% (95% CI [−32.7, −4.7%]) reduced neuropathy incidence, and 18.4% (95% CI [−34.5, −3.5%]) reduced retinopathy incidence | 1 computer-based simulation model study63 |
| KQ2: Chronic disease indicators | HbA1c | ↓ HbA1c (MD = −0.32%, 95% CI [−0.5, −0.15%) in periodontal tx vs no tx group at 3-6 months in 1 SR ↓ HbA1c (WMD = −0.29%, 95% CI [−0.48, 0.10%]) in periodontal tx vs no or control tx group at 3-4 months, no difference between groups at 6 months in the other SR Similar findings in ↓ HbA1c in 5 newer RCTs | 1 moderate-quality review of reviews,25 1 highquality Cochrane review,43 and 5 fair-quality RCTs65–69 published after reviews |
| FBG | ↓ FBG (WMD = −11.59 mg/dl, 95% CI [−15.2, −8.0]) in periodontal tx vs no tx group at 3-6 months Similar findings in ↓ FBG in 1 newer RCT | 1 moderate-quality review of reviews25 and 1 RCT65 published after review of reviews |
| PPG | ↓ PPG by 13.28 mg/dL in periodontal tx alone vs no tx group at 3 months (p>.01) | 1 fair-quality RCT65 |
| Total cholesterol | ↓ Total cholesterol (MD = −0.47 mmol/L, 95% CI [−0.75, −0.18]) in periodontal tx vs no or control tx group at 3 months; no difference at 6 months | 1 moderate-quality SR32 |
| Triglycerides | ↓ Triglycerides (MD = −0.2 mmol/L, 95% CI [−0.24, −0.16]) in periodontal tx vs no or control tx group at 3 months; no difference at 6 months | 1 moderate-quality SR32 |
| HDL | ↑ HDL (MD = 0.06 mmol/L, 95% CI [.03, .08]) in periodontal tx vs no or control tx group at 3 months; no difference at 6 months | 1 moderate-quality SR32 |
| LDL | No statistically significant difference between groups at 3 or 6 months | 1 moderate-quality SR32 |
| CRP | ↓ CRP (Difference in mean changes scores = 1.89 mg/L, 95% CI [1.70, 2.08]) from baseline in periodontal tx vs no tx group at 3-6 months in 1 SR No improvement in CRP at 6 months in 1 newer RCT | 1 moderate-quality SR26 and 1 RCT68 published after SR |
| IL-6 | Studies had mixed findings ranging from no improvement to small improvement favoring periodontal tx | 1 low-quality review37 and 1 RCT published after review68 |
| Systemic inflammation | Studies had mixed findings ranging from no improvement to improvement in markers of systematic inflammation favoring periodontal tx | 1 critically low-quality review of reviews30 and 1 RCT67 published after review |
| Cardiac indicators | Periodontal tx reduced the mean E/e’ ratio by 1.66 (95% CI: −2.64, −0.68, p<.01) compared to no tx at 6 months. Left ventricle mass index (LVMI) and NT-proBNP were not significantly improved in tx vs no tx at 6 months. | 1 fair-quality RCT68 |
| Oxidative stress | Improved oxidative index in periodontal tx vs no tx at 3 months (−1.19, 95% CI [−2.03, −0.35]). | 1 fair-quality RCT69 |
| KQ3: Health care utilization and costs | Costs | Mixed results on costs associated with periodontal tx vs no tx (ranging from higher, to lower, to no difference in costs) | 2 fair-quality retrospective cohort studies,52,59 4 poor-quality retrospective cohort studies,57,61,62,64 and 2 modeling studies51,63 |
| Health care utilization | Mixed results (ranging from lower rates of inpatient admissions in periodontal tx vs no tx group [40.4 vs. 66.6 inpatient admissions/1,000 subjects/year; p<.05] vs no significant differences between groups in total outpatient physician visits, probability of a hospitalization, or the occurrence of an emergency room visit) | 2 poor-quality retrospective cohort studies57,61 |
| KQ4: Harms | Harms | Some minor adverse events (diarrhea, headaches, and nausea) in both groups; some minor adverse events from doxycycline or chlorhexidine (diarrhea, pain, nausea, taste change, tooth stain) in some studies; otherwise; or no adverse events in periodontal tx group over max of 6 months. | 1 high-quality Cochrane review,43 1 moderate-quality review,26 and 2 RCTs66,69 published after reviews |
