Section of Graduate Periodontology, Faculty of Odontology, University Complutense, Madrid, Spain.
Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy.
J Dent Res. 2021 Jan;100(1):37-49. doi: 10.1177/0022034520952401. Epub 2020 Aug 31.
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).
牙周炎与全球范围内最常导致死亡的慢性非传染性疾病独立相关。本系统综述的目的是研究牙周炎/失牙患者与无牙周炎/失牙患者相比，是否有更高的全因和死因特异性死亡率风险。纳入了队列研究，这些研究 1）评估了牙周炎或失牙作为暴露因素与全因或死因特异性死亡率作为结局之间的关系，2）报告了风险比、风险比或比值比作为危害比，并附有 95%置信区间或粗数据。两位综述作者独立搜索了合格的研究，筛选了标题和摘要，进行了全文分析，从已发表的报告中提取数据，并进行了偏倚风险评估。如有分歧，将咨询第三位综述作者。通过随机效应荟萃分析总结研究结果。共纳入 57 项研究，涉及 48 个队列和 571 万参与者。牙周炎与全因死亡率增加相关（风险比 1.46[95%CI，1.15-1.85]）和心血管疾病死亡率增加相关（1.47[1.14-1.90]）、癌症死亡率增加相关（1.38[1.24-1.53]）、冠心病死亡率增加相关（2.58[2.20-3.03]）、脑血管疾病死亡率增加相关（3.11[2.42-3.98]），但肺炎死亡率无增加（0.98[0.69-1.38]）。全口失牙与全因死亡率增加相关（1.66[1.46-1.88]）和心血管疾病死亡率增加相关（2.03[1.50-2.74]）、癌症死亡率增加相关（1.55[1.24-1.94]）、肺炎死亡率增加相关（1.72[1.07-2.78]）、冠心病死亡率增加相关（2.98[2.43-3.65]）和脑血管疾病死亡率增加相关（3.18[2.24-4.51]）。牙周炎及其最终后果（失牙）与全因和死因特异性死亡率增加相关（PROSPERO CRD42018100095）。
