Senior scholar, School of Dental Hygiene, College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Professor emerita of clinical dentistry, University of Southern California, Los Angeles, CA, USA; Director, National Center for Dental Hygiene Research and Practice.
Can J Dent Hyg. 2020 Feb 1;54(1):32-41.
Previous position papers have confirmed associations between periodontal disease and cardiovascular disease. Causal associations have not been confirmed and have been the source of much confusion for oral health professionals and the public.
To investigate whether sufficient evidence exists for a causal relationship between periodontal disease and cardiovascular disease.
The PICO question was "For adults in good general health who are diagnosed with periodontal disease, will receiving non-surgical periodontal therapy (NSPT), as compared to not receiving NSPT, lower their risk for cardiovascular diseases?" Only systematic reviews (SRs) with or without meta-analyses (MAs) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic Reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality.
Of 53 cardiovascular disease studies retrieved, 7 met the inclusion criteria, of which 6 contained MAs. Results were mixed for various periodontal interventions lowering the risk for cardiovascular outcomes. Only one SR used cardiovascular events as a direct outcome; the other 6 used various surrogate measures.
Bradford Hill criteria analysis failed to support a causal relationship between periodontal disease and cardiovascular disease.
研究牙周病与心血管疾病之间是否存在因果关系。
采用 PICO 问题，即“对于被诊断为牙周病且身体状况良好的成年人，与不接受非手术牙周治疗（NSPT）相比，接受 NSPT 是否会降低其患心血管疾病的风险？”仅纳入 2007 年至 2019 年间发表的英语系统评价（SRs），无论是否有荟萃分析（MAs），并纳入了随机对照试验。检索的数据库包括 PubMed、MEDLINE、EbscoHost、CINAHL、Scopus、Cochrane 系统评价注册库和临床试验注册库。两位作者均使用 PRISMA 清单进行质量评估。使用布拉德福·希尔标准来确定因果关系的证据。
在检索到的 53 项心血管疾病研究中，有 7 项符合纳入标准，其中 6 项包含 MA。对于各种牙周干预措施降低心血管结局风险的结果不一。只有一项 SR 将心血管事件作为直接结局，而其他 6 项则使用了各种替代指标。
布拉德福·希尔标准分析未能支持牙周病与心血管疾病之间存在因果关系。
