Periodontal disease as a risk factor for aspiration pneumonia: a systematic review

Abstract

Academics. Inclusion criteria included randomized clinical trials, case-control and cohort studies, as well as cross sectional studies, in Portuguese and English. Teams of reviewers, independently and in duplicate, screened titles and abstracts of full text articles to determine eligibility. The selected articles were read in full and the variables evaluated independently and described in predetermined forms according to clinical outcomes. As a result, five studies out of 653 publications were included: three case-control studies and two cohort studies. Although these studies indicate a positive association between the presence of periodontal disease and the occurrence of aspiration pneumonia, the results must be interpreted with caution. They should not be taken as definitive conclusions due to variations in methodology and limitations, such as sample size, inadequate control of potential confounding variables, lack of calibration of periodontal measurements and inconsistent criteria for the establishment of aspiration pneumonia. There is little evidence to affirm that periodontal disease is a risk condition factor for aspiration pneumonia. Future studies are necessary to elucidate this association, as well as to establish the potential benefit of periodontal treatment with the goal of reducing the risk of developing aspiration pneumonia.

Periodontitis and respiratory diseases: A systematic review with meta‐analysis

“…Periodontitis is an important public health problem and needs to be measured and evaluated as a clinical entity, that is, the role of periodontitis in asthma, COPD, or pneumonia. Many previous systematic reviews (Cagnani et al, 2016;Ferreira et al, 2019;Mendes et al, 2018;Moraschini et al, 2018;Shi et al, 2018;Tan et al, 2016;Zeng et al, 2012) presented their conclusions only on the basis of the relationship between one or more periodontal clinical parameter with the abovementioned respiratory diseases, which is different from the main objective of this review.…”

“…The main findings of this systematic review showed a moderate to strong association between periodontitis and respiratory diseases, with high methodological quality among most of the studies and low to moderate heterogeneity of the selected investigations. Previous systematic reviews related to the association between periodontal clinical parameters and asthma (Ferreira et al, 2019;Mendes et al, 2018;Moraschini et al, 2018); worse periodontal condition and COPD (Shi et al, 2018;Tan et al, 2016;Zeng et al, 2012); and periodontal disease and pneumonia (Cagnani et al, 2016) showed a positive relationship between periodontal clinical parameters and the respiratory disease of interest.…”

“…The association between periodontitis and several respiratory diseases has been investigated in the last decades. While several systematic reviews have suggested an association between respiratory diseases and poor oral health (Cagnani et al, 2016;Ferreira et al, 2019;Mendes, Dos Santos, & Moraschini, 2018;Moraschini, Calasans-Maia, & Calasans-Maia, 2018;Shi et al, 2018;Tan, Wang, Pan, & Zhao, 2016;Zeng et al, 2012), one recent systematic review on the subject, which included studies from 2002 to 2012, concluded that the findings showed a weak association between periodontitis and pulmonary diseases (Linden, Lyons, & Scannapieco, 2013). Although several studies have shown that improvements in oral hygiene prevent several respiratory diseases, this question remains unresolved.…”

“…Seven recent systematic reviews assessing the association between poor oral health and pulmonary diseases have been published to date: 3 related to the association between periodontal clinical parameters and asthma (Ferreira et al, 2019;Mendes et al, 2018;Moraschini et al, 2018), 3 focused on the relationship between worse periodontal condition and COPD (Shi et al, 2018;Tan et al, 2016;Zeng et al, 2012), and 1 regarding the association between periodontal disease and pneumonia (Cagnani et al, 2016). All these reviews concluded that periodontal disease is associated with the target respiratory disease.…”

COVID‐19 Pandemic and Periodontal Practice: The Immunological, Clinical, and Economic Points of View

“…In addition, in critically ill patients due to weakness and hospitalization, oral hygiene is impaired, which exacerbates dysbiosis [70][71][72]. Several systematic reviews indicated a positive association between poor oral hygiene and oral care interventions in nursing home and hospital patients [73][74][75].…”