Separating fact from fiction: use of high-level evidence from research syntheses to identify diseases and disorders associated with periodontal disease.

Correlations with periodontitis have been reported for several diseases, although the biological mechanisms that might lead to these putative correlations are generally unclear. This paper describes the most robust of these associations, on the basis of an evaluation of research syntheses (meta-analyses and systematic reviews) available up to June 2011. This high-level evidence indicates that individuals with periodontitis have a signifi cantly higher risk of various other problems, including cardiovascular disease, diabetes mellitus, respiratory disease and preterm low-birth-weight deliveries. For some conditions, treatment of periodontitis leads to a reduction in the rates of the other disease, lending further support to the concept that the association is reversible. An understanding of these correlations is important to allow dental health care providers to inform patients with periodontitis of their increased risks and to counsel such patients to seek additional medical assessment or intervention, as indicated. Separating Fact from Fiction: Use of High-Level Evidence from Research Syntheses to Identify Diseases and Disorders Associated with Periodontal Disease Amir Azarpazhooh, DDS, MSc, PhD, FRCD(C); Howard C. Tenenbaum, DDS, Dip Perio, PhD, FRCD(C) Since publication of the US Surgeon General’s report on oral health in the year 2000,1 there has been increased interest in determining whether a link exists between oral health and overall health or disease. Several diseases appear to be correlated with periodontitis, but the mechanisms are generally unknown. Despite the biological plausibility of some of these associations, the biggest challenge is sift ing through and analyzing the published evidence to determine which are robust and which are only tenuous or weak. An understanding of the strength of the proposed associations is important so that patients with periodontitis can be informed of the risks (especially if they have other risk factors for an associated condition or disease) and can be counselled to seek further medical assessment. Such assessment may be considered prophylactic or may be related to the medical management of the particular disease or diseases for which the patient has an elevated risk. To establish as fi rmly as possible the association between certain health conditions and periodontal diseases, the literature was searched to identify the strongest of these associations, Clinical Review