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Table 2 Characteristics of the studies included in the systematic review. For periodontal outcomes see main text

From: Effect of periodontal therapy on COPD outcomes: a systematic review

First author/year/Country [Ref.] Study design Study population Study groups Periodontal interventions Outcomes/associations Follow up period Results
Das/2017/India [27] Randomized controlled trial 35 COPD patients with CP Periodontal treatment, n = 17
No treatment, n = 18
Mouth scaling and root planning with hand instruments versus no treatment SGRQ 1 year Treatment group: improvement in the SGRQ “activity” subscore (53.68 ± 16.37 vs. 38.20 ± 13.18; p = 0.005)
Control group: no change in SGRQ
Madalli/2016/India [33] Before-after treatment prospective cohort 30 COPD patients with CP N/A Supragingival scaling FEV1/FVC 3–5 months No significant improvement in FEV1/FVC
Shen/2016/Taiwan [30] Retrospective propensity-matched case–control 11,124 COPD patients with CP Periodontal treatment, n = 5562
No treatment, n = 5562
Subgingival curettage and root planning and/or invasive periodontal flap surgery versus no treatment ER visits for COPD exacerbation
Hospitalizations for adverse respiratory events
ICU admissions
All-cause mortality
5 years from inclusion
Occurrence of an adverse respiratory event
Death
Withdrawal from the insurance system
ER visits per 100 person-years for COPD exacerbation: 2.54 ( treatment group) versus 2.88 (control group); adjusted IRR of 0.86 (95% CI 0.78–0.94; p < 0.001)
Hospitalizations for adverse respiratory events per 100 person-years: 2.75 (treatment group) versus 3.65 (control group); adjusted IRR 0.74 (95% CI 0.69–0.80; p < 0.001)
ICU admissions per 100 person-years: 0.66 (treatment group) versus 0.75 (control group); adjusted IRR 0.84 (95% CI 0.75–0.94; p < 0.01)
All-cause mortality per 100 person-years: 1.81 (treatment group) versus 2.87 (control group); adjusted rate ratio 0.57 (95% CI 0.52–0.62; p < 0.001)
Zhou/2014/China [29] Randomized controlled trial 30 moderate-to-severe COPD patients Supragingival scaling, root planning and maintenance care (SRP group), n = 20
Supragingival scaling and maintenance care (scaling group), n = 20
No treatment (control group), n = 20
SRP versus scaling versus no treatment FEV1 (% predicted), FEV1/FVC
Proportion of frequent exacerbations (≥ 2/year)
2 years Control group lung function compared to baseline
Lower FEV1 at 2 years (56.3 ± 16.4 vs. 51.6 ± 18.4, p < 0.05)
Lower FEV1/FVC at 1 and 2 years (0.55 ± 0.11 vs. 0.54 ± 0.11 vs. 0.53 ± 0.11; p < 0.05)
SRP versus control group
Higher FEV1 at 1 year (55.9 ± 16 vs. 53.6 ± 18.7; p < 0.05) and at 2 years (57.1 ± 19 vs. 51.6 ± 18.4; p < 0.05)
Higher FEV1/FVC at 1 year (0.59 ± 0.09 vs. 0.54 ± 0.11; p < 0.05) and at 2 years (0.57 ± 0.10 vs. 0.53 ± 0.11; p < 0.05)
Scaling versus control group:
Higher FEV1 at 1 year (59.6 ± 17.1 vs. 53.6 ± 18.7, p < 0.005)
Higher FEV1/FVC at 2 years (0.56 ± 0.11 vs. 0.53 ± 0.11, p < 0.05)
Proportion of frequent exacerbations in SRP versus scaling versus control group
30% versus 15.8% versus 66.7%; p < 0.004
Adjusted OR for frequent exacerbations
SRP group: 0.29, (95% CI 0.10–0.84; p = 0.02)
Scaling group: 0.004 (95% CI 0.003–0.64; p = 0.02)
No differences in lung function and exacerbations between the 2 treatment groups
Kucukcoskun/2013/
Turkey [31]
Prospective case–control 40 COPD patients with CP and ≥ 1 exacerbation in the previous year Periodontal treatment, n = 20
No treatment, n = 20
Full-mouth scaling and root planning with hand instruments and ultrasonic devices Exacerbation frequency in 12 months
Number of hospitalizations
12 months Exacerbation frequency per patient-year: 1.95 (treatment group) versus 3.25 (control group)
Exacerbation frequency decreased in treatment group (3 ± 1.83 vs. 1.95 ± 1.46; p = 0.01) but remained unchanged in the control group (3.5 ± 4.62 vs. 3.25 ± 3.35; p = NS)
Hospitalizations increased from 4/year to 7/year in the treatment group and from 10/year to 12/year in the control group
Agado/2012/USA [28] Randomized controlled trial 30 COPD patients with CP Periodontal debridement with ultrasonic device, n = 10
Periodontal debridement with hand instruments, n = 10
No treatment, n = 10
Periodontal debridement SGRQ-A
5-point Likert scale of health status self-perception
7-item illness questionnaire
4–6 weeks No improvement in SGRQ-A, health status self-perception and illness questionnaire post treatment
Liu/2012/China [32] Cross-sectional 392 COPD patients Frequent exacerbators (≥ 2 events/year), n = 183
Infrequent exacerbators (< 2 events/year), n = 209
Supragingival scaling
 ≥ 1/year, n = 15
 < 1/year, n = 377
Correlation between periodontal/oral health and its treatment and frequency of COPD exacerbations N/A Risk factors for frequent exacerbations
 ≤ 25 remaining teeth (adjusted OR 1.69, 95% CI 1.03–2.77; p = 0.04)
 < 1 daily brushing frequency (adjusted OR 4.19, 95% CI 1.44–12.1; p = 0.008)
  1. COPD chronic obstructive pulmonary disease, CP chronic periodontitis, ER emergency room, GOLD global initiative for chronic obstructive lung disease, ICU intensive care unit, IRR incidence rate ratio, N/A not applicable, OR odds ratio, SGRQ St. George Respiratory Questionnaire, SGRQ-A American English modified SGRQ, SRP scaling and root planning