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Table 3 Summary of findings table according to GRADE approach

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

Periodontal therapy compared to no periodontal therapy in patients with PD and COPD
Patient or population: patients with PD and COPD
Setting: university clinics and Hospitals (India, Taiwan, China, Turkey and USA)
Intervention: periodontal therapy
Comparison: no periodontal therapy
Outcome no. of participants (studies) Impact Certainty What happens with periodontal therapy
Exacerbations of COPD assessed with: exacerbation frequency
No. of participants: 11,616
(4 studies)
In one study, acute exacerbation rate was 2.54 versus 2.88 per 100 person-years for emergency room use, [adjusted IRR = 0.86 (95% CI 0.78–0.94, p < 0,001)] and 1.36 versus 1.71 per 100 person-years for hospitalizatios, [adjusted IRR = 0.78 (95% CI 0.72–0.85, p < 0,001)]
In another study, proportion of frequent exacerbations was statistical significantly (p < 0.004) lower in periodontal therapy group at 2-years follow up
In the third study, frequency of exacerbations was 1.95 per patient-years compared to 3.25 in the control group (p = 0.01)
In the last study, although supragingival scaling < 1time/year was associated with higher proportion of patients with frequent exacerbations, in the adjusted model no statistical significance was obtained (OR = 2.23, 95% CI: 0.58–8.59, p = 0.24)

MODERATEa,b,c
Probably reduces frequency of exacerbations of COPD
Quality of life assessed with: SGRQ follow up: range 4 weeks to 1 years
No. of participants: 65
(2 studies)
In one study SGRQ domain scores were lower in study group at one year follow up(p < 0.05 only for activity domain score)
In another study, SGRQ and illness Questionnaire responses showed no significant difference between groups

VERY LOWc,d
Too heterogenous response to synthesize across studies
Lung function assessed with: FEV1, FEV1/FVC
follow up: range 3 months to 2 years
No. of participants: 116
(2 studies)
In one study, although FEV1/FVC mean value increased, no statistical significance was obtained
In another study, FEV1 increased statistical significantly in one year follow up for both periodontal therapy groups(p = 0.03), but only for SRP group in two years follow up. FEV1/FVC increased statistical significantly in two years follow up for both periodontal therapy groups(p = 0.02), but only for SRP group in one year follow up (p = 0.04)

VERY LOWc,e
Too heterogenous response to synthesize across studies
  1. aDowngraded by one level for bias due to the inclusion of non-randomized study with high risk of bias
  2. bInconsistency attributed to the fact that exacerbation frequency was expressed by different values(exacerbations per 100persons-years, exacerbations per patient-year, proportion of exacerbation, proportion of patients with exacerbations) was not serious to downgrade the quality of evidence for this outcome
  3. cNarrative synthesis was conducted. Estimates are not precise
  4. dDowngraded by two levels for bias, because one of the two included studies is non-randomized with high risk of bias and serious limitations
  5. eIncluded studies are judged as "high" and "serious" risk of bias