Introduction
Method
Search strategy
Eligibility criteria
Inclusion criteria
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Population: human.
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Exposure: subjects with periodontitis. The confident case definition for periodontitis were defined as periodontal pocket depth (PPD) ≥ 4 mm, clinical attachment loss (CAL) ≥ 3 mm, and community periodontal index (CPI) ≥ 3 [23]; The non-confident case definition was considered as ‘Alveolar bone loss’ without other measurements of PPD/CAL; Unclear diagnostic criteria for periodontitis.
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Non-exposure: subjects without periodontitis (with periodontal health or gingivitis).
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Outcome: the primary outcome was defined as prevalence of dental caries (crown caries or root caries) in individuals with periodontitis, the secondary outcome was mean DMFT (the amount of decayed, missing, filled permanent teeth) or DFR (the amount of decayed, filled root teeth), along with the correlation of pathogenic bacteria related to caries and PD.
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Study design: case–control or cohort studies.
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Population: human.
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Exposure: subjects with caries, it was defined as DT ≠ 0.
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Non-exposure: subjects without caries.
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Outcome: the primary outcome was defined as prevalence of periodontitis in individuals with caries; the secondary outcome was the correlation of pathogenic bacteria related to caries and periodontitis.
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Study design: case–control or cohort studies.
Exclusion criteria
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Studies with groups evaluating periodontitis or caries separately, case reports, review or guidelines, no full text available nor English language used.
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Publications were further excluded if periodontal status was only assessed by tooth loss or gingival appearance.
Quality assessment
Data extraction and processing
Statistical analysis
Results
Literature selection
Study characteristics and quality assessment
Author, year, country | Studies design | Population of study | Periodontal criteria | Caries criteria | Observed effect (OR, RR, etc.…) |
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María 2021 Spain | Case–control | N = 5130 | CPI (0–4); CAL (0-3 mm, 4-6 mm, ≥ 6 mm) | DMFT > 0 | Subjects with CAL 0–3 mm (n = 4070), 4–5 mm (n = 685) and ≥ 6 mm (n = 375) groups had a DMFT index of 7.8, 9.6 and 10.5; DFR index was 0.2, 0.5 and 0.8 respectively, with a statistically significant difference (p < 0.001). The prevalence of caries was 38.2%, 42.9%, and 47.7% |
Age | In the logistic regression analysis, having CPI ≥ 3, CAL ≥ 4 mm were significantly associated with a higher prevalence of cavitated caries (OR crude = 1.9, 95% CI [1.7–2.1], p < 0.001); After adjustment for confounders, having CPI ≥ 3 was significantly associated with a higher prevalence of cavitated caries (OR adjusted = 1.6, 95% CI [1.3–1.8], p < 0.001) | ||||
Gender: | |||||
Female = 2083 | |||||
Male = 3047 | |||||
Vehkalahti 1994 Finland | Case–control | N = 4777 | PD > 4 mm | DT ≠ 0 | Among female, the OR for the association between root caries and moderate periodontitis or severe periodontitis were 2.9 and 3.2 respectively |
Age: | Compared with subjects without periodontitis, the OR were 5.4 and 9.3 for men with 4–6 mm and 6 mm deep pockets | ||||
mean = 46 | Overall, periodontitis was associated with root caries OR = 1.3 (0.9–1.7) | ||||
Aron 2019 Sweden | Case–control | N = 1577 | Alveolar bone loss: healthy: 80% bone remnant; mild to moderate (79–66%); severe: (> 66%) | DT ≠ 0 | The prevalence of caries in no-periodontitis patients (n = 988), mild-moderate (n = 492) and severe periodontitis patients (n = 97) were 16%, 19%, 30% |
Age < 75 | |||||
Franz 2019 Chile | Case–control | N = 994 | CDC-APP | DT ≠ 0 | The prevalence of periodontitis (89.3%) was higher in patients with caries (n = 855) than in those without caries (n = 139) (78.4%), P < 0.05 |
Age: 35–44 | CAL > 3 mm | ||||
Gender: | PD > 4 mm | ||||
Female = 558 | The prevalence of caries in patients with periodontitis (n = 873) or without periodontitis (n = 121) was 89.3% and 10.6% | ||||
Male = 436 | The prevalence of caries in moderate (n = 498) and severe (n = 251) periodontitis patients was 58.2% and 29.3% | ||||
Belstrøm 2014 Denmark | Case–control | N = 586 Patients saliva samples, including periodontitis group (n = 139) and randomized control cohort (n = 447), 5% of this group also had periodontitis | BOP > 25%, (≥ 2 teeth) CAL > 4 mm and PD > 6 mm | DT ≠ 0 | The prevalence of periodontitis was 6% in patients with caries (n = 417) and 4% in those without caries (n = 30) |
The prevalence of caries in patients with periodontitis (n = 426) was 6.57%and 9.5% in those without periodontitis (n = 21) | |||||
Amare 2022 Ethiopia | Case–control | N = 443 | PD > 3 mm | DT ≠ 0 | The prevalence of periodontitis in patients with (n = 184) and without (n = 259) caries was 34.8% vs 22.4% |
Age:7–30 | |||||
Gender: | The prevalence of caries in patients with (n = 122) and without (n = 321) periodontitis was 34.8% vs 65.2% | ||||
Female = 206 | Multiple regression showed that caries had an effect on the risk of periodontitis (OR = 1.85, 95% CI: 1.21–2.82) | ||||
Male = 237 | |||||
Mattila 2010 Finland | Case–control | N = 5255 | PD > 4 mm | DT ≠ 0 | The prevalence of caries in patients with (n = 68) and without (n = 44) periodontitis was 33% vs 23%, which was higher in severe periodontitis (44%) |
Age: > 30 | The prevalence of periodontitis in patients with (n = 1524) and without (n = 3731) caries was 31% vs 16% | ||||
Gender: | |||||
Female = 2782 | |||||
Male = 2473 | |||||
Hani 2011 Saudi Arabia | Case–control | N = 112 | Alveolar bone loss | DT ≠ 0 | The prevalence of coronal caries in patients with (n = 68) and without (n = 44) periodontitis was 94% vs 93% |
The prevalence of root caries in patients with (n = 68) and without (n = 44) periodontitis was 29% vs 5% | |||||
Lina 2020 England | Case–control | N = 4738 | 16-34 s: diagnosed with PD > 35 s: diagnosed with CAL | DT ≠ 0 | Adults with PD ≥ 4 mm had a 1.03 rate ratio (RR) for coronal caries(P < 0.01) and 1.23 rate ratio (RR) for root caries (P < 0.001) |
Age > 35 | |||||
Li 2021 China | Case–control | N = 35-44 s 4407 65-74 s 4117 | CAL | DT ≠ 0 | Patients with periodontitis in the 35-44 s were significantly associated with caries DFT, with type B: OR = 1.21 (1.17–1.25) and type C: OR = 1.40 (1.24–1.56) |
A: crown caries | |||||
B: mixed-type caries | Patients with periodontitis in the 65-74 s were significantly associated with caries DFT, with type C: OR = 1.28 (1.21–1.35) | ||||
C: root caries | The prevalence of caries with moderate(n = 2552) or severe (n = 2198) periodontitis were 66.2% and 82.5% | ||||
Gürlek 2021 Turkey | Case–control | N = 100 (including 50 women of childbearing age and 50 infertile women) Age: 21-39 s | PD > 4 mm + | Combined clinical and imaging diagnosis DMFT | Both in all subjects and only in infertile women, caries was associated with periodontitis, the former OR = 1.39(1.17–1.65) and the latter OR = 1.40(1.07–1.82) |
CAL > 3 mm | |||||
Shrestha 2016 Nepal | Case–control | N = 100 | CPI | DMFT | The DMFT indices of periodontitis patients with CPI classification (0–2) and (3–4) were 4.70 ± 2.80; 4.09 ± 3.61 |
There were significant differences in number of teeth present between the control group and periodontitis group (OR crude = 1.29, 95% CI: 1.05–1.58, P = 0.014); (OR adjusted = 1.55, 95% CI: 1.15–2.09, P = 0.004) | |||||
Age: 27-58 s | |||||
Robert 2019 Canda | Case–control | N = 94 | PD/CAL | DM3FS: a missing tooth counts as 3 missing surfaces | Significant positive associations were found between the periodontal disease severity (CDC-AAP) and the DMFS (OR adjusted = 1.03; 95% CI: 1.01–1.05) and DS indices (OR adjusted = 1.18; 95% CI: 1.05–1.32) as well as between the tertiles of percentage of sites with CAL ≥ 3 mm and DMFS (OR adjusted = 1.03; 95% CI: 1.00–1.05) and DS indices (OR adjusted = 1.12; 95% CI: 1.00–1.25) |
Age > 30 s | A significant positive association was also found between oral levels of F. nucleatum and S. mutans (OR adjusted = 6.03; 95% CI: 1.55) | ||||
Kozlovsky 2015 Tel Aviv | Case–control | N = 30 (LAgP11 + GAgP19) | PD | DFS | DFS index was 10.62 ± 6.8, 7.5 ± 6.5 in GAgP and LAgP patients |
Age: | The number of patients with GAgP with high, medium and low (105-103C FU/ml) levels of S. m was 3/2/11 | ||||
LAgP:23.5 s | The number of LAgP patients with high, medium and low (105-103 CFU/m l) levels of S. m was 3/2/4 | ||||
GAgP:30.5 s | |||||
Van 2001 The Netherlands | Case–control | N = 154 | PD | The prevalence and rates of streptococcus mutans | The prevalence of Streptococcus mutans in the saliva of periodontitis patients in the untreated group vs. the post periodontal surgery group increased from 82 to 94% |
The mean proportions of Streptococcus pyogenes in the saliva of periodontitis patients in the untreated group vs. periodontal maintenance group were 6.65% and 1.86%, P = 0.005. After periodontal surgery, it reporter 2,51%, P = 0.041 | |||||
Gizani 1999 Belgium | Case–control | N = 10 | PD | Levels of Streptococcus pyogenes and Lactobacillus | Compared to the baseline Streptococcus pyogenes level of 2.5*105 ± 4.3*105, the level of Streptococcus pyogenes on the dorsum of the tongue increased significantly at 4/8 months to 4.8*105 ± 1.0*106 and 3.1*106 ± 6.8*106 after periodontal treatment |
Age = 23-66 s | In saliva, Streptococcus mutans increased significantly to 2.4*104 ± 5.1*104 at 8 months; in dental plaque, Lactobacillus content increased significantly at 8 months | ||||
Female = 4 | |||||
Male = 6 | |||||
Iwano 2009 Japan | Case–control | N = 40 | CPI | DT ≠ 0 | Salivary levels of Streptococcus pyogenes increased significantly in 10 patients with periodontitis before and after periodontal treatment, P < 0.05 |
Age = 23-78 s | |||||
Gender: | |||||
Female = 23 | |||||
Male = 17 | |||||
Yasuhiko 2006 Japan | Case–control | N = 368 | PD | Levels of Streptococcus pyogenes and Lactobacillus | Values > 4 mm of attachment loss (rAL4) and for average attachment loss (a AL) of sites measured were significantly higher in subjects with LB than those without Multiple regression analysis also showed a correlation between a AL and rAL4 values with the presence of LB (a AL p ¼ 0.003; rAL4 p ¼ 0.002) |
Age = 75 s | CAL | Further, multiple regression analysis of interacting factors regarding decayed root surfaces showed that LB carriers had a greater incidence of decayed root surface caries (p ¼ = 0.003), while MS and LB levels were correlated to the number of decayed root surfaces (LB p ¼ 0.010; MS p ¼ 0.026) |