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Title For Patients with Chronic Periodontitis, Non-surgical Therapy is more Effective than no Periodontal Treatment in Reducing Serum hs-CRP Levels
Clinical Question In patients with chronic periodontitis, what is the effect of non-surgical therapy on serum high-sensitivity C-reactive protein (hs-CRP) levels compared to no periodontal treatment?
Clinical Bottom Line For patients with chronic periodontitis, periodontal therapy is more effective than no periodontal treatment in reducing serum hs-CRP levels, a marker of inflammation). This is supported by systematic reviews of several randomized controlled trials in which non-surgical therapy had a positive result compared to no periodontal treatment by a statistically significant and clinically relevant margin.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24111886Teeuw/20131748 chronic periodontitis patients (Systemically healthy periodontitis patients and periodontitis patients with various systemic co-morbidities)Meta-Analysis
Key resultsMeta-analysis of data from 25 clinical trials demonstrated periodontal therapy significantly reduced serum hs-CRP levels overall (WMD between periodontal therapy and no therapy = -0.50 mg/l, 95%CI= -0.78; -0.22). Heterogeneity between the analyzed studies was statistically significant (p < 0.00001). Subanalysis showed that the effect of non-surgical therapy on hs-CRP was only significant in patients with systemic co-morbidities (WMD = -0.71 mg/l; 95% CI = -1.05, -0.36, p < 0.0001). In systemically healthy periodontitis patients, periodontal therapy did not result in a significant reduction in hs-CRP (p = 0.73).
#2) 17032104Ioannidou/2006Chronic periodontitis patients (not differentiated between systemic co-morbidities and systemically healthy patients)Systematic review of randomized trials
Key resultsThree randomized controlled trials demonstrated no significant effect of periodontal treatment on hs-CRP levels compared to no periodontal treatment (WMD = -0.18 mg/l;95% CI = -0.70, 0.35; p = 0.49). These RCTs did not differentiate between systemically healthy periodontitis patients and those with systemic co-morbidities. Heterogeneity between the studies analyzed was not statistically significant (p= 0.71).
Evidence Search ("periodontitis"[MeSH Terms] OR "periodontitis"[All Fields]) AND CVD[All Fields] AND ("biological markers"[MeSH Terms] OR ("biological"[All Fields] AND "markers"[All Fields]) OR "biological markers"[All Fields] OR "biomarkers"[All Fields]) AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields])
Comments on
The Evidence
Validity: In Teeuw’s article, a robust data set from 25 clinical trials was examined. The groups were similar at the start; one group received periodontal therapy and one group received no treatment. There was an 80% completion rate and adequate follow up. Perspective: In Teeuw’s article, even though there were a lot of studies and a lot of subjects, differences in trial design between studies resulted in significant heterogeneity. This may decrease the generalizability of results. A strength of this article is that they did not look only at the oral cavity. They showed the major effect of periodontal therapy on serum hs-CRP was in patients who had systemic co-morbidities
Applicability The acquired evidence has considerable applicability to all patients with chronic periodontitis, with or without systemic co-morbidities, and their serum hs-CRP levels, which is a marker of inflammation. It also is pertinent to dental practitioners who are capable of performing non-surgical periodontal therapy and can provide credible patient education for the positive outcomes of such treatment and is likely to be accepted by the average patient.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords periodontitis, C-reactive protein, CRP, therapy
ID# 2729
Date of submission: 05/12/2014spacer
E-mail cooperkl@livemail.uthscsa.edu
Author Kelly Cooper
Co-author(s) e-mail
Faculty mentor/Co-author Brian Mealey, DDS, MS
Faculty mentor/Co-author e-mail mealey@uthscsa.edu
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