Title	Serum C-Reactive Protein Levels Cannot Be Used To Accurately Assess The Extent Or Severity Of Periodontal Disease
Clinical Question	Do serum C-reactive protein (CRP) levels serve as a useful marker of the extent or severity of periodontitis?
Clinical Bottom Line	There is a correlation between periodontitis and elevated serum levels of C-reactive protein. However, infections, inflammatory conditions, smoking, obesity and trauma may also contribute to increases in CRP. Therefore, one cannot assume that an elevated CRP is a result of periodontitis.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 18294231 Paraskevas/2008 2,637 human subjects from 18 studies Systematic Review and Meta Analysis Key results Meta-analysis demonstrated a statistically significant difference of 1.56 mg/l in C-reactive protein levels between periodontitis patient’s and controls. (p=0.00001).
Evidence Search	("C-Reactive Protein"[Mesh] OR "Serum Amyloid A Protein"[Mesh] OR (("serum"[MeSH Terms] OR "serum"[All Fields]) AND inflammatory[All Fields] AND ("Markers"[Journal] OR "markers"[All Fields]))) AND "Periodontitis"[Mesh] AND (Meta-Analysis[ptyp] AND systematic[sb])
Comments on The Evidence	This systematic review used explicit and appropriate evidence quality criteria to select 18 studies out of 448 relevant papers. Selected studies included controlled trials and case-control studies, using high sensitivity CRP measurement and acceptable diagnostic criteria for periodontitis. This review provides strong evidence that plasma CRP is elevated in periodontitis as compared with controls. However, due to the large number of confounding factors, it is not possible to establish a causal relationship between the two variables.
Applicability	CRP is produced in response to exposure to inflammation originating from gram-negative bacteria both in the periodontal pocket and elsewhere in the body. While an elevated CRP level may be due in part to periodontal inflammation, it cannot be determined at this time to what extent it plays a role. Therefore, testing a patient's CRP level is not a practical means of evaluating the extent or severity of periodontitis.
Specialty	(Periodontics)
Keywords	C-reactive protein, periodontitis, serum inflammatory markers, inflammation
ID#	2098
Date of submission	09/16/2011
E-mail	hoge@livemail.uthscsa.edu
Author	Michael Hoge
Co-author(s)	Yong-Hee Patricia Chun, DDS, MS, PhD
Co-author(s) e-mail	Chuny@uthscsa.edu
Faculty mentor	Archie Jones, DDS, MBA
Faculty mentor e-mail	JonesA@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Garrett Rist, Monica Gerges (San Antonio, Texas) on 11/28/2017 A new search on this clinical question was completed in November 2017. Sharma A. et al, 2014 (PMID 24974939) does refute the original bottom line for this clinical question. The study concluded that CRP measurements could be used to assess periodontal damage.