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  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
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).
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 (General Dentistry) (Periodontics) (Dental Hygiene)
Keywords periodontitis, C-reactive protein, CRP, therapy
ID# 2729
Date of submission 05/12/2014
E-mail cooperkl@livemail.uthscsa.edu
Author Kelly Cooper
Co-author(s)
Co-author(s) e-mail
Faculty mentor Brian Mealey, DDS, MS
Faculty mentor e-mail mealey@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
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)
None available