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. 2023 Sep 13;12(18):5935. doi: 10.3390/jcm12185935

Table 4.

Effects of periodontal interventions on COPD outcomes.

Author (Year) Location Study Design Study Population n Periodontal Intervention Measured Outcome of COPD Main Findings
Madalli et al., 2016 [57] India Prospective cohort Patients diagnosed with COPD and chronic periodontitis 30 Supragingival scaling and oral hygiene
instructions to all patients		 Spirometric data (FEV1 and FVC)

  • No statistically significant improvement in FEV1/FVC values was observed before (mean ± SD, 48.08 ± 12.01) and after treatment (51.25 ± 12.29, p > 0.05).
Kucukcoskun et al., 2013 [53] Turkey Prospective case–control Patients with COPD attending the outpatient clinics of the three chest clinics with a history of at least one infectious exacerbation in the past year and with moderate to severe chronic periodontitis
Treatment group: patients who were able to visit the authors’ department regularly for treatment and subsequent follow-up
Control group: patients who came from hospitals distant from the authors’ periodontology department and had transportation problems 		40 Oral hygiene instructions, full-mouth scaling, and root planing
using hand instruments and ultrasonic devices under local anaesthesia, n = 20; no periodontal treatment, n = 20		 Rate of exacerbation (sustained
worsening of baseline respiratory symptoms for ≥2
days that required oral corticosteroids and antibiotics/hospitalization)
over the 12 months

  • Exacerbation frequency was significantly reduced in the treatment group (mean ± SD, 3 ± 1.83 at baseline; 1.95 ± 1.46 after 1-year follow-up; p = 0.01), whereas there was no change in the number of exacerbations in the control group. (3.5 ± 4.62 at baseline; 3.25 ± 3.35 after 1-year follow-up; p = 0.87).
Sharma et al., 2021 [54] India Prospective case–control Case group: patients with COPD having chronic periodontal disease and a history of exacerbation within the last month
Control group: systemically healthy outpatients with periodontitis		 75 Non-surgical periodontal therapy: oral hygiene instructions and professional full mouth SRP using an
Ultrasonic scaler and periodontal hand instruments without local anaesthesia, n = 37; no periodontal treatment, n = 38		 Spirometric data (FEV1 and FVC)

  • The case group showed a statistically significant improvement in mean FEV1/FVC values at 12 months (mean ± SD, 63.39 ± 11.65 vs. 73.43 ± 10.51; p < 0.001). In contrast, no significant changes were observed in the control group (mean ± SD, 82.49 ± 5.29 vs. 81.49 ± 3.82; p = 0.485).
Das et al., 2017 [55] India Randomized controlled trial Patients with COPD 35 Full-mouth scaling and root
planing using hand instruments, and oral hygiene
instructions, n = 18; no periodontal treatment, n = 17		 SGRQ

  • The intervention group showed a significant improvement in the activity score after 1 year of treatment (mean ± SD, 53.68 ± 16.37 before treatment vs. 38.20 ± 13.18 after treatment; p = 0.005), whereas there was no change in the control group.
Zhou et al., 2014 [56] China Randomized controlled trial Symptomatic patients with COPD attending a hospital in Beijing 60 SRP treatment, n = 20; supragingival scaling treatment, n = 20; no periodontal treatment, n = 20 Pulmonary function (FEV1 % predicted, FEV1/
FVC) and the frequencies of
COPD exacerbation

  • The mean FEV1 values of the two treatment groups were significantly higher (p = 0.03) than the control group at 1-year follow-up, although the difference did not reach statistical significance at a 2-year follow-up visit (p = 0.06).

  • The FEV1/FVC means of the two treatment groups were higher than the control group at 1 year (p = 0.04) and at the 2-year follow-up (p = 0.02), respectively.

  • At the 2-year follow-up visit, the treatment group had a lower rate of frequent exacerbations (SRP, 30%; supragingival scaling treatment, 15.8%) than the control group (66.7%), which was statistically significant between groups (p = 0.004).

  • Adjusted ORs for frequent exacerbation were 0.29 (95% CI: 0.10–0.84) for the SRP group and 0.04 (95% CI: 0.003–0.64) for the supragingival scaling group.
Agado et al., 2012 [46] USA Randomized controlled trial Patients diagnosed with COPD and chronic periodontitis 30 Magnetostrictive ultrasonic instrument, n = 10; hand instrument, n = 10; control, n = 10 SGRQ-A and Illness Questionnaire (developed by the principal investigator)

  • SGRQ-A (symptom, p = 0.124; activity, p = 0.702; impact, p = 0.926) and illness questionnaire scores did not demonstrate significant differences in QOL or illness after periodontal debridement between groups.
Sundh et al., 2021 [58] Sweden Randomized controlled trial Patients with COPD recruited at hospitals and primary healthcare centers 101 Advanced dental cleaning (modification of the full-mouth disinfection protocol), n = 45; control (dental examination and supra-gingival cleaning using toothpaste, corresponding to tooth brushing), n = 56 Exacerbation frequency, pulmonary function (FEV1 % predicted), and CAT score

  • The frequency of annual exacerbations was significantly reduced (p = 0.039) in patients who underwent repeated advanced dental cleanings (median, −1.0; IQR, −3.5–0.0), although no significant differences were found in the CAT score and FEV1 % predicted.

CAT, COPD Assessment Test; CI, confidence interval; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in one second; FVC, forced vital capacity; IQR, interquartile range; OR, odds ratio; QOL, quality of life; SGRQ, St. George’s Respiratory Questionnaire; SRP, scaling and root planing; SD = standard deviation.