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Canadian Journal of Dental Hygiene logoLink to Canadian Journal of Dental Hygiene
. 2026 Jun 1;60(2):132–140.

The impact of periodontitis on physical fitness: a systematic review

Davi da Silva Barbirato * , Bruno Leonardo Damasceno Gomes de Matos * , Taísa Coelho Guimarães * , Maria Cynésia Medeiros de Barros *
PMCID: PMC13340587  PMID: 42416680

Abstract

Background:

This study aimed to review evidence of the impact of periodontitis on physical fitness.

Methods:

An electronic literature search using MeSH terms and keywords was performed in 6 electronic databases, protocol records, and other sources. Eligibility criteria included observational studies on the impact of periodontitis on physical fitness as primary outcome. No restrictions were placed on the language or date of publication. The quality of primary studies was assessed. GRADE was used to assess the quality of responses.

Results:

The initial search identified 5,389 records; of that number, 2,690 duplicates were removed. Following a screening by title and abstract and then full-text review, 7 studies were included for analysis. Six reported a significant relationship between periodontitis or mean probing depth/clinical attachment loss and physical fitness.

Discussion:

The increase in clinical attachment loss and probing depth/clinical attachment loss was associated with decreased handgrip strength and chance to reach the highest physical fitness test score, respectively. Increased mean probing depth was associated with VO2peak (maximum oxygen consumption over 30 seconds during the test) and exercise duration. Higher VO2max (maximum oxygen consumption during exercise) was associated with lower risk of severe periodontitis and combined highest VO 2max, and lowest body mass index was associated with lower risk of severe periodontitis. Associations with mean probing depth were most convincing for VO2peak and exercise duration. The methodological quality of the studies was high, and the level of evidence ranged between 2 and 3.

Conclusions:

Periodontitis and unfavourable periodontal parameters were associated with worse physical fitness.

Keywords: exercise, periodontal disease, periodontitis, physical fitness

PRACTICAL IMPLICATIONS OF THIS RESEARCH.

  • The findings regarding the interaction between periodontitis and physical fitness underscore the importance of oral health professionals making evidence-based decisions when personalizing the treatment of periodontitis.

  • The scarcity of clinical trials examining the impact of periodontal treatment on physical fitness highlights a significant area for future research.

INTRODUCTION

Periodontitis is defined as a non-communicable chronic inflammatory disease (NCD) associated with a dysbiotic biofilm characterized by the progressive destruction of the dental support apparatus. 1 Gingivitis and periodontitis are a continuum of the same inflammatory disease. 2 Periodontitis affects more than 50% of the world’s adult population and the risk increases with age, 3 it being a highly common NCD, with a prevalence of its severe form between 7% and 11%. 4 In addition, severe periodontitis is considered the sixth most prevalent human disease, according to the 2010 Global Burden of Disease Study, with a standardized prevalence of 11.2%. 5

Cardiorespiratory fitness is defined as the ability of the cardiovascular and pulmonary system to deliver oxygen to sustain musculoskeletal function during exercise. Previous studies suggested that reduced levels of systemic inflammation markers are linked to improved cardiorespiratory fitness.6,7 It is important to emphasize that chronic periodontitis is associated with low-grade systemic inflammation 8 that is induced either directly via dislocation of periopathogenic bacteria into the bloodstream, 9 thus triggering an immune response, or indirectly via increased levels of locally produced proinflammatory mediators. 10 In this context, it is hypothesized that periodontal diseases may impact physical fitness.

Physical activity was inversely associated with periodontal disease in cross-sectional11-15 and prospective 16 studies. Although physical activity may affect periodontal health by improving insulin sensitivity12,15,16 and reducing inflammation, 17 obesity,12,17 and stress,11,18 the opposite remains uncertain. There are only a few known studies assessing associations between periodontitis and cardiorespiratory fitness. Thus, a potentially causal relationship between periodontitis and cardiorespiratory fitness would be of special interest, as it would also provide a possible mechanism linking periodontitis with cardiovascular diseases 19 and cardiovascular mortality 20 .

At first glance, the literature (although very limited) seems to support a relationship between periodontitis and physical fitness. Various methodological issues such as inappropriate confounder adjustment, small sample sizes, restriction to younger persons (ages 20 to 49 years), classification bias when identifying participants with periodontal disease (e.g., partial-mouth periodontal examination protocol), disuse of extent or severity estimates of periodontitis, and study design hinder well-founded conclusions. 21 While the impact of periodontitis on physical fitness has been reported, the level of evidence for this association has not yet been established. Thus, this study aimed to 1) systematically review the evidence of the impact of periodontitis on physical fitness; and 2) identify methodological limitations and the need for more well-designed studies.

MATERIALS AND METHODS

Protocol and registration

This study was conducted according to the EQUATOR Network website (equator-network.org), including the PRISMA 2020 statement 22 (prisma-statement.org). The protocol for this review was structured in accordance with PRISMA-P 23 ; the review protocol was registered in the PROSPERO database (crd.york.ac.uk/PROSPERO): #CRD42023390818. There were no deviations from the initial protocol.

Focused question

This systematic review aimed to answer the focused question: What is the effect of periodontitis on physical fitness? The question addressed in this review followed the PECOD principle:

  • P (population): Humans without gender and age restrictions

  • E (exposure): Periodontitis

  • C (comparator): Absence of periodontitis

  • O (outcome): Any impact of periodontitis on physical fitness that will be objectively evaluated through exercise tests, regardless of test types

  • D (study design): Observational studies, such as analytical cross-sectional studies (comparative studies), case-control, and cohort studies

Study selection criteria

Only observational studies that assessed the impact of periodontitis on physical fitness as a primary outcome were included in this systematic review. Questionnairebased studies, those with inaccurate or unavailable information related to the diagnosis of periodontitis, and those that were not available in full text were excluded from the review. Unpublished data were also excluded. No restrictions were placed on the language or date of publication when searching the electronic databases.

Information sources

An extensive literature search was performed in 6 electronic databases, namely MEDLINE via PubMed ( ncbi.nlm.nih.gov/sites/pubmed), Web of Science (webofknowledge.com) accessed through Clarivate Analytics (clarivate.com), Cochrane Central Register of Controlled Trials (CENTRAL) (cochranelibrary.com), Embase (embase.com) and Scopus (scopus.com) through Elsevier (elsevier.com), and LILACS via VHL (bvsalud.org). Other sources (grey literature) were consulted through the System for Information on Grey Literature in Europe (SIGLE) through OpenGrey ( easy.dans.knaw.nl/ui/datasets/id/easy-dataset:200362/tab/2) databases. The protocol registration database, ClinicalTrials.gov, was also assessed. Hand searches were performed in specialized periodontics periodicals with a strong impact factor and in reference lists of selected articles. Experts were identified using expertscape.com and contacted for other data sources.

Search strategy

Database search strategies included MeSH terms, entry terms, and keywords to query in PubMed, Web of Science, Cochrane Library, other sources (gray literature), and protocol records. The search strategies for the Embase, Scopus, and LILACS databases added Emtree, Index, and DeCS/MeSH terms, respectively. All terms were combined by the Boolean operators “OR” and “AND” connecting the key concepts in a “building blocks” strategy (Supplementary Table S1). The electronic searches were performed in January 2024 and database alerts were created to identify studies published after the time of the search, until the manuscript submission process.

Selection process

The retrieved articles were exported to Endnote® Web (myendnoteweb.com) and duplicates were removed by the program. Then, the references were exported to rayyan™ reference manager (rayyan.ai) for manual removal of duplicates and blind selection process of studies. The selection process was conducted in 2 phases. In phase 1, 2 researchers independently examined the titles and abstracts of all retrieved references, applying the inclusion criteria. In phase 2 (full text screening), the same 2 researchers independently applied the exclusion criteria. The full texts were evaluated and judged in their entirety. Inter-reviewer reliability in the study selection process was determined by the Cohen κ test, assuming an acceptable threshold value of 0.80. 24 Before the search was conducted, the researchers held a meeting to establish a protocol for handling potential situations that could lead to confusion. Disagreements at any stage were resolved by discussion and mutual decision with a third reviewer (MCMB). The final decision was always based on the full text reading— for more details on reasons for exclusion, see Figure 1.

Data collection process

Data were independently extracted by the 2 researchers using a standardized form in order to facilitate the critical appraisal process. The qualitative results were described in a consensus meeting, in the order of the PECOD contents: author/year, country, study design, population (sample size/gender, mean age, correlated conditions), periodontal assessment (diagnosis criteria, periodontal diagnosis), physical fitness (method, measure or category), and OCEBM 2011 levels of evidence (Supplementary Table S2); and author/year, dependent variable, sample size and exposition group, sample size and comparator group, p value, and statistical inference (Supplementary Table S3).

Study risk of bias assessment

Two researchers independently evaluated the quality of the included studies using “JBI Critical Appraisal Tools for Analytical Cross-Sectional Studies” (Table 1). This standard appraisal is a set of checklists regarding the criteria for inclusion, study participants and setting, measurement of exposure, measurement of the condition, confounding factors and the strategies to deal with them, measurement of outcomes, and statistical analysis. The overall appraisal was classified as “Include,” “Exclude,” and “Seek further info.” In case of disagreement, agreement was reached in a consensus meeting with a third reviewer (MCMB).

Synthesis methods and effect measures

The study selection process, study characteristics, risk of bias in studies, impact of periodontitis on physical fitness, and certainty of evidence are described in the form of text, figure, and tables. Methodological differences among studies restricted synthesis methods. The synthesis of qualitative results followed the SWiM reporting guideline. 25 The question addressed in this review followed the direction of effect and vote counting as standardized metrics. In addition, the robustness of the synthesized results and the potential impact of confounders were assessed using the results of the adjusted multivariate analyses.

Figure 1.

Figure 1.

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Screening and enrollment

Certainty assessment

The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the quality of responses in this systematic review, based on 5 factors: serious risk of bias, serious inconsistency between studies, serious indirectness, serious imprecision, and likely publication bias.26,27 Thus, the evidence quality index was defined in 4 categories: high, moderate, low, and very low applied to the primary outcomes.28-30 For each GRADE domain, authors have the option of decreasing their level of certainty by 1 or 2 levels. Observational studies starting at low could be upgraded based on 3 criteria: large effect, dose-response effect, and “Effect of all plausible confounding factors would be to reduce the effect (where an effect is observed) or suggest a spurious effect (when no effect is observed).” 31

RESULTS

Study selection

There were 5389 records identified during the initial search of the electronic databases and registers. After removing 2690 duplicates, the research team screened the remaining papers by title and abstract (Phase 1), followed by full text reading (Phase 2). Ninety-five studies were excluded by publication type, 22 by study design, and 2577 by participant type. The full text reading confirmed the inclusion of 7 studies, with a total enrollment of 10,478 patients (Figure 1 and Supplementary Table S2).21,32 –37 The inter-reviewer reliability in the study selection process was κ ≥ 0.8 for all databases.

Study characteristics

The studies included in this review were from 4 countries: Japan, 32 Germany,33,36 ,38 USA, 34 and Brazil35,37. The year of publication ranged from 2010 to 2021. The average number of participants per study was 1497 with a minimum of 72 33 and a maximum of 407821, and ages ranging between 20 and 77 years. Periodontal diagnostic criteria varied across studies, including mild, moderate, and severe periodontitis.36 ,37 Three studies reported the effect of periodontal parameters (e.g., PD [probing depth], CAL [clinical attachment loss], and BOP [bleeding on probing]), rather than periodontal diagnosis, on physical fitness.21,36-37 In addition, physical fitness assessment included maximum oxygen consumption,32-34 physical fitness test (PFT),35,37 handgrip strength, 36 and cardiopulmonary exercise testing (CPET) 21 .

Most of the studies had also been concerned about potential confounding factors that might affect the result of the studies. These confounding factors included age,21,32-37 gender,21,32,34 socioeconomic factors, 21 number of teeth, 32 smoking status,21,32,34 alcohol consumption, 21 anthropometric parameters,21,32-37 physical activity,21,33-35 ,37 diabetes,21,32 ,34,36 cardiovascular diseases,32,34 oral inflammatory burden, 37 CRP (C-reactive protein), 34 and hsCRP (high-sensitive C-reactive protein) 36 . The statistical results of these studies were adjusted for confounding factors, and Eremenko et al. 36 also stratified the results based on gender. Additionally, 4 studies included smoking history in the exclusion criteria.33 ,35-37

The level of evidence based on study design (OCEBM 2011) ranged between 221,36 and 332-35,37. For more details on the methods, see Supplementary Table S2.

Risk of bias within studies

Overall, the methodological quality of the included studies was high. All studies clearly defined the eligibility criteria of the participants and described them as well as the study settings in detail. The measurement of oral health conditions as the exposure was reliably performed by trained and calibrated examiners. The assessment of periodontal conditions including diagnostic criteria, PD, CAL, and BOP was carried out objectively, showing valid and reliable measurements. In addition, the outcomes were measured using a broad range of standardized tests, such as maximum oxygen consumption32-34, PFT35, 37, handgrip strength (GS) 36 , and CPET 21 . Due to the limited number of studies included, publication bias cannot be completely ruled out.

Impact of periodontitis on physical fitness

Participants in the lowest quintile for body mass index (BMI) and highest quintile for VO2max (maximum oxygen consumption during exercise) showed a lower risk of severe periodontitis compared to participants with other combined quintiles in BMI and in VO2max (OR = 0.17 [95% CI: 0.05, 0.55]) 32 . According to Shimazaki et al., 32 obesity and physical fitness had some interactive effect on periodontal health status. In addition, a high BMI score, increased hsCRP, low level of physical activity, and severe periodontitis were significantly associated with low VO2peak (maximum oxygen consumption over a period of 30 seconds during the test) levels. In contrast, age and moderate periodontitis were not significantly associated with low VO2peak. 33

Overweight/obese individuals demonstrated significantly lower PFT scores than eutrophic individuals. In addition, having ≥1 tooth with CAL ≥4 mm was significantly associated with lower PFT scores compared to those without periodontitis—a 1-mm increment in PD or CAL significantly decreased the odds of reaching the highest PFT score by 69% or 75%, respectively. 35 Furthermore, each millimeter of diminished CAL was associated with a reduction in GS by 1.47 kg (95% CI: ‒ 2.29, ‒ 0.65) and 0.38 kg ( ‒ 0.89, ‒ 0.14) in men and women, respectively. The impact of periodontitis on reducing GS was modified by anthropometric measures related to adiposity and inflammation. 36

Mean PD and mean CAL were consistently associated with VO2peak and exercise duration in the study by Holtfreter et al. 21 Statistically significant associations with VO2@AT (oxygen uptake at anaerobic threshold) and VÉ/VCO2 slope (slope of the minute ventilation changes as a function of the pulmonary carbon dioxide output) also occurred. Further, mainly older individuals with more severe periodontitis were associated with lower VO2peak. In addition, only mean PD reflecting current disease severity was consistently linked to cardiorespiratory fitness in 2 cross-sectional samples of the general population. 27

Hoppe et al. 37 evaluated the association between oral inflammatory burden (OIB)—the combination of periodontal and endodontic disease load—and physical fitness. There was no significant association between apical periodontitis, root canal treatment, and endodontic burden and physical fitness. Whereas PD, CAL, and OIB were significantly associated with low physical fitness, low endodontic burden compromised the association between unfavourable periodontal parameters and physical fitness. The OIB was independently associated with poor physical fitness in males. 37

In contrast, in the study by Thai et al. 34 clinical measures of periodontitis were not related to card,iorespiratory fitness. Multivariable adjusted mean eVO2max (estimated maximum amount of oxygen consumption during exercise) values were similar between healthy participants and those with moderate to severe periodontitis. Participants in the highest quartile of PD and CAL had lower odds of reduced eVO2max. For more details on results of individual studies, see Supplementary Table S2.

Quality of evidence

According to the GRADE approach, the certainty of evidence supporting the association between periodontitis and physical fitness is low (Figure 2). The inconsistency and imprecision domains limited the certainty of the evidence because of the heterogeneity or variability in results and the fact that relatively few events were included, respectively.

DISCUSSION

This study evaluated the evidence of the impact of periodontitis on physical fitness as reported in observational (analytical) studies. Recognizing the limitations of this study, the results suggest that periodontitis and unfavourable periodontal parameters may affect physical fitness. Importantly, the certainty of evidence for this cross-sectional association is considered low.

Many epidemiologic21,35 and cross-sectional studies32-34 ,37 have reported a significant relationship between periodontitis or mean PD/CAL and physical fitness. In contrast, a population-based study (NHANES [1999–2004]) 34 found no significant relationship between periodontitis and VO2max among healthy adults. The chance of reduced eVO2max was halved among patients with moderate to severe periodontitis compared to healthy participants, and there was no significant association between eVO2max and mean PD and CAL. 34 Although partial-mouth periodontal examination protocols frequently used in epidemiological periodontal surveys pose a risk of classification bias and of estimated effects potentially biased towards the null, 39 all studies included in this systematic review showed consistent cross-sectional associations of periodontitis or mean PD/CAL with physical fitness21,32-37, except for Thai et al. 34

Figure 2.

Figure 2.

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Assessing the quality of evidence across studies for main outcome (physical fitness)

Table 1.

JBI critical appraisal checklist for analytical cross-sectional studies

 

Questionsa

 

Studies

1

2

3

4

5

6

7

8

Overall appraisal

Shimazaki et al. (2010) 32

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Include

Eberhard et al. (2014) 33

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Include

Thai et al. (2014) 34

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Include

Oliveira et al. (2015) 35

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Include

Eremenko et al. (2016) 36

Yes

Yes

Yes

Yes

Yes

Yes

Unclear

Yes

Include

Hoppe et al. (2017) 37

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Include

Holtfreter et al. (2021) 21

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Include
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a Q1: Were the criteria for inclusion in the sample clearly defined? Q2: Were the study participants and the setting described in detail? Q3: Was the exposure measured in a valid and reliable way? Q4: Were objective, standard criteria used for measurement of the condition? Q5: Were confounding factors identified? Q6: Were strategies to deal with confounding factors stated? Q7: Were the outcomes measured in a valid and reliable way? Q8: Was appropriate statistical analysis used?

The severity of periodontal disease and some clinical parameters such as PD and CAL are associated and therefore may influence physical fitness. Increased CAL was associated with decreased GS and the chance of reaching the highest PFT score.35-37 The increased mean PD also decreased the chance of reaching the highest PFT score. 35 In 3 of the 7 studies, PD and CAL were significantly associated with physical fitness.21,35 ,37 It was not possible to distinguish between actual periodontal symptoms and the long-term consequences of the inflammatory episodes that add up to lifetime CAL. The negative effect of endodontic burden on physical fitness became more obvious when both endodontic and periodontal diseases were present. The OIB variable arising from merging endodontic burden and CAL may represent a cumulative experience of both periodontal and endodontic diseases load. 37

Participants who had a higher VO2max level tended to have a lower risk of severe periodontitis, and participants who had the combined highest VO2max and lowest BMI category had a conspicuously lower risk of severe periodontitis. 32 In the study by Holtfreter et al., 21 associations with mean PD were most convincing for VO2peak and exercise duration. According to the authors, this might be explained by the fact that assessments of VO2peak and exercise duration are observer independent, resulting in high measurement accuracy and validity. In addition, inconsistent results for remaining CPET parameters might be explained by high observer variabilities, the fact that they were derived from other parameters, and the fact that all of them are affected by multiple risk factors.37-41

Physical fitness denotes a multidimensional system that is difficult to assess. Medical history, physical examination, body composition, cardiorespiratory endurance, and potential confounders should be considered in association studies. Physical fitness and periodontitis share common risk factors including smoking42-46 and those associated with inflammation such as obesity, diabetes, and chronic inflammatory conditions47,48. Therefore, these risk factors should be considered confounders in correlation/causal studies. It is important to emphasize that all included studies considered these confounders as exclusion criteria or adjusted variables in multivariate regression analysis, thereby (theoretically) increasing homogeneity and validity.

The question addressed in this systematic review highlights an issue of clinical relevance that needs to be investigated. For Eremenko et al., 36 an association between physical strength and periodontal measures was to be expected even in the absence of causative pathological processes. The decline in physical power and periodontal deteriorations could occur in parallel without any causal relationship. It is possible that the biological mechanism involved in the relationship between periodontitis and physical fitness has similarities to those previously described in periodontal medicine for cardiometabolic conditions. Furthermore, aging (i.e., immunosenescence) and anthropometric measurements related to adiposity and inflammation could potentiate these mechanisms. 36,49- 52

The fatigue sensation during exercise may be magnified by periodontitis due to increasing levels of pro-inflammatory cytokines in the bloodstream.35,52 Jae et al. 50 reported an inverse association between resting inflammatory status and cardiorespiratory fitness. In addition, systemic inflammation has been linked to spirometric lung volumes, 53 which are in turn associated with decreased exercise capacity 54 . Although periodontal treatment improves systemic inflammation, 55 biomarkers of vascular health, and surrogate measures of cardiovascular diseases, 56 it remains unclear whether it would have clinically meaningful effects on cardiopulmonary function. Chronic low-grade inflammation, characterized by persistently elevated concentrations of circulating pro-inflammatory cytokines across the life span, has been associated with the development of noncommunicable diseases. Obesity and metabolic disorders interact with local inflammation in periodontitis and the development of muscle weakness, particularly with increasing age.57,58 It is important to consider that, if these factors attenuate the association between periodontitis and physical fitness, they may be associated with inflammation, mediating this relationship.32,33

Farazi et al. 59 examined the joint association of inflammation-related lifestyle behaviours with cardiorespiratory fitness and reported a strong inverse association between pro-inflammatory lifestyle and cardiorespiratory fitness. The term “P4 medicine” has been hailed as the future of medicine, 60-63 in which medicine moves from a reactive to a proactive clinical approach for patient care, incorporating the 4 pillars of prediction, prevention, personalization, and participation for patient management. Under this concept—a new paradigm—the focus should be on overall patient well-being rather than merely treating a disease and its symptoms. Regarding P4 periodontics, personalized periodontics 64 represents an innovative approach that considers individual differences in clinical decisions, including people’s lifestyle and behaviour.

The intersection between inflammation and infection leading to considerable disease-related tissue destruction has been discussed in recent years. More recently, host modulation and the personalized approach in health care seek to resolve inflammation and return to tissue homeostasis in chronic inflammatory conditions such as periodontitis.63,65,66 Periodontitis is a multifactorial chronic inflammatory disease associated with dysbiotic biofilm and characterized by the progressive destruction of the tooth support apparatus. 67 In this scenario, a new paradigm for managing periodontitis based on controlling inflammation has been presented.63,65,66 The principle of this treatment involves the medical model of “treat to target,” in which the disease course is altered from activity to remission focused on treatment target. 67 These principles are aligned with changing the trajectory of the periodontitis disease course, as proposed by Bartold and Ivanovski. 63 Modulating inflammation through anti-infective treatment does not disregard the important role of dental biofilm but refocuses attention on the central role of inflammation in the critical nexus between infection and inflammation. 68 Thus, modifiable traditional markers, modifiable inflammatory markers, and modifiable systemic risk factors must be taken into account when considering an individual’s disease status, including periodontitis and physical fitness. Reducing oral infection and inflammation must be the main goals of periodontal care in the context of personalized periodontics and systemic inflammatory conditions.

The following strengths of this systematic review merit special consideration: 1) 3 of the 7 studies were population based with a large number of individuals from both genders and a wide age range; 2) all examination methods were well standardized, and examiners were thoroughly trained and calibrated; and 3) the articles were of a high methodological quality (the main strength of the included studies). Nonetheless, it is important to mention that 432,33,35 ,37 of the 7 studies used convenience samples. In these cases, selection bias and the selection of specific groups of people with different characteristics from the general population may compromise the external validity of the study.

The following limitations must also be acknowledged: 1) cross-sectional observation is not able to provide more detailed information about the causal relationship between periodontitis and physical fitness—any inferences about causality cannot be made; and 2) meta-analyses were unfeasible due to the number of studies and methodological heterogeneity. The limitations of the literature made it quite challenging to draw conclusions about the impact of periodontitis on physical fitness. Lastly, it must be emphasized that results should be cautiously interpreted, and definitive conclusions in favour of an association between periodontitis and physical fitness cannot be made. Well-designed randomized controlled trials are necessary and should be encouraged.

CONCLUSION

The current findings suggest, with low certainty of evidence, that periodontitis and unfavourable periodontal parameters may affect physical fitness. Even with some limitations, this systematic review provides information on the interaction between periodontitis and physical fitness and highlights the need for further studies on this topic. It would be useful to perform randomized controlled trials investigating the effect of periodontal treatment on physical fitness, given the effect sizes of individual studies, cross-sectional associations, and methodological issues such as number of studies and dissimilarities in periodontal assessment and physical fitness measurement.

CONFLICTS OF INTEREST

None of the authors has disclosed any financial, consulting or personal relationships that could influence the authors’ work.

DATA AVAILABILITY STATEMENT

The datasets used or analyzed during the current study are available from the corresponding author on request.

Footnotes

CDHA Research Agenda category: oral health frameworks

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The datasets used or analyzed during the current study are available from the corresponding author on request.

Articles from Canadian Journal of Dental Hygiene are provided here courtesy of Canadian Dental Hygienists Association

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