Table 2 GRADE assessment of the evidence for periodontitis → noncommunicable diseases.
Year/author | Disease | Design | Risk of bias | Inconsistency | Indirectness | Imprecision | Pub Bias | Other considerations | Certainty | Importance |
|---|---|---|---|---|---|---|---|---|---|---|
Aguiar et al. 2024 | Gastric adenocarcinoma | 9 analytical studies | Serious. Several studies carried a large effect | Not serious. Heterogeneity 41.5% | Serious. Information regarding representativeness and comparability of groups was detected | Serious. Confidence intervals are wide in some studies | Not serious | 7/9 studies showed no association between periodontitis and gastric adenocarcinoma | Very low | Important |
Castaño-Suarez 2024 | Preterm birth | 25 analytical studies | Serious. 4/25 studies carried great weight to the effect. 11/25 studies considered as moderate/high bias | Serious: Heterogeneity 95%, Chi2 510.1 | Serious. Information regarding selection of participants is lacking in some studies | Serious. Confidence intervals are wide in some studies | Serious. Publication bias detected | Some of the studies demonstrated a higher prevalence of periodontitis in the case group compared to the control group | Low | Important |
Castaño-Suarez 2024 | Low birth weight | 20 analytical studies | Serious. 4/20 studies carried great weight to the effect. 4/20 studies considered as moderate/high bias | Serious: Heterogeneity 93%, Chi2 279.9 | Serious. Information regarding selection of participants is lacking in some studies | Serious. Confidence intervals are wide in some studies | Serious. Publication bias detected | Some of the studies demonstrated a higher prevalence of periodontitis in the case group compared to the control group | Low | Important |
Dewan et al. 2024 | Stroke | 13 analytical studies | 7/13 studies carried a large effect. risk of bias low to moderate | Not serious. Heterogeneity 30.3% | Serious. Information regarding representativeness and comparability of groups was detected | Serious. Confidence intervals are wide in some studies | Not performed | 2/13 studies showed no association between periodontitis and stroke | Low | Important |
Leelaviwat et al. 2024 | Heart failure | 3 cohort studies | Serious. risk of bias not reported | Serious. Heterogeneity 78.4% | Incomplete information. | Serious. Confidence intervals are wide in some studies | Not performed | Incomplete information. No RoB analyses and GRADE | Very low | Important |
Lin et al. 2024 | Cognitive impairment | 7 analytical studies | Serious. 3/7 studies carried great weight to the effect. 5/7 studies considered as moderate bias | Not serious. heterogeneity 0%. Chi2 5.79 | Not serious | Serious. Confidence intervals are wide in some studies | Publication bias analysis not performed due to low number of studies | 5/7 studies showed no association between periodontitis and cognitive impairment | Very low | Important |
Ma et al. 2024 | Oral cancer, oral squamous cell carcinoma, oropharyngeal cancer | 9 case control studies | Serious. 2 studies high risk of bias | Not serious. Heterogeneity 52.4%. | Serious. Information regarding representativeness and comparability of groups was detected | Serious. Confidence intervals are wide in some studies | Not serious | 2/9 studies showed no association between periodontitis and oral cancer | Low | Important |
Wang et al. 2024 | Inflammatory bowel disease | 4 cohort studies | Serious. Risk of bias detected in all studies | Not serious. Heterogeneity 27% | Serious. Information regarding representativeness and comparability of groups was detected | Serious. Confidence intervals are wide in some studies | Not serious | Studies show no association between periodontitis and IBD | Very low | Important |
Wang et al. 2024 | Crohn’s disease | 4 cohort studies | Serious. Risk of bias detected in all studies | Not serious. Heterogeneity 0% | Serious. Information regarding representativeness and comparability of groups was detected | Serious. Confidence intervals are wide in some studies | Not serious | Studies show no association between periodontitis and CD | Very low | Important |
Wang et al. 2024 | Ulcerative colitis | 4 cohort studies | Serious. Risk of bias detected in all studies | Not serious. Heterogeneity 38% | Serious. Information regarding representativeness and comparability of groups was detected | Serious. Confidence intervals are wide in some studies | Not serious | Some studies showed no association between periodontitis and UC. Otherwise the association is very close to 1 | Very low | Important |
Larvin et al. 2023 | Diabetes | 9 analytical studies | Serious | Not serious. heterogeneity 53.8%. Q 20.21 | Serious. Information regarding selection of participants is lacking in some studies | Serious. Confidence intervals are wide in some studies | Publication bias suspected | 3/9 studies showed no association between periodontitis and incident diabetes. Otherwise the association is close to 1 | Low | Important |
Larvin et al. 2023 | Kidney disease | 2 analytical studies | Very serious | Not serious. heterogeneity 0% | Serious. Information regarding selection of participants is lacking in some studies | Serious. Confidence intervals are wide in some studies | Publication bias suspected | Both studies showed significant association between periodontitis and kidney disease | Very low | Important |
Larvin et al. 2023 | Liver disease | 3 analytical studies | Very serious. 1/3 studies carried a large effect. Confounding factors are important. | Serious: Heterogeneity 91.6%, Q 13.55 | Serious. Information regarding selection of participants is lacking in some studies | Serious. Confidence intervals are wide in some studies | Publication bias suspected | The overall shows no association between periodontitis and liver disease | Very low | Important |
Larvin et al. 2023 | Osteoporosis | 4 analytical studies | Very serious. 2/4 carried a large effect. Confounding factors are important. | Serious: Heterogeneity 93%, Q 45.07 | Serious. Information regarding selection of participants is lacking in some studies | Serious. Confidence intervals are wide in some studies | None | All studies show association between periodontitis and osteoporosis | Very low | Important |
Larvin et al. 2023 | Rheumatoid arthritis | 4 analytical studies | Very serious. Confounding factors are important. | Serious. Heterogeneity 72.8%, Q 12.66 | Serious. Information regarding selection of participants is lacking in some studies | Not serious | None | All studies show association between periodontitis and RA | Low | Important |
Leelaviwat et al. 2023 | Atrial fibrillation (AF) and atrial flutter (AFL) | 3 cohort studies | Unknown since it was not mentioned in the article | Not serious. heterogeneity 3% | Unknown since it was not mentioned in the article | Not serious | Unknown since it was not mentioned in the article | Unknown since it the methods section is very short. Although the confidence interval is narrow, the value is close to 1 | Very low | Important |
Leng et al. 2023 | Myocardial infarction (MI), coronary heart disease (CHD), or stroke in MEN | 17 analytical studies in men | Not serious. 1 study high risk of bias | Serious. Heterogeneity 93%, Chi2 243.4 | Serious. Information regarding representativeness and comparability of groups was detected | Serious. Confidence intervals are wide in some studies | Not serious | 8/17 studies showed no association between periodontitis and CVD. Otherwise the association is close to 1 | Very low | Important |
Leng et al. 2023 | Myocardial infarction (MI), coronary heart disease (CHD), or stroke in WOMEN | 9 analytical studies in women | Not serious. 1 study high risk of bias | Serious. Heterogeneity 85%, Chi2 95.8 | Serious. Information regarding representativeness and comparability of groups was detected | Serious. Confidence intervals are wide in some studies | Not serious | Some studies showed no association between periodontitis and CVD. Otherwise the association is very close to 1 | Very low | Important |
Rosário-Dos-Santos et al. 2023 | Metabolic syndrome (MetS) | 6 analytical studies moderate-severe periodontitis | Serious. Sources of bias included lack of clarity in non-respondents, missing data and sample size calculation. 1/6 studies carried a large effect. | Serious.Heterogeneity 86.1% | Serious: information regarding representativeness of sample population and comparability is lacking | Not serious | Publication bias suspected | 1/6 studies showed no association between periodontitis and MetS | Low | Important |
Verma et al. 2023 | Lung cancer | 7 analytical studies | 1/7 studies carried a large effect. 3/7 studies considered medium risk of bias | Serious: Heterogeneity 82%, Chi2 33.9 | Serious. Information regarding selection of participants is lacking in some studies | Serious. Confidence intervals are wide in some studies | Publication bias performed with less than 10 studies | 2/7 studies showed no association between periodontitis and lung cancer. Otherwise the association is close to 1 | Very low | Important |
Yang et al. 2023 | Chronic obstructive pulmonary disease (COPD) | 22 analytical studies | Serious. 3/22 studies carried a large effect and risk of bias high in 4 studies | Serious: Heterogeneity 79%, Chi2 86.21 | Serious. Information regarding representativeness of sample population and comparability is lacking | Serious. Confidence intervals are wide in some studies | None | 9/22 studies showed no association between periodontitis and COPD | Low | Important |
Le et al. 2022 | Preeclampsia | 28 analytical studies | Very serious. 8/28 studies carried large effect | Serious: Heterogeneity 81%, Chi2 139.03 | Serious. Information regarding comparability is lacking in some studies | Serious. Confidence intervals are wide in some studies | None | 9/28 studies showed no association between periodontitis and preeclampsia | Low | Important |
Li et al. 2022 | Urogenital cancer | 11 analytical studies | Serious. Several studies carried a large effect. | Not serious. Heterogeneity 22.4% | Serious. Information regarding representativeness and comparability of groups was detected. | Serious. Confidence intervals are wide in some studies | Not serious | 5/11 studies showed no association between periodontitis and urogenital cancer. Otherwise the association is close to 1 | Very low | Important |
Mirzaei et al. 2022 | Dyslipidemia | 13 analytical studies | Serious. Moderate risk of bias detected in most studies | Not serious. Heterogeneity 28.7% | Serious. Information regarding representativeness and comparability of groups was detected. | Not serious | Not serious | Very low | Important | |
Xu et al. 2022 | Pancreatic cancer | 14 analytical studies | Serious. High risk of bias in 6 studies | Serious. Heterogeneity 60.8% | Serious. Information regarding representativeness and comparability of groups was detected | Serious. Confidence intervals are wide in some studies | Publication bias suspected | Not serious | Very low | Important |
Li et al. 2021 | Colorectal cancer | 7 cohort studies | Serious. Several studies carried a large effect. | Serious. Heterogeneity 53.9% | Serious. Information regarding representativeness and comparability of groups was detected | Serious. Confidence intervals are wide in some studies | Not serious | 4/7 studies showed no association between periodontitis and colorectal cancer | Very low | Important |
