Strong Evidence For Minor Effects

The recent joint workshop of the European Federation of Periodontology and the American Academy of Periodontology, apparently meant to revive again (and once and forever establish) the periodontitis/systemic disease issue, has resulted in remarkably weak conclusions in some of the seminal papers, for instance,

  • As regards pregnancy outcome: “Current evidence from RCTs does not support the provision of periodontal therapy to improve pregnancy outcomes” (Michalowicz et al. 2013).
  • As regards diabetes mellitus: “The modest [a meta-analysis indicated a mean treatment effect of -0.36% HbA1c (CI -0.54, -0.19)] reduction in HbA1c observed as a result of periodontal therapy in subjects with type 2 diabetes is consistent with previous systematic reviews. Despite this finding, there is limited confidence in the conclusion due to a lack of multi-centre trials of sufficient sample size are lacking” (Engebretson and Kocher 2013).
  • As regards biomarkers and cardiovascular disease outcomes:  “There is […] limited evidence that these acute [short-term inflammatory response] and chronic changes [progressive and consistent reduction of systemic inflammation and improvement in endothelial function] will either increase or reduce CVD burden of individuals suffering from periodontitis in the long term” (D’Aiutu et al. 2013).

Very large intervention studies which could challenge existing evidence, as demanded during the workshop (“Well-designed intervention trials on the impact of periodontal treatment on prevention of ACVD [atherosclerotic cardiovascular disease] hard clinical outcomes are needed,” Tonetti and van Dyke (2013)), may be very difficult to conduct. Mainly beneficial effects of periodontal treatment (essentially unrelated to systemic diseases and conditions under scrutiny) have already been shown, so denial of treatment for control patients must be regarded unethical.

8 May 2013 @ 6:20 pm.

Last modified May 8, 2013.

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