Periodontitis and Inflammatory Bowel Disease

A Meta-analysis

Yang-yang She; Xiang-bo Kong; Ya-ping Ge; Zhi-yong Liu; Jie-yu Chen; Jing-wei Jiang; Hong-bo Jiang; Si-lian Fang


BMC Oral Health. 2020;20(67) 

In This Article


Literature Selection

The literature search distilled 540 citations from databases of Web of Science, Pubmed, Cochrane, Embase, CNKI, Wangfang and CQVIP. After 200 duplications were excluded, 340 studies remained for further consideration. Of these, 325 citations were excluded after screening the titles or abstracts (Figure 1). On this screening, 302 citations were irrelevant, 23 citations were reviews, laboratory experimental investigations, case reports, or conference abstracts which were all excluded. After this screening, 14 articles were chosen for whole text review. Among these, three articles had no controls, another three articles presented no primary data and two articles presented the hazard ratio (HR) of periodontitis among IBD patients and non-IBD participants and these eight were excluded. Six studies[25–30] were included for final meta-analyses.

Figure 1.

PRISMA flowchart: selection process of studies and results of the literature search for meta-analysis

Study Characteristics

Characteristics of the included studies in the meta-analysis were shown in Table 1. All studies were published between 2003 and 2015. The participants were 599 IBD patients and 448 controls. Two studies were conducted in Greece and the other four studies were conducted in Germany, Switzerland, Brazil and Jordan respectively. Adjusted odds ratios (ORs) and the corresponding 95% CI between IBD and periodontitis were available in three of the six case control studies. The estimates were calculated using the numbers of IBD cases (with periodontitis or not) and controls (with periodontitis or not) in the other three studies. All studies had methodological quality with at least five scores according to the NOS.

The Association of Periodontitis Prevalence and IBD

Among the included studies, the pooled OR (95% CI) was 3.17 (2.09–4.8) for the association of periodontitis and IBD (Figure 2). The pooled OR (95% CI) was 3.64(2.33–5.67) for the association of periodontitis and CD (Figure 3). The pooled OR (95% CI) was 5.37 (3.30–8.74) for the association of periodontitis and UC (Figure 4).

Figure 2.

Forest plot displaying the meta-analysis results of association between periodontitis and IBD

Figure 3.

Forest plot displaying the meta-analysis results of association between periodontitis and CD

Figure 4.

Forest plot displaying the meta-analysis results of association between periodontitis and UC

IBD and Measures of Periodontitis

Two of the six studies reported oral PI.[25,28] Four of the studies reported BOP[25,27–29] and two on GI.[28,30] Five studies provided data on PPD and four on CAL.[25,27–29]

Publication Bias

No publication bias was observed (Begg's test, z = 0.49, and P = 0.624; Egger's test, t = 1.54, and P = 0.221). Visual inspection of the funnel plot illustrated a nearly symmetrical distribution, revealing the absence of publication bias (Figure 5).

Figure 5.

Funnel plot for publication bias regarding the association between periodontitis and IBD

Sensitivity Analysis

The sensitivity analysis showed that the estimates did not vary significantly ranging from 2.85 (95% CI: 1.72–4.71) to 3.45 (95% CI: 2.18–5.48) when omitting other studies one by one. Generally, the result revealed that no individual study carried enough weight to significantly affect the pooled performance (Figure 6).

Figure 6.

Sensitivity analyses by omitting individual study