Serum C-Reactive Protein and Periodontitis: A Systematic Review and Meta-Analysis
Open accessAbstract
Periodontitis has been associated with low-grade inflammation as assessed by C-reactive protein (CRP) levels and its treatment can decrease CRP serum levels. The aim of this systematic review was to critically appraise the evidence comparing CRP serum levels (standard and high-sensitivity [hs]) of otherwise healthy patients suffering from periodontitis when compared to controls. The impact of intensive and non-intensive nonsurgical periodontal treatment (NSPT) on hs-CRP was also investigated. Four electronic databases (Pubmed, The Cochrane Central Register of Controlled Trials [CENTRAL], EMBASE and Web of Science) were searched up to February 2021 and the review was completed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO No. CRD42020167454). Observational and intervention studies that: 1) evaluated CRP and hs-CRP serum levels in patients with and without periodontitis, and; 2) hs- CRP levels after NSPT were included. Following risk of bias appraisal, both qualitative and quantitative analyses were performed. Pooled estimates were rendered through ratio of means (RoM) random-effects meta-analyses. After screening 485 studies, 77 case-control studies and 67 intervention trials were included. Chronic and aggressive periodontitis diagnoses were consistently associated with higher levels of CRP and hs-CRP (p<0.001). Patients with aggressive periodontitis exhibited on average more than 50% higher levels of CRP (RoM [95% confidence interval [CI]]: 1.56 [1.15; 2.12], p=0.0039) than patients with chronic periodontitis. Intensive NSPT induced an immediate increase of hs-CRP followed by a progressive decrease whilst non-intensive NSPT consistently decreased hs-CRP after treatment up to 180 days (p<0.001). These findings provide robust evidence that periodontitis is associated with systemic inflammation as measured by serum CRP levels. Periodontitis treatment induces a short-term acute inflammatory increase when performed in an intensive session, whilst a progressive reduction up to 6 months was demonstrated when performed in multiple visits.
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Untreated periodontitis causes systemic inflammation.
“Current evidence suggests that untreated periodontitis causes systemic inflammation, and this could represent a key mechanism explaining the increased incidence of systemic health complications observed in these populations (D'Aiuto et al., 2018; Machado et al., 2021).”
From Treatment of periodontitis and <scp>C</scp> ‐reactive protein: A systematic review and meta‐analysis of randomized clinical trials (2023) · cites this paper as Machado et al., 2021
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Implication of thyroid function in periodontitis: a nationwide population-based study
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Enhanced Proliferative and Osteogenic Potential of Periodontal Ligament Stromal Cells
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Periodontitis is associated with stroke
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The Clinical Utility of Standard and High-Sensitivity C-Reactive Protein: A Narrative Review
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The Significance of Oral Inflammation in Elite Sports: A Narrative Review
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Role of Nonalcoholic Fatty Liver Disease in Periodontitis: A Bidirectional Relationship
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CCL5’s Role in Periodontal Disease: A Narrative Review
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Periodontitis and hypertension are linked through systemic inflammation: A 5‐year longitudinal study
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Chronic periodontitis and systemic inflammation in the elderly: implications for neurodegeneration
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Elevated serum hepatic transaminases in apical periodontitis individuals
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Association between periodontal disease and coronary heart disease: A bibliometric analysis
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Variations of Serum CRP Levels in Periodontal Health and Diseases: A Clinico-Biochemical Study
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Mechanistic and Therapeutic Insights into Nrf2-Mediated Redox Regulation in Periodontitis
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Periodontitis and Diabetes: Mechanistic Evidence of a Circular Relationship
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Periodontal Health and Blood Disorders
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Cardiovascular Biomarkers in Periodontitis: A Systematic Review and Meta‐Analysis
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Self-citationThe Complex Interplay between C-reactive Protein and Periodontal Health: A Narrative Review
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Self-citationAn Overview on the Relation Between Blood Disorders, Periodontitis and Dental Caries
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Association between periodontal disease and malignant soft tissue sarcomas
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Periodontitis Progression During Cardiac Rehabilitation After Acute Coronary Syndrome: Cohort Study
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- Authors
- Machado, V., Botelho, J., Escalda, C., Hussain, S. B., Luthra, S., Mascarenhas, P., Orlandi, M., Mendes, J. J., & D’Aiuto, F.
- Affiliations
- Egas Moniz - Cooperativa de Ensino Superior Crl (PT)
- University College London (GB)
- Corresponding author
- D’Aiuto, Francesco
- ORCID
- Venue
- Frontiers in Immunology
- Publisher
- Frontiers Media SA
- Published
- 2021-07-28
- Volume
- 12
- Pages
- 706432-706432
- ISSN
- 1664-3224 (ISSN-L)
- PMC
- PMC8355591
- OpenAlex
- W3186006244
- Cited by
- 160
- References
- 68
- Citations by year
- 2026: 34 · 2025: 33 · 2024: 43 · 2023: 30 · 2022: 18 · 2021: 2
- FWCI
- 3.97
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Immunology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
- Funders
- Fundação para a Ciência e a Tecnologia
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Medicine › Urology › Periodontal Regeneration and Treatments
- Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
- Keywords
- periodontitis, C-reactive protein, high-sensitivity C-reactive protein, systemic inflammation, non-surgical periodontal therapy, aggressive periodontitis, chronic periodontitis, periodontal treatment response, inflammatory markers
- MeSH terms
- C-Reactive Protein, Humans, Periodontitis
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