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Cited by 161Oral microbiology and periodontitis researchPeriodontal Regeneration and TreatmentsInflammatory Biomarkers in Disease Prognosis

The DOI matches its Crossref record; 67 of the 68 references it cites were found in a registry or an index.

Serum C-Reactive Protein and Periodontitis: A Systematic Review and Meta-Analysis

Open access
Machado, Vanessa, Botelho, João, Escalda, Cláudia, Hussain, Syed Basit, Luthra, Shailly, Mascarenhas, Paulo, Orlandi, Marco, Mendes, José João, D’Aiuto, Francesco·2021·Frontiers in Immunology
DOI 10.3389/fimmu.2021.706432PMC PMC8355591
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Abstract

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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Figure 1 PRISMA flow-chart representing the results of the workflow to identify eligible studies.
Figure 1 PRISMA flow-chart representing the results of the workflow to identify eligible studies.CC BY · PubMed Central
Figure 2 Variation of hs-CRP levels compared to baseline levels according to the type of NSPT, up to 180 days of follow-up. Points represent the mean value and the interval represents the 95%CI (Appendices S29, S30).
Figure 2 Variation of hs-CRP levels compared to baseline levels according to the type of NSPT, up to 180 days of follow-up. Points represent the mean value and the interval represents the 95%CI (Appendices S29, S30).CC BY · PubMed Central
Figure 3 Biologically mechanism linking periodontitis to increase of systemic levels of CRP.
Figure 3 Biologically mechanism linking periodontitis to increase of systemic levels of CRP.CC BY · PubMed Central

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Metadata

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)
DOI
10.3389/fimmu.2021.706432
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
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 › Dentistry › Periodontics › 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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