Periodontal Disease and Quality of Life: Umbrella Review of Systematic Reviews
According to a Global Burden of Disease study in 2015 periodontal disease is the 6th most prevalent disease worldwide with an overall prevalence of 11.2%. The cost of loss productivity in the U.S. from severe periodontal disease is estimated to be about 54 billion USD. How does periodontal disease affect the quality of life? A recent review published in 2020 in the Journal of Periodontal Research aimed to “establish the impact of periodontal disease and therapy on general and oral health quality of life.”1
This was an umbrella review that addressed the following ICO questions:
- “Does periodontal disease have an impact on HRQoL and OHRQoL?”
Null hypothesis: “There is no difference in HRQoL and OHRQoL instrument scores between subjects with periodontal disease and periodontally healthy subjects.”
- “Does periodontal therapy improve HRQoL and OHRQoL in subjects with periodontal disease?”
Null hypothesis: “There is no difference in HRQoL and OHRQoL instrument scores for subjects with periodontal disease before and after periodontal therapy.”
There were 8 articles included in the umbrella review that measured HRQoL and OHRQoL. All systematic reviews included in the umbrella review were published between 2006 and 2020. Of the systematic reviews included 3 were of critically low quality, 4 were of moderate quality, and 1 was of high quality.
The results of the umbrella review regarding the first PICO question showed that subjects with periodontal disease have worse or lower HRQoL and OHQoL, therefore the null hypothesis was rejected. Regarding the second PICO question the results showed that periodontal therapy can improve the OHRQoL, however, there was a lack of studies addressing how periodontal therapy affected HRQoL. Nonetheless, the null hypothesis for the second PICO question was also rejected.
Though the systematic reviews included showed a decrease in HRQoL in patients with periodontal disease, it was reported to a lesser extent when compared to TMD and ill-fitting dentures. This is likely due to the “silent” and chronic nature of periodontal disease. While TMD can be more acute and ill-fitting dentures have a direct daily impact on mastication. A limitation cited by the authors was the heterogeneity in methodologies which prevented a statistical analysis of the results.
The authors conclude by stating, “periodontal disease can negatively impact both HRQoL and OHRQoL. Both surgical and non-surgical periodontal therapy can improve OHRQoL, although to a different degree as perceived by the patient. There is currently a lack of suitable instruments to accurately assess how periodontal therapy can improve HRQoL. The development of disease-specific instrument for periodontal disease to assess both HRQoL and OHRQoL is strongly recommended.”
Have you had patients report improved HRQoL after periodontal therapy? Have you seen improvements in patients’ systemic health, such as lowered hbA1C after periodontal therapy? When patients present with severe periodontal disease, do they often complain about their OHRQoL, such as being unable to eat certain foods or persistent pain?
- Wong LB, Yap AU, Allen PF. Periodontal disease and quality of life: Umbrella review of systematic reviews. J Periodontal Res. 2021;56(1):1-17. doi:10.1111/jre.12805