Periodontal status and chronic obstructive pulmonary disease (COPD) exacerbations: a systematic review

BMC Oral Health

Table 4 Summary findings and evidence certainty for all outcomes using GRADE

Outcomes	Impact	№ of participants (studies)	Certainty of the evidence(GRADE)
Exacerbations	Periodontal treatment results in a significant reduction in the frequency of exacerbations at one and 2 years follow	100 (one randomised and one non randomised trial)	⨁⨁⨁◯ (a) MODERATE
Exacerbations	Periodontal health parameters mainly PI, GI, BI, as well as fewer number of teeth and lower brushing times, are significantly associated with exacerbations	698 (3 observational studies)	⨁⨁⨁◯ (b) MODERATE
Quality of Life	Periodontal treatment did not improve the quality of life of COPD patients	30 (1 clinical trial)	⨁⨁◯◯ (a, c) LOW
Quality of Life	Worse OHIP 5, missing teeth and high PI scores were associated with worse SGRQ Scores	362 (2 observational studies)	⨁⨁◯◯ (b) LOW
Hospitalisation	There are 7 hospitalisations in the test compared to 12 in the control group at 12 months follow up	40 (1 Clinical trial)	⨁⨁◯◯ (a, c) LOW
Hospitalisation	Edentulous, poor oral hygiene, periodontal parameters PI, GI, BI are associated with increased risk of hospitalisation	1941 (3 observational studies)	⨁⨁◯◯ (d) LOW

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
(a) Downgraded due to high risk of bias on randomisation and selection of reported results
(b) Observational studies upgraded due to effect size
(c) Downgraded due lack of precision (small sample size)
(d) Observational studies graded as low

ISSN: 1472-6831