Evidence Based Dentistry

  1. Diabetes
  1. Gastrointestinal Conditions and Oral Health
    1. Systematic review: gastro-oesophageal reflux disease and dental lesions. Aliment Pharmacol Ther.2008 Jun;27(12):1179-86. doi: 10.1111/j.1365-2036.2008.03694.x. Epub 2008 Mar 27. CONCLUSIONS: This systematic review shows that there is a strong association between GERD and DE. The severity of DEs seems to be correlated with the presence of GERD symptoms, and also, at least in adults, with the severity of proximal oesophageal or oral exposure to an acidic pH. The inspection of the oral cavity in search for DEs should become a routine manoeuvre in patients with GERD.
    2. Gastroesophageal reflux, dental erosion, and halitosis in epidemiological surveys: a systematic review. Eur J Gastroenterol Hepatol.2013 Feb;25(2):135-41. doi: 10.1097/MEG.0b013e32835ae8f7. Conclusion: This systematic review showed that there is a relationship between GERD and oral diseases (dental erosion and halitosis). The epidemiological surveys used different indices to analyze GERD and dental erosion. Further research could investigate the best method for assessing the two diseases.
  2. HPV
    1. Association between human papillomavirus (HPV) and oesophageal squamous cell carcinoma: a meta-analysis. Epidemiol Infect.2014 Jun;142(6):1119-37. doi: 10.1017/S0950268814000016.  Conclusion: Our results confirm an increase in HPV infection in OSCC cases.
    2. Prevalence of human papillomavirus in oropharyngeal and nonoropharyngeal head and neck cancer–systematic review and meta-analysis of trends by time and region. Head Neck.2013 May;35(5):747-55. doi: 10.1002/hed.22015. Epub 2012 Jan 20. CONCLUSIONS: The sharp increase in the proportion of HPV-positive OPC over the last decade has occurred at a faster rate in Europe compared with that in North America. In contrast, the relatively low prevalence of HPV in non-OPC remains unchanged.
  • Human Papillomavirus Types in Head and Neck Squamous Cell Carcinomas Worldwide: A Systematic Review. Cancer Epidemiol Biomarkers Prev.2005 Feb;14(2):467-75. Conclusions: HPV16 accounted for a larger majority of HPV-positive oropharyngeal SCCs compared with HPV-positive oral SCCs and laryngeal SCCs. Conversely, HPV18 was rare in HPV-positive oropharyngeal SCCs compared with other head and neck sites of oral SCCs and 17.0%  of laryngeal SCCs]. Aside from HPV16 and HPV18, other oncogenic HPVs were rarely detected in HNSCC. Tumor site–specific HPV prevalence was higher among studies from North America compared with Europe and Asia. The high HPV16 prevalence and the lack of HPV18 in oropharyngeal compared with other HNSCCs may point to specific virus-tissue interactions.
  1. Heart Disease
    1. Associations between periodontal disease and risk for atherosclerosis, cardiovascular disease, and stroke. A systematic review. Ann Periodontol. 2003 Dec;8(1):38-53. REVIEWERS’ CONCLUSIONS: Periodontal disease may be modestly associated with atherosclerosis, MI, and CVD. 2. Additional large-scale longitudinal epidemiologic and intervention studies are necessary to validate this association and to determine causality.
    2. A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol.2008 Apr;35(4):277-90. doi: 10.1111/j.1600-051X.2007.01173.x. Epub 2008 Feb 20. CONCLUSIONS: There is strong evidence from cross-sectional studies that plasma CRP in periodontitis is elevated compared with controls. There is modest evidence on the effect of periodontal therapy in lowering the levels of CRP.
  1. Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis. J Gen Intern Med.2008 Dec;23(12):2079-86. doi: 10.1007/s11606-008-0787-6. Epub 2008 Sep 20. CONCLUSION: Periodontal disease is a risk factor or marker for CHD that is independent of traditional CHD risk factors, including socioeconomic status. Further research in this important area of public health is warranted.
  2. The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis. Am Heart J.2007 Nov;154(5):830-7. Epub 2007 Aug 20. CONCLUSIONS: This meta-analysis indicates that both the prevalence and incidence of CHD are significantly increased in PD. Therefore, PD may be a risk factor for CHD. Prospective studies are required to prove this assumption and evaluate risk reduction with the treatment of PD.
  1. Brain Health
    1. A systematic review and meta-analysis of clinical, microbiological, and behavioural aspects of oral health among patients with stroke. Dai, R., Lam, O. L., Lo, E. C., Li, L. S., Wen, Y., McGrath, C.. J Dent. 2014;7(3):CD004345Clinical Impression: With comprehensive literature search, this systematic review and meta-analysis indicated a poorer oral health status and less frequent dental attendance behaviour among patients with stroke.
    2. Association between periodontal disease and strokeJ Vasc Surg. 2012 Apr;55(4):1178-84. doi: 10.1016/j.jvs.2011.10.008. Epub 2012 Jan 14. : Conclusions: There is evidence that periodontitis is associated with increased risk of stroke. However, the results of this meta-analysis should be interpreted with caution because of the heterogeneity of the studies as well as the differences in periodontitis definition.
    1. A systematic review of the management of oral candidiasis associated with HIV/AIDS. 2002 Dec;57(11):457-66. Abstract: The purpose of this review was to investigate the management of oral candidiasis in HIV/AIDS patients and to evaluate the different guidelines available for its management. A number of topical and systemic antifungal medications are used to treat oral candidiasis in HIV-positive patients. Milder episodes of oral candidiasis respond to topical therapy with nystatin, clotrimazole troches or oral ketoconazole. Fluconazole has been extensively evaluated as a treatment for candidiasis. With HIV-infection, a cure rate of 82% has been achieved with a daily oral dose of 50 mg. Fluconazole was found to be a better choice of treatment for relapsing oropharyngeal candidiasis, resulting in either better cure rates or better prevention of relapse. Intravenous amphotericin B has been found to be effective in azole-refractory candidiasis and is well tolerated. Topical therapies are effective for uncomplicated oropharyngeal candidiasis; however, patients relapsed more quickly than those treated with oral systemic antifungal therapy. Nystatin appeared less effective than clotrimazole and the azoles in the treatment of oropharyngeal candidiasis. Clotrimazole was found to be just as effective for resolution of clinical symptoms as the azoles, except when patient compliance was poor. Fluconazole-treated patients were more likely to remain disease-free during the fluconazole follow-up period than those treated with other antifungal agents.
  3. Pregnancy
    1. Effect of periodontal disease treatment during pregnancy on preterm birth incidence: a metaanalysis of randomized trials. Am J Obstet Gynecol.2009 Mar;200(3):225-32. doi: 10.1016/j.ajog.2008.09.020. Conclusion: Our metaanalysis provides evidence in favor of the treatment of periodontal disease during pregnancy. Despite moderate between-study heterogeneity we observed for 2 of the primary outcomes, treatment with scaling and root planing reduces the rate of PTB and may reduce the rate of LBW infants.
    2. Obstetric outcomes after treatment of periodontal disease during pregnancy: systematic review and meta-analysis. 2010 Dec 29;341:c7017. doi: 10.1136/bmj.c7017.. CONCLUSION: Treatment of periodontal disease with scaling and root planing cannot be considered to be an efficient way of reducing the incidence of preterm birth. Women may be advised to have periodical dental examinations during pregnancy to test their dental status and may have treatment for periodontal disease. However, they should be told that such treatment during pregnancy is unlikely to reduce the risk of preterm birth or low birthweight infants.
  1. The effectiveness of periodontal disease treatment during pregnancy in reducing the risk of experiencing preterm birth and low birth weight: a meta-analysis. J Am Dent Assoc. 2010 Dec;141(12):1423-34. CLINICAL IMPLICATIONS: Pooled results from the highest-quality RCTs do not support the hypothesis of a reduction of PTB or LBW in women who are treated for periodontal disease during pregnancy. Dental Research Journal. 2012;9(4):368-80. Conclusion: Generally, all the studies reviewed in the paper suggest that periodontal disease may be a potential risk factor for preterm LBW babies.
  2. Promoting oral health during pregnancy: current evidence and implications for Australian midwives. J Clin Nurs.2010 Dec;19(23-24):3324-33. doi: 10.1111/j.1365-2702.2010.03426.x. Epub 2010 Oct 19.RELEVANCE TO CLINICAL PRACTICE: Midwives have an excellent opportunity to offer preventive oral health services by providing oral health assessments, education and referrals for pregnant women attending antenatal clinics
  1. Kidney Disease
    1. Periodontitis and chronic kidney disease: a systematic review of the association of diseases and the effect of periodontal treatment on estimated glomerular filtration rate. J Clin Periodontol.2013 May;40(5):443-56. Doi: 10.1111/jcpe.12067. Epub 2013 Feb 21. CONCLUSION: There is quite consistent evidence to support the positive association between periodontitis and CKD, as well as the positive effect of PT on eGFR.
    2. Periodontal disease and rheumatoid arthritis: a systematic review. J Dent Res.2013 May;92(5):399-408. Doi: 10.1177/0022034513483142. Epub 2013 Mar 22. Conclusion: Good evidence was found to support an association between these conditions with regard to tooth loss, clinical attachment levels, and erythrocyte sedimentation rates. Moderate evidence was noted for C-reactive protein and interleukin-1β. Some evidence for a positive outcome of periodontal treatment on the clinical features of rheumatoid arthritis was noted. These results provide moderate evidence based on biochemical markers and stronger evidence with regard to clinical parameters that common risk factors or common pathologic processes may be responsible for an association between rheumatoid arthritis and periodontal disease. Further studies are required to fully explore both the biochemical processes and clinical relationships between these 2 chronic inflammatory conditions.



  1. Respiratory Conditions
    1. Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review. Ann Periodontol.2003 Dec;8(1):54-69.  Reviewer’s Conclusions Oral colonization by respiratory pathogens, fostered by poor oral hygiene and periodontal diseases, appears to be associated with nosocomial pneumonia. 2. Additional large-scale RCTs are warranted to provide the medical community with further evidence to institute effective oral hygiene procedures in high-risk patients to prevent nosocomial pneumonia. 3. The results associating periodontal disease and COPD are preliminary and large-scale longitudinal and epidemiologic and RCTs are needed.
    2. Epidemiologic associations between periodontal disease and chronic obstructive pulmonary disease. Ann Periodontol. 2001 Dec;6(1):71-7. Conclusion: The epidemiologic evidence identified in this systematic review indicates that worse periodontal health status is associated with an increased risk of COPD, with odds ratios ranging from 1.45 to 4.50 (significant at the 95% confidence interval). However, it is possible that residual confounding by tobacco smoking may account in part for the observations. A causal association between periodontal health status and risk of COPD, although biologically plausible, remains speculative. Randomized controlled trials will be required in order to address the question of causality and to better understand the biological basis of these epidemiologic associations.
  1. Sleep Apnea
    1. The effect of oral appliances that advanced the mandible forward and limited mouth opening in patients with obstructive sleep apnea: a systematic review and meta-analysis of randomised controlled trials. J Oral Rehabil.2014 Jul;41(7):542-54. doi: 10.1111/joor.12162. Epub 2014 Mar 21. Conclusion:  Apnea Hypopnea Index and arousal index were significantly improved by OA relative to the untreated disease. Apnea Hypopnea Index, lowest SpO2 and SF-36 were significantly better with CPAP than with OA. The results of this study suggested that OAs improve OSA compared with untreated. CPAP appears to be more effective in improving OSA than OAs.
    2. Effect of oral appliances on blood pressure in obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med.2013 Feb 1;9(2):165-74. doi: 10.5664/jcsm.2420. CONCLUSIONS: The pooled estimate shows a favorable effect of OAs on SBP, MAP, and DBP. Most of the studies were observational. Therefore, more RCTs are warranted involving a larger number of patients and longer treatment periods to confirm the effects of OA on BP.
  2. Cancer
    1. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer.2010 Aug;18(8):1039-60. doi: 10.1007/s00520-010-0827-8. Epub 2010 Mar 17. CONCLUSIONS: Salivary gland hypofunction and xerostomia are induced by radiotherapy in the head and neck region depending on the cumulative radiation dose to the gland tissue. Treatment focus should be on optimized/new approaches to further reduce the dose to the parotids, and particularly submandibular and minor salivary glands, as these glands are major contributors to moistening of oral tissues. Other cancer treatments also induce salivary gland hypofunction, although to a lesser severity, and in the case of chemotherapy and immunotherapy, the adverse effect is temporary. Fields of sparse literature included pediatric cancer populations, cancer chemotherapy, radioactive iodine treatment, total body irradiation/hematopoietic stem cell transplantation, and immunotherapy.


  1. Dental Implications
    1. Mother-to-child transmission of Streptococcus mutans: a systematic review and meta-analysis. J Dent.2015 Feb;43(2):181-91. doi: 10.1016/j.jdent.2014.12.001. Epub 2014 Dec 6. CONCLUSIONS: The present systematic review and meta-analysis demonstrated evidence of vertical transmission of S. mutans from mother to child because there was an association between S. mutans n mothers and their respective children.
    2. A systematic review and meta-analysis of the association between poor oral health and severe mental illness. Sychosom Med.2015 Jan;77(1):83-92. doi: 10.1097/PSY.0000000000000135. CONCLUSION: The increased focus on the physical health of people with SMI should encompass oral health. Possible interventions could include oral health assessment conducted using standard checklists that can be completed by non-dental personnel, help with oral hygiene, management of iatrogenic dry mouth, and early dental referral.