Periodontal diseases and cardiovascular diseases, diabetes, and respiratory diseases: Summary of the consensus report by the European Federation of Periodontology and WONCA Europe.

European Journal of General Practice 2024, VOL. 30, NO. 1, 2320120 https://doi.org/10.1080/13814788.2024.2320120 SYSTEMATIC REVIEW Periodontal diseases and cardiovascular diseases, diabetes, and respiratory diseases: Summary of the consensus report by the European Federation of Periodontology and WONCA Europe David Herreraa , Mariano Sanza , Lior Shapirab , Carlos Brotonsc , Iain Chappled,e , Thomas Fresef , Filippo Grazianig , F. D. Richard Hobbsh, Olivier Hucki , Eva Hummersj , Søren Jepsenk , Oleg Kravtchenkol , Phoebus Madianosm , Ana Molinaa , Mehmet Ungann Josep Vilasecao,p , Adam Windakq and Shlomo Vinkerr , ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases) Research Group, University Complutense of Madrid, Madrid, Spain; Department of Periodontology, Faculty of Dental Medicine, Hadassah and the Hebrew University Medical Center, Jerusalem, Israel; c Biomedical Research Institute Sant Pau (IIB Sant Pau), Sardenya Primary Health Care Center, Barcelona, Spain; dPeriodontal Research Group, and Birmingham NIHR Biomedical Research Centre in Inflammation, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK; eBirmingham Community Healthcare NHS Foundation Trust, Birmingham, UK; f Institut für Allgemeinmedizin, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany; gDepartment of Surgical, Medical and Molecular Pathology and Critical Care Medicine, School of Dentistry, University of Pisa, Pisa, Italy; hOxford Primary Care, Radcliffe Primary Care Building, ROQ, University of Oxford, Oxford, UK; iDental Faculty, University of Strasbourg, Strasbourg, France; j Department of General Practice and Family Medicine, University Medical Center Göttingen, Göttingen, Germany; kDepartment of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany; lDr. Odinaka’s Clinic, Bodø, Norway; m Department of Periodontology, Faculty of Dentistry, National & Kapodistrian University of Athens, Athens, Greece; nDepartment of Family Medicine, Ankara University School of Medicine, Ankara, Turkey; oDepartment of Medicine, University of Vic–Central Catalonia University, Vic, Spain; pPrimary Health Care Service, Althaia Foundation–Healthcare and University Network, Manresa, Spain; qDepartment of Family Medicine, Jagiellonian University Medical College, Krakow, Poland; rDepartment of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel a b KEY MESSAGES • Periodontitis is independently associated with cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, obstructive sleep apnoea, and COVID-19. • Periodontal treatment for optimal outcomes improves diabetes outcomes and surrogate measures of cardiovascular risk. • Closer collaboration between oral health care professionals and family doctors is important in the early case detection and management of non-communicable diseases. • Information on the reported associations should be made available to family doctors, oral health professionals, healthcare funders, patients, and the general population. ABSTRACT Background: Periodontitis is a chronic inflammatory non-communicable disease (NCD) characterised by the destruction of the tooth-supporting apparatus (periodontium), including alveolar bone, the presence of periodontal pockets, and bleeding on probing. Objectives: To outline, for family doctors, the implications of the association between periodontal and systemic diseases; to explore the role of family doctors in managing periodontitis as an ubiquitous non-communicable disease (NCD). Methods: The consensus reports of previous focused collaborative workshops between WONCA Europe and the European Federation of Periodontology (using previously undertaken systematic reviews), and a specifically commissioned systematic review formed the technical papers to underpin discussions. Working groups prepared proposals independently, and the proposals were subsequently discussed and approved at plenary meetings. Results: Periodontitis is independently associated with cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, obstructive sleep apnoea, and COVID-19 complications. Treatment of periodontitis has been associated with improvements in systemic health outcomes. The article ARTICLE HISTORY Received 18 October 2023 Revised 29 January 2024 Accepted 5 February 2024 KEYWORDS Periodontitis; cardiovascular diseases; diabetes; respiratory diseases; family doctors © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. 2 D. HERRERA ET AL. also presents evidence gaps. Oral health care professionals (OHPs) and family doctors should collaborate in managing these conditions, including implementing strategies for early case detection of periodontitis in primary medical care centres and of systemic NCDs in oral/dental care settings. There is a need to raise awareness of periodontal diseases, their consequences, and the associated risk factors amongst family doctors. Conclusion: Closer collaboration between OHPs and family doctors is important in the early case detection and management of NCDs like cardiovascular diseases, diabetes mellitus, and respiratory diseases. Strategies for early case detection/prevention of NCDs, including periodontitis, should be developed for family doctors, other health professionals (OHPs), and healthcare funders. Evidence-based information on the reported associations between periodontitis and other NCDs should be made available to family doctors, OHPs, healthcare funders, patients, and the general population. Introduction Periodontitis is a chronic inflammatory non-communicable disease (NCD) characterised by the destruction of the tooth-supporting apparatus (periodontium), including alveolar bone, the presence of periodontal pockets, and bleeding on probing [1]. It is initiated by the accumulation of a microbial biofilm at and below the gingival margin, which activates the host immune-inflammatory response. The latter drives biofilm dysbiosis, triggering a dysregulation of local immune-inflammatory processes that destroy the periodontal tissues [2]. Periodontitis presents a major public health problem due to its high prevalence and associated morbidity. It is the most common NCD in humans with 1.1 billion people experiencing severe periodontitis globally (2019) [3]. If untreated, severe periodontitis progresses to tooth loss, causing (...truncated)