The report is a product of the VA/HSR Evidence Synthesis Program.

Evidence Brief: Detection and Treatment of Dental Problems on Chronic Disease Outcomes

Poor dental health in the form of periodontal disease (a gum infection typically caused by poor oral hygiene) is a widespread issue in the United States. Nearly half of US adults aged 30 and older have periodontal disease, and prevalence is highest among older adults (70% of those 65 or older), men (56%), smokers (64%), and those below the federal poverty level (65%). In the last two decades, growing evidence has suggested periodontal disease is associated with chronic diseases such as heart disease, lung disease, stroke, and type 2 diabetes. However, it is unclear whether treatment of periodontal disease improves chronic disease outcomes or reduces costs associated with care for complications of chronic diseases. This is an important question for VA, as Veterans are older than the general population and therefore at higher risk of periodontal disease, and Veterans have a high prevalence of chronic diseases.

VA’s Evidence Synthesis Program (ESP) Coordinating Center in Portland, Oregon conducted a rapid review to synthesize evidence on the benefits and harms of detection and treatment of dental problems (specifically, periodontal disease) among adults with type 2 diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD), or cerebrovascular disease. Investigators searched medical literature databases including Ovid MEDLINE, Cochrane Database of Systematic Reviews, and CENTRAL from database inception to December 2020. After reviewing 1,768 potentially relevant articles, they prioritized 8 systematic reviews and included 21 primary studies.

Summary of Findings

• For adults with type 2 diabetes, periodontal treatment likely improves measures of chronic disease severity and inflammation (i.e., HbA1c, fasting blood glucose, total cholesterol) with only minor adverse events in the short term (3-4 months) based on several moderate- and high-quality systematic reviews and newly published RCTs. However, these improvements do not appear to persist beyond six months. Findings are unclear on the relation between periodontal treatment and diabetes-related complications and costs.
• For adults with cardiovascular disease, periodontal treatment likely improves measures of inflammation (i.e., TNF-α, IL-6 and CRP) at three months based on one moderate- and one high-quality systematic review; longer-term outcomes have not been evaluated. Findings are unclear on the relation between periodontal treatment and cardiovascular-related complications and costs.
• For adults with COPD, periodontal treatment may improve lung function and reduce the frequency of exacerbations at 1 and 2 years compared to no treatment based on two fair-quality controlled trials. Periodontal treatment may also contribute to lower annual medical costs based on one poor-quality retrospective cohort study.
• There is limited available evidence on the effect of periodontal treatment among adults with cerebrovascular disease. Existing studies are unclear on the relation of periodontal treatment to complications and costs, similar to findings for diabetes and cardiovascular disease.

Implications for VA

Evidence on chronic disease outcomes, health care use, and costs associated with periodontal treatment will be used to inform the implementation and evaluation of the VA Care Coordination for Dental Benefits demonstration program, which seeks to increase Veterans’ access to community-based, pro bono, or discounted dental service providers.

Research Gaps/Future Research

This review of the evidence found several gaps in current research. For example:

• Populations: More research is needed on people with cerebrovascular disease. Researchers should also consider evaluating whether outcomes for those with type 2 diabetes, cardiovascular disease or COPD vary by patient characteristics (e.g., age, sex, race/ethnicity), disease severity, and whether patients have single versus multiple chronic diseases.
• Interventions: Researchers of the Care Coordination for Dental Benefits program may be interested in evaluating whether referral to dental care improves chronic disease outcomes and reduces associated costs. In this case, it would be important to track whether referral to dental care results in increased receipt of dental services, what kinds of services are delivered, and whether participants continue to receive dental services on a regular basis.
• Outcomes: Because there is limited or unclear evidence on the impact of periodontal treatment on chronic disease-related complications, healthcare use, and costs, these outcomes should be evaluated in future research.
• Timing: Future studies should assess outcomes at both shorter (3 and 6 months) and longer-term (1+ years) time points for all four chronic disease populations.

A Cyberseminar titled “ESP Evidence Brief: Detection and Treatment of Dental Problems on Chronic Disease Outcomes” will be held on April 5, 2021 from 11:00am – 12:00pm ET. Register here.

Veazie S, Vela K, Parr NJ. Evidence Brief: Detection and Treatment of Dental Problems on Chronic Disease Outcomes. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-009; 2021.

To view the full report, go to http://www.hsrd.research.va.gov/publications/esp/preventive-dental.cfm

ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.

This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.

This report is a product of VA/HSR&D's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers –; and to disseminate these reports throughout VA.

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