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

Figures & data

Table 1. Primary references used for the discussion in each working group, with their main methodology and context.

Reference	Methodology	Additional information
Cardiovascular diseases and periodontitis
[8]	Consensus report	EFP and WHF focused workshop
[9]	Consensus report	EFP and WHF focused workshop
[10]	Narrative review	EFP and WHF focused workshop
[11]	Narrative review	EFP and WHF focused workshop
[12]	Narrative review	EFP and WHF focused workshop
[6]	S3 level clinical practice guideline	EFP guideline for the treatment of periodontitis in stage I-III
[5]	S3 level clinical practice guideline	EFP guideline for the treatment of periodontitis in stage IV
[13]	Systematic review, intervention	impact of periodontal therapy on systemic health
Diabetes and periodontitis
[14]	Consensus report	EFP and WHF focused workshop
[15]	Consensus report	EFP and WHF focused workshop
[16]	Systematic review, epidemiology	EFP and WHF focused workshop
[17]	Systematic review, plausibility	EFP and WHF focused workshop
[18]	Systematic review, intervention	EFP and WHF focused workshop
[13]	Systematic review, intervention	impact of periodontal therapy on systemic health
Respiratory diseases and periodontitis
[19]	Systematic review, epidemiology	EFP and WONCA focused workshop
[19]	Systematic review, intervention	EFP and WONCA focused workshop

EFP: European Federation of Periodontology; WHF: World Heart Federation; IDF: International Diabetes Federation; WONCA: WONCA Europe.

Table 2. Summary of the guidance agreed by the experts and proposed by the consensus report.

Potential association	Setting/HP	Patient with	Action*	Description
CVD and periodontitis	HP	Periodontitis therapy	Advise	May reduce CVD risk
				Improves surrogate CVD parameters (CRP, IL6, BA-FMD, BP, cIMT)
				Safe for CVD patients
				Consider anti-platelet and anti-coagulant drugs
				Consider hypertension
	OHP	Periodontitis	Advise	Higher CVD risk
				Risk factor control
			Screen	For CVD risk factors
		CVD risk factors	Advise	Risk factor control
			Refer	Consultation with GP
		Periodontitis and CVD	Advise	Higher CVD risk
				Preventive periodontal care
				Risk factor control
		Periodontitis therapy	Refer	In case of recent acute CVD event
	FD	CVD	Screen	For signs and symptoms of periodontitis
			Refer	Periodontal evaluation
Diabetes and periodontitis	HP	Periodontitis	Advise	Importance of periodontitis to diabetes control and complications
		Diabetes	Advise	Impact of hyperglycaemia upon periodontitis and compromised healing following periodontal therapy
		Diabetes and periodontitis	Refer	Bi-directional communication
	OHP	Diabetes	Advise	Increased risk of periodontitis and its impact on glycemic control and its complications
			Diagnose	Periodontal and peri-implant condition
			Treat	According to the periodontal and peri-implant condition
			Screen	Risk for diabetes
			Refer	For diabetes diagnosis
	FD	Diabetes	Advise	Increased risk of periodontitis and its impact on glycemic control and its complications
				Periodontal treatment can improve glycemic control and reduce diabetes complications
				Importance of regular oral health assessments and periodontal care tailored to individual needs
				Emerging evidence demonstrating an increased risk for peri-implantitis
			Refer	For regular oral assessment
		Diabetes and periodontitis	Advise	Improving glycemic control improves periodontal treatment outcomes
				Encourage patients to engage for regular oral healthcare appointments
COPD and periodontitis	HP	COPD and smoker	Refer	Smoking cessation
			Treat	Smoking cessation
	OHP	COPD	Advise	Oral hygiene habits
			Diagnose	Periodontal and peri-implant condition
			Treat	According to the periodontal and peri-implant condition
	FD	COPD, risk of COPD	Advise	Association between COPD and periodontitis
				Foreseeable improvements resulting from periodontal therapy
			Refer	Oral/periodontal health examination
Asthma and periodontitis	FD	Asthma	Advise	Documented oral side effects of asthma treatments
			Refer	Oral/periodontal health examination in specific cases (e.g. poor oral hygiene)
OSA and periodontitis	HP	OSA	Advise	Reported association between OSA and periodontitis
				Strategies for weight loss and healthy life styles
				Potential side effects on oral health (e.g. dry mouth, more plaque, and inflammation) of CPAP and BiPAP machine
				Potential side effects on oral health of oral appliances to treat mild or moderate OSA and snoring
		OSA in young patients	Refer	For orthodontic evaluation, in specific cases
	FD	OSA	Refer	Oral/periodontal health examination
COVID-19 and periodontitis	HP	Active COVID-19	Advise	Separate toothbrushes from co-habitants
				Consider using virucidal mouth rinses
		history of severe COVID-19	Advise	Oral consequences of ICU syndrome, oral lesions associated with COVID-19, periodontitis
			Refer	Oral/periodontal health examination

OHP: oral health professional; FD: family doctor; HP: health professional; CVD: cardiovascular disease; COPD: chronic obstructive pulmonary disease; OSA: obstructive sleep apnoea; CRP: C reactive protein; IL6: interleukin-6; BA-FMD: braquial artery flow mediated dilation; BP: blood pressure; cIMT: carotid intima media thickness; CPAP: continuous positive airway pressure; BiPAP: bi-level positive airway pressure; ICU: internal care unit.

Guidance is presented for each potential association [periodontitis with cardiovascular diseases (CVD), with diabetes, and with different respiratory diseases), for each health care setting [family doctor (FD), oral health professional (OHP) or both health professionals (HP)], and for different conditions/situations of patients. Actions are defined as to advise (i.e. inform); to screen, to diagnose to refer, and to treat.

* The present guidance is a summary of the consensus report of the joint workshop of experts of the European Federation of Periodontology and WONCA Europe. The evidence to support the guidance was discussed during the workshop (main methodology, expert discussion on overall evidence), and it is presented in Table 1 and in the manuscript. However, the level of evidence supporting each recommendation was not properly weighted and/or analysed.

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