title: The influence of anti-infective periodontal treatment on C-reactive protein: a systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Periodontal infections are hypothesized to increase the risk of adverse systemic outcomes through inflammatory mechanisms. The magnitude of effect, if any, of anti-infective periodontal treatment on systemic inflammation is unknown, as are the patient populations most likely to benefit. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to test the hypothesis that anti-infective periodontal treatment reduces systemic c-reactive protein (CRP).
  
  
  RESULTS
  MEDLINE, EMBASE, CENTRAL and CINAHL databases were searched using sensitivity-enhancing search terms. Eligible RCTs enrolled patients with periodontal infection, compared a clearly defined anti-infective periodontal intervention (experimental group) to an "inactive control" (no periodontal intervention) or to an "active control" (lower treatment intensity than the experimental group). Mean differences in final CRP values at the earliest post-treatment time point (typically 1-3 months) between experimental and control groups were analyzed using random-effects regression. Among 2,753 possible studies 20 were selected, which included 2,561 randomized patients(median=57). Baseline CRP values were >3.0 mg/L in 40% of trials. Among studies with a control group receiving no treatment, the mean difference in CRP final values among experimental treatment vs. control groups was -0.37 mg/L [95%CI=-0.64, -0.11], (P=0.005), favoring experimental treatment. Trials for which the experimental group received antibiotics had stronger effects (P for interaction=0.03) and the mean difference in CRP final values among experimental treatment vs. control was -0.75 mg/L [95%CI=-1.17,-0.33]. No treatment effect was observed among studies using an active treatment comparator. Treatment effects were stronger for studies that included patients with co-morbidities vs. studies that included "systemically healthy" patients, although the interaction was not significant (P=0.48).
  
  
  CONCLUSIONS
  Anti-infective periodontal treatment results in short-term modest reductions in systemic CRP.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Demmer
authors.forename: Ludovic
authors.initials: L
authors.lastname: Trinquart
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zuk
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Fu
authors.forename: Josefin
authors.initials: J
authors.lastname: Blomkvist
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Michalowicz
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravaud
authors.forename: Moïse
authors.initials: M
authors.lastname: Desvarieux
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism*; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000188:drug therapy; D010518:Periodontitis / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism*; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic
chemical_list: D000890:Anti-Infective Agents; D002097:C-Reactive Protein