Bidirectional Association Between Periodontal Diseases and Multimorbidity. a Systemic Review.

Objectives: With the exponential rise in non-communicable diseases, the occurrence of “multimorbidity” (MM), defined as the presence of 2 or more long-term physical or mental disorders, is rapidly increasing. This review aimed to systematically appraise the evidence linking periodontal diseases (PD) and MM.
Methods: Seven electronic databases were screened up to July 2023 to identify observational evidence investigating the prevalence of MM in patients with PD compared to controls, and vice versa. Independent and duplicate searches were conducted. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias of the included studies. Qualitative and if possible quantitative analyses were performed.
Results: Twenty-five studies were eligible for full-text analysis. Results from the qualitative analysis demonstrated a higher prevalence of MM in individuals with PD (range: 28.0-52.0%) compared to periodontally-healthy controls (range: 9.0-31.2%). The same direction of association was confirmed by multivariate regression models, showing that individuals with PD had 2- to 4-time higher odds of being affected by MM. Similarly, a qualitative analysis of all evidence demonstrated a higher prevalence of both PD and severe PD in individuals with MM (PD: range 42.9-52.4%; severe PD: range 7.1-72.3%) compared to those without MM (PD: range 36.4-47.6%; severe PD: range 8.0-27.7%). The same direction of association was confirmed by multivariate regressions models, although did not reach statistical significance in any of the included studies. Most of the included studies resulted as having moderate risk of bias.
Conclusions: This systematic review demonstrated that individuals affected by MM are more often burdened with PD compared to individuals without MM, and vice versa. These results should encourage clinicians and policymakers to shift from a “single-disease” to a “multiple-disease” framework in order to successfully manage chronic diseases.