The Impact of Non-Surgical Periodontal Therapy on P. gingivalis Count and DAS-28 Score in Periodontitis Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

<ns7:p> Background Rheumatoid Arthritis, autoimmune disease primarily affecting the joints, has a bidirectional relationship with periodontitis since they share common characteristics. Non-surgical periodontal therapy (NSPT), which includes scaling and root planning (SRP) and oral hygiene instructions (OHI), is widely regarded as the cornerstone of periodontal treatment but its role in managing RA has yet been established firmly. Therefore, this systematic review aims to analyze and synthesize existing research findings to provide a clearer understanding of the impact of NSPT on clinical outcomes. Methods This study is a systematic review and meta-analysis. A systematic literature search was performed across four electronic databases (PubMed, Embase, Scopus, and Web of Science) using a combination of keywords, including periodontitis, rheumatoid arthritis, and bacteria. Retrieved articles were then assessed for eligibility and tested for their risk of bias, followed by quantitative analysis through forest plots if plausible. Results A total of 7 studies are included in this systematic review, but only 3 studies are meta-analyzed. NSPT consistently demonstrated positive trends in reducing periodontal inflammation and <ns7:italic>P. gingivalis</ns7:italic> bacterial burden while showing potential systemic benefits in lowering DAS-28 scores. NSPT significantly reduced bleeding on probing [MD 18.15 (95% CI: [2.67, 33.63], p = 0.02)]. However, even though the studies all showed significant improvement in pocket depth and clinical attactchment loss, the meta-analysis found no statistically significant difference in pocket depth [MD 0.21 (95% CI: [-0.31, 0.74], p = 0.43)], and clinical attachment loss [MD 1.22 (95% CI: [-1.07, 3.50], p = 0.30)]. Conclusion NSPT have shown improvements in periodontal inflammation, clinical parameters (bleeding on probing, probing pocket depth, and clinical attachment loss), systemic markers of RA activity, including DAS-28 scores and <ns7:italic>P. gingivalis</ns7:italic> counts, which suggests it as an adjunctive treatment of RA. </ns7:p>