Impact of periodontal indices and therapeutic interventions on COPD: a systematic review with meta-analysis

Objectives This systematic review and meta-analysis aimed to evaluate the association between periodontal disease and chronic obstructive pulmonary disease (COPD), examine periodontal parameters associated with COPD, and assess the effects of periodontal treatment on COPD-related outcomes. Methods We searched PubMed, Web of Science, Cochrane Library, ScienceDirect, and Scopus from inception to May 2025. Included studies reported periodontal parameters in COPD patients or periodontal treatment effects on COPD outcomes. Two reviewers independently extracted data and assessed risk of bias using RoB 2 for randomized controlled trials, the Newcastle-Ottawa Scale (NOS) for case-control studies, and the Joanna Briggs Institute (JBI) critical appraisal checklist for cross-sectional studies. Meta-analyses were performed using random-effects models in R Studio. Results Analysis of 17 studies demonstrated poorer periodontal health in COPD patients, including higher PI, CAL, and ABL, fewer retained teeth, and higher odds of BOP positivity. CAL ≥ 3 mm showed a significant association with COPD (OR = 1.78), and individuals with periodontitis had higher odds of COPD (OR = 1.26). However, adjustment or control for smoking and other confounders was inconsistent across studies. Limited interventional evidence suggested possible benefits of periodontal treatment for COPD exacerbations, lung function, and quality of life, but these findings were based on a small number of studies with limited sample sizes and methodological concerns. Conclusions Poorer periodontal status appears to be associated with COPD, but residual confounding, particularly by smoking, cannot be excluded. Evidence for periodontal treatment effects on COPD outcomes remains limited and should be interpreted cautiously. Registration The protocol for this systematic review was registered prospectively with PROSPERO (registration number CRD420251109977).