The association between pemphigus and pemphigoid with periodontitis: A systematic review and meta-analysis with trial sequential analysis

Abstract

Aim: Ample evidence is available regarding the potential synergistic and bidirectional association between periodontal disease and systemic inflammatory diseases. However, the link between periodontal disease and autoimmune bullous diseases remains unclear in the literature. The present review aimed to investigate the association between periodontal disease and two major subgroups of autoimmune bullous diseases—pemphigus and pemphigoid. Materials and Methods: We performed a systematic review and meta-analysis on data extracted according to PRISMA. Relevant articles were selected from a literature search using MEDLINE, EMBASE, and CENTRAL from inception until December 7, 2020. Both randomized and non-randomized controlled studies were included. Non-systematic reviews and trials published as abstract, case series, and case reports were excluded. The meta-analysis was conducted with RevMan 5.3. Results: Three articles (199 subjects) were included for the analysis. Of the 199 participants, 99 patients with bullous disease were compared with 100 healthy controls. In comparison to the healthy cohort, the group with bullous disease had a statistically significant increase in clinical attachment loss (mean difference (MD) 0.82, 95% confidence interval (CI): 0.21–1.43, ρ=0.008, I2 = 92%) and probing depth (MD 0.79, 95% CI: 0.71–0.87, ρ<0.00001, I2 = 0%). No difference was demonstrated in the plaque index (MD 20.57, 95% CI: ‒3.35–44.5, ρ= 0.09, I2 = 98%) and gingival index (MD 6.87, 95% CI: ‒6.15–19.89, ρ=0.3, I2 = 98%) for both bullous and healthy groups. Conclusion: Both autoimmune bullous diseases, pemphigus and pemphigoid, are significantly associated with periodontal disease. However, the findings need to be interpreted cautiously as there is significant heterogeneity. Additional prospective studies are required to strengthen the evidence.