Periodontitis and Quality of Life: A Systematic Review and Meta-Analyses.

Abstract

Aim: To systematically review and meta-analyze population-based epidemiological evidence on the association between periodontitis and quality of life.

Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251130194). Embase, MEDLINE, PubMed, and Scopus were searched without date restrictions, supplemented by gray literature and reference screening. Population-based studies of adults (≥ 18 years) with representative sampling frames were eligible. Periodontitis was assessed using clinical measures, self-reports, or established classification systems, and compared with the absence of periodontitis. The primary outcome was oral health-related quality of life (OHRQoL) measured using validated instruments; general quality of life (QoL) was a secondary outcome. Random-effects meta-analyses were conducted using standardized and instrument-specific effect measures. Risk of bias was assessed using the Newcastle-Ottawa Scale for longitudinal studies, and its adaptation (NOS-xs) for cross-sectional studies.

Results: Twenty-three studies met the inclusion criteria, and 15 were included in the quantitative synthesis. Severe periodontitis was consistently associated with poorer OHRQoL across effect measures, including pooled standardized mean differences (SMDs) (0.29; 95% CI: 0.06-0.52; I² 89.1%), adjusted odds ratios (ORs) (1.58; 95% CI: 1.26-1.96; I² 3.2%), and mean ratios (MRs) (1.24; 95% CI: 1.07-1.44), although heterogeneity was substantial in several analyses. OHIP-14 mean differences indicated higher scores among individuals with severe periodontitis (2.51; 95% CI: 0.15-4.86; I² 92.6%). Associations for moderate periodontitis were weaker and less consistent, with several estimates crossing the null. Evidence on general QoL was limited and methodologically heterogeneous.

Conclusion: In representative population-based studies, severe periodontitis is consistently associated with poorer OHRQoL, whereas associations for moderate disease were less robust and consistent and should be interpreted with greater caution. These findings indicate that the population-level quality-of-life burden of periodontitis is driven primarily by advanced disease.