Impact of Periodontal Disease on Patients’ Quality of Life [Systematic Review]

Many studies show that gum disease has a high prevalence all over the globe. It is also known to affect systemic health and cause metabolic, cardiovascular, atheroscelerotic, and rheumatoid diseases, as well as aspiration pneumonia. Since the symptoms of periodontal disease often don’t cause a sense of pain, it is referred to as the silent disease. As a result, patients live with no or few symptoms for several years before seeking medical attention. This is one of the reasons why it is the topmost cause of tooth loss in adults.

In 1946, the World Health Organization adopted a biopsychosocial model of health. Subsequently, the American Dental Association stated that “Oral health is a functional, structural, aesthetic, physiologic and psychosocial state of well-being and is essential to an individual’s general health and quality of life.”

To account for these subjective evaluations and the patient’s expectations from oral care treatment, the concept of Oral Health-Related Quality of Life (OHRQoL) was introduced. It revealed that the patient’s perceived OHRQoL is linked to various oral problems, such as:

  • Dental caries
  • Malocclusion
  • Tooth loss
  • Tooth mobility

As a result, an important question arose: ‘Is periodontal disease really a silent condition or whether the affected individuals perceive it to impact their OHRQoL?’

Hence, a study was conducted to investigate the association between clinically measured periodontal disease and to analyse a potential influence of disease severity on the degree of perceived impairment. This systematic review was organized by researchers from University of Basel, Switzerland, University of Witten, Germany, and University of Michigan School of Dentistry, USA.


The objective was to review existing literature to investigate the influence of periodontal disease on OHRQoL.

Data Sources

The following data sources were utilized for the review:

  • Medline
  • Embase
  • OpenGrey
  • Journal of Clinical Periodontology
  • Journal of Periodontology
  • A hand search of the bibliographies of retrieved publications

Study Selection

For selecting the studies included in this systematic review, two reviewers screened the titles and abstracts of 1134 studies. After shortlisting the studies meeting the inclusion criteria, a full-text analysis of 109 papers was conducted. Out of the total 1134 studies, 37 papers were included in the review.

There were no language restrictions and the review was performed according to the MOOSE (Meta-analysis of observational studies in epidemiology) statement. All publications included a periodontal clinical examination as well as a validated OHRQoL questionnaire.

Data Extraction and Synthesis

  • The PECO format was used to extract data from each study.
  • Newcastle Ottawa Scale (NOS) was used to evaluate the quality of observational studies.
  • For clinical trials, Methodological Index for Non-randomised Studies (MINORS) was employed.
  • To assess the level of evidence and the strength of the recommendation, the Strength of Grading Taxonomy (SORT) was utilized.
  • Due to the heterogeneity of the studies included in the review, a meta-analysis was not carried out. Instead, a vote counting method was used for data synthesis.


  • NOS and MINORS revealed that the risk of bias was moderate with most studies assessing 50-83% of the established parameters.
  • For the relationship between clinically diagnosed gum disease and OHRQoL, the quality of evidence was established as level two. And level B was the strength of recommendation.
  • The evidence level across studies was consistent.
  • 28 out of the 37 studies showed an association between periodontal disease and OHRQoL.
  • While eight publications noted a dose-response relationship between the severity of periodontal disease and OHRQoL.


This systematic review concluded that periodontal diseases play a major role in oral health, and impact the quality of life of patients. Since the results were more evident in the publications that took a full mouth recording, a comprehensive periodontal exam along with a validated OHRQoL questionnaire is recommended.


Buset SL, Walter C, Friedmann A, Weiger R, Borgnakke WS, Zitzmann NU. Are periodontal diseases really silent? A systematic review of their effect on quality of life. J Clin Periodontol 2016; 43: 333–344. doi: 10.1111/jcpe.12517.

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