October 2013

During the 9th European Workshop in Periodontology, the evidence base for the link between periodontal disease and systemic conditions was scrutinised. In response, the European Federation of Periodontology (EFP) issued a manifesto that summarised these findings. This article has critically evaluated the research published after the 9th European Workshop in Periodontology in November 2012 to ascertain whether recent research has affected the merit of the manifesto. It was found that recent research supports the manifesto regarding diabetes mellitus, cardiovascular disease and adverse pregnancy outcomes, although further high-quality randomised controlled trials are required to support the manifesto statement that “certain populations of pregnant women may benefit from periodontal therapy.” Furthermore, there is now good evidence from systematic reviews for an association between periodontal disease and chronic obstructive pulmonary disease, rheumatoid arthritis, chronic kidney disease and metabolic syndrome. This may be sufficient to warrant an update to the manifesto. Causal relationships remain debatable. There is also recent emerging evidence for an association with obstructive sleep apnoea. The recent evidence investigating obesity and periodontal disease is mixed, and no new systematic studies or randomised controlled trials were found relating to cognitive impairment.