Association between periodontal disease and chronic obstructive pulmonary disease: an umbrella review

Aim To evaluate the strength and methodological quality of evidence regarding the association between periodontal disease (PD) and chronic obstructive pulmonary disease (COPD) through an umbrella review. Materials and methods A comprehensive search was conducted through April 2025 in PubMed, Cochrane Library, Scopus, Embase, Web of Science, Google Scholar, ProQuest Dissertations and Theses, and OpenGrey. Systematic reviews (SRs), with or without meta-analysis, investigating the association between PD and COPD were included without time or language restrictions. Narrative reviews, primary studies, protocols, and non-systematic reports were excluded. Methodological quality was assessed using AMSTAR-2. The degree of primary study overlap was calculated using the Corrected Covered Area (CCA) index. Due to high overlap (CCA = 14.45%) and clinical heterogeneity, no de novo meta-analysis was performed, and a structured qualitative synthesis was conducted. Results Of 313 identified records, 12 SRs comprising 145 primary studies were included. Six reviews were rated as high confidence, one as low confidence, and five as critically low confidence according to AMSTAR-2. Most SRs reported a positive association between PD and COPD. However, the magnitude and statistical significance of the association varied according to periodontal parameters, COPD outcomes, and smoking status. Conclusion Current evidence suggests a likely association between PD and COPD, although the relationship may be influenced by shared risk factors such as smoking and methodological heterogeneity. Integrating periodontal assessment into COPD management may be clinically relevant, but high-quality prospective studies are needed to clarify causal pathways. Systematic Review Registration Open Science Framework (OSF), https://doi.org/10.17605/OSF.IO/YTXB6 .