Obstructive sleep apnea and periodontitis: a systematic review with considerations on CPAP therapy

Clinical Snapshot

Key Findings

• P Value: Not reported at the review level; individual study significance reported narratively

• Effect Size: Not reported — no meta-analytic pooling performed; narrative synthesis only

• Primary Outcome: Association between OSA and periodontitis: 14 of 20 included studies (70%) reported a statistically significant positive association

• Nnt Or Sensitivity: Not applicable — no pooled diagnostic or therapeutic effect measure available; CPAP therapy showed no significant impact on periodontal outcomes in the limited available studies

• Confidence Interval: Not reported

Clinical Application

Periodontal screening in OSA patients is feasible and low-cost in dental settings. Bidirectional referral pathways between sleep medicine and dental/periodontal services are clinically practical but not yet supported by sufficient evidence to mandate as standard of care. CPAP therapy cannot currently be recommended as a periodontal intervention. In Australia, OSA affects an estimated 5–10% of adults and is a significant public health burden. CPAP therapy is available but not PBS-subsidised for device purchase (though sleep studies attract Medicare rebates). Periodontitis is the sixth most prevalent chronic disease globally and is highly prevalent in Australian adults, particularly in Indigenous communities and those with socioeconomic disadvantage. The RACGP does not currently include OSA-periodontitis bidirectional screening in its guidelines. The Australian Dental Association (ADA) and the Australasian Sleep Association (ASA) may consider collaborative position statements as evidence matures. TGA-approved CPAP devices are widely available; however, this review does not support their use as a periodontal treatment. Clinicians should be alert to shared risk factors (obesity, type 2 diabetes, smoking) that are highly prevalent in Australian OSA patients and independently drive periodontal disease. Adults diagnosed with OSA (particularly moderate-to-severe OSA) who may benefit from periodontal screening; adults with periodontitis who may warrant OSA risk assessment. Relevant to sleep medicine physicians, respiratory physicians, periodontists, and general dental practitioners.

Abstract

OBJECTIVE: To evaluate the association between obstructive sleep apnoea (OSA) and periodontitis and to assess the available evidence on the effects of continuous positive airway pressure (CPAP) therapy on periodontal status. MATERIALS AND METHODS: This review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. Comprehensive literature searches were performed in Cochrane, PubMed, Scopus, and Web of Science. Study selection and data extraction were carried out independently by two reviewers. A total of 20 original studies met the inclusion criteria. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tool. RESULTS: Fourteen of the 20 studies (70%) reported a significant association between OSA and periodontitis. However, only two studies fulfilled all methodological quality criteria, indicating an overall moderate to low quality of evidence. Data on the effects of CPAP therapy on periodontal outcomes were limited, and the available studies generally showed no significant impact. CONCLUSIONS: Current evidence supports an association between OSA and periodontitis, suggesting that OSA may contribute to periodontitis. Robust, well-designed studies with larger sample sizes and rigorous methodology are needed to clarify the nature of this relationship and to determine whether CPAP therapy influences periodontal health.

References

1. 1.Kukila, A., Manzoor, M., Salminen, A., Mäntylä, P., & Pussinen, P. (2026). Obstructive sleep apnea and periodontitis: a systematic review with considerations on CPAP therapy. Acta Odontologica Scandinavica. https://doi.org/10.2340/aos.v85.46512