Association between periodontitis and cytogenetic and cytotoxic damage in oral exfoliated cells: A systematic review with meta-analysis.

OBJECTIVE

To investigate the association between periodontitis and cytogenetic and cytotoxic damage in human oral exfoliated cells.

DESIGN

PubMed, Scopus, Web of Science, and Google Scholar were searched for studies published through June 2026, using combinations of the keywords "periodontitis", "periodontal disease", "genotoxicity", "micronucleus", "micronucleus assay", "mutagenicity", "genetic damage", "oral cells", "buccal cells", and "gingiva". Studies evaluating oral cell damage in individuals with periodontitis were included, following the PRISMA 2020 guidelines.

RESULTS

Ten observational studies were included; three were rated strong, three moderate, and four weak. Meta-analysis of five studies showed significantly higher frequencies of micronucleated cells (standardized mean difference [SMD] = 0.86, 95% confidence interval [CI]: 0.10-1.63), nuclear buds (SMD = 1.51, 95% CI: 0.35-2.67), and binucleated cells (SMD = 1.09, 95% CI: 0.76-1.41) in individuals with periodontitis than in controls; binucleated cells showed the lowest heterogeneity (I² = 44%) and the only moderate-certainty effect. Among cytotoxicity markers, condensed chromatin (SMD = 0.64, 95% CI: -0.22 to 1.50), karyolysis (SMD = 1.01, 95% CI: -0.00 to 2.03), and karyorrhexis (SMD = 1.01, 95% CI: -0.04 to 2.07) showed non-significant trends, and pyknosis a small, borderline increase (SMD = 0.46, 95% CI: 0.01-0.91).

CONCLUSIONS

These findings support an association between periodontitis and increased mutagenicity in orally exfoliated cells, particularly binucleated cells, whereas evidence of cytotoxic damage remains inconclusive. The overall certainty of evidence ranged from very low to moderate.