Das N. Gut microbiota axis in periodontitis: A systematic review and meta-analysis of inflammatory and microbial interactions. World J Meta-Anal 2026; 14(3): 121388 [DOI: 10.13105/wjma.121388]
Corresponding Author of This Article
Neelam Das, Associate Professor, Department of Periodontology, Sri Sai College of Dental Surgery, 1-2-64/1 and 2, Kothrepally, Alampally, Vikarabad 501102, Telangana, India. dasneelam423@gmail.com
Research Domain of This Article
Dentistry, Oral Surgery & Medicine
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research-article
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Das N. Gut microbiota axis in periodontitis: A systematic review and meta-analysis of inflammatory and microbial interactions. World J Meta-Anal 2026; 14(3): 121388 [DOI: 10.13105/wjma.121388]
World J Meta-Anal. Sep 18, 2026; 14(3): 121388 Published online Sep 18, 2026. doi: 10.13105/wjma.121388
Gut microbiota axis in periodontitis: A systematic review and meta-analysis of inflammatory and microbial interactions
Neelam Das
Neelam Das, Department of Periodontology, Sri Sai College of Dental Surgery, Vikarabad 501102, Telangana, India
Author contributions: Das N and an independent reviewer performed the literature search, study selection, data extraction, and risk of bias assessment; Das N performed the statistical analysis; Das N drafted the manuscript and revised it critically for important intellectual content; Das N approved the final version of the manuscript and agreed to be accountable for all aspects of the work.
Conflict-of-interest statement: The author declares no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The author has read the PRISMA 2020 Checklist, and the manuscript was prepared and revised according to the PRISMA 2020 Checklist.
Corresponding author: Neelam Das, Associate Professor, Department of Periodontology, Sri Sai College of Dental Surgery, 1-2-64/1 and 2, Kothrepally, Alampally, Vikarabad 501102, Telangana, India. dasneelam423@gmail.com
Received: March 24, 2026 Revised: May 12, 2026 Accepted: June 23, 2026 Published online: September 18, 2026 Processing time: 171 Days and 22.9 Hours
Abstract
BACKGROUND
Periodontitis is a chronic inflammatory disease driven by dysbiotic oral biofilms and host immune response. Emerging evidence suggests that gut microbiota imbalance may influence periodontal inflammation through systemic immune and metabolic pathways. The overall strength of this association remains unclear.
AIM
To evaluate the association between gut microbiota dysbiosis and periodontal disease severity.
METHODS
This systematic review and meta-analysis followed PRISMA guidelines. PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library were searched to January 31, 2026. Eligible studies included clinical and observational studies assessing gut microbiota and periodontal parameters. Two reviewers performed selection, extraction, and bias assessment. Random effects models calculated pooled standardized mean differences and odds ratios with 95 percent confidence intervals. Heterogeneity was assessed using I2.
RESULTS
Twenty-nine studies with 3876 participants were included. Periodontitis patients showed reduced gut microbial diversity compared with controls, the pooled standardized mean difference for alpha diversity was -0.76 (95%CI: -1.01 to -0.50), P < 0.001. Altered Firmicutes to Bacteroidetes ratio increased odds of severe periodontitis, odds ratio 2.18 (95%CI: 1.55 to 3.06), P < 0.001. Pro-inflammatory taxa increased, while butyrate producing genera decreased. C-reactive protein, interleukin 6, tumor necrosis factor alpha, and interleukin 17 were elevated.
CONCLUSION
Gut microbiota dysbiosis shows a significant association with periodontal disease severity and systemic inflammation.
Core Tip: This updated systematic review and meta-analysis up to January 2026 shows that gut microbiota dysbiosis is associated with increased periodontal disease severity. Reduced microbial diversity, altered Firmicutes to Bacteroidetes ratio, enrichment of pro inflammatory taxa, and depletion of short chain fatty acid producing bacteria were consistently observed. These changes correlated with elevated systemic inflammatory markers and worse periodontal clinical parameters. The findings support the role of the gut microbiota axis in periodontal disease and highlight its potential relevance for future diagnostic and therapeutic strategies.
