This review is undertaken to answer the following questions:

Key Question 1: What is the effectiveness of dental services before or during treatment with biologics and other immunosuppressants for autoimmune conditions on disease-related outcomes?

Key Question 2: What are the clinical practice guidelines or standards for dental care for people with autoimmune diseases treated with biologics and other immunosuppressants?

• The body of evidence that was synthesized for the effect of dental services on autoimmune disease-related outcomes focused on patients with rheumatoid arthritis (RA) who received non-surgical periodontal treatment (NSPT). Evidence on other autoimmune disease populations is sparse, and evidence on other dental services is lacking.
• All included studies examined the effect of NSPT during autoimmune treatments. No evidence evaluating the impact of NSPT prior to immunosuppressive treatment was available.
• The evidence reported here has been extracted from 3 systematic reviews (SRs) (1 fair and 2 poor quality SRs) and 10 primary studies (3 good, 2 fair and 5 poor quality).
• Most of the included studies had patients who were on either conventional or biologic disease-modifying anti-rheumatic drugs (DMARDs), or mixed type of therapies.
• Disease-activity: The evidence generally supports the effectiveness of NSPT in reducing disease activity scores for RA (3 SRs of 1 fair and 2 poor quality, 5/7 primary studies of 1 fair and 4 poor quality) and psoriasis (PSO) (2/2 good quality randomized controlled trials (RCTs)) with follow-up times ranging from 8 weeks to 6 months.
• Tender/Swollen joints: There is inconsistent evidence for the reduction of the number of tender/swollen joints after NSPT (1 fair quality SR, 1 fair and 2 poor quality RCTs).
• Inflammatory markers: There is moderate evidence that C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) levels are decreased post-NSPT in RA and systemic lupus erythematosus (SLE) and no evidence about these markers for PSO. There is weak evidence for lowering of other inflammatory markers like Tumor necrosis factor alpha (TNFα), Interleukin-6 (IL6) (in 1 RA SR of fair quality and 1 PSO RCT of good quality.)
• Quality of life outcomes: There is inconsistent evidence showing no effect on QoL measures for RA (2 RCTs of fair quality) and PSO (1 RCT of good quality).
• Other outcomes: We find weak evidence for other outcomes like anti-citrullinated protein autoantibodies (ACPAs), rheumatoid factor (RF), life impact measure and Musculoskeletal ultrasound (MSUS), which are reduced in less than 3 studies.
• Adverse events: None of the included studies reported on the impact of NSPT on adverse effects of therapies for autoimmune conditions.
• Future studies to evaluate dental services other than non-surgical periodontal treatment, and studies that include patients with autoimmune diseases other than rheumatoid arthritis, may enrich our understanding on the potential inextricable link between dental services and autoimmune disease treatment.
• Of the 31 clinical practice guidelines that were identified from our searches, only one official clinical practice guideline on dental care was available. This guideline focused on Sjogren’s syndrome.
• The American Dental Association published a practice guide that outlined various aspects of dental management for RA, lupus, Sjogren’s syndrome, and scleroderma.
• The British Dental Association provided a review and guidance for oral health management for patients with RA.
• The National Scleroderma Foundation published a patient-oriented fact sheet that included description and treatment of common oral health issues among patients with scleroderma.

Chou R, Fu R, Dana T, Pappas M, Hart E, Mauer KM. Interventional Treatments for Acute and Chronic Pain: Systematic Review. Comparative Effectiveness Review No. 247. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 75Q80120D00006.) AHRQ Publication No. 21-EHC030. Rockville, MD: Agency for Healthcare Research and Quality; September 2021. DOI: 10.23970/AHRQEPCCER247. Posted final reports are located on the Effective Health Care Program search page.