The Role of Oral Fusobacterium nucleatum in Female Breast Cancer: A Systematic Review and Meta-Analysis

Table 1

Inclusion and exclusion criteria. RCT = Randomised controlled trials. (a) In instances where numerous studies examined the same study populations, the longest period of follow-ups were selectively extracted and interpreted; (b) with satisfactory data provisions permitting data and methodology comparability between included articles. (c) Each area of the tooth is scored from 0 to3 (mesial, distal, vestibular, palatine, or lingual). The GI score per tooth is the sum of the scores from the four areas, divided by four. The GI for the subject = Sum of the indices of each tooth divided by the number of teeth examined.

Classification	Criteria
	Inclusion	Exclusion
Publication dates:	Articles published from 01/01/83–31/03/22	Publications >30 years old;
Language:	Articles in English	Articles unavailable in English
Study population	Adult women with breast cancer, diagnosed by certified and registered gynecologists specialized in mastology	Women requiring antibiotic prophylaxis prior to oral examinations
		Women with diagnostically confirmed BC malignancies.
	Women between the ages of 18–96 years	Adult females undergoing orthodontic treatment and thus wearing fixed orthodontic
	Participants evaluated by a fully registered and qualified dentist and who after clinical, histopathological and radiographic evaluations, are currently demonstrating (i) gingivitis	Appliances
	Clinical presentation: Utilisation of the GI grading system c	The usage of medications with inadvertent side effects resulting in gingival hyperplasia-nifedipine, cyclosporine, phenytoin
	Grade I: Mild inflammation–a slight color change, slight oedema confined to the interdental papillary region. No bleeding on probing	Females diagnosed with psychomotor disorders and who had taken antibiotics within 6 months before clinical examination.
	Grade II: Moderate inflammation–redness, oedema with involvement of both marginal gingiva and the interdental papilla, and glazing. Bleeding on probing	Pregnant females
		Females taking oral contraceptives
		Females diagnosed with Vitamin C deficiency and those with a “high refined–carbohydrate diet”
	Grade III: Severe inflammation–marked redness and oedema which covers ¾ or more of the crown of the affected tooth surface. Ulceration. Tendency to spontaneously bleed [33]	Studies focussing on children <18 years) were excluded
	Histopathological presentation:
	1 Initial lesions
	2 Early lesions
	3 Established lesions [34]
	(ii) Periodontal disease
	Clinical presentation:
	(i) “Attachment loss” of gingival tissues to the exterior surfaces of the tooth
	(ii) Presence of gingival recession
	(iii) Deep probing depths (more than >4 mm)
	(iv) Furcation involvement
	(v) Redness and oedema of surrounding gingival tissue
	(vi) Bleeding on probing
	Radiographic presentation
	(i) Horizontal/vertical bone loss (lamina dura layer of the cortical bone)
	Histopathological presentation:
	(i) Transition from the established stage to the advanced stage [34]
	(ii) Spread of inflammation from epithelium to connective tissue both apically and laterally with concomitant collagen fiber destruction [34]
Study designs	RCTs, prospective cohort studies, retrospective case studies, retrospective cohort studies, descriptive studies, comparative studies, crossover studies, literature reviews, clinical trials, original research articles b	Abstracts, editorials, directories, nonEnglish articles, retracted studies, lectures, biographies, reviews, case reports, and other studies without a comparison group, cross-sectional studies, reports from conferences or annual meetings, editorials, opinions and in vitro studies were excluded from this review
Additional eligibility criteria for inclusion:	Articles stating relative risks (RRs), HRs or odds ratios (ORs) and corresponding 95% CIs, or data for their calculation a
	Adult females with at least 10 teeth within the oral cavity, and with at least one tooth with a probing depth and intraorally determined gingival clinical attachment level of (CAL) ≥4 mm