INTRODUCTION: Current studies on the relationship between periodontitis and carotid atherosclerosis (CAS) remain inconclusive. This updated meta-analysis was conducted to evaluate the relevant observational studies to drive a definite conclusion. METHODS: Four major databases were searched for observational studies regarding the relationship between periodontitis and CAS published up to 14 December 2023. Software STATA 14.0 was used to calculate pooled odds ratios (OR) and 95% confidence interval (CI) in random-effects model. RESULTS: Twenty-six articles were finally included. Periodontitis was significantly associated with CAS (OR = 1.97, 95% CI = 1.64-2.36
p = 0.000), however, statistical heterogeneity among studies. Sensitivity analysis indicated our results were robust. Although publication bias was observed, OR corrected by the trim-and-fill method was still increased (OR = 1.30, 95% CI = 1.06-1.58
p = 0.000). CONCLUSION: The findings revealed a significant association between periodontitis and CAS. However, long-term randomized controlled trials should be conducted to identify the causality.