Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers.
D'Aiuto F,Parkar M,Andreou G,Suvan J,Brett P M,Ready D,Tonetti M S
Journal of dental research
Severe periodontitis is associated with elevated inflammatory markers in otherwise healthy populations. However, the nature of this association has not been determined. Our aim was to assess whether the degree of response to periodontal therapy was associated with changes in serological markers of systemic inflammation. Ninety-four systemically healthy subjects with severe generalized periodontitis participated in a prospective six-month blind intervention trial. Periodontal parameters and inflammatory markers [C-reactive Protein (CRP) and Interleukin-6 (IL-6)] were evaluated prior to and 2 and 6 mos after delivery of standard non-surgical periodontal therapy. Six months after treatment, significant reductions in serum IL-6 (p < 0.001, median decrease 0.2 ng/L, 95% CI 0.1-0.4 ng/L) and CRP (p < 0.0001, median decrease 0.5 mg/L, 95% CI 0.4-0.7) were observed. Decreases in inflammatory markers were significant in subjects with above average clinical response to periodontal therapy after correction for possible confounders. Periodontitis may add to the systemic inflammatory burden of affected individuals.
Risk factors for atherosclerosis in cases with severe periodontitis.
Buhlin Kåre,Hultin Margareta,Norderyd Ola,Persson Lena,Pockley Alan Graham,Rabe Per,Klinge Björn,Gustafsson Anders
Journal of clinical periodontology
AIM:Studies have reported on an association between cardiovascular disease (CVD) and periodontitis. The purpose of this case-control study was to provide an insight into this association by determining the plasma levels of some risk markers for CVD in cases with periodontitis. MATERIALS AND METHODS:Sixty-eight cases with periodontitis, mean age 53.9 (SD 7.9) years, and 48 randomly selected healthy controls, mean age 53.1 (SD 7.9) years, were investigated. Fasting blood plasma was analysed for glucose, lipids, markers systemic inflammation, cytokines and antibodies against heat shock proteins (Hsp). The associations between periodontitis and the various substances analysed in plasma were calculated using a multivariate logistic regression model, which compensated for age, gender, smoking and body mass index. RESULTS:The regression analyses revealed a significant association between periodontitis and high levels of C-reactive protein (CRP) [odds ratio (OR) 4.0, confidence interval (CI) 1.4-11.4] and fibrinogen (OR 8.7, CI 2.6-28.4), IL-18 (OR 6.5, CI 2.2-19.5), and decreased levels of IL-4 (OR 0.12, CI 0.0-0.5). The study showed increased levels of antibodies against Hsp65 (OR 2.8, CI 1-7.6) and 70 (OR 2.9, CI 1.1-7.8) and decreased levels of antibodies against Hsp60 (OR 0.3, CI 0.1-0.8). CONCLUSIONS:Periodontitis was associated with increased levels of CRP, glucose, fibrinogen and IL-18, and with decreased levels of IL-4.
Severe chronic periodontitis is associated with endothelial and microvascular dysfunctions: a pilot study.
Lira-Junior Ronaldo,Figueredo Carlos Marcelo,Bouskela Eliete,Fischer Ricardo Guimarães
Journal of periodontology
BACKGROUND:Periodontitis is an inflammatory chronic disease that has been implicated as a risk factor for cardiovascular disease (CVD). Endothelium has a central role in CVD pathogenesis, and chronic inflammation can make it dysfunctional, contributing to CVD emergence. Thus, the aim of this study is to investigate the existence of an association between severe chronic periodontitis (CP) and nailfold microvascular, gingival microvascular, and endothelial functions. METHODS:Twenty-three patients were included, 13 with severe periodontitis (median age, 46 years; interquartile range, 9.5 years) and 10 healthy control patients (median age, 35.5 years; interquartile range, 12.5 years). Clinical and laboratorial variables were gathered, and patients were examined by the following: 1) nailfold videocapillaroscopy to assess functional capillary density (FCD), capillary diameters, red blood cell velocity at rest (RBCV) and after 1-minute arterial occlusion (RBCVmax), and time taken to reach RBCVmax (TRBCVmax); 2) side-stream dark-field imaging to determine gingival capillary density (GCD); and 3) venous occlusion plethysmography to assess endothelium-dependent (% Hyper) and endothelium-independent vasodilatation (% Nitro). RESULTS:Patients with CP have smaller values for FCD, RBCV, RBCVmax, and % Hyper and higher values for TRBCVmax and GCD compared with controls (P <0.05). There were significant correlations between periodontal parameters with FCD, RBCV, RBCVmax, TRBCVmax, GCD, and % Hyper. There was also a negative correlation between FCD and GCD (r = -0.7; P <0.01). Associations between periodontitis and FCD, RBCVmax, TRBCVmax, GCD, and % Hyper remained significant after adjustments for age and systolic blood pressure. CONCLUSION:Severe CP was directly associated with endothelial and microvascular dysfunctions.
Periodontal treatment improves endothelial dysfunction in patients with severe periodontitis.
Seinost Gerald,Wimmer Gernot,Skerget Martina,Thaller Erik,Brodmann Marianne,Gasser Robert,Bratschko Rudolf O,Pilger Ernst
American heart journal
BACKGROUND:Because epidemiological studies provide evidence that periodontal infections are associated with an increased risk of progression of cardiovascular and cerebrovascular disease, we postulated that endothelial dysfunction, a critical element in the pathogenesis of atherosclerosis, would be present in patients with periodontal disease. METHODS:We tested endothelial function in 30 patients with severe periodontitis and 31 control subjects using flow-mediated dilation (FMD) of the brachial artery. The groups were matched for age, sex, and cardiovascular risk factors. Three months after periodontal treatment, including both mechanical and pharmacological therapy, endothelial function was reassessed by brachial artery FMD. Markers of systemic inflammation were measured at baseline and at follow up. RESULTS:Flow-mediated dilation was significantly lower in patients with periodontitis than in control subjects (6.1% +/- 4.4% vs 8.5% +/- 3.4%, P = .002). Successful periodontal treatment resulted in a significant improvement in FMD (9.8% +/- 5.7%; P = .003 compared to baseline) accompanied by a significant decrease in C-reactive protein concentrations (1.1 +/- 1.9 vs 0.8 +/- 0.8 at baseline, P = .026). Endothelium-independent nitro-induced vasodilation did not differ between the study groups at baseline or after periodontal therapy. CONCLUSION:These results indicate that treatment of severe periodontitis reverses endothelial dysfunction. Whether improved endothelial function will translate into a beneficial effect on atherogenesis and cardiovascular events needs further investigation.
Severe periodontitis in young adults is associated with sub-clinical atherosclerosis.
Cairo Francesco,Castellani Sergio,Gori Anna Maria,Nieri Michele,Baldelli Giorgia,Abbate Rosanna,Pini-Prato Giovan Paolo
Journal of clinical periodontology
AIM:The aim of this study was to evaluate the association between severe periodontitis and sub-clinical atherosclerosis in young (< or =40 years) systemically healthy individuals. MATERIAL AND METHODS:Ninety systemically healthy subjects, 45 affected by severe periodontitis (mean age 36.35+/-3.65 years) and 45 controls without a history of periodontal disease (mean age 33.78+/-3.28 years), were enrolled in this study. Patients and controls were paired for age, gender, body mass index and smoking habits. Carotid intima-media thickness (IMT) was bilaterally assessed by ultrasonography at the level of common carotid artery. Traditional cardiovascular risk factors for atherosclerosis were also evaluated. RESULTS:The overall mean carotid IMT was 0.82+/-0.13 mm in the test group and 0.72+/-0.07 mm in the control group ( p<0.0001). Stepwise regression analysis showed that periodontitis ( p<0.0001) and regular physical activity ( p=0.0009) were predictor variables of overall mean carotid IMT. When considering an IMT> or =0.82 mm as the critical index of increased cardiovascular risk, periodontal patients overcame this threshold compared with healthy patients by an odds ratio=8.55 [confidence interval 95%: 2.38; 39.81]. No investigated haemostatic variable was associated with increased carotid IMT. CONCLUSION:Severe periodontitis is associated with sub-clinical atherosclerosis in young systemically healthy patients.
Periodontitis and atherosclerosis: an observational study.
Pinho M Morado,Faria-Almeida R,Azevedo E,Manso M Conceição,Martins L
Journal of periodontal research
BACKGROUND:Poor oral health has been related with cardiovascular diseases. Specifically, periodontitis has been implicated in the pathogenesis of atherosclerosis. Our aim was to evaluate the relationship between the degree of carotid atherosclerosis and severity of periodontitis in a patient cohort. METHODS:Fifty adult patients receiving carotid duplex scans in a cerebral hemodynamics lab were included in the study. Ultrasound protocol included measurement of carotid intima-media thickness (IMT), which is a marker of atherosclerosis, and characterization of any atherosclerotic plaques in the cervical common and internal carotid arteries. Patients were divided into two main groups: the test group had IMT ≥ 1 mm or the presence of any carotid atherosclerotic plaque, and the control group had IMT < 1 mm and absence of atherosclerotic plaques. Periodontal evaluation was performed in all the teeth and characterized according to the clinical attachment level, which between 1 mm and 2 mm was classified as slight, 3 mm and 4 mm as moderate and ≥5 mm as severe. RESULTS:The control group included 15 (30%), while the test group included 35 (70%) subjects. The most common diagnosis was severe periodontitis (40%); moderate and slight periodontitis were also frequent occurrences (32% and 28%, respectively). In the control group, 53.3% had slight, 33.3% had moderate and 13.3% had severe periodontitis. In the test group, those percentages were respectively 22.2%, 44.4% and 33.3%. Patients with atheroma plaque had the highest percentage of severe periodontitis (70.6%). More severe periodontitis was related to atherosclerosis (P = 0.007). CONCLUSION:This study showed an association between periodontitis severity and carotid atherosclerosis, suggesting that periodontal disease might be a risk indicator for atherosclerotic disease.
Periodontitis is associated with the risk of subclinical atherosclerosis and peripheral arterial disease in Korean adults.
Ahn Yoo-Been,Shin Myung-Seop,Han Dong-Hun,Sukhbaatar Munkhzaya,Kim Mi-Sun,Shin Hye-Sun,Kim Hyun-Duck
BACKGROUND AND AIMS:We aimed to evaluate the association of periodontitis with the development of early atherosclerotic vascular disease in Korean adults. METHODS:In this cross-sectional study, a total of 1343 adults aged over 40 years were recruited from a community-based cohort of Yangpyeong county, Korea, during the period 2010-2014. Only dentate individuals were included in the study. Subclinical atherosclerosis (SA) was defined as carotid intima-media thickness (cIMT)≥0.754 mm, as assessed bilaterally by B-mode ultrasound. Peripheral arterial disease (PAD) was defined as ankle-brachial index (ABI)≤1.0, as measured by Doppler. History of periodontitis was assessed by measuring the radiographic alveolar bone loss (RABL) on a digital dental panorama and was classified into three groups: normal, moderate and severe periodontitis (≥2 non-adjacent interproximal sites with RABL≥4 mm and 6 mm, respectively). The associations of periodontitis with SA and PAD were evaluated by multivariable logistic regression analysis and analysis of covariance, adjusted for age, sex, education level, tooth loss, smoking, drinking, exercise, obesity, triglycerides, HDL, LDL, hs-CRP, diabetes and hypertension. Stratified analyses were performed to identify specific risk groups. RESULTS:After controlling for confounders, severe periodontitis was associated with SA [adjusted odds ratio (aOR) = 1.55; 95% confidence interval (CI): 1.07-2.24] and PAD (aOR = 2.03; 95% CI: 1.05-3.93). These associations were highlighted in never-smokers. For increasing severity of periodontitis, the adjusted mean cIMT increased (p = 0.011) while that of ABI decreased (p = 0.033). CONCLUSIONS:Our data showed that periodontitis is a substantially important risk factor for atherosclerotic vascular disease among Korean adults.