Oral infection, hyperglycemia, and endothelial dysfunction

Periodontal status of patients with metabolic syndrome compared to those without metabolic syndrome

BACKGROUND

Metabolic syndrome (MeS) is common among Arab populations in Mediterranean countries. This study was conducted to assess the distribution of periodontal parameters among patients with MeS and subjects without MeS in northern Jordan.

METHODS

A list of all subjects aged > or =25 years who participated in a previous study that aimed to estimate the prevalence of MeS in northern Jordan was obtained. A simple random sample of 78 patients who had MeS and another simple random sample of 78 persons who did not have MeS were selected and invited for dental examination. The oral hygiene of six selected teeth and the periodontal status of all teeth, excluding third molars, were assessed using the plaque index of Silness and Löe, the gingival index of Löe and Silness, probing depth (PD), and clinical attachment level (CAL). Data were analyzed using the general linear model multivariate procedure with average PD, average CAL, percentage of sites with CAL > or =3 mm, and percentage of sites with PD > or =3 mm as outcome variables and MeS and its individual components as predictors.

RESULTS

In the multivariate analysis, the severity of periodontal disease, as measured by average PD and average CAL, and the extent of periodontal disease, as measured by the percentage of sites with CAL > or =3 mm and the percentage of sites with PD > or =3 mm, were significantly greater among patients with MeS compared to those without MeS.

CONCLUSIONS

Patients with MeS displayed more severe and extensive periodontal disease compared to subjects without MeS. Additional large-scale longitudinal epidemiologic and interventional studies are needed to establish whether periodontal disease is a contributing factor to or a result of MeS.

Cardiovascular disease and periodontitis: an update on the associations and risk

BACKGROUND

Associations between periodontitis and cardiovascular diseases have been recognized.

MATERIAL AND METHODS

New literature since the last European Workshop on Periodontology has been reviewed.

RESULTS

The lack of reliable epidemiological data on disease prevalence makes an assessment of the associations and risks between periodontitis and cardiovascular diseases difficult. Two recent meta-analysis reports have identified associations between periodontitis and cardiovascular diseases (odds ratios: 1.1-2.2). Different surrogate markers for both disease entities, including serum biomarkers, have been investigated. Brachial artery flow-mediated dilatation, and carotid intima media thickness have in some studies been linked to periodontitis. Studies are needed to confirm early results of improvements of such surrogate markers following periodontal therapy. While intensive periodontal therapy may enhance inflammatory responses and impair vascular functions, studies are needed to assess the outcome of periodontal therapies in subjects with confirmed cardiovascular conditions. Tooth eradication may also reduce the systemic inflammatory burden of individuals with severe periodontitis. The role of confounders remain unclear.

CONCLUSIONS

Periodontitis may contribute to cardiovascular disease and stroke in susceptible subjects. Properly powered longitudinal case-control and intervention trials are needed to identify how periodontitis and periodontal interventions may have an impact on cardiovascular diseases.

Salivary lysozyme and prevalent hypertension

Although the etiology of essential hypertension is not clearly understood, endothelial dysfunction from chronic infection and/or impaired glucose metabolism may be involved. We hypothesized that salivary lysozyme, a marker for oral infection and hyperglycemia, might display a significant relationship with hypertension, an early stage of cardiovascular disease. Logistic regression analyses of the Kuopio Oral Health and Heart Study demonstrated that persons with higher lysozyme levels were more likely to have hypertension, after adjustment for age, gender, smoking, BMI, diabetes, the ratio of total cholesterol to HDL cholesterol, and C-reactive protein. The exposure to increasing quartiles of lysozyme was associated with adjusted Odds Ratios for the outcome, hypertension, 1.00 (referent), 1.25, 1.42, and 2.56 (linear trend p < 0.003). When we restricted the sample to the individuals without heart disease (N = 250), we observed a non-significant trend for increasing odds. Our hypothesis--"high salivary lysozyme levels are associated with the odds of hypertension"--was confirmed.