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Suematsu Y, Miura SI, Zhang B, Uehara Y, Ogawa M, Yonemoto N, Nonogi H, Nagao K, Kimura T, Saku K. Association between dental caries and out-of-hospital cardiac arrests of cardiac origin in Japan. J Cardiol 2015. [PMID: 26213251 DOI: 10.1016/j.jjcc.2015.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oral infection contributes to atherosclerosis and coronary heart disease. We hypothesized that dental caries may be associated with out-of-hospital cardiac arrests (OHCA) of cardiac origin, but not non-cardiac origin. METHODS AND RESULTS We compared the age-adjusted incidence of OHCA (785,591 cases of OHCA: 55.4% of cardiac origin and 44.6% of non-cardiac origin) to the age-adjusted prevalence of dental caries between 2005 and 2011 in the 47 prefectures of Japan. In both the total population and males over 65 years, the number of cases of dental caries was significantly associated with the number of OHCA of total and cardiac origin from 2005 to 2011, but not those of non-cardiac origin. In the total population, the age-adjusted prevalence of dental caries was not significantly associated with the age-adjusted incidence of OHCA (total OHCA: r correlation coefficient=0.22, p=0.14; OHCA of cardiac origin: r=0.25, p=0.09; OHCA of non-cardiac origin: r=-0.002, p=0.99). Among male patients over 65 years, the age-adjusted prevalence of dental caries was significantly associated with OHCA of total and cardiac origin, but not non-cardiac origin (total OHCA: r=0.47, p<0.001; OHCA of cardiac origin: r=0.37, p=0.01; OHCA of non-cardiac origin: r=0.28, p=0.054). CONCLUSIONS While oral hygiene is important in all age groups, it may be particularly associated with OHCAs of cardiac origin in males over 65 years.
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Affiliation(s)
- Yasunori Suematsu
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; The AIG Collaborative Research Institute of Cardiovascular Medicine, Fukuoka University, Fukuoka, Japan
| | - Bo Zhang
- The AIG Collaborative Research Institute of Cardiovascular Medicine, Fukuoka University, Fukuoka, Japan; Department of Biochemistry, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yoshinari Uehara
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; The AIG Collaborative Research Institute of Cardiovascular Medicine, Fukuoka University, Fukuoka, Japan
| | - Masahiro Ogawa
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; The AIG Collaborative Research Institute of Cardiovascular Medicine, Fukuoka University, Fukuoka, Japan
| | - Naohiro Yonemoto
- Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | - Ken Nagao
- Department of Cardiology, Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; The AIG Collaborative Research Institute of Cardiovascular Medicine, Fukuoka University, Fukuoka, Japan.
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Ricardo AC, Athavale A, Chen J, Hampole H, Garside D, Marucha P, Lash JP. Periodontal disease, chronic kidney disease and mortality: results from the third National Health and Nutrition Examination Survey. BMC Nephrol 2015; 16:97. [PMID: 26149680 PMCID: PMC4492086 DOI: 10.1186/s12882-015-0101-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/28/2015] [Indexed: 11/25/2022] Open
Abstract
Background Periodontal disease is associated with increased mortality in the general population, however its prognostic significance in chronic kidney disease (CKD) is not known. We evaluated the joint effect of periodontal disease and CKD on all-cause and cardiovascular mortality. Methods Prospective observational study of 10,755 adult participants in the National Health and Nutrition Examination Survey, 1988–1994 (NHANES III). CKD was defined as estimated glomerular filtration rate < 60 ml/minute/1.73 m2 or albumin-to-creatinine ratio ≥ 30 mg/g. Periodontal disease was defined as moderate (> 4 mm attachment loss in ≥ 2 mesial sites or 5 mm pocket depth in ≥ 2 mesial sites), or severe (> 6 mm attachment loss in ≥ 2 mesial sites and > 5 mm pocket depth in ≥ 1 mesial site). All-cause and cardiovascular mortality were evaluated using Cox proportional hazards models. Results There were 1,813 deaths over a median follow-up of 14 years. In multivariate analyses, as compared to participants with neither periodontal disease nor CKD, those with periodontal disease only or CKD only had increased all-cause mortality (HR 1.39; 95 % CI, 1.06 - 1.81 and 1.55; 1.30 - 1.84, respectively). The presence of both periodontal disease and CKD was associated with HR (95 % CI) 2.07 (1.65 - 2.59) for all-cause mortality, and 2.11 (1.52 - 2.94) for cardiovascular mortality. We found no evidence of multiplicativity or additivity between periodontal disease and CKD. In stratified analyses limited to individuals with CKD, periodontal disease (vs. not) was associated with adjusted HR (95 % CI) 1.35 (1.04 - 1.76) for all-cause, and 1.36 (0.95 - 1.95) for cardiovascular mortality. Conclusions These findings confirm the well-established association between periodontal disease and increased mortality in the general population, and provide new evidence of this association among individuals with CKD.
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Affiliation(s)
- Ana C Ricardo
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, 60612, Chicago, IL, USA.
| | - Ambarish Athavale
- Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA.
| | - Jinsong Chen
- Institute of Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA.
| | - Hemanth Hampole
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, 60612, Chicago, IL, USA.
| | - Daniel Garside
- Institute of Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA.
| | - Phillip Marucha
- School of Dentistry, Oregon Health and Science University, Portland, OR, USA.
| | - James P Lash
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, 820 South Wood Street, 418W CSN, MC 793, 60612, Chicago, IL, USA.
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Major Adverse Cardiovascular Events in Treated Periodontitis: A Population-Based Follow-Up Study from Taiwan. PLoS One 2015; 10:e0130807. [PMID: 26114433 PMCID: PMC4482590 DOI: 10.1371/journal.pone.0130807] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/26/2015] [Indexed: 02/07/2023] Open
Abstract
Background The aim of the present study was to identify the long-term major adverse cardiovascular events (MACE) in treated periodontitis patients in Taiwan. Methods From the National Health Insurance Research Database (2001-2010), adult patients (≥ 18 years) with treated periodontitis were identified. Comparison was made between patients with mild form and severe form of treated periodontitis after propensity score matching. The primary end point was the incidence of MACE. Results A total of 32,504 adult patients with treated periodontitis were identified between 2001 and 2010. After propensity score matching, 27,146 patients were preserved for comparison, including 13,573 patients with mild form and 13,573 patients with severe form of treated periodontitis. During follow-up, 728 individuals in mild treated periodontitis group and 1,206 individuals in severe treated periodontitis group had at least 1 MACE event. After adjustment for gender, hyperlipidemia, hypertension and diabetes mellitus, severe treated periodontitis was associated with a mildly but significantly increased risk of MACE among older patients > 60 years of age (incidence rate ratio, 1.26; 95% confidence interval, 1.08–1.46). No association was found among younger patients ≤ 60 years of age. Conclusions Severe form of treated periodontitis was associated with an increased risk of MACE among older Taiwanese patients, but not among younger Taiwanese patients. We should put more efforts on the improvement of periodontal health to prevent further MACE.
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Yu YH, Chasman DI, Buring JE, Rose L, Ridker PM. Cardiovascular risks associated with incident and prevalent periodontal disease. J Clin Periodontol 2015; 42:21-8. [PMID: 25385537 DOI: 10.1111/jcpe.12335] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 01/12/2023]
Abstract
AIM While prevalent periodontal disease associates with cardiovascular risk, little is known about how incident periodontal disease influences future vascular risk. We compared effects of incident versus prevalent periodontal disease in developing major cardiovascular diseases (CVD), myocardial infarction (MI), ischaemic stroke and total CVD. MATERIAL AND METHODS In a prospective cohort of 39,863 predominantly white women, age ≥45 years and free of cardiovascular disease at baseline were followed for an average of 15.7 years. Cox proportional hazard models with time-varying periodontal status [prevalent (18%), incident (7.3%) versus never (74.7%)] were used to assess future cardiovascular risks. RESULTS Incidence rates of all CVD outcomes were higher in women with prevalent or incident periodontal disease. For women with incident periodontal disease, risk factor adjusted hazard ratios (HRs) were 1.42 (95% CI, 1.14-1.77) for major CVD, 1.72 (1.25-2.38) for MI, 1.41 (1.02-1.95) for ischaemic stroke and 1.27 (1.06-1.52) for total CVD. For women with prevalent periodontal disease, adjusted HRs were 1.14 (1.00-1.31) for major CVD, 1.27 (1.04-1.56) for MI, 1.12 (0.91-1.37) for ischaemic stroke and 1.15 (1.03-1.28) for total CVD. CONCLUSION New cases of periodontal disease, not just those that are pre-existing, place women at significantly elevated risks for future cardiovascular events.
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Affiliation(s)
- Yau-Hua Yu
- Division of Periodontology, Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
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Lee YL, Hu HY, Chou P, Chu D. Dental prophylaxis decreases the risk of acute myocardial infarction: a nationwide population-based study in Taiwan. Clin Interv Aging 2015; 10:175-82. [PMID: 25609934 PMCID: PMC4293300 DOI: 10.2147/cia.s67854] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose To investigate the association between periodontal disease (PD) and acute myocardial infarction (AMI), and evaluate the effect of dental prophylaxis on the incidence rate (IR) of AMI. Methods The Longitudinal Health Insurance Database 2000 from the National Health Insurance program was used to identify 511,630 patients with PD and 208,713 without PD during 2000–2010. Subjects with PD were grouped according to treatment (dental prophylaxis, intensive treatment, and PD without treatment). The IRs of AMI during the 10-year follow-up period were compared among groups. Cox regression analysis adjusted for age, sex, socioeconomic status, residential urbanicity, and comorbidities was used to evaluate the effect of PD treatment on the incidence of AMI. Results The IR of AMI among subjects without PD was 0.19%/year. Among those with PD, the IR of AMI was lowest in the dental prophylaxis group (0.11%/year), followed by the intensive treatment (0.28%/year) and PD without treatment (0.31%/year; P<0.001) groups. Cox regression showed that the hazard ratio (HR) for AMI was significantly lower in the dental prophylaxis group (HR =0.90, 95% confidence interval =0.86–0.95) and higher in the intensive treatment (HR =1.09, 95% confidence interval =1.03–1.15) and PD without treatment (HR =1.23, 95% confidence interval =1.13–1.35) groups than in subjects without PD. Conclusion PD is associated with a higher risk of AMI, which can be reduced by dental prophylaxis to maintain periodontal health.
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Affiliation(s)
- Ya-Ling Lee
- Department of Dentistry, Taipei City Hospital, Taipei, Taiwan ; Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Yun Hu
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan ; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Dachen Chu
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan ; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan ; Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan
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Lafon A, Tala S, Ahossi V, Perrin D, Giroud M, Béjot Y. Association between periodontal disease and non-fatal ischemic stroke: a case-control study. Acta Odontol Scand 2014; 72:687-93. [PMID: 24720864 DOI: 10.3109/00016357.2014.898089] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between clinical and radiological markers of periodontal disease and ischemic stroke and to assess the potential influence of inflammatory response on the observed associations. METHODS A prospective case-control study including a series of 48 cases with a minor ischemic stroke and 47 controls was conducted at the University Hospital of Dijon. Vascular risk factors, clinical dental examination (plaque index, gingival index, percentage of pockets >5 mm, percentage of bleeding on probing (BOP) sites), dental panoramic (bone loss) and biological parameters (CRP, total cholesterol, HDL, LDL, fasting glucose) were collected. Conditional regression analyses were performed to identify factors associated with ischemic stroke. RESULTS The prevalence of hypertension, high CRP and glucose levels and overall odontological variables was higher in stroke patients. In multivariable analyses, hypertension (OR = 12.56; 95% CI = 2.29-69.96, p = 0.004), CRP levels >5 mg/L (OR = 18.54; 95% CI = 2.01-171.17, p = 0.010), BOP (OR = 1.049; 95% CI = 1.012-1.88, p = 0.009) and bone loss >20% (OR = 1.053; 95% CI = 1.017-1.091, p = 0.004) were associated with ischemic stroke. Among stroke patients, there was a non-significant trend towards higher CRP levels in patients with bone loss >20% compared with those with bone loss <20% (8.1 ± 1.27 mg/L vs 3.12 ± 3.14 mg/L, p = 0.25), whereas other biological parameters were very similar between the two groups. CONCLUSION This case-control study demonstrates that periodontal disease, especially markers such as BOP and bone loss, is independently associated with ischemic stroke.
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Affiliation(s)
- Arnaud Lafon
- University of Champagne-Ardenne , Reims Cedex , France
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Abstract
Background. The pathophysiology of cardiovascular disease (CVD) includes inflammation in the development of atherosclerosis and thrombosis. Increasing evidence supports oral infections, and in particular the common periodontal disease, to be associated with CVD development. Periodontal infection is present in populations worldwide and in the moderate to mild form in about 35% of populations according to the World Health Organization. Objective. This review of the literature aims to present cross evidence from medical research disciplines that explore how oral infections can contribute to increase the risk for CVDs and how treatment of oral infections can reduce the risk for CVDs. Design. Review article. Results. Long-term exposure to active nontreated infections of the oral cavity presents an opportunity for bacteria, bacterial products, and viruses to enter the circulation. Toxic bacterial products enter the circulation, affecting atherosclerosis, causing platelet adhesiveness that results in clot formation, and establishing cardiac vegetation. Pathological observations have identified oral bacteria in heart valves, aortic aneurysms, and arterial walls. Clinical intervention studies on periodontal disease reduce the risk level of serological predictors for CVDs. Conclusions. This paper presents evidence across medical research disciplines for oral infections to be considered as one of the risk factors for CVDs.
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Vedin O, Hagström E, Gallup D, Neely ML, Stewart R, Koenig W, Budaj A, Sritara P, Wallentin L, White HD, Held C. Periodontal disease in patients with chronic coronary heart disease: Prevalence and association with cardiovascular risk factors. Eur J Prev Cardiol 2014; 22:771-8. [PMID: 24721691 DOI: 10.1177/2047487314530660] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/17/2014] [Indexed: 11/16/2022]
Abstract
AIM There are reported links between periodontal disease (PD) and cardiovascular (CV) risk but data are lacking, especially from populations with established coronary heart disease (CHD). This study describes self-reported indicators of PD and associations with CV risk factors in a global stable CHD population. METHODS AND RESULTS A total of 15,828 participants in the global STABILITY trial underwent a physical examination, blood sampling, and completed a lifestyle questionnaire. They reported remaining number of teeth (none, 1-14, 15-20, 21-25 or 26-32 (all)) and frequency of gum bleeding (never/rarely, sometimes, often or always). Adjusted linear and logistic regression models assessed associations between tooth loss, gum bleeding, and socioeconomic and CV risk factors. A total of 40.9% of participants had <15 remaining teeth; 16.4% had no teeth; and 25.6% reported gum bleeding with large differences in prevalence among countries, regions and ethnic groups. Less tooth loss was associated with lower levels of glucose, low-density lipoprotein (LDL) cholesterol, systolic blood pressure, waist circumference and hs-CRP; higher estimated glomerular filtration rate; decreased odds for diabetes and smoking, and increased odds for higher education, alcohol consumption and work stress. Gum bleeding was associated with higher LDL cholesterol and systolic blood pressure; decreased odds for smoking, but increased odds for higher education, alcohol consumption and stress. CONCLUSION Self-reported indicators of PD were common in this chronic CHD population and were associated with an increasing socioeconomic and CV risk factor burden. However, causality between self-reported PD and CV risk and outcome needs further investigation.
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Affiliation(s)
- Ola Vedin
- Department of Medical Sciences, Uppsala University, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Uppsala University, Sweden
| | | | | | - Ralph Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand
| | | | - Andrzej Budaj
- Postgraduate Medical School, Grochowski Hospital, Poland
| | | | - Lars Wallentin
- Department of Medical Sciences, Uppsala University, Sweden
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand
| | - Claes Held
- Department of Medical Sciences, Uppsala University, Sweden
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Lafon A, Pereira B, Dufour T, Rigouby V, Giroud M, Béjot Y, Tubert-Jeannin S. Periodontal disease and stroke: a meta-analysis of cohort studies. Eur J Neurol 2014; 21:1155-61, e66-7. [PMID: 24712659 DOI: 10.1111/ene.12415] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/10/2014] [Indexed: 12/31/2022]
Abstract
This review aimed to determine the association between periodontal disease and stroke incidence by a meta-analysis of cohort studies. Cohort studies that evaluated the incidence of stroke (fatal or non-fatal, ischaemic or haemorrhagic) and baseline periodontal status and calculated relative risk values were included. The quality of the included studies was assessed using an evaluation grid. The analyses were conducted separately for three outcomes: periodontitis, gingivitis and loss of teeth. Adjusted values of relative risk or of hazard ratio were used to assess risk values in each study. Random effects meta-analyses were conducted when data could be pooled. From the 743 references retrieved, only nine cohort studies were suitable for inclusion in this review. Quality scores of the studies varied greatly. Three prospective studies, which used reliable indicators of periodontal disease, obtained the highest scores. Conversely, three studies that used a subjective evaluation of stroke incidence or diagnosed stroke without imaging obtained the lowest score. The results of the meta-analyses varied depending on the outcome considered and the type of stroke. The risk of stroke was significantly increased by the presence of periodontitis [relative risk 1.63 (1.25, 2.00)]. Tooth loss was also a risk factor for stroke [relative risk 1.39 (1.13, 1.65)]. The risk of stroke did not vary significantly with the presence of gingivitis. This review shows that periodontitis and tooth loss are associated with the occurrence of stroke.
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Affiliation(s)
- A Lafon
- CHU Dijon, Service Odontologie, Hôpital Général, Dijon, France; Dental Faculty of Reims, University of Champagne-Ardenne, Dijon, France
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Zhang C, Xiang X, Xu M, Fan C, Sowa MG, Liu KZ. Assessment of tissue oxygenation of periodontal inflammation in patients with coronary artery diseases using optical spectroscopy. BMC Oral Health 2014; 14:25. [PMID: 24666796 PMCID: PMC3987688 DOI: 10.1186/1472-6831-14-25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/19/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We have recently developed a non-invasive periodontal diagnostic tool that was validated in periodontitis patients without systemic disorders like coronary artery disease (CAD). The purpose of present study is to verify whether this optical instrument can also be used in periodontitis patients with CAD. METHODS A total of 62 periodontitis patients with CAD were recruited along with a control group consisting of 59 age and gender matched periodontitis volunteers without systemic disorders. Using a portable optical near-infrared spectrometer, optical spectra were obtained, processed and evaluated from the two groups. A modified Beer-Lambert unmixing model that incorporates a nonparametric scattering loss function was used to determine the relative contribution of deoxygenated hemoglobin (Hb) and oxygenated hemoglobin (HbO2) to the overall spectrum. The balance between tissue oxygen delivery and utilization in periodontal tissues was then assessed. RESULTS Tissue oxygen saturation was significantly decreased in the periodontitis sites (p < 0.01), compared to the healthy sites in those individuals with CAD. There was a trend towards increased concentration of Hb and decreased concentration of HbO2 from healthy to diseased sites, without statistical significance (p > 0.05). No statistical differences were found in tissue oxygen saturation between the CAD and control groups either in periodontal healthy or inflammatory sites. CONCLUSION This study supports the hypothesis that optical spectroscopy can determine the periodontal inflammation in patients with certain systemic disorders like CAD. And the overall periodontal oxygenation profiles in CAD patients resemble those in non-CAD individuals either in healthy or inflammatory sites.
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Affiliation(s)
| | | | | | | | | | - Kan-Zhi Liu
- Medical Devices Portfolio, National Research Council of Canada, 435 Ellice Ave,, Winnipeg, MB R3B 1Y6, Canada.
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Eberhard J, Stiesch M, Kerling A, Bara C, Eulert C, Hilfiker-Kleiner D, Hilfiker A, Budde E, Bauersachs J, Kück M, Haverich A, Melk A, Tegtbur U. Moderate and severe periodontitis are independent risk factors associated with low cardiorespiratory fitness in sedentary non-smoking men aged between 45 and 65 years. J Clin Periodontol 2013; 41:31-7. [DOI: 10.1111/jcpe.12183] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Jörg Eberhard
- Department of Prosthetic Dentistry and Biomedical Materials Science; Hannover Medical School; Hannover Germany
| | - Meike Stiesch
- Department of Prosthetic Dentistry and Biomedical Materials Science; Hannover Medical School; Hannover Germany
| | - Arno Kerling
- Institute of Sports Medicine; Hannover Medical School; Hannover Germany
| | - Christoph Bara
- Department of Cardiothoracic, Transplantation and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Christine Eulert
- Department of Cardiology and Angiology; Hannover Medical School; Hannover Germany
| | | | - Andres Hilfiker
- Department of Cardiothoracic, Transplantation and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Eva Budde
- Institute of Biometry; Hannover Medical School; Hannover Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology; Hannover Medical School; Hannover Germany
| | - Momme Kück
- Institute of Sports Medicine; Hannover Medical School; Hannover Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Anette Melk
- Department for Paediatric Nephrology, Hepatology and Metabolic Disorders; Hannover Medical School; Hannover Germany
| | - Uwe Tegtbur
- Institute of Sports Medicine; Hannover Medical School; Hannover Germany
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Periodontal disease is an independent predictor of intracardiac calcification. BIOMED RESEARCH INTERNATIONAL 2013; 2013:854340. [PMID: 24106721 PMCID: PMC3784081 DOI: 10.1155/2013/854340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/23/2013] [Accepted: 08/07/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Periodontitis is the most common chronic inflammatory condition worldwide and is associated with incident coronary disease. HYPOTHESIS We hypothesized that periodontal disease would also be associated with cardiac calcification, a condition which shares many risk factors with atherosclerosis and is considered a marker of subclinical atherosclerosis. METHODS Cross-sectional study at two sites (USA and Japan) involving subjects with both clinical echocardiograms and detailed dental examinations. Semiquantitative scoring systems were used to assess severity of periodontal disease and echocardiographic calcification. RESULTS Fifty-six of 73 subjects (77%) had cardiac calcifications, and 51% had moderate to severe periodontal disease (score > 2). In unadjusted analysis, a significant relationship between periodontal score and cardiac calcification (Spearman rho = 0.4, P = 0.001) was noted, with increases in mean calcification score seen across increasing levels of periodontal disease. On multivariate logistic regression, adjusted for age, gender, race, glomerular filtration rate, and traditional risk factors, this association remained significant (P = 0.024). There was no significant interaction by study site, race, or gender. CONCLUSIONS In a multiracial population, we found a significant association between the degree of periodontal disease, a chronic inflammatory condition, and cardiac calcification. Further, higher periodontal scores were associated with greater degrees of calcification.
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Association of oral health and cardiovascular disease risk factors "results from a community based study on 5900 adult subjects". ISRN CARDIOLOGY 2013; 2013:782126. [PMID: 23956878 PMCID: PMC3727197 DOI: 10.1155/2013/782126] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 06/03/2013] [Indexed: 11/17/2022]
Abstract
Objectives. This study aimed to determine the association between some oral health status as a risk factor for cardiac diseases and other cardiovascular disease (CVD) risk factors in a sample of Iranian population in 2011. Methods. The study recruited 5900 inhabitants who aged 15–75 years old of Kerman city through a population based cluster sampling. Having collected informed consent, participants were interviewed for CVD risk factors. Some oral health indicators such as DMFT, Gingival Inflammation index, and Community Periodontal Index were assessed. The association between oral health indices and CVD risk factors was tested using multivariate regression models. Results. The mean age of participants was 33.5 years, and 45.1% were male. Moderate gingival inflammation was observed in 67.6% of participants. Presence of sub- or supragingival calculus was more common (90%) in participants. Older age (RR from 2.7 to 3.88), cigarette smoking (RR = 1.49), and high blood glucose (RR = 1.41) showed an increased risk for oral diseases after adjustment for different covariates including established CVD risk factors. Conclusion. The study results showed an increase in periodontal diseases in the presence of some CVD risk factors. Therefore there may be a bilateral but independent association for both conditions and common risk factor approach preventive program is highly recommended.
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Parkar SM, Modi GN, Jani J. Periodontitis as risk factor for acute myocardial infarction: A case control study. Heart Views 2013; 14:5-11. [PMID: 23580918 PMCID: PMC3621229 DOI: 10.4103/1995-705x.107113] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To assess the periodontal status among the patients suffering from acute myocardial infarction (AMI) and to investigate whether periodontitis is a risk factor for AMI or not. MATERIALS AND METHODS A cross-sectional study of 60 subjects, 30 subjects in each AMI group and control group was conducted. Details of risk factors like age, sex, smoking, and alcohol consumption were obtained through a personal interview. Medical history was retrieved from the medical file. The oral hygiene status was assessed by using a simplified oral hygiene index (OHI-S) and the periodontal status was assessed by community periodontal index (CPI) and loss of attachment (LOA) as per World Health Organization (WHO) methodology 1997. Chi-square test was used to analyze qualitative data whereas t-test and one way analysis of variance (ANOVA) test was used for quantitative data. Multiple regression model was applied to check the risk factors for AMI. RESULTS The mean OHI-S score for case and control group was 3.98 ± 0.70 and 3.11 ± 0.68, respectively, which was statistically highly significant ( P < 0.001). There was high severity of periodontitis (for both in terms of CPI and LOA) in the case group as compared with control group, that was found to be statistically highly significant ( P < 0.001). There was a significant result for OHI-S and LOA score with odds ratio of 0.13 and 0.79, respectively, when the multiple logistic regression model was applied. CONCLUSION The results of the present study show evidence that those patients who have experienced myocardial infarction exhibit poor periodontal conditions in comparison to healthy subjects and suggest an association between chronic oral infections and myocardial infarction.
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Affiliation(s)
- Sujal M. Parkar
- Department of Public Health Dentistry, Ahmedabad Dental College and Hospital, Gujarat, India
| | - Gunjan N. Modi
- Department of Public Health Dentistry, Ahmedabad Dental College and Hospital, Gujarat, India
| | - Jalak Jani
- Department of Oral Medicine and Radiology, Ahmedabad Dental College and Hospital, Gujarat, India
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Ziebolz D, Priegnitz A, Hasenfuss G, Helms HJ, Hornecker E, Mausberg RF. Oral health status of patients with acute coronary syndrome--a case control study. BMC Oral Health 2012; 12:17. [PMID: 22727119 PMCID: PMC3444382 DOI: 10.1186/1472-6831-12-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 06/22/2012] [Indexed: 11/07/2022] Open
Abstract
Background The aim of this investigation was to assess the state of oral health of patients with acute coronary syndrome (ACS) and to compare this with that of a provably healthy control group (H). Methods 33 patients who were receiving treatment as inpatients following acute myocardial infarction or unstable angina pectoris took part in the study (ACS-group). A healthy control group (H-group) made up of blood donors, was formed following matching for age, gender, and smoking habit with the study patient group. The dental investigation consisted of the dental status (DMF-T), a plaque-Index (PI), an assessment of gingival inflammation (GI) and periodontal situation (Periodontal Screening Index: PSR®/PSI), and attachment loss (AL). Statistical evaluation: t-test, Mann–Whitney-test and chi- squared test (level of significance p < 0.05). Results The mean DMF-T of the ACS-group (18.7 ± 6.8) and the H-group (19.4 ± 5.1) showed no difference (p = 0.7). Although, in the ACS-group the average loss of teeth (M-T: 8.4 ± 5.2) was higher than in the H-group (M-T: 5.8 ± 6.6) the difference was not significant (p = 0.2). Whereas with the PI no difference between the two groups was found (p = 0.9), the ACS-group showed significantly more signs of inflammation (GI) than the H-group (p = 0.045). In the case of PSR®/PSI, there was no difference between the two groups (p = 0.7). With regard to AL, no difference was revealed between ACS- and H-group (p = 0.2). Conclusion Although, the state of oral health of the ACS-group differed only insignificantly from that of control, patients with ACS showed more signs of gingival inflammation and a higher loss of teeth.
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Affiliation(s)
- Dirk Ziebolz
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Centre Goettingen, Goettingen, Germany.
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Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME, Taubert KA, Newburger JW, Gornik HL, Gewitz MH, Wilson WR, Smith SC, Baddour LM. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association. Circulation 2012; 125:2520-44. [PMID: 22514251 DOI: 10.1161/cir.0b013e31825719f3] [Citation(s) in RCA: 669] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A link between oral health and cardiovascular disease has been proposed for more than a century. Recently, concern about possible links between periodontal disease (PD) and atherosclerotic vascular disease (ASVD) has intensified and is driving an active field of investigation into possible association and causality. The 2 disorders share several common risk factors, including cigarette smoking, age, and diabetes mellitus. Patients and providers are increasingly presented with claims that PD treatment strategies offer ASVD protection; these claims are often endorsed by professional and industrial stakeholders. The focus of this review is to assess whether available data support an independent association between ASVD and PD and whether PD treatment might modify ASVD risks or outcomes. It also presents mechanistic details of both PD and ASVD relevant to this topic. The correlation of PD with ASVD outcomes and surrogate markers is discussed, as well as the correlation of response to PD therapy with ASVD event rates. Methodological issues that complicate studies of this association are outlined, with an emphasis on the terms and metrics that would be applicable in future studies. Observational studies to date support an association between PD and ASVD independent of known confounders. They do not, however, support a causative relationship. Although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent ASVD or modify its outcomes.
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67
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Sfyroeras GS, Roussas N, Saleptsis VG, Argyriou C, Giannoukas AD. Association between periodontal disease and stroke. J Vasc Surg 2012; 55:1178-84. [PMID: 22244863 DOI: 10.1016/j.jvs.2011.10.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/27/2011] [Accepted: 10/02/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Periodontitis is a very common human infection. There is evidence that periodontitis is associated with cerebrovascular disease (CVD) and stroke. The aim of this study is to examine the relationship between periodontal disease and CVD in observational studies. METHODS An electronic search of the English literature using PubMed was conducted. A meta-analysis of the studies reporting on the risk of stroke in patients with periodontitis was performed. RESULTS Six prospective and seven retrospective studies met the inclusion criteria. Patients with both hemorrhagic and ischemic cerebrovascular events, fatal and nonfatal, were included. Definition of periodontitis was taken directly from included studies. Most studies have been adjusted for common cardiovascular risk factors. Separate statistical analysis was performed for prospective and retrospective studies. Overall adjusted risk of stroke in subjects with periodontitis was 1.47 times higher than in subjects without (95% confidence interval, 1.13-1.92;P = .0035) in prospective and 2.63 times (95% confidence interval, 1.59-4.33;P = .0002) in retrospective studies. The application of the trim and fill algorithm does not change the initial significant inference. CONCLUSIONS There is evidence that periodontitis is associated with increased risk of stroke. However, the results of this meta-analysis should be interpreted with caution because of the heterogeneity of the studies as well as the differences in periodontitis definition.
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Affiliation(s)
- George S Sfyroeras
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
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68
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Gita B, Sajja C, Padmanabhan P. Are lipid profiles true surrogate biomarkers of coronary heart disease in periodontitis patients?: A case-control study in a south Indian population. J Indian Soc Periodontol 2012; 16:32-6. [PMID: 22628960 PMCID: PMC3357031 DOI: 10.4103/0972-124x.94601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 12/09/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is abundant literature delving into whether periodontal infection contributes to atherosclerosis. However, whether periodontitis is a definite risk factor for atherosclerosis still remains empirical, with no systematic reviews or longitudinal studies to confirm this hypothesis. The prevalence of periodontitis and coronary artery disease also varies among racial and ethnic groups based on various factors such as diet, lifestyle, and genetic predisposition. This study was designed in a south Indian population with the aim of assessing and correlating the lipid levels (a surrogate biomarker for coronary heart disease) in patients with periodontitis and health. AIMS (1) To assess the levels of total cholesterol, low density lipoproteins (LDL), high density lipoproteins (HDL), and triglycerides in periodontal disease, and health in a south Indian population. (2) To assess associations between elevated lipid profiles and periodontal disease. MATERIALS AND METHODS This case control study included 60 individuals. Blood sampling for lipid levels and periodontal examination were performed for each study group. STATISTICAL ANALYSIS Appropriate statistical tools like Chi-square (P<0.05) and student's "t" test were used. The lipid levels were separately regressed using logistic regression to determine any association with periodontitis cases. RESULTS The differences between the mean lipid levels of cases and controls were not statistically significant (P>0.05) after eliminating confounding factors. Odds Ratio=(Total cholesterol (1.005), HDL (0.971), LDL (1.006), VLDL (0.997), CHO-HDL (1.358), TGL (1.007), LDL-HDL (1.180)). The odds ratio stated that there is no significant relation between the lipid levels and periodontal condition. The above findings confirm that there is still no concrete evidence which determines if periodontitis is an independent risk factor for atherosclerotic cardiovascular disease. Future periodontal interventional studies and assessment of genetic markers can ascertain the validity of this hypothesis. CONCLUSION There is no association among periodontal disease and the levels of total cholesterol, LDL, HDL, and triglycerides.
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Affiliation(s)
- Bagavad Gita
- Department of Periodontology, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Chandrasekaran Sajja
- Department of Periodontology, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Preethi Padmanabhan
- Department of Periodontology, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
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69
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Iwabuchi H, Fujibayashi T, Yamane GY, Imai H, Nakao H. Relationship between hyposalivation and acute respiratory infection in dental outpatients. Gerontology 2011; 58:205-11. [PMID: 22104982 DOI: 10.1159/000333147] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 09/09/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hyposalivation may affect respiratory disease because the mouth serves as the entrance to the respiratory apparatus, as well as to the digestive tract. Patients with acute respiratory infection generally have a favorable prognosis and a short natural course. However, in cases in which the host has lowered resistance, such as in elderly patients, the infection may develop into pneumonia. OBJECTIVES A prospective study was performed to examine the relationship between hyposalivation, which is common in elderly patients, and acute respiratory infection, which tends to become severe in elderly patients. METHODS The subjects were 323 male and female patients ≥40 years old who lived in Utsunomiya City and surrounding areas and regularly visited the Department of Dentistry and Oral Surgery, Tochigi National Hospital. A 6-month follow-up survey was performed to examine development of acute respiratory infection. Age, sex, and known risk factors were also investigated. Hyposalivation was defined as a saliva production (saliva secretion rate) of ≤0.6 ml/min. Multivariate analysis adjusted for age and sex was performed to examine potential risk factors associated with the development of acute respiratory infection. RESULTS Data were analyzed for 278 subjects who completed the follow-up survey. The incidence of acute respiratory infection was 60.4%, while hyposalivation was present in 96 subjects (35.5%). Multivariate analysis showed that the incidence of acute respiratory infection was higher in subjects with hyposalivation than in those without hyposalivation (adjusted odds ratio 1.761, p = 0.048). CONCLUSION The results of this study suggest that hyposalivation may be a risk factor for acute respiratory infection. This also suggests that improvement of hyposalivation might prevent acute respiratory infection.
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Affiliation(s)
- Hiroshi Iwabuchi
- Department of Dentistry and Oral Surgery, Tochigi National Hospital, Utsunomiya, Japan.
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Vaishnava P, Narayan R, Fuster V. Understanding systemic inflammation, oral hygiene, and cardiovascular disease. Am J Med 2011; 124:997-9. [PMID: 22017776 DOI: 10.1016/j.amjmed.2011.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 04/22/2011] [Accepted: 04/22/2011] [Indexed: 01/07/2023]
Affiliation(s)
- Prashant Vaishnava
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Medical Center, New York, NY, USA
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71
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Laky M, Assinger A, Esfandeyari A, Bertl K, Haririan H, Volf I. Decreased phosphorylation of platelet vasodilator-stimulated phosphoprotein in periodontitis – a role of periodontal pathogens. Thromb Res 2011; 128:155-60. [DOI: 10.1016/j.thromres.2011.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 02/07/2011] [Accepted: 02/21/2011] [Indexed: 01/22/2023]
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Prospective association of periodontal disease with cardiovascular and all-cause mortality: NHANES III follow-up study. Atherosclerosis 2011; 218:536-42. [PMID: 21831372 DOI: 10.1016/j.atherosclerosis.2011.07.091] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 07/13/2011] [Accepted: 07/14/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND It has been suggested that periodontal disease (PD) was associated with an increased risk for cardiovascular diseases (CVD), although evidence is inconclusive. PURPOSE We first sought to prospectively evaluate the relationship of PD to CVD and all-cause mortality using a national representative sample in the United States. METHODS The study population consisted of 10,849 participants who were 30 years or older and received a periodontal examination from NHANES III mortality follow-up sample (1988-2006). CVD and all-cause deaths were ascertained from the National Death Index records. The causes of death were defined using the International Classification of Disease coding (ICD-10). The severity of PD was categorized as non-PD, modest and severe PD based on clinical attachment loss and pocket depth. RESULTS Of the study sample, 3105 and 561 participants were identified as modest and severe PD cases, respectively. After up to 18 years of follow-up, there were total 2894 deaths, of which 1225 were from CVD. The levels of inflammation markers (high sensitivity C-reactive protein, white cell count and fibrinogen) were significantly higher in men with severe PD compared to men without PD (p<0.05). The prospective associations were evaluated using multivariable Cox proportional-hazards models. After adjusting for age, gender, race, household income and traditional risk factors of CVD, severe PD was associated with an increase risk of CVD mortality and all-cause mortality in men aged 30-64 years (HR=2.13 with 95% confidence interval of 1.37-3.31 for CVD mortality; HR=1.64 with 95% confidence interval of 1.25-2.15 for all-cause mortality). In addition, significant linear trends were found in CVD and all-cause mortality across the severity of PD (p<0.001). However, no significant associations were found in men aged ≥65 and in women. CONCLUSIONS There appears to be prospective associations between PD and CVD and all-cause mortality in men aged 30-64 years. Inflammation may be one possible pathway to link PD with CVD.
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Abstract
It is now well accepted that besides the cholesterol associated mechanisms of atherogenesis, inflammation plays a crucial role in all stages of the development of the atherosclerotic lesion. This 'inflammation hypothesis' raises the possibility that through systemic elevations of pro-inflammatory cytokines, periodontal diseases might also contribute to systemic inflammation and, therefore, to atherogenesis. In fact, there is evidence that periodontal diseases are associated with higher systemic levels of high-sensitivity C-reactive protein and a low grade systemic inflammation. This phenomenon has been explained based on mechanisms associated with either the infectious or the inflammatory nature of periodontal diseases. The purposes of this article were to review (1) the evidence suggesting a role for oral bacterial species, particularly periodontal pathogens, in atherogenesis; (2) the potential mechanisms explaining an etiological role for oral bacteria in atherosclerosis; (3) the evidence suggesting that periodontal infections are accompanied by a heightened state of systemic inflammation; (4) the potential sources of systemic inflammatory biomarkers associated with periodontal diseases; and (5) the effects of periodontal therapy on systemic inflammatory biomarkers and cardiovascular risk.
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Affiliation(s)
- R Teles
- Department of Periodontology, The Forsyth Institute, Cambridge, MA 02142, USA.
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75
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Yoshida M, Murakami T, Yoshimura O, Akagawa Y. The evaluation of oral health in stroke patients. Gerodontology 2011; 29:e489-93. [DOI: 10.1111/j.1741-2358.2011.00505.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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76
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Is periodontal inflammation associated with raised blood pressure? Evidence from a National US survey. J Hypertens 2011; 28:2386-93. [PMID: 20706132 DOI: 10.1097/hjh.0b013e32833e0fe1] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
There is incomplete and inconclusive evidence for the association between periodontal disease markers and arterial blood pressure, particularly from large national epidemiological studies. This study assessed the relationship between different markers of periodontal inflammation and disease with arterial blood pressure in people aged 17 years and over in USA. We analysed data from the Third National Health and Nutrition Examination Survey on 6617 men and 7377 women who received a periodontal examination. Blood pressure was analysed in both a continuous format and a binary variable for case definition of hypertension. Periodontal disease markers (extent of gingival bleeding, pocket depth, and loss of attachment, and a case definition of periodontitis) were associated on the arterial blood pressure outcomes through a series of regression models, incrementally adjusting for confounders (demographic, inflammation markers, chronic conditions, smoking, BMI, socio-economic status). All periodontal measures had significant crude associations with SBP and hypertension. Gingival bleeding, a marker of current periodontal inflammation, was the only measure consistently and significantly associated with raised SBP and an increased odds of hypertension in the US adult population throughout the adjustment process. For a 10% greater extent of gingival bleeding, the average SBP was higher by 0.5 (0.3, 0.6) mmHg in the fully adjusted model. By referring to the general population and the whole distribution of blood pressure, not only to those at higher risk for hypertension, this association might have some important implications for clinical practice and public health strategies.
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Tsioufis C, Kasiakogias A, Thomopoulos C, Stefanadis C. Periodontitis and blood pressure: the concept of dental hypertension. Atherosclerosis 2011; 219:1-9. [PMID: 21640351 DOI: 10.1016/j.atherosclerosis.2011.04.030] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 03/24/2011] [Accepted: 04/19/2011] [Indexed: 01/23/2023]
Abstract
Chronic periodontitis is a common inflammatory disorder that is being contemplated as a risk factor for atherosclerotic complications. Current epidemiological evidence also supports its potential association with increases in blood pressure levels and hypertension prevalence. Furthermore, data from cross-sectional studies suggest that in hypertensive subjects periodontitis may enhance the risk and degree of target organ damage. A possible pathogenetic background of an effect of periodontitis on blood pressure should include the systemic generalization of the local oral inflammation, the role of the host immune response, the direct microbial effect on the vascular system and alterations in endothelial function. Inversely, the concept of hypertension unfavorably affecting periodontal tissues cannot be excluded. The two conditions share multiple common risk factors that should be readily controlled for when assessing a possible association. Thoroughly designed prospective and interventional trials are needed in order to determine the impact of periodontitis on blood pressure regulation and incident hypertension and its integration in the clinical approach of both dental and hypertensive patients.
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Affiliation(s)
- Costas Tsioufis
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece.
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78
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Holmlund A, Hedin M, Pussinen PJ, Lerner UH, Lind L. Porphyromonas gingivalis (Pg) a possible link between impaired oral health and acute myocardial infarction. Int J Cardiol 2011; 148:148-53. [DOI: 10.1016/j.ijcard.2009.10.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 10/18/2009] [Indexed: 01/22/2023]
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79
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Ford PJ, Raphael SL, Cullinan MP, Jenkins AJ, West MJ, Seymour GJ. Why should a doctor be interested in oral disease? Expert Rev Cardiovasc Ther 2011; 8:1483-93. [PMID: 20936934 DOI: 10.1586/erc.10.109] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Oral health has been implicated in systemic disease throughout the ages; however, the understanding of the relationship between oral disease and systemic diseases such as cardiovascular disease and Type 2 diabetes mellitus is still emerging today. Chronic periodontal disease is widespread in the general population and a significant proportion of adults suffer from the most severe form of the disease. Dental plaque biofilm is necessary for the development of chronic periodontal disease with genetic and environmental factors contributing towards the pathogenesis. The putative biological mechanisms of the association between oral disease and atherogenesis are discussed, although there is insufficient evidence to establish causality at this time. Regardless of a direct causal relationship between oral disease and cardiovascular disease, treatment of oral disease leads to both a reduction in the systemic inflammatory burden as reflected in inflammatory markers and an improvement in endothelial function and hence improved overall health outcomes. A brief overview of periodontal disease including etiology, pathogenesis, screening and therapeutic implications is presented.
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Affiliation(s)
- Pauline J Ford
- The University of Queensland, School of Dentistry, 200 Turbot Street, Brisbane, QLD 4000, Australia
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Abstract
Cardiovascular disease (CVD) and type 2 diabetes are common systemic illnesses with reliable, predictive risk factors. CVD is the number one killer worldwide accounting for nearly 30% of deaths and type 2 diabetes has reached epidemic proportions in many western industrialized countries. Both of these illnesses can go undiagnosed in an alarming number of people for significant periods of time. The relationship between oral health and systemic health has become the focus of much discussion and research in recent times. It is now widely accepted that periodontal disease is associated with systemic illnesses such as CVD and type 2 diabetes. Cigarette smoking and obesity are major risk factors accounting for a large portion of the global disease burden. Many periodontal patients may be at risk of systemic conditions but be asymptomatic and undiagnosed. With an aging population who are mostly retaining their natural dentition, the need for periodontal management will continue to rise in the future. Dental professionals are well placed to perform general health screening for their patients. Therefore, risk assessment during the periodontal examination may facilitate the early identification of the large proportion of people who are unaware of their risk status. As identification and intervention of patients with increased risk factors is key to lowering the systemic disease burden, general health screening during periodontal examinations may present an important opportunity for many patients.
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Affiliation(s)
- Sarah L. Raphael
- Faculty of Dentistry, The University of Sydney, Westmead, NSW, Australia
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81
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The relationship between periodontal disease (pd) and cardiovascular disease (cvd). Mediterr J Hematol Infect Dis 2010; 2:e2010030. [PMID: 21415980 PMCID: PMC3033151 DOI: 10.4084/mjhid.2010.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 09/28/2010] [Indexed: 11/28/2022] Open
Abstract
The recent focus on the potential link between periodontal and cardiovascular disease (PD and CVD) is part of the larger renewed interest on the role of infection and inflammation in the etiology of atherosclerosis and its clinical manifestations. Periodontal Disease is an inflammatory process affecting the periodontium, the tissue that surrounds and supports the teeth. The process usually starts with an inflammatory process of the gum (gingivitis) but it may progress with an extensive involvement of the gum, as well as the periodontal ligament and the bone surrounding the teeth resulting in substantial bone loss. Periodontal disease is a common oral pathological condition in the adult age and represents the leading cause of tooth loss. PD prevalence increases with age and there are estimates that up to 49,000,000 Americans may suffer from some form of gum disease. The gingival plaque associated with PD is colonized by a number of gram-positive and gram-negative bacteria that have been shown to affect the initiation and development of PD and have been associated with the potential etiological role of PD in CVD and other chronic conditions. A potential etiological link between PD and CVD may have important public health implications as both the exposure (PD) and the outcomes (CVD) are highly prevalent in industrialized societies. In situations in which both the exposure and the outcome are highly prevalent even modest associations, like those observed in the studies reporting on the link between PD and CVD outcomes, may have relevance. There are not definite data on the effect of periodontal treatment on CVD clinical outcomes (either in primary or secondary prevention) however it should be pointed out that the limited (both in terms of numbers and study design) experimental evidence in humans suggests a possible beneficial effect of periodontal treatment of indices of functional and structural vascular health.
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82
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Yau WY, Hankey GJ. Which dietary and lifestyle behaviours may be important in the aetiology (and prevention) of stroke? J Clin Neurosci 2010; 18:76-80. [PMID: 20851607 DOI: 10.1016/j.jocn.2010.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Revised: 04/22/2010] [Accepted: 05/29/2010] [Indexed: 11/25/2022]
Abstract
Prevention of stroke requires optimal control of causal risk factors. However, only three-quarters of all strokes can be attributable to known causal risk factors. We aimed to identify novel risk factors for acute stroke in 48 patients with acute (<1 week) stroke admitted to Royal Perth Hospital Stroke Unit and 47 controls matched for age and sex from the northeast Perth metropolitan area. Patients and controls were interviewed, and had physical measurements and blood taken. Multiple odds ratios (OR) for risk factors, with 95% confidence intervals (CI), were calculated by unconditional multiple logistic regression. Mediterranean diet (OR: 0.1; 95% CI, 0.02-0.4), increased waist-to-hip ratio (OR 4.0, 95% CI, 1.5-11), physical activity during leisure time (OR 0.2; 95% CI, 0.1-0.9), periodontal disease (OR 6.4; 95% CI, 1.5-27), and acute febrile illness (OR 14; 95% CI, 1.5-127) were associated significantly and independently with ischaemic stroke. These preliminary data suggest that certain dietary and lifestyle behaviours may play as important a role in the aetiology (and prevention) of stroke as other conventional causal risk factors for stroke. However, these associations need confirmation from larger randomised trials given the small sample size of the current study.
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Affiliation(s)
- W Y Yau
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
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83
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Holmlund A, Holm G, Lind L. Number of teeth as a predictor of cardiovascular mortality in a cohort of 7,674 subjects followed for 12 years. J Periodontol 2010; 81:870-6. [PMID: 20350152 DOI: 10.1902/jop.2010.090680] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND That oral health is related to the development of different cardiovascular disorders is reported in a number of studies. This study investigates if different parameters of oral health are associated with future mortality in different cardiovascular disorders in a dose-dependent manner. METHODS A total of 7,674 subjects (3,300 males and 4,374 females; age range 20 to 89 years) received a dental examination by specialists in periodontology between the years 1976 and 2002. Number of remaining teeth, severity of periodontal disease, number of deepened periodontal pockets, and bleeding on probing were evaluated in relation to cause of death. RESULTS During a median follow-up period of 12 years, 629 of the subjects died. For 299 subjects the cause of mortality was cardiovascular disease (CVD); 167 of these subjects died from coronary heart disease (CHD); 83 died from stroke; and 49 died from aortic aneurysm or congestive heart failure. The causes of death for the remaining 330 subjects were other than CVD. After adjustment for age, gender, and smoking, number of remaining teeth predicted in a dose-dependent manner all-cause mortality and mortality in CVD and in CHD (P <0.0001 for all), but not mortality from stroke (P = 0.15). Cox regression analysis revealed a seven-fold increased risk for mortality from CHD in subjects with <10 teeth compared to those with >25 teeth. Severity of periodontal disease, number of deepened periodontal pockets, and bleeding on probing were not related to mortality in a dose-dependent manner after adjustment for confounders. CONCLUSION This fairly large, prospective study with a long follow-up period presents for the first time a dose-dependent relationship between number of teeth and both all-cause and CVD mortality, indicating a link between oral health and CVD, and that the number of teeth is a proper indicator for oral health in this respect.
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Affiliation(s)
- Anders Holmlund
- Department of Periodontology, County Hospital of Gävle-Sandviken, 801 87 Gävle, Sweden.
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Dhadse P, Gattani D, Mishra R. The link between periodontal disease and cardiovascular disease: How far we have come in last two decades ? J Indian Soc Periodontol 2010; 14:148-54. [PMID: 21760667 PMCID: PMC3100856 DOI: 10.4103/0972-124x.75908] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 10/05/2010] [Indexed: 11/23/2022] Open
Abstract
Many epidemiological studies have investigated the relationship between periodontal disease (PD) and cardiovascular disease (CVD), but their results are heterogeneous. This review article is designed to update the potential association, that forms the basis of understanding for a (causal) role for PD to cardiovascular events; as reported by various observational (case-control, cohort, cross-sectional) studies, epidemiological and interventional studies, not considering the other number of systemic health outcomes like cerebrovascular disease, pregnancy complications, chronic obstructive pulmonary disease, diabetes mellitus complications, osteoporosis, etc. A brief overview has been included for atherosclerosis (ATH), its pathophysiology and the association of periodontal infections as a risk factor for causing ATH, which seems to be a rational one; as development of ATH involves a chronic low-grade inflammation and moreover, it has long been set up prior to development of ischemic heart disease and thus provides potential contributing mechanisms that ATH may contribute singly or in concert with other risk factors to develop ischemic heart disease. This article goes on to discuss the correlation of evidence that is gathered from many scientific studies showing either strong, modest, weak or even no links along with their critical analyses. Finally, this article summarizes the present status of the links that possibly exist between PD and its role as a risk factor in triggering cardiovascular events, in the fairly long journey for the last two decades.
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Affiliation(s)
- Prasad Dhadse
- Department of Periodontics, Hitkarini Dental College and Hospital, Dumna Road, Jabalpur - 482002, India
| | - Deepti Gattani
- Department of Periodontics, Hitkarini Dental College and Hospital, Dumna Road, Jabalpur - 482002, India
| | - Rohit Mishra
- Department of Periodontics, Hitkarini Dental College and Hospital, Dumna Road, Jabalpur - 482002, India
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Nesse W, Dijkstra PU, Abbas F, Spijkervet FKL, Stijger A, Tromp JAH, van Dijk JL, Vissink A. Increased prevalence of cardiovascular and autoimmune diseases in periodontitis patients: a cross-sectional study. J Periodontol 2010; 81:1622-8. [PMID: 20583916 DOI: 10.1902/jop.2010.100058] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Associations between periodontitis and cardiovascular and autoimmune diseases are most often assessed in patients with a particular cardiovascular or autoimmune disease. To prevent selection bias, this study assesses the existence of associations between periodontitis and cardiovascular and autoimmune diseases in patients attending a dental or periodontal clinic. METHODS Data were collected from 1,276 randomly selected dental records from patients attending a dental (n = 588) or periodontal (n = 688) clinic. Data on the prevalence of cardiovascular and autoimmune diseases were obtained from a validated health questionnaire. Data on the presence of periodontitis were taken from patients' dental records. RESULTS In uncontrolled analyses, the prevalence of hypertension, diabetes mellitus (DM), and rheumatoid arthritis (RA) is significantly increased in patients with periodontitis. Controlled for confounding, periodontitis was associated with DM, with an odds ratio of 4 (1.03 to 15.3), in the dental clinic. DM was not associated with periodontitis in periodontal clinics. Hypertension does not seem to be associated with periodontitis when controlling for confounders. Periodontitis may be associated with RA in both clinic types. CONCLUSIONS The increased prevalence of cardiovascular and autoimmune diseases among patients with periodontitis attending dental or periodontal clinics may, at least in part, be influenced by confounding. However, the increased prevalence of DM and RA in patients with periodontitis could not be explained by confounding.
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Affiliation(s)
- Willem Nesse
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Kim HD, Sim SJ, Moon JY, Hong YC, Han DH. Association Between Periodontitis and Hemorrhagic Stroke Among Koreans: A Case-Control Study. J Periodontol 2010; 81:658-65. [DOI: 10.1902/jop.2010.090614] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dorn JM, Genco RJ, Grossi SG, Falkner KL, Hovey KM, Iacoviello L, Trevisan M. Periodontal Disease and Recurrent Cardiovascular Events in Survivors of Myocardial Infarction (MI): The Western New York Acute MI Study. J Periodontol 2010; 81:502-11. [DOI: 10.1902/jop.2009.090499] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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89
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Pradeep AR, Hadge P, Arjun Raju P, Shetty SR, Shareef K, Guruprasad CN. Periodontitis as a risk factor for cerebrovascular accident: a case-control study in the Indian population. J Periodontal Res 2010; 45:223-8. [DOI: 10.1111/j.1600-0765.2009.01220.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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90
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Stein JM, Kuch B, Conrads G, Fickl S, Chrobot J, Schulz S, Ocklenburg C, Smeets R. Clinical periodontal and microbiologic parameters in patients with acute myocardial infarction. J Periodontol 2010; 80:1581-9. [PMID: 19792846 DOI: 10.1902/jop.2009.090170] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of clinical periodontal parameters and the presence of periodontal pathogens in patients with acute myocardial infarction (AMI). METHODS A total of 104 subjects (54 patients with AMI and 50 healthy controls) were included. Subgingival plaque samples were analyzed for periodontal pathogens Aggregatibacter actinomycetemcomitans (Aa; previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf; previously T. forsythensis), and Prevotella intermedia (Pi) using dot-blot hybridization. RESULTS Patients with AMI had a significantly higher frequency of probing depths (PDs) >or=4 mm than controls (39.2% versus 14.9%; P <0.0001). Among different cutoff levels, the frequency of >50% sites with PDs >or=4 mm showed the highest discrepancy between both groups (33% versus 0%; P <0.001). All periodontal pathogens were overrepresented in patients with AMI and positively correlated with increased periodontal PD and clinical attachment level (CAL). After adjustment for age, gender, smoking, body mass index, hypertension, plaque index, statin intake, and ratio of cholesterol to high-density lipoprotein, Pg remained a significant predictor for AMI (odds ratio [OR]: 13.6; 95% confidence interval [CI]: 3.1 to 59.8; P = 0.0005). Furthermore, the simultaneous presence of Aa + Pg (P = 0.0005) and Aa + Pg + Tf (P = 0.0018) were found with significantly higher frequency in patients with AMI than controls. CONCLUSIONS The results of our study confirm an association between periodontitis and AMI in which periodontal destruction was correlated with the presence of periodontal pathogens. In particular, Pg might be considered a potential risk indicator for AMI.
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Affiliation(s)
- Jamal M Stein
- Department of Operative Dentistry, Perdiodontology, and Dentistry, University Hospital Aachen, Aachen, Germany.
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Friedewald VE, Kornman KS, Beck JD, Genco R, Goldfine A, Libby P, Offenbacher S, Ridker PM, Van Dyke TE, Roberts WC. The American Journal of Cardiology and Journal of Periodontology editors' consensus: periodontitis and atherosclerotic cardiovascular disease. J Periodontol 2009; 80:1021-32. [PMID: 19563277 DOI: 10.1902/jop.2009.097001] [Citation(s) in RCA: 169] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ACKNOWLEDGMENT This Editors' Consensus is supported by an educational grant from Colgate-Palmolive, Inc., New York, New York, and is based on a meeting of the authors held in Boston, Massachusetts, on January 9, 2009. DISCLOSURE Dr. Friedewald has received honoraria for speaking from Novartis, East Hanover, New Jersey. Dr. Kornman is a full-time employee and shareholder of Interleukin Genetics, Waltham, Massachusetts, which owns patents on genetic biomarkers for chronic inflammatory diseases. Dr. Genco is a consultant to Merck, Whitehouse Station, New Jersey. Dr. Ridker has received research support from AstraZeneca, Wilmington, Delaware; Novartis; Pfizer, New York, New York; Roche, Nutley, New Jersey; Sanofi-Aventis, Bridgewater, New Jersey; and Abbott Laboratories, Abbott Park, Illinois. Dr. Ridker has received non-financial research support from Amgen, Thousand Oaks, California. Dr. Ridker is a co-inventor on patents held by Brigham and Women's Hospital that relate to the use of inflammatory biomarkers in cardiovascular disease. Dr. Ridker is a research consultant for Schering-Plough, Kenilworth, New Jersey; Sanofi-Aventis; AstraZeneca; Isis, Carlsbad, California; Novartis; and Vascular Biogenics, Tel Aviv, Israel. Dr. Van Dyke is a co-inventor on patents held by Boston University, Boston, Massachusetts, that relate to inflammation control, including consulting fees. Dr. Roberts has received honoraria for speaking from Merck, Schering-Plough, AstraZeneca, and Novartis. All other individuals in a position to control content disclosed no relevant financial relationships.
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Mucci LA, Hsieh CC, Williams PL, Arora M, Adami HO, de Faire U, Douglass CW, Pedersen NL. Do genetic factors explain the association between poor oral health and cardiovascular disease? A prospective study among Swedish twins. Am J Epidemiol 2009; 170:615-21. [PMID: 19648170 PMCID: PMC2732988 DOI: 10.1093/aje/kwp177] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 06/01/2009] [Indexed: 02/06/2023] Open
Abstract
Epidemiologic studies suggest positive associations between poor oral health and cardiovascular disease. The authors undertook a prospective study among 15,273 Swedish twins (1963-2000) to examine whether genetic factors underlying the 2 diseases could explain previous associations. They estimated hazard ratios and 95% confidence intervals controlling for individual factors and stratifying on twin pairs to control for familial effects. Quantitative genetic analyses estimated genetic correlations between oral diseases and cardiovascular disease outcomes. Tooth loss (hazard ratio (HR) = 1.2, 95% confidence interval (CI): 1.1, 1.4) and periodontal disease (HR = 1.3, 95% CI: 1.0, 1.4) were associated with small excess risks of cardiovascular disease; periodontal disease was also associated with coronary heart disease (HR = 1.4, 95% CI: 1.1, 1.6). Adjustment for genetic factors in co-twin analyses did not appreciably change estimates. In contrast, tooth loss was more strongly associated with coronary heart disease in twin models (HR = 2.1, 95% CI: 1.2, 3.8) compared with adjusting for individual factors alone (HR = 1.3, 95% CI: 1.1, 1.4). There was evidence of shared genetic factors between cardiovascular disease and tooth loss (r(G) = 0.18) and periodontal disease (r(G) = 0.29). Oral disease was associated with excess cardiovascular disease risk, independent of genetic factors. There appear to be common pathogenetic mechanisms between poor oral health and cardiovascular disease.
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Affiliation(s)
- Lorelei A Mucci
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, 9th Floor, Boston, MA 02115, USA.
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93
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Periodontal disease and risk of atherosclerotic coronary heart disease. Odontology 2009; 97:84-91. [PMID: 19639450 DOI: 10.1007/s10266-009-0104-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2009] [Accepted: 05/11/2009] [Indexed: 12/22/2022]
Abstract
Atherosclerosis is an important component of coronary heart disease (CHD), which is the leading cause of death worldwide, including in Japan. Because atherosclerotic processes are typified by chronic inflammatory responses, which are similar to those elicited by chronic infection, the role of infection in promoting or accelerating atherosclerosis has received considerable focus. Increasing evidence supports the notion that periodontitis is associated with increased risk of atherosclerosis through dysfunction of endothelial cells induced by either periodontopathic bacteria or their products, or inflammatory mediators derived from infected periodontal tissue. Here we review whether periodontitis represents a risk factor for CHD or atherosclerosis, particularly in a Japanese population.
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Stein JM, Smeets R, Reichert S, Chrobot J, Fickl S, Stanzel S, Kuch B. The Role of the Composite Interleukin-1 Genotype in the Association Between Periodontitis and Acute Myocardial Infarction. J Periodontol 2009; 80:1095-102. [DOI: 10.1902/jop.2009.080639] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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95
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Friedewald VE, Kornman KS, Beck JD, Genco R, Goldfine A, Libby P, Offenbacher S, Ridker PM, Van Dyke TE, Roberts WC. The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: periodontitis and atherosclerotic cardiovascular disease. Am J Cardiol 2009; 104:59-68. [PMID: 19576322 DOI: 10.1016/j.amjcard.2009.05.002] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 05/06/2009] [Indexed: 11/16/2022]
Affiliation(s)
- Vincent E Friedewald
- The American Journal of Cardiology, University of Notre Dame, Notre Dame, IN, USA.
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Periodontal treatment: Potential to reduce cardiovascular morbidity and/or mortality. Med Hypotheses 2009; 73:33-5. [DOI: 10.1016/j.mehy.2009.01.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 01/14/2009] [Accepted: 01/23/2009] [Indexed: 01/30/2023]
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Higashi Y, Goto C, Hidaka T, Soga J, Nakamura S, Fujii Y, Hata T, Idei N, Fujimura N, Chayama K, Kihara Y, Taguchi A. Oral infection-inflammatory pathway, periodontitis, is a risk factor for endothelial dysfunction in patients with coronary artery disease. Atherosclerosis 2009; 206:604-10. [PMID: 19410250 DOI: 10.1016/j.atherosclerosis.2009.03.037] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 03/04/2009] [Accepted: 03/25/2009] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Several studies have shown that periodontitis is a risk factor for cardiovascular diseases. There is an association between inflammation and endothelial dysfunction. The purpose of this study was to evaluate endothelial function in patients with coronary artery disease (CAD) who had periodontitis. METHODS AND RESULTS We evaluated forearm blood flow (FBF) responses to acetylcholine (ACh), an endothelium-dependent vasodilator, and to sodium nitroprusside (SNP), an endothelium-independent vasodilator, in 101 CAD patients with periodontitis (37 men and 11 women, 63+/-12 yr) and without periodontitis (36 men and 17 women, 62+/-13 yr). FBF was measured by using strain-gauge plethysmography. Circulating levels of C-reactive protein and interleukin-6 were significantly higher in the periodontitis group than in the non-periodontitis group. FBF response to ACh was significantly smaller in the periodontitis group than in the non-periodontitis group. SNP-stimulated vasodilation was similar in the two groups. Periodontal therapy reduced serum concentrations of C-reactive protein from 2.7+/-1.9 to 1.8+/-0.9mg/L (P<0.05) and interleukin-6 from 2.6+/-3.4 to 1.6+/-2.6ng/L (P<0.05) and augmented ACh-induced vasodilation from 14.7+/-5.2 to 20.1+/-6.1mL/(min100mL) tissue (P<0.05) in patients with periodontitis. The SNP-stimulated vasodilation was similar before and after treatment. After administration of N(G)-monomethyl-l-arginine, a nitric oxide synthase inhibitor, FBF response to ACh was similar before and after treatment. CONCLUSION These findings suggest that periodontitis is associated with endothelial dysfunction in patients with CAD through a decrease in nitric oxide bioavailability. Systemic inflammation may be, at least in part, a cause and predictor of progression of endothelial dysfunction.
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Affiliation(s)
- Yukihito Higashi
- Department of Cardiovascular Physiology and Medicine, Hiroshima University, Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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Wakai K, Naito M, Naito T, Nakagaki H, Umemura O, Yokota M, Hanada N, Kawamura T. Longitudinal Evaluation of Multi-phasic, Odontological and Nutritional Associations in Dentists (LEMONADE Study): study design and profile of nationwide cohort participants at baseline. J Epidemiol 2009; 19:72-80. [PMID: 19265274 PMCID: PMC3924117 DOI: 10.2188/jea.je20070458] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background To examine the association between oral health and general well-being, we are currently conducting a nationwide cohort study comprising members of the Japan Dental Association (JDA). Herein, we describe the study design and the profile of the participants at baseline. Methods From 2001 through 2006, the participants completed a baseline questionnaire that surveyed factors related to lifestyle, general health, and oral health. Morbidity and mortality have been monitored by using information from fraternal insurance programs operated by prefectural dental associations. All respondents provided written, informed consent for participation and the use of their insurance data. Results A total of 21 272 JDA members participated in the baseline survey (response rate, 36.2%). Their mean age ± SD was 52.3 ± 12.3 years; 8.0% were women. Among the respondents, 30.2% of men and 10.7% of women were current smokers; 73.5% of men and 44.8% of women were current drinkers. The cohort scored higher on oral health indices than did the general Japanese population: dentists were more likely to brush their teeth ≥3 times/day, to have ≥20 teeth, to have fewer lost teeth, to be free from periodontal diseases, and to have higher General Oral Health Assessment Index scores. There was, however, considerable inter-individual variation in scores on the indices. Conclusions More than one-third of JDA members participated in the study. Their oral average health status was better than that of the general population. Nevertheless, it will be possible to compare morbidity and mortality between those with better and worse scores on oral health indices.
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Affiliation(s)
- Kenji Wakai
- Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
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Kandelman D, Petersen PE, Ueda H. Oral health, general health, and quality of life in older people. SPECIAL CARE IN DENTISTRY 2009; 28:224-36. [PMID: 19068063 DOI: 10.1111/j.1754-4505.2008.00045.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The purpose of this report is to review the interrelationship between poor oral health conditions of older people and general health. The impact of poor oral health on quality of life (QOL) is analyzed, and the implications for public health intervention and oral health care are discussed. Findings from the current research may lead to the following conclusions: The available scientific evidence is particularly strong for a direct relationship between diabetes and periodontal disease; the direct relationship between periodontal disease and cardiovascular disease is less convincing. General and associated oral health conditions have a direct influence on elder people's QOL and lifestyle. The growing number of elderly people challenges health authorities in most countries. The evidence on oral health-general health relationships is particularly important to WHO in its effort to strengthen integrated oral health promotion and disease prevention around the globe.
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Affiliation(s)
- Daniel Kandelman
- Faculty of Dental Medicine, University of Montreal, Montreal, Canada.
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Kallio KAE, Buhlin K, Jauhiainen M, Keva R, Tuomainen AM, Klinge B, Gustafsson A, Pussinen PJ. Lipopolysaccharide associates with pro-atherogenic lipoproteins in periodontitis patients. Innate Immun 2009; 14:247-53. [PMID: 18669610 DOI: 10.1177/1753425908095130] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Periodontitis patients are known to suffer from endotoxemia, which may be among the major risk factors for atherosclerosis. In health, lipopolysaccharide (LPS) is mainly carried with high density lipoprotein (HDL) particles. Shift of LPS toward lipoproteins with lower densities may result in less effective endotoxin scavenging. Our aim was to determine plasma LPS activity and lipoprotein-distribution before and after treatment in periodontitis patients. PATIENTS AND METHODS Very low and intermediate density (VLDL-IDL), low density (LDL), HDL 2, HDL3, and lipoprotein-deficient plasma (LPDP) were isolated by sequential ultracentrifugation. Patients included 34 subjects aged 53.5 +/- 8.3 years, before and 6 months after periodontal treatment. RESULTS The mean LPS distribution decreased among lipoprotein classes as follows: VLDL-IDL 41.3 +/- 12.1%, LPDP 25.0 +/- 7.0%, HDL3 13.1 +/- 5.2%, LDL 11.5 +/- 3.7%, and HDL2 9.2 +/- 2.8%. Plasma and VLDL-IDL-associated LPS correlated positively, and LDL- and HDL-associated LPS negatively with clinical periodontal parameters and plasma cytokine concentrations. Mean plasma LPS activity increased after periodontal treatment from 44.0 +/- 17.0 to 55.7 +/- 24.2 EU/ml (P = 0.006). No significant changes were found in LPS lipoprotein distribution and lipoprotein compositions after the treatment. CONCLUSIONS Endotoxemia increases with severity of periodontitis. In periodontitis, LPS associates preferentially with the pro-atherogenic VLDL-IDL fraction. Periodontal treatment has only minor effects on plasma LPS activity or distribution, which reflects persistence of the disease.
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Affiliation(s)
- K A Elisa Kallio
- Institute of Dentistry, University of Helsinki, and Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland.
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