Periodontal disease and cardiovascular disease: epidemiology and possible mechanisms

Factors contributing to tooth loss among the elderly: A cross sectional study

BACKGROUND

The present study evaluates the influence of several demographic, health, personal, and clinical factors on the number of missing teeth in old age sample.

METHODS

The number of patients included was 259; they received a full mouth examination and answered a questionnaire provided by one examiner. All the variables related to teeth loss based on the literature were included. These variables focused on age, gender, race, marital status, clinical attachment level, pocket depth, year of smoking, number of cigarettes smoked per day, number of medications, root decay, coronal decay, health status, and year of education. Statistical analysis involved stepwise multivariate linear regression.

RESULTS

Teeth loss was statistically associated with clinical attachment level (CAL)(p value 0.0001), pocket depth (PD) (0.0007) and education level (0.0048). When smoking was included in the model, age was significantly associated with teeth loss (0.0037). At least one of these four factors was also related to teeth loss in several specific groups such as diabetes mellitus, male, and White. The multiple linear regressions for all the proposed variables showed that they contributed to teeth loss by about 23%.

CONCLUSIONS

It can be concluded that less education or increased clinical attachment level loss may increase number of missing teeth. Additionally, age may cause teeth loss in the presence of smoking.

Salivary inflammatory cytokines may be novel markers of carotid atherosclerosis in a Japanese general population: the Suita study

OBJECTIVE

Salivary biomarkers have been recently useful of periodontal disease, which is also risk factor of atherosclerosis. However, there are few studies of the association between salivary inflammatory cytokines and carotid atherosclerosis. We aimed to clarify the association between salivary inflammatory cytokines and periodontal disease and carotid atherosclerosis in a general urban population.

METHODS

We studied 608 Japanese men and women (mean age: 65.4 years) in the Suita study. Carotid atherosclerosis was evaluated by high-resolution ultrasonography with atherosclerotic indexes of intima-media thickness (IMT). Periodontal status was evaluated by the Community Periodontal Index (CPI). Salivary levels of interleukin-1β, interleukin-6, tumor necrosis factor-α (TNF-α), and prostaglandin E2 (PGE2) were measured by enzyme linked immunosorbent assay. The risks of carotid atherosclerosis (≥75th percentiles of mean- [0.88 mm] and Max-IMT [1.50 mm]) according to the quartiles of salivary inflammatory cytokines were compared using of adjusted-logistic regression models.

RESULTS AND CONCLUSION

All salivary inflammatory cytokines were positively associated with CPI. The adjusted odds ratios for carotid atherosclerosis of mean-IMT in the highest quartile of interleukin-6 and TNF-α were higher than those in the lowest quartiles (OR = 2.32 and 2.88; 95% confidence intervals = 1.19-4.51 and 1.51-5.49, respectively). The adjusted odds ratio for carotid atherosclerosis of mean-IMT in the highest quartile of PGE2 was greater than those in the lowest quartile in women (OR = 2.78; 95% confidence intervals = 1.11-6.95). In conclusion, higher levels of salivary inflammatory cytokines were associated with both periodontal disease and carotid atherosclerosis. Selected salivary inflammatory cytokines may be useful screening markers for periodontal disease and carotid atherosclerosis.

Periodontal disease and atherosclerosis

Atherosclerotic disease (AD) is one of the most important causes of morbidity and mortality in the world. It expresses inflammatory markers such as C-reactive protein (CRP) and can provoke arterial wall thickening, which can be evaluated using Doppler ultrasound. Risk factors associated with AD include diabetes mellitus, systemic arterial hypertension, dyslipidemia and smoking. More recently, periodontal disease (PD) has been identified as a factor related to AD. Periodontal disease has a high prevalence in the global population and the inflammatory process and bacterial activity at the periodontium appear to increase the risk of AD. Encouraging good oral hygiene can reduce expression of inflammatory markers of AD. A review of literature on PD, AD and inflammatory markers and the interrelationships between the two diseases was conducted using data published in articles indexed on the PUBMED, SCIELO and BIREME databases.

Periodontal therapy for the management of cardiovascular disease in patients with chronic periodontitis

BACKGROUND

There is an association between chronic periodontitis and cardiovascular disease (CVD). However, it is not known whether periodontal therapy could prevent or manage CVD in patients with chronic periodontitis.

OBJECTIVES

The objective of this systematic review was to investigate the effects of periodontal therapy in preventing the occurrence of, and management or recurrence of, CVD in patients with chronic periodontitis.

SEARCH METHODS

The electronic databases that were searched were the Cochrane Oral Health Group's Trials Register (to 7 April 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 3), MEDLINE via OVID (1946 to 7 April 2014), EMBASE via OVID (1980 to 7 April 2014), CINAHL via EBSCO (1937 to 7 April 2014), OpenGrey (to 7 April 2014), the Chinese BioMedical Literature Database (1978 to April 2014), the China National Knowledge Infrastructure (1994 to April 2014) and the VIP database (1989 to April 2014). We searched the US National Institutes of Health Trials Register, the World Health Organization (WHO) Clinical Trials Registry Platform and Sciencepaper Online for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs were considered eligible. Studies were selected if they included patients with a diagnosis of chronic periodontitis and previous CVD (secondary prevention studies) or no CVD (primary prevention studies); patients in the intervention group received active periodontal therapy compared to maintenance therapy, no periodontal treatment or another kind of periodontal treatment in the control group.

DATA COLLECTION AND ANALYSIS

Two review authors carried out the study identification, data extraction and risk of bias assessment independently and in duplicate. Any discrepancies between the two authors were resolved by discussion or with a third review author. A formal pilot-tested data extraction form was adopted for the data extraction, and the Cochrane Collaboration's tool for risk of bias assessment was used for the critical appraisal of the literature.

MAIN RESULTS

No studies were identified that assessed primary prevention of CVD in people with periodontitis. One study involving 303 participants with ≥ 50% blockage of one coronary artery or a coronary event within three years, but not the three months prior, was included. The study was at high risk of bias due to deviation from the protocol treatment allocation and lack of follow-up data. The trial compared scaling and root planing (SRP) with community care for a follow-up period of six to 25 months. No data on deaths (all-cause or CVD-related) were reported. There was insufficient evidence to determine the effect of SRP and community care in reducing the risk of CVD recurrence in patients with chronic periodontitis (risk ratio (RR) 0.72; 95% confidence interval (CI) 0.23 to 2.22; very low quality evidence). The effects of SRP compared with community care on high-sensitivity C-reactive protein (hs-CRP) (mean difference (MD) 0.62; -1.45 to 2.69), the number of patients with high hs-CRP (RR 0.77; 95% CI 0.32 to 1.85) and adverse events (RR 9.06; 95% CI 0.49 to 166.82) were also not statistically significant. The study did not assess modifiable cardiovascular risk factors, other blood test results, heart function parameters or revascularisation procedures.

AUTHORS' CONCLUSIONS

We found very low quality evidence that was insufficient to support or refute whether periodontal therapy can prevent the recurrence of CVD in the long term in patients with chronic periodontitis. No evidence on primary prevention was found.

The influence of prevalent cohort bias in the association between periodontal disease progression and incident coronary heart disease

PURPOSE

In longitudinal studies, the onset of the index condition (e.g. exposure) does not always coincide with the start of a study's observation period, leading to the possibility of bias in estimation that derives from studying prevalent exposure rather than new exposure. We investigate the possible role of this bias in the relationship between periodontitis progression and coronary heart disease (CHD) among a cohort of men participating in the Veterans Administration Dental Longitudinal Study.

METHODS

At baseline, there were 298 men with existing (i.e., prevalent) periodontitis. During follow-up, routine dental inspection identified 163 new (i.e., incident) cases of periodontitis. Change in mean alveolar bone loss score (MBLS) served as the measure of disease progression. Tabular analyses were performed to obtain crude, stratified, and adjusted measures of the association for periodontitis cases overall and separately for prevalent and incident cases. Potential bias was evaluated by comparing estimates across these subcohorts.

RESULTS

Among all periodontitis cases, increasing MBLS was associated with increasing risk of CHD event. Subdividing periodontal cases into new and prevalent cases revealed that the relationship was most pronounced among incident periodontitis cases (incident rate ratio for MBLS change >0.5 = 5.4), compared with prevalent cases (incident rate ratio for MBLS change >0.5 = 2.5).

CONCLUSIONS

Studying prevalent cases of periodontitis underestimates the association between incidence periodontitis and CHD.

Transglutaminase 2 is essential for adherence of Porphyromonas gingivalis to host cells

Porphyromonas gingivalis is the major causative agent of periodontitis, and it may also be involved in the development of systemic diseases (atherosclerosis, rheumatoid arthritis). P. gingivalis is found on and within oral and gingival epithelial cells following binding to surface components of host cells, which serve as receptors for the bacterium. Evidence is presented in this study that shows that transglutaminase 2 (TG2) plays a critical role in the adherence of P. gingivalis to host cells. Studies of confocal microscopy indicate colocalization of P. gingivalis with TG2 on the surface of HEp-2 epithelial cells, with clusters of TG2 seen at bacterial attachment sites. By silencing the expression of TG2 with siRNA in HEp-2 cells, P. gingivalis association was greatly diminished. The bacterium does not bind well to a mouse fibroblast cell line that produces low amounts of surface TG2, but binding can be restored by introduction of TG2 expressed on a plasmid. TG2 can form very tight complexes with fibronectin (FN), and the complementary binding sites of the two proteins are known. A synthetic peptide that mimics the main FN-binding sequence of TG2 blocks the formation of TG2-FN complexes and is highly effective in inhibiting adherence of P. gingivalis to host cells. These findings provide evidence of a role for cell-surface TG2 in bacterial attachment and subsequent internalization.

High-dose atorvastatin reduces periodontal inflammation: a novel pleiotropic effect of statins

OBJECTIVES

The purpose of this study was to test whether high-dose statin treatment would result in a reduction in periodontal inflammation as assessed by (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT).

BACKGROUND

Periodontal disease (PD) is an independent risk factor for atherosclerosis.

METHODS

Eighty-three adults with risk factors or with established atherosclerosis and who were not taking high-dose statins were randomized to atorvastatin 80 mg vs. 10 mg in a multicenter, double-blind trial to evaluate the impact of atorvastatin on arterial inflammation. Subjects were evaluated using FDG-PET/CT at baseline and at 4 and 12 weeks. Arterial and periodontal tracer activity was assessed while blinded to treatment allocation, clinical characteristics, and temporal sequence. Periodontal bone loss (an index of PD severity) was evaluated using contrast-enhanced CT images while blinded to clinical and imaging data.

RESULTS

Seventy-one subjects completed the study, and 59 provided periodontal images for analysis. At baseline, areas of severe PD had higher target-to-background ratio (TBR) compared with areas without severe PD (mean TBR: 3.83 [95% confidence interval (CI): 3.36 to 4.30] vs. 3.18 [95% CI: 2.91 to 3.44], p = 0.004). After 12 weeks, there was a significant reduction in periodontal inflammation in patients randomized to atorvastatin 80 mg vs. 10 mg (ΔTBR 80 mg vs. 10 mg group: mean -0.43 [95% CI: -0.83 to -0.02], p = 0.04). Between-group differences were greater in patients with higher periodontal inflammation at baseline (mean -0.74 [95% CI: -1.29 to -0.19], p = 0.01) and in patients with severe bone loss at baseline (-0.61 [95% CI: -1.16 to -0.054], p = 0.03). Furthermore, the changes in periodontal inflammation correlated with changes in carotid inflammation (R = 0.61, p < 0.001).

CONCLUSIONS

High-dose atorvastatin reduces periodontal inflammation, suggesting a newly recognized effect of statins. Given the concomitant changes observed in periodontal and arterial inflammation, these data raise the possibility that a portion of that beneficial impact of statins on atherosclerosis relate to reductions in extra-arterial inflammation, for example, periodontitis. (Evaluate the Utility of 18FDG-PET as a Tool to Quantify Atherosclerotic Plaque; NCT00703261).

An interprofessional educational approach to oral health care in the geriatric population

An interprofessional educational approach was used to provide five in-service training sessions for all direct health care providers in a long-term care facility, and one half-day seminar/live webinar for community-licensed health care professionals. Content included presentations by five disciplines: (a) periodontist: oral-systemic relationship, (b) oral pathologist: oral pathology, (c) pharmacist: oral health-pharmacological link, (d) dietitian: oral health-dietary link, and (e) occupational therapist: providing and practicing proper oral hygiene. Significant improvement in posttest scores for the five in-service training sessions and the half-day seminar/live webinar was revealed in t-test results, representing an increase in knowledge gained. Approximately 80% of the 145 participants indicated that they would make a change in patient care. Findings indicate that the in-service training sessions and half-day seminar/live webinar supported development of the geriatric work force by utilizing an interprofessional educational approach which will assist in meeting the oral health care needs of the geriatric population.

Porphyromonas gingivalis peptidylarginine deiminase substrate specificity

While a group of oral commensals have been implicated in the aetiology of chronic periodontitis; the asaccharolytic Gram negative anaerobe Porphyromonas gingivalis is most commonly reported to be associated with severe forms of the disease. Although a variety of human tissues can produce a number of peptidylarginine deiminase (PAD), enzymes that convert peptide bound arginine residues to citrulline, P. gingivalis is one of the few prokaryotes known to express PAD. Protein and peptide citrullination are important in the development of rheumatoid arthritis and in recent years a number of authors have suggested a possible link between periodontitis and rheumatoid arthritis (RA). Indeed, some have linked P. gingivalis directly to RA via the action of PAD. Accordingly, the prime purpose of this study was to further characterise PAD in P. gingivalis cells particular emphasis on substrate specificity, using arginine containing peptides and RA relevant proteins.

METHODS

P. ginigvalis W50 was anaerobically cultured in BHI broth, cells harvested and resuspended in assay buffer. A colourimetric assay was developed to measure citrulline and employed to determine enzyme activity using the substrate BAEE. The assay was employed to investigate the effects of environmental pH and temperature on activity. Citrullination of BAEE by sonicated cells allowed the proportion of intracellular enzyme to be estimated. Enzyme specificity and substrate preference were investigated by using various arginine containing peptides, proteins and arginine analogues, as substrates and measuring the rate of citrullination. The influence of gingipains on citrullination was assessed by measuring the rates of citrullination of bovine serum albumin in the presence of protease inhibitors.

RESULTS

Enzyme activity decreased by 13% following exposure of cells to 60 °C for 10 min. A comparison of intact and disrupted cells indicated that 90% of PAD activity is cell surface associated and the remainder cytoplasmic. Optimal pH for enzyme activity was between pH 7.5 and 8. All small arginine-containing peptides were citrullinated with reaction rates faster than that for free arginine with rates that varied with arginine residue position and number. Arginine analogues exhibited minimal effect and influence when tested as either substrates or competitive inhibitors. Cells were able to citrullinate yeast enolase, human vimentin and fibrin at varying rates. All proteins were modified at slower rates than those for peptide substrates. Inhibition of gingipains had no influence on the rate of protein citrullination.

CONCLUSIONS

P. gingivalis PAD is a primarily cell surface associated, heat stable, enzyme that exhibits optimal activity under alkaline conditions similar to those present in the inflammatory environment. The enzyme displays high specificity for arginine residues in peptides and modified arginine in all positions and the gingipains did not influence the rate of protein citrullination. The ability of the enzyme to convert arginine residues in all proteins tested would indicate that its presence in inflamed tissue may promote autoimmune reactions by creation of altered host epitopes.

Antibody levels to persistent pathogens and incident stroke in Mexican Americans

Background

Persistent pathogens have been proposed as risk factors for stroke; however, the evidence remains inconclusive. Mexican Americans have an increased risk of stroke especially at younger ages, as well as a higher prevalence of infections caused by several persistent pathogens.

Methodology/Principal

Findings Using data from the Sacramento Area Latino Study on Aging (n = 1621), the authors used discrete-time regression to examine associations between stroke risk and (1) immunoglobulin G antibody levels to Helicobacter pylori (H. pylori), Cytomegalovirus, Varicella Zoster Virus, Toxoplasma gondii and Herpes simplex virus 1, and (2) concurrent exposure to several pathogens (pathogen burden), defined as: (a) summed sero-positivity, (b) number of pathogens eliciting high antibody levels, and (c) average antibody level. Models were adjusted for socio-demographics and stroke risk factors. Antibody levels to H. pylori predicted incident stroke in fully adjusted models (Odds Ratio: 1.58; 95% Confidence Interval: 1.09, 2.28). No significant associations were found between stroke risk and antibody levels to the other four pathogens. No associations were found for pathogen burden and incident stroke in fully adjusted models.

Conclusions/Significance

Our results suggest that exposure to H. pylori may be a stroke risk factor in Mexican Americans and may contribute to ethnic differences in stroke risk given the increased prevalence of exposure to H. pylori in this population. Future studies are needed to confirm this association.

Oral health problems and mortality

BACKGROUND/PURPOSE

Previous studies have shown the relationship between individual oral health conditions and mortality; however, the relationship between mortality and multiple oral health conditions has not been examined. This study investigates the link between individual oral health problems and oral comorbidity and mortality risk.

MATERIALS AND METHODS

Data are derived from the National Health and Nutrition Examination Survey 1999-2004, which is linked to the National Death Index for mortality follow-up through 2006. We estimated the risk of mortality among people with three individual oral health conditions-tooth loss, root caries, and periodontitis as well as with oral comorbidity-or having all three conditions.

RESULTS

Significant tooth loss, root caries, and periodontal disease were associated with increased odds of dying. The relationship between oral health conditions and mortality disappeared when controlling for sociodemographic, health, and/or health behavioral indicators. Having multiple oral health problems was associated with an even higher rate of mortality.

CONCLUSION

Individual oral health conditions-tooth loss, root caries, and periodontal disease-were not related to mortality when sociodemographic, health, and/or health behavioral factors were considered, and there was no differential pattern between the three conditions. Multiple oral health problems were associated with a higher risk of dying.

Cardiovascular risk in obese patients with chronic periodontitis: a clinical controlled study

INTRODUCTION: Studies have shown that obesity is considered a risk factor for the development of periodontal disease and cardiovascular events. OBJECTIVE: The objective was to evaluate the risk for cardiovascular diseases (CVDs) in obese patients with and without periodontal. MATERIAL AND METHOD: One hundred patients were divided into four groups: Group O - obese without chronic periodontitis (n=25); Group OP - obese with chronic periodontitis (n=25); Group NO - non-obese without chronic periodontitis (n=25); and Group NOP - non-obese with chronic periodontitis (n=25). Demographic and laboratorial data (total cholesterol, high-density lipoprotein - HDL and low-density lipoprotein - LDL, triglycerides, and glucose); anthropometric measurements (body mass index - BMI; waist circumference - WC; body fat - BF); blood pressure; and periodontal parameters (bleeding on probing - BOP, periodontal probing depth - PPD, and the clinical attachment level - CAL) were evaluated. Cardiovascular risk was obtained according to the PROCAM's score. The correlation between obesity, periodontal disease and risk for CVD was verified by Spearman's test (α = 0.05). RESULT: The group OP showed a statistically higher rate of PPD > 7 mm (11.2 ± 2.03) when compared with other groups, as well as higher levels of triglycerides, total cholesterol, and LDL (p<0.05). The risk for CVD was statistically higher in the group OP (28.1 ± 3.3) when compared with group O (16.5 ± 3.5), group NOP (12.8 ± 3.9), and group NO (7.7 ± 0.9). Obesity and periodontal disease are directly related to a moderate increase in CVD risk (r = 0.53, p <0.0001 and r = 0.62, p <0.0001, respectively). CONCLUSION: It was concluded that obesity and periodontal disease increases the risk to cardiovascular events.

Relationship between periodontal disease, Porphyromonas gingivalis, peripheral vascular resistance markers and coronary artery disease in Asian Indians

INTRODUCTION

A close association exists between oral health and cardiovascular disease. Periodontal disease induces early vascular changes while oral pathogens have been detected in sub gingival and atheromatous plaques. We examined the interrelationship between Periodontal disease, oral bacteria, surrogate sub-clinical markers and coronary artery disease (CAD) in a representative Asian Indian cohort.

MATERIALS AND METHODS

532 Gingivitis cases and 282 Periodontitis cases were assessed for early peripheral vascular changes, namely pulse wave velocity (PWV), arterial stiffness index (ASI) and ankle brachial index (ABI) using computerized oscillometry method. Relative quantitation (RQ) of Porphyromonas gingivalis (Pg) was estimated in saliva samples of 54 Periodontitis, 25 Gingivitis and 51 CAD cases (38 also had oral disease) by Taqman assay by amplifying pathogen-specific gene targets, 16srRNA and IktA, respectively, and 16s universal bacterial rRNA as endogenous control.

RESULTS

PWV and ASI were elevated in Periodontitis compared to Gingivitis cases (p<0.0001) and in those with diabetes and hypertension. Cases with Periodontitis showed higher mean expression of Pg than Gingivitis (0.37±0.05 versus 0.15±0.04, p<0.0001), while CAD patients with oral disease (N=38) showed lower mean Pg expression than those without oral disease (N=13) (0.712±0.119 versus 1.526±0.257, p=0.008). Higher Pg expression was recorded in subjects with diabetes and hypertension.

CONCLUSION

Oral disease induces early changes in the peripheral blood vessels. Further, common presence of Pg in subjects with oral disease, in those with established cardiovascular risk factors and in patients with symptomatic CAD reflects the importance of oral hygiene in the development of Coronary Artery Disease in Asian Indians.

Effects of Aggregatibacter actinomycetemcomitans leukotoxin on endothelial cells

Aggregatibacter actinomycetemcomitans is a human pathogen that produces leukotoxin (LtxA) as a major virulence factor. In this study the effect of LtxA on microvascular endothelial cell viability and phenotype was studied. High doses of single LtxA treatment (500 ng/ml to 5 μg/ml) significantly and irreversibly decreased cell proliferation and induced apoptosis, as assessed by tetrazolium salt and annexin V assay, respectively. Apoptosis was partially inhibited by the pan-caspase inhibitor, z-VAD-fmk. LtxA caused a cell cycle arrest in the G2/M phase after 72 h. Between 500 ng/ml and 5 μg/ml, after long- or short-term stimulation LtxA increased the expression of ICAM-1 and VCAM-1, as well as the percentages of endothelial cells expressing these adhesion molecules. Thus, A. actinomycetemcomitans LtxA has substantial pro-inflammatory effects on human brain endothelial cells by upregulation of ICAM-1 and VCAM-1. Furthermore, LtxA in higher concentration was found to decrease proliferation and induces apoptosis in microvascular endothelial cells.

Periodontitis and systemic diseases: A literature review

Studies have revealed possible link between periodontitis and different systemic diseases. There is need to review this interesting subject. The aims are: to provide a comprehensive literature that can easily be consulted, on the subject; to draw the attention of health practitioners to the impact of oral health on the general well-being; and to emphasize the need for a deeper interaction between medical and dental training. The Medline database was searched for relevant literature by combining each of the following terms, “oral health,” “oral infection,” “periodontitis,” with “systemic diseases.” Manual library search and review of bibliographies of published literature were also conducted. Periodontitis is a constant potential source of infection and has been considered as a separate risk factor for some cardiovascular, respiratory, endocrine, musculoskeletal, and reproductive system related abnormalities. Oral health impacts on the general well-being, and if comprehensive health care is ever to be achieved, oral health should not be seen as a separate, distant, and less important area of health, which is totally unrelated to lifespan and its quality.

Oral hygiene status of individuals with cardiovascular diseases and associated risk factors

Dentist and oral health screening may be the latest weapon in identifying persons at risk of cardiovascular disease. Oral infections, specifically periodontitis, may confer independent risks for different systemic conditions. The risk factors associated with cardiovascular diseases also suggest that the relationship between periodontal disease and diabetes works in both ways. The aim of this study was to support and strengthen the association and relationship between oral hygiene status of individuals with cardiovascular diseases and its associated risk factors. A simple random sampling was carried out in 200 inhabitants of Western Utter Pradesh, India. An oral health visit and examination was made for an equal number of males and females of different age groups with cardiovascular diseases. Evaluation of the oral status was made by means of an oral hygiene index, community periodontal index of treatment needs and loss of attachment. Evaluation of oral status in patients with cardiovascular diseases and in the control group has shown a statistically significant low level of oral health in patients with cardiovascular diseases as compared to control. Prevalence of systemic diseases in different age groups significantly correlated with the prevalence of severe periodontal diseases. Treating gum disease may reduce the risk of heart disease and improve health outcomes for patients with periodontal disease and vascular heart problems.

Lack of association between maternal periodontal status and adverse pregnancy outcomes: a multicentric epidemiologic study

OBJECTIVE(S)

The aim of this study was to explore the relationship between periodontal health and pregnancy outcomes in a large cohort of Italian postpartum women.

METHODS

750 postpartum women were enrolled in a case-control study within 5 days from delivery at three Italian obstetric clinics. Cases were defined as those mothers who delivered an infant weighing under 2500 g (LBW) and/or had premature delivery and/or delivered small for gestational age newborns (SGA) and/or experienced preeclampsia/pregnancy induced hypertension (PE/PIH) or preterm premature rupture of membranes (pPROM) during pregnancy. All women received comprehensive oral and dental examination. Associations between adverse pregnancy outcome and exposures of interest were evaluated by the use of multivariate logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

There was no significant difference between cases and controls with respect to country of birth, age, place of residence, educational achievement, smoking, and periodontal status. By definition, infant birth weight [2,750 g (IQR = 2,300-3,200 g) and 3,275, (IQR = 3,010-3,538 g) p < 0.001, respectively] and gestational age at delivery [259 days (IQR = 245-273) and 273 days (IQR = 266-280), p < 0.01, respectively] were significantly lower in cases than in controls. In multivariate analyses, a borderline association was found between poor obstetric outcomes and current smokers (OR: 1.5; 95% CI: 0.1-2.5). Finally, after adjusting for smoking status neither country of birth, nor age or place of residence or education or periodontitis were associated with a significantly increased risk of adverse pregnancy outcome.

CONCLUSION(S)

Our data failed to demonstrate the association between periodontitis and an adverse pregnancy outcome such as preterm birth, low birth weight, preeclampsia, intrauterine growth restriction, and premature rupture of membranes.

Serum antibodies to periodontal pathogens are a risk factor for Alzheimer's disease

BACKGROUND

Chronic inflammation in periodontal disease has been suggested as a potential risk factor in Alzheimer's disease (AD). The purpose of this study was to examine serum antibody levels to bacteria of periodontal disease in participants who eventually converted to AD compared with the antibody levels in control subjects.

METHODS

Serum samples from 158 participants in the Biologically Resilient Adults in Neurological Studies research program at the University of Kentucky were analyzed for immunoglobulin G antibody levels to seven oral bacteria associated with periodontitis, including Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Campylobacter rectus, Treponema denticola, Fusobacterium nucleatum, Tannerella forsythia, and Prevotella intermedia. All 158 participants were cognitively intact at baseline venous blood draw. In all, 81 of the participants developed either mild cognitive impairment (MCI) or AD or both, and 77 controls remained cognitively intact in the years of follow-up. Antibody levels were compared between controls and subjects with AD at baseline draw and after conversion and controls and subjects with MCI at baseline draw and after conversion using the Wilcoxon rank-sum test. AD and MCI participants were not directly compared. Linear regression models were used to adjust for potential confounding.

RESULTS

Antibody levels to F nucleatum and P intermedia were significantly increased (α = 0.05) at baseline serum draw in the patients with AD compared with controls. These results remained significant when controlling for baseline age, Mini-Mental State Examination score, and apolipoprotein epsilon 4 status.

CONCLUSIONS

This study provides initial data that demonstrate elevated antibodies to periodontal disease bacteria in subjects years before cognitive impairment and suggests that periodontal disease could potentially contribute to the risk of AD onset/progression. Additional cohort studies profiling oral clinical presentation with systemic response and AD and prospective studies to evaluate any cause-and-effect association are warranted.

Periodontitis and diabetes associations with measures of atherosclerosis and CHD

OBJECTIVE

Diabetes has been linked with more severe periodontal disease and with coronary heart disease (CHD). The purpose of this study was to determine if periodontal infection was a significant modifier in the risk that diabetes poses for increased carotid artery intimal-medial wall thickness (IMT) and more advanced atheroma lesions as reflected in atherosclerotic plaque calcification measured by acoustic shadowing.

METHODS AND RESULTS

Comparisons for analyses of cardiovascular outcomes were performed based upon periodontitis and diabetes status. Periodontitis was measured using pocket depth and attachment loss at six sites per tooth. Cross-sectional data on 6048 persons aged 52-74 years were obtained from the Dental Atherosclerosis Risk in Communities Study. Participants without diabetes (n=5257) were compared to those with diabetes (n=791). Dependent variables were thick IMT (>1 mm), presence of acoustic shadowing, and prevalent CHD. All models were adjusted for the following covariates: gender, age, race/center, LDL and HDL cholesterol, BMI, triglycerides, hypertension, smoking, income and education. For multivariate model building, all non-normally distributed variables were transformed and multivariable logistic regression analyses were performed to evaluate the relationship between periodontal infection, diabetes, and cardiovascular outcomes. Individuals with diabetes and with severe periodontitis were found to be significantly more likely to have IMT>1 mm [OR=2.2, (1.4-3.5)], acoustic shadowing [OR=2.5, (1.3-4.6)], and CHD [OR=2.6, (1.6-4.2)] compared to those without diabetes or periodontal disease.

CONCLUSION

Results from this study suggest that among people with diabetes, periodontal disease may increase the likelihood of subclinical atherosclerotic heart disease and CHD.

The association of tooth loss with all-cause and circulatory mortality. Is there a benefit of replaced teeth? A systematic review and meta-analysis

We systematically reviewed whether the number of teeth is related to all-cause or circulatory mortality and whether replaced teeth are protective against all-cause or circulatory mortality. The search was based on the PubMed database. All cohort studies published in peer-reviewed journals were selected. Studies on periodontal disease and mortality were excluded if they did not provide information on the number of teeth. Risk estimates from studies with appropriate exposure definition, confounder adjustment and sample size were included in a meta-analysis. Three high-quality studies found a relationship between the number of teeth and circulatory mortality, whereas a moderate study did not. Two out of four moderate- to high-quality studies reported a relationship between the number of teeth and all-cause mortality. No study has investigated whether replaced teeth are protective against mortality. Therefore, denture use was taken as proxy. The methodological quality of studies on denture use and mortality was generally low to moderate. The findings of two moderate studies indicated an effect of prosthodontic replacements on all-cause mortality, which was supported in bias analysis. It is open whether competing risks of cause-specific death other than circulatory mortality reduce an effect of the number of teeth on all-cause mortality. An effect of denture use on circulatory mortality remains to be established, as well as whether the number of replaced teeth affects mortality. Specifying the role of potential pathways by which tooth loss-related mortality is mediated will possibly increase the value of dental treatment for general health.

A prospective cohort study of periodontal disease measures and cardiovascular disease markers in HIV-infected adults

The determinants of HIV-associated cardiovascular disease (CVD) are not well understood. Periodontal disease (PD) has been linked to CVD but this connection has not been examined in HIV infection. We followed a cohort of HIV-infected adults to ascertain whether PD was associated with carotid artery intima media thickness (IMT) and brachial artery flow-mediated dilation (FMD). We performed a longitudinal observational study of HIV-infected adults on HAART for <2 years with no known heart disease. PD was characterized clinically and microbiologically. Cardiovascular disease was assessed by IMT/FMD. Linear mixed models assessed cross-sectional and longitudinal associations between PD and FMD/IMT. Forty three HIV(+) adults completed a median of 24 (6-44) months on the study. Defining delta to be the change in a variable between baseline and a follow-up time, longitudinally, on average and after adjusting for change in time, CVD-specific and HIV-specific potential confounding covariates, a 1-log(10) increase in delta Porphyromonas gingivalis was associated with a 0.013 mm increase in delta IMT (95% CI: 0.0006-0.0262; p=0.04). After adjusting for the same potential confounding covariates, a 10% increase in delta gingival recession was associated with a 2.3% increase in delta FMD (95% CI: 0.4-4.2; p=0.03). In a cohort of HIV-infected adults, an increase in subgingival Porphyromonas gingivalis, a known periodontal pathogen, was significantly associated with longitudinal increases in IMT, while increased gingival recession, which herein may represent PD resolution, was significantly associated with longitudinal improvement in FMD. In the context of HIV infection, PD may contribute to CVD risk. Intervention studies treating PD may help clarify this association.

The PedsQL™ Oral Health Scale in Iranian children: reliability and validity

OBJECTIVE

The primary objective of the study was to translate and evaluate the psychometric properties of the Pediatric Quality of Life Inventory™ (PedsQL™) Oral Health Scale in over 1000 Iranian children.

METHODS

A standard forward and backward translation procedure was used to convert the US English dialect version of the PedsQL™ Oral Health Scale into the Iranian language (Persian). The Iranian version of the PedsQL™ Oral Health Scale, in combination with the PedsQL™ 4.0 Generic Core Scales, was then subsequently administered to 1053 Iranian children and 1026 parents. The reliability of the PedsQL™ Oral Health Scale was evaluated using internal consistency and test-retest methods. Known-groups discriminant validity, exploratory factor analysis (EFA) of the Oral Health and the four Generic Core Scales combined, and confirmatory factor analysis (CFA) of the Oral Health Scale alone were conducted. The Benjamini-Hochberg procedure was used to correct P-values for multiple comparisons.

RESULTS

Good to excellent internal consistency and test-retest reliabilities were demonstrated. The PedsQL™ Oral Health Scale demonstrated discriminant validity for subgroups of children across different decayed, missing and filled teeth (DMFT) index categories and gender. The EFA supported the a priori factor model of the combined five scales. The CFA analysis confirmed the unidimensional factor structure of the Oral Health Scale.

CONCLUSIONS

The PedsQL™ Oral Health Scale demonstrated excellent psychometric properties in combination with the PedsQL™ 4.0 Generic Core Scales. These five scales combined can be utilized to assess the multidimensional oral-health-related quality of life of Iranian children.

Prospective association of periodontal disease with cardiovascular and all-cause mortality: NHANES III follow-up study

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.

Why Iranian adolescents do not brush their teeth: a qualitative study

OBJECTIVES

To explore and describe attitudes towards tooth-brushing among Iranian adolescents.

METHODS

A series of focus-group sessions were held with 37 Iranian adolescents in schools. The groups comprised five to eight adolescents. All focus-group discussions were tape-recorded and then transcribed verbatim. All transcripts, codes and categories were read several times to extract a theme. Data were analysed using a qualitative content analysis approach.

RESULTS

Four major categories emerged from the analysis: brushing teeth is a necessary evil, parental influence on not brushing teeth, brushing teeth is insignificant, and brushing teeth is a health hazard. The theme identified in the latent content described that tooth-brushing is not part of the adolescents' activities of daily living.

CONCLUSIONS

Health educators should stress on the engagement of parents, awareness of the adolescents on brushing techniques and causes of toothache, and address any misconceptions regarding tooth-brushing.

Residential rurality and oral health disparities: influences of contextual and individual factors

The purposes of the study were (a) to identify disparities between urban and rural adults in oral health and (b) to examine contextual (i.e., external environment and access to dental care) and individual (i.e., predisposing, enabling, and lifestyle behavioral) factors associated with oral health problems in a community population. Study data were derived from a two-stage, telephone-mailed survey conducted in 2006. The subjects were 2,591 adults aged 18 years and older. Cochran-Mantel-Haenszel statistics for categorical variables were applied to explore conditional independence between both health access and individual factors and oral health problems after controlling for the urban or rural residence. Logistic regression was used to investigate the simultaneous associations of contextual and individual factors in both rural and urban areas. Approximately one quarter (24.1%) of the study population reported oral health problems. Participants residing in rural areas reported more oral health disparities. Oral health problems were significantly associated with delaying dental care. These problems also were more common among those who were less educated, were African American, skipped breakfast every day, and currently smoked. The study findings suggest that oral health disparities persist for people in rural areas, and improving oral health status is strongly related to better access to oral health care and improved lifestyles in both rural and urban areas.

Association between chronic azotemic kidney disease and the severity of periodontal disease in dogs

Naturally occurring periodontal disease affects >75% of dogs and has been associated with cardiac lesions and presumptive endocarditis. However, the relationships between periodontal disease and chronic kidney disease (CKD) in dogs have not been studied. In a retrospective longitudinal study the incidence of azotemic CKD was compared between a cohort of 164,706 dogs with periodontal disease and a cohort of age-matched dogs with no periodontal disease from a national primary care practice. These dogs contributed 415,971 dog-years of follow-up from 2002 to 2008. Hazard ratios and 95% confidence intervals from Cox regression were used to compare the incidence of azotemic CKD in dogs with stage 1, 2, or 3/4 periodontal disease to dogs with no periodontal disease. The hazard ratio for azotemic CKD increased with increasing severity of periodontal disease (stage 1 hazard ratio=1.8, 95% confidence interval: 1.6, 2.1; stage 2 hazard ratio=2.0, 95% confidence interval: 1.7, 2.3; stage 3/4 hazard ratio=2.7, 95% confidence interval: 2.3, 3.0; P(trend)=<0.0001) after adjustment for age, gender, neuter status, breed, body weight, number of hospital visits, and dental procedures. Increasing severity of periodontal disease was also associated with serum creatinine >1.4 mg/dl and blood urea nitrogen >36 mg/dl, independent of a veterinarian's clinical diagnosis of CKD.

Review: Pathogen-induced inflammation at sites distant from oral infection: bacterial persistence and induction of cell-specific innate immune inflammatory pathways

A hallmark of infection with the gram-negative pathogen Porphyromonas gingivalis is the induction of a chronic inflammatory response. P. gingivalis induces a local chronic inflammatory response that results in oral inflammatory bone destruction, which manifests as periodontal disease. In addition to chronic inflammation at the initial site of infection, mounting evidence has accumulated supporting a role for P. gingivalis-mediated periodontal disease as a risk factor for several systemic diseases including, diabetes, preterm birth, stroke, and atherosclerotic cardiovascular disease. A growing number of in vitro studies have demonstrated that P. gingivalis infection stimulates cell activation commensurate with expected responses paralleling inflammatory atherosclerotic-type responses. Furthermore, various mouse models have been used to examine the ability of P. gingivalis to stimulate chronic inflammatory plaque accumulation and recent studies have pointed to a pivotal role for innate immune signaling via the Toll-like receptors in the chronic inflammation associated with P. gingivalis infection. In this review we discuss the pathogen and host cell specificity of these responses and discuss possible mechanisms by which this oral pathogen can induce and maintain a chronic state of inflammation at sites distant from oral infection.

Periodontal and coronary heart disease in patients undergoing coronary angiography

Periodontal inflammation has been implicated in atherosclerosis and coronary heart disease (CHD). Coronary angiography (CA) is used in the assessment of CHD; only a few studies have evaluated periodontal disease (PD) and angiographic measures of coronary atherosclerosis. The aim of this study was to investigate the association between CHD and PD. In this prospective epidemiologic study, 466 patients underwent CA and were assessed for PD. All patients underwent physical, laboratory, cardiac, and dental examination including dental x-rays. Periodontal disease and coronary angiograms were evaluated blindly by a dentist and 2 cardiologists, respectively. A coronary stenosis greater than 50% was ruled as CHD. Periodontal disease was defined and measured with the Community Periodontal Index of Treatment Needs (CPITN); and if at least 2 sextants (segments dividing mandible and maxilla into 6) were recorded as having CPITN of at least 3 (signifying that sextant had periodontal pocket depth ≥ 3.5 mm), the patient was coded as having PD. Three-hundred forty-nine patients (74.9%) had CHD assessed by CA The CHD patients had PD in 55.6% vs 41.9% in the non-CHD patients (P < .01). The CPITN scores were significantly higher in patients with vs without CHD, 2.43 vs 2.16, respectively (P = .023). After adjusting for age, sex, and risk factors for atherosclerosis with additional inclusion of C-reactive protein and erythrocyte sedimentation rate, PD remained significantly related to CHD (odds ratio = 1.9; 95% confidence interval, 1.2-3.1). Other predictors for CHD were male sex, age, high-density lipoprotein cholesterol, and diabetes. Our results demonstrate an increased odds ratio for angiographically determined CHD in patients with PD and that CHD and PD may cluster in particular groups of a population. Our data indicate that PD represents a potentially modifiable risk factor that is both preventable and treatable with predictable treatments that pose negligible risk.

Oral disease and subsequent cardiovascular disease in people with type 2 diabetes: a prospective cohort study based on the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial

AIMS/HYPOTHESIS

While there are plausible biological mechanisms linking oral health with cardiovascular disease (CVD) and mortality rates, no study, to our knowledge, has examined this association in a representative population of people with type 2 diabetes.

METHODS

We used the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) study, a large, detailed, randomised controlled trial among a general population of individuals with type 2 diabetes. For the purposes of the present analyses, data from the trial are used within a prospective cohort study design. A total of 10,958 men and women, aged 55 to 88 years and with type 2 diabetes, participated in a baseline medical examination, during which they counted their number of natural teeth and reported the number of days that their gums had bled over the preceding year. Study members were followed up for mortality and morbidity over 5 years.

RESULTS

After controlling for a range of potential confounding factors, the group with no teeth had a markedly increased risk of death due to all causes (HR 1.48, 95% CI 1.24-1.78), CVD (1.35, 1.05-1.74) and non-CVD (1.64, 1.26-2.13), relative to the group with the most teeth (≥22 teeth). Frequency of bleeding gums was not associated with any of the outcomes of interest. There was no suggestion that treatment group or sex modified these relationships.

CONCLUSIONS/INTERPRETATION

In people with type 2 diabetes, oral disease, as indexed by fewer teeth, was related to an increased risk of death from all causes and of death due to CVD and non-CVD.

The core genome of the anaerobic oral pathogenic bacterium Porphyromonas gingivalis

BACKGROUND

The Gram negative anaerobic bacterium Porphyromonas gingivalis has long been recognized as a causative agent of periodontitis. Periodontitis is a chronic infectious disease of the tooth supporting tissues eventually leading to tooth-loss. Capsular polysaccharide (CPS) of P. gingivalis has been shown to be an important virulence determinant. Seven capsular serotypes have been described. Here, we used micro-array based comparative genomic hybridization analysis (CGH) to analyze a representative of each of the capsular serotypes and a non-encapsulated strain against the highly virulent and sequenced W83 strain. We defined absent calls using Arabidopsis thaliana negative control probes, with the aim to distinguish between aberrations due to mutations and gene gain/loss.

RESULTS

Our analyses allowed us to call aberrant genes, absent genes and divergent regions in each of the test strains. A conserved core P. gingivalis genome was described, which consists of 80% of the analyzed genes from the sequenced W83 strain. The percentage of aberrant genes between the test strains and control strain W83 was 8.2% to 13.7%. Among the aberrant genes many CPS biosynthesis genes were found. Most other virulence related genes could be found in the conserved core genome. Comparing highly virulent strains with less virulent strains indicates that hmuS, a putative CobN/Mg chelatase involved in heme uptake, may be a more relevant virulence determinant than previously expected. Furthermore, the description of the 39 W83-specific genes could give more insight in why this strain is more virulent than others.

CONCLUSION

Analyses of the genetic content of the P. gingivalis capsular serotypes allowed the description of a P. gingivalis core genome. The high resolution data from three types of analysis of triplicate hybridization experiments may explain the higher divergence between P. gingivalis strains than previously recognized.

Photoactivated disinfection of Streptococcus intermedius through dentin disc at clinically relevant intervals: an in vitro study

In this present study we have tested the impact of porfimer sodium (Photofrin, AXCAN PHARMA Inc., Quebec, Canada) photoactivated disinfection (PD) on cells of Streptococcus intermedius in suspension. In order to provide basic data to support future clinical studies of PD in dentistry the study used exposure to Quartz-tungsten-halogen (QTH) dental curing light for clinically relevant time periods to activate Photofrin and measured its effectiveness under a variety of conditions including activation through dentin hard tissue. S. intermedius was grown in planktonic suspension for 48h. Nine groups were formed: three control groups (1-3) and six experimental groups (4-9). Groups 4-6 tested the use of Photofrin treatment combined with QTH light at various intervals of irradiation (5, 15 and 60s). Groups 7-9 were similar to groups 4-6 with the exception that irradiation commenced through a dentin disc. Following treatment, bacteria were plated. Colony counts were measured following 72h incubation at 37 degrees C. Statistical analysis was carried out by one-way ANOVA at a 95% confidence level. A significant reduction in S. intermedius colony counts was observed for all experimental groups and one control group. The reduction in numbers of colonies in the experimental groups varied from 79.28 to 99.40% with an average of 94.61%. Reduction in viable bacterial cells indicated a strong relationship between power density and irradiation interval. When curing light energy density was lower due to the irradiation through the 1mm dentin disc, prolonged irradiation interval enhanced bacterial kill. In conclusion, where direct irradiation is not possible for PD treatment, irradiation through dentin may still be done successfully within a clinically relevant interval.

The link between periodontal disease and cardiovascular disease: How far we have come in last two decades ?

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.

Development of a novel PCR method to comprehensively analyze salivary bacterial flora and its application to patients with odontogenic infections

OBJECTIVE

The objective of this study was to develop a novel polymerase chain reaction (PCR) method to comprehensively analyze salivary bacterial flora.

STUDY DESIGN

The bacterial flora in the saliva of 10 healthy persons and 11 patients with odontogenic infections were examined using a DNA extraction method with a high level of cell destruction efficiency and a novel universal primer set to amplify approximately 580 bp of the 16S rDNA sequence.

RESULTS

Streptococcus (54.5%), Neisseria (14.7%), Actinomyces (8.4%), Gemella (4.1%), Granulicatella (3.8%), and Prevotella (1.4%) were dominant in a total of 1655 clones examined from the saliva of the healthy subjects. The dominant genera differed among the patients with odontogenic infections (a total of 823 clones) and were entirely different from those of the healthy subjects.

CONCLUSION

This novel comprehensive salivary bacterial flora analysis method may be a useful supportive method to identify causative agents of odontogenic infections.

Do genetic factors explain the association between poor oral health and cardiovascular disease? A prospective study among Swedish twins

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.

Prevalence of periodontal pathogens in coronary atherosclerotic plaque of patients undergoing coronary artery bypass graft surgery

BACKGROUND

Chronic bacterial infections have been associated with an increased risk for atherosclerosis and coronary artery disease. The ability of oral pathogens to colonize in coronary atheromatous plaque is well known. The aim of our study was to detect the presence of four common periodontal pathogens in coronary plaques. We detected the presence of 16S rRNA of Treponema denticola, Eikenella Corrodens, Porphyromonas gingivalis and Campylobacter rectus in subgingival and atherosclerotic plaques of CABG surgery by using Polymerase Chain Reaction.

METHODS

51 patients in the age group of 40 to 80 years with chronic periodontitis were recruited for the study. These patients were suffering from Coronary Artery Disease (CAD) and underwent Coronary Artery Bypass Grafting (CABG). DNA was extracted from the subgingival plaque and coronary atheromatous plaque samples. Universal Primer for the general detection of bacterial DNA and the primers for T.denticola, E. Corrodens, C.rectus and P.gingivalis were used to amplify part of 16SrRNA gene by Polymerase Chain Reaction.

RESULTS

T.denticola, E.corrodens, C.rectus and P.gingivalis were detected in 49.01 %, 27.45 %, 21.51% and 45.10% of atherosclerotic plaque samples. In both subgingival and coronary plaque samples, T. denticola was detected in 39.21% of the cases, E.corrodens in 19.60%, C.rectus in 11.76% and P.gingivalis in 39.22% of the cases respectively.

CONCLUSION

Our study revealed the presence of significant bacterial DNA of oral pathogens in coronary plaques. This suggests possible relationship between periodontal infection and atherosclerosis and can help devise preventive treatment strategies.