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Barnawi BM, Alanazi MM, Al-Mutiri FA, Alqahtani RS, Al-Harbi MS, Al-Raqqas SK, Mahjoub WK, Alsetri MM, Al-Sultan ZM, Alghamdi GM, Almutawah RI. Interlinked Pathways: Exploring the Bidirectional Impacts of Periodontitis and Metabolic Syndrome. Cureus 2024; 16:e67544. [PMID: 39310407 PMCID: PMC11416629 DOI: 10.7759/cureus.67544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/25/2024] Open
Abstract
Metabolic syndrome (MBS) and periodontitis are distinct conditions with overlapping and unique risk factors. Periodontitis is a chronic destructive disease of the periodontium, driven by alterations in the host immune-inflammatory response to virulent periodontal pathogens. MBS is characterized by various abnormalities, including visceral abdominal obesity, dyslipidemia (low high-density lipoprotein (HDL) and high triglyceride (TG) levels), hypertension, and hyperglycemia. These factors collectively increase the risk of atherosclerotic cardiovascular disease (CVD) and diabetes. Several pro-inflammatory mediators are involved in the pathogenesis of periodontitis and MBS, and the deleterious bidirectional effects of these mediators exacerbate the severity and progression of both conditions. This comprehensive review focuses on the intricate relationship between MBS and periodontitis. Specifically, it explores the pathophysiological mechanisms of each disease component of MBS and its impact on periodontitis, and vice versa.
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Affiliation(s)
| | - Maram M Alanazi
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Fai A Al-Mutiri
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Rahaf S Alqahtani
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Madhawi S Al-Harbi
- College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Nicolosi G, Donzella M, Polizzi A, Angjelova A, Santonocito S, Zanoli L, Annunziata M, Isola G. Early detection of cardiovascular risk markers through non-invasive ultrasound methodologies in periodontitis patients. Open Med (Wars) 2024; 19:20241003. [PMID: 39034949 PMCID: PMC11260002 DOI: 10.1515/med-2024-1003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/07/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024] Open
Abstract
Objectives This narrative review aims to update the current evidence and offer insight into the new non-invasive ultrasound techniques used to early identify degenerative vascular changes in subjects with periodontitis and to investigate if these methodologies could be useful to identify subclinical cardiovascular disease (CVD) dysfunction in periodontitis patients and to monitor changes in CVD risk after periodontal treatment. Methods Studies examining the assessment of vascular endothelial function through the latest methodologies were analyzed. Systematic reviews, observational studies, and clinical trials in the English language were identified using PubMed, Web of Science, and Google Scholar databases with key search terms such as "periodontitis," "endothelial dysfunction (ED)," "arterial stiffness," and "periodontal therapy." Results Several mechanisms are involved in the association between periodontitis and CVD. The key players are periodontal bacteria and their toxins, which can enter the circulation and infiltrate blood vessel walls. The increase in proinflammatory molecules such as interleukins and chemokines, c-reactive protein, fibrinogen, and oxidative stress also plays a decisive role. In addition, an increase in parameters of ED, arterial stiffness, and atherosclerosis, such as carotid intima-media thickness, pulse wave velocity, and flow-mediated dilatation, has been shown in periodontal patients. Conclusions The literature today agrees on the association of periodontitis and CVD and the positive role of periodontal therapy on systemic inflammatory indices and cardiovascular outcomes. Hopefully, these non-invasive methodologies could be extended to periodontal patients to provide a comprehensive understanding of the CVD-periodontitis link from the perspective of a personalized medicine approach in periodontology.
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Affiliation(s)
- Giada Nicolosi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124, Catania, Italy
| | - Martina Donzella
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124, Catania, Italy
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124, Catania, Italy
| | - Angela Angjelova
- University Dental Clinical Center St. Pantelejmon, Faculty of Dentistry, Ss. Cyril and Methodius University in Skopje, 1000, Skopje, North Macedonia
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124, Catania, Italy
| | - Luca Zanoli
- Department of Clinical and Experimental Medicine, University of Catania, 95123, Catania, Italy
| | - Marco Annunziata
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124, Catania, Italy
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Angjelova A, Jovanova E, Polizzi A, Laganà L, Santonocito S, Ragusa R, Isola G. Impact of Periodontitis on Endothelial Risk Dysfunction and Oxidative Stress Improvement in Patients with Cardiovascular Disease. J Clin Med 2024; 13:3781. [PMID: 38999345 PMCID: PMC11242897 DOI: 10.3390/jcm13133781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Periodontitis is a multifactorial chronic inflammatory disease that affects the periodontium and overall oral health and is primarily caused by a dysbiotic gingival biofilm, which includes, among others, Gram-negative bacteria such as Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, and Tannerella forsythensis that colonize gingival tissues and that can lead, if not properly treated, to periodontal tissue destruction and tooth loss. In the last few decades, several large-scale epidemiological studies have evidenced that mild and severe forms of periodontitis are strictly bilaterally associated with several cardiovascular diseases (CVDs), stroke, and endothelial dysfunction. Specifically, it is hypothesized that patients with severe periodontitis would have compromised endothelial function, a crucial step in the pathophysiology of atherosclerosis and several CVD forms. In this regard, it was postulated that periodontal treatment would ameliorate endothelial dysfunction, hence bolstering the notion that therapeutic approaches targeted at diminishing cardiovascular risk factors and different forms of periodontal treatment could improve several CVD biomarker outcomes in the short- and long-term in CVD patients. The aim of this review is to update and analyze the link between periodontitis and CVD, focusing on the inflammatory nature of periodontitis and its correlation with CVD, the effects of periodontal therapy on endothelial dysfunction and oxidative stress, and the impact of such therapy on CVD biomarkers and outcomes. The article also discusses future research directions in this field.
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Affiliation(s)
- Angela Angjelova
- University Dental Clinical Center St. Pantelejmon, Skopje, Faculty of Dentistry, Ss. Cyril and Methodius University in Skopje, 1000 Skopje, North Macedonia
| | - Elena Jovanova
- University Dental Clinical Center St. Pantelejmon, Skopje, Faculty of Dentistry, Ss. Cyril and Methodius University in Skopje, 1000 Skopje, North Macedonia
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Ludovica Laganà
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Rosalia Ragusa
- Health Direction of Policlinic Hospital, 95100 Catania, Italy
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
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Brun A, Petit C, Huck O, Bouchard P, Carra MC, Gosset M. [Periodontitis : An underestimated risk of cardiovascular diseases]. Med Sci (Paris) 2024; 40:35-41. [PMID: 38299901 DOI: 10.1051/medsci/2023193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Epidemiological studies have identified periodontitis as a contributing factor to cardiovascular risk. Periodontitis is a chronic inflammatory disease that affects the tissues supporting the teeth. Although the nature of the association between periodontitis and cardiovascular disease (CVD) remains to be defined, the low-grade systemic inflammation and chronic bacteremia associated with periodontitis appear to be involved in the development of atherosclerosis and associated cardiovascular pathologies. Periodontal treatment has been shown to improve cardiovascular health parameters. A bidirectional preventive approach, involving the management of both periodontitis and cardiovascular risk factors, could lead to a reduction in morbidity and mortality related to cardiovascular disease.
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Affiliation(s)
- Adrian Brun
- Unité de recherche URP2496, Biomedical Research In Odontology (BRIO), France - Université Paris Cité, faculté de santé, UFR d'odontologie, Montrouge, France - Hôpital Henri Mondor (AP-HP), service de médecine bucco-dentaire, Créteil, France
| | - Catherine Petit
- Laboratoire de nanomédecine régénérative, Inserm UMR 1260, CRBS, 1 rue Eugène Boeckel, 67000 Strasbourg, France - Département de parodontologie, faculté de chirurgie dentaire Robert Frank, Strasbourg, France - Hôpitaux universitaires de Strasbourg, pôle de médecine et chirurgie bucco-dentaire, Strasbourg, France
| | - Olivier Huck
- Laboratoire de nanomédecine régénérative, Inserm UMR 1260, CRBS, 1 rue Eugène Boeckel, 67000 Strasbourg, France - Département de parodontologie, faculté de chirurgie dentaire Robert Frank, Strasbourg, France - Hôpitaux universitaires de Strasbourg, pôle de médecine et chirurgie bucco-dentaire, Strasbourg, France
| | - Philippe Bouchard
- Unité de recherche URP2496, Biomedical Research In Odontology (BRIO), France - Université Paris Cité, faculté de santé, UFR d'odontologie, Montrouge, France - Hôpital Rothschild (AP-HP), service d'odontologie, 5 rue Santerre 75012 Paris
| | - Maria Clotilde Carra
- Université Paris Cité, faculté de santé, UFR d'odontologie, Montrouge, France - Hôpital Rothschild (AP-HP), service d'odontologie, 5 rue Santerre 75012 Paris - Epidemiology and Statistics Research Centre, Inserm UMR1153, Paris, France
| | - Marjolaine Gosset
- Unité de recherche URP2496, Biomedical Research In Odontology (BRIO), France - Université Paris Cité, faculté de santé, UFR d'odontologie, Montrouge, France - Hôpital Charles Foix (AP-HP), service de médecine bucco-dentaire, Ivry/Seine, France
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Chauhan N, Mittal S, Tewari S, Sen J, Laller K. Effect of endodontic treatment on endothelial dysfunction and subclinical atherosclerosis-a prospective intervention study. Clin Oral Investig 2023; 27:5617-5625. [PMID: 37522992 DOI: 10.1007/s00784-023-05183-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE The objective of this study is to investigate the effect of endodontic treatment on flow-mediated dilatation (FMD) and carotid intima-media thickness (c-IMT) in patients with apical periodontitis (AP). MATERIAL AND METHOD The study includes 32 young men having AP with a mean age of 25.78 years free from cardiovascular disease (CVD) and its risk factors, including periodontitis. All subjects underwent complete physical and dental examination, echocardiography, and ultrasound assessment of FMD on the brachial artery and c-IMT on the carotid artery at baseline and 12 months after the endodontic treatment. Data were analyzed using paired Student's t-test and Pearson's correlation coefficient (r) test using SPSS 26 version. RESULTS Endodontic treatment leads to the improvement of FMD significantly from a pooled baseline value of 4.84 ± 1.55% to 7.68 ± 2.08% (p < 0.05). The study also depicts a statistically significant difference between c-IMT (mean = 0.62 ± 0.11 mm) before treatment as compared to 12 months after treatment (mean = 0.59 ± 0.11 mm) (p < 0.05). CONCLUSION Endodontic treatment leads to improved FMD and decreased c-IMT suggesting that treating AP can be help revert the early stages of CVD. CLINICAL RELEVANCE AP could be a potential etiological factor of future CVD and should be treated as soon as diagnosed.
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Affiliation(s)
- Nishant Chauhan
- Post Graduate Institute of Dental Sciences, Rohtak, Haryana, 124001, India.
| | - Shweta Mittal
- Post Graduate Institute of Dental Sciences, Rohtak, Haryana, 124001, India
| | - Sanjay Tewari
- Post Graduate Institute of Dental Sciences, Rohtak, Haryana, 124001, India
| | - Jyotsna Sen
- Post Graduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
| | - Kuldip Laller
- Post Graduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India
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Cicmil S, Cicmil A, Pavlic V, Krunić J, Sladoje Puhalo D, Bokonjić D, Čolić M. Periodontal Disease in Young Adults as a Risk Factor for Subclinical Atherosclerosis: A Clinical, Biochemical and Immunological Study. J Clin Med 2023; 12:jcm12062197. [PMID: 36983201 PMCID: PMC10051366 DOI: 10.3390/jcm12062197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
Although a strong relationship between periodontal disease (PD) and atherosclerosis was shown in adults, little data are published in younger PD patients. Therefore, this study aimed to investigate and correlate clinical parameters of PD, pro- and immunoregulatory cytokines in gingival crevicular fluid (GCF) and serum, biochemical and hematological parameters associated with atherosclerosis risk, and carotid intima-media thickness (IMT) in our younger study participants (n = 78) (mean age 35.92 ± 3.36 years) who were divided into two equal groups: subjects with and without PD. PD patients had higher values of IMT, hs-CRP, triglycerides, total cholesterol, and LDL; most proinflammatory and Th1/Th17-associated cytokines in GCF; and IL-8, IL-12, IL-18, and IL-17A in serum compared to subjects without PD. These cytokines in GCF positively correlated with most clinical periodontal parameters. Clinical periodontal parameters, TNF-α and IL-8 in GCF and IL-17A, hs-CRP, and LDL in serum, had more significant predictive roles in developing subclinical atherosclerosis (IMT ≥ 0.75 mm) in comparison with other cytokines, fibrinogen, and other lipid status parameters. Hs-CRP correlated better with the proinflammatory cytokines than the parameters of lipid status. Except for serum IL-17A, there was no significant association of clinical and immunological PD parameters with lipid status. Overall, these results suggest that dyslipidemia and PD status seem to be independent risk factors for subclinical atherosclerosis in our younger PD population.
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Affiliation(s)
- Smiljka Cicmil
- Department of Oral Rehabilitation, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
- Correspondence:
| | - Ana Cicmil
- Department of Oral Rehabilitation, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Verica Pavlic
- Department of Periodontology and Oral Medicine, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
- Department of Periodontology and Oral Medicine, The Republic of Srpska, Institute of Dentistry, 78000 Banja Luka, Bosnia and Herzegovina
| | - Jelena Krunić
- Department of Dental Pathology, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Dragana Sladoje Puhalo
- Department of Biochemistry, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Dejan Bokonjić
- Department of Pediatrics, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Miodrag Čolić
- Center for Biomedical Sciences, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
- Serbian Academy of Sciences and Arts, 11000 Belgrade, Serbia
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Association between cardiovascular diseases and periodontal disease: more than what meets the eye. Drug Target Insights 2023; 17:31-38. [PMID: 36761891 PMCID: PMC9906023 DOI: 10.33393/dti.2023.2510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/10/2022] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular diseases (CVDs) are inflammatory diseases of coronary arteries accompanying atheroma formation that can spawn impairment and, in severe cases, death. CVDs are the leading cause of death in the world. In recent decades, investigators have focused their impact on CVD by periodontal disease (PD). PD is a risk factor that can trigger the formation, maturation, and instability of atheroma in the arteries. Two mechanisms have been proposed to explain this relationship: periodontopathic pathogens explicitly invade the circulation or indirectly increase systemic levels of inflammatory mediators. It has been suggested that improvement in disease state has a positive effect on others. This review summarizes evidence from epidemiological studies as well as researches focusing on potential causation channels to deliver a comprehensive representation of the relationship between PD and CVD.
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Chaudhry A, Kassim NK, Zainuddin SLA, Taib H, Ibrahim HA, Ahmad B, Hanafi MH, Adnan AS. Potential Effects of Non-Surgical Periodontal Therapy on Periodontal Parameters, Inflammatory Markers, and Kidney Function Indicators in Chronic Kidney Disease Patients with Chronic Periodontitis. Biomedicines 2022; 10:biomedicines10112752. [PMID: 36359271 PMCID: PMC9687126 DOI: 10.3390/biomedicines10112752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic kidney disease (CKD) and chronic periodontitis (CP) contribute to the increased level of inflammatory biomarkers in the blood. This study hypothesized that successful periodontal treatment would reduce the level of inflammatory biomarkers in CKD patients. This prospective study recruited two groups of CP patients: 33 pre-dialysis CKD patients and 33 non-CKD patients. All patients underwent non-surgical periodontal therapy (NSPT). Their blood samples and periodontal parameters were taken before and after six weeks of NSPT. The serum level of high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and periodontal parameters were compared between groups. On the other hand, kidney function indicators such as serum urea and estimated glomerular filtration rate (eGFR) were only measured in CKD patients. Clinical periodontal parameters and inflammatory markers levels at baseline were significantly higher (p < 0.05) in the CKD group than in the non-CKD group and showed significant reduction (p < 0.05) after six weeks of NSPT. CKD patients demonstrated a greater periodontitis severity and higher inflammatory burden than non-CKD patients. Additionally, CKD patients with CP showed a good response to NSPT. Therefore, CKD patients’ periodontal health needs to be screened for early dental interventions and monitored accordingly.
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Affiliation(s)
- Ahmed Chaudhry
- Periodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Nur Karyatee Kassim
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Basic Sciences and Medical Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Chemical Pathology Department, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Correspondence: ; Tel.: +60-199-822-305
| | - Siti Lailatul Akmar Zainuddin
- Periodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Haslina Taib
- Periodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Hanim Afzan Ibrahim
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Basic Sciences and Medical Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Chemical Pathology Department, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Basaruddin Ahmad
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Biostatics Unit, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Muhammad Hafiz Hanafi
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Azreen Syazril Adnan
- Advanced Medical & Dental Institute, Universiti Sains Malaysia, Bertam, Jalan Tun Hamdan Sheikh Tahir, Pulau Pinang 13200, Malaysia
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Intensive Periodontal Treatment Does Not Affect the Lipid Profile and Endothelial Function of Patients with Type 2 Diabetes: A Randomized Clinical Trial. Biomedicines 2022; 10:biomedicines10102524. [PMID: 36289786 PMCID: PMC9599760 DOI: 10.3390/biomedicines10102524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/23/2022] [Accepted: 10/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Local eradication of periodontal infection could potentially have a much broader impact on the diabetic condition by also contributing to the modification of the lipid profile, which is directly compromised in the alteration of endothelium-dependent vasodilation. The aim of this trial was to assess the benefits of intensive periodontal treatment (IPT) on the lipid profile and endothelial function of diabetic patients. Methods: This was a 6-month, randomized controlled trial involving diabetic patients with generalized periodontitis. The study group comprised 290 individuals who were randomly assigned to receive Intensive Periodontal Treatment (IPT, Intervention Group) or conventional adult prophylaxis (Control Periodontal Treatment, CPT, Control Group). Outcomes encompassed lipid profile involving serum total cholesterol, serum triglyceride, low-density lipoprotein cholesterol, high-density lipo-protein cholesterol, and flow-mediated vasodilation (FMD) as an index of endothelium-dependent vasodilation (primary outcomes); periodontal indices and high-sensitive C-reactive protein were evaluated at baseline, 3 and 6 months after periodontal treatment. Results: An increase in endothelium-dependent flow-mediated dilatation (FMD) was observed in the Intensive Periodontal Treatment group in comparison with Control (p < 0.001), but results are not statistically different. There were no differences in lipid profile in individuals of both groups. Conclusions: An intensive periodontal treatment might improve endothelial function, suggesting a direct beneficial effect on the vasculature, possibly mediated by systemic inflammatory reduction. However, no statistically significant differences between groups were observed, and no benefits were proved on lipid profile.
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Ding L, You Q, Jiang Q, Cao S, Jiang S. Meta-analysis of the association between periodontal disease, periodontal treatment and carotid intima-media thickness. J Periodontal Res 2022; 57:690-697. [PMID: 35700316 DOI: 10.1111/jre.13006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
Periodontal disease is a major threat to oral health and would further contribute to systemic diseases without timely control. We aimed to evaluate the relation between periodontal disease, periodontal treatment and carotid intima-media thickness (CIMT) based on available epidemiological and clinical evidence. PubMed and Scopus were searched for relevant studies through May 2021. Observational studies reporting risk estimates with 95% confidence intervals (95% CIs) for the association between periodontal disease (including periodontitis and gingivitis) and risk of increased CIMT (defined as CIMT value that exceeded the cut-off value of clinical and prognostic significance), as well as interventional studies providing mean values with standard deviations of CIMT before and after periodontal intervention, were included. Random-effect models for meta-analysis were used to calculate the summary effect estimates with 95% CIs. A total of 406 citations were retrieved from electronic databases and 45 full-text articles were screened, leaving 11 articles using ultrasound to measure CIMT with 8744 participants included. Pooled results of seven cross-sectional studies involving 8558 participants indicated that compared to those without periodontitis, patients with periodontitis and those with severe periodontitis had an odds ratio of 1.42 (95% CI: 1.16, 1.75) and 1.70 (95% CI: 1.24, 2.33) for increased CIMT, respectively. Although publication bias was detected in these results, odds ratios corrected by the trim-and-fill method were still statistically significant. Results of four non-randomized controlled trials with 186 patients suggested that periodontal intervention may help reduce CIMT in patients with periodontal disease in the short term. Periodontitis, especially severe periodontitis, was significantly associated with the risk of increased CIMT. Periodontal intervention might help slow the progression of carotid intima-media thickening in patients with periodontal disease in the short term.
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Affiliation(s)
- Lifang Ding
- Department of Stomatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qiqi You
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingqing Jiang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengjun Jiang
- Department of Stomatology, Renmin Hospital of Wuhan University, Wuhan, China
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Irwandi RA, Kuswandani SO, Harden S, Marletta D, D'Aiuto F. Circulating inflammatory cell profiling and periodontitis: A systematic review and meta-analysis. J Leukoc Biol 2022; 111:1069-1096. [PMID: 35199874 DOI: 10.1002/jlb.5ru1021-524r] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 12/13/2022] Open
Abstract
Inflammation is a key driver of common noncommunicable diseases. Among common triggers of inflammation, chronic gingival inflammation (periodontitis) triggers a consistent humoral host inflammatory response, but little is known on its impact on circulating inflammatory cell profiles. We aimed to systematically appraise all the evidence linking periodontitis and its treatment to circulating inflammatory cell profiles. From 6 databases, 157 studies were eligible for qualitative synthesis and 29 studies for meta-analysis. Our meta-analysis showed that participants with periodontitis exhibited a significant mean increase in circulating CD4+ , CD4+ CD45RO+ , IFNγ-expressing CD4+ and CD8+ T cells, CD19+ CD27+ and CD5+ B cells, CD14+ CD16+ monocytes, and CD16+ neutrophils but decrease in CD8+ T and CD14++ CD16- monocytes. Our qualitative synthesis revealed that peripheral blood neutrophils of patients with periodontitis consistently showed elevated production of reactive oxygen species (ROS) when compared with those of healthy controls. Some evidence suggested that the treatment of periodontitis reversed the exaggerated ROS production, but limited and inconclusive data were found on several circulating inflammatory cell profiling. We conclude that periodontitis and its treatment are associated with minor but consistent alterations in circulating inflammatory cell profiles. These changes could represent key mechanisms explaining the association of periodontitis with other comorbidities such as cardiovascular disease, diabetes, and rheumatoid arthritis.
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Affiliation(s)
- Rizky A Irwandi
- Periodontology Unit, Eastman Dental Institute, University College London, London, United Kingdom
| | - Sandra O Kuswandani
- Periodontology Unit, Eastman Dental Institute, University College London, London, United Kingdom.,Department of Periodontology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia
| | - Simon Harden
- Department of Statistical Science, University College London, London, United Kingdom
| | - Debora Marletta
- Cruciform Hub, University College London, London, United Kingdom
| | - Francesco D'Aiuto
- Periodontology Unit, Eastman Dental Institute, University College London, London, United Kingdom
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Nayanar B, Hemanth B, Fareed N, Praveena J. Effect of periodontal therapy on endothelial dysfunction – A systematic review. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2022. [DOI: 10.4103/jiaphd.jiaphd_6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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13
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Yu YH, Cheung WS, Steffensen B, Miller DR. Number of teeth is associated with all-cause and disease-specific mortality. BMC Oral Health 2021; 21:568. [PMID: 34749715 PMCID: PMC8574051 DOI: 10.1186/s12903-021-01934-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tooth loss has been shown to correlate with multiple systemic comorbidities. However, the associations between the number of remaining natural teeth (NoT) and all-cause mortality have not been explored extensively. We aimed to investigate whether having fewer NoT imposes a higher risk in mortality. We tested such hypotheses using three groups of NoT (20-28,10-19, and 0-9), edentulism and without functional dentition (NoT < 19). METHODS The National Health and Nutrition Examination Survey in the United States (NHANES) (1999-2014) conducted dental examinations and provided linkage of mortality data. NHANES participants aged 20 years and older, without missing information of dental examination, age, gender, race, education, income, body-mass-index, smoking, physical activities, and existing systemic conditions [hypertension, total cardiovascular disease, diabetes, and stroke (N = 33,071; death = 3978), or with femoral neck bone mineral density measurement (N = 13,131; death = 1091)] were analyzed. Cox proportional hazard survival analyses were used to investigate risks of all-cause, heart disease, diabetes and cancer mortality associated with NoT in 3 groups, edentulism, or without functional dentition. RESULTS Participants having fewer number of teeth had higher all-cause and disease-specific mortality. In fully-adjusted models, participants with NoT0-9 had the highest hazard ratio (HR) for all-cause mortality [HR(95%CI) = 1.46(1.25-1.71); p < .001], mortality from heart diseases [HR(95%CI) = 1.92(1.33-2.77); p < .001], from diabetes [HR(95%CI) = 1.67(1.05-2.66); p = 0.03], or cancer-related mortality [HR(95%CI) = 1.80(1.34-2.43); p < .001]. Risks for all-cause mortality were also higher among the edentulous [HR(95%CI) = 1.35(1.17-1.57); p < .001] or those without functional dentition [HR(95%CI) = 1.34(1.17-1.55); p < .001]. CONCLUSIONS Having fewer NoT were associated with higher risks for all-cause mortality. More research is needed to explore possible biological implications and validate our findings.
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Affiliation(s)
- Yau-Hua Yu
- Department of Periodontology, Tufts University School of Dental Medicine, One Kneeland Street, Boston, MA, 02111, USA.
| | - Wai S Cheung
- Department of Periodontology, Tufts University School of Dental Medicine, One Kneeland Street, Boston, MA, 02111, USA
| | - Bjorn Steffensen
- Department of Periodontology, Tufts University School of Dental Medicine, One Kneeland Street, Boston, MA, 02111, USA
| | - Donald R Miller
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, VA Bedford Health Care System, Bedford, MA, USA
- School of Public Health, Department of Health Law, Policy and Management, Boston University, Boston, MA, USA
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14
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Fischer RG, Gomes Filho IS, Cruz SSD, Oliveira VB, Lira-Junior R, Scannapieco FA, Rego RO. What is the future of Periodontal Medicine? Braz Oral Res 2021; 35:e102. [PMID: 34586216 DOI: 10.1590/1807-3107bor-2021.vol35.0102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 01/14/2023] Open
Abstract
In the last five decades, considerable progress has been made towards understanding the etiology and pathogenesis of periodontal diseases and their interactions with the host. The impact of an individual periodontal condition on systemic homeostasis became more evident because of this knowledge and prompted advances in studies that associate periodontitis with systemic diseases and conditions. The term Periodontal Medicine describes how periodontal infection/inflammation can affect extraoral health. This review presents the current scientific evidence on the most investigated associations between periodontitis and systemic diseases and conditions, such as cardiovascular diseases, diabetes, preterm birth and low birth weight, and pneumonia. Additionally, other associations between periodontitis and chronic inflammatory bowel disease, colorectal cancer, and Alzheimer's disease that were recently published and are still poorly studied were described. Thus, the aim of this review was to answer the following question: What is the future of Periodontal Medicine? Epidemiological evidence and the evidence of biological plausibility between periodontitis and general health reinforce the rationale that the study of Periodontal Medicine should continue to advance, along with improvements in the epidemiological method, highlighting the statistical power of the studies, the method for data analysis, the case definition of periodontitis, and the type of periodontal therapy to be applied in intervention studies.
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Affiliation(s)
- Ricardo Guimarães Fischer
- Universidade do Estado do Rio de Janeiro - UERJ, Department of Periodontology, Rio de Janeiro, RJ, Brazil
| | - Isaac Suzart Gomes Filho
- Universidade Estadual de Feira de Santana - UEFS, Department of Health, Feira de Santana, BA, Brazil
| | - Simone Seixas da Cruz
- Universidade Federal do Recôncavo da Bahia - UFRB, Health Sciences Center, Santo Antônio de Jesus, BA, Brazil
| | - Victor Bento Oliveira
- Universidade Federal do Ceará - UFC, Faculty of Pharmacy, Dentistry and Nursing, Graduate Program in Dentistry, Fortaleza, CE, Brazil
| | | | - Frank Andrew Scannapieco
- The State University of New York, Univeristy at Buffalo, School of Dental Medicine, Department of Oral Biology, Buffalo, NY, USA
| | - Rodrigo Otávio Rego
- Universidade Federal do Ceará - UFC, School of Dentistry, Department of Dentistry, Sobral, CE, Brazil
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15
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Erdal E, Ustaoğlu G, Karaş Z, Bilgin S. Investigation of patients with coronary slow flow in terms of periodontal health status. Rev Assoc Med Bras (1992) 2021; 67:561-565. [PMID: 34495061 DOI: 10.1590/1806-9282.20201043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the relationship between periodontal health status and coronary slow flow phenomenon. METHODS One hundred and two patients who underwent coronary angiography with the diagnosis of stable angina pectoris were included in the study. Patients were divided into two groups: patients with coronary slow flow (Test group) (n=51), and patients with normal coronary angiography (Control group) (n=51). Diagnosis of slow coronary flow was made according to Beltrame criteria by coronary angiography. Demographic characteristics of the participants were recorded. The periodontal health was assessed by clinical periodontal parameters such as probing depth, clinical attachment level, gingival index, plaque index, and bleeding on probing. RESULTS There were no significant differences between groups as regards the frequencies of hypertension, smoking (p>0.05). As for the periodontal parameters of the study groups, probing depth, gingival index, plaque index, bleeding on probing, and clinical attachment level values were statistically higher in the test group compared to the control group (p<0.05). CONCLUSIONS Periodontitis might be accepted as one of the underlying causes of coronary slow flow. Patients with coronary slow flow should be evaluated for an underlying periodontal disease, and treatment of periodontal disease can protect against future cardiovascular events.
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Affiliation(s)
- Emrah Erdal
- Bolu Abant Izzet Baysal University, Medical Faculty, Department of Cardiology - Bolu, Turkey
| | - Gülbahar Ustaoğlu
- Bolu Abant Izzet Baysal University, Dentistry Faculty, Department of Periodontology - Bolu, Turkey
| | - Zeynep Karaş
- Bolu Abant Izzet Baysal University, Dentistry Faculty, Department of Periodontology - Bolu, Turkey
| | - Satılmış Bilgin
- Bolu Abant Izzet Baysal University, Medical Faculty, Department of Internal Medicine - Bolu, Turkey
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16
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Kuraji R, Sekino S, Kapila Y, Numabe Y. Periodontal disease-related nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: An emerging concept of oral-liver axis. Periodontol 2000 2021; 87:204-240. [PMID: 34463983 PMCID: PMC8456799 DOI: 10.1111/prd.12387] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Periodontal disease, a chronic inflammatory disease of the periodontal tissues, is not only a major cause of tooth loss, but it is also known to exacerbate/be associated with various metabolic disorders, such as obesity, diabetes, dyslipidemia, and cardiovascular disease. Recently, growing evidence has suggested that periodontal disease has adverse effects on the pathophysiology of liver disease. In particular, nonalcoholic fatty liver disease, a hepatic manifestation of metabolic syndrome, has been associated with periodontal disease. Nonalcoholic fatty liver disease is characterized by hepatic fat deposition in the absence of a habitual drinking history, viral infections, or autoimmune diseases. A subset of nonalcoholic fatty liver diseases can develop into more severe and progressive forms, namely nonalcoholic steatohepatitis. The latter can lead to cirrhosis and hepatocellular carcinoma, which are end‐stage liver diseases. Extensive research has provided plausible mechanisms to explain how periodontal disease can negatively affect nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, namely via hematogenous or enteral routes. During periodontitis, the liver is under constant exposure to various pathogenic factors that diffuse systemically from the oral cavity, such as bacteria and their by‐products, inflammatory cytokines, and reactive oxygen species, and these can be involved in disease promotion of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Also, gut microbiome dysbiosis induced by enteral translocation of periodontopathic bacteria may impair gut wall barrier function and promote the transfer of hepatotoxins and enterobacteria to the liver through the enterohepatic circulation. Moreover, in a population with metabolic syndrome, the interaction between periodontitis and systemic conditions related to insulin resistance further strengthens the association with nonalcoholic fatty liver disease. However, most of the pathologic links between periodontitis and nonalcoholic fatty liver disease in humans are provided by epidemiologic observational studies, with the causal relationship not yet being established. Several systematic and meta‐analysis studies also show conflicting results. In addition, the effect of periodontal treatment on nonalcoholic fatty liver disease has hardly been studied. Despite these limitations, the global burden of periodontal disease combined with the recent nonalcoholic fatty liver disease epidemic has important clinical and public health implications. Emerging evidence suggests an association between periodontal disease and liver diseases, and thus we propose the term periodontal disease–related nonalcoholic fatty liver disease or periodontal disease–related nonalcoholic steatohepatitis. Continued efforts in this area will pave the way for new diagnostic and therapeutic approaches based on a periodontologic viewpoint to address this life‐threatening liver disease.
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Affiliation(s)
- Ryutaro Kuraji
- Department of Life Science Dentistry, The Nippon Dental University, Tokyo, Japan.,Department of Periodontology, The Nippon Dental University School of Life Dentistry at Tokyo, Tokyo, Japan.,Department of Orofacial Sciences, University of California San Francisco School of Dentistry, San Francisco, California, USA
| | - Satoshi Sekino
- Department of Periodontology, The Nippon Dental University School of Life Dentistry at Tokyo, Tokyo, Japan
| | - Yvonne Kapila
- Department of Orofacial Sciences, University of California San Francisco School of Dentistry, San Francisco, California, USA
| | - Yukihiro Numabe
- Department of Periodontology, The Nippon Dental University School of Life Dentistry at Tokyo, Tokyo, Japan
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17
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Jara CM, Pereira KKY, Maito FLDM, Adorno CG, Gomes MS. Impact of endodontic and periodontal diseases and treatments on the aorta and liver of obese and non-obese rats. Int Endod J 2021; 54:2074-2085. [PMID: 34351629 DOI: 10.1111/iej.13601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 12/26/2022]
Abstract
AIM To evaluate the impact of the presence and treatment of periodontal disease (PD) and apical periodontitis (AP) on the aorta and liver of obese and non-obese rats. METHODOLOGY One hundred and forty Wistar rats were divided into two groups, according to the diet administered: normal diet (-n), without obesity; and cafeteria diet (-c), with induced obesity. These groups were divided into seven subgroups according to the specific experimental protocols: naïve control (NC); AP; AP with treatment (APt); PD; PE with treatment (PDt); AP and PD (APPD); and AP and PD with treatment (APPDt). AP and PD lesions were induced for four weeks. Four weeks after treatments, the animals were euthanatized, and the aorta and liver were dissected for histological evaluation. For the comparison of the thickness of the aorta between groups, the Kruskal-Wallis test was used, followed by the Mann-Whitney test. For the analysis of other variables related to the aorta and liver outcomes, logistic regression was carried out. RESULTS Both PD and AP were associated with the development of histological alterations in the aortic arch, with no significant difference between obese and non-obese animals (p = .17). The aorta thickness was increased significantly (p < .05) with the combination of PD and AP in obese rats (APPDt-c group) compared with the other groups (NC-n, APt-n, APt-c and AP-c). The logistic regression models revealed that the untreated (OR = 7.78; 95%CI = 2.4-25) and treated (OR = 2.9; 95%CI = 1.0-8.4) groups were significantly more likely to have endothelial alterations compared with the control groups (p = .002). Obesity (OR = 16.5; 95%CI = 3.4-81.3) was the only predictor variable of liver steatosis (p < .001). CONCLUSION Histological alterations in the aortic arch of obese and non-obese rats were observed in the presence of periodontal disease and apical periodontitis. The combination of PD and AP increased the aorta thickness in obese rats. A reduction of vascular endothelial lesions was observed with the treatments of PD and AP.
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Affiliation(s)
- Cynthia Mireya Jara
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Faculty of Dentistry of the National University of Asunción, Asunción, Paraguay
| | | | | | | | - Maximiliano Schünke Gomes
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Medical and Dental Center of the Military Police of Rio Grande do Sul, Porto Alegre, Brazil
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18
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HATİPOĞLU H, KABAY Ş. PERIODONTAL AND SYSTEMIC DISEASES: ERECTILE DYSFUNCTION. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.928767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Periodontal hastalıklar toplumda yaygın bir şekilde görülmektedir. Son yıllarda yapılan çalışmalarla periodontal hastalıkların sistemik hastalıklara, benzer şekilde sistemik rahatsızlıklarında periodontal hastalıklara katkıda bulunabileceği bilinmektedir. Periodontal hastalıklar ve sistemik hastalıklar arasındaki bu iki yönlü ilişki son yıllarda dikkat çekici bir şekilde araştırmalara neden olmuştur. Bu konulardan biri de erektil disfonksiyondur. Periodontal hastalıkların erektil disfonksiyon ile ilişkisi ilgi çekicidir. Farklı etyolojiye sahip olan erektil disfonksiyonda periodontal hastalıkların etkisi son dönemde sıkça araştırılmıştır.
Bu geleneksel derlemede, tedavi sağlayıcılara periodontal hastalıkların genel özellikleri, erektil disfonksiyonun genel özellikleri ve birbiri ile olan ilişkiler üzerinde durulacaktır.
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Affiliation(s)
- Hasan HATİPOĞLU
- KÜTAHYA SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, DİŞ HEKİMLİĞİ FAKÜLTESİ
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19
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Escobar Arregocés FM, Del Hierro Rada M, Sáenz Martinez MJ, Hernández Meza FJ, Roa NS, Velosa-Porras J, Latorre Uriza C. Systemic inflammatory response to non-surgical treatment in hypertensive patients with periodontal infection. Medicine (Baltimore) 2021; 100:e24951. [PMID: 33787581 PMCID: PMC8021383 DOI: 10.1097/md.0000000000024951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/05/2021] [Indexed: 01/04/2023] Open
Abstract
Hypertension is associated with chronic inflammation in the tissues and organs that are involved in the regulation of arterial pressure, such as kidneys and blood vessels. Periodontal disease affects systemic inflammatory markers, leading to endothelial dysfunction, atherosclerotic plaque instability, dyslipidaemia, and insulin resistance. These conditions can also cause an increase in the blood pressure. Nonsurgical periodontal therapies, such as scaling and root planning, can affect systemic markers of inflammation. We evaluated the effect of scaling and root planning on serum levels of inflammation biomarkers in hypertensive patients. The sample consisted of 19 hypertensive patients with Periodontitis. The patients underwent laboratory tests that included glycaemia, cholesterol, triglycerides and blood count. Blood pressure was measured before periodontal therapy, and the second blood pressure recording was obtained at the re-evaluation appointment. Quantification of peripheral blood cytokines was performed using the Milliplex Inflammation Human Cytokine kit (Interleukin 1-β, Interleukin-4, Interleukin-6, Interleukin-8, Interleukin-10, Interleukin-12 P70, Interleukin-17A, vascular endothelial growth factor and tumor necrosis factor-alpha). All cytokine levels decreased from the initial examination to reassessment. Cytokines that reflected a statistically significant difference included Interleukin-1β and endothelial vascular growth factor (P = .04 and P = .004). Hypertensive patients with periodontitis undergoing non-surgical periodontal treatment exhibited a decrease in proinflammatory cytokine levels. Non-surgical periodontal treatment decreases the levels of systemic proinflammatory cytokines in controlled hypertensive patients.
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Affiliation(s)
| | | | | | | | - Nelly S. Roa
- Centro de Investigaciones Odontológicas (CIO), Faculty of Dentistry
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20
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Periodontitis and Cytomegalovirus Associate With Atherosclerosis Among HIV Patients After 5 Years on ART. J Acquir Immune Defic Syndr 2021; 85:195-200. [PMID: 32541382 DOI: 10.1097/qai.0000000000002417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Atherosclerosis has been linked with periodontitis in the general population and with persistent immune activation and a high burden of cytomegalovirus (CMV) in HIV patients responding to antiretroviral therapy (ART). Here, we assess risk factors for cardiovascular changes in younger HIV patients representative of patient populations in Asia. STUDY DESIGN HIV-infected adults (n = 82) with <200 CD4 T-cells/μl were examined as they began ART at Cipto Mangunkusumo Hospital, Jakarta, and after 3 months. 32 patients were re-assessed after 5 years, alongside 32 age-matched healthy controls. METHODS We assessed the community periodontal index of treatment needs, carotid -thickness (cIMT), plasma markers of immune activation (using commercial enzyme-linked immunosorbent assay) and CMV antibodies by in-house enzyme-linked immunosorbent assay. RESULTS Periodontitis persisted in 16/32 patients after 5 years and was potentiated by greater age (P = 0.03) and poor oral hygiene (P = 0.05), with no effect of smoking, pulmonary tuberculosis, oral candidiasis, or low CD4 T-cell counts (P > 0.05). After 5 years on ART, right and left cIMT were greater in HIV patients with periodontitis (P = 0.02, 0.006, respectively). Moreover, cIMT values were higher in patients with periodontitis (P = 0.05-0.01) than in equivalent controls. Simple linear regressions showed that patients with periodontitis had greater right (P = 0.01) and left (P = 0.004) cIMT than those without periodontitis. Multiple linear regressions showed that periodontitis and CMV antibody levels optimally predicted poor right and left cIMT (Adjusted R = 0.36, P = 0.0013; Adjusted R = 0.40, P = 0.001, respectively). CONCLUSIONS Our data identify periodontitis and CMV as independent predictors of atherosclerosis in young adult HIV patients.
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21
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Gürlek B, Zihni Korkmaz M, Kurt Bayrakdar S, Alan Y, Akça N, Uzun H. Is sexual dysfunction associated with periodontal status in perimenopausal women?: A pilot study. Oral Dis 2021; 28:1270-1278. [PMID: 33660899 DOI: 10.1111/odi.13815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 02/09/2021] [Accepted: 02/20/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The current study aimed to investigate the possible relationship between periodontal status and sexual dysfunction in perimenopausal women. MATERIALS AND METHODS This study was conducted on 106 participants. After the evaluation of the sexual functioning of participants with the Female Sexual Function Index (FSFI), their periodontal status and decayed-missing-filled teeth (DMFT) were assessed using appropriate indexes and obtained results were recorded for comparisons. Participants were divided into two groups by the periodontal status. Patients with periodontitis were grouped by the stage and the extent of the disease. Besides, participants were grouped according to the bleeding on probing (BOP) ratios for more detailed analyses. RESULTS A negative significant correlation was observed between total FSFI scores and each of the clinical periodontal parameters. Total FSFI scores and the scores of arousal, lubrication, orgasm, satisfaction, and pain domains were significantly lower in periodontitis patients (p < .05). When the patients were grouped as having localized or generalized periodontitis or whether they had stage-I, -II, and -III periodontitis, no statistically significant differences were observed in the distribution of general sexual dysfunction parameters across the groups (p > .05). CONCLUSION Periodontal status in perimenopausal women may be associated with sexual dysfunction.
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Affiliation(s)
- Beril Gürlek
- Department of Obstetrics and Gynecology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Meltem Zihni Korkmaz
- Department of Periodontology, Faculty of Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
| | - Sevda Kurt Bayrakdar
- Department of Periodontology, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Yasemin Alan
- Department of Obstetrics and Gynecology, İzmir Metropolitan Municipality Eşrefpaşa Hospital, İzmir, Turkey
| | - Nezih Akça
- Department of Urology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Hakkı Uzun
- Department of Urology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
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22
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Zardawi F, Gul S, Abdulkareem A, Sha A, Yates J. Association Between Periodontal Disease and Atherosclerotic Cardiovascular Diseases: Revisited. Front Cardiovasc Med 2021; 7:625579. [PMID: 33521070 PMCID: PMC7843501 DOI: 10.3389/fcvm.2020.625579] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/17/2020] [Indexed: 01/15/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ACVD) is an inflammatory disease of the coronary arteries associated with atheroma formation, which can cause disability and often death. Periodontitis is ranked as the sixth most prevalent disease affecting humans affecting 740 million people worldwide. In the last few decades, researchers have focused on the effect of periodontal disease (PD) on cardiovascular disease. The aim of this review was to investigate the association between these two diseases. PD is a potential risk factor that may initiate the development, maturation, and instability of atheroma in the arteries. Two mechanisms were proposed to explain such association, either periodontal pathogens directly invade bloodstream or indirectly by increasing systemic level of inflammatory mediators. Interestingly, it has been suggested that improvement in the condition of one disease positively impact the condition of the other one. Highlighting the association between these two diseases, the importance of early diagnosis and treatment of PD and its impact on cardiovascular status may be of great value in reducing the complications associated with ACVDs. Further in vitro and in vivo studies with longer follow up are necessary to confirm the causal relationship between PD and ACVDs.
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Affiliation(s)
- Faraedon Zardawi
- Periodontics Department, College of Dentistry, University of Sulaimani, Sulaymaniyah, Iraq
| | - Sarhang Gul
- Periodontics Department, College of Dentistry, University of Sulaimani, Sulaymaniyah, Iraq
| | - Ali Abdulkareem
- Department of Periodontics, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Aram Sha
- Periodontics Department, College of Dentistry, University of Sulaimani, Sulaymaniyah, Iraq
| | - Julian Yates
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
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23
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Periodontal treatment and vascular inflammation in patients with advanced peripheral arterial disease: A randomized controlled trial. Atherosclerosis 2020; 313:60-69. [DOI: 10.1016/j.atherosclerosis.2020.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 02/04/2023]
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Jepsen S, Suvan J, Deschner J. The association of periodontal diseases with metabolic syndrome and obesity. Periodontol 2000 2020; 83:125-153. [PMID: 32385882 DOI: 10.1111/prd.12326] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Periodontitis is a multifactorial chronic inflammatory disease associated with dysbiotic plaque biofilms and characterized by progressive destruction of the tooth-supporting apparatus. Globally, it is estimated that 740 million people are affected by its severe form. Periodontitis has been suggested to be linked to obesity and metabolic syndrome. Obesity, defined as excessive fat accumulation, is a complex multifactorial chronic inflammatory disease, with a high and increasing prevalence. Metabolic syndrome is defined as a cluster of obesity, dyslipidemia, hypertension, and dysglycemia. Obesity, metabolic syndrome and periodontitis are among the most common non-communicable diseases and a large body of evidence from epidemiologic studies supports the association between these conditions. Extensive research has established plausible mechanisms to explain how these conditions can negatively impact each other, pointing to a bidirectional adverse relationship. At present there is only limited evidence available from a few intervention studies. Nevertheless, the global burden of periodontitis combined with the obesity epidemic has important clinical and public health implications for the dental team. In accordance with the common risk factor approach for tackling non-communicable diseases, it has been proposed that oral healthcare professionals have an important role in the promotion of periodontal health and general well-being through facilitation of healthy lifestyle behaviours.
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Affiliation(s)
- Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Jean Suvan
- Department of Periodontology, UCL Eastman Dental Institute, London, UK
| | - James Deschner
- Department of Periodontology and Operative Dentistry, University of Mainz, Mainz, Germany
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25
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Orlandi M, Graziani F, D'Aiuto F. Periodontal therapy and cardiovascular risk. Periodontol 2000 2020; 83:107-124. [PMID: 32385887 DOI: 10.1111/prd.12299] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cardiovascular diseases are the worldwide leading cause of mortality. Cardiovascular diseases are noncommunicable conditions with a complex pathogenesis, and their clinical manifestations include major cardiovascular events such as myocardial infarction and stroke. Epidemiologic evidence suggests a consistent association between periodontitis and increased risk of cardiovascular diseases. Some evidence supports a beneficial effect of the treatment of periodontitis on both surrogate and hard cardiovascular outcomes. This narrative review has been conducted as an update of the most recent evidence on the effects of periodontitis treatment on cardiovascular outcomes since the last commissioned review of the European Federation of Periodontology-American Academy of Periodontology World Workshop in 2012. Newer evidence originating from published randomized controlled trials confirms a positive effect of periodontal treatment on surrogate measures of cardiovascular diseases, whereas there have been no randomized controlled trials investigating the effect of periodontal treatment on the incidence of cardiovascular disease events such as myocardial infarction and stroke. In conclusion, there is sufficient evidence from observational and experimental studies on surrogate cardiovascular measures to justify the design and conduct of appropriately powered randomized controlled trials investigating the effect of effective periodontal interventions on cardiovascular disease outcomes (ie, myocardial infarction and stroke) with adequate control of traditional cardiovascular risk factors.
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Affiliation(s)
- Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute, London, UK
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
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Kyrklund M, Bildo M, Akhi R, Nissinen AE, Pussinen P, Hörkkö S, Wang C. Humoral immune response to heat shock protein 60 of Aggregatibacter actinomycetemcomitans and cross-reactivity with malondialdehyde acetaldehyde-modified LDL. PLoS One 2020; 15:e0230682. [PMID: 32210456 PMCID: PMC7094845 DOI: 10.1371/journal.pone.0230682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/05/2020] [Indexed: 11/18/2022] Open
Abstract
Atherosclerosis is a chronic inflammatory disease and major cause of mortality worldwide. One of the crucial steps for atherosclerotic plaque development is oxidation of low-density lipoprotein (LDL). Through the oxidation, highly immunogenic epitopes are created and the immune system is activated. Association between atherosclerosis and periodontal diseases is well documented, and one of the main oral pathogens common in periodontitis is Aggregatibacter actinomycetemcomitans (Aa). Heat shock protein 60 (HSP60) is an important virulence factor for Aa bacteria and a strong activator of the immune system. Cross-reactivity of HSP60 and oxidized LDL (OxLDL) antibodies could be a potential mechanism in the progression of atherosclerosis and one possible link between atherosclerosis and periodontitis. Human plasma samples from neonates and mothers were analyzed to determine if antibody titer to Aa-HSP60 protein is already present in newborns. Further objectives were to characterize antibody response in Aa-HSP60 immunized mice and to determine possible antibody cross-reaction with oxidized LDL. We demonstrated that newborns already have IgM antibody levels to Aa-HSP60. We also showed that in mice, Aa-HSP60 immunization provoked IgG and IgM antibody response not only to Aa-HSP60 but also to malondialdehyde acetaldehyde-modified LDL (MAA-LDL). Competition assay revealed that the antibodies were specific to Aa-HSP60 and cross-reacted with MAA-LDL. Our results suggest a possibility of molecular mimicry between Aa-HSP60 and MAA-LDL, making it intriguing to speculate on the role of HSP60 protein in atherosclerosis that manifests at young age.
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Affiliation(s)
- Mikael Kyrklund
- Research Unit of Biomedicine, Medical Microbiology and Immunology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center and Nordlab Oulu, University Hospital and University of Oulu, Oulu, Finland
| | - Mika Bildo
- Research Unit of Biomedicine, Medical Microbiology and Immunology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Ramin Akhi
- Research Unit of Biomedicine, Medical Microbiology and Immunology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center and Nordlab Oulu, University Hospital and University of Oulu, Oulu, Finland
| | - Antti E. Nissinen
- Research Unit of Biomedicine, Medical Microbiology and Immunology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center and Nordlab Oulu, University Hospital and University of Oulu, Oulu, Finland
| | - Pirkko Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sohvi Hörkkö
- Research Unit of Biomedicine, Medical Microbiology and Immunology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center and Nordlab Oulu, University Hospital and University of Oulu, Oulu, Finland
| | - Chunguang Wang
- Research Unit of Biomedicine, Medical Microbiology and Immunology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center and Nordlab Oulu, University Hospital and University of Oulu, Oulu, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
- * E-mail:
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Aarabi G, Raedel M, Kreutzburg T, Hischke S, Debus ES, Marschall U, Seedorf U, Behrendt CA. Periodontal treatment and peripheral arterial disease severity – a retrospective analysis of health insurance claims data. VASA 2020; 49:128-132. [DOI: 10.1024/0301-1526/a000846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Summary: Background: Although epidemiological data suggest an association between periodontitis (PD) and peripheral arterial disease (PAD), it is currently unclear whether treatment of PD influences the severity of PAD. Patients and methods: Whether periodontal treatment is associated with PAD disease severity was examined by analysing health insurance claims data of patients insured by the German health insurance fund, BARMER, between January 1, 2012 and December 31, 2016. The presence of PAD was determined in individuals using International Classification of Diseases (ICD) 10th revision codes for intermittent claudication (IC) or chronic limb threatening ischaemia (CLTI). Treatment of PD was assessed by adequate ambulatory coding for non-surgical and surgical treatment of PD. Multivariate logistic regression analysis was performed to evaluate the association between PAD stages and periodontal treatment, adjusted for diabetes, age and sex. Results: The study cohort included 70,944 hospitalized patients with a diagnosis of symptomatic PAD (54.99 % women, 49.05 % IC). Among these patients, 3,567 (5.03 %) had received prior treatment for PD by supra- or sub-gingival debridement. PAD patients who had received periodontal treatment showed a lower proportion of CLTI (28.76 % among treated vs. 52.12 % among non-treated). Using multivariable regression methods, exhibiting a CLTI (vs. IC) was associated with not being treated for PD (Odds Ratio 1.97, 95 %–CI 1.83–2.13) after adjustment for age, gender, and diabetes. Conclusions: In this large-scale retrospective analysis of health insurance claims data comprising hospitalized symptomatic PAD patients, treatment of PD was associated with PAD disease severity independent of age, gender and diabetes. A potential benefit of periodontal treatment in relation to PAD will have to be determined in further prospective studies.
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Affiliation(s)
- Ghazal Aarabi
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Raedel
- Prosthodontics, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Thea Kreutzburg
- Department of Vascular Medicine, University Heart and Vascular Center Hamburg, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Hischke
- Institute and Outpatients Clinic Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Vascular Medicine, University Heart and Vascular Center Hamburg, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Sebastian Debus
- Department of Vascular Medicine, University Heart and Vascular Center Hamburg, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Udo Seedorf
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, University Heart and Vascular Center Hamburg, Research Group GermanVasc, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ahmadian E, Rahbar Saadat Y, Hosseiniyan Khatibi SM, Nariman-Saleh-Fam Z, Bastami M, Zununi Vahed F, Ardalan M, Zununi Vahed S. Pre-Eclampsia: Microbiota possibly playing a role. Pharmacol Res 2020; 155:104692. [PMID: 32070720 DOI: 10.1016/j.phrs.2020.104692] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/23/2020] [Accepted: 02/10/2020] [Indexed: 02/07/2023]
Abstract
Pre-eclampsia (PE) is a complication of pregnancy that is associated with mortality and morbidity in mothers and fetuses worldwide. Oxygen dysregulation in the placenta, abnormal remodeling of the spiral artery, defective placentation, oxidative stress at the fetal-maternal border, inflammation and angiogenic impairment in the maternal circulation are the main causes of this syndrome. These events result in a systemic and diffuse endothelial cell dysfunction, an essential pathophysiological feature of PE. The impact of bacteria on the multifactorial pathway of PE is the recent focus of scientific inquiry since microbes may cause each of the aforementioned features. Microbes and their derivatives by producing antigens and other inflammatory factors may trigger infection and inflammatory responses. A mother's bacterial communities in the oral cavity, gut, vagina, cervix and uterine along with the placenta and amniotic fluid microbiota may be involved in the development of PE. Here, we review the mechanistic and pathogenic role of bacteria in the development of PE. Then, we highlight the impact of alterations in a set of maternal microbiota (dysbiosis) on the pathogenesis of PE.
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Affiliation(s)
- Elham Ahmadian
- Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yalda Rahbar Saadat
- Nutrition Research Center, Students Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Ziba Nariman-Saleh-Fam
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Milad Bastami
- Department of Medical Genetics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Wang MM, Zhao Y, Wang C, Li H, Shi XX, Ren XY. [Influence of periodontal non-surgical therapy on serum interleukin 6 expression and carotid artery wall in rats with periodontitis and type 2 diabetes mellitus]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 37:589-593. [PMID: 31875435 PMCID: PMC7030757 DOI: 10.7518/hxkq.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/11/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To study the effect of periodontal non-surgical treatment on serum interleukin-6 (IL-6) expression and carotid vascular wall in a rat model of chronic periodontitis (CP) with type 2 diabetes mellitus (T2DM). METHODS Twenty-eight 6-week-old SD rats were randomly divided into group A (control group, 7 rats) and group B (T2DM+CP group, 21 rats). According to different intervention measures, group B was randomly subdivided into B1 (natural process), B2 (periodontal mechanical treatment), and B3 (periodontal mechanical treatment + 2% minocycline hydrochloride + systemic metronidazole plus amoxicillin). Serum IL-6 was measured by enzyme-linked immunosorbent assay, and carotid tissue was observed under light microscopy after hematoxylin-eosin (HE) staining. RESULTS The carotid artery wall of group A was normal. In group B1, the endothelial cells disappeared, the elastic fibers of the middle membrane were disordered, the local necrosis of smooth muscle tissue was amorphous particles, a small amount of calcium salt was deposited, and the wall thickening was obvious. The endothelial cells in groups B2 and B3 disappeared, and the smooth muscle cells in the middle membrane underwent denaturation. No significant thickening of the vessel wall was noted. The serum IL-6 level in group B1 continually increased with time, and it was higher than that in group A (P<0.001). The IL-6 levels of groups B2 and B3 peaked a week after the first intervention. Subsequently, IL-6 levels gradually decreased. At the last point (five weeks after the second intervention ), the IL-6 levels of groups B2 and B3 were significantly lower than that of group B1 (P<0.001). CONCLUSIONS For rats with periodontitis and diabetes, periodontal mechanical treatment may elevate serum IL-6 levels in the short term but might reduce the whole inflammatory state in the long term. Thus, this treatment might be valuable to the improvement of vascular disease. The adjunctive benefits of systemic metronidazole and amoxicillin in non-surgical periodontal therapy are decreased serum IL-6 expression and normal carotid artery.
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Affiliation(s)
- Miao-Miao Wang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
| | - Yong Zhao
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
| | - Chong Wang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
| | - Hao Li
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
| | - Xue-Xue Shi
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
| | - Xiu-Yun Ren
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, China
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Bizzarro S, Loos BG. The link between periodontitis and erectile dysfunction: a review. Br Dent J 2019; 227:599-603. [DOI: 10.1038/s41415-019-0724-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Calmasini FB, Klee N, Webb RC, Priviero F. Impact of Immune System Activation and Vascular Impairment on Male and Female Sexual Dysfunction. Sex Med Rev 2019; 7:604-613. [PMID: 31326360 DOI: 10.1016/j.sxmr.2019.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/03/2019] [Accepted: 05/30/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Male and female sexual dysfunction (SD) is considered a multifactorial condition. Numerous studies have shown the involvement of inflammatory processes in this pathological condition. Sexual intercourse requires healthy and functioning vessels to supply the pelvic region in both males and females, generating penile erection and clitoral and vaginal lubrication, respectively. Cardiovascular diseases and associated risk factors may contribute negatively to pelvic blood flow, possibly through immune system activation. AIM The study aimed to address the correlation between vascular inflammation driven by immune system activation and SD in males and females. METHODS A literature review was performed to identify articles addressing male and female SD and vascular inflammation. Key words included "male and female sexual dysfunction," "vascular inflammation," "iliac and pudendal arteries dysfunction," "genitourinary tract," and "blood flow." MAIN OUTCOME MEASURES Management of systemic and local inflammation may be a useful alternative to improve SD and reduce the risk of cardiovascular diseases in the future. RESULTS Increased levels of cytokines and chemokines have been detected in humans and animals with hypertension, obesity, and diabetic conditions. Chronic activation of the innate immune system, especially by pathogen- or damage-associated molecular patterns, and metabolic-related disorders may act as triggers further contributing to an increased inflammatory condition. Due to the reduced size of vessels, SD and retinal vascular impairments have been shown to be predictive factors for cardiovascular diseases. Therefore, considering that blood flow to the genitalia is essential for sexual function, endothelial dysfunction and vascular remodeling, secondary to chronic immune system activation, may be implicated in male and female vasculogenic SD. CONCLUSIONS Several conditions appear to play a role in SD. In the present review, we have identified a role for the immune system in generating vascular and tissue impairments contributing to erectile dysfunction and female SD. Calmasini FB, Klee N, Webb RC, et al. Impact of Immune System Activation and Vascular Impairment on Male and Female Sexual Dysfunction. Sex Med Rev 2019;7:604-613.
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Affiliation(s)
- Fabiano B Calmasini
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA, USA; Deparment of Pharmacology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
| | - Nicole Klee
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - R Clinton Webb
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Fernanda Priviero
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Martinez‐Herrera M, López‐Domènech S, Silvestre FJ, Silvestre‐Rangil J, Bañuls C, Victor VM, Rocha M. Chronic periodontitis impairs polymorphonuclear leucocyte–endothelium cell interactions and oxidative stress in humans. J Clin Periodontol 2018; 45:1429-1439. [DOI: 10.1111/jcpe.13027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/15/2018] [Accepted: 10/19/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Mayte Martinez‐Herrera
- Service of StomatologyUniversity Hospital Doctor Peset‐FISABIO Valencia Spain
- Department of StomatologyUniversity of Valencia Valencia Spain
| | - Sandra López‐Domènech
- Service of Endocrinology and NutritionUniversity Hospital Doctor Peset‐FISABIO Valencia Spain
| | - Francisco Javier Silvestre
- Service of StomatologyUniversity Hospital Doctor Peset‐FISABIO Valencia Spain
- Department of StomatologyUniversity of Valencia Valencia Spain
| | | | - Celia Bañuls
- Service of Endocrinology and NutritionUniversity Hospital Doctor Peset‐FISABIO Valencia Spain
| | - Victor M. Victor
- Service of Endocrinology and NutritionUniversity Hospital Doctor Peset‐FISABIO Valencia Spain
- CIBER CB06/04/0071 Research GroupCIBER Hepatic and Digestive DiseasesUniversity of Valencia Valencia Spain
- Department of PhysiologyUniversity of Valencia Valencia Spain
| | - Milagros Rocha
- Service of Endocrinology and NutritionUniversity Hospital Doctor Peset‐FISABIO Valencia Spain
- CIBER CB06/04/0071 Research GroupCIBER Hepatic and Digestive DiseasesUniversity of Valencia Valencia Spain
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Makkar H, Reynolds MA, Wadhawan A, Dagdag A, Merchant AT, Postolache TT. Periodontal, metabolic, and cardiovascular disease: Exploring the role of inflammation and mental health. Pteridines 2018; 29:124-163. [PMID: 30705520 PMCID: PMC6350811 DOI: 10.1515/pteridines-2018-0013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Previous evidence connects periodontal disease, a modifiable condition affecting a majority of Americans, with metabolic and cardiovascular morbidity and mortality. This review focuses on the likely mediation of these associations by immune activation and their potential interactions with mental illness. Future longitudinal, and ideally interventional studies, should focus on reciprocal interactions and cascading effects, as well as points for effective preventative and therapeutic interventions across diagnostic domains to reduce morbidity, mortality and improve quality of life.
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Affiliation(s)
- Hina Makkar
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Mark A Reynolds
- Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Abhishek Wadhawan
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Aline Dagdag
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Teodor T Postolache
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO 80220, USA; Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD 21201, USA,
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Wallet SM, Puri V, Gibson FC. Linkage of Infection to Adverse Systemic Complications: Periodontal Disease, Toll-Like Receptors, and Other Pattern Recognition Systems. Vaccines (Basel) 2018; 6:E21. [PMID: 29621153 PMCID: PMC6027258 DOI: 10.3390/vaccines6020021] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/25/2018] [Accepted: 03/30/2018] [Indexed: 12/13/2022] Open
Abstract
Toll-like receptors (TLRs) are a group of pattern recognition receptors (PRRs) that provide innate immune sensing of conserved pathogen-associated molecular patterns (PAMPs) to engage early immune recognition of bacteria, viruses, and protozoa. Furthermore, TLRs provide a conduit for initiation of non-infectious inflammation following the sensing of danger-associated molecular patterns (DAMPs) generated as a consequence of cellular injury. Due to their essential role as DAMP and PAMP sensors, TLR signaling also contributes importantly to several systemic diseases including cardiovascular disease, diabetes, and others. The overlapping participation of TLRs in the control of infection, and pathogenesis of systemic diseases, has served as a starting point for research delving into the poorly defined area of infection leading to increased risk of various systemic diseases. Although conflicting studies exist, cardiovascular disease, diabetes, cancer, rheumatoid arthritis, and obesity/metabolic dysfunction have been associated with differing degrees of strength to infectious diseases. Here we will discuss elements of these connections focusing on the contributions of TLR signaling as a consequence of bacterial exposure in the context of the oral infections leading to periodontal disease, and associations with metabolic diseases including atherosclerosis and type 2 diabetes.
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Affiliation(s)
- Shannon M Wallet
- Department of Oral Biology, College of Dental Medicine, University of Florida, Gainesville, FL 32610, USA.
| | - Vishwajeet Puri
- Department of Biomedical Sciences and Diabetes Institute, Ohio University, Athens, OH 45701, USA.
| | - Frank C Gibson
- Department of Oral Biology, College of Dental Medicine, University of Florida, Gainesville, FL 32610, USA.
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Jockel-Schneider Y, Bechtold M, Haubitz I, Störk S, Fickl S, Harks I, Eigenthaler M, Vollrath O, Baulmann J, Schlagenhauf U. Impact of anti-infective periodontal therapy on parameters of vascular health. J Clin Periodontol 2018; 45:354-363. [PMID: 29218774 DOI: 10.1111/jcpe.12849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 11/30/2022]
Abstract
AIM This study assessed the impact of anti-infective periodontal therapy on the status of vascular health. MATERIALS AND METHODS Periodontal and vascular health of 55 patients with severe untreated chronic periodontitis was evaluated before and 12 months after anti-infective periodontal therapy. Observed parameters were bleeding on probing (BoP), pocket probing depth (PPD), periodontal inflamed surface area index (PISA), pulse wave velocity (PWV), augmentation index (AIx), central pulse pressure (PPao) and peripheral systolic pressure (RRsys). RESULTS ΔPISA (baseline-12 months) correlated with ΔPWV (τ 0.21; p < .03), ΔAIx (τ 0.29; p < .002) and ΔPPao (τ 0.23; p < .02). ΔBoP% (baseline-12 months) correlated with ΔPWV (τ 0.18; p < .05) and ΔAIx (τ 0.25; p < .01), while mean ΔPPD (baseline-12 months) correlated with ΔPWV (τ 0.24; p < .01) and ΔAIx (τ 0.21; p < .03). Grouping patients evenly into three groups based on tertiles of BoP resolution after 12 months revealed a significant decrease in the observed PWV median value by -0.6 m/s (p < .04) in the best response tertile (ΔBoP ≥ 88%). In the worst response tertile (ΔBoP ≤ 66%), by contrast, significant increase in PPao (+10.5 mmHg; p < .02) and AIx (+5.5; p < .02) was observed. CONCLUSION Efficacious resolution of periodontal inflammation may beneficially impact on vascular health.
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Affiliation(s)
| | - Markus Bechtold
- Department of Periodontology, University Hospital Würzburg, Würzburg, Germany
| | - Imme Haubitz
- Department of Periodontology, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center Würzburg & Department of Internal Medicine I, University Hospital and University of Würzburg, Würzburg, Germany
| | - Stefan Fickl
- Department of Periodontology, University Hospital Würzburg, Würzburg, Germany
| | - Inga Harks
- Department of Periodontology, University Hospital Münster, Münster, Germany
| | - Martin Eigenthaler
- Department of Orthodontics, University Hospital Würzburg, Würzburg, Germany
| | - Oliver Vollrath
- Comprehensive Heart Failure Center Würzburg & Department of Internal Medicine I, University Hospital and University of Würzburg, Würzburg, Germany
| | - Johannes Baulmann
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Ulrich Schlagenhauf
- Department of Periodontology, University Hospital Würzburg, Würzburg, Germany
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Immunization with gingipain A hemagglutinin domain of Porphyromonas gingivalis induces IgM antibodies binding to malondialdehyde-acetaldehyde modified low-density lipoprotein. PLoS One 2018; 13:e0191216. [PMID: 29329335 PMCID: PMC5766137 DOI: 10.1371/journal.pone.0191216] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/29/2017] [Indexed: 12/12/2022] Open
Abstract
Treatment of periodontitis has beneficial effects on systemic inflammation markers that relate to progression of atherosclerosis. We aimed to investigate whether immunization with A hemagglutinin domain (Rgp44) of Porphyromonas gingivalis (Pg), a major etiologic agent of periodontitis, would lead to an antibody response cross-reacting with oxidized low-density lipoprotein (OxLDL) and how it would affect the progression of atherosclerosis in low-density lipoprotein receptor-deficient (LDLR-/-) mice. The data revealed a prominent IgM but not IgG response to malondialdehyde-acetaldehyde modified LDL (MAA-LDL) after Rgp44 and Pg immunizations, implying that Rgp44/Pg and MAA adducts may share cross-reactive epitopes that prompt IgM antibody production and consequently confer atheroprotection. A significant negative association was observed between atherosclerotic lesion and plasma IgA to Rgp44 in Rgp44 immunized mice, supporting further the anti-atherogenic effect of Rgp44 immunization. Plasma IgA levels to Rgp44 and to Pg in both Rgp44- and Pg-immunized mice were significantly higher than those in saline control, suggesting that IgA to Rgp44 could be a surrogate marker of immunization in Pg-immunized mice. Distinct antibody responses in plasma IgA levels to MAA-LDL, to Pg lipopolysaccharides (Pg-LPS), and to phosphocholine (PCho) were observed after Rgp44 and Pg immunizations, indicating that different immunogenic components between Rpg44 and Pg may behave differently in regard of their roles in the development of atherosclerosis. Immunization with Rgp44 also displayed atheroprotective features in modulation of plaque size through association with plasma levels of IL-1α whereas whole Pg bacteria achieved through regulation of anti-inflammatory cytokine levels of IL-5 and IL-10. The present study may contribute to refining therapeutic approaches aiming to modulate immune responses and inflammatory/anti-inflammatory processes in atherosclerosis.
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Kudo C, Shin WS, Sasaki N, Harai K, Kato K, Seino H, Goke E, Fujino T, Kuribayashi N, Pearce YO, Taira M, Matsushima R, Minabe M, Takashiba S. Effects of periodontal treatment on carotid intima-media thickness in patients with lifestyle-related diseases: Japanese prospective multicentre observational study. Odontology 2018; 106:316-327. [PMID: 29330707 DOI: 10.1007/s10266-017-0331-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 10/22/2017] [Indexed: 11/28/2022]
Abstract
Atherosclerosis, a chronic inflammatory disease in arterial blood vessels, is one of the major causes of death in worldwide. Meanwhile, periodontal disease is a chronic inflammatory disease caused by infection with periodontal pathogens such as P. gingivalis (Porphyromonas gingivalis). Several studies have reported association between periodontal infection and atherosclerosis, but direct investigation about the effects of periodontal treatment on atherosclerosis has not been reported. We have planned Japanese local clinics to determine the relationship between periodontal disease and atherosclerosis under collaborative with medical and dental care. A prospective, multicentre, observational study was conducted including 38 medical patients with lifestyle-related diseases in the stable period under consultation at participating medical clinics and 92 periodontal patients not undergoing medical treatment but who were consulting at participating dental clinics. Systemic and periodontal examinations were performed before and after periodontal treatment. At baseline, LDL-C (low-density lipoprotein cholesterol) levels and percentage (%) of mobile teeth were positively related to plasma IgG (immunoglobulin) antibody titer against P. gingivalis with multivariate analysis. Corresponding to improvements in periodontal clinical parameters after treatment, right and left max IMT (maximum intima-media thickness) levels were decreased significantly after treatment (SPT-S: start of supportive periodontal therapy, SPT-1y: at 1 year under SPT, and SPT-3y: at 3 years under SPT). The present study has clarified our previous univariate analysis results, wherein P. gingivalis infection was positively associated with progression of atherosclerosis. Thus, routine screening using plasma IgG antibody titer against P. gingivalis and periodontal treatment under collaborative with medical and dental care may prevent cardiovascular accidents caused by atherosclerosis.
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Affiliation(s)
- Chieko Kudo
- Division of Periodontology, Department of Oral Function & Restoration, Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, Kanagawa, 238-8580, Japan.
| | - Wee Soo Shin
- Sekimachi Medical Clinic, 5-6-1 Sekimachikita, Nerima-ku, Tokyo, 177-0051, Japan
| | - Nobuhiro Sasaki
- Katsutadai Dental Clinic, 1-3-7 Katsutadai, Yachiyo-shi, Chiba, 276-0024, Japan
| | - Kazuo Harai
- Matsumoto Dental Office, 2-6-12-1F, Senzoku, Meguro-ku, Tokyo, 152-0012, Japan.,Harai Dental Office, 2-20-17-1F Sangenjaya, Setagaya-ku, Tokyo, 154-0024, Japan
| | - Kai Kato
- Mejiro Medical-Road Dental Clinic, 2-5-27 Mejiro, Toshima-ku, Tokyo, 171-0031, Japan
| | - Hiroaki Seino
- Tomiya Central Hospital, 2-1-6 Kamisakuragi, Tomiya-machi, Kurokawa-gun, Miyagi, 981-3328, Japan
| | - Eiji Goke
- Goke Dental Clinic, 5-41-17 Higashioizumi, Nerima-ku, Tokyo, 178-0063, Japan
| | - Takemasa Fujino
- Kyodo Dental Clinic, 1-32-2 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Nobuichi Kuribayashi
- Misaki Internal Medicine Clinic, 6-44-9 Futawa Higashi, Funabashi-shi, Chiba, 274-0805, Japan
| | - Youko Onuki Pearce
- Pearce Clinic, 7-20-5 Konakadai, Inage-ku Chiba-shi, Chiba, 263-0043, Japan
| | - Masato Taira
- Taira Clinic, 1-36-11 Katsutadai Yachiyo-shi, Chiba, 276-0023, Japan
| | - Ryoji Matsushima
- Matsushima Dental Clinic, 2-6-12-1F, Senzoku, Meguro-ku, Tokyo, 152-0012, Japan
| | - Masato Minabe
- Division of Periodontology, Department of Oral Function & Restoration, Graduate School of Dentistry, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, Kanagawa, 238-8580, Japan.,Bunkyo Do-ri Dental Clinic, 2-4-1, Anagawa, Inage-ku Chiba-shi, Chiba, 263-0024, Japan
| | - Shogo Takashiba
- Department of Pathophysiology-Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8525, Japan
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McCully KS. Hyperhomocysteinemia, Suppressed Immunity, and Altered Oxidative Metabolism Caused by Pathogenic Microbes in Atherosclerosis and Dementia. Front Aging Neurosci 2017; 9:324. [PMID: 29056905 PMCID: PMC5635055 DOI: 10.3389/fnagi.2017.00324] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/20/2017] [Indexed: 12/19/2022] Open
Abstract
Many pathogenic microorganisms have been demonstrated in atherosclerotic plaques and in cerebral plaques in dementia. Hyperhomocysteinemia, which is a risk factor for atherosclerosis and dementia, is caused by dysregulation of methionine metabolism secondary to deficiency of the allosteric regulator, adenosyl methionine. Deficiency of adenosyl methionine results from increased polyamine biosynthesis by infected host cells, causing increased activity of ornithine decarboxylase, decreased nitric oxide and peroxynitrate formation and impaired immune reactions. The down-regulation of oxidative phosphorylation that is observed in aging and dementia is attributed to deficiency of thioretinaco ozonide oxygen complexed with nicotinamide adenine dinucleotide and phosphate, which catalyzes oxidative phosphorylation. Adenosyl methionine biosynthesis is dependent upon thioretinaco ozonide and adenosine triphosphate (ATP), and the deficiency of adenosyl methionine and impaired immune function in aging are attributed to depletion of thioretinaco ozonide from mitochondrial membranes. Allyl sulfides and furanonaphthoquinones protect against oxidative stress and apoptosis by increasing the endogenous production of hydrogen sulfide and by inhibiting electron transfer to the active site of oxidative phosphorylation. Diallyl trisulfide and napabucasin inhibit the signaling by the signal transducer and activator of transcription 3 (Stat3), potentially enhancing immune function by effects on T helper lymphocytes and promotion of apoptosis. Homocysteine promotes endothelial dysfunction and apoptosis by the unfolded protein response and endoplasmic reticulum stress through activation of the N-methyl D-aspartate (NMDA) receptor, causing oxidative stress, calcium influx, apoptosis and endothelial dysfunction. The prevention of atherosclerosis and dementia may be accomplished by a proposed nutritional metabolic homocysteine-lowering protocol which enhances immunity and corrects the altered oxidative metabolism in atherosclerosis and dementia.
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Affiliation(s)
- Kilmer S. McCully
- Pathology, VA Boston Healthcare System (VHA), Boston, MA, United States
- Pathology, Harvard Medical School, Boston, MA, United States
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Berquist VL, Hearps AC, Ford P, Jaworowski A, Leishman SJ, Hoy JF, Trevillyan JM. Porphyromonas gingivalis antibody levels and diagnosis of coronary artery disease in HIV-positive individuals. J Periodontal Res 2017; 52:930-935. [PMID: 28397248 DOI: 10.1111/jre.12460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Periodontal disease has been associated with cardiovascular disease in the general population. It is unknown whether IgG antibody levels for periodontal pathogens are associated with the diagnosis of coronary artery disease (CAD) in HIV-positive individuals. MATERIAL AND METHODS Twenty-four HIV-positive individuals (cases) with stored plasma available in the 12 months before CAD diagnosis were age- and sex-matched 1:2 with 46 HIV-positive individuals without CAD (controls). Antibody levels to whole cell extracts from periodontal pathogens Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum, as well as markers of inflammation sCD14, CXCL10 and high-sensitivity C-reactive protein, were compared between cases and controls using enzyme-linked immunosorbent assays. RESULTS P. gingivalis-specific IgG levels (μg/mL) were significantly higher in individuals with CAD (median 1.48 [IQR 1.06-2.05]) compared to controls (0.70 [IQR 0.35-1.24], P<.001), and remained significantly higher following adjustment for traditional cardiovascular risk factors and HIV viral load (OR 21.6 [95% CI 3.73-125.63] P=.001). There was a borderline association between A. actinomycetemcomitans IgG antibody levels (cases, median 3.86 [IQR 3.19-4.72]; controls, 3.34 [IQR 2.59-4.07], P=.050) and no association found between F. nucleatum antibody levels and CAD. sCD14 levels (μg/mL) were higher in cases compared with controls (median 3.45 [IQR 3.03-4.11] vs 2.65 [IQR 2.32-2.99] P<.001), while CXCL10 (median 127 pg/mL [IQR 88-157] vs 153 [IQR 90-244] P=.321) and high-sensitivity C-reactive protein (median 3.44 mg/L [1.98-5.32] vs 1.85 [1.13-6.88] P=.203) levels were not different between cases and controls. CONCLUSION Periodontal bacteria may be contributing to CAD risk in HIV-positive individuals.
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Affiliation(s)
- V L Berquist
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic., Australia
| | - A C Hearps
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic., Australia.,Centre for Biomedical Research, Burnet Institute, Melbourne, Vic., Australia
| | - P Ford
- School of Dentistry, The University of Queensland, Brisbane, Qld, Australia
| | - A Jaworowski
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic., Australia.,Centre for Biomedical Research, Burnet Institute, Melbourne, Vic., Australia
| | - S J Leishman
- School of Dentistry, The University of Queensland, Brisbane, Qld, Australia
| | - J F Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic., Australia
| | - J M Trevillyan
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic., Australia
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Dakic A, Boillot A, Colliot C, Carra MC, Czernichow S, Bouchard P. Detection of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans after Systemic Administration of Amoxicillin Plus Metronidazole as an Adjunct to Non-surgical Periodontal Therapy: A Systematic Review and Meta-Analysis. Front Microbiol 2016; 7:1277. [PMID: 27594851 PMCID: PMC4990718 DOI: 10.3389/fmicb.2016.01277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/02/2016] [Indexed: 12/29/2022] Open
Abstract
Objective: To evaluate the variations in the detection of Porphyromonas gingivalis and/or Aggregatibacter actinomycetemcomitans before and after systemic administration of amoxicillin plus metronidazole in association with non-surgical periodontal therapy (NSPT). Background: The adjunctive use of antibiotics has been advocated to improve the clinical outcomes of NSPT. However, no systematic review has investigated the microbiological benefit of this combination. Materials and Methods: An electronic search was conducted up to December 2015. Randomized clinical trials comparing the number of patients testing positive for P. gingivalis and/or A. actinomycetemcomitans before and after NSPT with (test group) or without (control group) amoxicillin plus metronidazole were included. The difference between groups in the variation of positive patients was calculated using the inverse variance method with a random effects model. Results: The frequency of patients positive for A. actinomycetemcomitans was decreased by 30% (p = 0.002) and by 25% (p = 0.01) in the test group compared to the control group at 3- and 6-month follow-up, respectively. Similar findings were observed when considering the frequency of patients positive for Porphyromonas gingivalis, with a reduction by 28% (p < 0.0001), 32% (p < 0.0001), and 34% (p = 0.03) in the test group compared to the control group at 3-, 6-, and 12-month follow-up, respectively. Conclusion: The systemic administration of amoxicillin plus metronidazole as an adjunct to NSPT significantly decreased the number of patients positive for P. gingivalis and A. actinomycetemcomitans compared with periodontal therapy alone or with a placebo.
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Affiliation(s)
- Aleksandar Dakic
- Department of Periodontology, Service of Odontology, U.F.R. of Odontology, Rothschild Hospital, AP-HP, Paris Diderot University Paris, France
| | - Adrien Boillot
- Department of Periodontology, Service of Odontology, U.F.R. of Odontology, Rothschild Hospital, AP-HP, Paris Diderot UniversityParis, France; UMS 011, Population-based Epidemiologic Cohorts Unit, Institut National de la Santé et de la Recherche MédicaleVillejuif, France
| | - Cyrille Colliot
- Department of Periodontology, Service of Odontology, U.F.R. of Odontology, Rothschild Hospital, AP-HP, Paris Diderot University Paris, France
| | - Maria-Clotilde Carra
- Department of Periodontology, Service of Odontology, U.F.R. of Odontology, Rothschild Hospital, AP-HP, Paris Diderot UniversityParis, France; UMS 011, Population-based Epidemiologic Cohorts Unit, Institut National de la Santé et de la Recherche MédicaleVillejuif, France
| | - Sébastien Czernichow
- UMS 011, Population-based Epidemiologic Cohorts Unit, Institut National de la Santé et de la Recherche MédicaleVillejuif, France; Department of Nutrition, Hôpital Européen Georges Pompidou, AP-HP, Paris Descartes UniversityParis, France
| | - Philippe Bouchard
- Department of Periodontology, Service of Odontology, U.F.R. of Odontology, Rothschild Hospital, AP-HP, Paris Diderot UniversityParis, France; EA 2496, U.F.R. of Odontology, Paris Descartes UniversityMontrouge, France
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Krane V, Wanner C. Should we aim for oral health to improve outcomes in chronic kidney disease? Nephrol Dial Transplant 2016; 31:1551-4. [PMID: 27190378 DOI: 10.1093/ndt/gfw049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vera Krane
- Department of Medicine 1, Division of Nephrology, University of Würzburg, Würzburg, Germany Comprehensive Heart Failure Centre, University of Würzburg, Würzburg, Germany
| | - Christoph Wanner
- Department of Medicine 1, Division of Nephrology, University of Würzburg, Würzburg, Germany Comprehensive Heart Failure Centre, University of Würzburg, Würzburg, Germany
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42
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D'Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Clin Periodontol 2016; 40 Suppl 14:S85-105. [PMID: 23627337 DOI: 10.1111/jcpe.12061] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/11/2022]
Abstract
AIM The aim of this review was to critically appraise the evidence on the impact of periodontal treatment of cardiovascular diseases (CVDs) biomarkers and outcomes. METHODS A systematic search was performed in Cinhal, Cochrane, Embase and Medline for relevant articles up to July 2012. Duplicate screening and reference hand searching were performed. Data were then summarized and evidence graded in tables. RESULTS The search resulted in: (a) no evidence on the effects of periodontal therapy on subclinical atherosclerosis, serum levels of CD40 ligand, serum amyloid A and monocyte chemoattractant protein-1, (b) limited evidence on the effects of periodontal therapy on arterial blood pressure, leucocyte counts, fibrinogen, tissue necrosis factor-α, sE-selectin, von Willebrand factors, d-dimers, matrix metalloproteinases, oxidative stress and CVD events, and (c) moderate evidence suggesting a negligible effect of periodontal therapy in reducing interleukin-6 and lipids levels, whilst a positive effect in reducing serum C-reactive protein levels and improving endothelial function. CONCLUSIONS Periodontal therapy triggers a short-term inflammatory response followed by (a) a progressive and consistent reduction of systemic inflammation and (b) an improvement in endothelial function. There is however limited evidence that these acute and chronic changes will either increase or reduce CVD burden of individuals suffering from periodontitis in the long term.
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Affiliation(s)
- Francesco D'Aiuto
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, London, UK.
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D'Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Periodontol 2016; 84:S85-S105. [PMID: 23631587 DOI: 10.1902/jop.2013.134007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM The aim of this review was to critically appraise the evidence on the impact of periodontal treatment of cardiovascular diseases (CVDs) biomarkers and outcomes. METHODS A systematic search was performed in Cinhal, Cochrane, Embase and Medline for relevant articles up to July 2012. Duplicate screening and reference hand searching were performed. Data were then summarized and evidence graded in tables. RESULTS The search resulted in: (a) no evidence on the effects of periodontal therapy on subclinical atherosclerosis, serum levels of CD40 ligand, serum amyloid A and monocyte chemoattractant protein-1, (b) limited evidence on the effects of periodontal therapy on arterial blood pressure, leucocyte counts, fibrinogen, tissue necrosis factor-a, sE-selectin, von Willebrand factors, d-dimers, matrix metalloproteinases, oxidative stress and CVD events, and (c) moderate evidence suggesting a negligible effect of periodontal therapy in reducing interleukin-6 and lipids levels, whilst a positive effect in reducing serum C-reactive protein levels and improving endothelial function. CONCLUSIONS Periodontal therapy triggers a short-term inflammatory response followed by (a) a progressive and consistent reduction of systemic inflammation and (b) an improvement in endothelial function. There is however limited evidence that these acute and chronic changes will either increase or reduce CVD burden of individuals suffering from periodontitis in the long term.
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Affiliation(s)
- Francesco D'Aiuto
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, University College London, UK.
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Wang Q, Kang J, Cai X, Wu Y, Zhao L. The association between chronic periodontitis and vasculogenic erectile dysfunction: a systematic review and meta-analysis. J Clin Periodontol 2016; 43:206-15. [PMID: 26749274 DOI: 10.1111/jcpe.12512] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Qianting Wang
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu Sichuan China
| | - Jian Kang
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu Sichuan China
| | - Xiang Cai
- Department of Urology; West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Yafei Wu
- Department of Periodontics; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
| | - Lei Zhao
- Department of Periodontics; West China Hospital of Stomatology; Sichuan University; Chengdu Sichuan China
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45
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Links between atherosclerotic and periodontal disease. Exp Mol Pathol 2016; 100:220-35. [DOI: 10.1016/j.yexmp.2016.01.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/08/2016] [Indexed: 02/06/2023]
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Affiliation(s)
- Ralph Stewart
- From Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (R.S.); The University of Queensland, Brisbane, Australia (M.W.); and The Prince Charles Hospital, Brisbane, Australia (M.W.).
| | - Malcolm West
- From Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (R.S.); The University of Queensland, Brisbane, Australia (M.W.); and The Prince Charles Hospital, Brisbane, Australia (M.W.)
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Jamieson L, Skilton M, Maple-Brown L, Kapellas K, Askie L, Hughes J, Arrow P, Cherian S, Fernandes D, Pawar B, Brown A, Boffa J, Hoy W, Harris D, Mueller N, Cass A. Periodontal disease and chronic kidney disease among Aboriginal adults; an RCT. BMC Nephrol 2015; 16:181. [PMID: 26520140 PMCID: PMC4628248 DOI: 10.1186/s12882-015-0169-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/14/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This study will assess measures of vascular health and inflammation in Aboriginal Australian adults with chronic kidney disease (CKD), and determine if intensive periodontal intervention improves cardiovascular health, progression of renal disease and periodontal health over a 24-month follow-up. METHODS The study will be a randomised controlled trial. All participants will receive the periodontal intervention benefits, with the delayed intervention group receiving periodontal treatment 24 months following baseline. Inclusion criteria include being an Aboriginal Australian, having CKD (a. on dialysis; b. eGFR levels of < 60 mls/min/1.73 m(2) (CKD Stages 3 to 5); c. ACR ≥ 30 mg/mmol irrespective of eGFR (CKD Stages 1 and 2); d. diabetes plus albuminuria (ACR ≥ 3 mg/mmol) irrespective of eGFR), having moderate or severe periodontal disease, having at least 12 teeth, and living in Central Australia for the 2-year study duration. The intervention involves intensive removal of dental plaque biofilms by scaling, root-planing and removal of teeth that cannot be saved. The intervention will occur in three visits; baseline, 3-month and 6-month follow-up. The primary outcome will be changes in carotid intima-media thickness (cIMT). Secondary outcomes will include progression of CKD or death as a consequence of CKD/cardiovascular disease. Progression of CKD will be defined by time to the development of the first of: (1) new development of macroalbuminuria; (2) 30 % loss of baseline eGFR; (3) progression to end stage kidney disease defined by eGFR < 15 mLs/min/1.73 m(2); (4) progression to end stage kidney disease defined by commencement of renal replacement therapy. A sample size of 472 is necessary to detect a difference in cIMT of 0.026 mm (SD 0.09) at the significance criterion of 0.05 and a power of 0.80. Allowing for 20 % attrition, 592 participants are necessary at baseline, rounded to 600 for convenience. DISCUSSION This will be the first RCT evaluating the effect of periodontal therapy on progression of CKD and cardiovascular disease among Aboriginal patients with CKD. Demonstration of a significant attenuation of CKD progression and cardiovascular disease has the potential to inform clinicians of an important, new and widely available strategy for reducing CKD progression and cardiovascular disease for Australia's most disadvantaged population. TRIAL REGISTRATION This trial is registered with the Australian New Zealand Clinical Trial Registry ANZCTR12614001183673.
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Affiliation(s)
- Lisa Jamieson
- Indigenous Oral Health Unit, University of Adelaide, Adelaide, Australia.
| | | | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Kostas Kapellas
- Indigenous Oral Health Unit, University of Adelaide, Adelaide, Australia
| | - Lisa Askie
- Clinical Trials Centre, Unversity of Sydney, Sydney, Australia
| | - Jaqui Hughes
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Peter Arrow
- Indigenous Oral Health Unit, University of Adelaide, Adelaide, Australia
| | - Sajiv Cherian
- Alice Springs Renal Unit, Northern Territory Government, Alice Springs, Australia
| | - David Fernandes
- Alice Springs Renal Unit, Northern Territory Government, Alice Springs, Australia
| | - Basant Pawar
- Alice Springs Renal Unit, Northern Territory Government, Alice Springs, Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - John Boffa
- Central Australian Aboriginal Congress, Alice Springs, Australia
| | - Wendy Hoy
- Centre for Chronic Disease, University of Queensland, Brisbane, Australia
| | - David Harris
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nicole Mueller
- Indigenous Oral Health Unit, University of Adelaide, Adelaide, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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Carallo C, Franceschi MSD, Tripolino C, Iovane C, Catalano S, Giudice A, Crispino A, Figliuzzi M, Irace C, Fortunato L, Gnasso A. Periodontal Treatment Elevates Carotid Wall Shear Stress in the Medium Term. Medicine (Baltimore) 2015; 94:e1724. [PMID: 26496285 PMCID: PMC4620837 DOI: 10.1097/md.0000000000001724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Periodontal disease is associated with endothelial dysfunction of the brachial artery and hemodynamic alterations of the common carotid artery. Periodontal therapy improves endothelial function. It is not known if it is able also to improve the hemodynamics of the carotid artery. The aim of the current study was to evaluate the efficacy of 2 different periodontal treatments on carotid hemodynamics: scaling and root planing (SRP) alone or together with low-level laser therapy (LLLT). Forty patients were recruited and randomly treated with SRP (n = 20) or SRP + LLLT (n = 20). Periodontal indices (plaque, gingival, and probing depth indices) were measured before and 5 months after treatment. Blood viscosity, common carotid wall shear stress, circumferential wall tension, and Peterson elastic modulus were evaluated before, soon after and 5 months after treatment. It was found that the periodontal indices improved in both groups, but significantly more so for SRP + LLLT than for SRP (decrease in gingival index 69.3% versus 45.4%, respectively, P = 0.04). In the SRP + LLLT group, after a transient reduction by 5% immediately after therapy, shear stress increased by 11% after 5 months. In SRP only group, however, shear stress variations were less marked. No significant changes were found for the other hemodynamic parameters in either of the groups. Periodontal disease treatment by SRP + LLLT can therefore be said to improve common carotid wall shear stress. This suggests a possible mechanism by which the treatment of periodontal disease has beneficial effects on the cardiovascular system.
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Affiliation(s)
- Claudio Carallo
- From the Department of Chemical Engineering, Imperial College London, London, United Kingdom (CC, SC); Department of Clinical and Experimental Medicine, Institute of Dentistry, "Magna Graecia" University (MSDF, CI, AG, AC, MF, LF); and Department of Clinical and Experimental Medicine, Metabolic Disease Unit, "Magna Graecia" University, Catanzaro, Italy (CC, MSDF, CT, CI, AG)
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Papapanou PN. Systemic effects of periodontitis: lessons learned from research on atherosclerotic vascular disease and adverse pregnancy outcomes. Int Dent J 2015; 65:283-91. [PMID: 26388299 DOI: 10.1111/idj.12185] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Studies conducted over the past 25 years have focussed on the role of periodontitis, an inflammatory condition of microbial aetiology that destroys the tooth-supporting tissues, as a systemic inflammatory stressor that can act as an independent risk factor of atherosclerotic vascular disease (AVSD) and adverse pregnancy outcomes (APOs). It has been suggested that periodontitis-associated bacteraemias and systemic dissemination of inflammatory mediators produced in the periodontal tissues may result in systemic inflammation and endothelial dysfunction, and that bacteria of oral origin may translocate into the feto-placental unit. Epidemiological studies largely support an association between periodontitis and ASVD/APOs, independently of known confounders; indeed, periodontitis has been shown to confer statistically significantly elevated risk for clinical events associated with ASVD and APOs in multivariable adjustments. On the other hand, intervention studies demonstrate that although periodontal therapy reduces systemic inflammation and improves endothelial function, it has no positive effect on the incidence of APOs. Studies of the effects of periodontal interventions on ASVD-related clinical events are lacking. This review summarises key findings from mechanistic, association and intervention studies and attempts to reconcile the seemingly contradictory evidence that originates from different lines of investigation.
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Affiliation(s)
- Panos N Papapanou
- Section of Oral and Diagnostic Sciences, Division of Periodontics, Columbia University College of Dental Medicine, New York, NY, USA
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Groves DW, Krantz MJ, Hokanson JE, Johnson LR, Eckel RH, Kinney GL, Rewers M, Snell-Bergeon JK, Alman AC. Comparison of Frequency and Duration of Periodontal Disease With Progression of Coronary Artery Calcium in Patients With and Without Type 1 Diabetes Mellitus. Am J Cardiol 2015; 116:833-7. [PMID: 26189036 DOI: 10.1016/j.amjcard.2015.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/06/2015] [Accepted: 06/06/2015] [Indexed: 11/18/2022]
Abstract
People with type 1 diabetes mellitus manifest a greater burden of both periodontal disease and coronary artery disease (CAD); however, little is known about their interrelation. Coronary artery calcium (CAC) measures subclinical atherosclerosis and predicts major adverse coronary events. The relation between periodontal disease and CAC progression in individuals with type 1 diabetes has not been previously described. We determined the prevalence and progression of CAC in relation to self-reported periodontal disease. Multivariate logistic and tobit regression models were used to examine the relation between periodontal disease duration and CAC progression and whether this relation differs by diabetes status after controlling for age, gender, total and high-density lipoprotein cholesterol, hypertension, smoking, body mass index (BMI), duration of diabetes, and baseline CAC. A total of 473 patients with type 1 diabetes and 548 without diabetes were followed for a mean of 6.1 years. At baseline, the prevalence and duration of periodontal disease did not differ between subjects with and without diabetes (14.5% vs 13.4%, p = 0.60; 6 vs 9 years, p = 0.18). Duration of periodontal disease was not significantly associated with baseline CAC prevalence. In patients with type 1 diabetes, periodontal disease duration was significantly related to CAC progression (p = 0.004) but not in subjects without diabetes (p = 0.63). In conclusion, this study suggests that periodontal disease is an independent predictor of long-term progression of CAC in patients with type 1 diabetes.
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Affiliation(s)
| | | | - John E Hokanson
- University of Colorado-Denver, Aurora, Colorado; Colorado School of Public Health, Aurora, Colorado
| | - Lonnie R Johnson
- University of Colorado-Denver, Aurora, Colorado; Colorado School of Dentistry, Aurora, Colorado
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