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Hopkins S, Gajagowni S, Qadeer Y, Wang Z, Virani SS, Meurman JH, Leischik R, Lavie CJ, Strauss M, Krittanawong C. More than just teeth: How oral health can affect the heart. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 43:100407. [PMID: 38873102 PMCID: PMC11169959 DOI: 10.1016/j.ahjo.2024.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/14/2024] [Indexed: 06/15/2024]
Abstract
Epidemiological evidence has revealed a potential relationship between periodontal disease and cardiovascular disease (CVD). Consensus regarding a link between these pathologies remains elusive, however, largely secondary to the considerable overlap between risk factors and comorbidities common to both disease processes. This review article aims to update the evidence for an association by summarizing the evidence for causality between periodontitis and comorbidities linked to CVD, including endocarditis, hypertension (HTN), atrial fibrillation (AF), coronary artery disease (CAD), diabetes mellitus (DM) and hyperlipidemia (HLD). This article additionally discusses the role for periodontal therapy to improved management of the comorbidities, with the larger goal of examining the value of periodontal therapy on reduction of CVD risk. In doing so, we endeavor to further the understanding of the commonality between periodontitis, and CVD.
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Affiliation(s)
- Steven Hopkins
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Yusuf Qadeer
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Salim S. Virani
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Office of the Vice Provost (Research), The Aga Khan University, Karachi 74800, Pakistan
| | - Jukka H. Meurman
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Roman Leischik
- Department of Cardiology, Sector Preventive Medicine, Health Promotion, Faculty of Health, School of Medicine, University Witten/Herdecke, 58095 Hagen, Germany
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA 70121, USA
| | - Markus Strauss
- Department of Cardiology, Sector Preventive Medicine, Health Promotion, Faculty of Health, School of Medicine, University Witten/Herdecke, 58095 Hagen, Germany
- Department of Cardiology I- Coronary and Periphal Vascular Disease, Heart Failure Medicine, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
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2
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Hopkins S, Gajagowni S, Qadeer Y, Wang Z, Virani SS, Meurman JH, Krittanawong C. Oral Health and Cardiovascular Disease. Am J Med 2024; 137:304-307. [PMID: 38141902 DOI: 10.1016/j.amjmed.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/25/2023]
Abstract
Several studies have examined a potential relationship between periodontal disease and cardiovascular disease. This article aims to update the evidence for a potential association by summarizing the evidence for causality between periodontitis and comorbidities linked to cardiovascular disease, including hypertension, atrial fibrillation, coronary artery disease, diabetes mellitus, and hyperlipidemia. We additionally discuss the evidence for periodontal therapy as a means to improved management of these comorbidities, with the larger goal of examining the value of periodontal therapy on reduction of cardiovascular disease risk.
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Affiliation(s)
- Steven Hopkins
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Yusuf Qadeer
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Salim S Virani
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Office of the Vice Provost (Research), The Aga Khan University, Karachi, Pakistan
| | - Jukka H Meurman
- Department of Oral and Maxillofacial Diseases, Institute of Dentistry, Helsinki University Central Hospital, University of Helsinki, Finland
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3
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Nagy FT, Gheorghita D, Dharmarajan L, Braunitzer G, Achim A, Ruzsa Z, Antal MÁ. Oral Health of Patients Undergoing Percutaneous Coronary Intervention-A Possible Link between Periodontal Disease and In-Stent Restenosis. J Pers Med 2023; 13:jpm13050760. [PMID: 37240930 DOI: 10.3390/jpm13050760] [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: 03/29/2023] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction: There is a well-documented association between coronary artery disease (CHD) and periodontal disease (PD) mediated by common inflammatory pathways. This association, however, has not been investigated extensively in the special context of in-stent restenosis. This study aimed to investigate the periodontal status of patients undergoing percutaneous coronary intervention (PCI) for restenotic lesions. Methods and Results: We enrolled 90 patients undergoing percutaneous coronary intervention and 90 age- and gender-matched healthy controls in the present study. All subjects received a full-mouth examination by a periodontist. Plaque index, periodontal status, and tooth loss were determined. The periodontal state was significantly worse (p < 0.0001) in the PCI group, and each periodontal stage increased the odds of belonging to the PCI group. This effect of PD was independent of diabetes mellitus, another strong risk factor for CAD. The PCI group was further divided into two subgroups: PCI for restenotic lesions (n = 39) and PCI for de novo lesions (n = 51). Baseline clinical and procedural characteristics were comparable between the two PCI subgroups. A significant (p < 0.001) association was found between the PCI subgroup and the severity of periodontal disease, with the incidence of severe PD reaching 64.1%. Conclusions: Patients undergoing PCI for in-stent restenosis exhibit more severe forms of periodontal disease not only as compared to healthy controls but also as compared to patients stented for de novo lesions. The potential causality between PD and restenosis must be studied in larger prospective studies.
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Affiliation(s)
- Ferenc Tamás Nagy
- Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Dorottya Gheorghita
- Faculty of Dentistry, Department of Esthetic and Operative Dentistry, University of Szeged, 6720 Szeged, Hungary
| | | | | | - Alexandru Achim
- "Nicolae Stancioiu" Heart Institute, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Zoltán Ruzsa
- Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Márk Ádám Antal
- Faculty of Dentistry, Department of Esthetic and Operative Dentistry, University of Szeged, 6720 Szeged, Hungary
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4
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Paju S, Tallgren M, Kivimäki A, Lahdentausta L, Salminen A, Oksanen L, Sanmark E, Geneid A, Pussinen P, Pietiäinen M. Effect of RNA quality to SARS-CoV-2 RT-qPCR detection from saliva. J Med Microbiol 2022; 71. [PMID: 35417320 DOI: 10.1099/jmm.0.001507] [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] [Indexed: 11/18/2022] Open
Abstract
Saliva is an alternative sample material to nasopharyngeal swab in SARS-CoV-2 diagnostics. We investigated possible aspects to improve the reliability of SARS-CoV-2 detection from saliva. Saliva was collected from asymptomatic healthy subjects (n=133) and COVID-19 patients (n=9). SARS-CoV-2 detection was performed with quantitative reverse-transcriptase PCR (RT-qPCR) with two viral and one host target serving as an internal control. The use of internal control revealed that in the first RT-qPCR run 25-30 % of assays failed. The failure is associated with poor RNA quality. When the amount of RNA was cut down to half from the original amount, the performance of RT-qPCR was greatly enhanced (95 % of the assays succeeded). The quality of RNA was not affected by the use of different nucleic acid stabilizing buffers. Our study showed that saliva is suitable material for RT-qPCR based SARS-CoV-2 diagnostics, but the use of internal control is essential to distinguish the true negative samples from failed assays.
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Affiliation(s)
- Susanna Paju
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland
| | | | - Anne Kivimäki
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland
- Medical Nutrition Physiology, Pharmacology, University of Helsinki, FI-00014 Helsinki, Finland
| | - Laura Lahdentausta
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland
| | - Aino Salminen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland
| | - Lotta Oksanen
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, FI-00029 Helsinki, Finland
| | - Enni Sanmark
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, FI-00029 Helsinki, Finland
| | - Ahmed Geneid
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, FI-00029 Helsinki, Finland
| | - Pirkko Pussinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland
| | - Milla Pietiäinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland
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5
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Salminen A, Pietiäinen M, Paju S, Sorsa T, Mäntylä P, Buhlin K, Sinisalo J, Pussinen PJ. Common complement factor H polymorphisms are linked with periodontitis in elderly patients. J Periodontol 2022; 93:1626-1634. [PMID: 35315933 PMCID: PMC10084333 DOI: 10.1002/jper.22-0005] [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: 01/03/2022] [Revised: 02/25/2022] [Accepted: 03/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In our recent genome-wide association study, we found that genetic polymorphisms in the complement factor H (CFH) gene and S100A gene region are strongly associated with serum matrix metalloproteinase 8 (MMP-8) concentration and the release of MMP-8 from neutrophils. As MMP-8 is centrally involved in the pathogenesis of periodontitis, we aimed to evaluate the presence of genetic polymorphisms of S100A8/A9/A12, MMP8, and CFH in periodontitis. In addition, we studied whether polymorphisms of these genes affect the concentrations of S100A8, S100A12, MMP-8, or complement activation marker in saliva. METHODS We genotyped four SNPs (rs1560833 in S100A8/A9/A12, rs11225395 in MMP8, rs800292 in CFH, and rs1061170 in CFH) and measured salivary concentrations of S100A8, S100A12, MMP-8, and terminal complement complex (TCC) in the Parogene cohort (n = 508). The cohort was composed of patients with an indication to coronary angiography and all underwent a clinical and radiographic oral examination. RESULTS Complement factor H polymorphisms rs800292 and rs1061170 were associated with periodontal parameters. None of the polymorphisms showed association with salivary proteins. However, salivary concentrations of S100A8, S100A12, MMP-8, and TCC were strongly associated with the number of periodontal pockets and alveolar bone loss. CONCLUSION Interestingly, genetic variants of CFH, MMP8, and S100A8/A9/A12 gene region did not affect salivary levels of measured proteins. However, saliva levels of S100A8, S100A12, MMP-8, and TCC, and CFH polymorphisms were associated with clinical and radiographic signs of periodontitis. Our study further supports the observations that any dysregulation of complement may increase the risk of inflammatory disorders, such as periodontitis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Aino Salminen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Milla Pietiäinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Paju
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo Sorsa
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi Mäntylä
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - Kåre Buhlin
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Juha Sinisalo
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Pirkko J Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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6
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Jaago M, Pupina N, Rähni A, Pihlak A, Sadam H, Vrana NE, Sinisalo J, Pussinen P, Palm K. Antibody response to oral biofilm is a biomarker for acute coronary syndrome in periodontal disease. Commun Biol 2022; 5:205. [PMID: 35246599 PMCID: PMC8897497 DOI: 10.1038/s42003-022-03122-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/08/2022] [Indexed: 12/15/2022] Open
Abstract
Cumulative evidence over the last decades have supported the role of gum infections as a risk for future major cardiovascular events. The precise mechanism connecting coronary artery disease (CAD) with periodontal findings has remained elusive. Here, we employ next generation phage display mimotope-variation analysis (MVA) to identify the features of dysfunctional immune system that associate CAD with periodontitis. We identify a fine molecular description of the antigenic epitope repertoires of CAD and its most severe form - acute coronary syndrome (ACS) by profiling the antibody reactivity in a patient cohort with invasive heart examination and complete clinical oral assessment. Specifically, we identify a strong immune response to an EBV VP26 epitope mimicking multiple antigens of oral biofilm as a biomarker for the no-CAD group. With a 2-step biomarker test, we stratify subjects with periodontitis from healthy controls (balanced accuracy 84%), and then assess the risk for ACS with sensitivity 71-89% and specificity 67-100%, depending on the oral health status. Our findings highlight the importance of resolving the immune mechanisms related to severe heart conditions such as ACS in the background of oral health. Prospective validation of these findings will support incorporation of these non-invasive biomarkers into clinical practice.
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Affiliation(s)
- Mariliis Jaago
- Protobios Llc, Mäealuse 4, 12618, Tallinn, Estonia.,Department of Chemistry and Biotechnology, Tallinn University of Technology, Akadeemia tee 15, 12618, Tallinn, Estonia
| | | | - Annika Rähni
- Protobios Llc, Mäealuse 4, 12618, Tallinn, Estonia.,Department of Chemistry and Biotechnology, Tallinn University of Technology, Akadeemia tee 15, 12618, Tallinn, Estonia
| | - Arno Pihlak
- Protobios Llc, Mäealuse 4, 12618, Tallinn, Estonia
| | - Helle Sadam
- Protobios Llc, Mäealuse 4, 12618, Tallinn, Estonia.,Department of Chemistry and Biotechnology, Tallinn University of Technology, Akadeemia tee 15, 12618, Tallinn, Estonia
| | - Nihal Engin Vrana
- Spartha Medical, 14B Rue de la Canardiere, 67100, Strasbourg, France
| | - Juha Sinisalo
- Heart and Lung Center, Helsinki University Hospital, and Helsinki University, Helsinki, Finland
| | - Pirkko Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki, FI-00014, Helsinki, Finland
| | - Kaia Palm
- Protobios Llc, Mäealuse 4, 12618, Tallinn, Estonia. .,Department of Chemistry and Biotechnology, Tallinn University of Technology, Akadeemia tee 15, 12618, Tallinn, Estonia.
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7
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Kopra E, Lahdentausta L, Pietiäinen M, Buhlin K, Mäntylä P, Hörkkö S, Persson R, Paju S, Sinisalo J, Salminen A, Pussinen PJ. Systemic Antibiotics Influence Periodontal Parameters and Oral Microbiota, But Not Serological Markers. Front Cell Infect Microbiol 2021; 11:774665. [PMID: 35004349 PMCID: PMC8738095 DOI: 10.3389/fcimb.2021.774665] [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] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
The use of systemic antibiotics may influence the oral microbiota composition. Our aim was to investigate in this retrospective study whether the use of prescribed antibiotics associate with periodontal status, oral microbiota, and antibodies against the periodontal pathogens. The Social Insurance Institution of Finland Data provided the data on the use of systemic antibiotics by record linkage to purchased medications and entitled reimbursements up to 1 year before the oral examination and sampling. Six different classes of antibiotics were considered. The Parogene cohort included 505 subjects undergoing coronary angiography with the mean (SD) age of 63.4 (9.2) years and 65% of males. Subgingival plaque samples were analysed using the checkerboard DNA-DNA hybridisation. Serum and saliva antibody levels to periodontal pathogens were analysed with immunoassays and lipopolysaccharide (LPS) activity with the LAL assay. Systemic antibiotics were prescribed for 261 (51.7%) patients during the preceding year. The mean number of prescriptions among them was 2.13 (range 1-12), and 29.4% of the prescriptions were cephalosporins, 25.7% penicillins, 14.3% quinolones, 12.7% macrolides or lincomycin, 12.0% tetracycline, and 5.8% trimethoprim or sulphonamides. In linear regression models adjusted for age, sex, current smoking, and diabetes, number of antibiotic courses associated significantly with low periodontal inflammation burden index (PIBI, p < 0.001), bleeding on probing (BOP, p = 0.006), and alveolar bone loss (ABL, p = 0.042). Cephalosporins associated with all the parameters. The phyla mainly affected by the antibiotics were Bacteroidetes and Spirochaetes. Their levels were inversely associated with the number of prescriptions (p = 0.010 and p < 0.001) and directly associated with the time since the last prescription (p = 0.019 and p < 0.001). Significant inverse associations were observed between the number of prescriptions and saliva concentrations of Prevotella intermedia, Tannerella forsythia, and Treponema denticola and subgingival bacterial amounts of Porphyromonas gingivalis, P. intermedia, T. forsythia, and T. denticola. Saliva or serum antibody levels did not present an association with the use of antibiotics. Both serum (p = 0.031) and saliva (p = 0.032) LPS activity was lower in patients having any antibiotic course less than 1 month before sampling. Systemic antibiotics have effects on periodontal inflammation and oral microbiota composition, whereas the effects on host immune responses against the periodontal biomarker species seem unchanged.
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Affiliation(s)
- Elisa Kopra
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Lahdentausta
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Milla Pietiäinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kåre Buhlin
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Päivi Mäntylä
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - Sohvi Hörkkö
- Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Rutger Persson
- Department of Periodontics, University of Washington, Seattle, WA, United States
- Department of Oral Medicine, University of Washington, Seattle, WA, United States
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Susanna Paju
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Sinisalo
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Cardiology, Heart and Lung Center, Department of Medicine, Helsinki University Hospital, Helsinki, Finland
| | - Aino Salminen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirkko J. Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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8
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Hosseinpour-Moghadam R, Mehryab F, Torshabi M, Haeri A. Applications of Novel and Nanostructured Drug Delivery Systems for the Treatment of Oral Cavity Diseases. Clin Ther 2021; 43:e377-e402. [PMID: 34844769 DOI: 10.1016/j.clinthera.2021.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Novel drug delivery systems (DDSs) hold great promise for the treatment of oral cavity diseases. The main objective of this article was to provide a detailed overview regarding recent advances in the use of novel and nanostructured DDSs in alleviating and treating unpleasant conditions of the oral cavity. Strategies to maximize the benefits of these systems in the treatment of oral conditions and future directions to overcome these issues are also discussed. METHODS Publications from the last 10 years investigating novel and nanostructured DDSs for pathologic oral conditions were browsed in a systematic search using the PubMed/MEDLINE, Web of Science, and Scopus databases. Research on applications of novel DDSs for periodontitis, oral carcinomas, oral candidiasis, xerostomia, lichen planus, aphthous stomatitis, and oral mucositis is summarized. A narrative exploratory review of the most recent literature was undertaken. FINDINGS Conventional systemic administration of therapeutic agents could exhibit high clearance of drugs from the bloodstream and low accumulation at the target site. In contrast, conventional topical systems face problems such as short residence time in the affected region and low patient compliance. Novel and nanostructured DDSs are among the most effective and commonly used methods for overcoming the problems of conventional DDSs. The main advantages of these systems are that they possess the ability to protect active agents from systemic and local clearance, enhance bioavailability and cellular uptake, and provide immediate or modified release of therapeutic agents after administration. In the design of local drug delivery devices such as nanofiber mats, films, and patches, components and excipients can significantly affect factors such as drug release rate, residence time in the oral cavity, and taste in the mouth. Choosing appropriate additives is therefore essential. IMPLICATIONS Local drug delivery devices such as nanofiber mats, nanoparticles, liposomes, hydrogels, films, and patches for oral conditions can significantly affect drug efficacy and safety. However, more precise clinical studies should be designed and conducted to confirm promising in vitro and in vivo results. In recent years, novel and nanostructured DDSs increasingly attracted the attention of researchers as a means of treatment and alleviation of oral diseases and unpleasant conditions. However, more clinical studies should be performed to confirm promising in vitro and in vivo results. To transform a successful laboratory model into a marketable product, the long-term stability of prepared formulations is essential. Also, proper scale-up methods with optimum preparation costs should be addressed.
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Affiliation(s)
- Reza Hosseinpour-Moghadam
- Department of Pharmaceutics and Pharmaceutical Nanotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mehryab
- Department of Pharmaceutics and Pharmaceutical Nanotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Torshabi
- Department of Dental Biomaterials, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azadeh Haeri
- Department of Pharmaceutics and Pharmaceutical Nanotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Protein Technology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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9
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Akhi R, Nissinen AE, Wang C, Kyrklund M, Paju S, Mäntylä P, Buhlin K, Sinisalo J, Pussinen PJ, Hörkkö S. Salivary IgA antibody to malondialdehyde-acetaldehyde associates with mild periodontal pocket depth. Oral Dis 2021; 28:2285-2293. [PMID: 34124817 DOI: 10.1111/odi.13936] [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: 10/15/2020] [Revised: 05/03/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Oxidized epitopes such as malondialdehyde-acetaldehyde (MAA) play a crucial role in the progression of atherosclerosis through activation of the humoral immune response. The exact mechanism of the association between atherosclerosis and periodontal diseases is not fully understood. The aim of the current study is to evaluate the association of oral humoral immune response to oxidized epitopes with parameters of periodontal disease. MATERIALS AND METHODS The Parogene cohort consist of patients who have undergone coronary angiography due to cardiac symptoms. In this study, 423 patients were randomly selected for an extensive oral examination. Salivary Immunoglobulin A to oxidized epitopes and bacterial antigens was determined by chemiluminescence immunoassay. RESULTS In a binary logistic regression model adjusted with periodontal disease confounders, periodontal pocket depth (PPD) 4-5 mm associated with salivary IgA antibodies to MAA-LDL (p = 0.034), heat shock protein 60 of Aggregatibacter actinomycetemcomitans (p = 0.045), Porphyromonas gingivalis (p = 0.045), A. actinomycetemcomitans (p = 0.005), P. intermedia (p = 0.020), and total IgA (p = 0.003). CONCLUSIONS The current study shows the association of salivary IgA to MAA-LDL with PPD 4-5 mm in a cohort of patients with chronic coronary artery disease. Humoral immune cross-reactivation to oxidized epitopes such MAA-LDL could partly explain the link of periodontitis with systemic diseases.
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Affiliation(s)
- Ramin Akhi
- Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Antti E Nissinen
- Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Chunguang Wang
- Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mikael Kyrklund
- Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Susanna Paju
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi Mäntylä
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Kåre Buhlin
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Juha Sinisalo
- HUCH Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Pirkko J Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sohvi Hörkkö
- Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
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10
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Liljestrand JM, Salminen A, Pussinen PJ. Response to Letter to Editor regarding article, 'Association between dental factors and mortality'. Int Endod J 2021; 54:1001. [PMID: 33951218 DOI: 10.1111/iej.13498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J M Liljestrand
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - A Salminen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - P J Pussinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
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11
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Önal MA, Fentoğlu Ö, Aksoy F, Calapoğlu M, Varol E, Orhan H. Salivary levels of last generation specific pro-resolving lipid mediators (SPMs) (protectin and maresin) in patients with cardiovascular and periodontal disease: A case-control study. J Periodontal Res 2021; 56:606-615. [PMID: 33650687 DOI: 10.1111/jre.12861] [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: 08/21/2020] [Revised: 01/15/2021] [Accepted: 01/27/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Periodontal disease and cardiovascular disease (CVD), which are both deemed to be triggered by inflammation, are recognized as public health problems. Evidence of host modulation via pro-resolving lipid shown in previous studies supports a two-way relationship between periodontitis and CVD. Last generation endogenous specific pro-resolution lipid mediators (SPMs) such as protectins (PDs) and maresins (MaRs) may have potential effects on inflammatory pathogenesis via activation and resolution mechanisms. Currently, there are no data on SPM levels in patients with CVD and periodontal disease. We aimed to evaluate salivary levels of PD and MaR in patients with CVD and periodontal disease. MATERIALS AND METHODS At total of 181 individuals comprising of 79 healthy controls (C) and 102 patients with diagnosed CVD were included cross-sectionally. Unstimulated total salivary samples were obtained, and clinical periodontal parameters were determined. Salivary levels of PD and MaR were evaluated by ELISA. The periodontal status of the study population was classified as gingivitis (g) or periodontitis (p). RESULTS Patients with CVD showed lower sociodemographic characteristics, increased clinical periodontal parameters (p < .05), decreased salivary PD (p < .001), and increased salivary MaR levels (p > .05). In the CVDg group, leukocyte, hemoglobin, hematocrit, and high-density lipoprotein values were higher (p < .05). The CVDp group had a higher neutrophil-to-lymphocyte ratio (p < .05). While the PD level was highest in the Cg group, MaR was highest in the CVDp group. The salivary levels of PD and MaR were independent of other confounders in CVD and periodontal disease (p > .05). CONCLUSION(S) PDs and MaRs may play effective roles in pathogenesis associated with worsening cardiometabolic and periodontal status. These SPMs could also be predictors for conversion from a healthy (systemically and periodontally) to diseased state (CVD and/or periodontitis). Elucidation of the role of SPMs in the relationship between periodontal disease and CVD will enable the development of new host modulation strategies in the prevention and treatment of both diseases, and may also constitute an important public health step by increasing the quality of life of patients with CVD and periodontal disease.
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Affiliation(s)
- Mehmet Artuğ Önal
- Department of Periodontology, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - Özlem Fentoğlu
- Department of Periodontology, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - Fatih Aksoy
- Department of Cardiology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Mustafa Calapoğlu
- Department of Biochemistry, Faculty of Science, Süleyman Demirel University, Isparta, Turkey
| | - Ercan Varol
- Department of Cardiology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Hikmet Orhan
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
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12
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Liljestrand JM, Salminen A, Lahdentausta L, Paju S, Mäntylä P, Buhlin K, Tjäderhane L, Sinisalo J, Pussinen PJ. Association between dental factors and mortality. Int Endod J 2020; 54:672-681. [PMID: 33275782 DOI: 10.1111/iej.13458] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
AIM To study whether oral parameters such as endodontic infections, root canal fillings, number of teeth or wearing removable dentures at baseline are associated with cardiovascular- and all-cause mortality in a follow-up of approximately 8 years. METHODOLOGY The Finnish Parogene cohort consists of 508 Finnish adults (mean age 63.3 years, SD 9.1) with cardiac symptoms, all of whom had undergone coronary angiography for accurate baseline coronary status. Extensive clinical and radiographic oral examinations were performed, and additional data were acquired from medical records and questionnaires. Root canal fillings and endodontic lesions, as well as their co-occurrence, were determined from panoramic radiographs. The mortality data were assessed via record linkage with the Finnish Causes of Death register (mean follow-up time 7.81 years, SD 1.45 years). A total of n = 471 dentate patients were included in the statistical analyses. RESULTS A total of n = 69 deaths were recorded, of which n = 41 were due to cardiovascular diseases (CVDs, ICD-10 I00-I99). The deceased had fewer root canal fillings (mean 1.57; SD 1.64 vs. mean 2.30; SD 2.34, P = 0.03) than the survivors. The number of missing teeth was associated with smoking, occluded coronary arteries and diabetes. Cox regression with Firth's penalized maximum-likelihood method using age as timescale revealed an inverse association (HR; 95%CI) between mortality and number of teeth (all-cause 0.91; 0.86-0.96, CVD mortality 0.89; 0.83-0.96), use of removable dentures (all-cause 0.24; 0.09-0.62, CVD mortality 0.20; 0.06-0.72), root canal fillings (all-cause 0.82; 0.70-0.94, CVD mortality 0.79; 0.63-0.96) and having root canal fillings in all teeth with apical rarefactions (all-cause 0.27; 0.06-0.79, CVD mortality 0.09; 0.01-0.63), when gender, smoking, occluded coronary arteries, periodontal inflammatory burden index and the number of teeth were adjusted for. CONCLUSIONS The number of missing teeth appeared to be the strongest predictor of mortality in this study, whereas endodontic infections per se had no independent association. Nevertheless, signs of professional intervention in these problems, such as root canal fillings and removable dentures, appeared to be associated with improved survival, which might partly be explained by the utilization of healthcare services.
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Affiliation(s)
- J M Liljestrand
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Salminen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L Lahdentausta
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Paju
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Mäntylä
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute of Dentistry, University of Eastern Finland and Kuopio University Hospital, Oral and Maxillofacial Diseases, Kuopio, Finland
| | - K Buhlin
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - L Tjäderhane
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Unit of Oral Health Sciences, and Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - J Sinisalo
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P J Pussinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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13
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Määttä AM, Salminen A, Pietiäinen M, Leskelä J, Palviainen T, Sattler W, Sinisalo J, Salomaa V, Kaprio J, Pussinen PJ. Endotoxemia is associated with an adverse metabolic profile. Innate Immun 2020; 27:3-14. [PMID: 33243051 PMCID: PMC7780360 DOI: 10.1177/1753425920971702] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Our aim was to analyze whether endotoxemia, i.e. translocation of LPS to circulation, is reflected in the serum metabolic profile in a general population and in participants with cardiometabolic disorders. We investigated three Finnish cohorts separately and in a meta-analysis (n = 7178), namely population-based FINRISK97, FinnTwin16 consisting of young adult twins, and Parogene, a random cohort of cardiac patients. Endotoxemia was determined as serum LPS activity and metabolome by an NMR platform. Potential effects of body mass index (BMI), smoking, metabolic syndrome (MetS), and coronary heart disease (CHD) status were considered. Endotoxemia was directly associated with concentrations of VLDL, IDL, LDL, and small HDL lipoproteins, VLDL particle diameter, total fatty acids (FA), glycoprotein acetyls (GlycA), aromatic and branched-chain amino acids, and Glc, and inversely associated with concentration of large HDL, diameters of LDL and HDL, as well as unsaturation degree of FAs. Some of these disadvantageous associations were significantly stronger in smokers and subjects with high BMI, but did not differ between participants with different CHD status. In participants with MetS, however, the associations of endotoxemia with FA parameters and GlycA were particularly strong. The metabolic profile in endotoxemia appears highly adverse, involving several inflammatory characters and risk factors for cardiometabolic disorders.
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Affiliation(s)
- Anne-Mari Määttä
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Aino Salminen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Milla Pietiäinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaakko Leskelä
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teemu Palviainen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Wolfgang Sattler
- Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Juha Sinisalo
- Department of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Veikko Salomaa
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Pirkko J Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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14
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Presence of bacterial DNA in thrombotic material of patients with myocardial infarction. Sci Rep 2020; 10:16299. [PMID: 33004892 PMCID: PMC7530676 DOI: 10.1038/s41598-020-73011-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/07/2020] [Indexed: 12/29/2022] Open
Abstract
Infectious agents have been suggested to be involved in etiopathogenesis of Acute Coronary Syndrome (ACS). However, the relationship between bacterial infection and acute myocardial infarction (AMI) has not yet been completely clarified. The objective of this study is to detect bacterial DNA in thrombotic material of patients with ACS with ST-segment elevation (STEMI) treated with Primary Percutaneous Coronary Intervention (PPCI). We studied 109 consecutive patients with STEMI, who underwent thrombus aspiration and arterial peripheral blood sampling. Testing for bacterial DNA was performed by probe-based real-time Polymerase Chain Reaction (PCR). 12 probes and primers were used for the detection of Aggregatibacter actinomycetemcomitans, Chlamydia pneumoniae, viridans group streptococci, Porphyromonas gingivalis, Fusobacterium nucleatum, Tannarella forsythia, Treponema denticola, Helycobacter pylori, Mycoplasma pneumoniae, Staphylococus aureus, Prevotella intermedia and Streptococcus mutans. Thus, DNA of four species of bacteria was detected in 10 of the 109 patients studied. The most frequent species was viridans group streptococci (6 patients, 5.5%), followed by Staphylococus aureus (2 patients, 1.8%). Moreover, a patient had DNA of Porphyromonas gingivalis (0.9%); and another patient had DNA of Prevotella intermedia (0.9%). Bacterial DNA was not detected in peripheral blood of any of our patients. In conclusion, DNA of four species of endodontic and periodontal bacteria was detected in thrombotic material of 10 STEMI patients. Bacterial DNA was not detected in the peripheral blood of patients with bacterial DNA in their thrombotic material. Bacteria could be latently present in plaques and might play a role in plaque instability and thrombus formation leading to ACS.
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15
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Paju S, Pietiäinen M, Liljestrand JM, Lahdentausta L, Salminen A, Kopra E, Mäntylä P, Buhlin K, Hörkkö S, Sinisalo J, Pussinen PJ. Carotid artery calcification in panoramic radiographs associates with oral infections and mortality. Int Endod J 2020; 54:15-25. [PMID: 32865251 DOI: 10.1111/iej.13394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/24/2020] [Indexed: 12/23/2022]
Abstract
AIM To study the prevalence of carotid artery calcification (CAC) in relation to apical and marginal periodontitis, subgingival dysbiotic bacterial species and serum and saliva immune responses against them. In addition, the aim was to analyse the association of CAC with angiographically verified coronary artery disease (CAD) and mortality. METHODOLOGY In the present random Parogene cohort, the patients had an indication for coronary angiography. Apical and marginal periodontitis were diagnosed during clinical and radiographic oral examinations, and CAC on panoramic radiographs (n = 492). Presence and severity of CAD were registered from angiography. Subgingival dysbiotic bacterial species were quantitated using checkerboard DNA-DNA-hybridization, and serum and saliva antibody levels were determined by immunoassays. The cohort was followed-up for 10 years or until death (median 9.9, range 0.21-10.4) via linkage to the national death register. The statistical models were adjusted for age, gender, smoking, hypertension, diabetes and dyslipidemia. RESULTS A total of 102 (20.7%) patients had detectable CAC, which was moderate in 81 (16.4%) and severe in 21 (4.3%). CAC was associated (OR, 95% CI) with severe apical periodontitis (2.25, 1.15-4.41), root canal fillings (1.15, 1.04-1.26), alveolar bone loss (2.66, 1.21-5.84), severe periodontal inflammation (2.23, 1.11-4.47), high level of gram-negative subgingival species (2.73, 1.34-5.50), saliva IgG against dysbiotic species (1.05, 1.01-1.10/unit) and severe (2.58, 1.36-4.90) and chronic (2.13, 1.15-3.93) CAD. A total of 105 (20.7%) patients died during the follow-up and 53 (10.4%) deaths were because of cardiovascular diseases (CVD). Severe CAC predicted worse survival with HRs (95% CI) of 3.08 (1.58-6.06) for all-cause and 3.43 (1.42-8.25) for CVD death. CONCLUSIONS CAC on panoramic tomography was associated with (i) apical and marginal periodontitis and dysbiotic bacterial species giving rise to an immunological response, and with (ii) severe, chronic CAD and increased mortality. The results further emphasize the role of oral infections in CAD and the importance of referring a patient with CAC for a cardiovascular evaluation.
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Affiliation(s)
- S Paju
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Pietiäinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J M Liljestrand
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L Lahdentausta
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Salminen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - E Kopra
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Mäntylä
- Oral and Maxillofacial Diseases, Institute of Dentistry, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - K Buhlin
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Periodontology, Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - S 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
| | - J Sinisalo
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - P J Pussinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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16
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Immunological and Microbiological Profiling of Cumulative Risk Score for Periodontitis. Diagnostics (Basel) 2020; 10:diagnostics10080560. [PMID: 32764360 PMCID: PMC7460115 DOI: 10.3390/diagnostics10080560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022] Open
Abstract
The cumulative risk score (CRS) is a mathematical salivary diagnostic model to define an individual's risk of having periodontitis. In order to further validate this salivary biomarker, we investigated how periodontal bacteria, lipopolysaccharide (LPS), and systemic and local host immune responses relate to CRS. Subgingival plaque, saliva, and serum samples collected from 445 individuals were used in the analyses. Plaque levels of 28 microbial species, especially those of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Porphyromonas endodontalis, Prevotella intermedia, and Tannerella forsythia, and serum and salivary levels of IgA and IgG against these five species were determined. Additionally, LPS activity was measured. High CRS associated strongly with all IgA/IgG antibody and LPS levels in saliva, whereas in serum the associations were not that obvious. In the final logistic regression model, the best predictors of high CRS were saliva IgA burden against the five species (OR 7.04, 95% CI 2.25-22.0), IgG burden (3.79, 1.78-8.08), LPS (2.19, 1.38-3.47), and the sum of 17 subgingival Gram-negative species (6.19, 2.10-18.3). CRS is strongly associated with microbial biomarker species of periodontitis and salivary humoral immune responses against them.
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17
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Bilgin Çetin M, Önder C, Orhan K, Kumbasar D, Serdar MA, Ünsal E. Relationship of periodontitis and edentulism to angiographically diagnosed coronary artery disease: A cross-sectional study. J Periodontal Res 2020; 55:895-904. [PMID: 32648271 DOI: 10.1111/jre.12782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The objective of the study is to examine the connection between oral status and the extent of coronary artery disease (CAD), which is diagnosed by angiography. BACKGROUND Periodontitis and tooth loss have been linked to atherosclerosis and CAD in previous studies. However, no distinct connection was revealed due to the diversity of the results and the variety of diagnostic methods. To provide a more consistent data pool and stronger evidence, there is a need for studies with standard measurements and diagnostic criteria. METHODS 309 patients, who consulted to Ankara University, Faculty of Medicine, Department of Cardiology and had coronary angiography, were enrolled to this study. Individuals were grouped based on their coronary angiography results, as CAD (+) (n = 233) and CAD (-) (n = 76). Studied parameters included cardiovascular risk factors, plaque index (PI), remaining teeth count, bleeding on probing (BOP), and probing pocket depth (PPD). Periapical radiographs were taken from teeth with ≥4 mm PPD. Oral status was categorized as periodontally healthy subjects/patients with gingivitis (Group 1), patients with periodontitis (Group 2), and edentulous subjects (Group 3). RESULTS PI (P < 0.001), PPD (P = 0.001), BOP (P = 0.004), the number of patients with less than 10 teeth (P = 0.014), and edentulism (P = 0.009) were significantly higher in CAD (+) patients, who were mostly older (P < 0.001) and male (P < 0.001). Multivariate logistic regression analysis revealed that Group 2 (odds ratio = 2.48, 95% confidence interval = 1.24-4.95, P = 0.010) and Group 3 (odds ratio = 2.01, 95% confidence interval = 1.14-5.17, P = 0.040) were highly associated with CAD. Two and three stenosed vessels were significantly higher in Groups 2 and 3 compared to Group 1 (P = 0.003). CONCLUSIONS It was found that both edentulism and periodontitis were related to CAD.
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Affiliation(s)
- Mehtap Bilgin Çetin
- Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Canan Önder
- Department of Periodontology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Kaan Orhan
- Department of Dento Maxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Deniz Kumbasar
- Department of Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Elif Ünsal
- Department of Periodontology, Faculty of Dentistry, Ankara University, Ankara, Turkey
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18
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Porphyromonas gingivalis triggers the shedding of inflammatory endothelial microvesicles that act as autocrine effectors of endothelial dysfunction. Sci Rep 2020; 10:1778. [PMID: 32019950 PMCID: PMC7000667 DOI: 10.1038/s41598-020-58374-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/13/2020] [Indexed: 12/15/2022] Open
Abstract
A link between periodontitis and atherothrombosis has been highlighted. The aim of this study was to determine the influence of Porphyromonas gingivalis on endothelial microvesicles (EMVPg) shedding and their contribution to endothelial inflammation. Endothelial cells (EC) were infected with P. gingivalis (MOI = 100) for 24 h. EMVPg were isolated and their concentration was evaluated by prothrombinase assay. EMVPg were significantly increased in comparison with EMVCtrl shedded by unstimulated cells. While EMVCtrl from untreated EC had no effect, whereas, the proportion of apoptotic EC was increased by 30 nM EMVPg and viability was decreased down to 25%, a value elicited by P. gingivalis alone. Moreover, high concentration of EMVPg (30 nM) induced a pro-inflammatory and pro-oxidative cell response including up-regulation of TNF-α, IL-6 and IL-8 as well as an altered expression of iNOS and eNOS at both mRNA and protein level. An increase of VCAM-1 and ICAM-1 mRNA expression (4.5 folds and 3 folds respectively (p < 0.05 vs untreated) was also observed after EMVPg (30 nM) stimulation whereas P. gingivalis infection was less effective, suggesting a specific triggering by EMVPg. Kinasome analysis demonstrated the specific effect induced by EMVPg on main pro-inflammatory pathways including JNK/AKT and STAT. EMVPg are effective pro-inflammatory effectors that may have detrimental effect on vascular homeostasis and should be considered as potential autocrine and paracrine effectors involved in the link between periodontitis and atherothrombosis.
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19
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Saliva and Serum Immune Responses in Apical Periodontitis. J Clin Med 2019; 8:jcm8060889. [PMID: 31234349 PMCID: PMC6617293 DOI: 10.3390/jcm8060889] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 12/26/2022] Open
Abstract
Apical periodontitis is an inflammatory reaction at the apex of an infected tooth. Its microbiota resembles that of marginal periodontitis and may induce local and systemic antibodies binding to bacteria- and host-derived epitopes. Our aim was to investigate the features of the adaptive immune response in apical periodontitis. The present Parogene cohort (n = 453) comprises patients with cardiac symptoms. Clinical and radiographic oral examination was performed to diagnose apical and marginal periodontitis. A three-category endodontic lesion score was designed. Antibodies binding to the bacteria- and host-derived epitopes were determined from saliva and serum, and bacterial compositions were examined from saliva and subgingival samples. The significant ORs (95% CI) for the highest endodontic scores were observed for saliva IgA and IgG to bacterial antigens (2.90 (1.01-8.33) and 4.91 (2.48-9.71)/log10 unit), saliva cross-reacting IgG (2.10 (1.48-2.97)), serum IgG to bacterial antigens (4.66 (1.22-10.1)), and Gram-negative subgingival species (1.98 (1.16-3.37)). In a subgroup without marginal periodontitis, only saliva IgG against bacterial antigens associated with untreated apical periodontitis (4.77 (1.05-21.7)). Apical periodontitis associates with versatile adaptive immune responses against both bacterial- and host-derived epitopes independently of marginal periodontitis. Saliva immunoglobulins could be useful biomarkers of oral infections including apical periodontitis-a putative risk factor for systemic diseases.
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20
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FARGHALY M, BADRAN A, KERAA K. Assessment of oral hygiene trends among dental patients in relation to chronic medical conditions by dental students. A cross-sectional study. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E109-E118. [PMID: 31312740 PMCID: PMC6614563 DOI: 10.15167/2421-4248/jpmh2019.60.2.1098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/05/2019] [Indexed: 12/05/2022]
Abstract
INTRODUCTION There is a lack of information about knowledge, attitude and behavior regarding oral hygiene and dietary habits of adult patients attending dental clinical settings. Hypertension, diabetes, obesity and caries are increasing among different populations, resulting in the deterioration of the quality of life related to oral and general health. OBJECTIVES To involve second year dental students in assessing oral health knowledge, attitude, behavior, dietary habits and general health of dental patients, and screening for blood pressure, blood glucose level and obesity. PARTICIPANTS AND METHODS A convenient sample of 652 adult subjects participated in the study. They were screened, and involved in an interviewer - led questionnaire, led by the students over the period of two successive academic years (2013-2014 and 2014-2015). RESULTS Subjects with high blood pressure and /or blood glucose levels were more likely to disagree regarding the presence of a relation between general health and dental health [(correlation coefficient (r) = - 0.159, probability value P < 0.001) (correlation coefficient (r) = - 0.257, probability value P < 0.001) respectively]. Subjects with high BMI were less aware of the importance of using the tooth brush in prevention of gingival inflammation. The overall students' satisfaction score was 71.5%. The practical part of the research had the highest satisfaction score (83.7%). CONCLUSIONS There is scarcity of data regarding dental healthcare knowledge and attitudes in dental clinical settings. Additional clinical training for dental students would increase their willingness to play a preventive and educational role in the oral care of patients.
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Affiliation(s)
- M.M. FARGHALY
- Professor of Dental Public Health &Vice President of Community Service and Environmental Affairs
| | - A.S. BADRAN
- Lecturer of Pediatric Dentistry and Dental Public Health
| | - K. KERAA
- Biostatistician, Faculty of Oral & Dental Medicine, Misr International University, Cairo, Egypt
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21
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Pyysalo MJ, Mishra PP, Sundström K, Lehtimäki T, Karhunen PJ, Pessi T. Increased tooth brushing frequency is associated with reduced gingival pocket bacterial diversity in patients with intracranial aneurysms. PeerJ 2019; 7:e6316. [PMID: 30701137 PMCID: PMC6348950 DOI: 10.7717/peerj.6316] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/19/2018] [Indexed: 11/20/2022] Open
Abstract
Objectives The objective of this study was to investigate the association of tooth brushing frequency and bacterial communities of gingival crevicular fluid in patients subjected to preoperative dental examination prior to operative treatment for unruptured intracranial aneurysms. Methods Gingival crevicular fluid samples were taken from their deepest gingival pocket from a series of hospitalized neurosurgical patients undergoing preoperative dental screening (n = 60). The patients were asked whether they brushed their teeth two times a day, once a day, or less than every day. Total bacterial DNA was isolated and the V3–V4 region of the 16S rRNA gene was amplificated. Sequencing was performed with Illumina’s 16S metagenomic sequencing library preparation protocol and data were analyzed with QIIME (1.9.1) and R statistical software (3.3.2). Results Bacterial diversity (Chao1 index) in the crevicular fluid reduced along with reported tooth brushing frequency (p = 0.0002; R2 = 34%; p (adjusted with age and sex) = 0.09; R2 = 11%) showing that patients who reported brushing their teeth twice a day had the lowest bacterial diversity. According to the differential abundant analysis between the tooth brushing groups, tooth brushing associated with two phyla of fusobacteria [p = 0.0001; p = 0.0007], and one bacteroidetes (p = 0.004) by reducing their amounts. Conclusions Tooth brushing may reduce the gingival bacterial diversity and the abundance of periodontal bacteria maintaining oral health and preventing periodontitis, and thus it is highly recommended for neurosurgical patients.
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Affiliation(s)
- Mikko J Pyysalo
- Department of Otorhinolaryngology, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland.,Department of Oral and Maxillofacial diseases, Tampere University Hospital, Tampere, Finland.,Oral Health Services, City of Tampere, Tampere, Finland.,Department of Molecule Microbiology, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Pashupati P Mishra
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center, University of Tampere, Tampere, Finland.,Fimlab Laboratories ltd, Tampere, Finland
| | - Kati Sundström
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center, University of Tampere, Tampere, Finland.,Fimlab Laboratories ltd, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center, University of Tampere, Tampere, Finland.,Fimlab Laboratories ltd, Tampere, Finland
| | - Pekka J Karhunen
- Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center, University of Tampere, Tampere, Finland.,Fimlab Laboratories ltd, Tampere, Finland
| | - Tanja Pessi
- Department of Molecule Microbiology, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
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22
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Akhi R, Wang C, Nissinen AE, Kankaanpää J, Bloigu R, Paju S, Mäntylä P, Buhlin K, Sinisalo J, Pussinen PJ, Hörkkö S. Salivary IgA to MAA-LDL and Oral Pathogens Are Linked to Coronary Disease. J Dent Res 2019; 98:296-303. [PMID: 30669938 DOI: 10.1177/0022034518818445] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
A large body of literature has established the link between periodontal disease and cardiovascular disease. Oxidized low-density lipoproteins (OxLDLs) have a crucial role in atherosclerosis progression through initiation of immunological response. Monoclonal IgM antibodies to malondialdehyde-modified low-density lipoprotein (MDA-LDL) and to malondialdehyde acetaldehyde-modified low-density lipoprotein (MAA-LDL) have been shown to cross-react with the key virulence factors of periodontal pathogens Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. We have previously shown that salivary IgA antibodies to MAA-LDL cross-react with P. gingivalis in healthy humans. In this study, we aim to assess whether oral mucosal immune response represented by salivary IgA to MAA-LDL and oral pathogens is associated with coronary artery disease (CAD). Also, the molecular mimicry through antibody cross-reaction between salivary IgA to MAA-LDL and oral pathogens was evaluated. The study subjects consisted of 451 patients who underwent a coronary angiography with no CAD ( n = 133), stable CAD ( n = 169), and acute coronary syndrome (ACS, n = 149). Elevated salivary IgA antibody levels to MAA-LDL, Rgp44 (gingipain A hemagglutinin domain of P. gingivalis), and Aa-HSP60 (heat shock protein 60 of A. actinomycetemcomitans) were discovered in stable-CAD and ACS patients when compared to no-CAD patients. In a multinomial regression model adjusted for known cardiovascular risk factors, stable CAD and ACS were associated with IgA to MAA-LDL ( P = 0.016, P = 0.043), Rgp44 ( P = 0.012, P = 0.004), Aa-HSP60 ( P = 0.032, P = 0.030), Tannerella forsythia ( P = 0.002, P = 0.004), Porphyromonas endodontalis ( P = 0.016, P = 0.020), Prevotella intermedia ( P = 0.038, P = 0.005), and with total IgA antibody concentration ( P = 0.002, P = 0.016). Salivary IgA to MAA-LDL showed cross-reactivity with the oral pathogens tested in the study patients. The study highlights an association between salivary IgA to MAA-LDL and atherosclerosis. However, whether salivary IgA to MAA-LDL and the related oral humoral responses play a causal role in the development in the CAD should be elucidated in the future.
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Affiliation(s)
- R Akhi
- 1 Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,2 Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.,3 Nordlab, Oulu University Hospital, Oulu, Finland
| | - C Wang
- 1 Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,2 Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.,3 Nordlab, Oulu University Hospital, Oulu, Finland
| | - A E Nissinen
- 1 Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,2 Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.,3 Nordlab, Oulu University Hospital, Oulu, Finland
| | - J Kankaanpää
- 1 Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,2 Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.,3 Nordlab, Oulu University Hospital, Oulu, Finland
| | - R Bloigu
- 4 Medical Informatics and Statistics Research Group Oulu, University of Oulu, Oulu, Finland
| | - S Paju
- 5 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Mäntylä
- 5 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,6 Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,7 Kuopio University Hospital, Oral and Maxillofacial Diseases, Kuopio, Finland
| | - K Buhlin
- 5 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,8 Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - J Sinisalo
- 9 HUCH Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - P J Pussinen
- 5 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Hörkkö
- 1 Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,2 Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.,3 Nordlab, Oulu University Hospital, Oulu, Finland
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23
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Toothache as a Warning Sign of Subarachnoid Hemorrhage Postmortem Findings. J Craniofac Surg 2019; 30:e418-e420. [DOI: 10.1097/scs.0000000000005399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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24
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Lahdentausta L, Paju S, Mäntylä P, Buhlin K, Pietiäinen M, Tervahartiala T, Nieminen MS, Sinisalo J, Sorsa T, Pussinen PJ. Smoking confounds the periodontal diagnostics using saliva biomarkers. J Periodontol 2018; 90:475-483. [PMID: 30447005 DOI: 10.1002/jper.18-0545] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Smoking is a risk factor for periodontal disease because of its complex impact on the inflammatory response in the periodontium. We investigated the effect of smoking on salivary periodontal biomarkers, matrix metalloproteinase (MMP)-8, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-1 and myeloperoxidase (MPO). METHODS Saliva biomarkers were analyzed in the Parogene population (n = 480) comprising a random cohort of patients that have undergone coronary angiography and oral examination. The effect of time since cessation and pack years of smoking on biomarkers were investigated. RESULTS Saliva MMP-8, MMP-9, TIMP-1, and MPO concentrations distinguished periodontitis patients significantly from patients without periodontitis. When the time since cessation was considered, the area-under-the-curve values (p-value) for periodontitis were 0.76 (<0.001), 0.74 (<0.001), 0.70 (<0.001), and 0.76 (<0.001), respectively. Adding information about smoking habits in the models improved slightly the sensitivities of all biomarkers. In logistic regression model saliva, MMP-8 was mainly affected by pack years of smoking, whereas saliva MMP-9, TIMP-1, and MPO were mostly affected by time since cessation, especially if smoking currently or quit recently (<1 year ago). CONCLUSION Smoking confounds the salivary diagnostics of periodontitis and should be considered when interpreting the results obtained by potential diagnostic tests.
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Affiliation(s)
- Laura Lahdentausta
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland
| | - Susanna Paju
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland
| | - Päivi Mäntylä
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland.,Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Oral and Maxillofacial Diseases, Kuopio, Finland
| | - Kåre Buhlin
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland.,Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Milla Pietiäinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland
| | - Taina Tervahartiala
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland
| | - Markku S Nieminen
- HUCH Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Sinisalo
- HUCH Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland.,Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Pirkko J Pussinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland
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25
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Gürsoy UK, Pussinen PJ, Salomaa V, Syrjäläinen S, Könönen E. Cumulative use of salivary markers with an adaptive design improves detection of periodontal disease over fixed biomarker thresholds. Acta Odontol Scand 2018; 76:493-496. [PMID: 29463174 DOI: 10.1080/00016357.2018.1441436] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Aim was to analyze the diagnostic ability of cumulative risk score (CRS), which uses salivary levels of Porphyromonas gingivalis, interleukin (IL)-1β, and matrix metalloproteinase (MMP)-8 in an adaptive design, compared to previously reported thresholds of each marker alone. MATERIALS AND METHODS Oral and general health information of 463 participants were included in the analysis. Having the percentage of bleeding on probing (BOP) > 25%, having at least two sites with probing pocket depth (PPD) of 4-5 mm or having at least one tooth with alveolar bone loss (ABL) of at least 1/3 of the root length were accepted as outcome variables. Being above the salivary threshold concentrations of P. gingivalis, IL-1β, and MMP-8 and CRS values were used as explanatory variables. Receiver operating characteristics (ROC) producing an area under the curve (AUC) and multinomial regression analysis were used in statistical analysis. RESULTS CRS provided AUCs larger than any other tested biomarker threshold. Sensitivity and specificity of CRS for detecting clinical markers of periodontitis were acceptable, and a strong association was observed between the highest CRS score and having at least two sites with PPD of 4-5 mm. CONCLUSION CRS brings additional power over fixed thresholds of single biomarkers in detecting periodontitis.
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Affiliation(s)
| | - Pirkko J. Pussinen
- Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Sanna Syrjäläinen
- Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Eija Könönen
- Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
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26
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Liukkonen J, Gürsoy UK, Könönen E, Gürsoy M, Metso J, Salminen A, Kopra E, Jauhiainen M, Mäntylä P, Buhlin K, Paju S, Sorsa T, Nieminen MS, Lokki ML, Sinisalo J, Pussinen PJ. Salivary biomarkers in association with periodontal parameters and the periodontitis risk haplotype. Innate Immun 2018; 24:439-447. [PMID: 30176756 PMCID: PMC6830876 DOI: 10.1177/1753425918796207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Genetic factors play a role in periodontitis. Here we examined whether the risk
haplotype of MHC class III region BAT1-NFKBIL1-LTA and lymphotoxin-α
polymorphisms associate with salivary biomarkers of periodontal disease. A total
of 455 individuals with detailed clinical and radiographic periodontal health
data were included in the study. A 610 K genotyping chip and a Sequenom platform
were used in genotyping analyses. Phospholipid transfer protein activity,
concentrations of lymphotoxin-α, IL-8 and myeloperoxidase, and a cumulative risk
score (combining Porphyromonas gingivalis, IL-1β and matrix
metalloproteinase-8) were examined in saliva samples. Elevated IL-8 and
myeloperoxidase concentrations and cumulative risk scores associated with
advanced tooth loss, deepened periodontal pockets and signs of periodontal
inflammation. In multiple logistic regression models adjusted for periodontal
parameters and risk factors, myeloperoxidase concentration (odds ratio (OR);
1.37, P = 0.007) associated with increased odds for having the
risk haplotype and lymphotoxin-α concentration with its genetic variants
rs2857708, rs2009658 and rs2844482. In conclusion, salivary levels of IL-8,
myeloperoxidase and cumulative risk scores associate with periodontal
inflammation and tissue destruction, while those of myeloperoxidase and
lymphotoxin-α associate with genetic factors as well.
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Affiliation(s)
| | - Ulvi K Gürsoy
- 1 Institute of Dentistry, University of Turku, Finland
| | - Eija Könönen
- 1 Institute of Dentistry, University of Turku, Finland.,2 Oral Health Care, Welfare Division, Finland
| | - Mervi Gürsoy
- 1 Institute of Dentistry, University of Turku, Finland
| | - Jari Metso
- 3 Minerva Foundation Institute for Medical Research and Genomics and Biomarkers Unit, National Institute for Health and Welfare, Finland
| | - Aino Salminen
- 4 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland
| | - Elisa Kopra
- 4 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland
| | - Matti Jauhiainen
- 3 Minerva Foundation Institute for Medical Research and Genomics and Biomarkers Unit, National Institute for Health and Welfare, Finland
| | - Päivi Mäntylä
- 4 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland.,5 Institute of Dentistry, University of Eastern Finland, Finland.,6 Oral and Maxillofacial Diseases, Kuopio University Hospital, Finland
| | - Kåre Buhlin
- 4 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland.,7 Department of Periodontology, Institute of Odontology, Karolinska Institutet, Sweden
| | - Susanna Paju
- 4 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland
| | - Timo Sorsa
- 4 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland.,7 Department of Periodontology, Institute of Odontology, Karolinska Institutet, Sweden
| | - Markku S Nieminen
- 8 HUCH Heart and Lung Center, Helsinki University Central Hospital, Finland
| | - Marja-Liisa Lokki
- 9 Transplantation Laboratory, Medicum, University of Helsinki, Finland
| | - Juha Sinisalo
- 8 HUCH Heart and Lung Center, Helsinki University Central Hospital, Finland
| | - Pirkko J Pussinen
- 4 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland
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27
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Pyysalo MJ, Pyysalo LM, Hiltunen J, Järnstedt J, Helminen M, Karhunen PJ, Pessi T. The dental infections in patients undergoing preoperative dental examination before surgical treatment of saccular intracranial aneurysm. BMC Res Notes 2018; 11:600. [PMID: 30126459 PMCID: PMC6102815 DOI: 10.1186/s13104-018-3704-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/10/2018] [Indexed: 01/09/2023] Open
Abstract
Objective Dental bacterial DNA and bacterial-driven inflammation markers have previously been detected in intracranial aneurysm tissue samples. This study aimed (i) to assess the possible presence of dental infectious foci, (ii) and the possible association between typical odontogenic bacteria and clinical dental findings in patients undergoing pre-operative dental examination before surgical treatment of saccular intracranial aneurysm. Ninety patients with an intracranial aneurysm were recruited to the study, and the patients’ teeth were routinely investigated. Clinical data and bacterial samples from the gingival pockets were collected from a subpopulation of 60 patients. Five typical dental pathogens and total bacteria amounts were measured from gingival samples using real-time quantitative PCR. Results The amounts of total bacterial and Fusobacterium nucleatum DNA were significantly higher in the patients with ≥ 6 mm gingival pockets than patients without them (p < 0.01 and p < 0.01, respectively). A total of 43% of patients with an aneurysm had gingival pockets of 6 mm or deeper. Dental infectious foci are fairly common in the Finnish population, with the prevalence of severe periodontitis being around 20%. The frequency of chronic dental infections, especially periodontitis seems to be higher in patients with intracranial aneurysm. Electronic supplementary material The online version of this article (10.1186/s13104-018-3704-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mikko J Pyysalo
- Department of Oral and Maxillofacial Diseases, Tampere University Hospital, P O Box 2000, 33521, Tampere, Finland. .,Oral Health Services, City of Tampere, Tampere, Finland.
| | - Liisa M Pyysalo
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Jenni Hiltunen
- Faculty of Medicine and Life Sciences, University of Tampere and Fimlab Laboratories Ltd, Pirkanmaa Hospital District, Tampere, Finland
| | - Jorma Järnstedt
- Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Mika Helminen
- Science Centre, Pirkanmaa Hospital District, Tampere, Finland.,School of Health Sciences, University of Tampere, Tampere, Finland
| | - Pekka J Karhunen
- Faculty of Medicine and Life Sciences, University of Tampere and Fimlab Laboratories Ltd, Pirkanmaa Hospital District, Tampere, Finland.,Department of Clinical Pathology and Forensic Medicine, University of Kuopio, Kuopio, Finland
| | - Tanja Pessi
- Faculty of Medicine and Life Sciences, University of Tampere and Fimlab Laboratories Ltd, Pirkanmaa Hospital District, Tampere, Finland.,Science Centre, Pirkanmaa Hospital District, Tampere, Finland.,School of Health Sciences, University of Tampere, Tampere, Finland
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28
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Lahdentausta LSJ, Paju S, Mäntylä P, Buhlin K, Tervahartiala T, Pietiäinen M, Alfthan H, Nieminen MS, Sinisalo J, Sorsa T, Pussinen PJ. Saliva and serum biomarkers in periodontitis and coronary artery disease. J Clin Periodontol 2018; 45:1045-1055. [DOI: 10.1111/jcpe.12976] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/14/2018] [Accepted: 07/02/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Laura S. J. Lahdentausta
- Department of Oral and Maxillofacial Diseases; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Susanna Paju
- Department of Oral and Maxillofacial Diseases; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Päivi Mäntylä
- Department of Oral and Maxillofacial Diseases; Helsinki University Hospital; University of Helsinki; Helsinki Finland
- Institute of Dentistry; University of Eastern Finland; Kuopio Finland
- Department of Oral and Maxillofacial Diseases; Kuopio University Hospital; Kuopio Finland
| | - Kåre Buhlin
- Department of Oral and Maxillofacial Diseases; Helsinki University Hospital; University of Helsinki; Helsinki Finland
- Division of Periodontology; Department of Dental Medicine; Karolinska Institutet; Huddinge Sweden
| | - Taina Tervahartiala
- Department of Oral and Maxillofacial Diseases; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Milla Pietiäinen
- Department of Oral and Maxillofacial Diseases; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Henrik Alfthan
- Laboratory, HUSLAB; Helsinki University Hospital; Helsinki Finland
| | - Markku S. Nieminen
- HUCH Heart and Lung Center; Helsinki University Central Hospital; Helsinki Finland
| | - Juha Sinisalo
- HUCH Heart and Lung Center; Helsinki University Central Hospital; Helsinki Finland
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases; Helsinki University Hospital; University of Helsinki; Helsinki Finland
- Division of Periodontology; Department of Dental Medicine; Karolinska Institutet; Huddinge Sweden
| | - Pirkko J. Pussinen
- Department of Oral and Maxillofacial Diseases; Helsinki University Hospital; University of Helsinki; Helsinki Finland
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29
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Färkkilä E, Rautemaa-Richardson R, Färkkilä A, Grönholm L, Lauhio A. Evaluation of risk factors for oral infection with potential for spread in a 1-year cohort study. Clin Oral Investig 2018; 23:905-911. [PMID: 29948280 DOI: 10.1007/s00784-018-2518-7] [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] [Received: 05/05/2017] [Accepted: 06/05/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To determine the frequency of oral infection with potential for spread (OIPS) and behavioural risk factors in patients referred to a regional tertiary care-centre for OIPS assessment and clearance. MATERIALS AND METHODS A database search of all referrals to the Oral and Maxillofacial Diseases unit of HUH in 2009 was performed. Of the 2807 referrals, 408 were due to a known or suspected OIPS. The electronic patient records of these patients were analysed for patient demographics, lifestyle factors, radiological findings and clinical oral findings. Risk factors for OIPS were analysed using logistic regression and using the significant factors in univariate analyses in the multivariate models. RESULTS The mean age of the patients was 58 years. Most patients (n = 270, 66%) were referred due to upcoming cancer or other immunosuppressive therapy. The majority (n = 314, 77%) were diagnosed with one or more OIPS. In univariate analyses, smoking (OR 3.2, 95% CI 1.6-6.4; p = 0.0006), male gender (OR 1.7, 95% CI 1.1-2.8; p = 0.02), excessive alcohol use (OR 3.0, 95% 1.1-7.9; p = 0.03) and irregular dental care (OR 4.8, 95% CI 2.6-8.8; p < 0.0001) were risk factors for OIPS. However, in multivariate analyses, smoking was the only independent risk factor for OIPS (OR 3.6, 95% CI 1.2-11.8; p = 0.02). CONCLUSIONS OIPS are common in patients referred for OIPS clearance, and smoking was identified as an independent behavioural risk factor for them. These findings highlight the burden of disease in this patient group and the importance of smoking cessation encouragement. CLINICAL RELEVANCE To identify patients at increased risk of OIPS.
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Affiliation(s)
- Esa Färkkilä
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4 E, P.O. Box 220, 00029, HUS, Helsinki, Finland.
| | - Riina Rautemaa-Richardson
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M23 9LT, UK.,Department of Infectious Diseases, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - Anniina Färkkilä
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Tukholmankatu 8, P.O. Box 20, 00029, HUS, Helsinki, Finland
| | - Lotta Grönholm
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, P.O. Box 180, 00029, HUS, Helsinki, Finland
| | - Anneli Lauhio
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Nordenskiöldinkatu 20, building 5 3rd floor, P.O. BOX 348, 00029, HUS, Helsinki, Finland
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30
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Pietiäinen M, Kopra KAE, Vuorenkoski J, Salminen A, Paju S, Mäntylä P, Buhlin K, Liljestrand JM, Nieminen MS, Sinisalo J, Hyvärinen K, Pussinen PJ. Aggregatibacter actinomycetemcomitansserotypes associate with periodontal and coronary artery disease status. J Clin Periodontol 2018; 45:413-421. [DOI: 10.1111/jcpe.12873] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Milla Pietiäinen
- Oral and Maxillofacial Diseases; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - K. A. Elisa Kopra
- Oral and Maxillofacial Diseases; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Juha Vuorenkoski
- Oral and Maxillofacial Diseases; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Aino Salminen
- Oral and Maxillofacial Diseases; University of Helsinki and Helsinki University Hospital; Helsinki Finland
- Department of Dental Medicine Huddinge; Division of Periodontology; Karolinska Institutet; Huddinge Sweden
| | - Susanna Paju
- Oral and Maxillofacial Diseases; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Päivi Mäntylä
- Oral and Maxillofacial Diseases; University of Helsinki and Helsinki University Hospital; Helsinki Finland
- Institute of Dentistry; University of Eastern Finland; Kuopio Finland
- Oral and Maxillofacial Diseases; Kuopio University Hospital; Kuopio Finland
| | - Kåre Buhlin
- Oral and Maxillofacial Diseases; University of Helsinki and Helsinki University Hospital; Helsinki Finland
- Department of Dental Medicine Huddinge; Division of Periodontology; Karolinska Institutet; Huddinge Sweden
| | - John M. Liljestrand
- Oral and Maxillofacial Diseases; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Markku S. Nieminen
- Department of Cardiology, Heart and Lung Center; Helsinki University Hospital; Helsinki Finland
| | - Juha Sinisalo
- Department of Cardiology, Heart and Lung Center; Helsinki University Hospital; Helsinki Finland
| | - Kati Hyvärinen
- Oral and Maxillofacial Diseases; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Pirkko J. Pussinen
- Oral and Maxillofacial Diseases; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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Liljestrand JM, Paju S, Pietiäinen M, Buhlin K, Persson GR, Nieminen MS, Sinisalo J, Mäntylä P, Pussinen PJ. Immunologic burden links periodontitis to acute coronary syndrome. Atherosclerosis 2018; 268:177-184. [DOI: 10.1016/j.atherosclerosis.2017.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/10/2017] [Accepted: 12/05/2017] [Indexed: 12/25/2022]
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Liljestrand JM, Paju S, Buhlin K, Persson GR, Sarna S, Nieminen MS, Sinisalo J, Mäntylä P, Pussinen PJ. Lipopolysaccharide, a possible molecular mediator between periodontitis and coronary artery disease. J Clin Periodontol 2017; 44:784-792. [PMID: 28556187 DOI: 10.1111/jcpe.12751] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2017] [Indexed: 12/11/2022]
Abstract
AIM We aimed to study how lipopolysaccharide (LPS) in saliva and serum associates with each other, periodontal microbial burden, periodontitis and coronary artery disease (CAD). MATERIALS AND METHODS The used Parogene cohort comprised N = 505 Finnish adults. Coronary diagnosis was acquired by coronary angiography, and the main outcomes were as follows: no significant CAD (n = 123), stable CAD (n = 184) and acute coronary syndrome (n = 169). Periodontitis was defined according to clinical and radiographic examinations. Levels for 75 strains of subgingival bacteria were determined by checkerboard DNA-DNA hybridization. Saliva and serum LPS activity was analysed by Limulus amebocyte lysate assay. RESULTS The level of 11 bacterial strains, which were mainly oral and respiratory Gram-negative species, associated with salivary LPS levels in an age- and gender-adjusted linear regression. A total of 4.9% of the serum LPS, that is endotoxemia, variation was explainable by saliva LPS among patients with periodontitis (n = 247, R2 = .049, Pearson's r = .222, p < .001). Endotoxemia associated with stable CAD in a confounder adjusted multinomial logistic regression model (OR 1.99, 95% CI 1.04-3.81, p = .039, 3rd tertile). CONCLUSIONS In particular in periodontitis patients, subgingival microbial burden contributes to endotoxemia. LPS is a possible molecular mediator between periodontitis and CAD.
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Affiliation(s)
- John M Liljestrand
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Paju
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kåre Buhlin
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - G Rutger Persson
- Departments of Oral Medicine and Periodontics, University of Washington, Seattle, WA, USA
| | - Seppo Sarna
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Markku S Nieminen
- Department of Cardiology, Heart and Lung Center, Department of Medicine, Helsinki University Hospital, Helsinki, Finland
| | - Juha Sinisalo
- Department of Cardiology, Heart and Lung Center, Department of Medicine, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Mäntylä
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirkko J Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Nguyen TT, Ngo LQ, Promsudthi A, Surarit R. Salivary oxidative stress biomarkers in chronic periodontitis and acute coronary syndrome. Clin Oral Investig 2016; 21:2345-2353. [PMID: 27987039 DOI: 10.1007/s00784-016-2029-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 12/06/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The study aimed at assessing oxidative stress (OS) biomarker levels in the saliva of patients with chronic periodontitis (CP) and acute coronary syndrome (ACS) and establishing their correlation to periodontal parameters and markers for cardiovascular events. MATERIALS AND METHODS The present study enrolled 24 patients with ACS and CP (the ACSCP group), 24 patients with ACS only (the ACS group), 24 patients with CP only (the CP group), and 24 healthy controls. Plaque index (PI), gingival index, bleeding on probing, probing pocket depth (PPD), and clinical attachment loss were recorded. Markers for cardiovascular events included serum high sensitivity C-reactive protein (hsCRP) and plasma fibrinogen. 8-Hydroxydeoxyguanosine (8-OHdG), protein carbonyl (PC), malondialdehyde (MDA), and total antioxidant capacity (TAOC) were used as OS biomarkers. RESULTS Salivary 8-OHdG, MDA, and PC levels were significantly higher in the ACSCP, ACS, and CP groups than in healthy controls (p < 0.05). There were significant correlations between salivary PC levels and PI or PPD (p < 0.05) as well as between salivary 8-OHdG levels and all periodontal parameters (p < 0.05). TAOC levels in saliva were correlated to both serum hsCRP and plasma fibrinogen (p < 0.05). Salivary MDA levels were correlated to all periodontal parameters and biomarkers for cardiovascular events (p < 0.05). CONCLUSIONS Salivary OS biomarker levels were higher in diseased groups compared to control. They also correlated to clinical periodontal parameters and markers for cardiovascular events in ACS patients, with or without CP. CLINICAL RELEVANCE Salivary OS biomarkers could potentially serve as diagnostic tools for cardiovascular and/or periodontal diseases.
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Affiliation(s)
- Thuy T Nguyen
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, 6 Yothi Street, Ratchathewi, Bangkok, 10400, Thailand.,Department of Periodontology, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy-Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Lan Q Ngo
- Department of Dental Basic Sciences, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy-Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ananya Promsudthi
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Rudee Surarit
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, 6 Yothi Street, Ratchathewi, Bangkok, 10400, Thailand.
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Reichert S, Schulz S, Benten AC, Lutze A, Seifert T, Schlitt M, Werdan K, Hofmann B, Wienke A, Schaller HG, Schlitt A. Periodontal conditions and incidence of new cardiovascular events among patients with coronary vascular disease. J Clin Periodontol 2016; 43:918-925. [PMID: 27502057 DOI: 10.1111/jcpe.12611] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 12/27/2022]
Abstract
AIM We wanted to investigate whether periodontal conditions and/or oral care habits are associated with new cardiovascular events among patients with coronary vascular disease (CVD). MATERIALS AND METHODS In this longitudinal cohort study, 1002 inpatients with CVD were included. They were examined regarding prevalence of severe periodontitis, bleeding upon probing (BOP), number of missing teeth and oral care habits. The combined endpoint was defined as myocardial infarction, stroke/transient ischaemic attack, cardiovascular death and death caused by stroke. Survival analyses were carried out after a 3-year follow-up period. Hazard ratios (HRs) were adjusted for known cardiac risk factors using Cox regression. RESULTS Nine hundred and fifty-three patients completed the 3-year follow-up. The overall incidence of the combined endpoint was 16.4%. Significant HRs for BOP (HR = 2, 95% CI: 1.2-3.3), severe tooth loss (HR = 1.8, 95% CI: 1.3-2.5), brushing teeth more than once a day (HR = 0.6, 95% CI: 0.5-1.0) and use of floss/inter-dental brushes (HR = 0.5, 95% CI: 0.3-0.9) were evaluated only in univariate but not in multivariate survival analyses. Patients with severe periodontitis achieved the combined endpoint more often (18.9% versus 14.2%), but the result was not statistically significant after both univariate and multivariate survival analyses. CONCLUSIONS Periodontal conditions and oral care habits are not independent indicators for further adverse events in patients with CVD.
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Affiliation(s)
- Stefan Reichert
- Department of Operative Dentistry and Periodontology, Martin Luther University Halle-Wittenberg, Halle, Germany.
| | - Susanne Schulz
- Department of Operative Dentistry and Periodontology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Ann-Christin Benten
- Department of Operative Dentistry and Periodontology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Andrea Lutze
- Department of Operative Dentistry and Periodontology, Martin Luther University Halle-Wittenberg, Halle, Germany.,Department of Internal Medicine III, Heart Centre of the University Clinics Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Tim Seifert
- Department of Operative Dentistry and Periodontology, Martin Luther University Halle-Wittenberg, Halle, Germany.,Department of Internal Medicine III, Heart Centre of the University Clinics Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Manuela Schlitt
- Department of Internal Medicine III, Heart Centre of the University Clinics Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Karl Werdan
- Department of Internal Medicine III, Heart Centre of the University Clinics Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Britt Hofmann
- Department of Cardiothoracic Surgery, Heart Centre of the University Clinics Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Andreas Wienke
- Institute for Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Hans-Günter Schaller
- Department of Operative Dentistry and Periodontology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Axel Schlitt
- Department of Internal Medicine III, Heart Centre of the University Clinics Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany.,Department of Cardiology, Paracelsus Harz-Clinic Bad Suderode, Halle, Germany
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Liljestrand J, Mäntylä P, Paju S, Buhlin K, Kopra K, Persson G, Hernandez M, Nieminen M, Sinisalo J, Tjäderhane L, Pussinen P. Association of Endodontic Lesions with Coronary Artery Disease. J Dent Res 2016; 95:1358-1365. [DOI: 10.1177/0022034516660509] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
An endodontic lesion (EL) is a common manifestation of endodontic infection where Porphyromonas endodontalis is frequently encountered. EL may associate with increased risk for coronary artery disease (CAD) via similar pathways as marginal periodontitis. The aim of this cross-sectional study was to delineate the associations between EL and CAD. Subgingival P. endodontalis, its immune response, and serum lipopolysaccharide were examined as potential mediators between these 2 diseases. The Finnish Parogene study consists of 508 patients (mean age, 62 y) who underwent coronary angiography and extensive clinical and radiographic oral examination. The cardiovascular outcomes included no significant CAD ( n = 123), stable CAD ( n = 184), and acute coronary syndrome (ACS; n = 169). EL was determined from a panoramic tomography. We combined data of widened periapical spaces (WPSs) and apical rarefactions to a score of EL: 1, no EL ( n = 210); 2, ≥1 WPS per 1 apical rarefaction ( n = 222); 3, ≥2 apical rarefactions ( n = 76). Subgingival P. endodontalis was defined by checkerboard DNA-DNA hybridization analysis, and corresponding serum antibodies were determined by ELISA. In our population, 50.4% had WPSs, and 22.8% apical rarefactions. A total of 51.2% of all teeth with apical rarefactions had received endodontic procedures. Subgingival P. endodontalis levels and serum immunoglobulin G were associated with a higher EL score. In the multiadjusted model (age, sex, smoking, diabetes, body mass index, alveolar bone loss, and number of teeth), having WPSs associated with stable CAD (odds ratio [OR] = 1.94, 95% confidence interval [95% CI] = 1.13 to 3.32, P = 0.016) and highest EL score were associated with ACS (OR = 2.46, 95% CI = 1.09 to 5.54, P = 0.030). This association was especially notable in subjects with untreated teeth with apical rarefactions ( n = 59, OR = 2.72, 95% CI = 1.16 to 6.40, P = 0.022). Our findings support the hypothesis that ELs are independently associated with CAD and in particular with ACS. This is of high interest from a public health perspective, considering the high prevalence of ELs and CAD.
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Affiliation(s)
- J.M. Liljestrand
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P. Mäntylä
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S. Paju
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - K. Buhlin
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - K.A.E. Kopra
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - G.R. Persson
- Departments of Oral Medicine, and Periodontics, University of Washington, Seattle, Washington, USA
| | - M. Hernandez
- Laboratory of Periodontal Biology and Department of Oral Pathology and Medicine, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - M.S. Nieminen
- Department of Cardiology, Heart and Lung Center, Department of Medicine, Helsinki University Hospital, Helsinki, Finland
| | - J. Sinisalo
- Department of Cardiology, Heart and Lung Center, Department of Medicine, Helsinki University Hospital, Helsinki, Finland
| | - L. Tjäderhane
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Unit of Oral Health Sciences, and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - P.J. Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Gürkan A, Eren G, Çetinkalp Ş, Akçay YD, Emingil G, Atilla G. Monocyte chemotactic protein-1, RANTES and macrophage migration inhibitory factor levels in gingival crevicular fluid of metabolic syndrome patients with gingivitis. Arch Oral Biol 2016; 69:82-8. [PMID: 27270225 DOI: 10.1016/j.archoralbio.2016.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of the present study was to determine gingival crevicular fluid (GCF) levels of monocyte chemotactic protein-1 (MCP-1), regulated on activation, normal T-cell expressed and secreted protein (RANTES) and macrophage migration inhibitory factor (MIF) in metabolic syndrome patients with gingivitis. DESIGN Twenty metabolic syndrome patients with gingivitis (MSG), 20 MetS patients with clinically healthy periodontium (MSH), 20 systemically healthy subjects with gingivitis and 20 subjects who were both systemically and periodontally healthy were included. Periodontal and systemical parameters were recorded. GCF MCP-1, RANTES and MIF levels were assayed by enzyme-linked immunosorbent assay method. RESULTS MSG and MSH groups had elevated blood pressure, triglyceride, waist circumference and fasting glucose values in comparison to gingivitis and healthy groups (P<0.0001). Clinical periodontal parameters were higher in MSG and gingivitis groups when compared to those of the MSH and healthy groups (P<0.0001). MCP-1 and RANTES levels (ng/mg total protein) of MSG group were higher than those of the MSH groups (P=0.005, P=0.0001, respectively). Also gingivitis group had higher MCP-1, RANTES and MIF levels compared to the healthy group (P=0.011, P=0.0001, P=0.011 respectively). The RANTES level of MSG group was significantly higher than those of the gingivitis group (P=0.01), but MCP-1 and MIF levels were similar in the MSG and gingivitis groups (P>0.05). CONCLUSION Elevated levels of GCF RANTES in MetS patients with gingivitis might associate with the presence of increased gingival inflammation by MetS. Low-grade systemic inflammation associated with MetS and adipose tissue-derived RANTES might lead to altered GCF RANTES levels in the presence of gingival inflammation.
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Affiliation(s)
- Ali Gürkan
- Ege University, School of Dentistry, Department of Periodontology, İzmir, Turkey.
| | - Gülnihal Eren
- Ege University, School of Dentistry, Department of Periodontology, İzmir, Turkey
| | - Şevki Çetinkalp
- Ege University, School of Medicine, Department of Metabolic Diseases and Endocrinology, İzmir, Turkey
| | - Yasemin Delen Akçay
- Ege University, School of Medicine, Department of Biochemistry, İzmir, Turkey
| | - Gülnur Emingil
- Ege University, School of Dentistry, Department of Periodontology, İzmir, Turkey
| | - Gül Atilla
- Ege University, School of Dentistry, Department of Periodontology, İzmir, Turkey
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Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Periodontol 2016; 84:S70-84. [PMID: 23631585 DOI: 10.1902/jop.2013.134008] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The objective of this study was to systematically review the epidemiological evidence for an association between periodontitis (PD) and incident atherosclerotic cardiovascular disease (ACVD), including coronary heart disease (CHD), cerebrovascular disease and peripheral arterial disease. METHODS Systematic review of cohort and case-control studies on the association of clinically or radiographically diagnosed PD and ACVD. RESULTS Overall, 12 studies were included in this study (six studies on CHD, three studies on cerebrovascular disease, two studies on both coronary heart and cerebrovascular disease mortality and one study on peripheral arterial disease).All but one study reported positive associations between various periodontal disease measures and the incidence of ACVD, at least in specific subgroups. The association was stronger in younger adults and there was no evidence for an association between PD and incident CHD in subjects older than 65 years. Only one study evaluated the association between PD and secondary cardiovascular events. CONCLUSIONS There is evidence for an increased risk of ACVD in patients with PD compared to patients without. However, this may not apply to all groups of the population. There is insufficient evidence for an association between PD and the incidence of secondary cardiovascular events.
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Affiliation(s)
- Thomas Dietrich
- Department of Oral Surgery, The School of Dentistry, University of Birmingham, Birmingham, UK
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38
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Linden GJ, Lyons A, Scannapieco FA. Periodontal systemic associations: review of the evidence. J Clin Periodontol 2016; 40 Suppl 14:S8-19. [PMID: 23627336 DOI: 10.1111/jcpe.12064] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/24/2022]
Abstract
AIM To critically appraise recent research into associations between periodontal disease and systemic diseases and conditions specifically respiratory disease, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer. METHODS A MEDLINE literature search of papers published between 2002 and April 2012 was conducted. Studies that included periodontitis as an exposure were identified. Cross-sectional epidemiological investigations on large samples, prospective studies and systematic reviews formed the basis of the narrative review. A threshold set for the identification of periodontitis was used to identify those studies that contributed to the conclusions of the review. RESULTS Many of the investigations were cross-sectional secondary analyses of existing data sets in particular the NHANES studies. There were a small number of systematic reviews and prospective studies. There was substantial variability in the definitions of exposure to periodontitis. A small number of studies met the threshold set for periodontitis and supported associations; however, in some of the chronic diseases there were no such studies. There was strong evidence from randomized controlled trials that interventions, which improve oral hygiene have positive effects on the prevention of nosocomial pneumonias. CONCLUSIONS There was substantial heterogeneity in the definitions used to identify periodontitis and very few studies met a stringent threshold for periodontitis. Published evidence supports modest associations between periodontitis and some, although not all, of the diseases and conditions reviewed. There is a need to reach a consensus on what constitutes periodontitis for future studies of putative associations with systemic diseases.
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Affiliation(s)
- Gerard J Linden
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK.
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39
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Linden GJ, Lyons A, Scannapieco FA. Periodontal systemic associations: review of the evidence. J Periodontol 2016; 84:S8-S19. [PMID: 23631586 DOI: 10.1902/jop.2013.1340010] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM To critically appraise recent research into associations between periodontal disease and systemic diseases and conditions specifically respiratory disease, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer. METHODS A MEDLINE literature search of papers published between 2002 and April 2012 was conducted. Studies that included periodontitis as an exposure were identified. Cross-sectional epidemiological investigations on large samples, prospective studies and systematic reviews formed the basis of the narrative review. A threshold set for the identification of periodontitis was used to identify those studies that contributed to the conclusions of the review. RESULTS Many of the investigations were cross-sectional secondary analyses of existing data sets in particular the NHANES studies. There were a small number of systematic reviews and prospective studies. There was substantial variability in the definitions of exposure to periodontitis. A small number of studies met the threshold set for periodontitis and supported associations; however, in some of the chronic diseases there were no such studies. There was strong evidence from randomized controlled trials that interventions, which improve oral hygiene have positive effects on the prevention of nosocomial pneumonias. CONCLUSIONS There was substantial heterogeneity in the definitions used to identify periodontitis and very few studies met a stringent threshold for periodontitis. Published evidence supports modest associations between periodontitis and some, although not all, of the diseases and conditions reviewed. There is a need to reach a consensus on what constitutes periodontitis for future studies of putative associations with systemic diseases.
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Affiliation(s)
- Gerard J Linden
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK.
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40
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Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Clin Periodontol 2016; 40 Suppl 14:S70-84. [PMID: 23627335 DOI: 10.1111/jcpe.12062] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/19/2012] [Accepted: 11/14/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The objective of this study was to systematically review the epidemiological evidence for an association between periodontitis (PD) and incident atherosclerotic cardiovascular disease (ACVD), including coronary heart disease (CHD), cerebrovascular disease and peripheral arterial disease. METHODS Systematic review of cohort and case-control studies on the association of clinically or radiographically diagnosed PD and ACVD. RESULTS Overall, 12 studies were included in this study (six studies on CHD, three studies on cerebrovascular disease, two studies on both coronary heart and cerebrovascular disease mortality and one study on peripheral arterial disease). All but one study reported positive associations between various periodontal disease measures and the incidence of ACVD, at least in specific subgroups. The association was stronger in younger adults and there was no evidence for an association between PD and incident CHD in subjects older than 65 years. Only one study evaluated the association between PD and secondary cardiovascular events. CONCLUSIONS There is evidence for an increased risk of ACVD in patients with PD compared to patients without. However, this may not apply to all groups of the population. There is insufficient evidence for an association between PD and the incidence of secondary cardiovascular events.
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Affiliation(s)
- Thomas Dietrich
- Department of Oral Surgery, The School of Dentistry, University of Birmingham, Birmingham, UK
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41
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Short-term changes on C-reactive protein (CRP) levels after non-surgical periodontal treatment in systemically healthy individuals. Clin Oral Investig 2016; 21:477-484. [PMID: 27068411 DOI: 10.1007/s00784-016-1817-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 04/03/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aim of the present study was to evaluate serum C-reactive protein (CRP) levels in chronic periodontitis patients and periodontally healthy individuals and to assess the effect of non-surgical periodontal treatment on the CRP levels. MATERIALS AND METHODS Twenty-two patients with chronic periodontitis (test group) and 22 periodontally healthy individuals (control group), both groups without any systemic disorder or potential confounding factors, were included in the study. At baseline, periodontal clinical variables and CRP levels were obtained in both groups. In the test group, oral hygiene instruction and scaling and root planning were carried out; then, after 60 days, periodontal clinical variables and CRP levels were reevaluated. RESULTS The baseline CRP level in the test group was significantly higher than the corresponding value in the control group (1.98 ± 1.55 vs. 1.26 ± 1.05 mg/L; p < 0.05). After periodontal treatment in the test group, there were improvements in all periodontal clinical variables (p < 0.05). The CRP level decreased significantly in those patients with higher baseline levels of CRP (>3 mg/L). CONCLUSIONS Chronic periodontitis seemed to promote elevated levels of CRP. Furthermore, non-surgical periodontal treatment significantly decreased the levels of CRP only in patients with high baseline levels of such pro-inflammatory cytokine. CLINICAL RELEVANCE Periodontitis may be a potential factor to change the risk of CVD. Thus, the control of periodontal infection performed by health professionals may improve cardiovascular health.
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Pyysalo MJ, Pyysalo LM, Pessi T, Karhunen PJ, Lehtimäki T, Oksala N, Öhman JE. Bacterial DNA findings in ruptured and unruptured intracranial aneurysms. Acta Odontol Scand 2016; 74:315-20. [PMID: 26777430 DOI: 10.3109/00016357.2015.1130854] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Chronic inflammation has earlier been detected in ruptured intracranial aneurysms. A previous study detected both dental bacterial DNA and bacterial-driven inflammation in ruptured intracranial aneurysm walls. The aim of this study was to compare the presence of oral and pharyngeal bacterial DNA in ruptured and unruptured intracranial aneurysms. The hypothesis was that oral bacterial DNA findings would be more common and the amount of bacterial DNA would be higher in ruptured aneurysm walls than in unruptured aneurysm walls. MATERIALS AND METHODS A total of 70 ruptured (n = 42) and unruptured (n = 28) intracranial aneurysm specimens were obtained perioperatively in aneurysm clipping operations. Aneurysmal sac tissue was analysed using a real-time quantitative polymerase chain reaction to detect bacterial DNA from several oral species. Both histologically non-atherosclerotic healthy vessel wall obtained from cardiac by-pass operations (LITA) and arterial blood samples obtained from each aneurysm patient were used as control samples. RESULTS Bacterial DNA was detected in 49/70 (70%) of the specimens. A total of 29/42 (69%) of the ruptured and 20/28 (71%) of the unruptured aneurysm samples contained bacterial DNA of oral origin. Both ruptured and unruptured aneurysm tissue samples contained significantly more bacterial DNA than the LITA control samples (p-values 0.003 and 0.001, respectively). There was no significant difference in the amount of bacterial DNA between the ruptured and unruptured samples. CONCLUSION Dental bacterial DNA can be found using a quantitative polymerase chain reaction in both ruptured and unruptured aneurysm walls, suggesting that bacterial DNA plays a role in the pathogenesis of cerebral aneurysms in general, rather than only in ruptured aneurysms.
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Affiliation(s)
- Mikko J Pyysalo
- a Department of Oral and Maxillofacial Diseases , Tampere University Hospital , Tampere , Finland
- b Oral Health Services , City of Tampere, Tampere , Finland
| | - Liisa M Pyysalo
- c Department of Neurosurgery , Tampere University Hospital , Tampere , Finland
| | - Tanja Pessi
- d School of Medicine, University of Tampere and Fimlab Laboratories Ltd, Pirkanmaa Hospital District , Tampere , Finland
| | - Pekka J Karhunen
- d School of Medicine, University of Tampere and Fimlab Laboratories Ltd, Pirkanmaa Hospital District , Tampere , Finland
- e Department of Clinical Pathology and Forensic Medicine , University of Kuopio , Kuopio , Finland
| | - Terho Lehtimäki
- f Department of Clinical Chemistry , Fimlab Laboratories and School of Medicine University of Tampere , Tampere , Finland
| | - Niku Oksala
- f Department of Clinical Chemistry , Fimlab Laboratories and School of Medicine University of Tampere , Tampere , Finland
- g Department of Surgery, Vascular Surgery , Tampere University Hospital , Tampere , Finland
| | - Juha E Öhman
- c Department of Neurosurgery , Tampere University Hospital , Tampere , Finland
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Salminen A, Kopra KAE, Hyvärinen K, Paju S, Mäntylä P, Buhlin K, Nieminen MS, Sinisalo J, Pussinen PJ. Quantitative PCR analysis of salivary pathogen burden in periodontitis. Front Cell Infect Microbiol 2015; 5:69. [PMID: 26484315 PMCID: PMC4589666 DOI: 10.3389/fcimb.2015.00069] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/18/2015] [Indexed: 12/27/2022] Open
Abstract
Our aim was to investigate the value of salivary concentrations of four major periodontal pathogens and their combination in diagnostics of periodontitis. The Parogene study included 462 dentate subjects (mean age 62.9 ± 9.2 years) with coronary artery disease (CAD) diagnosis who underwent an extensive clinical and radiographic oral examination. Salivary levels of four major periodontal bacteria were measured by quantitative real-time PCR (qPCR). Median salivary concentrations of Porphyromonas gingivalis, Tannerella forsythia, and Prevotella intermedia, as well as the sum of the concentrations of the four bacteria, were higher in subjects with moderate to severe periodontitis compared to subjects with no to mild periodontitis. Median salivary Aggregatibacter actinomycetemcomitans concentrations did not differ significantly between the subjects with no to mild periodontitis and subjects with moderate to severe periodontitis. In logistic regression analysis adjusted for age, gender, diabetes, and the number of teeth and implants, high salivary concentrations of P. gingivalis, T. forsythia, and P. intermedia were significantly associated with moderate to severe periodontitis. When looking at different clinical and radiographic parameters of periodontitis, high concentrations of P. gingivalis and T. forsythia were significantly associated with the number of 4-5 mm periodontal pockets, ≥6 mm pockets, and alveolar bone loss (ABL). High level of T. forsythia was associated also with bleeding on probing (BOP). The combination of the four bacteria, i.e., the bacterial burden index, was associated with moderate to severe periodontitis with an odds ratio (OR) of 2.40 (95% CI 1.39-4.13). When A. actinomycetemcomitans was excluded from the combination of the bacteria, the OR was improved to 2.61 (95% CI 1.51-4.52). The highest OR 3.59 (95% CI 1.94-6.63) was achieved when P. intermedia was further excluded from the combination and only the levels of P. gingivalis and T. forsythia were used. Salivary diagnostics of periodontitis has potential especially in large-scale population studies and health promotion. The cumulative strategy appears to be useful in the analysis of salivary bacteria as markers of periodontitis.
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Affiliation(s)
- Aino Salminen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital Helsinki, Finland
| | - K A Elisa Kopra
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital Helsinki, Finland
| | - Kati Hyvärinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital Helsinki, Finland
| | - Susanna Paju
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital Helsinki, Finland
| | - Päivi Mäntylä
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital Helsinki, Finland
| | - Kåre Buhlin
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital Helsinki, Finland ; Division of Periodontology, Department of Dental Medicine, Karolinska Institutet Huddinge, Sweden
| | - Markku S Nieminen
- Department of Cardiology, Heart and Lung Center, Department of Medicine, Helsinki University Hospital Helsinki, Finland
| | - Juha Sinisalo
- Department of Cardiology, Heart and Lung Center, Department of Medicine, Helsinki University Hospital Helsinki, Finland
| | - Pirkko J Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital Helsinki, Finland
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Zanella SM, Pereira SS, Barbisan JN, Vieira L, Saba-Chujfi E, Haas AN, Rösing CK. Periodontal disease, tooth loss and coronary heart disease assessed by coronary angiography: a cross-sectional observational study. J Periodontal Res 2015. [DOI: 10.1111/jre.12301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S. M. Zanella
- Periodontology; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - S. S. Pereira
- Periodontology; Faculty of Dentistry; São Leopoldo Mandic University; Campinas Brazil
| | - J. N. Barbisan
- Institute of Cardiology of Porto Alegre; Porto Alegre Brazil
| | - L. Vieira
- Institute of Cardiology of Porto Alegre; Porto Alegre Brazil
| | - E. Saba-Chujfi
- Periodontology; Faculty of Dentistry; São Leopoldo Mandic University; Campinas Brazil
| | - A. N. Haas
- Periodontology; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - C. K. Rösing
- Periodontology; Faculty of Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
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Activated matrix metalloproteinase-8 in saliva as diagnostic test for periodontal disease? A case–control study. Med Microbiol Immunol 2015; 204:665-72. [DOI: 10.1007/s00430-015-0413-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/23/2015] [Indexed: 01/25/2023]
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46
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miR-146a-5p Antagonized AGEs- and P.g-LPS-Induced ABCA1 and ABCG1 Dysregulation in Macrophages via IRAK-1 Downregulation. Inflammation 2015; 38:1761-8. [DOI: 10.1007/s10753-015-0153-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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47
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Marfil-Álvarez R, Mesa F, Arrebola-Moreno A, Ramírez-Hernández JA, Magán-Fernández A, O'Valle F, Galindo-Moreno P, Catena A. Acute myocardial infarct size is related to periodontitis extent and severity. J Dent Res 2014; 93:993-8. [PMID: 25139359 DOI: 10.1177/0022034514548223] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Cardiovascular disease has been associated with 40% of deaths in high-income countries and 28% in lower-income countries. The relationship between periodontitis and acute myocardial infarction is well documented, but it has not been established whether the extent and severity of periodontitis influence the infarct size. This cross-sectional and analytic study was designed to investigate the association of chronic periodontitis extent and severity with acute myocardial infarct size as indicated by serum cardiac troponin I and myoglobin levels. Sociodemographic, periodontal, cardiologic, and hematologic variables were gathered in 112 consecutive patients with myocardial infarction. The extent (Arbes Index) and severity (Periodontal Inflammatory Severity Index) of the chronic periodontitis were significantly associated with troponin I levels after controlling for sociodemographic and clinical confounders (change in R (2) = .041, p < .02, and R (2) = .031, p = .04). However, only the extent index accounted for levels of myoglobin (change in R (2) = .030, p < .05), total leukocytes (change in R (2) = .041 p < .02), and neutrophils (change in R (2) = .059, p < .01). Mediated regression analysis showed that leukocytes and neutrophils may underlie these observed relationships of chronic periodontitis with troponin I and myoglobin. To our knowledge, this study contributes the first research data demonstrating that the extent and severity of periodontitis is positively associated with acute myocardial infarct size as measured by serum troponin I and myoglobin levels.
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Affiliation(s)
- R Marfil-Álvarez
- Department of Periodontics, School of Dentistry, University of Granada, Spain
| | - F Mesa
- Department of Periodontics, School of Dentistry, University of Granada, Spain
| | - A Arrebola-Moreno
- Department of Cardiology, "Vírgen de las Nieves" Hospital and University of Granada, Spain
| | - J A Ramírez-Hernández
- Department of Cardiology, "Vírgen de las Nieves" Hospital and University of Granada, Spain
| | - A Magán-Fernández
- Department of Periodontics, School of Dentistry, University of Granada, Spain
| | - F O'Valle
- Departments of Pathology, School of Medicine and Biopathology and Medicine Regenerative Institute, University of Granada, Spain
| | - P Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Spain
| | - A Catena
- Department of Experimental Psychology, School of Psychology, University of Granada, Spain
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48
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Lin G, Shi X, Chen S, Lei L, You X, Huang M, Luo L, Li Y, Zhao X, Yan F. Effects of micro-amounts of Porphyromonas gingivalis
lipopolysaccharide on rabbit inflammatory immune response and development of atherosclerosis. J Periodontal Res 2014; 50:356-62. [PMID: 25065326 DOI: 10.1111/jre.12214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2014] [Indexed: 11/29/2022]
Affiliation(s)
- G. Lin
- School and Hospital of Stomatology; Fujian Medical University, and Stomatological Key Laboratory of Fujian College and University; Fuzhou China
- Department of Stomatology; Fujian Provincial People's Hospital; Fujian University of Traditional Chinese Medicine; Fuzhou China
| | - X. Shi
- School and Hospital of Stomatology; Fujian Medical University, and Stomatological Key Laboratory of Fujian College and University; Fuzhou China
| | - S. Chen
- School and Hospital of Stomatology; Fujian Medical University, and Stomatological Key Laboratory of Fujian College and University; Fuzhou China
| | - L. Lei
- School and Hospital of Stomatology; Fujian Medical University, and Stomatological Key Laboratory of Fujian College and University; Fuzhou China
| | - X. You
- School and Hospital of Stomatology; Fujian Medical University, and Stomatological Key Laboratory of Fujian College and University; Fuzhou China
| | - M. Huang
- School and Hospital of Stomatology; Fujian Medical University, and Stomatological Key Laboratory of Fujian College and University; Fuzhou China
| | - L. Luo
- School and Hospital of Stomatology; Fujian Medical University, and Stomatological Key Laboratory of Fujian College and University; Fuzhou China
| | - Y. Li
- School and Hospital of Stomatology; Fujian Medical University, and Stomatological Key Laboratory of Fujian College and University; Fuzhou China
| | - X. Zhao
- School and Hospital of Stomatology; Fujian Medical University, and Stomatological Key Laboratory of Fujian College and University; Fuzhou China
| | - F. Yan
- School and Hospital of Stomatology; Fujian Medical University, and Stomatological Key Laboratory of Fujian College and University; Fuzhou China
- School and Hospital of Stomatology; Fujian Medical University; Fuzhou Fujian China
- School of Stomatology; Nanjing University; Nanjing Stomatological Hospital; Nanjing China
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Periodontal disease in relation to selected parameters of the cardiovascular system in a group of patients with stable angina pectoris. Cent Eur J Immunol 2014; 39:181-6. [PMID: 26155121 PMCID: PMC4440030 DOI: 10.5114/ceji.2014.43720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 05/05/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction Periodontal diseases (PD), which are the cause of chronic inflammatory processes, can develop increased susceptibility to vascular diseases through atherosclerosis. Due to the raised inflammatory and thrombotic risk, PD can have a significant influence on the course and results of stable angina pectoris (SAP). Objectives The aim of the study is to evaluate the influence of chosen PD parameters on selected cardiovascular system parameters, and the correlation between chosen parameters of periodontitis and cardiovascular system parameters. Material and methods The case group included 67 patients with SAP, ≤ 60 years of age. The occurrence of well-known cardiovascular disease risk factors was evaluated on the basis of the clinical interview, clinical examination and laboratory tests. The occurrence of known risk factors for cardiovascular diseases (CVD) was established on the basis of the interview, clinical research and laboratory tests. Periodontal examination included API (approximal plaque index), CAL (clinical attachment level), PD (pocket depth), and BI (bleeding index). IMT (intima-media thickness) and the size of atherosclerotic plaque in carotid arteries were assessed by ultrasound examination. Segmental contractility abnormalities were assessed on the basis of echocardiography examination, presence of the single-vessel vascular and multi-vessel vascular disease on the basis of angiographic examination. Results In the study group of patients, numerous risk factors and a higher level of API, CAL, PD and BI were observed. A higher prevalence of multi-vessel disease (75%) than single-vessel disease (25%) was noted on the basis of angiographic examination. Patients with contractility abnormalities demonstrated also poor oral cavity health. In addition, a higher concentration of CRP (3.2 mg/dl), fibrinogen (3.3 g/l)) and the progression of atherosclerosis, e.g. increased IMT (2.1 mm) and formation of atherosclerotic plaques were noted. Results of multivariate logistic regression demonstrated that API and PD had a significant influence on IMT. In patients with BMI ≥ 30 kg/m2, the risk of increased IMT (OR = 4.67) was fourfold higher. Summary Periodontitis may influence the occurrence and course of the atherosclerotic process in persons with stable angina.
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50
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Reichert S, Schlitt A, Beschow V, Lutze A, Lischewski S, Seifert T, Dudakliewa T, Gawe R, Werdan K, Hofmann B, Schaller HG, Schulz S. Use of floss/interdental brushes is associated with lower risk for new cardiovascular events among patients with coronary heart disease. J Periodontal Res 2014; 50:180-8. [DOI: 10.1111/jre.12191] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2014] [Indexed: 12/19/2022]
Affiliation(s)
- S. Reichert
- Department of Operative Dentistry and Periodontology; Martin Luther University Halle-Wittenberg; Halle Germany
| | - A. Schlitt
- Department of Cardiology; Paracelsus-Harz-Clinic Bad Suderode; Quedlinburg Germany
| | - V. Beschow
- Department of Operative Dentistry and Periodontology; Martin Luther University Halle-Wittenberg; Halle Germany
| | - A. Lutze
- Department of Operative Dentistry and Periodontology; Martin Luther University Halle-Wittenberg; Halle Germany
- Department of Internal Medicine III; Heart Centre of the University Clinics Halle (Saale); Martin Luther University Halle-Wittenberg; Halle Germany
| | - S. Lischewski
- Department of Operative Dentistry and Periodontology; Martin Luther University Halle-Wittenberg; Halle Germany
| | - T. Seifert
- Department of Operative Dentistry and Periodontology; Martin Luther University Halle-Wittenberg; Halle Germany
- Department of Internal Medicine III; Heart Centre of the University Clinics Halle (Saale); Martin Luther University Halle-Wittenberg; Halle Germany
| | - T. Dudakliewa
- Department of Internal Medicine III; Heart Centre of the University Clinics Halle (Saale); Martin Luther University Halle-Wittenberg; Halle Germany
| | - R. Gawe
- Department of Internal Medicine III; Heart Centre of the University Clinics Halle (Saale); Martin Luther University Halle-Wittenberg; Halle Germany
| | - K. Werdan
- Department of Internal Medicine III; Heart Centre of the University Clinics Halle (Saale); Martin Luther University Halle-Wittenberg; Halle Germany
| | - B. Hofmann
- Department of Cardiothoracic Surgery; Heart Centre of the University Clinics Halle (Saale); Martin Luther University Halle-Wittenberg; Halle Germany
| | - H.-G. Schaller
- Department of Operative Dentistry and Periodontology; Martin Luther University Halle-Wittenberg; Halle Germany
| | - S. Schulz
- Department of Operative Dentistry and Periodontology; Martin Luther University Halle-Wittenberg; Halle Germany
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