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Ono Y, Chou YC, Chien WC, Sun CA. Association between severity of dental caries and the risk of stroke. Oral Dis 2024; 30:3413-3421. [PMID: 37864387 DOI: 10.1111/odi.14756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE The relationship between dental caries and stroke remains inconclusive. The aim of this study is to investigate whether different severities of dental caries affect the risk of stroke. METHODS This retrospective cohort study was conducted using the 2000-2013 Taiwan National Health Insurance Database. We selected 23,662 patients with advanced/severe dental caries and 23,662 patients with incipient/moderate dental caries between 2000 and 2006. These patients were followed to the occurrence of stroke or to the end of the study in 2013. Hazard ratios (HRs) and 95% confidence intervals (CIs) derived from the Cox proportional hazards models were calculated to assess the association between severity of dental caries and the risk of stroke. RESULTS The advanced/severe dental caries group had a significantly higher risk of stroke compared with incipient/moderate dental caries group (adjusted HR, 1.16; 95% CI, 1.03-1.31). Stratified analyses showed that advanced/severe dental caries was positively associated with the risk of ischemic stroke in patients aged ≥40 years and with the risk of hemorrhagic stroke in patients aged <40 years. CONCLUSION There is a severity-dependent association between dental caries and stroke in an Asian population.
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Affiliation(s)
- Yukiko Ono
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense medical Center, Taipei City, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
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Zhuang J, Zhang S, Chen H, Qiu C, Feng T, Zhou W, Han X, Song Z. Evidence of microbiota-host dysbiosis between periodontitis and cerebral small vessel disease. Oral Dis 2024. [PMID: 38923260 DOI: 10.1111/odi.15041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To investigate the correlation between periodontitis and cerebral small vessel disease (CSVD) from the clinical and microbiological aspects. SUBJECTS AND METHODS Periodontitis patients (CP group, n = 31) and CSVD patients (CSVD group, n = 30) were examined for neurological and periodontal condition. Subgingival plaque was collected and performed using 16S rRNA sequencing. Logistic regression and LASSO regression were used to analyze the periodontal parameters and subgingival microbiota related to CSVD, respectively. Inflammatory factors in gingival crevicular fluid (GCF) were also detected and compared between the two groups. RESULTS Clinical attachment level (CAL), teeth number and plaque index demonstrated a significant difference between CP and CSVD group, meanwhile, CAL was independently associated with CSVD. Besides, the microbial richness and composition were distinct between two groups. Five genera related to periodontal pathogens (Treponema, Prevotella, Streptococcus, Fusobacterium, Porphyromonas) were screened out by LASSO regression, suggesting a potential association with CSVD. Finally, the levels of inflammatory factors in GCF were statistically higher in CSVD group than those in CP group. CONCLUSIONS Cerebral small vessel disease patients demonstrated worse periodontal condition, meanwhile the interaction between microbiota dysbiosis and host factors (inflammation) leading to a better understanding of the association between periodontitis and CSVD.
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Affiliation(s)
- Jiabao Zhuang
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Shufan Zhang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Huiwen Chen
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Che Qiu
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Tienan Feng
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhou
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xiang Han
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhongchen Song
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
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Leskelä J, Putaala J, Martinez-Majander N, Tulkki L, Manzoor M, Zaric S, Ylikotila P, Lautamäki R, Saraste A, Suihko S, Könönen E, Sinisalo J, Pussinen P, Paju S. Periodontitis, Dental Procedures, and Young-Onset Cryptogenic Stroke. J Dent Res 2024; 103:494-501. [PMID: 38623924 PMCID: PMC11047014 DOI: 10.1177/00220345241232406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Periodontitis is associated with an increased risk of ischemic stroke, and the risk may be particularly high among young people with unexplained stroke etiology. Thus, we investigated in a case-control study whether periodontitis or recent invasive dental treatments are associated with young-onset cryptogenic ischemic stroke (CIS). We enrolled participants from a multicenter case-control SECRETO study including adults aged 18 to 49 y presenting with an imaging-positive first-ever CIS and stroke-free age- and sex-matched controls. Thorough clinical and radiographic oral examination was performed. Furthermore, we measured serum lipopolysaccharide (LPS) and lipotechoic acid (LTA) levels. Multivariate conditional regression models were adjusted for stroke risk factors, regular dentist visits, and patent foramen ovale (PFO) status. We enrolled 146 case-control pairs (median age 41.9 y; 58.2% males). Periodontitis was diagnosed in 27.5% of CIS patients and 20.1% of controls (P < 0.001). In the fully adjusted models, CIS was associated with high periodontal inflammation burden (odds ratio [OR], 95% confidence interval) with an OR of 10.48 (3.18-34.5) and severe periodontitis with an OR of 7.48 (1.24-44.9). Stroke severity increased with the severity of periodontitis, having an OR of 6.43 (1.87-23.0) in stage III to IV, grade C. Invasive dental treatments performed within 3 mo prestroke were associated with CIS, with an OR of 2.54 (1.01-6.39). Association between CIS and invasive dental treatments was especially strong among those with PFO showing an OR of 6.26 (1.72-40.2). LPS/LTA did not differ between CIS patients and controls but displayed an increasing trend with periodontitis severity. Periodontitis and recent invasive dental procedures were associated with CIS after controlling for multiple confounders. However, the role of bacteremia as a mediator of this risk was not confirmed.
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Affiliation(s)
- J. Leskelä
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - J. Putaala
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - N. Martinez-Majander
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - L. Tulkki
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M. Manzoor
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - S. Zaric
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
| | - P. Ylikotila
- Neurocenter, Turku University Hospital, University of Turku, Turku, Finland
| | - R. Lautamäki
- Heart Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - A. Saraste
- Heart Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - S. Suihko
- Department of Medicine, Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - E. Könönen
- Institute of Dentistry, University of Turku, Turku, Finland
| | - J. Sinisalo
- Department of Medicine, Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - P.J. Pussinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
- School of Medicine, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - S. Paju
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
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Suryawanshi KR, Martande S, Kalal DN, Pv S, Gopalakrishnan D, Kulloli A, Shetty S, Thakur S, Rokade S, Thomas J. Assessment of periodontal health status in patients with Parkinson's disease-A systematic review and meta-analysis of cross-sectional studies. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38654464 DOI: 10.1111/scd.13001] [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: 10/11/2023] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Parkinson's disease (PKD) is neurodegenerative disorder marked by tremors, bradykinesia, muscle rigidity and reduction in precise hand movements which could lead to improper oral hygiene and Periodontal disease. Current systematic review aims to review existing literature and provide assessment of periodontal health in PKD patients through a meta-analysis METHODS: Review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered in PROSPERO-CRD42023451700. Databases were searched for studies having sufficient data on periodontal health in patients with PKD compared to healthy controls and reporting outcomes in terms of various periodontal parameters of probing depth (PD), plaque index (PI), clinical attachment level (CAL), presence of bleeding on probing and gingivitis. Quality assessment of included was evaluated using Newcastle Ottawa Scale (NOS). RESULTS Eleven studies fulfilled the eligibility criteria, of which ten studies were suitable for meta-analysis. Pooled estimate through the SMD showed that all periodontal parameters were altered and significantly deteriorated in PKD compared to controls but this group differences were statistically insignificant (p > 0.05). Publication bias through the funnel plot showed symmetric distribution with absence of systematic heterogeneity. CONCLUSION Parkinson's disease could be a possible factor in deterioration of periodontal health.
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Affiliation(s)
- Krishna R Suryawanshi
- Department of Periodontology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Santosh Martande
- Department of Periodontology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Darshan N Kalal
- Department of Psychiatry, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Swathi Pv
- Department of Orthodontics and Dentofacial Orthopedics, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Dharmarajan Gopalakrishnan
- Department of Periodontology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Anita Kulloli
- Department of Periodontology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Sharath Shetty
- Department of Periodontology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Shambhavi Thakur
- Department of Periodontology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Shreya Rokade
- Department of Periodontology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
| | - Jonathan Thomas
- Department of Periodontology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India
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Lee S, Haraga H, Satoh T, Mutoh N, Watanabe K, Hamada N, Tani-Ishii N. Effect of periodontitis induced by Fusobacterium nucleatum on the microbiota of the gut and surrounding organs. Odontology 2024; 112:177-184. [PMID: 37432500 DOI: 10.1007/s10266-023-00827-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 06/06/2023] [Indexed: 07/12/2023]
Abstract
Detection of the oral bacterium Fusobacterium nucleatum in colorectal cancer tissues suggests that periodontitis may alter gut microbiota. The purpose of this study was to analyze the influence and infection route of periodontal inflammation caused by F. nucleatum, and microbiota of the gut and surrounding organs (heart, liver, kidney). Wistar female rats were orally inoculated with F. nucleatum to establish an experimental periodontitis model that was confirmed by X-ray imaging and histopathological analysis. The mandibles, gut, liver, heart, and kidneys were collected from the experimental group at 2, 4, and 8 weeks, and from the uninfected control group at 0 weeks, for DNA extraction for PCR amplification and comprehensive microbiota analysis using the Illumina MiSeq platform. Imaging confirmed the onset of periodontitis at 2 weeks post-inoculation, and histopathology showed inflammatory cell infiltration from 2 to 8 weeks. PCR and comprehensive microbiota analysis showed the presence of F. nucleatum in the heart and liver at 2 weeks, and in the liver at 4 and 8 weeks. There were changes of microbiota of the gut, heart, liver, and kidneys at 4 weeks: namely, decreased Verrucomicrobia and Bacteroidetes, and increased Firmicutes. F. nucleatum induced the onset of periodontitis and infected the heart and liver in rats. As the periodontic lesion progressed, the microbiota of the gut, liver, heart, and kidneys were altered.
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Affiliation(s)
- Sangmin Lee
- Department of Pulp Biology and Endodontics, Kanagawa Dental University, 82. Inaoka-Cho, Yokosuka, Kanagawa, 238-8580, Japan
| | - Hiroshi Haraga
- Department of Pulp Biology and Endodontics, Kanagawa Dental University, 82. Inaoka-Cho, Yokosuka, Kanagawa, 238-8580, Japan
- Ministry of Defense Japan Self-Defense Forces Hospital Yokosuka, 1766-1 Tauraminato-Cho, Yokosuka, Kanagawa, 237-0071, Japan
| | - Takenori Satoh
- Department of Molecular-Biology, Kanagawa Dental University, 82. Inaoka-Cho, Yokosuka, Kanagawa, 238-8580, Japan
| | - Noriko Mutoh
- Department of Pulp Biology and Endodontics, Kanagawa Dental University, 82. Inaoka-Cho, Yokosuka, Kanagawa, 238-8580, Japan
| | - Kiyoko Watanabe
- Department of Oral Microbiology, Kanagawa Dental University, 82. Inaoka-Cho, Yokosuka, Kanagawa, 238-8580, Japan
| | - Nobushiro Hamada
- Department of Oral Microbiology, Kanagawa Dental University, 82. Inaoka-Cho, Yokosuka, Kanagawa, 238-8580, Japan
| | - Nobuyuki Tani-Ishii
- Department of Pulp Biology and Endodontics, Kanagawa Dental University, 82. Inaoka-Cho, Yokosuka, Kanagawa, 238-8580, Japan.
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Freiherr Von Seckendorff A, Nomenjanahary MS, Labreuche J, Ollivier V, Di Meglio L, Dupont S, Hamdani M, Brikci-Nigassa N, Brun A, Boursin P, Piotin M, Mazighi M, Ho-Tin-Noé B, Desilles JP, Delbosc S. Periodontitis in ischemic stroke: impact of Porphyromonas gingivalis on thrombus composition and ischemic stroke outcomes. Res Pract Thromb Haemost 2024; 8:102313. [PMID: 38318152 PMCID: PMC10840352 DOI: 10.1016/j.rpth.2023.102313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024] Open
Abstract
Background Periodontitis is associated with an increased risk of ischemic stroke, but the mechanisms underlying this association remain unclear. Objectives Our objective was to determine whether Porphyromonas gingivalis (Pg), a periodontal bacterium, could be detected within thrombus aspirates, modify thrombus composition, and endovascular therapy responses. Methods The presence of Pg gingipain in 175 consecutive thrombi from patients with large vessel occlusion stroke enrolled in the multicenter research cohort compoCLOT was investigated by immunostaining. Thrombus blood cell composition according to gingipain status was analyzed in a subset of 63 patients. Results Pg gingipain immunostaining was positive in 33.7% of thrombi (95% CI, 26.7%-40.8%). The percentage of near to complete reperfusion (modified Thrombolysis in Cerebral Infarction Score 2c/3) at the end of the procedure was lower in the Pgpos group than the Pgneg group (39.0% vs 57.8% respectively; adjusted odds ratio, 0.38; 95% CI, 0.19-0.77). At 3 months, 35.7% of patients in the Pgpos group had a favorable neurological outcome vs 49.5% in the Pgneg group (odds ratio, 0.65; 95% CI, 0.30-1.40). Quantitative analysis of a subset of 63 thrombi showed that neutrophil elastase content was significantly (P < .05) higher in Pgpos thrombi than in Pgneg thrombi. Conclusion Our results indicate that intrathrombus Pg gingipain is associated with increased neutrophil content and resistance to endovascular therapy.
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Affiliation(s)
- Aurélien Freiherr Von Seckendorff
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Mialitiana Solo Nomenjanahary
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Julien Labreuche
- Department of Biostatistics, Centre Hospitalier Universitaire Lille, Lille, France
| | - Véronique Ollivier
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Lucas Di Meglio
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Sebastien Dupont
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Mylène Hamdani
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Nahida Brikci-Nigassa
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Adrian Brun
- Laboratory of Orofacial Pathologies, Imaging and Biotherapies URP2496, Unité de Formation et de Recherche Odontologie, Faculté de Santé, Université Paris Cité, Montrouge, France
- Division of Periodontology, Department of Oral Medicine, Assisantance Publique Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
| | - Perrine Boursin
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
- Fédération Hospitalo-Universitaire Neurovasc, Department of Neurology, Hopital Lariboisière, Assisantance Publique Hôpitaux de Paris, Paris, France
- Department of Neurology, Hôpital Lariboisière, Assisantance Publique Hôpitaux de Paris Nord, Paris, France
| | - Benoit Ho-Tin-Noé
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
- Fédération Hospitalo-Universitaire Neurovasc, Department of Neurology, Hopital Lariboisière, Assisantance Publique Hôpitaux de Paris, Paris, France
| | - Sandrine Delbosc
- Institut National de la Santé et de la Recherche Médicale, Laboratory for Vascular Translational Research, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France
| | - compoCLOT study group
- Interventional Neuroradiology Department and Biological Resources Center, Rothschild Foundation Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Unité de Formation et de Recherche Pharmacie, Université Paris Cité, Paris, France
- Department of Biostatistics, Centre Hospitalier Universitaire Lille, Lille, France
- Laboratory of Orofacial Pathologies, Imaging and Biotherapies URP2496, Unité de Formation et de Recherche Odontologie, Faculté de Santé, Université Paris Cité, Montrouge, France
- Division of Periodontology, Department of Oral Medicine, Assisantance Publique Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
- Fédération Hospitalo-Universitaire Neurovasc, Department of Neurology, Hopital Lariboisière, Assisantance Publique Hôpitaux de Paris, Paris, France
- Department of Neurology, Hôpital Lariboisière, Assisantance Publique Hôpitaux de Paris Nord, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Laboratory for Vascular Translational Research, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France
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Shen M, Li Z, Li H, Yan X, Feng B, Xu L. Association of periodontitis and tooth loss with extent of coronary atherosclerosis in patients with type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2023; 14:1243992. [PMID: 38075042 PMCID: PMC10702216 DOI: 10.3389/fendo.2023.1243992] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Aim The objective was to investigate the association of periodontitis and tooth loss with extent of diabetic coronary atherosclerosis. Materials and methods 272 patients who were hospitalized at Shanghai East hospital and underwent a coronary artery calcium (CAC) CT scan were enrolled in this study. Individuals were grouped based on their CAC scores into a normal-to-mild coronary atherosclerosis (AS) group (0 ≤ score ≤ 100, n=184) and a moderate-to-severe group (score≥101, n=88). Periodontitis parameters and number of missing teeth were evaluated for every patient. The severity of periodontitis was categorized as mild, moderate, or severe. The taxonomic composition of the microbiota was determined using full-length 16S ribosomal RNA gene sequencing. Salivary inflammatory factors were tested by ELISA. Results Clinical attachment loss (CAL) (P =0.05) and the number of teeth lost (P = 0.016) were significantly higher in the moderate-to-severe coronary AS group, with these differences being more obvious in younger patients and patients with short-duration diabetes. Multivariate logistic regression analysis revealed that CAL (OR = 1.231, 95% CI = 1.066-1.214, P = 0.047) and having 10-19 missing teeth (OR = 1.604, 95% CI = 1.393-6.555, P = 0.05) were strongly associated with the presence of moderate-to-severe coronary AS. Salivary IL-6 and TNF-α levels, as well as levels of Porphyromonas gingivalis and Neisseria mucosa, were significantly elevated in the moderate-to-severe coronary AS group. Conclusion It was found that both tooth loss and CAL were related to the extent of diabetic coronary AS. Saliva inflammatory factors and oral bacteremia may be new biomarkers for moderate-to-severe coronary AS.
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Affiliation(s)
- Minhua Shen
- Department of Stomatology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhen Li
- Department of Stomatology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huizhi Li
- Department of Endocrinology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xinfeng Yan
- Department of Endocrinology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bo Feng
- Department of Endocrinology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Xu
- Department of Endocrinology, East Hospital, Tongji University School of Medicine, Shanghai, China
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8
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Patrakka O, Tuomisto S, Pienimäki J, Ollikainen J, Oksala N, Lampinen V, Ojanen MJT, Huhtala H, Hytönen VP, Lehtimäki T, Martiskainen M, Karhunen PJ. Thrombus Aspirates From Patients With Acute Ischemic Stroke Are Infiltrated by Viridans Streptococci. J Am Heart Assoc 2023; 12:e030639. [PMID: 37982253 PMCID: PMC10727284 DOI: 10.1161/jaha.123.030639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/27/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Acute ischemic stroke may be due to embolism from ruptured atherosclerotic carotid arteries. DNA of oral bacteria, mainly the viridans streptococci group, has been detected in thrombus aspirates of patients with ischemic stroke as well as in carotid endarterectomy samples. Because viridans streptococci are known to possess thrombogenic properties, we studied whether their presence in thrombus aspirates and in carotid artery specimens can be confirmed using bacterial immunohistochemistry. METHODS AND RESULTS Thrombus aspirates from 61 patients with ischemic stroke (70.5% men; mean age, 66.8 years) treated with mechanical thrombectomy, as well as carotid endarterectomy samples from 20 symptomatic patients (65.0% men; mean age, 66.2 years) and 48 carotid artery samples from nonstroke autopsy cases (62.5% men; mean age, 66.4 years), were immunostained with an antibody cocktail against 3 species (Streptococcus sanguinis, Streptococcus mitis, and Streptococcus gordonii) of viridans streptococci. Of the thrombus aspirates, 84.8% were immunopositive for viridans streptococci group bacteria, as were 80.0% of the carotid endarterectomy samples, whereas immunopositivity was observed in 31.3% of the carotid artery samples from nonstroke autopsies. Most streptococci were detected inside neutrophil granulocytes, but there were also remnants of bacterial biofilm as well as free bacterial infiltrates in some samples. CONCLUSIONS Oral streptococci were found in aspirated thrombi of patients with acute ischemic stroke as well as in carotid artery samples. Our results suggest that viridans streptococci group bacteria may play a role in the pathophysiology of ischemic stroke.
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Affiliation(s)
- Olli Patrakka
- Department of Forensic Medicine, Faculty of Medicine and Health TechnologyTampere University and Fimlab LaboratoriesTampereFinland
| | - Sari Tuomisto
- Department of Forensic Medicine, Faculty of Medicine and Health TechnologyTampere University and Fimlab LaboratoriesTampereFinland
| | | | - Jyrki Ollikainen
- Department of NeurologyTampere University HospitalTampereFinland
| | - Niku Oksala
- Vascular CentreTampere University HospitalTampereFinland
- Surgery, Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Vili Lampinen
- Department of Forensic Medicine, Faculty of Medicine and Health TechnologyTampere University and Fimlab LaboratoriesTampereFinland
| | - Markus J. T. Ojanen
- Department of Forensic Medicine, Faculty of Medicine and Health TechnologyTampere University and Fimlab LaboratoriesTampereFinland
- Laboratory of Protein Dynamics, Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Heini Huhtala
- Faculty of Social SciencesTampere UniversityTampereFinland
| | - Vesa P. Hytönen
- Department of Forensic Medicine, Faculty of Medicine and Health TechnologyTampere University and Fimlab LaboratoriesTampereFinland
- Laboratory of Protein Dynamics, Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Faculty of Medicine and Health TechnologyTampere University, Fimlab Laboratories and Finnish Cardiovascular Research Center TampereTampereFinland
| | - Mika Martiskainen
- Department of Forensic Medicine, Faculty of Medicine and Health TechnologyTampere University and Fimlab LaboratoriesTampereFinland
- National Institute for Health and WelfareHelsinkiFinland
| | - Pekka J. Karhunen
- Department of Forensic Medicine, Faculty of Medicine and Health TechnologyTampere University and Fimlab LaboratoriesTampereFinland
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9
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Abstract
Gastrointestinal (GI) complications are seen in over 50% of ischemic stroke survivors; the most common complications are dysphagia, constipation, and GI bleeding. The bidirectional relationship of the gut-brain axis and stroke has recently gained traction, wherein stroke contributes to gut dysbiosis (alterations in the normal host intestinal microbiome) and gut dysbiosis perpetuates poor functional neurologic outcomes in stroke. It is postulated that the propagation of proinflammatory cells and gut metabolites (including trimethylamine N-oxide and short-chain fatty acids) from the GI tract to the central nervous system play a central role in gut-brain axis dysfunction. In this review, we discuss the known GI complications in acute ischemic stroke, our current knowledge from experimental stroke models for gut-brain axis dysfunction in stroke, and emerging therapeutics that target the gut-brain axis.
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Affiliation(s)
- Heather Y F Yong
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Carlos Camara-Lemarroy
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
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10
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Mosaddad SA, Mahootchi P, Safari S, Rahimi H, Aghili SS. Interactions between systemic diseases and oral microbiota shifts in the aging community: A narrative review. J Basic Microbiol 2023. [PMID: 37173818 DOI: 10.1002/jobm.202300141] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/23/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
As a gateway to general health and a diverse microbial habitat, the oral cavity is colonized by numerous microorganisms such as bacteria, fungi, viruses, and archaea. Oral microbiota plays an essential role in preserving oral health. Besides, the oral cavity also significantly contributes to systemic health. Physiological aging influences all body systems, including the oral microbial inhabitants. The cited effect can cause diseases by forming dysbiotic communities. Since it has been demonstrated that microbial dysbiosis could disturb the symbiosis state between the host and the resident microorganism, shifting the condition toward a more pathogenic one, this study investigated how the oral microbial shifts in aging could associate with the development or progression of systemic diseases in older adults. The current study focused on the interactions between variations in the oral microbiome and prevalent diseases in older adults, including diabetes mellitus, Sjögren's syndrome, rheumatoid arthritis, pulmonary diseases, cardiovascular diseases, oral candidiasis, Parkinson's disease, Alzheimer's disease, and glaucoma. Underlying diseases can dynamically modify the oral ecology and the composition of its resident oral microbiome. Clinical, experimental, and epidemiological research suggests the associations of systemic disorders with bacteremia and inflammation after oral microbial changes in older adults.
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Affiliation(s)
- Seyed Ali Mosaddad
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pegah Mahootchi
- Department of Oral and Maxillofacial Diseases, School of Dentistry, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Sajedeh Safari
- Department of Prosthodontics, Islamic Azad University, Tehran, Iran
| | - Hussein Rahimi
- Student Research Committee, School of Dentistry, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Seyedeh Sara Aghili
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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11
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LaValley EA, Sen S, Mason E, Logue M, Trivedi T, Moss K, Beck J, Rosamond WD, Gottesman RF. Dental Caries a Risk Factor for Intracerebral Hemorrhage. Cerebrovasc Dis 2023; 53:98-104. [PMID: 37231788 PMCID: PMC10988391 DOI: 10.1159/000530568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/23/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Streptococcus mutans is a known cause of dental caries that contains a collagen-binding protein, Cnm, and exhibits inhibition of platelet aggregation and matrix metalloproteinase-9 activation. This strain has been linked to aggravation of experimental intracerebral hemorrhage (ICH) and may be a risk factor for ICH. The purpose of this study was to test the association between dental caries and incident ICH. METHODS The presence of dental caries and periodontal disease was assessed in subjects from the Dental Atherosclerosis Risk in Communities (DARIC) study without prior stroke or ICH. This cohort was followed for incident ICH over a period of 10 years. Cox regression was used to compute crude and adjusted hazards ratio from the dental assessment. RESULTS Among 6,315 subjects, dental surface caries and/or root caries were recorded in 1,338 (27%) subjects. Of those, 7 (0.5%) had incident ICH over a period of 10 years following the visit 4 assessment. Of the remaining 4,977 subjects, 10 (0.2%) had incident ICH. Those with dental caries versus those without dental caries were slightly younger (mean age 62.0 ± 5.7 vs. 62.4 ± 5.6, p = 0.012), had a greater proportion of males (51 vs. 44%, p < 0.001), African Americans (44 vs. 10%, p < 0.001), and were hypertensive (42 vs. 31%, p < 0.001). The association between caries and ICH was significant (crude HR 2.69, 95% CI 1.02-7.06) and strengthened after adjustment for age, gender, race, education level, hypertension, and periodontal disease (adjusted HR 3.88, 95% CI 1.34-11.24). CONCLUSION Dental caries is a potential risk for incident ICH after caries detection. Future studies are needed to determine if treatment of dental caries can reduce the risk of ICH.
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Affiliation(s)
- Elizabeth A LaValley
- Department of Neurology, University of South Carolina, School of Medicine, Columbia, South Carolina, USA
| | - Souvik Sen
- Department of Neurology, University of South Carolina, School of Medicine, Columbia, South Carolina, USA
| | - Emma Mason
- Department of Neurology, University of South Carolina, School of Medicine, Columbia, South Carolina, USA
| | - Makenzie Logue
- Department of Neurology, University of South Carolina, School of Medicine, Columbia, South Carolina, USA
| | - Tushar Trivedi
- Department of Neurology, Regional Medical Center, Orangeburg, South Carolina, USA
| | - Kevin Moss
- Division of Comprehensive Oral Health/Periodontology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - James Beck
- Division of Comprehensive Oral Health/Periodontology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Wayne D Rosamond
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Rebecca F Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland, USA
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12
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Ma C, Wu M, Gao J, Liu C, Xie Y, Lv Q, Zhang X. Periodontitis and stroke: A Mendelian randomization study. Brain Behav 2023; 13:e2888. [PMID: 36621868 PMCID: PMC9927832 DOI: 10.1002/brb3.2888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/15/2022] [Accepted: 12/24/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Periodontitis has been implicated in the incidence of ischemic stroke. However, the generalizability of results to individuals with different subtypes of periodontitis is unknown. We aimed to investigate the causal relationship of chronic periodontitis (CP) and aggressive periodontitis (AgP) with ischemic stroke and its subtypes in the Mendelian randomization framework. METHODS The genetic proxies of CP were derived from large-scale summary statistics from the UK Biobank datasets (950 cases and 455,398 controls). The genetic associations of AgP were selected from another large genome-wide association study of European ancestry (851 cases and 6836 controls). The instruments of ischemic stroke (34,217 cases and 406,111 controls) and its subtypes were selected from the MEGASTROKE consortium of European ancestry. The inverse variant weighted method was performed to determine the causal inference and a comprehensive set of sensitivity analyses to test the robustness of the results. RESULTS In population-wide genetic analysis, there was no association of genetically predicted AgP (odds ratio [OR], 0.982; 95% confidence interval [CI], 0.956-1.009; p = .197) with ischemic stroke or its subtypes. For patients with CP, there was also no significant causal inference on ischemic stroke (OR, 1.017; 95% CI, 0.992-1.043; p = .184). However, regarding the stroke subtypes, the genetic analysis provided evidence of a causal relationship of CP with cardioembolic stroke (OR, 1.052; 95% CI, 1.002-1.104; p = .042), but not with large artery atherosclerosis (OR, 1.005; 95% CI, 0.944-1.069; p = .875) or small vessel occlusion (OR, 1.039; 95% CI, 0.981-1.101; p = .193). CONCLUSION This study suggested that there was a potential causal effect of CP on cardioembolic stroke.
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Affiliation(s)
- Chaoyang Ma
- Department of EndodontologyAffiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative MedicineGuangzhouChina
| | - Min Wu
- Department of NeurologyJinling HospitalNanjing Medical UniversityNanjingChina
| | - Jie Gao
- Department of NeurologyJinling HospitalMedical School of Nanjing UniversityNanjingChina
| | - Chuanzi Liu
- Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Institute of Stomatological Research, Guanghua School of StomatologySun Yat‐sen UniversityGuangzhouChina
| | - Yi Xie
- Department of NeurologyJinling HospitalMedical School of Nanjing UniversityNanjingChina
| | - Qiushi Lv
- Department of NeurologyJinling HospitalMedical School of Nanjing UniversityNanjingChina
| | - Xiaohao Zhang
- Department of NeurologyNanjing First HospitalNanjing Medical UniversityNanjingChina
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13
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Sun W, Huang S, Yang X, Luo Y, Liu L, Wu D. The oral microbiome of patients with ischemic stroke predicts their severity and prognosis. Front Immunol 2023; 14:1171898. [PMID: 37138888 PMCID: PMC10150016 DOI: 10.3389/fimmu.2023.1171898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Background and objectives Stroke is a common group of cerebrovascular diseases that can lead to brain damage or death. Several studies have shown a close link between oral health and stroke. However, the oral microbiome profiling of ischemic stroke (IS) and its potential clinical implication are unclear. This study aimed to describe the oral microbiota composition of IS, the high risk of IS, and healthy individuals and to profile the relationship between microbiota and IS prognosis. Methods This observational study recruited three groups: IS, high-risk IS (HRIS), and healthy control (HC) individuals. Clinical data and saliva were collected from participants. The modified Rankin scale score after 90 days was used to assess the prognosis of stroke. Extracted DNA from saliva and performed 16S ribosomal ribonucleic acid (rRNA) gene amplicon sequencing. Sequence data were analyzed using QIIME2 and R packages to evaluate the association between the oral microbiome and stroke. Results A total of 146 subjects were enrolled in this study according to the inclusion criteria. Compared with HC, HRIS and IS demonstrated a progressive increase trend in Chao1, observed species richness, and Shannon and Simpson diversity index. On the basis of permutational multivariate analysis of variance, the data indicate a great variation in the saliva microbiota composition between HC and HRIS (F = 2.40, P < 0.001), HC and IS (F = 5.07, P < 0.001), and HRIS and IS (F = 2.79, P < 0.001). The relative abundance of g_Streptococcus, g_Prevotella, g_Veillonella, g_Fusobacterium, and g_Treponema was higher in HRIS and IS compared with that in HC. Furthermore, we constructed the predictive model by differential genera to effectively distinguish patients with IS with poor 90-day prognoses from those with good (area under the curve = 79.7%; 95% CI, 64.41%-94.97%; p < 0.01). Discussion In summary, the oral salivary microbiome of HRIS and IS subjects have a higher diversity, and the differential bacteria have some predictive value for the severity and prognosis of IS. Oral microbiota may be used as potential biomarkers in patients with IS.
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Affiliation(s)
- Wenbo Sun
- Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Shengwen Huang
- Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Xiaoli Yang
- Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Yufan Luo
- Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Luqiong Liu
- Department of General Medicine, Shaoxing People’s Hospital, Zhejiang University, Shaoxing, China
| | - Danhong Wu
- Department of Neurology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
- *Correspondence: Danhong Wu,
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14
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Lee YT, Tsai CF, Yen YC, Huang LK, Chao SP, Hu LY, Shen CC, Lee HC. Periodontitis is a potential risk factor for transient ischemic attack and minor ischemic stroke in young adults: A nationwide population-based cohort study. J Periodontol 2022; 93:1848-1856. [PMID: 35297043 DOI: 10.1002/jper.21-0528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/26/2021] [Accepted: 01/09/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study aims to determine whether periodontitis is a risk factor for transient ischemic attack (TIA) in young adults. METHODS The National Health Insurance (NHI) Research Database in Taiwan was the source of the data used in this retrospective cohort study. Individuals aged 20 to 53 years with periodontitis in 2001 and 2002 (n = 792,426) and an age- and sex-matched control group (n = 792,426) were selected. All participants were followed up until TIA diagnosis, 55 years of age, removal from the NHI program, death, or December 31, 2016. The incidence density and hazard ratio (HR) of new-onset TIA were compared between individuals with periodontitis and controls. Periodontitis was defined by dentists according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 523.3-5 with concurrent antibiotic prescription or periodontal treatment excluding scaling performed by certified dentists. TIA was defined according to the ICD-9-CM code 435.x at hospital discharge. RESULTS After adjustment for confounding factors, the risk of developing TIA/minor ischemic stroke was calculated to be higher in participants with periodontitis (HR, 1.24; 95% confidence interval, 1.15-1.32; P <0.001) than in those without. The HR was slightly higher among people aged 20 to 40 years than among those aged 40 to 53 years. CONCLUSION Periodontitis is associated with an increased risk of developing TIA/minor ischemic stroke. Periodontitis might be a modifiable risk factor for stroke in young adults. Clinicians must devote greater attention to this potential association to develop new preventive and therapeutic strategies for stroke in young adults.
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Affiliation(s)
- Yao-Tung Lee
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Center of Dementia, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chia-Fen Tsai
- Department of Psychiatry, Neurological Institute, Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chun Yen
- Biostatistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Li-Kai Huang
- Center of Dementia, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shu-Ping Chao
- Center of Dementia, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Li-Yu Hu
- Division of Psychiatry, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Che Shen
- Division of Psychiatry, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry & Sleep Center, Taipei Medical University Hospital, Taipei, Taiwan
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15
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The Link between Stroke Risk and Orodental Status-A Comprehensive Review. J Clin Med 2022; 11:jcm11195854. [PMID: 36233721 PMCID: PMC9572898 DOI: 10.3390/jcm11195854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
One of the primary causes of disability and mortality in the adult population worldwide is stroke. A person's general health is significantly impacted by their oral and dental health. People who have poor oral health are more susceptible to conditions such as stroke. Stroke risk has long been linked to oral and dental conditions. The risk of stroke and its cost impact on the healthcare systems appear to be significantly reduced as a result of the decline in the incidence and prevalence of oral and dental illnesses. Hypothetically, better management of oral hygiene and dental health lead to reduced stroke risk. To the authors' best knowledge, for the first time, the potential link between dental health and stroke were cross-examined. The most typical stroke symptoms, oral and dental illnesses linked to stroke, and the role of oral healthcare professionals in stroke prevention are revealed. The potential mediating processes and subsequent long-term cognitive and functional neurological outcomes are based on the available literature. It must be noted that periodontal diseases and tooth loss are two common oral health measures. Lack of knowledge on the effects of poor oral health on systemic health together with limited access to primary medical or dental care are considered to be partially responsible for the elevated risk of stroke. Concrete evidence confirming the associations between oral inflammatory conditions and stroke in large cohort prospective studies, stratifying association between oral disease severity and stroke risk and disease effects on stroke survival will be desirable. In terms of clinical pathology, a predictive model of stroke as a function of oral health status, and biomarkers of systemic inflammation could be useful for both cardiologists and dentists.
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16
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Hsu PW, Shen YW, Syam S, Liang WM, Wu TN, Hsu JT, Fuh LJ. Patients with periodontitis are at a higher risk of stroke: A Taiwanese cohort study. J Chin Med Assoc 2022; 85:1006-1010. [PMID: 36000972 DOI: 10.1097/jcma.0000000000000797] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aimed to investigate the risk of stroke incidence in patients with periodontitis. METHODS Data on patients diagnosed with periodontitis were collected from Taiwan's National Health Insurance Research Database and were matched (1:1) with patients without periodontitis between 2001 and 2010. A multivariable Cox survival model was used to predict stroke between patients with and without periodontitis, and the possibility of confounders. Hazard ratios (HRs) with 95% confidence intervals (CIs) were used to explore the risk of stroke in the case and control groups. Diseases found during the follow-up period were analyzed to determine possible effects on the study. A total of 282 560 periodontitis and nonperiodontitis patients were enrolled, with most subjects aged 40 to 59 years. RESULTS The overall cumulative incidence of stroke was 2.14 times higher in periodontitis than in nonperiodontitis, and the highest HR was in the more than 80 years age group (HR = 9.30; 95% CI, 7.06-12.26). The multivariate Cox model indicated that the adjusted HR (aHR) between the case and control was 2.03 (95% CI, 1.99-2.08), and a higher aHR was associated with hypertension. Atherosclerosis, atrial fibrillation, obesity, kidney disease, anxiety, and gout discovered during follow-up also showed a potential risk of stroke in patients with periodontitis. CONCLUSION Therefore, this study suggests a high risk of stroke in patients with periodontitis.
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Affiliation(s)
- Pei-Wei Hsu
- School of Dentistry, China Medical University, Taichung, Taiwan, ROC
| | - Yen-Wen Shen
- School of Dentistry, China Medical University, Taichung, Taiwan, ROC
- Department of Dentistry, China Medical University and Hospital, Taichung, Taiwan, ROC
| | - Syamsiah Syam
- School of Dentistry, China Medical University, Taichung, Taiwan, ROC
- Faculty of Dentistry, Universitas Muslim Indonesia, Makassar, Indonesia
| | - Wen-Miin Liang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Trong-Neng Wu
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC
| | - Jui-Ting Hsu
- School of Dentistry, China Medical University, Taichung, Taiwan, ROC
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan, ROC
| | - Lih-Jyh Fuh
- School of Dentistry, China Medical University, Taichung, Taiwan, ROC
- Department of Dentistry, China Medical University and Hospital, Taichung, Taiwan, ROC
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17
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Dembowska E, Samulak R, Jędrzychowska A, Dołęgowska B. Effects of a 980 nm Diode Laser as an Adjunct to Nonsurgical Periodontal Therapy on Periodontal Status and Inflammatory Markers in Patients After Myocardial Infarction: A Randomized Controlled Trial. Photobiomodul Photomed Laser Surg 2022; 40:532-542. [DOI: 10.1089/photob.2021.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Elżbieta Dembowska
- Department of Periodontology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Renata Samulak
- Department of Periodontology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Adriana Jędrzychowska
- Department of Medical Analytics, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Barbara Dołęgowska
- Department of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
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18
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The Influence of Periodontal Diseases and the Stimulation of Saliva Secretion on the Course of the Acute Phase of Ischemic Stroke. J Clin Med 2022; 11:jcm11154321. [PMID: 35893412 PMCID: PMC9329893 DOI: 10.3390/jcm11154321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/14/2022] [Accepted: 07/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background and purpose: The course of an ischemic stroke depends on many factors. The influence of periodontal diseases and the stimulation of salivation on the course and severity of stroke remains unresolved. Therefore, the aim of the study was to analyze the severity of ischemic stroke depending on the occurrence of periodontal diseases and saliva stimulation. Methods: The severity of the neurological condition was assessed using the NIHSS scale on days one, three and seven of stroke. The incidence of periodontal diseases was classified using the Hall’s scale in the first day of stroke. On days one and seven of stroke, the concentration of IL-1β, MMP-8, OPG and RANKL in the patients’ saliva was assessed using the Elisa technique. At the same time, the level of CRP and the number of leukocytes in the peripheral blood were tested on days one, three and seven of the stroke, and the incidence of upper respiratory and urinary tract infections was assessed. Results:100 consecutive patients with their first ever ischemic stroke were enrolled in the study. 56 randomly selected patients were subjected to the stimulation of salivation, the remaining patients were not stimulated. In the study of the severity of the neurological condition using the NIHS scale on days three and seven of stroke, the degree of deficit in patients without periodontal disease significantly improved compared to patients with periodontal disease, respectively (p < 0.01 and p = 0.01). Patients from the stimulated group had more severe neurological deficit at baseline (p = 0.04). On days three and seven of neurological follow-up, the condition of patients from both groups improved with a further distinct advantage of the unstimulated group over the stimulated group, respectively (p = 0.03 and p < 0.001). In patients from both groups, a statistically significant decrease in CRP and lymphocyte levels was observed on day seven in relation to day one. Conclusions: The occurrence of periodontal disease in a patient with stroke affects the severity of stroke. Stimulation of the mouth and salivary glands in these patients may have a positive effect on the course of stroke, taking into account the dynamics of neurological symptoms.
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Global Noncoding microRNA Profiling in Mice Infected with Partial Human Mouth Microbes (PAHMM) Using an Ecological Time-Sequential Polybacterial Periodontal Infection (ETSPPI) Model Reveals Sex-Specific Differential microRNA Expression. Int J Mol Sci 2022; 23:ijms23095107. [PMID: 35563501 PMCID: PMC9105503 DOI: 10.3390/ijms23095107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 11/17/2022] Open
Abstract
Periodontitis (PD) is a polymicrobial dysbiotic immuno-inflammatory disease. It is more prevalent in males and has poorly understood pathogenic molecular mechanisms. Our primary objective was to characterize alterations in sex-specific microRNA (miRNA, miR) after periodontal bacterial infection. Using partial human mouth microbes (PAHMM) (Streptococcus gordonii, Fusobacterium nucleatum, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia) in an ecological time-sequential polybacterial periodontal infection (ETSPPI) mouse model, we evaluated differential mandibular miRNA profiles by using high-throughput Nanostring nCounter® miRNA expression panels. All PAHMM mice showed bacterial colonization (100%) in the gingival surface, an increase in alveolar bone resorption (p < 0.0001), and the induction of a specific immunoglobin G antibody immune response (p < 0.001). Sex-specific differences in distal organ bacterial dissemination were observed in the heart (82% male vs. 28% female) and lungs (2% male vs. 68% female). Moreover, sex-specific differential expression (DE) of miRNA was identified in PAHMM mice. Out of 378 differentially expressed miRNAs, we identified seven miRNAs (miR-9, miR-148a, miR-669a, miR-199a-3p, miR-1274a, miR-377, and miR-690) in both sexes that may be implicated in the pathogenesis of periodontitis. A strong relationship was found between male-specific miR-377 upregulation and bacterial dissemination to the heart. This study demonstrates sex-specific differences in bacterial dissemination and in miRNA differential expression. A novel PAHMM mouse and ETSPPI model that replicates human pathobiology can be used to identify miRNA biomarkers in periodontitis.
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20
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2,3,5,4′-Tetrahydroxystilbene-2-O-β-glucoside Attenuates Reactive Oxygen Species-Dependent Inflammation and Apoptosis in Porphyromonas gingivalis-Infected Brain Endothelial Cells. Antioxidants (Basel) 2022; 11:antiox11040740. [PMID: 35453424 PMCID: PMC9024880 DOI: 10.3390/antiox11040740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 12/04/2022] Open
Abstract
We recently reported that the periodontopathic bacteria Porphyromonas gingivalis (P. gingivalis) initiates an inflammatory cascade that disrupts the balance of reactive oxygen species (ROS), resulting in apoptotic cell death in brain endothelial cells. An extract from Polygonum multiflorum Thunb., 2,3,5,4′-Tetrahydroxystilbene-2-O-β-glucoside (THSG) has been well-reported to diminish the inflammation in many disease models. However, the effects of THSG in the area of the brain–oral axis is unknown. In this study, we examined the effects of THSG in P. gingivalis-stimulated inflammatory response and apoptotic cell death in brain endothelial cells. THSG treatment remarkably lessened the upregulation of IL-1β and TNF-α proteins in bEnd.3 cells infected with P. gingivalis. Treatment of THSG further ameliorated brain endothelial cell death, including apoptosis caused by P. gingivalis. Moreover, the present study showed that the inhibitory effects on NF-κB p65 and antiapoptotic properties of THSG is through inhibiting the ROS pathway. Importantly, the ROS inhibitory potency of THSG is similar to a ROS scavenger N-Acetyl-L-Cysteine (NAC) and NADPH oxidase inhibitor apocynin. Furthermore, the protective effect of THSG from P. gingivalis infection was further confirmed in primary mouse brain endothelial cells. Taken together, this study indicates that THSG attenuates an ROS-dependent inflammatory response and cell apoptosis in P. gingivalis-infected brain endothelial cells. Our results also suggest that THSG could be a potential herbal medicine to prevent the risk of developing cerebrovascular diseases from infection of periodontal bacteria.
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Adam HS, Lakshminarayan K, Wang W, Norby FL, Mosley T, Walker KA, Gottesman RF, Meyer K, Hughes TM, Pankow JS, Wong DF, Jack CR, Sen S, Lutsey PL, Beck J, Demmer RT. The prospective association between periodontal disease and brain imaging outcomes: The Atherosclerosis Risk in Communities study. J Clin Periodontol 2022; 49:322-334. [PMID: 34905804 PMCID: PMC8934294 DOI: 10.1111/jcpe.13586] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/10/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
AIM We investigate if periodontal disease is prospectively associated with cerebrovascular and neurodegenerative markers of dementia and Alzheimer's pathology. MATERIALS AND METHODS N = 1306 participants (Visit 5 mean age = 76.5 [standard deviation = 5.4] years) in the Atherosclerosis Risk in Communities study with completed dental exams at Visit 4 underwent brain magnetic resonance imaging scans at Visit 5 while N = 248 underwent positron emission tomography scans. Participants were classified as edentulous or, among the dentate, by the modified Periodontal Profile Class. Brain volumes were regressed on periodontal status in linear regressions. Cerebrovascular measures and β-amyloid positivity were regressed on periodontal status in logistic regressions. RESULTS Periodontal disease was not associated with brain volumes, microhaemorrhages, or elevated β-amyloid. Compared with periodontally healthy individuals, odds ratios [95% confidence interval] for all-type infarcts were 0.37 [0.20, 0.65] for severe tooth loss and 0.56 [0.31, 0.99] for edentulous participants. CONCLUSIONS Within the limitations of this study, periodontal disease was not associated with altered brain volumes, microhaemorrhages, or β-amyloid positivity. Tooth loss was associated with lower odds of cerebral infarcts.
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Affiliation(s)
- Hamdi S. Adam
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455
| | - Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455
| | - Faye L. Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455
| | - Thomas Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216
| | - Keenan A. Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21218
| | - Rebecca F. Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21218
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21218
| | - Katie Meyer
- Department of Nutrition, University of North Carolina, Chapel Hill, Chapel Hill, NC, 27599
| | - Timothy M. Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27101
| | - James S. Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455
| | - Dean F. Wong
- Mallinckrodt Institute of Radiology, Washington University in St. Louis Missouri, St. Louis, MO, 63110
| | | | - Souvik Sen
- Department of Neurology, University of South Carolina, School of Medicine, Columbia, SC, 29203
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455
| | - Jim Beck
- Division of Comprehensive Oral Health - Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - Ryan T. Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032
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22
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Hajishengallis G, Li X, Divaris K, Chavakis T. Maladaptive trained immunity and clonal hematopoiesis as potential mechanistic links between periodontitis and inflammatory comorbidities. Periodontol 2000 2022; 89:215-230. [PMID: 35244943 DOI: 10.1111/prd.12421] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Periodontitis is bidirectionally associated with systemic inflammatory disorders. The prevalence and severity of this oral disease and linked comorbidities increases with aging. Here, we review two newly emerged concepts, trained innate immunity (TII) and clonal hematopoiesis of indeterminate potential (CHIP), which together support a potential hypothesis on how periodontitis affects and is affected by comorbidities and why the susceptibility to periodontitis and comorbidities increases with aging. Given that chronic diseases are largely triggered by the action of inflammatory immune cells, modulation of their bone marrow precursors, the hematopoietic stem and progenitor cells (HSPCs), may affect multiple disorders that emerge as comorbidities. Such alterations in HSPCs can be mediated by TII and/or CHIP, two non-mutually exclusive processes sharing a bias for enhanced myelopoiesis and production of innate immune cells with heightened proinflammatory potential. TII is a state of elevated immune responsiveness based on innate immune (epigenetic) memory. Systemic inflammation can initiate TII in the bone marrow via sustained rewiring of HSPCs, which thereby display a skewing toward the myeloid lineage, resulting in generation of hyper-reactive or "trained" myeloid cells. CHIP arises from aging-related somatic mutations in HSPCs, which confer a survival and proliferation advantage to the mutant HSPCs and give rise to an outsized fraction of hyper-inflammatory mutant myeloid cells in the circulation and tissues. This review discusses emerging evidence that supports the notion that TII and CHIP may underlie a causal and age-related association between periodontitis and comorbidities. A holistic mechanistic understanding of the periodontitis-systemic disease connection may offer novel diagnostic and therapeutic targets for treating inflammatory comorbidities.
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Affiliation(s)
- George Hajishengallis
- Department of Basic and Translational Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xiaofei Li
- Department of Basic and Translational Sciences, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kimon Divaris
- Division of Pediatrics and Public Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Triantafyllos Chavakis
- Institute for Clinical Chemistry and Laboratory Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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23
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Tooth Loss and the Incidence of Ischemic Stroke and Transient Ischemic Attack: A Systematic Review and Meta-Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1088371. [PMID: 35198131 PMCID: PMC8860521 DOI: 10.1155/2022/1088371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/02/2022] [Accepted: 01/10/2022] [Indexed: 01/28/2023]
Abstract
Generally, as the population is aging, ischemic stroke is imposing rising social and economic burdens. On that basis, the early intervention and prevention of ischemic stroke turns out to be a major public health issue. Extensive studies have reached mixed conclusions regarding the correlation between tooth loss and ischemic stroke, as well as transient ischemic attack (TIA). In this paper, a systematic review and meta-analysis is presented where we have aimed to examine whether tooth loss is correlated with a higher incidence of ischemic stroke and TIA in adults. The systematical search was conducted in PubMed, Web of Science, Embase, and The Cochrane library from the inception dates to September 23, 2021, by employing the keywords (i.e., tooth loss and ischemic stroke). Observational studies conducted in adults were included, in which people with and without tooth loss (Exposition and Comparison) were observed to determine the incidence of ischemic stroke/TIA (Outcome). The data were extracted, and the study quality was assessed by two reviewers independently. Moreover, a meta-analysis was conducted to obtain the risk ratios (RRs) and 95% CIs by adopting random-effects models. The major outcome was the incidence of ischemic stroke/TIA in adults with and without tooth loss. On the whole, four cohort studies and three case-control studies were covered, which involved 4,625,514 participants with 33,088 ischemic stroke/TIA cases. In cohort (adjusted RR = 2.58, 95% CI: 2.39-2.79, P < 0.00001, I 2 = 31%) and case-control studies (adjusted MD = -4.15, 95% CI: -6.09-(-2.22), P < 0.001, I 2 = 77%), a significant correlation was identified between tooth loss and ischemic stroke. The subgroup analyses reported that the results in case-control studies were generally consistent regardless of the selection of controls. This meta-analysis indicated a certain correlation between tooth loss and ischemic stroke.
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24
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Costea CA, Christodorescu R, Soancă A, Roman A, Micu IC, Stratul ȘI, Rusu D, Popescu DM, Popa-Wagner A, Bulboacă AE. Periodontitis in Ischemic Stroke Patients: Case Definition Challenges of the New Classification Scheme (2018). J Clin Med 2022; 11:520. [PMID: 35159973 PMCID: PMC8836590 DOI: 10.3390/jcm11030520] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
The identification of the associative relationships between ischemic stroke (IS) and risk factors such as advanced age and periodontitis is essential to design real screening protocols and to address them using primary and secondary preventive policies. This study primarily aimed to evaluate the diagnostic performance of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) case definition in detecting periodontitis against the 2012 Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) case definition in a group of IS patients. Secondarily, we report the periodontal status of IS patients and the associative relationship with respect to some risk factors. Patients with their first IS were assessed based on demographic data, medical, oral risk factors and periodontal parameters. The two case definitions were applied to identify the periodontitis burden. The agreement between the two case definition systems, as well as the misclassification ratio, were calculated. A total of 141 patients were included. According to the 2012 CDC/AAP and the 2018 EFP/AAP case definitions, a frequency of periodontitis of 98.5% and 97.8% based on two modalities of inclusion of cases in the severity groups, sensitivity values of 98.54% or 100%, and specificity values of 25% or 14.7% were calculated. Thus, the new case definition system has a higher capacity to detect periodontitis, especially the well-established forms.
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Affiliation(s)
- Cristina Andrada Costea
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeş St., No. 15, 400012 Cluj-Napoca, Romania; (C.A.C.); (A.S.); (A.R.)
| | - Ruxandra Christodorescu
- Institute of Cardiovascular Diseases Research Center, Victor Babeș University of Medicine and Pharmacy Timisoara, Bulevardul Revoluției, No. 12, 300024 Timisoara, Romania;
| | - Andrada Soancă
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeş St., No. 15, 400012 Cluj-Napoca, Romania; (C.A.C.); (A.S.); (A.R.)
| | - Alexandra Roman
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeş St., No. 15, 400012 Cluj-Napoca, Romania; (C.A.C.); (A.S.); (A.R.)
| | - Iulia Cristina Micu
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Victor Babeş St., No. 15, 400012 Cluj-Napoca, Romania; (C.A.C.); (A.S.); (A.R.)
| | - Ștefan Ioan Stratul
- Department of Periodontology, Anton Sculean Research Center of Periodontal and Peri-implant Diseases, Faculty of Dental Medicine, Victor Babeș University of Medicine and Pharmacy Timisoara, Bulevardul Revoluției din 1989, No. 9, 300230 Timisoara, Romania; (Ș.I.S.); (D.R.)
| | - Darian Rusu
- Department of Periodontology, Anton Sculean Research Center of Periodontal and Peri-implant Diseases, Faculty of Dental Medicine, Victor Babeș University of Medicine and Pharmacy Timisoara, Bulevardul Revoluției din 1989, No. 9, 300230 Timisoara, Romania; (Ș.I.S.); (D.R.)
| | - Dora Maria Popescu
- Department of Periodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy, Petru Rareș St., No. 2, 200349 Craiova, Romania;
| | - Aurel Popa-Wagner
- Chair of Vascular Neurology and Dementia Center, University of Medicine, Essen, Hufeland St., No. 55, 45122 Essen, Germany
- Experimental Research Center in Normal and Pathological Aging (ARES), University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Adriana Elena Bulboacă
- Department of Pathophysiology, Iuliu Hațieganu University of Medicine and Pharmacy, Victor Babeș St., No. 2–4, 400012 Cluj-Napoca, Romania;
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25
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Abt E, Kumar S, Weyant RJ. Periodontal disease and medical maladies: What do we really know? J Am Dent Assoc 2021; 153:9-13. [PMID: 34861990 DOI: 10.1016/j.adaj.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/11/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
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26
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Song E, Park MJ, Kim JA, Roh E, Yu JH, Kim NH, Yoo HJ, Seo JA, Kim SG, Kim NH, Baik SH, Choi KM. Implication of thyroid function in periodontitis: a nationwide population-based study. Sci Rep 2021; 11:22127. [PMID: 34764408 PMCID: PMC8586139 DOI: 10.1038/s41598-021-01682-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/02/2021] [Indexed: 11/09/2022] Open
Abstract
Possible links between periodontitis and various cardiometabolic and autoimmune diseases have been advocated on the basis of chronic inflammation or oxidative stress. However, the association between periodontitis and thyroid dysfunction is under-researched. Participants without previous thyroid disease or ongoing thyroid-related medication were included from a nationwide population-level survey. Participants were categorized into tertiles of thyroid stimulating hormone (TSH) levels (first tertile < 1.76 mIU/L; second tertile 1.76-2.83 mIU/L; third tertile > 2.83 mIU/L), and periodontal condition was assessed using the Community Periodontal Index. Of the total of 5468 participants, 1423 had periodontitis (26%). A significant difference in the weighted prevalence of periodontitis according to TSH tertiles was observed, with the highest prevalence in the first tertile (26.5%) and the lowest prevalence in the third tertile (20.9%, p = 0.003). Subjects in the first TSH tertile had higher odds for periodontitis than those in the third tertile (OR 1.36, 95% CI 1.10-1.68; p for trend = 0.005) after adjusting for covariates. This association was consistent across subgroups and within sensitivity analyses among subjects without specific factors affecting thyroid function or diseases reported to be related to periodontitis. The present study demonstrated that low TSH levels were associated with significantly higher odds for periodontitis.
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Affiliation(s)
- Eyun Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Korea
| | - Min Jeong Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Korea
| | - Jung A Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Korea
| | - Eun Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Korea
| | - Ji Hee Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul, Korea.
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27
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Charoensaensuk V, Chen YC, Lin YH, Ou KL, Yang LY, Lu DY. Porphyromonas gingivalis Induces Proinflammatory Cytokine Expression Leading to Apoptotic Death through the Oxidative Stress/NF-κB Pathway in Brain Endothelial Cells. Cells 2021; 10:3033. [PMID: 34831265 PMCID: PMC8616253 DOI: 10.3390/cells10113033] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022] Open
Abstract
Porphyromonas gingivalis, a periodontal pathogen, has been proposed to cause blood vessel injury leading to cerebrovascular diseases such as stroke. Brain endothelial cells compose the blood-brain barrier that protects homeostasis of the central nervous system. However, whether P. gingivalis causes the death of endothelial cells and the underlying mechanisms remain unclear. This study aimed to investigate the impact and regulatory mechanisms of P. gingivalis infection in brain endothelial cells. We used bEnd.3 cells and primary mouse endothelial cells to assess the effects of P. gingivalis on endothelial cells. Our results showed that infection with live P. gingivalis, unlike heat-killed P. gingivalis, triggers brain endothelial cell death by inducing cell apoptosis. Moreover, P. gingivalis infection increased intracellular reactive oxygen species (ROS) production, activated NF-κB, and up-regulated the expression of IL-1β and TNF-α. Furthermore, N-acetyl-L-cysteine (NAC), a most frequently used antioxidant, treatment significantly reduced P. gingivalis-induced cell apoptosis and brain endothelial cell death. The enhancement of ROS production, NF-κB p65 activation, and proinflammatory cytokine expression was also attenuated by NAC treatment. The impact of P. gingivalis on brain endothelial cells was also confirmed using adult primary mouse brain endothelial cells (MBECs). In summary, our results showed that P. gingivalis up-regulates IL-1β and TNF-α protein expression, which consequently causes cell death of brain endothelial cells through the ROS/NF-κB pathway. Our results, together with the results of previous case-control studies and epidemiologic reports, strongly support the hypothesis that periodontal infection increases the risk of developing cerebrovascular disease.
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Affiliation(s)
- Vichuda Charoensaensuk
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (V.C.); (Y.-H.L.)
| | - Yen-Chou Chen
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
| | - Yun-Ho Lin
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan; (V.C.); (Y.-H.L.)
| | - Keng-Liang Ou
- 3D Global Biotech Inc., New Taipei City 22175, Taiwan;
| | - Liang-Yo Yang
- Department of Physiology, School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Laboratory for Neural Repair, China Medical University Hospital, Taichung 40447, Taiwan
| | - Dah-Yuu Lu
- Department of Pharmacology, School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Photonics and Communication Engineering, Asia University, Taichung 41354, Taiwan
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28
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Pirih FQ, Monajemzadeh S, Singh N, Sinacola RS, Shin JM, Chen T, Fenno JC, Kamarajan P, Rickard AH, Travan S, Paster BJ, Kapila Y. Association between metabolic syndrome and periodontitis: The role of lipids, inflammatory cytokines, altered host response, and the microbiome. Periodontol 2000 2021; 87:50-75. [PMID: 34463996 PMCID: PMC8457155 DOI: 10.1111/prd.12379] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Periodontitis has been associated with many systemic diseases and conditions, including metabolic syndrome. Metabolic syndrome is a cluster of conditions that occur concomitantly and together they increase the risk of cardiovascular disease and double the risk of type 2 diabetes. In this review, we focus on the association between metabolic syndrome and periodontitis; however, we also include information on diabetes mellitus and cardiovascular disease, since these two conditions are significantly intertwined with metabolic syndrome. With regard to periodontitis and metabolic syndrome, to date, the vast majority of studies point to an association between these two conditions and also demonstrate that periodontitis can contribute to the development of, or can worsen, metabolic syndrome. Evaluating the effect of metabolic syndrome on the salivary microbiome, data presented herein support the hypothesis that the salivary bacterial profile is altered in metabolic syndrome patients compared with healthy patients. Considering periodontitis and these three conditions, the vast majority of human and animal studies point to an association between periodontitis and metabolic syndrome, diabetes, and cardiovascular disease. Moreover, there is evidence to suggest that metabolic syndrome and diabetes can alter the oral microbiome. However, more studies are needed to fully understand the influence these conditions have on each other.
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Affiliation(s)
- Flavia Q Pirih
- Section of Periodontics, UCLA School of Dentistry, Los Angeles, California
| | | | - Neelima Singh
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, California
| | | | - Jae Min Shin
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Tsute Chen
- The Forsyth Institute, Cambridge, Massachusetts
- Department of Oral Medicine, Infection & Immunity, Harvard School of Dental Medicine, Boston, Massachusetts
| | - J Christopher Fenno
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Pachiyappan Kamarajan
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, California
| | - Alexander H Rickard
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Suncica Travan
- Department of Periodontics & Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Bruce J Paster
- The Forsyth Institute, Cambridge, Massachusetts
- Department of Oral Medicine, Infection & Immunity, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Yvonne Kapila
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, California
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29
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Association between Oral Pathology, Carotid Stenosis, and Oral Bacterial DNA in Cerebral Thrombi of Patients with Stroke. Stroke Res Treat 2021; 2021:5402764. [PMID: 34531969 PMCID: PMC8440111 DOI: 10.1155/2021/5402764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/17/2021] [Indexed: 12/02/2022] Open
Abstract
Methods Thrombus aspirates and control arterial blood were taken from 71 patients (70.4% male; mean age, 67.4 years) with acute ischemic stroke. Tooth pathology was registered using CT scans. Carotid stenosis was estimated with CTA and ultrasonography. The presence of bacterial DNA from aspirated thrombi was determined using quantitative PCR. We also analyzed the presence of these bacterial DNAs in carotid endarterectomies from patients with peripheral arterial disease. Results Bacterial DNA was found in 59 (83.1%) of the thrombus aspirates (median, 8.6-fold). Oral streptococcal DNA was found in 56 (78.9%) of the thrombus aspirates (median, 5.1-fold). DNA from A. actinomycetemcomitans and P. gingivalis was not found. Most patients suffered from poor oral health and had in median 19.0 teeth left. Paradoxically, patients with better oral health had more oral streptococcal DNA in their thrombus than the group with the worst pathology (p = 0.028). There was a trend (OR 7.122; p = 0.083) in the association of ≥50% carotid artery stenosis with more severe dental pathology. Oral streptococcal DNA was detected in 2/6 of carotid endarterectomies. Conclusions Stroke patients had poor oral health which tended to associate with their carotid artery stenosis. Although oral streptococcal DNA was found in thrombus aspirates and carotid endarterectomy samples, the amount of oral streptococcal DNA in thrombus aspirates was the lowest among those with the most severe oral pathology. These results suggest that the association between poor oral health and acute ischemic stroke is linked to carotid artery atherosclerosis.
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AbdelMassih A, Hassan AA, Abou-Zeid AS, Hassan A, Hussein E, Gadalla M, Hussein M, Eid MA, Elahmady M, El Nahhas N, Emad N, Zahra N, Aboushadi N, Ibrahim N, Mokhtar S, Ismail HA, El-Husseiny N, Moharam RK, Menshawey E, Menshawey R. Salivary markers and coronavirus disease 2019: insights from cross-talk between the oral microbiome and pulmonary and systemic low-grade inflammation and implications for vascular complications. Cardiovasc Endocrinol Metab 2021; 10:162-167. [PMID: 34386717 PMCID: PMC8352626 DOI: 10.1097/xce.0000000000000242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/22/2020] [Indexed: 12/25/2022]
Abstract
To date, coronavirus disease 2019 (COVID-19) has affected over 6.2 million individuals worldwide, including 1.46 million deaths. COVID-19 complications are mainly induced by low-grade inflammation-causing vascular degeneration. There is an increasing body of evidence that suggests that oral dysbiotic taxa are associated with worse prognosis in COVID-19 patients, especially the Prevotella genus, which was retrieved from nasopharyngeal and bronchoalveolar lavage samples in affected patients. Oral dysbiosis may act by increasing the likelihood of vascular complications through low-grade inflammation, as well as impairing respiratory mucosal barrier mechanisms against SARS-CoV-2. Salivary markers can be used to reflect this oral dysbiosis and its subsequent damaging effects on and the lungs and vasculature. Salivary sampling can be self-collected, and is less costly and less invasive, and thus may be a superior option to serum markers in risk stratification of COVID-19 patients. Prospective studies are needed to confirm such hypothesis. Video Abstract: http://links.lww.com/CAEN/A28.
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Affiliation(s)
- Antoine AbdelMassih
- Pediatric Cardiology Unit, Pediatrics' Department, Faculty of Medicine, Cairo University, Giza
- Pediatric Cardio-Oncology Department, Children Cancer Hospital of Egypt
| | - Alaa A Hassan
- Research Department, School of Oral and Dental Medicine, New Giza University, New Giza
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | - Aya S Abou-Zeid
- Research Department, School of Oral and Dental Medicine, New Giza University, New Giza
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | - Aya Hassan
- Research Department, School of Oral and Dental Medicine, New Giza University, New Giza
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | - Engy Hussein
- Research Department, School of Oral and Dental Medicine, New Giza University, New Giza
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | - Mahenar Gadalla
- Research Department, School of Oral and Dental Medicine, New Giza University, New Giza
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | - Mahinour Hussein
- Research Department, School of Oral and Dental Medicine, New Giza University, New Giza
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | - Maryam A Eid
- Research Department, School of Oral and Dental Medicine, New Giza University, New Giza
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | - Maryam Elahmady
- Research Department, School of Oral and Dental Medicine, New Giza University, New Giza
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | - Nadine El Nahhas
- Research Department, School of Oral and Dental Medicine, New Giza University, New Giza
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | - Nadine Emad
- Research Department, School of Oral and Dental Medicine, New Giza University, New Giza
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | - Nihal Zahra
- Research Department, School of Oral and Dental Medicine, New Giza University, New Giza
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | - Nour Aboushadi
- Research Department, School of Oral and Dental Medicine, New Giza University, New Giza
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | - Nourhan Ibrahim
- Research Department, School of Oral and Dental Medicine, New Giza University, New Giza
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | - Sherouk Mokhtar
- Research Department, School of Oral and Dental Medicine, New Giza University, New Giza
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | | | - Nadine El-Husseiny
- Research Department, Faculty of Medicine, Cairo University, Cairo
- Department of Oral and Maxillo-facial Surgery, Faculty of Dentistry, Cairo University, Giza
- Department of Scientific Design, Pixagon Graphic Design Agency, Cairo
| | - Reham Khaled Moharam
- Residency Training Program of Plastic Surgery Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Esraa Menshawey
- Research Department, Faculty of Medicine, Cairo University, Cairo
| | - Rahma Menshawey
- Research Department, Faculty of Medicine, Cairo University, Cairo
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Mosen DM, Banegas MP, Dickerson JF, Fellows JL, Pihlstrom DJ, Kershah HM, Scott JL, Keast EM. Evaluating the Effectiveness of Medical-Dental Integration to Close Preventive and Disease Management Care Gaps. FRONTIERS IN DENTAL MEDICINE 2021; 2:670012. [PMID: 36213339 PMCID: PMC9536421 DOI: 10.3389/fdmed.2021.670012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The integration of medical care into the dental setting has been shown to facilitate the closure of care gaps among patients with unmet needs. However, little is known about whether program effectiveness varies depending on whether the care gap is related to preventive care or disease management. Materials and Methods We used a matched cohort study design to compare closure of care gaps between patients aged 65+ who received care at a Kaiser Permanente Northwest (KPNW) Medical-Dental Integration (MDI) clinic or a non-MDI dental clinic between June 1, 2018, and December 31, 2019. The KPNW MDI program focuses on closing 12 preventive (e.g., flu vaccines) and 11 disease management care gaps (e.g., HbA1c testing) within the dental setting. Using the multivariable logistic regression, we separately analyzed care gap closure rates (yes vs. no) for patients who were overdue for: (1) preventive services only (n = 1,611), (2) disease management services only (n = 538), or (3) both types of services (n = 429), analyzing closure of each care gap type separately. All data were obtained through the electronic health record of KPNW. Results The MDI patients had significantly higher odds of closing preventive care gaps (OR = 1.51, 95% CI = 1.30-1.75) and disease management care gaps (OR = 1.65, 95% CI = 1.27-2.15) than the non-MDI patients when they only had care gaps of one type or the other. However, no significant association was found between MDI and care gap closure when patients were overdue for both care gap types. Conclusions Patients with care gaps related to either preventive care or disease management who received dental care in an MDI clinic had higher odds of closing these care gaps, but we found no evidence that MDI was helpful for those with both types of care gaps. Practical Implications MDI may be an effective model for facilitating the delivery of preventive and disease management services, mainly when patients are overdue for one type of these services. Future research should examine the impact of MDI on long-term health outcomes.
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Affiliation(s)
- David M. Mosen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Matthew P. Banegas
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - John F. Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Jeffrey L. Fellows
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | | | - Hala M. Kershah
- Dental Administration, Kaiser Permanente Northwest, Portland, OR, United States
| | - Jason L. Scott
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | - Erin M. Keast
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
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Tuominen H, Taina M, Puranen M, Onatsu J, Huumonen S, Vanninen R. Serum High-Sensitive C-reactive Protein May Reflect Periodontitis in Patients With Stroke. In Vivo 2021; 34:2829-2835. [PMID: 32871821 DOI: 10.21873/invivo.12109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM Chronic infectious diseases are believed to increase the risk of stroke. We aimed to evaluate the prevalence of periodontal disease and its association with systemic inflammatory processes in patients suffering an acute stroke/transient ischemic attack (TIA). PATIENTS AND METHODS Altogether 36 acute stroke/TIA patients underwent clinical, laboratory and radiological examinations. The level of systemic inflammation was analyzed both with routine measurements of plasma C-reactive protein (p-CRP) and serum high-sensitivity CRP (s-hsCRP) to analyze their associations with periodontitis. The diagnostic criteria for periodontitis included increased probing depth (>4 mm) measured from four different sites, bleeding on probing, and horizontal (>1 mm), vertical (>1 mm) or apical bone loss observed on orthopantomography. RESULTS Twenty-six (72.2%) patients were diagnosed with periodontitis. Only five of the patients with periodontitis (19.2%) had elevated p-CRP values whereas the majority, (17/26; 65.4%) had elevated s-hsCRP values (p<0.01). Absolute s-hsCRP values in patients with periodontitis (8.9±12.5 mg/l) were significantly higher than in patients without periodontitis (2.3±3.0 mg/l; p<0.05). Absolute p-CRP concentrations did not differ (2.3±5.8 vs. 2.4±5.1 mg/l; p=not significant). The total number of periodontitis findings was significantly associated with s-hsCRP values (r=1.83) but not with p-CRP values. Conversely, seventeen of the nineteen patients with elevated s-hsCRP (89.5%) indicative of systemic inflammation had periodontitis. CONCLUSION Periodontitis is a common finding among patients with acute stroke/TIA as over 80% of patients with cryptogenic stroke/TIA had periodontitis. S-hsCRP is a useful tool for detecting subclinical systemic inflammation.
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Affiliation(s)
- Hanna Tuominen
- The Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Mikko Taina
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Mirja Puranen
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland.,Oral and Maxillofacial Department, Kuopio University Hospital, Kuopio, Finland
| | - Juha Onatsu
- NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Sisko Huumonen
- The Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
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Meyerhoefer CD, Pepper JV, Manski RJ, Moeller JF. Dental Care Use, Edentulism, and Systemic Health among Older Adults. J Dent Res 2021; 100:1468-1474. [PMID: 34138663 DOI: 10.1177/00220345211019018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Past research suggests there are systematic associations between oral health and chronic illness among older adults. Although causality has not yet been credibly established, periodontitis has been found to be associated with higher risk of both heart disease and stroke. We advance this literature by estimating the direct association between dental care use and systemic health using multiple waves of the 1992 to 2016 Health and Retirement Study. Through the inclusion of individual fixed effects in our regression models, we account for unobservable time-invariant characteristics of individuals that might otherwise bias estimates of the association between dental care use and health. We find statistically significant negative associations between dental care use and the number of health conditions, self-reported overall health, the incidence of heart disease, and the incidence of stroke. In particular, the use of dental care within the past 2 y is associated with a 2.7% reduction in the likelihood of being diagnosed with a heart condition and a reduction in the likelihood of a stroke diagnosis of between 5.3% and 11.6%. We also find large positive correlations between edentulism and the measures of chronic illness. Associations from models estimated separately for men and women are qualitatively similar to one another. These findings provide additional motivation for the consideration of a Medicare dental benefit.
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Affiliation(s)
| | - J V Pepper
- University of Virginia, Charlottesville, VA, USA
| | - R J Manski
- University of Maryland School of Dentistry, Baltimore, MD, USA
| | - J F Moeller
- University of Maryland School of Dentistry, Baltimore, MD, USA
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Leao TSDS, Zanoni AV, Franzon R, Tomasi GH, Conzatti LP, Marrone LCP, Reynolds MA, Gomes MS. Number of teeth is independently associated with ischemic stroke: A case-control study. J Clin Neurosci 2021; 90:233-237. [PMID: 34275555 DOI: 10.1016/j.jocn.2021.05.059] [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: 01/02/2021] [Revised: 03/15/2021] [Accepted: 05/27/2021] [Indexed: 12/17/2022]
Abstract
Poor oral health has been suggested as a potential risk factor for the occurrence of cardiovascular events. The present study aimed to test the hypothesis that the number of permanent natural teeth (NT) is independently associated with the occurrence of ischemic stroke (IS) or transient ischemic attack (TIA) in a southern Brazilian population. This case-control study enrolled 458 subjects, 229 hospital patients diagnosed with IS or TIA (cases) and 229 patients with no history of cardiovascular disease (controls). NT was assessed through a head and neck multidetector computed tomography angiography (MDCTA) and panoramic radiographs. The participants were matched by age and sex. Sociodemographic and medical confounding variables were obtained from the hospital charts and through a structured questionnaire. Multivariate logistic regression analysis were carried out to estimate the association between NT and the occurrence of IS or TIA. The mean age was 58.37 ± 10.75 years, with 46.7% males. Adjusted analyses showed an independent association between IS or TIA and hypertension (OR = 6.34, 95%CI = 3.93-10.24), smoking (OR = 4.70, 95%CI = 2.76-7.99) and NT (lower quartile: ≤7 teeth) (OR = 5.59, 95%CI = 2.88-10.86). The number of permanent natural teeth was inversely and independently associated with the occurrence of IS or TIA in this population. Present findings suggest a gradient effect on the association between oral health and IS.
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Affiliation(s)
- Thayana Salgado de Souza Leao
- Graduate Program in Dentistry, School of Health and Life Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, United States.
| | - Aline Veloso Zanoni
- Graduate Program in Dentistry, School of Health and Life Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Raiane Franzon
- Graduate Program in Dentistry, School of Health and Life Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gustavo Henrique Tomasi
- Department of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lucas Piccoli Conzatti
- Department of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luiz Carlos Porcelo Marrone
- Department of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Mark Allan Reynolds
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, United States.
| | - Maximiliano Schünke Gomes
- Graduate Program in Dentistry, School of Health and Life Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil; Medical and Dental Center of the Military Police of Rio Grande do Sul, Brazil.
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Liu K, Sun J, Shao L, He H, Liu Q, Li Y, Ge H. Correlation of periodontal diseases with intracranial aneurysm formation: novel predictive indicators. Chin Neurosurg J 2021; 7:31. [PMID: 34092261 PMCID: PMC8182916 DOI: 10.1186/s41016-021-00249-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 05/13/2021] [Indexed: 12/02/2022] Open
Abstract
Background We investigated whether periodontal diseases, specifically, periodontitis and gingivitis, could be risk factors of the incidence of intracranial aneurysms (IAs). Methods We performed a case–control study to compare the differences in the periodontal disease parameters of 281 cases that were divided into the IAs group and non-IAs group. All cases underwent complete radiographic examination for IAs and examination for periodontal health. Results Comparing with those in the non-IAs group, the cases in the IAs group were older (53.95 ± 8.56 vs 47.79 ± 12.33, p < 0.001) and had a higher incidence of hypertension (76 vs 34, p = 0.006). Univariate logistic regression analysis revealed that age (> 50 years) and hypertension were predictive risk factors of aneurysm formation (odds ratio [OR] 1.047, 95% confidence interval [95% CI] 1.022–1.073, p < 0.001 and OR 2.047, 95% CI 1.232–3.401, p = 0.006). In addition, univariate and multivariate logistic regression analyses showed that the parameters of periodontal diseases, including gingival index, plaque index, clinical attachment loss, and alveolar bone loss, were significantly associated with the occurrence of IAs (all p < 0.05). For further statistical investigation, the parameters of periodontal diseases were divided into four layers based on the quartered data. Poorer periodontal health condition (especially gingival index > 1.1 and plaque index > 1.5) had the correlation with IAs formation (p = 0.007 and p < 0.001). Conclusion Severe gingivitis or periodontitis, combining with hypertension, is significantly associated with the incidence of IAs.
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Affiliation(s)
- Keyun Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai, Beijing, 100070, People's Republic of China
| | - Jia Sun
- Department of Stomatology, Tianjin Stomatological Hospital, Hospital of Stomatology, Nankai University, Tianjin, 300041, People's Republic of China
| | - Lingling Shao
- Department of Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing Chest Hospital, Capital Medical University, Beijing, 101149, People's Republic of China
| | - Hongwei He
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai, Beijing, 100070, People's Republic of China
| | - Qinglin Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai, Beijing, 100070, People's Republic of China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai, Beijing, 100070, People's Republic of China.
| | - Huijian Ge
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai, Beijing, 100070, People's Republic of China.
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Bengtsson VW, Persson GR, Berglund JS, Renvert S. Periodontitis related to cardiovascular events and mortality: a long-time longitudinal study. Clin Oral Investig 2021; 25:4085-4095. [PMID: 33506429 PMCID: PMC8137476 DOI: 10.1007/s00784-020-03739-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The present study assessed if individuals ≥ 60 years of age with periodontitis are more likely to develop stroke or ischemic heart diseases, or at a higher risk of death for 17 years. MATERIAL AND METHODS At baseline individuals ≥ 60 received a dental examination including a panoramic radiograph. Periodontitis was defined as having ≥ 30% sites with ≥ 5-mm distance from the cementoenamel junction to the marginal bone level. Medical records were annually reviewed from 2001 to 2018. Findings from the medical records identifying an ICD-10 code of stroke and ischemic heart diseases or death were registered. RESULTS Associations between periodontitis and incidence of ischemic heart disease were found in this 17-year follow-up study in all individuals 60-93 years (HR: 1.5, CI: 1.1-2.1, p = 0.017), in women (HR: 2.1, CI: 1.3-3.4, p = 0.002), and in individuals 78-96 years (HR: 1.7, CI: 1.0-2.6, p = 0.033). Periodontitis was associated with mortality in all individuals (HR: 1.4, CI: 1.2-1.8, p = 0.002), specifically in men (HR: 1.5, CI: 1.1-1.9, p = 0.006) or in ages 60-72 years (HR: 2.2, CI: 1.5-3.2, p = 0.000). Periodontitis was more prevalent among men (OR: 1.8, CI: 1.3-2.4, p = 0.000). CONCLUSIONS Individuals with periodontitis have an increased risk for future events of ischemic heart diseases and death. CLINICAL RELEVANCE Improving periodontal health in older individuals may reduce overall mortality and ischemic heart diseases. Both dental and medical professionals should be aware of the associations and ultimately cooperate.
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Affiliation(s)
| | - Gösta Rutger Persson
- University of Kristianstad, Elmetorpsvägen 15, 29188 Kristianstad, Sweden
- Department of Periodontics, University of Washington, Seattle, WA USA
- Departments of Periodontics and Oral Medicine, University of Washington, Seattle, WA USA
| | - Johan Sanmartin Berglund
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Stefan Renvert
- University of Kristianstad, Elmetorpsvägen 15, 29188 Kristianstad, Sweden
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
- Dublin Dental Hospital Trinity College, Dublin, Ireland
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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Chen C, Zhu J, Deng X, Yang Z, Lin W, Ma Y, Huang S, Chen L, Liu Y, Zhu F. Severe periodontitis is associated with the serum levels of hypersensitive C reactive protein and lipoprotein-associated phospholipase A2 in the patients of acute ischemic stroke. J Clin Neurosci 2021; 88:232-236. [PMID: 33992190 DOI: 10.1016/j.jocn.2021.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/23/2021] [Accepted: 04/04/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Periodontitis is associated with the pathogenesis of atherosclerotic plaque, and hypersensitive C reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) are the serum biomarkers of the stability of atherosclerotic plaque. Whether periodontitis is associated with the serum level of hs-CRP and Lp-PLA2 of acute ischemic stroke remains unclear. MATERIAL AND METHODS We recruited 103 cases with acute ischemic stroke within 7 days after stroke onset. Pocket depth and clinical attachment loss were assessed by oral examination to define the severe periodontitis. Demographic information including gender, age and body weight index, income level, education level, past medical history include smoking history, drinking history, ischemic stroke history, coronary heart disease, hypertension, diabetes and hyperlipidemia were collected, and serum biomarkers including white blood cell (WBC), fibrinogen, total cholesterol (TC), triglyceride (TG), lower density lipoprotein (LDL-C), high density lipoprotein (HDL-C), hs-CRP, HemoglobinA1c (HbAlc), Homocysteine (HCY) and Lp-PLA2 were tested. RESULTS 65 (63.1%) cases were diagnosed as severe periodontitis. Severe periodontitis group showed more male, age, drinking history, higher levels of hs-CRP and Lp-PLA2. Multivariate logistic regression showed that severe periodontitis was were significantly associated with hs-CRP (OR = 2.367, 95%CI: 1.182-4.738; P = .015) and Lp-PLA2 (OR = 2.577, 95% CI: 1.010-6.574; P = .048). CONCLUSIONS Severe periodontitis is independently associated with the serum Level of hs-CRP and Lp-PLA2 in patients with acute ischemic stroke. Whether the improvement of periodontitis could decrease the occurrence and re-occurrence of ischemic stroke by stablizating atherosclerotic plaque need be further studied in future.
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Affiliation(s)
- Chunchun Chen
- Cognitive Impairment Ward of Neurology Department, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen City, Guangdong Province 518001, PR China; Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province 512025, PR China
| | - Jinhua Zhu
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province 512025, PR China
| | - Xuhui Deng
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province 512025, PR China
| | - Zhi Yang
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province 512025, PR China
| | - Weifeng Lin
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou City, Guangdong Province 510632, PR China
| | - Ying Ma
- Department of Cardiology, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen City, Guangdong Province 518001, PR China
| | - Shuxuan Huang
- Department of Neurology, People 's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, PR China
| | - Lue Chen
- Department of Neurology, Shunde Hospital of Southern Medical University, Shunde, Guangdong Province 528300, PR China
| | - Yuan Liu
- Department of Neurology, The Third People's Hospital of Hangzhou, Hangzhou, Zhejiang Province 310009, PR China
| | - Feiqi Zhu
- Cognitive Impairment Ward of Neurology Department, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen City, Guangdong Province 518001, PR China; Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province 512025, PR China.
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Cardiovascular risks of periodontitis and oral hygiene indicators in patients with diabetes mellitus. DIABETES & METABOLISM 2021; 47:101252. [PMID: 33862198 DOI: 10.1016/j.diabet.2021.101252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 12/29/2022]
Abstract
AIM Periodontitis is a common chronic inflammatory disease prevalent in diabetes. The aim of this study was to evaluate periodontitis and poor oral hygiene as independent risk factors for either cerebral or myocardial infarction in the diabetes population. METHODS This retrospective cohort study included 17,009 patients with diabetes who had participated in a nationwide health-screening programme, including oral health examination, during 2002-2003 in South Korea. Presence of periodontitis, tooth loss and carious teeth were assessed by professional dentists, and the number of tooth brushings per day was evaluated through self-reported questionnaires. The primary study outcome was the development of cerebral or myocardial infarction, based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes, up to 31 December 2015. RESULTS The study enrolled 17,009 patients with diabetes. Over the mean 11.64 years of follow-up, 1341 patients presented with either cerebral or myocardial infarction. On multivariable Cox proportional hazards regression analysis, presence of periodontitis was an independent risk factor for either cerebral or myocardial infarction [adjusted hazard ratio (HR): 1.17, 95% confidence interval (CI): 1.02-1.34; P = 0.030]. An increased number of carious teeth (≥5) was also associated with risk of cerebral or myocardial infarction (adjusted HR: 1.67, 95% CI: 1.20-2.32; P = 0.002), whereas frequent tooth brushing (≥2 times/day) was negatively associated with risk of cerebral or myocardial infarction (adjusted HR: 0.79, 95% CI: 0.70-0.90; P < 0.001) compared with tooth brushing ≤1 time/day. CONCLUSION Early identification and intervention of periodontal disease may be effective in reducing cardiovascular complications in the diabetes population, and improved oral hygiene would probably be associated with lower cardiovascular risk in diabetes.
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Wadhawan A, Reynolds MA, Makkar H, Scott AJ, Potocki E, Hoisington AJ, Brenner LA, Dagdag A, Lowry CA, Dwivedi Y, Postolache TT. Periodontal Pathogens and Neuropsychiatric Health. Curr Top Med Chem 2021; 20:1353-1397. [PMID: 31924157 DOI: 10.2174/1568026620666200110161105] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 02/08/2023]
Abstract
Increasing evidence incriminates low-grade inflammation in cardiovascular, metabolic diseases, and neuropsychiatric clinical conditions, all important causes of morbidity and mortality. One of the upstream and modifiable precipitants and perpetrators of inflammation is chronic periodontitis, a polymicrobial infection with Porphyromonas gingivalis (P. gingivalis) playing a central role in the disease pathogenesis. We review the association between P. gingivalis and cardiovascular, metabolic, and neuropsychiatric illness, and the molecular mechanisms potentially implicated in immune upregulation as well as downregulation induced by the pathogen. In addition to inflammation, translocation of the pathogens to the coronary and peripheral arteries, including brain vasculature, and gut and liver vasculature has important pathophysiological consequences. Distant effects via translocation rely on virulence factors of P. gingivalis such as gingipains, on its synergistic interactions with other pathogens, and on its capability to manipulate the immune system via several mechanisms, including its capacity to induce production of immune-downregulating micro-RNAs. Possible targets for intervention and drug development to manage distal consequences of infection with P. gingivalis are also reviewed.
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Affiliation(s)
- Abhishek Wadhawan
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, United States.,Department of Psychiatry, Saint Elizabeths Hospital, Washington, D.C. 20032, United States
| | - Mark A Reynolds
- Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore 21201, United States
| | - Hina Makkar
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, United States
| | - Alison J Scott
- Department of Microbial Pathogenesis, University of Maryland School of Dentistry, Baltimore, United States
| | - Eileen Potocki
- VA Maryland Healthcare System, Baltimore VA Medical Center, Baltimore, United States
| | - Andrew J Hoisington
- Air Force Institute of Technology, Wright-Patterson Air Force Base, United States
| | - Lisa A Brenner
- Departments of Psychiatry, Neurology, and Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, United States.,Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Aurora, United States.,Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, United States
| | - Aline Dagdag
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, United States
| | - Christopher A Lowry
- Departments of Psychiatry, Neurology, and Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, United States.,Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Aurora, United States.,Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, United States.,Department of Integrative Physiology, Center for Neuroscience and Center for Microbial Exploration, University of Colorado Boulder, Boulder, United States.,Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, United States
| | - Yogesh Dwivedi
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Alabama, United States
| | - Teodor T Postolache
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, United States.,Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Aurora, United States.,Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, United States.,Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, United States
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Van Dyke TE, El Kholy K, Ishai A, Takx RA, Mezue K, Abohashem SM, Ali A, Yuan N, Hsue P, Osborne MT, Tawakol A. Inflammation of the periodontium associates with risk of future cardiovascular events. J Periodontol 2021; 92:348-358. [PMID: 33512014 PMCID: PMC8080258 DOI: 10.1002/jper.19-0441] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 09/10/2020] [Accepted: 09/25/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND While growing evidence suggests a link between periodontal disease (PD) and cardiovascular disease (CVD), the independence of this association and the pathway remain unclear. Herein, we tested the hypotheses that: (1) inflammation of the periodontium (PDinflammation ) predicts future CVD independently of disease risk factors shared between CVD and PD, and (2) the mechanism linking the two diseases involves heightened arterial inflammation. METHODS 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG-PET/CT) imaging was performed in 304 individuals (median age 54 years; 42.4% male) largely for cancer screening; individuals without active cancer were included. PDinflammation and arterial inflammation were quantified using validated 18 F-FDG-PET/CT methods. Additionally, we evaluated the relationship between PDinflammation and subsequent major adverse cardiovascular events (MACE) using Cox models and log-rank tests. RESULTS Thirteen individuals developed MACE during follow-up (median 4.1 years). PDinflammation associated with arterial inflammation, remaining significant after adjusting for PD and CVD risk factors (standardized β [95% CI]: 0.30 [0.20-0.40], P < 0.001). PDinflammation predicted subsequent MACE (standardized HR [95% CI]: 2.25 [1.47 to 3.44], P <0.001, remaining significant in multivariable models), while periodontal bone loss did not. Furthermore, mediation analysis suggested that arterial inflammation accounts for 80% of the relationship between PDinflammation and MACE (standardized log odds ratio [95% CI]: 0.438 [0.019-0.880], P = 0.022). CONCLUSION PDinflammation is independently associated with MACE via a mechanism that may involve increased arterial inflammation. These findings provide important support for an independent relationship between PDinflammation and CVD.
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Affiliation(s)
- Thomas E. Van Dyke
- Forsyth Institute, Cambridge, MA
- Harvard School of Dental Medicine, Boston, MA
| | - Karim El Kholy
- Forsyth Institute, Cambridge, MA
- Harvard School of Dental Medicine, Boston, MA
| | | | | | - Kene Mezue
- Cardiovascular Imaging Research Center, Boston, MA
- Nuclear Cardiology, Boston, MA
- Cardiology Division, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Shady M. Abohashem
- Cardiovascular Imaging Research Center, Boston, MA
- Nuclear Cardiology, Boston, MA
- Cardiology Division, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | | | - Neal Yuan
- San Francisco General Hospital and the University of California San Francisco, San Francisco, CA
| | - Priscilla Hsue
- San Francisco General Hospital and the University of California San Francisco, San Francisco, CA
| | - Michael T. Osborne
- Cardiovascular Imaging Research Center, Boston, MA
- Nuclear Cardiology, Boston, MA
- Cardiology Division, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Boston, MA
- Nuclear Cardiology, Boston, MA
- Cardiology Division, Massachusetts General Hospital, and Harvard Medical School, Boston, MA
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Gao X, Liu H, Xu W, Sun Y, Zhang Y, Zhu X, Wang W. Postoperative subdural hematoma as a rare complication of non-traumatic craniotomy: Two cases report. Medicine (Baltimore) 2021; 100:e23589. [PMID: 33578510 PMCID: PMC7886491 DOI: 10.1097/md.0000000000023589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 11/09/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Postoperative intracranial hemorrhage is a serious and even fatal complication after non-traumatic craniotomy, in which epidural hematoma and intracerebral hematoma are relatively common. Postoperative subdural hematoma is rare, and its pathogenic mechanism remains unclear. PATIENT CONCERNS In the present study, we report 2 cases with postoperative subdural hematoma after non-traumatic craniotomy. DIAGNOSES The diagnosis of acute subdural hematoma (aSDH) was rendered according to the imaging features. INTERVENTIONS Hematoma evacuation was performed immediately. OUTCOMES Two months later, the first patient continued to have impaired consciousness and sensorimotor deficiency in the right extremities. And the second one remained unconscious and continued to have sensorimotor disturbance in the right extremities after 6 weeks of rehabilitation. LESSONS Neurosurgeons should be aware of potential subdural hematoma after non-traumatic craniotomy, since this condition is usually latent and associated with poor prognosis. Early identification and surgical evacuation should be highlighted.
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Affiliation(s)
| | - Huibo Liu
- Department of Dermatology, First Hospital, Jilin University, Changchun, China
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42
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Zardawi F, Gul S, Abdulkareem A, Sha A, Yates J. Association Between Periodontal Disease and Atherosclerotic Cardiovascular Diseases: Revisited. Front Cardiovasc Med 2021; 7:625579. [PMID: 33521070 PMCID: PMC7843501 DOI: 10.3389/fcvm.2020.625579] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/17/2020] [Indexed: 01/15/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ACVD) is an inflammatory disease of the coronary arteries associated with atheroma formation, which can cause disability and often death. Periodontitis is ranked as the sixth most prevalent disease affecting humans affecting 740 million people worldwide. In the last few decades, researchers have focused on the effect of periodontal disease (PD) on cardiovascular disease. The aim of this review was to investigate the association between these two diseases. PD is a potential risk factor that may initiate the development, maturation, and instability of atheroma in the arteries. Two mechanisms were proposed to explain such association, either periodontal pathogens directly invade bloodstream or indirectly by increasing systemic level of inflammatory mediators. Interestingly, it has been suggested that improvement in the condition of one disease positively impact the condition of the other one. Highlighting the association between these two diseases, the importance of early diagnosis and treatment of PD and its impact on cardiovascular status may be of great value in reducing the complications associated with ACVDs. Further in vitro and in vivo studies with longer follow up are necessary to confirm the causal relationship between PD and ACVDs.
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Affiliation(s)
- Faraedon Zardawi
- Periodontics Department, College of Dentistry, University of Sulaimani, Sulaymaniyah, Iraq
| | - Sarhang Gul
- Periodontics Department, College of Dentistry, University of Sulaimani, Sulaymaniyah, Iraq
| | - Ali Abdulkareem
- Department of Periodontics, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Aram Sha
- Periodontics Department, College of Dentistry, University of Sulaimani, Sulaymaniyah, Iraq
| | - Julian Yates
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
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Tanji F, Komiyama T, Ohi T, Hattori Y, Watanabe M, Lu Y, Tsuji I. The Association between Number of Remaining Teeth and Maintenance of Successful Aging in Japanese Older People: A 9-Year Longitudinal Study. TOHOKU J EXP MED 2020; 252:245-252. [PMID: 33162454 DOI: 10.1620/tjem.252.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
With population aging, an increasing attention has been paid to quality of life rather than mere longevity. Now, it is urgently needed to clarify predictors of well-being in later life, i.e., "successful aging (SA)." The aim of this study is to investigate whether the number of remaining teeth impacts on maintenance of SA among Japanese older people. The present study was conducted in Tsurugaya district, a suburban area of Sendai, in northern Japan, and included older people aged ≥ 70 years who had met the criteria for SA at a 2003 baseline survey. At the baseline survey, dentists obtained data for the number of remaining teeth. We obtained information about Long-term Care Insurance certification, including the dates of incident functional disability and death between 2003 and 2012. Data pertaining to health-related quality of life (HRQOL) were collected at the 2003 baseline survey and the 2012 follow-up survey. Maintenance of SA was defined in terms of survival, disability-free status and high HRQOL in both 2003 and 2012. Among 450 participants, 108 (24.0%) were considered to have maintained a state of SA. When participants were classified into three groups according to previous studies, in comparison with participants who retained 0-9 teeth, the multivariate prevalence ratios (95% confidence intervals) were 1.39 (0.81-2.36) for those who retained 10-19 teeth and 1.58 (1.002-2.50) for those who retained ≥ 20 teeth (p trend = 0.046). The present results suggest that retaining ≥ 20 teeth is associated with maintenance of SA among Japanese older people.
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Affiliation(s)
- Fumiya Tanji
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine.,Faculty of Nursing, Japanese Red Cross Akita College of Nursing
| | - Takamasa Komiyama
- Division of Aging and Geriatric Dentistry, Department Oral Function and Morphology, Tohoku University Graduate School of Dentistry
| | - Takashi Ohi
- Division of Aging and Geriatric Dentistry, Department Oral Function and Morphology, Tohoku University Graduate School of Dentistry
| | - Yoshinori Hattori
- Division of Aging and Geriatric Dentistry, Department Oral Function and Morphology, Tohoku University Graduate School of Dentistry
| | - Makoto Watanabe
- Institute of Living and Environmental Sciences, Miyagi Gakuin Women's University
| | - Yukai Lu
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine
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44
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Winning L, Patterson CC, Linden K, Evans A, Yarnel J, McKeown PP, Kee F, Linden GJ. Periodontitis and risk of prevalent and incident coronary heart disease events. J Clin Periodontol 2020; 47:1446-1456. [DOI: 10.1111/jcpe.13377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/24/2020] [Accepted: 09/22/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Lewis Winning
- Centre for Public Health School of Medicine, Dentistry and Biomedical Sciences Queen’s University Belfast Belfast UK
- Dublin Dental University HospitalTrinty College Dublin Dublin Ireland
| | - Christopher C. Patterson
- Centre for Public Health School of Medicine, Dentistry and Biomedical Sciences Queen’s University Belfast Belfast UK
| | - Katie Linden
- Centre for Public Health School of Medicine, Dentistry and Biomedical Sciences Queen’s University Belfast Belfast UK
| | - Alun Evans
- Centre for Public Health School of Medicine, Dentistry and Biomedical Sciences Queen’s University Belfast Belfast UK
| | - John Yarnel
- Centre for Public Health School of Medicine, Dentistry and Biomedical Sciences Queen’s University Belfast Belfast UK
| | - Pascal P. McKeown
- Centre for Public Health School of Medicine, Dentistry and Biomedical Sciences Queen’s University Belfast Belfast UK
| | - Frank Kee
- Centre for Public Health School of Medicine, Dentistry and Biomedical Sciences Queen’s University Belfast Belfast UK
| | - Gerard J. Linden
- Centre for Public Health School of Medicine, Dentistry and Biomedical Sciences Queen’s University Belfast Belfast UK
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Patel UK, Malik P, Kodumuri N, Patel P, Pitti V, Tyagi G, Chauhan B, Lunagariya A, Kothari R, Sen S. Chronic Periodontitis is Associated With Cerebral Atherosclerosis -A Nationwide Study. Cureus 2020; 12:e11373. [PMID: 33304705 PMCID: PMC7721345 DOI: 10.7759/cureus.11373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction Chronic periodontitis and atherosclerosis share common risk factors and produce the same inflammatory markers. Many studies found a high prevalence of chronic periodontitis in patients with atherosclerosis but there is no strong evidence to support a specific association of chronic periodontitis with cerebral atherosclerosis. We aimed to study the concurrent prevalence and association of chronic periodontitis with cerebral atherosclerosis and cerebrovascular diseases among the US population. Methods We performed a cross-sectional analysis of a Nationwide Inpatient Sample with adult hospitalizations to identify the primary diagnosis of cerebrovascular diseases [acute ischemic stroke (AIS), hemorrhagic stroke (HS), and transient ischemic attack (TIA)] with concurrent cerebral atherosclerosis and chronic periodontitis. Multivariate survey logistic regression models were fitted to evaluate the linkage of chronic periodontitis with cerebral atherosclerosis and cerebrovascular diseases. Results Of total 56,499,788 hospitalizations, 0.01% had chronic periodontitis. Prevalence of chronic periodontitis was higher in 50-64 years (36.18% vs. 23.91%), males (59.19% vs. 41.06% in females), Afro-Americans (25.93% vs. 15.21%), and 0-25th percentile median-household-income-category (38.31% vs. 30.15%) compared to non-chronic periodontitis. There was significantly higher prevalence of cerebral atherosclerosis (0.71% vs. 0.41%; p<0.0001) with weak evidence of high prevalence of cerebrovascular diseases (AIS:2.21% vs. 1.97%; p=0.1563; HS:0.57% vs. 0.46%; p=0.1560) among chronic periodontitis compared to non-chronic periodontitis. In regression analysis, odds of having cerebral atherosclerosis were 2.48-folds higher in patients with chronic periodontitis compared to that without-chronic periodontitis, and cerebral atherosclerosis patients were associated with higher odds of TIA (aOR:2.40; p<0.0001), AIS (aOR:3.35; p<0.0001), and HS (aOR:1.51; p<0.0001) compared to without-cerebral atherosclerosis. No significant relationship between chronic periodontitis and cerebrovascular diseases was observed. Conclusion Although chronic periodontitis may not directly increase the risk of cerebrovascular diseases, it increases the burden of cerebrovascular diseases by evidently increasing the risk of cerebral atherosclerosis. Early identification of chronic periodontitis and atherosclerotic risk factors may help to mitigate the risk of cerebrovascular diseases.
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Affiliation(s)
- Urvish K Patel
- Neurology and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Preeti Malik
- Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
- Neurology, Massachusetts General Hospital, Andover, USA
| | - Nishanth Kodumuri
- Neurology, Palmetto Health-University of South Carolina School of Medicine, Columbia, USA
| | | | - Varun Pitti
- Dentistry, Rutgers School of Dental Medicine, Newark, USA
| | - Gaurav Tyagi
- Dentistry, Rutgers School of Dental Medicine, Newark, USA
| | - Bindi Chauhan
- Public Health, Long Island University, New York, USA
| | | | - Ravish Kothari
- Neurology, Palmetto Health-University of South Carolina School of Medicine, Columbia, USA
| | - Souvik Sen
- Neurology, Palmetto Health-University of South Carolina School of Medicine, Columbia, USA
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Liu YCG, Lan SJ, Hirano H, Lin LM, Hori K, Lin CS, Zwetchkenbaum S, Minakuchi S, Teng AYT. Update and review of the gerodontology prospective for 2020's: Linking the interactions of oral (hypo)-functions to health vs. systemic diseases. J Dent Sci 2020; 16:757-773. [PMID: 33854730 PMCID: PMC8025188 DOI: 10.1016/j.jds.2020.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/03/2020] [Indexed: 02/07/2023] Open
Abstract
New lines of evidence suggest that the oral-systemic medical links and oral hypo-function are progressively transcending beyond the traditional clinical signs and symptoms of oral diseases. Research into the dysbiotic microbiome, host immune/inflammatory regulations and patho-physiologic changes and subsequent adaptations through the oral-systemic measures under ageism points to pathways leading to mastication deficiency, dysphagia, signature brain activities for (neuro)-cognition circuitries, dementia and certain cancers of the digestive system as well. Therefore, the coming era of oral health-linked systemic disorders will likely reshape the future of diagnostics in oral geriatrics, treatment modalities and professional therapies in clinical disciplines. In parallel to these highlights, a recent international symposium was jointly held by the International Association of Gerontology and Geriatrics (IAGG), Japanese Society of Gerodontology (JSG), the representative of USA and Taiwan Academy of Geriatric Dentistry (TAGD) on Oct 25th, 2019. Herein, specific notes are briefly addressed and updated for a summative prospective from this symposium and the recent literature.
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Affiliation(s)
- Yen Chun G. Liu
- Center for Osteoimmunology & Biotechnology Research (COBR) and Dept. of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University (KMU), Kaohsiung, Taiwan
- Corresponding author. Dept. of Oral Hygiene & COBR, College of Dental Medicine, Kaohsiung Medical University; No. 100, Shih-Chun 1st Rd, Kaohsiung 807, Taiwan. Fax: +886 07 3223141.
| | - Shou-Jen Lan
- Dept. of Healthcare Administration, Asia University, Tai-Chung, Taiwan
| | - Hirohiko Hirano
- Research Team for Promoting Independence & Mental Health, and Dentistry & Oral Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Li-min Lin
- Div. of Oral Pathology & Oral Maxillo-facial Radiology, School of Dentistry, Kaohsiung Medical University & KMU-Hospital, Kaohsiung, Taiwan
| | - Kazuhiro Hori
- Div. of Comprehensive Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Chia-shu Lin
- Dept. of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
| | - Samuel Zwetchkenbaum
- Rhode Island Dept. of Health, Rhode Island, USA
- School of Public Health, Brown University, Providence, RI, USA
| | - Shunsuke Minakuchi
- Gerodontology & Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Andy Yen-Tung Teng
- Center for Osteoimmunology & Biotechnology Research (COBR) and Dept. of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University (KMU), Kaohsiung, Taiwan
- Center for Osteoimmunology & Biotechnology Research (COBR) and School of Dentistry, College of Dental Medicine, Kaohsiung Medical University and KMU-Hospital, Kaohsiung, Taiwan
- Corresponding author. Center for Osteoimmunology and Biotechnology Research (COBR), College of Dental Medicine, Kaohsiung Medical University (KMU) & KMU-Hospital, Kaohsiung, Taiwan.
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47
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Çetin MB, Sezgin Y, Yilmaz MNN, Seçgin CK. Assessment of carotid artery calcifications on digital panoramic radiographs and their relationship with periodontal condition and cardiovascular risk factors. Int Dent J 2020; 71:160-166. [PMID: 32996164 PMCID: PMC9275109 DOI: 10.1111/idj.12618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The main purpose of this study is to determine the presence of carotid artery calcification (CAC) detected on digital panoramic radiographs (DPRs) retrospectively and correlate the findings with cardiovascular risk factors including gender, age, smoking status, hypertension, diabetes, and hyperlipidemia, along with atherosclerotic cardiovascular disease and periodontal status. METHODS This clinical study is registered at ClinicalTrials.gov as NCT04017078. DPRs, periodontal status and cardiovascular risk factors of 1,101 patients (576 males, 525 females) were evaluated. The patients were grouped based on whether CAC was detected in dental DPRs [CAC (+)] or not [CAC (-)]. Periodontal status was categorised as gingivitis, periodontitis, and gingivitis with reduced periodontium (periodontally stable patient). RESULTS Out of 1,101 patients, whose mean age was 42.1 ± 15.5 years and 525 (47.7%) were female, 34 (3.1%) were diagnosed with CAC on DPRs. No significant difference was observed between groups considering gender, hypertension, diabetes, hyperlipidemia, smoking, and periodontal status. Patients aged 40-55 years (n = 398, 36.15%) and patients older than 55 years (n = 222, 20.16%) were associated with CAC (odds ratio = 4.49, 95% confidence interval = 1.65-12.17, P = 0.003; odds ratio = 4.41, 95% confidence interval = 1.33-14.61, P = 0.015, respectively). CONCLUSION Among all parameters, only age exhibited significant correlation with an increased risk of carotid calcification. Further studies with prospective designs and larger study populations are needed.
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Affiliation(s)
- Mehtap Bilgin Çetin
- Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Yasemin Sezgin
- Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | | | - Cansu Köseoğlu Seçgin
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Baskent University, Ankara, Turkey
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48
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Patrakka O, Pienimäki JP, Tuomisto S, Ollikainen J, Lehtimäki T, Karhunen PJ, Martiskainen M. Oral Bacterial Signatures in Cerebral Thrombi of Patients With Acute Ischemic Stroke Treated With Thrombectomy. J Am Heart Assoc 2020; 8:e012330. [PMID: 31117858 PMCID: PMC6585368 DOI: 10.1161/jaha.119.012330] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Chronic infections have been reported to be risk factors for both coronary heart disease and ischemic stroke. DNA of oral bacteria, mainly from the viridans streptococci group, has been detected in coronary thrombus aspirates of myocardial infarction and cerebral aneurysms. Viridans streptococci are known to cause infective endocarditis and possess thrombogenic properties. We studied the presence of oral bacterial DNA in thrombus aspirates of patients with acute ischemic stroke treated with mechanical thrombectomy. Methods and Results Thrombus aspirates and arterial blood were taken from 75 patients (69% men; mean age, 67 years) with acute ischemic stroke. The presence of Streptococcus species, mainly the Streptococcus mitis group, belonging to viridans streptococci as well as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in samples were determined using a quantitative polymerase chain reaction with specific primers and probes. The relative amount of bacterial DNA in a sample was determined with the comparative threshold cycle method. Bacterial DNA was detected in 84% (n=63) of aspired thrombi, and 16% (n=12) of samples were considered bacterial DNA negative. DNA of Streptococcus species, mainly the S mitis group, was found in 79% (n=59) of samples. The median relative amount of Streptococcus species DNA was 5.10‐fold higher compared with the control blood samples from the same patients. All thrombi were negative for both P gingivalis and A actinomycetemcomitans. Conclusions This is the first study showing the common presence of bacterial DNA from viridans streptococci in aspired thrombi of patients with acute ischemic stroke. Streptococcal bacteria, mostly of oral origin, may contribute to the progression and thrombotic events of cerebrovascular diseases.
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Affiliation(s)
- Olli Patrakka
- 1 Department of Forensic Medicine Faculty of Medicine and Health Technology Tampere University and Fimlab Laboratories Tampere Finland
| | - Juha-Pekka Pienimäki
- 2 Division of Interventional Radiology Department of Radiology Tampere University Hospital Tampere Finland
| | - Sari Tuomisto
- 1 Department of Forensic Medicine Faculty of Medicine and Health Technology Tampere University and Fimlab Laboratories Tampere Finland
| | - Jyrki Ollikainen
- 3 Department of Neurology Tampere University Hospital Tampere Finland
| | - Terho Lehtimäki
- 4 Department of Clinical Chemistry Faculty of Medicine and Health Technology Tampere University Fimlab Laboratories and Finnish Cardiovascular Research Center Tampere Finland
| | - Pekka J Karhunen
- 1 Department of Forensic Medicine Faculty of Medicine and Health Technology Tampere University and Fimlab Laboratories Tampere Finland
| | - Mika Martiskainen
- 1 Department of Forensic Medicine Faculty of Medicine and Health Technology Tampere University and Fimlab Laboratories Tampere Finland.,5 National Institute for Health and Welfare Helsinki Finland
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Yoshioka S, Miyamoto T, Satomi J, Tada Y, Yagi K, Shimada K, Naruishi K, Shikata E, Yamaguchi I, Yamaguchi T, Korai M, Okayama Y, Harada M, Kitazato KT, Kanematsu Y, Nagahiro S, Takagi Y. Disequilibrium of Plasma Protease/Anti-Protease Due to Severe Periodontal Disease Contributes to Human Subarachnoid Hemorrhage. NEUROSURGERY OPEN 2020. [DOI: 10.1093/neuopn/okaa007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
ABSTRACT
BACKGROUND
The pathophysiology of subarachnoid hemorrhages (SAHs) due to ruptured intracranial aneurysms (IAs) remains unclear. Although a relationship between SAHs and periodontal disease (PD) has been suggested, the mechanism requires clarification.
OBJECTIVE
To evaluate the relationship between PD and SAHs and to identify periodontal pathogens associated with SAHs.
METHODS
This prospective study included consecutive patients with ruptured (n = 11) and unruptured (n = 14) IAs and healthy controls (n = 8). The plasma and plaque subgingival bacterial deoxyribonucleic acid (DNA) levels in PD were evaluated by a dentist using the Community Periodontal Index of Treatment Needs (CPITN). Plasma levels of matrix metalloproteinase (MMP-9), tissue inhibitors of matrix metalloproteinase (TIMP2), and procollagen I were analyzed.
RESULTS
Patients with ruptured IAs, had significantly higher CPITN scores than the controls, suggesting that ruptured IAs were associated with severe PD. Although no rupture-specific bacteria were identified, the positive rate of plaque subgingival bacterial DNA was significantly higher in patients with severe PD than in those without severe PD. Multivariate logistic regression analysis indicated that bleeding on probing (BOP) was associated with ruptured IAs (odds ratio, 1.10; 95% confidence interval 1.04–1.20; P = .0001). BOP was positively associated with plasma MMP-9 levels and a disequilibrium in the MMP-9/TIMP2 ratio. BOP was negatively correlated with plasma procollagen I levels (P < .05, for each). This suggested that local inflammation with severe PD might have systemic effects and lead to ruptured IAs.
CONCLUSION
Disequilibrium of plasma protease/anti-protease associated with a high BOP rate in severe PD may be attributable to IA rupture.
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Affiliation(s)
- Shotaro Yoshioka
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Takeshi Miyamoto
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Junichiro Satomi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yoshiteru Tada
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kenji Yagi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kenji Shimada
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Koji Naruishi
- Department of Periodontology and Endodontology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Eiji Shikata
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Izumi Yamaguchi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Tadashi Yamaguchi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Masaaki Korai
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yoshihiro Okayama
- Clinical Trial Center, Tokushima University and Tokushima University Hospital, Tokushima, Japan
| | - Masafumi Harada
- Department of Radiology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Keiko T Kitazato
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yasuhisa Kanematsu
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Shinji Nagahiro
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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50
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Matsushita K, Yamada-Furukawa M, Kurosawa M, Shikama Y. Periodontal Disease and Periodontal Disease-Related Bacteria Involved in the Pathogenesis of Alzheimer's Disease. J Inflamm Res 2020; 13:275-283. [PMID: 32636667 PMCID: PMC7335281 DOI: 10.2147/jir.s255309] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/29/2020] [Indexed: 12/11/2022] Open
Abstract
Alzheimer’s disease (AD) is the most common cause of dementia, and it exhibits pathological properties such as deposition of extracellular amyloid β (Aβ) and abnormally phosphorylated Tau in nerve cells and a decrease of synapses. Conventionally, drugs targeting Aβ and its related molecules have been developed on the basis of the amyloid cascade hypothesis, but sufficient effects on the disease have not been obtained in past clinical trials. On the other hand, it has been pointed out that chronic inflammation and microbial infection in the brain may be involved in the pathogenesis of AD. Recently, attention has been focused on the relationship between the periodontopathic bacterium Porphylomonas gingivalis and AD. P. gingivalis and its toxins have been detected in autopsy brain tissues from patients with AD. In addition, pathological conditions of AD are formed or exacerbated in mice infected with P. gingivalis. Compounds that target the toxins of P. gingivalis ameliorate the pathogenesis of AD triggered by P. gingivalis infection. These findings indicate that the pathological condition of AD may be regulated by controlling the bacteria in the oral cavity and the body. In the current aging society, the importance of oral and periodontal care for preventing the onset of AD will increase.
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Affiliation(s)
- Kenji Matsushita
- Department of Oral Disease Research, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Masae Yamada-Furukawa
- Department of Oral Disease Research, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Mie Kurosawa
- Department of Oral Disease Research, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
| | - Yosuke Shikama
- Department of Oral Disease Research, National Center for Geriatrics and Gerontology, Obu, Aichi 474-8511, Japan
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