Assessing the relationship between dental disease and coronary heart disease in elderly U.S. veterans

Tooth loss and periodontal status in patients with cardiovascular disease in the Serbian population: A randomized prospective study

OBJECTIVES

Chronic periodontal infections may predispose to cardiovascular disease. Since tooth loss may be due to periodontitis it is assumed that tooth loss can also predisposes cardiovascular disease. The aim was to investigate the possible relationship between the severity of the clinical picture of periodontitis and the occurrence of cardiovascular disease.

METHODS

We evaluated the association between clinical periodontal parameters, tooth loss and cardiovascular incident. A total of 100 subjects (50 subjects diagnosed with cardiovascular disease and 50 in control group without cardiovascular disease) underwent a dental examination. Tooth loss in all participants was caused only as a consequence of periodontitis. In addition to periodontal status, conventional risk factors for cardiovascular diseases (hypertension, smoking, obesity, hypercholesterolemia, diabetes) were measured, too.

RESULTS

Periodontal status was worse in patients in the group with cardiovascular disease compared to the group without cardiovascular disease. A significant association was observed between tooth loss levels and cardiovascular disease. In the group of patients who had cardiovascular disease, tooth loss was more than 50%. In the group of patients without cardiovascular disease, tooth loss was about 20% of the total number of teeth. A significant association was observed between tooth loss levels and cardiovascular disease prevalence.

CONCLUSION

This study presents relationship between number of teeth and cardiovascular disease, indicating a link between oral health and cardiovascular disease.

Association between oral health and cardiovascular outcomes in patients with hypertension: a nationwide cohort study

OBJECTIVE

Studies on the association of oral hygiene indicators with cardiovascular disease in hypertensive patients have been lacking. Oral hygiene is directly or indirectly associated with systemic inflammation, one of the essential mechanisms of cardiovascular disease. Therefore, we hypothesized that oral hygiene would be related to the risk of cardiovascular diseases in hypertensive patients.

METHODS

We included 52 677 hypertensive participants who completed oral health checkups from the Korean National Health Insurance Service-National Health Screening Cohort between 2003 and 2004. We collected data on periodontitis diagnosis and treatment history, number of teeth loss, number of dental caries, and frequency of tooth brushing from medical records of health claims and oral health examination. The primary outcome was defined as composite outcomes of stroke and myocardial infarction. Follow-up was done until the date of primary outcome, or 31 December 2015.

RESULTS

During the 11.26 ± 2.39 years (mean ± standard deviation) of the study follow-up, 3292 participants developed primary outcomes [stroke (n = 2430), myocardial infarction (n = 862)]. In multivariable Cox regression analyses, participants with dental caries (≥ 5) were independently associated with occurrence of a primary outcome [adjusted hazard ratio: 1.37; 95% confidence interval (CI):1.10-1.72; P = 0.006]. Frequent tooth brushing (≥ 2 times/day) was significantly related to lower risk of primary outcomes (adjusted hazard ratio: 0.88; 95% CI: 0.81-0.96; P = 0.002).

CONCLUSION

Our study demonstrated that multiple dental caries were related to the risk of cardiovascular diseases in hypertensive patients. Better oral hygiene may attenuate the risk of cardiovascular events in hypertensive patients.

Association of periodontitis with microvascular complications of diabetes mellitus: A nationwide cohort study

BACKGROUND

Periodontitis is a common chronic inflammatory disease and one of oral complications in diabetes. Diabetes-related microvascular complications and periodontitis are also closely related to systemic inflammation. We hypothesized that periodontitis and oral hygiene markers might increase the risk of microvascular complications in diabetes mellitus.

METHODS

We enrolled 11,353 diabetes participants without prior microvascular complications who received complete oral health checkups in the National Health Insurance Service-National Health Screening Cohort in 2003-2004. The primary outcome was the first development of diabetes-related microvascular complications, including nephropathy, neuropathy, and retinopathy.

RESULTS

The age of all participants was 55.27 ± 9.46 years, and 7833 (68.99%) participants were male. Periodontitis was noted in 8.37%. During the 7.03 ± 4.30 year of the mean follow-up period, 7227 patients experienced diabetes-related microvascular complications (2645 with nephropathy, 2513 with neuropathy, 2069 with retinopathy). Multivariable Cox regression analyses revealed that periodontitis was an independent risk factor for diabetes-related microvascular complications (adjusted hazard ratio (HR):1.13; 95% confidence interval (CI):1.04-1.23; p = 0.004). In the secondary analysis for individual microvascular complications, periodontitis was an independent risk factor for retinopathy (adjusted HR: 1.21; 95% CI: 1.04-1.40; p = 0.013).

CONCLUSIONS

The presence of periodontitis was associated with an increased risk of microvascular complications in diabetes patients.

Relationship of coronary heart disease and comorbide dental background

Cardiovascular disease has serious economic and social consequences that affect people, health systems and societies around the world. Ischemic heart disease is one of the main global causes of death of the population, and its growth is predicted in the coming years. This fact continues to be of serious concern to health, social and economic services. Cardiovascular disease remains the most common cause of death, and age-standardized rates are higher for men than for women. Cardiovascular comorbidity increases significantly with age.The combination of ischemic heart disease and comorbid pathology is noted in cancer incidence, bronchial asthma, non-alcoholic fatty liver disease, type 2 diabetes mellitus, chronic obstructive pulmonary disease, periodontal disease, etc. It is necessary to analyze the existing disease with past diseases, risk factors and predictors available in the patient. The presence of concomitant diseases quite often requires additional diagnostic methods and changes in the tactics of treating coronary heart disease due to the fact that some of them are a contraindication to the use of certain groups of drugs. Periodontal disease includes a wide range of inflammatory conditions that affect the supporting structures of the teeth, which can lead to tooth loss and contribute to systemic inflammation. Periodontal disease is associated with several systemic diseases, one of which is coronary artery disease. It is imperative that clinicians understand the link between periodontal disease and cardiovascular disease. Comprehensive treatment of periodontitis and restoration of a healthy periodontium can help reduce overall inflammation in the body and reduce the risks of coronary heart disease.

Tooth loss is associated with an increased risk of hypertension: A nationwide population-based cohort study

Tooth loss is closely associated with suboptimal oral care. Suboptimal oral care can facilitate local infections. These can lead to systemic inflammation and endothelial dysfunction, which are important pathological mechanisms of hypertension. The aim of this study was to investigate the link between tooth loss and the risk of hypertension. From the national health insurance system-health screening cohort in Korea, 19,680 participants who underwent three or more health examinations, including blood pressure measurements, between January 2003 and December 2008, without any history or diagnosis of hypertension were included in this study. Hypertension was defined as the diagnosis of hypertension (International Classification of Diseases-10 code “I10–11”) accompanied by the prescription of an antihypertensive agent or at least one health examination result of blood pressure of ≥140/90 mmHg. Kaplan-Meier survival curves with the log-rank test were used to evaluate the relationship between oral hygiene indicators and the incidence of hypertension. Cox proportional hazard models were applied to determine the association between oral hygiene indicators and the development of hypertension. During a median follow-up of 7.4 years, 1,853 patients developed hypertension. The estimated incidence of hypertension within seven years was 8.8%. Multivariable analysis confirmed a significant relationship between the number of lost teeth and hypertension (hazard ratio: 2.26; 95% confidence interval [1.24–4.10], p = 0.007, p for trend = 0.005). There was a positive association between the number of lost teeth and the risk of hypertension in a longitudinal research. In conclusion, the number of lost teeth may be associated with the risk of development of hypertension.

Recruiting and retaining dental labor in federal facilities: Harder than pulling teeth?

The U.S. Veterans Administration (VA) is a large publicly financed health system that has long struggled with provider shortages. Shortages may arise at the VA because it offers different compensation than private sector employment options or because of differences in the way that labor is supplied to public versus private employers. In the mid-2000s, the VA adopted a more generous and flexible pay schedule for its dentists. We exploit this salary schedule change to study the impact of a positive wage shock on dental labor supplied to the VA, within a difference-in-differences framework. We find limited effects on VA separation and new hire rates overall-though early career dentists appear more sensitive to the wage change. More generous pay has its clearest effects on employment type for VA dentists, reducing the likelihood of being part-time by roughly 10%.

Oral hygiene and periodontal conditions in the Chinese patients with aortic aneurysm

Background

This cross-sectional study aims to evaluate the association of periodontal conditions and oral hygiene habits in the Chinese patients with an aortic aneurysm (AA).

Methods

A questionnaire and periodontal examinations were carried out in the AA patients and non-AA volunteers recruited from the Center for Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University between August 2011 and June 2016. General information (e.g., height and weight), history of systemic diseases, and oral hygiene habits (e.g., brushing methods and regular oral examinations) were collected in the self-reported survey. Periodontal examinations, such as plaque index and bleeding index, were conducted in all the subjects. The correlation between periodontal indices and AA was further explored using univariate and multivariate analyses.

Results

Our analyses revealed that 87.6% of AA patients have chronic periodontitis, which is significantly higher than that of the non-AA patients (55.8%). In addition, AA patients demonstrated more severe periodontal damages with 69.3% moderate and severe periodontitis, compared to only 16.0% in the non-AA group. Using AA as the dependent variable and all the potential risk factors as covariates (e.g., gender, age, smoking, obesity, diabetes, hypertension, and hyperlipidemia), a logistic regression analysis was performed to show clinical attachment loss (CAL) being an independent risk factor for AA (OR = 2.309, 95% CI: 1.623–3.284, p = 0.000). In comparison with the non-AA patients, more AA patients have poor oral hygiene habits and don’t have regular dental appointments for supra-gingival cleaning.

Conclusion

Poor periodontal condition and dental hygiene were identified in the AA patients, suggesting that periodontitis-induced CAL may play a role in AA disease mechanisms.

Poor oral health and risk of incident myocardial infarction: A prospective cohort study of Swedish adults, 1973-2012

Previous studies provide conflicting evidence as to whether there is an association between poor oral health and an increased risk of myocardial infarction. The aim of the study was to deepen knowledge of the association between oral health and myocardial infarction risk using a large (n = 20,133), prospective, and population-based cohort in Uppsala, Sweden. Oral health was determined during a clinical dental examination at entry into the cohort in 1973/74. Individuals were followed through linkage with the Swedish National Patient Register, Cause of Death Register and Emigration Register. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) for total, non-fatal and fatal myocardial infarction events. Increased risks of total, non-fatal and fatal myocardial infarction events among individuals with fewer reference teeth at examination, more dental plaque and a borderline significant increased risk among individuals with oral lesions were observed. Adjustment for multiple potential confounding factors did not change the results appreciably. However, the observed HRs generally decreased towards one when the analysis was confined to non-tobacco users only. The results from this study indicate that poor oral health is associated with a slightly increased risk of myocardial infarction; however, these results may be partly explained by residual confounding.

Correlation between dental conditions and comorbidities in an elderly Japanese population: A cross-sectional study

The purpose of this study was to investigate the correlation between dental conditions and comorbidities in an elderly population in Japan.A database constructed using data obtained from 12 nursing homes in Japan was used in this study. The study period ranged from January 2014 to December 2015, and elderly individuals with dental and other medical records were included in the analysis. Linear regression models were used to analyze univariate and multivariate correlation between dental conditions, comorbidities, and other sociodemographic/clinical backgrounds.After excluding individuals with missing data, 289 elderly individuals (107 men and 182 women; mean age, 85 years) were included in the analysis. These individuals had an average of 11.6 teeth, and the number decreased with older age (P < .001). The average number of decayed teeth was 1.4. A total of 116 subjects (40.1%) had dementia. In terms of comorbidities, dementia was not significantly associated with the number of present teeth (P = .56), but it was associated with the number of decayed teeth (P = .018). This association was also observed after adjusting for confounding variables in the multivariate regression analysis (P = .030).The number of decayed teeth was associated with dementia. While causality cannot be inferred from these observational results, the findings indicate that dental health could represent a marker of impending dementia, and probably represent a marker of general health status in the elderly population. Additional longitudinal studies are highly desirable to understand the causal relationships between dental conditions and comorbidities.

Exploring the Association between Alzheimer's Disease, Oral Health, Microbial Endocrinology and Nutrition

Longitudinal monitoring of patients suggests a causal link between chronic periodontitis and the development of Alzheimer’s disease (AD). However, the explanation of how periodontitis can lead to dementia remains unclear. A working hypothesis links extrinsic inflammation as a secondary cause of AD. This hypothesis suggests a compromised oral hygiene leads to a dysbiotic oral microbiome whereby Porphyromonas gingivalis, a keystone periodontal pathogen, with its companion species, orchestrates immune subversion in the host. Brushing and chewing on teeth supported by already injured soft tissues leads to bacteremias. As a result, a persistent systemic inflammatory response develops to periodontal pathogens. The pathogens, and the host’s inflammatory response, subsequently lead to the initiation and progression of multiple metabolic and inflammatory co-morbidities, including AD. Insufficient levels of essential micronutrients can lead to microbial dysbiosis through the growth of periodontal pathogens such as demonstrated for P. gingivalis under low hemin bioavailability. An individual’s diet also defines the consortium of microbial communities that take up residency in the oral and gastrointestinal (GI) tract microbiomes. Their imbalance can lead to behavioral changes. For example, probiotics enriched in Lactobacillus genus of bacteria, when ingested, exert some anti-inflammatory influence through common host/bacterial neurochemicals, both locally, and through sensory signaling back to the brain. Early life dietary behaviors may cause an imbalance in the host/microbial endocrinology through a dietary intake incompatible with a healthy GI tract microbiome later in life. This imbalance in host/microbial endocrinology may have a lasting impact on mental health. This observation opens up an opportunity to explore the mechanisms, which may underlie the previously detected relationship between diet, oral/GI microbial communities, to anxiety, cognition and sleep patterns. This review suggests healthy diet based interventions that together with improved life style/behavioral changes may reduce and/or delay the incidence of AD.

A simple point of care test can indicate the need for periodontal therapy to reduce the risk for adverse pregnancy outcomes in mothers attending antenatal clinics

INTRODUCTION

Although the association between periodontal disease (PD) and adverse pregnancy outcomes has gained recognition amongst antenatal healthcare workers, not much has changed in practice to address it. This prospective study tested the hypothesis that BANA (N-benzoyl-DL-arginine-2-naphthylamide), a diagnostic test for PD, may inform obstetricians and other antenatal healthcare practitioners, of the risk of adverse pregnancy outcomes in mothers attending antenatal clinics.

METHODS

At first visit, the presence of suspected periodontopathogens was assessed by BANA testing of dental plaque from 443 mothers attending antenatal clinics in KwaZulu-Natal, South Africa and an association later sought with pregnancy outcomes. The accuracy of BANA to predict adverse pregnancy outcomes was evaluated by the calculation of likelihood ratios. The study complied with the Declaration of Helsinki.

RESULTS

Significant differences were found between pregnancy outcomes of BANA-negative and BANA-positive mothers (p < 0.0001). BANA showed sensitivity and negative predictive values of 87% and 91%; 75% and 78%; 87% and 94% in detecting low birth weight, preterm delivery, and preterm low birth weight delivery respectively.

CONCLUSION

This study confirms that BANA may indicate the need for periodontal therapy to reduce the risk of adverse pregnancy outcomes and could form part of the routine antenatal examination.

Association of periodontal and cardiovascular diseases: South-Asian studies 2001-2012

Large proportion of Asian populations have moderate to severe periodontal disease and a substantial number are anticipated to be at high risk of cardiovascular diseases (CVD). This study reviews epidemiology and association of periodontal and CVDs from the South-Asian region. Observational studies and clinical trials published during January 2001-December 2012 focusing association between periodontitis and CVDs in South-Asian countries were retrieved from various databases and studied. Current evidence suggests that both periodontal and CVDs are globally prevalent and show an increasing trend in developing countries. Global data on epidemiology and association of periodontal and CVDs are predominantly from the developed world; whereas Asia with 60% of the world's population lacks substantial scientific data on the link between periodontal and CVDs. During the search period, 14 studies (5 clinical trials, 9 case-controls) were reported in literature from South-Asia; 100% of clinical trials and 77% case-control studies have reported a significant association between the oral/periodontal parameters and CVD. Epidemiological and clinical studies from South-Asia validate the global evidence on association of periodontal disease with CVDs. However, there is a need for meticulous research for public health and scientific perspective of the Periodontal and CVDs from South-Asia.

Prevalence of diseases and conditions which impact on oral health and oral health self-care among older chilean

OBJECTIVE

The aim is to describe the prevalence of chronic diseases and conditions that may affect the oral health and oral health self-care of independent living Chilean older adults.

METHOD

In all, 4,766 residents aged 60 years and older took part in the study. Participants were interviewed using an 11-module instrument, including demographic data, quality of life, nutritional status, systemic diseases, and lists of medications.

RESULTS

Participants with cognitive impediments (n = 553) were eliminated from further analysis. Of the remaining 4,213, 61.2% were female. The mean age was 71.1 (SD = 7.8) years. A total of 19.6% reported no medical conditions, 53.1% reported one or two conditions, and 27.3% reported between three and nine conditions. The most commonly reported conditions were high blood pressure (78.0%), diabetes (26.5%), depression (23.4%), and cardiovascular disease (18.7%). Seventy-six percent reported taking medication, with an average of 3.4 drugs per person. Among those taking medication, 70.2% were taking at least one that may cause salivary hypofunction.

DISCUSSION

With the aging of Chile and the reciprocal links between oral disease and chronic diseases, policies and innovative initiatives need to be implemented so that programs become affordable and accessible for this population.

Development and applications of porous tantalum trabecular metal-enhanced titanium dental implants

BACKGROUND

Porous tantalum trabecular metal has recently been incorporated in titanium dental implants as a new form of implant surface enhancement. However, there is little information on the applications of this material in implant dentistry.

PURPOSE

The purpose of this article is to summarize the contemporary concept on the applications of porous tantalum trabecular metal in implant dentistry.

MATERIALS AND METHODS

We therefore review the current literature on the basic science and clinical uses of this material.

RESULTS

Porous tantalum metal is used to improve the contact between osseous structure and dental implants and therefore presumably facilitate osseointegration. Success of porous tantalum metal in orthopedic implants led to the incorporation of porous tantalum metal in the design of root-form endosseous titanium implants. The porous tantalum three-dimensional enhancement of titanium dental implant surface allows for combining bone ongrowth together with bone ingrowth, or osseoincorporation. While little is known about the biological aspect of the porous tantalum in the oral cavity, there seems to be several possible advantages of this implant design. This article reviews the biological aspects of porous tantalum-enhanced titanium dental implants, in particular the effects of anatomical consideration and oral environment to implant designs.

CONCLUSIONS

We propose here possible clinical situations and applications for this type of dental implant. Advantages and disadvantages of the implants as well as needed future clinical studies are discussed.

Clinical indicators of periodontal disease in patients with coronary heart disease: a 10 years longitudinal study

OBJECTIVES

There is evidence about a possible relationship existing between periodontal diseases and coronary heart disease. The aim of the present longitudinal study was to investigate the changes in periodontal evolution after etiological periodontal treatment, comparing a healthy control group with another having coronary heart disease.

STUDY DESIGN

The study included initially 55 patients of which 44 finished it. They were placed into two groups: Healthy Control Group (HCG) n =9, and Coronary Heart Disease Group (CHDG) n=35. The gingival level (GL), probing depth (PD), clinical attachment level (CAL), plaque index (PI) and bleeding on probing (BOP) were measured to compare the periodontal status in both groups. The patients were examined and etiological periodontal treatment was performed and they were then examined at the end of 1 and 10 years.

STATISTICAL METHOD

A one way-ANOVA and a MR-ANOVA were established; significance p<0.05.

RESULTS

No significant differences between both groups were detected on the first visit (p>0.5). However, at the second visit the CHDG presented a significantly higher PD (p<0.05) and PI (p<0.01). CHDG patients gradually increase PD through time and in comparison to the control group (p<0.041). CHDG patients present a significantly higher CAL loss (p<0.0385) and a significant increase in PI (p<0.0041) at the end of one year, while on the third visit no significant differences were detected in any of these indices. Likewise, a similar fact can be observed on evaluating BOP at the end of ten years causal treatment, a smaller decrease in the cardiac group was observed in regards to the initial values (p<0.001).

CONCLUSION

Patients with coronary heart disease showed a worse evolution of periodontal indices than healthy ones, when referring to probing depth, plaque index and bleeding on probing index.

Poor oral health and coronary artery disease: a case-control study

BACKGROUND

There is insufficient research on the relationship of oral health and coronary artery disease (CAD) from developing countries, such as Pakistan. This study observes the status of oral health in the CAD population.

METHODS

A case-control study was conducted on 145 cases and 145 controls. Otherwise healthy patients with CAD (cases) and individuals free from previous/current history of CAD (controls), having ≥14 remaining teeth, were examined for oral health status through missing teeth, plaque index (PI), and community periodontal index (CPI). Student t test, χ2 test, and multivariate regression analysis were applied at significance level of 95% (P ≤ 0.05) to compare study parameters between cases and controls.

RESULTS

A significant difference between cases and controls was observed in this study sample with respect to missing teeth (P = 0.027) and periodontal parameters of PI and CPI (P < 0.001). Cases were observed with significantly higher scores of PI (2 and 3) and CPI (3 and 4) compared with controls. Prevalence of periodontal parameters was observed to be higher in cases than controls at subgroup-level (sex and age group) analysis. A significant odds ratio (OR), unadjusted, between CAD and periodontal indicators of PI (mild to severe plaque/no plaque: OR = 5.04, 95% confidence interval [95% CI] = 2.24 to 11.36) and CPI (healthy/poor periodontal status: OR = 4.59, 95% CI = 1.81 to 11.61) scores was noted; cases were at odds of 1.20 (95% CI = 0.93 to 15.68, P = 0.017) for having poor oral health after adjusting age, sex, and education.

CONCLUSION

Poor oral health was significantly associated with CAD in this study sample matched for sociodemographic characteristics.

Number of teeth is related to atherosclerotic plaque in the carotid arteries in an elderly population

BACKGROUND

Periodontal disease has been associated with cardiovascular disorders with an atherosclerotic background, and number of teeth (NT) has been suggested as a possible risk indicator for cardiovascular disease. The objective of this study is to investigate whether NT was related to the intima-media thickness (IMT) and to atherosclerotic plaque in carotid arteries in an elderly population.

METHODS

In a population-based study including 1,016 participants aged 70 years, the NT was self-reported by 947 of the participants. Carotid artery IMT was evaluated by ultrasound. The occurrence of plaque was also measured. Logistic regression was used to analyze the associations between NT and the number of carotid arteries with plaque.

RESULTS

A significant inverse relationship was found between the NT and the number of carotid arteries with plaque after adjustment for age, sex, smoking, body mass index, waist/hip ratio, blood glucose, triglycerides, cholesterol, C-reactive protein, leukocyte count, blood pressure, and Framingham risk score, with odds ratio of 0.89, 95% confidence interval of 0.82 to 0.98, and P = 0.016. The relationship was fairly linear, suggesting a dose-response relationship. When NT was divided into quintiles using the first one as referent, the relationship persisted for all quintiles except for the second one. However, no relationship to IMT was seen.

CONCLUSION

The present study further emphasizes that tooth loss could be an easily obtained risk indicator for atherosclerosis.

Association of periodontitis with rheumatoid arthritis: a pilot study

BACKGROUND

Similarities exist in the epidemiology and immunopathogenesis of periodontitis and rheumatoid arthritis (RA), but the associations between their respective disease activities and severities are less well documented. We evaluated the prevalence and severity of periodontitis in United States (U.S.) veterans with RA and their relationship to RA disease activity and severity.

METHODS

Patients with RA from an outpatient rheumatology clinic were eligible, and patients with osteoarthritis (OA) served as controls. Dentists, masked to the rheumatologic diagnoses, performed periodontal probing and examined dental panoramic radiographs to assess the presence and severity of periodontitis. Associations of periodontitis with RA were examined using multivariate regression, whereas the association of periodontitis with disease-severity measures in RA was examined using the chi(2) test.

RESULTS

Sixty-nine patients with RA (57 males and 12 females) and 35 patients with OA (30 males and five females) were studied. Moderate to severe periodontitis was more prevalent in patients with RA (51%) than controls (26%) (P = 0.03), an association independent of age, race, smoking, diabetes mellitus, and gender. Patients with RA who were seropositive for rheumatoid factor (RF) were more likely to have moderate to severe periodontitis (59%) than patients who were RF negative (15%) (P = 0.02). Likewise, patients with RA who were positive for the anti-cyclic citrullinated peptide (CCP) antibodies were more likely to have moderate to severe periodontitis (56%) than patients who were anti-CCP negative (22%) (P = 0.01). There were no associations of periodontitis status with other measures of RA disease activity or severity.

CONCLUSIONS

In a cohort of U.S. veterans, periodontitis was more common and severe in patients with RA compared to patients with OA. Although unrelated to disease activity, the presence of periodontitis in patients with RA was associated with seropositivity for RF and the anti-CCP antibody, which was highly relevant given the associations of these autoantibodies with poor outcomes and disease pathogenesis in RA.

The flavonoids luteolin and quercetagetin inhibit lipoteichoic acid actions on H9c2 cardiomyocytes

Dental focal infections are infections in the mouth that cause subsequent infection and symptoms in other parts of the body. Dental conditions such as periodontitis have been associated with coronary heart disease. In this study, we investigated the effect of flavonoids on activation of mitogen-activated protein kinase (MAPK) family members, protein kinase B (AKT), and IL-1 beta expression by rat heart embryonic (H9c2) cells upon stimulation with LTA. Pretreatment with four flavonoids, including quercetin, genistein, quercetagetin, and luteolin diminished LTA-induced ERK1/2, JNK, p38, and AKT phosphorylation and IL-1 beta gene expression. Our findings indicate that flavonoids interfere with LTA signal transduction.

Dental health of community-living older people attending secondary healthcare: a cross-sectional comparison between those with and without diagnosed mental illness

BACKGROUND

Mental illness and cognitive impairment are risk factors for poor dental health.

METHODS

We conducted a cross-sectional study to compare the dental health of older patients attending out-patient clinics and day hospitals of old age psychiatry services (the psychiatry group, n = 103) with those attending general/geriatric medical services (the medical group; n = 99). Those living in care homes, and those with diagnosed mental illness (in the medical group) were excluded. A registered mental health nurse assessed mental and general health using validated and previously published instruments. A registered dentist made an independent assessment of dental health (examination to assess oral pathology, status of remaining teeth, and dentures) and made an overall judgment about whether the patient needed any dental treatment (a "normative" need).

RESULTS

The normative need for dental treatment was significantly higher among the psychiatry group compared to the medical group (85% vs 52%; p<0.001); even after taking account of the effect of age, gender, teeth status, physical comorbidity, cognition, depressive symptoms, and overall mental and social health [adjusted odds ratio, OR (95% confidence interval): 4.32 (2.09, 8.91)]. The presence of any natural remaining teeth [OR: 4.44 (2.10, 9.42)] and Barthel Index [OR: 0.96 (0.93, 0.99)] were the two other independent predictors of the need for treatment.

CONCLUSION

Dental problems are common in community-living older people, especially those with some natural remaining teeth and those with mental illness. There is a need to develop integrated mental health and dental care services for older people with emphasis on prevention of dental problems.

The American Journal of Cardiology and Journal of Periodontology editors' consensus: periodontitis and atherosclerotic cardiovascular disease

ACKNOWLEDGMENT

This Editors' Consensus is supported by an educational grant from Colgate-Palmolive, Inc., New York, New York, and is based on a meeting of the authors held in Boston, Massachusetts, on January 9, 2009.

DISCLOSURE

Dr. Friedewald has received honoraria for speaking from Novartis, East Hanover, New Jersey. Dr. Kornman is a full-time employee and shareholder of Interleukin Genetics, Waltham, Massachusetts, which owns patents on genetic biomarkers for chronic inflammatory diseases. Dr. Genco is a consultant to Merck, Whitehouse Station, New Jersey. Dr. Ridker has received research support from AstraZeneca, Wilmington, Delaware; Novartis; Pfizer, New York, New York; Roche, Nutley, New Jersey; Sanofi-Aventis, Bridgewater, New Jersey; and Abbott Laboratories, Abbott Park, Illinois. Dr. Ridker has received non-financial research support from Amgen, Thousand Oaks, California. Dr. Ridker is a co-inventor on patents held by Brigham and Women's Hospital that relate to the use of inflammatory biomarkers in cardiovascular disease. Dr. Ridker is a research consultant for Schering-Plough, Kenilworth, New Jersey; Sanofi-Aventis; AstraZeneca; Isis, Carlsbad, California; Novartis; and Vascular Biogenics, Tel Aviv, Israel. Dr. Van Dyke is a co-inventor on patents held by Boston University, Boston, Massachusetts, that relate to inflammation control, including consulting fees. Dr. Roberts has received honoraria for speaking from Merck, Schering-Plough, AstraZeneca, and Novartis. All other individuals in a position to control content disclosed no relevant financial relationships.

Periodontal disease and risk of atherosclerotic coronary heart disease

Atherosclerosis is an important component of coronary heart disease (CHD), which is the leading cause of death worldwide, including in Japan. Because atherosclerotic processes are typified by chronic inflammatory responses, which are similar to those elicited by chronic infection, the role of infection in promoting or accelerating atherosclerosis has received considerable focus. Increasing evidence supports the notion that periodontitis is associated with increased risk of atherosclerosis through dysfunction of endothelial cells induced by either periodontopathic bacteria or their products, or inflammatory mediators derived from infected periodontal tissue. Here we review whether periodontitis represents a risk factor for CHD or atherosclerosis, particularly in a Japanese population.

Number of teeth and myocardial infarction and stroke among elderly never smokers

Background

In most previous studies the association between number of teeth and cardiovascular diseases has been found to be stronger among younger age groups than in older age groups, which indicates that age may modify the association between number of teeth and cardiovascular diseases.

We investigated the association between tooth loss and atherosclerotic vascular diseases such as myocardial infarction and stroke in a homogeneous elderly population.

The study population was comprised of a subpopulation of 392 community-living elderly people who participated in the population-based Kuopio 75+ study. The data were collected through an interview, a structured clinical health examination and from patient records. The main outcome measures were a history of diagnosed myocardial infarction and diagnosed ischemic stroke. Prevalence proportion ratios (PPR) were estimated using generalised linear models.

Results

Edentate subjects had a weakly, statistically non-significantly increased likelihood of a history of myocardial infarction and ischemic stroke compared with dentate subjects. Those with a large number of teeth had a slightly, but not statistically significantly increased likelihood of a history of myocardial infarction and ischemic stroke compared with those with a small number of teeth.

Conclusion

These data did not show evidence that total or partial tooth loss would be associated with atherosclerotic vascular diseases such as myocardial infarction and ischemic stroke among an elderly population aged 75 years or older.

Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis

BACKGROUND

Periodontal disease is common among adults in the US and is a potential source of chronic inflammation. Recent data have suggested an important role for chronic inflammation in the development of coronary heart disease (CHD).

OBJECTIVE

To aid the United States Preventive Services Task Force (USPSTF) in evaluating whether periodontal disease is an independent novel risk factor for incident CHD.

METHODS

Studies were identified by searching Medline (1966 through March 2008) and reviewing prior systematic reviews, reference lists, and consulting experts. Prospective cohort studies that assessed periodontal disease, Framingham risk factors, and coronary heart disease incidence in the general adult population without known CHD were reviewed and quality rated using criteria developed by the USPSTF. Meta-analysis of good and fair quality studies was conducted to determine summary estimates of the risk of CHD events associated with various categories of periodontal disease.

RESULTS

We identified seven articles of good or fair quality from seven cohorts. Several studies found periodontal disease to be independently associated with increased risk of CHD. Summary relative risk estimates for different categories of periodontal disease (including periodontitis, tooth loss, gingivitis, and bone loss) ranged from 1.24 (95% CI 1.01-1.51) to 1.34 (95% CI 1.10-1.63). Risk estimates were similar in subgroup analyses by gender, outcome, study quality, and method of periodontal disease assessment.

CONCLUSION

Periodontal disease is a risk factor or marker for CHD that is independent of traditional CHD risk factors, including socioeconomic status. Further research in this important area of public health is warranted.

Inflammation as a potential mediator for the association between periodontal disease and Alzheimer's disease

Periodontal disease (PDD) is associated with increased risk of cardiovascular disease, cerebrovascular disease, and mortality in many studies, while other studies have begun to suggest an association of PDD with Alzheimer's disease (AD). This paper discusses how infectious pathogens and systemic infection may play a role in AD. The roles of infection and inflammation are addressed specifically with regard to known AD pathologic lesions including senile plaques, neuron death, neurofibrillary tangles, and cerebrovascular changes. A testable model of proposed pathways between periodontal infection and AD is presented including three possible mechanisms: a) direct effects of infectious pathogens, b) inflammatory response to pathogens, and c) the effects on vascular integrity. The role of gene polymorphisms is discussed, including apolipoprotein (APOE) varepsilon4 as a pro-inflammatory and pro-infection genotype.

The stomatognathic system in the elderly. Useful information for the medical practitioner

Aging per se has a small effect on oral tissues and functions, and most changes are secondary to extrinsic factors. The most common oral diseases in the elderly are increased tooth loss due to periodontal disease and dental caries, and oral precancer/cancer. There are many general, medical and socioeconomic factors related to dental disease (ie, disease, medications, cost, educational background, social class). Retaining less than 20 teeth is related to chewing difficulties. Tooth loss and the associated reduced masticatory performance lead to a diet poor in fibers, rich in saturated fat and cholesterols, related to cardiovascular disease, stroke, and gastrointestinal cancer. The presence of occlusal tooth contacts is also important for swallowing. Xerostomia is common in the elderly, causing pain and discomfort, and is usually related to disease and medication. Oral health parameters (ie, periodontal disease, tooth loss, poor oral hygiene) have also been related to cardiovascular disease, diabetes, bacterial pneumonia, and increased mortality, but the results are not yet conclusive, because of the many confounding factors. Oral health affects quality of life of the elderly, because of its impact on eating, comfort, appearance and socializing. On the other hand, impaired general condition deteriorates oral condition. It is therefore important for the medical practitioner to exchange information and cooperate with a dentist in order to improve patient care.

The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis

BACKGROUND

Previous studies have shown conflicting results as to whether periodontitis (PD) is associated with increased risk of coronary heart disease (CHD). The aim of the current study was to evaluate whether such an association exists.

METHODS

A systematic review of the literature revealed 5 prospective cohort studies (follow-up >6 years), 5 case-control studies, and 5 cross-sectional studies that were eligible for meta-analysis. Individual studies were adjusted for confounding factors such as age, sex, diabetes mellitus, and smoking. The 3 study categories were analyzed separately. Heterogeneity of the studies was assessed by Cochran Q test. The studies were homogeneous; therefore, the Mantel-Haenszel fixed-effect model was used to compute common relative risk and odds ratio (OR).

RESULTS

Meta-analysis of the 5 prospective cohort studies (86092 patients) indicated that individuals with PD had a 1.14 times higher risk of developing CHD than the controls (relative risk 1.14, 95% CI 1.074-1.213, P < .001). The case-control studies (1423 patients) showed an even greater risk of developing CHD (OR 2.22, 95% CI 1.59-3.117, P < .001). The prevalence of CHD in the cross-sectional studies (17724 patients) was significantly greater among individuals with PD than in those without PD (OR 1.59, 95% CI 1.329-1.907, P < .001). When the relationship between number of teeth and incidence of CHD was analyzed, cohort studies showed 1.24 times increased risk (95% CI 1.14-1.36, P < .0001) of development of CHD in patients with <10 teeth.

CONCLUSIONS

This meta-analysis indicates that both the prevalence and incidence of CHD are significantly increased in PD. Therefore, PD may be a risk factor for CHD. Prospective studies are required to prove this assumption and evaluate risk reduction with the treatment of PD.

Dental health, nutritional status and recent-onset dementia in a Korean community population

BACKGROUND

Dental health is an important determinant of nutritional status, but has not been investigated as a risk factor for dementia. This study aimed to investigate the association between number of teeth, use of dentures and recent-onset dementia.

METHODS

This was a cross-sectional analysis nested within a prospective study of community dwelling elderly residents in two areas of Kwangju, South Korea. In a study of 686 community residents aged 65 or over without dementia followed over 2.4 years, measures of dental health were compared between those with and without dementia at follow-up.

RESULTS

Fewer teeth were significantly associated with dementia and Alzheimer's disease. This association was strongest in participants without dentures. Strong associations were found between fewer teeth and indices of poor nutrition in this group, but these did not account for the association with dementia.

CONCLUSIONS

Having fewer teeth may be a marker of risk for dementia. This might be explained by specific nutritional deficits, or by other side effects of periodontal disease. Further prospective research is indicated.

Periodontal disease as a risk factor for acute myocardial infarction. A case-control study in Goans highlighting a review of the literature

OBJECTIVES

The aim of the present study was to investigate the possible association between periodontal health and acute myocardial infarction (AMI) in a case-control design.

MATERIALS AND METHODS

A total of 500 patients, 250 with AMI and 250 with coronary heart disease (CHD) were included in this study. The patients in the AMI group were admitted in the department of Medicine, Goa Medical College and Hospital, Bambolim-Goa because of AMI. The patients in the CHD group had no documented history of recent acute coronary events. Medical history was taken and data on serum lipid values, decayed teeth, missing teeth, filled teeth, probing depth (PD), simplified oral hygiene index (OHI-S) and bleeding on probing (BOP) were recorded. Sample proportions were compared by Pearson's chi-square test and quantitative variables with Student's t-test. The relation of clinical parameters and conventional risk factors with AMI was assessed with multivariate logistic regression analysis.

RESULTS

All the serum lipids and dental parameters were statistically different between AMI and CHD groups (p <0.05). Logistic regression analysis showed that serum lipids, number of decayed teeth, mean PD, percentage of sites with BOP, and oral hygiene were significantly associated with AMI (p <0.05).

CONCLUSION

The results of this study indicate that periodontal disease may be associated with AMI. We propose that prospective randomised studies are needed to determine whether periodontal disease is a risk factor in the occurrence of AMI.

Antibodies to Periodontal Organisms Are Associated with Decreased Kidney Function

BACKGROUND/AIMS

Increasing evidence suggests that clinical signs of periodontal disease are independently associated with renal impairment. However, no studies have examined the possible linkage of kidney disease with serum antibody to oral pathogens.

METHODS

The periodontal disease status was assessed in an older community-dwelling population (Dental Atherosclerosis Risk in Communities) to include: clinical measurements; oral biofilm microbial composition by DNA checkerboard, and serum antibody immunoglobulin-gamma (IgG) titers to specific bacteria by immunocheckerboard. Baseline characteristics were used to compute estimated glomerular filtration rate defining eGFR <60 ml/min/1.73 m(2) as impaired renal function in 103 of 5,032 subjects. Levels of serum IgG to specific oral bacteria were categorized by quartiles (comparing upper vs. lower three) as high titer and GFR <60 as the dependent variable in logistic regression models, adjusting for multiple comparisons (Hotelling T(2)) and traditional risk factors including age, race, smoking, diabetes, hypertension, body mass, waist-to-hip ratio, serum triglycerides, HDL, and LDL cholesterol.

RESULTS

High levels of serum IgG to selected periodontal pathogens including Porphyromonas gingivalis, Treponema denticola and Aggregobacter actinomycetemcomitans were associated with an increased odds for GFR <60 ml/min/1.73 m(2), adjusted odds ratio ranging from 1.6 to 1.8 and p < 0.05.

CONCLUSIONS

Elevated IgG to periodontal pathogens is significantly associated with impaired kidney function, independent of traditional risk factors. Prospective studies are necessary to confirm these findings.

The use of different measurements and definitions of periodontal disease in the study of the association between periodontal disease and risk of myocardial infarction

BACKGROUND

The role of periodontal disease as an independent risk factor for cardiovascular disease (CVD) has been under debate because of the inconsistency of findings across studies. One of the major issues is the method used to assess or define periodontal disease. The present study assesses if the observed association between periodontal disease and incident myocardial infarction (MI) depends on the measurements and/or criteria used to define periodontal disease.

METHODS

A population-based case-control study to evaluate the association between PD and risk of MI was conducted between 1997 and 2001 in Western New York with 537 cases and 800 controls, aged 35 to 69 years. Cases were survivors of incident MI from local hospitals in Erie and Niagara counties. Controls were randomly selected from residents of the same counties. Periodontal disease was assessed using interproximal clinical attachment loss (CAL), probing depth (PD), alveolar crest height (ACH), and number of missing teeth. From these measurements, four different case definitions of periodontal disease were created.

RESULTS

Using the continuous forms of periodontal measurements, the odds ratios (ORs) (95% confidence interval) of the association with incident MI were 1.46 (1.26 to 1.69), 2.19 (1.66 to 2.89), 1.30 (1.14 to 1.49), and 1.04 (1.02 to 1.07) for mean CAL, PD, ACH, and number of missing teeth, respectively. Regardless of the case definition of periodontal disease, the estimates of the association with incident MI were statistically significant.

CONCLUSIONS

The observed association between periodontal disease and incident MI was consistent across different measurements and/or case definitions of periodontal disease used. The magnitude of the association varies depending on the measurements or the criteria used to define periodontal disease.

Fimbria-dependent activation of pro-inflammatory molecules in Porphyromonas gingivalis infected human aortic endothelial cells

Epidemiological studies support that chronic periodontal infections are associated with an increased risk of cardiovascular disease. Previously, we reported that the periodontal pathogen Porphyromonas gingivalis accelerated atherosclerotic plaque formation in hyperlipidemic apoE-/- mice, while an isogenic fimbria-deficient (FimA-) mutant did not. In this study, we utilized 41 kDa (major) and 67 kDa (minor) fimbria mutants to demonstrate that major fimbria are required for efficient P. gingivalis invasion of human aortic endothelial cells (HAEC). Enzyme-linked immunosorbent assay (ELISA) revealed that only invasive P. gingivalis strains induced HAEC production of pro-inflammatory molecules interleukin (IL)-1beta, IL-8, monocyte chemoattractant protein (MCP)-1, intracellular adhesion molecule (ICAM)-1, vascular cellular adhesion molecule (VCAM)-1 and E-selectin. The purified native forms of major and minor fimbria induced chemokine and adhesion molecule expression similar to invasive P. gingivalis, but failed to elicit IL-1beta production. In addition, the major and minor fimbria-mediated production of MCP-1 and IL-8 was inhibited in a dose-dependent manner by P. gingivalis lipopolysaccharide (LPS). Both P. gingivalis LPS and heat-killed organisms failed to stimulate HAEC. Treatment of endothelial cells with cytochalasin D abolished the observed pro-inflammatory MCP-1 and IL-8 response to invasive P. gingivalis and both purified fimbria, but did not affect P. gingivalis induction of IL-1beta. These results suggest that major and minor fimbria elicit chemokine production in HAEC through actin cytoskeletal rearrangements; however, induction of IL-1beta appears to occur via a separate mechanism. Collectively, these data support that invasive P. gingivalis and fimbria stimulate endothelial cell activation, a necessary initial event in the development of atherogenesis.

Gingivitis, dental caries and tooth loss: risk factors for cardiovascular diseases or indicators of elevated health risks

OBJECTIVES

The results of earlier studies connecting dental diseases to cardiovascular diseases are inconsistent. Our aim in this cross-sectional study was to investigate whether there are associations of dental diseases and diagnosed angina pectoris among the 1966 Northern Finland Birth Cohort.

MATERIALS AND METHODS

A postal questionnaire was sent to all cohort members in 1997-1998. The number of replies totalled 8690. Angina pectoris was determined by asking whether the respondent had been diagnosed with angina pectoris. Gingivitis, dental caries and tooth loss were determined on the basis of self-reported gingival bleeding, presence of dental caries and six or more missing teeth.

RESULTS

We found overall associations of gingivitis (odds ratio (OR) 1.52, confidence interval (CI) 1.04-2.22), dental caries (OR 1.50, CI 1.04-2.18) and tooth loss (OR 1.53, CI 0.69-3.42) with the presence of angina pectoris. The associations were modified by gender and socioeconomic status. In addition, gingivitis, dental caries and tooth loss were also associated with several cardiovascular risk factors.

CONCLUSION

There were associations of self-reported gingivitis, dental caries and tooth loss with angina pectoris. However, the associations between dental diseases and cardiovascular risk factors suggest that the associations may be because of confounding.

Sensitization of human aortic endothelial cells to lipopolysaccharide via regulation of Toll-like receptor 4 by bacterial fimbria-dependent invasion

Toll-like receptors (TLRs) are differentially up-regulated in response to microbial infection and chronic inflammatory diseases such as atherosclerosis. Epidemiological data support the idea that periodontal disease may be a risk factor for acceleration of atherosclerosis. Porphyromonas gingivalis, the etiological agent of periodontal disease, invades endothelium, has been detected in human atheromatous tissue, and accelerates atheroma formation in apolipoprotein E-/- mice with concurrent induction of TLRs in the aorta. As endothelial cells can present antigen via TLRs and play an important role in the development of atherosclerosis, we examined TLR expression in human aortic endothelial cells (HAEC) cultured with wild-type P. gingivalis, a fimbria-deficient mutant, and purified antigens. We observed increased TLR expression in HAEC infected with wild-type P. gingivalis by fluorescence-activated cell sorter, but not with noninvasive, fimbria-deficient mutant or purified P. gingivalis antigens. Following a wild-type P. gingivalis challenge, functional TLR2 and TLR4 activation was assessed by subsequent stimulation with TLR agonists Staphylococcus aureus lipoteichoic acid (SLTA; TLR2 ligand) and Escherichia coli lipopolysaccharide (LPS; TLR4 ligand). Unchallenged HAEC failed to elicit monocyte chemoattractant protein 1 (MCP-1) in response to LPS or SLTA but did so when cultured with wild-type P. gingivalis. P. gingivalis-induced TLR2 and -4 expression on HAEC functionally reacted to SLTA and E. coli LPS as measured by a further increase in MCP-1 production. Furthermore, MCP-1 expression elicited by E. coli LPS was inhibitable with TLR4-specific antibody and polymyxin B. These results indicate that invasive P. gingivalis stimulates TLR expression on the surface of endothelium and these primed cells respond to defined TLR-specific ligands.

Salivary isoprostanes indicate increased oxidation injury in periodontitis with additional tobacco abuse

Isoprostanes (IPs) are indicators of in-vivo oxidative stress, and have been successfully used as markers for chronic inflammatory processes. The presence of chronic periodontal disease and cigarette smoking has been individually linked to the development of atherosclerosis, yet data regarding oxidative stress in this context are not available yet. The aim of this study was to evaluate levels of the salivary prostaglandins (PGs) 8-epi-PGF(2alpha), 6-oxo-PGF(1alpha), thromboxane B(2) (TXB(2)) and PGF(2alpha) in association with periodontal disease status with and without additional cigarette smoking. We analyzed saliva samples from 121 adults, (aged 21-73 years, 90 non-smokers, 31 smokers) for levels of 8-epi-PGF(2alpha), 6-oxo-PGF(1alpha), TXB(2) and PGF(2alpha). On the basis of periodontal disease indices the periodontal status of each subject was assessed and outcomes were then correlated with smoking status and laboratory findings. Salivary 8-epi-PGF(2alpha) levels increased with deteriorating plaque index, and were significantly higher (115.5 +/- 23.5 pg/ml) in smoking individuals, when compared to non-smokers (70.2 +/- 20.4 pg/ml, p<0.0001). In addition, smokers showed higher TXB(2) and PGF(2alphas) and lower 6-oxo-PGF(1alpha) levels p<0.0001). Oxidative stress, as reflected by elevated salivary 8-epi-PGF(2alpha) levels, is associated with the extent of periodontal disease and is significantly aggravated by concomitant tobacco abuse. Chronic inflammation and smoking have been individually associated with the development of atherosclerosis. The results of this study indicate that: 1) salivary IPs can reliably assess the degree of oxidative stress, and: 2) smoking and periodontal disease are two modifiable cardiovascular risk factors, able to potentiate each other.

Periodontal disease is associated with renal insufficiency in the Atherosclerosis Risk In Communities (ARIC) study

BACKGROUND

Periodontitis, a chronic bacterial infection of the oral cavity, is a novel risk factor for atherosclerotic cardiovascular disease (CVD). Given the numerous shared risk factors for CVD and chronic kidney disease (CKD), we hypothesized that periodontitis also is associated with renal insufficiency in the Dental Atherosclerosis Risk in Communities study.

METHODS

We conducted a cross-sectional study of 5,537 middle-aged black and white men and women. Periodontitis was determined by using an independent clinically derived definition and categorized as healthy/gingivitis, initial, and severe. Renal insufficiency is defined as glomerular filtration rate (GFR) less than 60 mL/min/1.73 m2 . Multivariable logistic regression models were used to estimate odds ratios and 95% confidence intervals for renal insufficiency using healthy/gingivitis as the referent group.

RESULTS

A total of 2,276 individuals had initial periodontitis, and 947 individuals had severe periodontal disease. One hundred ten individuals (2%) had a GFR less than 60 mL/min/1.73 m2 . Compared with healthy/gingivitis, initial and severe periodontal disease were associated with a GFR less than 60 mL/min/1.73 m2 (odds ratio, 2.00; 95% confidence interval, 1.23 to 3.24) for initial periodontal disease and an odds ratio of 2.14 for severe disease (95% confidence interval, 1.19 to 3.85) after adjustment for important risk factors for CVD and CKD. Sensitivity analysis showed that initial and severe periodontitis were each associated with an elevated serum creatinine level (men, >1.4 mg/dL [>124 micromol/L]; women, >1.2 mg/dL [>106 micromol/L]; odds ratio, 3.21; 95% confidence interval, 1.32 to 7.76 and odds ratio, 5.39; 95% confidence interval, 2.08 to 13.99, respectively).

CONCLUSION

This is the first study to show an association of periodontal disease with prevalent renal insufficiency. A prospective study is necessary to determine the exact nature of the observed relationship.

The immunoreactivity of systemic antibodies to Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in adult periodontitis

Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis secrete several potent virulence factors and are known to be two of the major periodontal pathogens. In the present case-control study, the systemic immunoreactivity to A. actinomycetemcomitans exotoxins, cytolethal distending toxin (Cdt) and leukotoxin was analyzed in adult subjects with periodontitis and in periodontally healthy controls. Furthermore, systemic immunoreactivity to P. gingivalis was analyzed in these subjects. Reactivity to the A. actinomycetemcomitans toxins was determined in bioassays that quantified neutralizing antibodies, and P. gingivalis antibodies were detected by enzyme-linked immunosorbent assay (ELISA). The results showed a significantly enhanced immunoreactivity to P. gingivalis in the subjects with periodontitis, while the reactivity to A. actinomycetemcomitans leukotoxin showed no significant difference between patients and controls. However, combined immunoreactivity to leukotoxin and Cdt was more prevalent in the subjects with periodontitis than in the controls. In addition, immunoreactivity to leukotoxin correlated to periodontitis in men but not in women. In conclusion, data from the present study indicate that immunoreactivity to P. gingivalis is frequent in adult periodontitis, while the role of A. actinomycetemcomitans seems to be more complex and depends on gender of the infected subject as well as the virulence of the bacteria.

Can the relation between tooth loss and chronic disease be explained by socio-economic status? A 24-year follow-up from the population study of women in Gothenburg, Sweden

The objective of this study was to evaluate the association between number of missing teeth and all cause, cardiovascular, and cancer mortality as well as morbidity and to explore whether socio-economic factors mediate this association. An ongoing prospective cohort study of 1462 Swedish women included a dental survey in 1968/69 with follow-up until 1992/93. The dental examination included a panoramic radiographic survey and a questionnaire. Number of missing teeth at baseline was analysed in a Cox proportional hazards model to estimate time to mortality and morbidity. Number of missing teeth, independently of socio-economic status variables (the husband's occupational category, combined income, and education) was associated with increased all cause mortality and cardiovascular disease mortality respectively (relative risk (RR): 1.36; 95% confidence interval (95% CI): 1.18-1.58) and (RR: 1.46; 95% CI: 1.15-1.85 per 10 missing teeth), but no associations were found for cancer mortality (RR: 1.18; 95% CI: 0.91-1.52). The relation between poor oral health and future cardiovascular disease could not be explained by measures of socio-economic status in this study.

Systemic effects of periodontal diseases

A number of studies suggest an association between periodontal disease and cardiovascular disease, pulmonary disease, diabetes,and pregnancy complications. Presently, the data must be regarded as preliminary. Additional large-scale longitudinal epidemiologic and interventional studies are necessary to validate these associations and to determine whether the associations are causal. The goal of this article is to review the history of this concept, describe the biologically plausible circumstances that may underlie these potential associations, and provide a summary of the published literature that supports or refutes them.