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Montero E, Herrera D. Response to Letter to the Editor "Diabetes and periodontitis". J Clin Periodontol 2024; 51:1254. [PMID: 38815960 DOI: 10.1111/jcpe.14006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 06/01/2024]
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Laky B, Bruckmann C, Blumenschein J, Durstberger G, Haririan H. Effect of a multinutrient supplement as an adjunct to nonsurgical treatment of periodontitis: A randomized placebo-controlled clinical trial. J Periodontol 2024; 95:101-113. [PMID: 37439597 DOI: 10.1002/jper.23-0115] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/03/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND The aim of this double-blind randomized placebo-controlled clinical trial was to evaluate the efficacy of a multinutrient supplement as an add-on therapy to scaling and root planing for patients with periodontitis. METHODS Forty-two patients with stage III or IV periodontitis were randomly allocated to a 2-month treatment of either a multinutrient supplement containing vitamin C, vitamin E, zinc, selenium, alpha-lipoic-acid, cranberry extract, grapeseed extract, and coenzyme Q10 or placebo capsules as an adjunct to conservative periodontal therapy. Periodontal parameters, including probing pocket depth, gingival recession, bleeding on probing, approximal plaque index, and papillary bleeding index, were assessed. Clinical attachment loss, periodontal inflamed surface area, periodontal epithelial surface area, and percentages of pocket sites with ≤3, ≤4, ≥5, ≥6, ≥7, and ≥4 mm with bleeding on probing were calculated. RESULTS All clinical parameters significantly improved from baseline to reevaluation within each group (p < 0.05). Multinutrient intake resulted in a significantly higher reduction of probing-pocket-depth (-0.75 ± 0.42 mm) and bleeding-on-probing (-21.9 ± 16.1%) from baseline to reevaluation compared with placebo (-0.51 ± 0.30 mm, p = 0.040 and -12.5 ± 9.8%, p = 0.046, respectively). All periodontal parameters showed insignificantly higher improvements in patients receiving the supplement compared with those receiving the placebo (p > 0.05). CONCLUSIONS Multinutrient supplementation as an adjunct to nonsurgical treatment of periodontitis showed some additional benefit regarding probing-pocket-depth and bleeding-on-probing. However, the clinical relevance needs to be further explored.
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Affiliation(s)
- Brenda Laky
- Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
- Department of Periodontology, Faculty of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Corinna Bruckmann
- Division of Conservative Dentistry and Periodontology, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Julian Blumenschein
- Division of Conservative Dentistry and Periodontology, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Gerlinde Durstberger
- Division of Conservative Dentistry and Periodontology, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Hady Haririan
- Department of Periodontology, Faculty of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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de Vasconcelos Calixto NR, Lopes FF, Franco MMP, Gomes-Filho IS, Benatti BB, Alves CMC. Comparative Study on the Periodontal Parameters Used in Diagnosing Periodontitis in Puerperae and Periodontitis' Relationship with the Birth of Preterm Infants: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:156. [PMID: 38397649 PMCID: PMC10887772 DOI: 10.3390/ijerph21020156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
To compare different criteria for the diagnosis of periodontitis and to evaluate the association of this condition with prematurity, this case-control study was conducted on 283 mothers of infants, divided into two groups based on gestational age (cases: <37 weeks, controls: ≥37 weeks), with 71 cases and 212 controls. The periodontal evaluation included probing depth (PD), clinical attachment level (CAL), plaque index, and bleeding on probing (BOP). Participants were classified regarding periodontitis per 14 criteria based on different periodontal parameters. The criterion selected as the gold standard was the presence of at least four teeth with one or more sites with a PD ≥ 4 mm, CAL ≥ 3 mm, and BOP at the same site. The prevalence of periodontal disease ranged from 8.1% to 55.1%. Moreover, compared to the gold standard, the sensitivities of the other criteria were 100%, while specificity ranged from 50.4% to 96.4%. Periodontitis, defined by six of the selected criteria, was associated with prematurity after multivariate adjustment, with OR ranging from 1.85 to 2.69 and 95% CI from 1.01 to 5.56; one of them was the gold standard mentioned above. Measurements using the clinical parameters of PD, CAL, and bleeding at the same site (criteria 5, 6, 7, 8), CPI (criterion 10), and at least four teeth with a PD ≥ 4 mm and CAL ≥ 3 mm (criterion 11) to define periodontitis showed a statistically significant association (p < 0.05). Given this study's limitations, we can conclude that the diagnostic criteria for a periodontitis definition using a PD ≥ 4 mm and CAL ≥ 3 mm in two or more teeth, with BOP at the same site, seem stronger when detecting an association between periodontitis and prematurity.
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Affiliation(s)
| | - Fernanda Ferreira Lopes
- Graduate Program in Dentistry, Federal University of Maranhão, São Luís 65080-805, Brazil (F.F.L.); (M.M.P.F.); (B.B.B.)
- Department of Dentistry II, Federal University of Maranhão, São Luís 65080-805, Brazil
| | - Marcela Mayana Pereira Franco
- Graduate Program in Dentistry, Federal University of Maranhão, São Luís 65080-805, Brazil (F.F.L.); (M.M.P.F.); (B.B.B.)
| | | | - Bruno Braga Benatti
- Graduate Program in Dentistry, Federal University of Maranhão, São Luís 65080-805, Brazil (F.F.L.); (M.M.P.F.); (B.B.B.)
- Department of Dentistry II, Federal University of Maranhão, São Luís 65080-805, Brazil
| | - Cláudia Maria Coêlho Alves
- Graduate Program in Dentistry, Federal University of Maranhão, São Luís 65080-805, Brazil (F.F.L.); (M.M.P.F.); (B.B.B.)
- Department of Dentistry II, Federal University of Maranhão, São Luís 65080-805, Brazil
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Ilango P, Mahendra J, Mahendra L, Cherian SM, Suresh V, Mahalingam A, Khanna VV, Thanigaimalai A. Association of pentraxin in periodontitis patients with coronary artery disease. J Indian Soc Periodontol 2023; 27:612-618. [PMID: 38434506 PMCID: PMC10906795 DOI: 10.4103/jisp.jisp_487_22] [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: 11/07/2022] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 03/05/2024] Open
Abstract
Objectives Pentraxin 3 (PTX3) is a biomarker, associated with the pathogenesis of Periodontitis and coronary artery disease (CAD) individually, but their role in patients with both diseases remains unclear. The current study aims to evaluate the association of PTX in patients with concomitant periodontitis and CAD. Materials and Methods In a case-control study, 240 participants were selected and divided into four groups. Nonperiodontitis + noncardiac = 60 patients, periodontitis + noncardiac (P + NC) = 60 patients, nonperiodontitis + cardiac (NP + C) = 60 patients, periodontitis + cardiac (P + C) = 60 patients. Demographic variables, cardiac and periodontal parameters were recorded. PTX was evaluated in the subgingival plaque and atheromatous plaque samples using real-time quantitative polymerase chain reaction and compared between the groups. The results were statistically analyzed. Results Among the demographic variables, age showed a significant difference between the groups. Systolic and diastolic blood pressure, low-density lipoprotein, and random blood sugar were significantly higher in NP + C and P + C groups (P ≤ 0.05). The plaque index, probing pocket depth, and clinical attachment loss were significantly higher in P + NC and P + C groups (P ≤ 0.05). PTX was significantly elevated in P + C group (P = 0.000). Pearson's correlation revealed a significant correlation between the periodontal parameters and PTX in both the cardiac and oral samples. Conclusion PTX3 levels were elevated in CAD patients with periodontitis suggesting the influence of periodontal inflammation in the progression of CAD. PTX3 may serve as a diagnostic and prognostic tool for both periodontitis and CAD. This study could provide an understanding and awareness about the potential role of PTX3 in both periodontitis and CAD.
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Affiliation(s)
- Paavai Ilango
- Department of Periodontics, Priyadarshini Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Jaideep Mahendra
- Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Little Mahendra
- Department of Periodontics, Maktoum bin Hamdan Dental University, Dubai, United Arab Emirates
| | - Sanjay M. Cherian
- Department of Cardiac Surgery, Frontier Lifeline Hospital, Chennai, Tamil Nadu, India
| | - Vasugi Suresh
- Department of Physiology, Indira Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Arulpari Mahalingam
- Department of Pedodontics, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - V. Vinoth Khanna
- Department of Animal Biotechnology, Madras Veterinary College, Chennai, Tamil Nadu, India
| | - Abirami Thanigaimalai
- Department of Periodontics, Priyadarshini Dental College and Hospital, Chennai, Tamil Nadu, India
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Andriankaja OM, Pérez CM, Modi A, Suaréz EL, Gower BA, Rodríguez E, Joshipura K. Systemic Inflammation, Endothelial Function, and Risk of Periodontitis in Overweight/Obese Adults. Biomedicines 2023; 11:1507. [PMID: 37371602 PMCID: PMC10294979 DOI: 10.3390/biomedicines11061507] [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: 04/10/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
The network interaction between systemic inflammatory mediators, endothelial cell adhesion function, and adiponectin as mediators of the association between metabolic diseases and periodontitis has not been evaluated. The objective of this study is to assess whether the interaction of baseline serum levels of TNF-α, hs-CRP, ICAM-1, VCAM-1, and adiponectin leads to periodontitis. Five hundred and ninety-seven overweight/obese (overweight: BMI 25 to <30 kg/m2; obese: >30 kg/m2) adults, aged 40-65 years, with complete 3-year follow-up data were included. Generalized structural equation models with negative binomial regression were used to estimate the regression coefficient (β) for the outcome number of teeth with probing pocket depth (PPD) ≥ 4 mm and bleeding on probing (BOP) at 3-year follow-up for a 1 standard deviation unit increase (Δ = +1SD) in each biomarker. After adjusting for multiple covariates, baseline ICAM-1 and VCAM-1 had significant direct effects on increased log-transformed number of teeth with PPD ≥ 4 mm and BOP (β: 0.16; 95% CI: 0.02-0.30; β: 0.15; 95% CI: 0.02-0.30, respectively). Baseline hs-CRP showed a significant indirect effect via ICAM-1 on the log-transformed number of teeth with PPD ≥ 4 mm and BOP (β: 4.84; 95% CI: 0.27-9.42). Thus, elevated serum ICAM-1 and VCAM-1 have a significant direct effect and increased hs-CRP has a significant indirect effect on the predicted level of periodontitis at the 3-year follow-up among overweight/obese Hispanic adults.
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Affiliation(s)
- Oelisoa M. Andriankaja
- Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, KY 40536, USA
| | - Cynthia M. Pérez
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan 00936-5067, Puerto Rico; (C.M.P.); (E.L.S.)
| | - Ashwin Modi
- Center for Clinical Research and Health Promotion, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan 00936-5067, Puerto Rico; (A.M.); (E.R.); (K.J.)
| | - Erick L. Suaréz
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan 00936-5067, Puerto Rico; (C.M.P.); (E.L.S.)
| | - Barbara A. Gower
- Department of Nutrition Sciences, Division of Physiology & Metabolism, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Elaine Rodríguez
- Center for Clinical Research and Health Promotion, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan 00936-5067, Puerto Rico; (A.M.); (E.R.); (K.J.)
| | - Kaumudi Joshipura
- Center for Clinical Research and Health Promotion, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan 00936-5067, Puerto Rico; (A.M.); (E.R.); (K.J.)
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
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Zhan Y, Jiao J, Jing W, Feng X, Tai B, Hu D, Lin HC, Wang B, Wang C, Zheng S, Liu X, Rong W, Wang W, Wang X, Si Y, Meng H. Association between periodontitis and hypertension: cross-sectional survey from the Fourth National Oral Health Survey of China (2015-2016). BMJ Open 2023; 13:e068724. [PMID: 36972967 PMCID: PMC10069577 DOI: 10.1136/bmjopen-2022-068724] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES To evaluate the association between periodontitis severity and hypertension based on Chinese epidemiological data. DESIGN This cross-sectional survey enrolled adults from the Fourth National Oral Health Survey of China (2015-2016). SETTING The data were obtained from the Fourth National Oral Health Survey of China (2015-2016). PARTICIPANTS The study included individuals aged 35-44 years (n=4409), 55-64 years (n=4568) and 65-74 years (n=4218). PRIMARY AND SECONDARY OUTCOME MEASURES Periodontal status, defined on the basis of the 2017 classification scheme, and periodontal parameters (eg, bleeding on probing (BOP)) were compared between individuals with hypertension and individuals with normotension. Smoothed scatterplots were constructed to demonstrate the associations of periodontal parameters and periodontal status with hypertension. RESULTS Severe periodontitis (stages III and IV) was present in 41.4% of individuals with hypertension and 28.0% of individuals with normotension, respectively (p<0.001). The prevalence of severe periodontitis was higher in individuals with hypertension than that in individuals with normotension among participants aged 35-44 years (18.0% vs 10.1%, p<0.001) and 55-64 years (40.2% vs 36.7%, p=0.035), but not in participants aged 65-74 years (46.4% vs 45.1%, p=0.429). Therefore, the difference in periodontal status between individuals with hypertension and individuals with normotension decreased with age. There were higher prevalences of BOP, probing depth (PD) ≥4 mm and PD ≥6 mm in individuals with hypertension than in individuals with normotension (52.1% vs 49.2%, 19.6% vs 14.7% and 1.8% vs 1.1%, respectively). Periodontitis severity and the proportion of teeth with PD ≥4 or ≥6 mm were positively associated with hypertension. CONCLUSION Periodontitis is associated with hypertension in Chinese adults. Hypertension prevalence increased with periodontitis severity, particularly among young participants. Accordingly, it is necessary to improve the education, awareness of periodontal treatment and preventive management among individuals at risk of hypertension, particularly in the younger population.
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Affiliation(s)
- Yalin Zhan
- First Clinical Division & Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
| | - Jian Jiao
- First Clinical Division & Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
| | - Wudi Jing
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
| | - Xiping Feng
- Department of Preventive Dentistry, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, People's Republic of China
| | - Baojun Tai
- School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Deyu Hu
- West China School of Stomatology, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Huan-Cai Lin
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Bo Wang
- Chinese Stomatological Association, Beijing, People's Republic of China
| | - Chunxiao Wang
- Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Shuguo Zheng
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
| | - Xuenan Liu
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
| | - Wensheng Rong
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
| | - Weijian Wang
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
| | - Xing Wang
- Chinese Stomatological Association, Beijing, People's Republic of China
| | - Yan Si
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
| | - Huanxin Meng
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People's Republic of China
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Evaluating the relationship between ankylosing spondylitis and periodontal disease: a case-control study. Clin Oral Investig 2023; 27:411-420. [PMID: 36394610 DOI: 10.1007/s00784-022-04776-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/06/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study aimed to determine the possible relationship between periodontal disease and ankylosing spondylitis (AS) by evaluating clinical periodontal measurements and gingival crevicular fluid (GCF) levels of sclerostin, interleukin-1β (IL-1ß), and matrix metalloproteinase-8 (MMP-8) levels. MATERIALS AND METHODS Twenty-eight patients with AS (AS group) and 28 systemically healthy controls (C group) were enrolled in this study. Full-mouth periodontal measurements: plaque index, bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) measurements were obtained from all patients. AS-related parameters were included in the data analyses. An enzyme-linked immunosorbent assay determined GCF IL-1β, MMP-8, and sclerostin levels. RESULTS There were no significant differences in the clinical periodontal measurements between the two groups (p > 0.05). Interestingly, patients with AS had significantly lower GCF sclerostin levels than the C group (p < 0.05). But there were no statistical differences in the GCF levels of IL-1ß and MMP-8 between the two groups (p > 0.05). Serum C-reactive protein (CRP) levels strongly correlated with both BOP (r = 0.497, p < 0.05) and PPD (r = 0.570, p < 0.05) in the AS group. Bath AS Metrology Index (BASMI) also positively correlated with both BOP (r = 0.530, p < 0.05) and CAL (r = 0.568, p < 0.05). Similarly, Maastrıcht Ankylosing Spondylitis Enthesis Score (MASES) strongly correlated with both BOP (r = 0.487, p < 0.05) and CAL (r = 0.522, p < 0.05). CONCLUSION These results suggest that the patient's systemic condition may influence local sclerostin levels in GCF, and the strong correlations between periodontal measurements and AS-related parameters may indicate an interrelationship between inflammatory periodontal disease and AS. CLINICAL RELEVANCE The present study provides important information concerning the relationship between periodontal disease and ankylosing spondylitis. TRIAL REGISTRATION Thai Clinical Trials.gov (TCTR20200908001) (08. September 2020).
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Ilango P, Mahendra J, Mahendra L, Cherian SM, Suresh V, Mahalingam A, Khanna VV, Abirami T. Evaluation of the periodontal viruses in cardiovascular patients associated with periodontitis. Oral Dis 2022; 29:1826-1835. [PMID: 35229412 DOI: 10.1111/odi.14175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/24/2022] [Accepted: 02/12/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The current study aims in evaluating the prevalence of Epstein-barr virus (EBV), Cytomegalovirus (CMV) and Herpes simplex virus (HSV) in periodontitis and/or Coronary artery disease (CAD) patients to compare with their healthy controls and insist their significance in the same. METHODOLOGY Two hundred and forty patients were divided into 4 groups. Non-periodontitis+non-cardiac (NP+NC) =60 patients, periodontitis+non-cardiac patients (P+NC)=60 patients, non-periodontitis+cardiac patients (NP+C)=60 patients and periodontitis+cardiac (P+C)=60 patients. Demographic variables, cardiac and periodontal parameters were recorded. EBV, CMV and HSV were evaluated in the sub- gingival plaque samples using RT-PCR (Real time polymerase chain reaction) and compared between the groups. The results were statistically analysed using Students t test, Pearson's chi square, Turkey post hoc analysis and multiple logistic regression analysis. RESULTS The demographic variables did not differ significantly between the groups, except for age. Systolic blood pressure, Diastolic blood pressure, Low density lipoprotein, Random blood sugar were significantly higher in NP+C and P+C (p≤0.05). The Plaque Index, Probing Pocket Depth and Clinical Attachment Loss (p≤0.05) were significantly higher in P+NC and P+C. EBV and CMV was significantly higher in the two periodontitis groups P+NC and P+C (p-value=0.000). HSV was significantly higher in the two cardiac groups (NP+C and P+C) (p≤0.05). Multiple logistic regression analysis revealed a significant association between EBV and CAL (p≤0.05). CONCLUSION The study concluded that higher prevalence of EBV and CMV were found in groups with periodontitis patients. This indicates the significant role of the viruses in periodontitis as confirmed by association of EBV and CAL. The viruses were said to be highest in periodontitis patients with CAD. This could pave a new link in the risk of CAD in periodontitis patients.
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Affiliation(s)
- Paavai Ilango
- Department of Periodontics, Priyadarshini Dental College and Hospital, Chennai, 600 095, India
| | - Jaideep Mahendra
- Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research, Chennai, 600 095, India
| | - Little Mahendra
- Department of Periodontics, Dean, Maktoum bin Hamdan Dental University, Dubai
| | - Sanjay M Cherian
- Department of Cardiac Surgery, Frontier Lifeline Hospital, Chennai, 600 037, India
| | | | - Arulpari Mahalingam
- Department of Pedodontics, Thai Moogambigai Dental College and Hospital, Chennai, 600 107, India
| | - V Vinoth Khanna
- Department of Animal Biotechnology, Madras Veterinary college, VeperyS, Chennai, 600 007, India
| | - T Abirami
- Department of Periodontics, Priyadarshini Dental College and Hospital, Chennai, 600 095, India.,Department of Physiology, Priyadarshini Dental College and Hospital, Chennai, 600 095, India
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Pietropaoli D, Monaco A, D'Aiuto F, Muñoz Aguilera E, Ortu E, Giannoni M, Czesnikiewicz-Guzik M, Guzik TJ, Ferri C, Del Pinto R. Active gingival inflammation is linked to hypertension. J Hypertens 2020; 38:2018-2027. [PMID: 32890278 DOI: 10.1097/hjh.0000000000002514] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVD) including hypertension, are characterized by underlying systemic inflammation. Periodontitis, which can impact the systemic inflammatory burden has recently been linked to high blood pressure (BP). However, the relationship of gingival bleeding, as an easily accessible marker of periodontal disorder, with hypertension, remains unclear. METHODS Survey-based propensity score matching (PSM) incorporating major confounders shared between hypertension and periodontal diseases was applied to cross-sectional NHANES III data from 5396 adults at least 30 years old who underwent BP measurement and periodontal examination, identifying two matched groups with and without gingival bleeding. The association of bleeding gums with SBP (mmHg) and high/uncontrolled BP was then assessed with generalized additive models incorporating inflammatory markers. Stratification by periodontal status (healthy; gingivitis; stable periodontitis; unstable periodontitis) was performed. Variables importance was estimated using machine learning. RESULTS Gingival bleeding (gingivitis; unstable periodontitis) was independently associated with +2.6 mmHg (P < 0.001) SBP compared with no bleeding (healthy periodontium; stable periodontitis), and with greater odds (OR = 1.42; 95% CI = 1.19-1.68; P < 0.001) of high/uncontrolled BP. Participants with unstable periodontitis had higher SBP than those with stable periodontitis (+2.1 mmHg; P < 0.001) or gingivitis (+5.3 mmHg; P < 0.001). Unstable periodontitis and gingivitis were consistently associated with increased risk of high/uncontrolled BP (OR = 1.65, 95% CI = 2.14-1.82; OR = 1.49, 95% CI = 1.22-1.82, respectively). Inflammatory markers allowed a maximum of 12% gain in the models' predictive power. CONCLUSION Gingival bleeding contributes to shaping the relationship between periodontal diseases and BP, but the burden represented by periodontitis is also crucial. Periodontal evaluation might be of importance in difficult to control hypertension.
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Affiliation(s)
- Davide Pietropaoli
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Dental Clinic - Unit of Oral Diseases, Prevention and Translational Research - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Annalisa Monaco
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Dental Clinic - Unit of Oral Diseases, Prevention and Translational Research - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London
| | - Eva Muñoz Aguilera
- Periodontology Unit, UCL Eastman Dental Institute and Hospital, University College London, London
| | - Eleonora Ortu
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Dental Clinic - Unit of Oral Diseases, Prevention and Translational Research - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Mario Giannoni
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Dental Clinic - Unit of Oral Diseases, Prevention and Translational Research - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Marta Czesnikiewicz-Guzik
- Department of Periodontology and Oral Sciences Research Group, University of Glasgow Dental School, Glasgow, UK
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Internal and Agricultural Medicine, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Unit of Internal Medicine and Nephrology, Center for Hypertension and Cardiovascular Prevention - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
| | - Rita Del Pinto
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila - Unit of Internal Medicine and Nephrology, Center for Hypertension and Cardiovascular Prevention - Oral DISeases and SYstemic interactions study group (ODISSY group), L'Aquila, Italy
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10
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Gil-Montoya JA, Garrido-Martínez M, Barrios-Rodríguez R, Ramos-García P, Lenouvel D, Montes-Castillo C, Martínez-Ramírez MJ. Association between low bone mineral density and periodontitis in generally healthy perimenopausal women. J Periodontol 2020; 92:95-103. [PMID: 32716051 DOI: 10.1002/jper.20-0029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The association between low bone mineral density (BMD) and periodontitis in perimenopausal women is controversial. The purpose of this study was to determine whether osteoporosis or osteopenia is associated with periodontal disease in a population of adult women. METHODS A sample of over-45-year-old women with or without low BMD underwent lumbar spine and hip bone densitometry and a complete periodontal examination. The extent/severity or absence of periodontal disease was noted using two different case definitions. Data were gathered on socio-economic status, medication history, systemic co-morbidities, alcohol or tobacco use as well as serum levels of calcium and vitamin D. RESULTS One hundred seventy three women aged between 45 and 72 years old were recruited with a mean age of 57.8 years. One hundred and three had decreased BMD (61 with osteoporosis and 42 with osteopenia) and 70 were healthy. Moderate or severe periodontitis was present in 52.6% of the women. Multivariate analysis showed a clear association between low BMD and periodontitis, but only in women above 58 years old and independent of tobacco consumption or oral hygiene. CONCLUSION In this sample of generally healthy perimenopausal women, low BMD was associated with clinical attachment level (CAL). Women over 58 years old with decreased BMD presented with a higher mean percentage of sites with CAL ≥ 4 mm as well as CAL ≥ 6 mm when compared to controls, independent of active smoking status or poor oral hygiene.
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Affiliation(s)
- José Antonio Gil-Montoya
- Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain
| | | | - Rocío Barrios-Rodríguez
- Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain
| | - Pablo Ramos-García
- Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain
| | - Daniel Lenouvel
- Biosanitary Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain
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11
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Nwizu N, Wactawski-Wende J, Genco RJ. Periodontal disease and cancer: Epidemiologic studies and possible mechanisms. Periodontol 2000 2020; 83:213-233. [PMID: 32385885 PMCID: PMC7328760 DOI: 10.1111/prd.12329] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Epidemiologic and cancer control studies on the association of periodontal disease and cancer risk mostly suggest a positive association with overall cancer risk and certain specific types of cancer. These findings are generally consistent among cross‐sectional and longitudinal studies. In this paper, we review epidemiologic studies and current knowledge on periodontal disease and cancer, with a focus on those studies conducted in the years following the Joint European Federation of Periodontology/American Academy of Periodontology Workshop on “Periodontitis and Systemic Diseases” in November 2012. This review also explores the role of chronic inflammation as a biologically plausible mechanistic link between periodontal disease and risk of cancer. Furthermore, it highlights studies that have examined the potential importance of certain periodontal pathogens in this association.
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Affiliation(s)
- Ngozi Nwizu
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, USA.,School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, USA.,Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, USA
| | - Jean Wactawski-Wende
- School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, USA
| | - Robert J Genco
- Department of Oral Biology, University at Buffalo, The State University of New York, Buffalo, USA
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12
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Schenkein HA, Papapanou PN, Genco R, Sanz M. Mechanisms underlying the association between periodontitis and atherosclerotic disease. Periodontol 2000 2020; 83:90-106. [PMID: 32385879 DOI: 10.1111/prd.12304] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Atherosclerosis is central to the pathology of cardiovascular diseases, a group of diseases in which arteries become occluded with atheromas that may rupture, leading to different cardiovascular events, such as myocardial infarction or ischemic stroke. There is a large body of epidemiologic and animal model evidence associating periodontitis with atherosclerotic disease, and many potential mechanisms linking these diseases have been elucidated. This chapter will update knowledge on these mechanisms, which generally fall into 2 categories: microbial invasion and infection of atheromas; and inflammatory and immunologic. With respect to the invasion and infection of atheromas, it is well established that organisms from the subgingival biofilm can enter the circulation and lodge in most distant tissues. Bacteremias resulting from oral interventions, and even oral hygiene activities, are well documented. More recently, indirect routes of entry of oral organisms (via phagocytes or dendritic cells) have been described for many oral organisms, into many tissues. Such organisms include the periodontal pathogens Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Tannerella forsythia, and Fusobacterium nucleatum. Intracellular survival of these organisms with dissemination to distant sites (The Trojan Horse approach) has been described. Their relative contribution to atheroma formation and progression has been studied mainly in experimental research, with results demonstrating that these organisms can invade endothelial cells and phagocytic cells within the atheroma, leading to pathogenic changes and progression of the atheroma lesion. The second category of mechanisms potentially linking periodontitis to atherosclerosis includes the dumping of inflammatory mediators originating from periodontal lesions into the systemic circulation. These inflammatory mediators, such as C-reactive protein, matrix metalloproteinases, fibrinogen, and other hemostatic factors, would further accelerate atheroma formation and progression, mainly through oxidative stress and inflammatory dysfunction. Moreover, direct effects on lipid oxidation have also been described. In summary, the evidence supports the concept that periodontitis enhances the levels of systemic mediators of inflammation that are risk factors for atherosclerotic diseases.
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Affiliation(s)
- Harvey A Schenkein
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia
| | - Panos N Papapanou
- Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, NewYork, New York, USA
| | - Robert Genco
- Departments of Oral Biology, and Microbiology and Immunology, Center for Microbiome Research, University at Buffalo, Buffalo, New York, USA
| | - Mariano Sanz
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain
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13
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Bilgin Çetin M, Önder C, Orhan K, Kumbasar D, Serdar MA, Ünsal E. Relationship of periodontitis and edentulism to angiographically diagnosed coronary artery disease: A cross-sectional study. J Periodontal Res 2020; 55:895-904. [PMID: 32648271 DOI: 10.1111/jre.12782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The objective of the study is to examine the connection between oral status and the extent of coronary artery disease (CAD), which is diagnosed by angiography. BACKGROUND Periodontitis and tooth loss have been linked to atherosclerosis and CAD in previous studies. However, no distinct connection was revealed due to the diversity of the results and the variety of diagnostic methods. To provide a more consistent data pool and stronger evidence, there is a need for studies with standard measurements and diagnostic criteria. METHODS 309 patients, who consulted to Ankara University, Faculty of Medicine, Department of Cardiology and had coronary angiography, were enrolled to this study. Individuals were grouped based on their coronary angiography results, as CAD (+) (n = 233) and CAD (-) (n = 76). Studied parameters included cardiovascular risk factors, plaque index (PI), remaining teeth count, bleeding on probing (BOP), and probing pocket depth (PPD). Periapical radiographs were taken from teeth with ≥4 mm PPD. Oral status was categorized as periodontally healthy subjects/patients with gingivitis (Group 1), patients with periodontitis (Group 2), and edentulous subjects (Group 3). RESULTS PI (P < 0.001), PPD (P = 0.001), BOP (P = 0.004), the number of patients with less than 10 teeth (P = 0.014), and edentulism (P = 0.009) were significantly higher in CAD (+) patients, who were mostly older (P < 0.001) and male (P < 0.001). Multivariate logistic regression analysis revealed that Group 2 (odds ratio = 2.48, 95% confidence interval = 1.24-4.95, P = 0.010) and Group 3 (odds ratio = 2.01, 95% confidence interval = 1.14-5.17, P = 0.040) were highly associated with CAD. Two and three stenosed vessels were significantly higher in Groups 2 and 3 compared to Group 1 (P = 0.003). CONCLUSIONS It was found that both edentulism and periodontitis were related to CAD.
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Affiliation(s)
- Mehtap Bilgin Çetin
- Department of Periodontology, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Canan Önder
- Department of Periodontology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Kaan Orhan
- Department of Dento Maxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Deniz Kumbasar
- Department of Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Elif Ünsal
- Department of Periodontology, Faculty of Dentistry, Ankara University, Ankara, Turkey
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14
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Yılmaz Şaştım Ç, Gürsoy M, Könönen E, Kasurinen A, Norvio S, Gürsoy UK, Doğan B. Salivary and serum markers of angiogenesis in periodontitis in relation to smoking. Clin Oral Investig 2020; 25:1117-1126. [PMID: 32643086 DOI: 10.1007/s00784-020-03411-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Angiogenesis is essential in maintenance of periodontal homeostasis, and it is regulated by growth factors and cytokines, including basic fibroblast growth factor (b-FGF), endoglin, platelet and endothelial cell adhesion molecule (PECAM-1), vascular endothelial growth factor (VEGF), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1). In this study, the salivary and serum concentrations of these angiogenesis-related proteins in relation to smoking and periodontitis were examined. MATERIAL AND METHODS Full-mouth periodontal status together with unstimulated whole saliva and serum samples was collected from 78 individuals, including 40 periodontitis patients (20 smokers and 20 nonsmokers) and 38 periodontally healthy controls (20 smokers and 18 nonsmokers). The Luminex®-xMAP™ technique was used for protein analyses. RESULTS Concentrations of all tested proteins in saliva as well as VEGF in serum were significantly higher in periodontitis patients than in healthy controls. In smokers, serum concentrations of endoglin (p = 0.017) and sICAM-1 (p = 0.001) were elevated in comparison to nonsmokers. After adjusting for smoking and gender, periodontitis associated significantly with salivary concentrations of b-FGF, PECAM-1, VEGF, sICAM-1, and sVCAM-1 (p < 0.01). CONCLUSION Taken together, salivary concentrations of b-FGF, PECAM-1, and VEGF associate with periodontitis. The suppressive effect of smoking on salivary marker levels is limited to periodontitis patients only. CLINICAL RELEVANCE Smoking-related suppression of salivary marker levels is observed only in periodontitis patients.
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Affiliation(s)
- Çiğdem Yılmaz Şaştım
- Department of Periodontology, Faculty of Dentistry, University of Marmara, 34854 Maltepe, Istanbul, Turkey
| | - Mervi Gürsoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Eija Könönen
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
- Oral Health Care, Welfare Division, City of Turku, Turku, Finland
| | - Akseli Kasurinen
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Susanna Norvio
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Ulvi Kahraman Gürsoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Başak Doğan
- Department of Periodontology, Faculty of Dentistry, University of Marmara, 34854 Maltepe, Istanbul, Turkey.
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15
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Ilango P, Mahendra J, Mahendra L, Cherian SM, Kathaperumal K, Suresh V, Mahalingam A, T A. Evidence linking the role of periodontal viruses in coronary artery disease with and without periodontitis. J Periodontol 2020; 92:113-122. [PMID: 32449954 DOI: 10.1002/jper.19-0704] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/09/2020] [Accepted: 04/08/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Viruses are considered to be a newer family associated with inflammatory diseases. Yet the role of periodontal viruses in coronary artery diseases (CAD) remains unclear. Thus, the current study aims to evaluate the prevalence of periodontal viruses and compare the same in cardiac samples of CAD patients with and without periodontitis. METHODS A total of 60 patients with CAD indicated for coronary artery bypass graft surgery (CABG) were included. These were grouped into 36 patients with healthy periodontium (CAD only) and 24 patients with periodontitis (CAD + P). The demographic variables, cardiac parameters and periodontal parameters were recorded. Cardiac tissue samples were collected during the CABG surgery and were analyzed by reverse transcriptase polymerase chain reaction for periodontal viruses such as Epstein-Barr virus (EBV), cytomegalovirus (CMV) and Herpes simplex virus. All the parameters were statistically analyzed. RESULTS Among the demographic variables, age was statistically significant between the groups. Plaque index, bleeding index, probing depth, and clinical attachment level (CAL) were significantly higher in CAD+P group (P ˂0.05). Periodontal viruses such as EBV and CMV were significantly higher (62.5% and 75% respectively, P ˂0.05) in the cardiac samples of the CAD+P than CAD only (25% and 47.2%, respectively). A significant association between EBV and CAL was revealed by multiple logistic regression analysis. (B = 0.374, P = 0.046) CONCLUSIONS: The results revealed a higher prevalence of periodontal viruses such as EBV and CMV in CAD patients with periodontitis suggesting it as one of the risk factors for CAD. This is supported by the fact that severity of periodontal disease (CAL) is associated with the presence of EBV in coronary artery plaque samples in the current study.
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Affiliation(s)
- Paavai Ilango
- Department of Periodontics, Priyadarshini Dental College and Hospital, Chennai, India
| | - Jaideep Mahendra
- Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Chennai, India
| | - Little Mahendra
- Department of Periodontics, Maktoum bin Hamdan Dental University, Dubai, UAE
| | - Sanjay M Cherian
- Department of Cardiac Surgery, Frontier Lifeline Hospital, Chennai, India
| | - Kumanan Kathaperumal
- Department of Animal Biotechnology, Tamil Nadu Veterinary and Animal Sciences University, Chennai, India
| | - Vasugi Suresh
- Department of Pedodontics, Thai Moogambigai Dental College and Hospital, Chennai, India
| | - Arulpari Mahalingam
- Department of Physiology, Priyadarshini Dental College and Hospital, Chennai, India
| | - Abirami T
- Department of Periodontics, Priyadarshini Dental College and Hospital, Chennai, India
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16
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Beck JD, Philips K, Moss K, Sen S, Morelli T, Preisser J, Pankow J. Periodontal disease classifications and incident coronary heart disease in the Atherosclerosis Risk in Communities study. J Periodontol 2020; 91:1409-1418. [PMID: 32449797 DOI: 10.1002/jper.19-0723] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Periodontal disease has been linked to coronary heart disease (CHD), but studies have been inconclusive. This study investigates the link between periodontal disease and incident CHD. METHODS Baseline periodontal data from a full-mouth periodontal exam (N = 6,300) and CHD outcomes through 2017 were obtained from the Atherosclerosis Risk in Communities Study. Periodontitis was defined by the Periodontal Profile Class System adapted to Stages (PPC stages) and the Centers for Disease Control/American Academy of Periodontology (CDC/AAP) index. Competing risk models were used to determine hazard ratios (HR) for incident CHD, congestive heart failure (CHF), and other causes of death. Secondary analysis included myocardial infarction (MI) and fatal CHD. RESULTS Females comprised 56% of participants and males 44% with a combined mean age of 62.3 years (range: 52 to 74). Participants were followed for an average of 16.7 (SD: 5.5) years. In a fully adjusted model, PPC stage VII (Severe Tooth Loss) was moderately significantly related to incident CHD, (HR 1.51 [1.11 to 2.09]). PPC stage V (Mild Tooth Loss/High Gingival Inflammation) was significant for fatal CHD (HR, 5.27 [1.80 to 15.4]) and PPC stage VII was significant for incident MI (HR, 1.59 [1.13 to 2.23]). The CDC/AAP definition was not significantly associated with incident CHD. CONCLUSIONS Incident CHD was moderately significantly associated with a specific stage of periodontal disease characterized by severe tooth loss, while none of the categories of the CDC/AAP were significantly associated. Thus, while periodontal therapy may improve oral health, it may be effective at impacting CHD incidence in only certain groups of people.
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Affiliation(s)
- James D Beck
- Division of Comprehensive Oral Health - Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kamaira Philips
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kevin Moss
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Souvik Sen
- Department of Neurology, University of South Carolina, School of Medicine, Columbia, SC
| | - Thiago Morelli
- Division of Comprehensive Oral Health - Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - James Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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17
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Machado V, Aguilera EM, Botelho J, Hussain SB, Leira Y, Proença L, D’Aiuto F, Mendes JJ. Association between Periodontitis and High Blood Pressure: Results from the Study of Periodontal Health in Almada-Seixal (SoPHiAS). J Clin Med 2020; 9:E1585. [PMID: 32456145 PMCID: PMC7291060 DOI: 10.3390/jcm9051585] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/11/2022] Open
Abstract
Periodontitis is a common chronic inflammatory disease which could have an important impact on blood pressure (BP). This study aimed to explore (a) the association between periodontal health and BP in a large representative cohort, (b) the predictive value of diagnosis of periodontitis in undiagnosed raised BP and (c) whether age is a mediator of this relationship. In total, 1057 randomly recruited individuals (mean age, 60.9 ± 16.3 years, 57.7% women) underwent periodontal clinical assessment and one-single BP measurement using an automated sphygmomanometer device. Logistic and linear regression models were used to estimate the odds of hypertension based on periodontitis case definitions. Mediation analysis was performed to understand the effect of age on the association of periodontitis with hypertension. Adjusted logistic model for gender, smoking habits and body mass index confirmed the association between high BP and periodontitis (OR = 2.31, 95%CI: 1.75-3.04, p < 0.001). Among 168 participants with undiagnosed high BP (15.9% of the study sample), 62.5% had periodontitis (n = 105). In this study, the association between periodontitis with both systolic blood pressure (SBP) (77.6%, p < 0.001) and diastolic blood pressure (DBP) (66.0%, p < 0.001) was mediated by age. Periodontitis is closely linked to BP in a representative Portuguese population.
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Affiliation(s)
- Vanessa Machado
- Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal;
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal;
| | - Eva Muñoz Aguilera
- Periodontology Unit, University College London Eastman Dental Institute, 21 University Street, London WC1E 6DE, UK; (E.M.A.); (S.B.H.); (Y.L.); (F.D.)
- Department of Periodontology, Faculty of Dentistry, Universitat Internacional de Catalonia, 08195 Barcelona, Spain
| | - João Botelho
- Periodontology Department, Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal;
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal;
| | - Syed Basit Hussain
- Periodontology Unit, University College London Eastman Dental Institute, 21 University Street, London WC1E 6DE, UK; (E.M.A.); (S.B.H.); (Y.L.); (F.D.)
| | - Yago Leira
- Periodontology Unit, University College London Eastman Dental Institute, 21 University Street, London WC1E 6DE, UK; (E.M.A.); (S.B.H.); (Y.L.); (F.D.)
- Medical-Surgical Research Group, Health Research Institute of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Luís Proença
- Quantitative Methods for Health Research (MQIS), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal;
| | - Francesco D’Aiuto
- Periodontology Unit, University College London Eastman Dental Institute, 21 University Street, London WC1E 6DE, UK; (E.M.A.); (S.B.H.); (Y.L.); (F.D.)
| | - José João Mendes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), 2829-511 Caparica, Portugal;
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18
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Pietropaoli D, Del Pinto R, Ferri C, Marzo G, Giannoni M, Ortu E, Monaco A. Association between periodontal inflammation and hypertension using periodontal inflamed surface area and bleeding on probing. J Clin Periodontol 2019; 47:160-172. [PMID: 31680283 DOI: 10.1111/jcpe.13216] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/29/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
Abstract
AIM Periodontitis is a relapsing-remitting disease. Compared with bleeding on probing (BoP), expression of disease activity, periodontal inflamed surface area (PISA), incorporates chronic disease parameters. We tested the association of PISA and BoP with blood pressure (BP) in NHANES III. MATERIALS AND METHODS A total of 8,614 subjects (≥30 years) with complete periodontal and BP examinations were enrolled. PISA was derived from periodontal probing depth and BoP. The association of PISA and BoP with high/uncontrolled BP was examined by multiple-adjusted models. Inflammatory markers were tested as possible mediators. A machine learning (ML) approach was used to define the relative importance of PISA and BoP and estimate the power of BP status prediction. RESULTS Compared to no inflammation, severe PISA and BoP were associated with 43% (p < .001) and 32% (p = .006) higher odds of high/uncontrolled BP (≥130/80 mmHg), and with higher systolic BP by ≈4 (p < .001) and 5 (p < .001) mmHg, respectively. Inflammatory markers appeared to mediate this association with various extents, without threshold effect. BoP predicted high/uncontrolled BP more efficiently than PISA using ML. CONCLUSION PISA and BoP describe the association of periodontal inflammation and hypertension with subtle differences. The contribution of local inflammation to the global inflammatory burden might explain the observed findings.
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Affiliation(s)
- Davide Pietropaoli
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Rita Del Pinto
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Giuseppe Marzo
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Mario Giannoni
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Eleonora Ortu
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Annalisa Monaco
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
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Yagnik K, Mahendra J, Kurian VM. The Periodontal-Cardiovascular alliance: Evaluation of miRNA-146a in subgingival plaque samples of chronic periodontitis patients with and without coronary heart disease. ACTA ACUST UNITED AC 2019; 10:e12442. [PMID: 31338994 DOI: 10.1111/jicd.12442] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 01/08/2023]
Abstract
AIM To quantify the levels of miRNA-146a in subgingival plaque samples, and correlate with periodontal and cardiac parameters, in chronic periodontitis patients with and without coronary heart disease. METHODS The study involved 90 subjects; 30 patients with chronic periodontitis and coronary heart disease (CP + CHD) as part of Group I; group II comprising 30 with chronic periodontitis alone (CP); and group III comprising 30 systemically healthy controls. Demographic variables, periodontal parameters such as plaque index, bleeding on probing, probing pocket depth and clinical attachment levels, cardiac parameters such as total cholesterol, high-density lipoprotein, low-density lipoprotein, triglyceride levels, and systolic and diastolic blood pressure were recorded from the patients. miRNA-146a level was analyzed in subgingival plaque samples by real-time polymerase chain reaction assay and correlated with periodontal and cardiac parameters. RESULTS miRNA-146a showed the highest levels in the CP + CHD group and also showed a positive correlation with body mass index, and periodontal and cardiac parameters. CONCLUSION miRNA-146a is involved in the pathogenesis of both periodontitis and coronary heart disease.
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Affiliation(s)
- Krutika Yagnik
- Department of Periodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai, India
| | - Jaideep Mahendra
- Department of Periodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai, India
| | - V M Kurian
- Institute of Cardiovascular Diseases, Adult Cardiac Surgery, Madras Medical Mission Hospital, Chennai, India
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20
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Makkar H, Reynolds MA, Wadhawan A, Dagdag A, Merchant AT, Postolache TT. Periodontal, metabolic, and cardiovascular disease: Exploring the role of inflammation and mental health. Pteridines 2018; 29:124-163. [PMID: 30705520 PMCID: PMC6350811 DOI: 10.1515/pteridines-2018-0013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Previous evidence connects periodontal disease, a modifiable condition affecting a majority of Americans, with metabolic and cardiovascular morbidity and mortality. This review focuses on the likely mediation of these associations by immune activation and their potential interactions with mental illness. Future longitudinal, and ideally interventional studies, should focus on reciprocal interactions and cascading effects, as well as points for effective preventative and therapeutic interventions across diagnostic domains to reduce morbidity, mortality and improve quality of life.
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Affiliation(s)
- Hina Makkar
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Mark A Reynolds
- Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Abhishek Wadhawan
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Aline Dagdag
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Teodor T Postolache
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO 80220, USA; Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD 21201, USA,
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21
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Menezes CC, Ribeiro CCC, Alves CMC, Thomaz EBAF, Franco MM, Batista RFL, Silva AAM. Soft drink consumption and periodontal status in pregnant women. J Periodontol 2018; 90:159-166. [PMID: 30257045 DOI: 10.1002/jper.16-0388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 06/13/2018] [Accepted: 06/28/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Periodontal disease is associated with metabolic syndrome, and during pregnancy, it is linked to preeclampsia and preterm birth. We hypothesized that soft drink consumption, which has also been associated with metabolic disorders, may also be linked to periodontal disease. The purpose of this study was to evaluate the association between soft drink consumption and periodontal status in pregnancy. METHODS This was a cross-sectional study nested in BRISA (Brazilian Ribeirão Preto and São Luís Birth Cohort Studies). Pregnant women (n = 1,185) completed a questionnaire and underwent periodontal examination from the 22nd to 25th week of pregnancy. The explanatory variable was the frequency of soft drink consumption (times per week). The outcome was periodontal status measured as the number of teeth with probing depth ≥4 mm with bleeding on probing (PD/BOP) or with clinical attachment level ≥4 mm (CAL). Means ratio (MR) was estimated using zero-inflated Poisson, adjusted for maternal age and income. RESULTS The higher tertile of consumption of soft drinks during pregnancy was associated with PD/BOP (MR = 1.34; 95% confidence interval (CI): 1.03 to 1.75); while the highest tertile of diastolic blood pressure was also associated to CAL (MR = 1.21; 95% CI 1:07 to 1.35). CONCLUSION High soft drink consumption was associated with the number of teeth with PD/BOP in pregnant women, suggesting that beverage consumption is a factor that contributes to the systemic inflammatory burden, which is common to periodontal disease, metabolic syndrome, and adverse pregnancy outcomes.
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Affiliation(s)
- Carla C Menezes
- Post-Graduate Program in Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Cecilia C C Ribeiro
- Post-Graduate Program in Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil.,Post-Graduate Program in Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Claudia M C Alves
- Post-Graduate Program in Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil.,Post-Graduate Program in Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Erika B A F Thomaz
- Post-Graduate Program in Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil.,Post-Graduate Program in Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Mayra M Franco
- Post-Graduate Program in Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Rosângela F L Batista
- Post-Graduate Program in Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Antônio A M Silva
- Post-Graduate Program in Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil
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22
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Samietz S, Jürgens C, Ittermann T, Holtfreter B, Pink C, Schipf S, Biffar R, Völzke H, Kocher T, Tost F. Cross-sectional association between oral health and retinal microcirculation. J Clin Periodontol 2018; 45:404-412. [DOI: 10.1111/jcpe.12872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Stefanie Samietz
- Department of Prosthodontics, Gerostomatology and Biomaterials; Center for Oral Health; University Medicine Greifswald; Greifswald Germany
| | - Clemens Jürgens
- Institute for Community Medicine; University Medicine Greifswald; Greifswald Germany
| | - Till Ittermann
- Institute for Community Medicine; University Medicine Greifswald; Greifswald Germany
| | - Birte Holtfreter
- Unit of Periodontology; Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics; Center for Oral Health; University Medicine Greifswald; Greifswald Germany
| | - Christiane Pink
- Unit of Periodontology; Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics; Center for Oral Health; University Medicine Greifswald; Greifswald Germany
| | - Sabine Schipf
- Institute for Community Medicine; University Medicine Greifswald; Greifswald Germany
| | - Reiner Biffar
- Department of Prosthodontics, Gerostomatology and Biomaterials; Center for Oral Health; University Medicine Greifswald; Greifswald Germany
| | - Henry Völzke
- Institute for Community Medicine; University Medicine Greifswald; Greifswald Germany
| | - Thomas Kocher
- Unit of Periodontology; Department of Restorative Dentistry, Periodontology, Endodontology, Preventive Dentistry and Pedodontics; Center for Oral Health; University Medicine Greifswald; Greifswald Germany
| | - Frank Tost
- Department of Ophthalmology; University Medicine Greifswald; Greifswald Germany
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23
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Carmo CDS, Ribeiro MRC, Teixeira JXP, Alves CMC, Franco MM, França AKTC, Benatti BB, Cunha-Cruz J, Ribeiro CCC. Added Sugar Consumption and Chronic Oral Disease Burden among Adolescents in Brazil. J Dent Res 2018; 97:508-514. [PMID: 29342369 DOI: 10.1177/0022034517745326] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic oral diseases are rarely studied together, especially with an emphasis on their common risk factors. This study examined the association of added sugar consumption on "chronic oral disease burden" among adolescents, with consideration of obesity and systemic inflammation pathways through structural equation modeling. A cross-sectional study was conducted of a complex random sample of adolescent students enrolled at public schools in São Luís, Brazil ( n = 405). The outcome was chronic oral disease burden, a latent variable based on the presence of probing depth ≥4 mm, bleeding on probing, caries, and clinical consequences of untreated caries. The following hypotheses were tested: 1) caries and periodontal diseases among adolescents are correlated with each other; 2) added sugar consumption and obesity are associated with chronic oral disease burden; and 3) chronic oral disease burden is linked to systemic inflammation. Models were adjusted for socioeconomic status, added sugar consumption, oral hygiene behaviors, obesity, and serum levels of interleukin 6 (IL-6). All estimators of the latent variable chronic oral disease burden involved factor loadings ≥0.5 and P values <0.001, indicating good fit. Added sugar consumption (standardized coefficient [SC] = 0.212, P = 0.005), high IL-6 levels (SC = 0.130, P = 0.036), and low socioeconomic status (SC = -0.279, P = 0.001) were associated with increased chronic oral disease burden values. Obesity was associated with high IL-6 levels (SC = 0.232, P = 0.001). Visible plaque index was correlated with chronic oral disease burden (SC = 0.381, P < 0.001). Our finding that caries and periodontal diseases are associated with each other and with added sugar consumption, obesity, and systemic inflammation reinforces the guidance of the World Health Organization that any approach intended to prevent noncommunicable diseases should be directed toward common risk factors.
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Affiliation(s)
- C D S Carmo
- 1 Postgraduate Program of Dentistry, Federal University of Maranhão, São Luís, Brazil
| | - M R C Ribeiro
- 2 Department of Medicine III, Federal University of Maranhão, São Luís, Brazil
| | - J X P Teixeira
- 3 Postgraduate Program of Public Health, Federal University of Maranhão, São Luís, Brazil
| | - C M C Alves
- 1 Postgraduate Program of Dentistry, Federal University of Maranhão, São Luís, Brazil
| | - M M Franco
- 1 Postgraduate Program of Dentistry, Federal University of Maranhão, São Luís, Brazil
| | - A K T C França
- 3 Postgraduate Program of Public Health, Federal University of Maranhão, São Luís, Brazil
| | - B B Benatti
- 1 Postgraduate Program of Dentistry, Federal University of Maranhão, São Luís, Brazil
| | - J Cunha-Cruz
- 4 Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - C C C Ribeiro
- 1 Postgraduate Program of Dentistry, Federal University of Maranhão, São Luís, Brazil.,3 Postgraduate Program of Public Health, Federal University of Maranhão, São Luís, Brazil
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24
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Wellappuli N, Fine N, Lawrence H, Goldberg M, Tenenbaum H, Glogauer M. Oral and Blood Neutrophil Activation States during Experimental Gingivitis. JDR Clin Trans Res 2017; 3:65-75. [DOI: 10.1177/2380084417742120] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Polymorphonuclear neutrophils (PMNs) are the primary leukocytes present in the healthy and inflamed oral cavity. While unique PMN activation states have been shown to differentiate health and periodontitis, little is known about the changes in PMN activation states that occur during the transition from periodontal health to gingivitis. The objective of this study was to characterize oral and circulatory PMNs during induction and resolution of experimental gingivitis. Healthy volunteers were recruited to undergo experimental gingivitis. Clinical assessment of pocket depths, bleeding on probing, gingival index, and plaque index, as well as flow cytometric analysis of CD (cluster of differentiation) activation markers on blood and oral PMNs, was performed weekly. All clinical parameters increased significantly during the induction period and returned to baseline levels during the resolution phase. During the induction phase, while oral PMN counts increased, oral PMN activation state based on surface expression of CD63, CD11b, CD16, and CD14 was diminished compared to those seen in health and during the resolution phase. PMNs in circulation during onset showed increased activation based on CD55, CD63, CD11b, and CD66a. Using clinical parameters and oral PMN counts assessed at day 21, we noted 2 unique disease patterns where one-third of subjects displayed an exaggerated influx of oral PMNs with severe inflammation compared to the majority of the population who experienced a moderate level of inflammation and PMN influx. This supports the notion that PMN influx and severe inflammatory changes during gingivitis could identify subjects at risk for the development of severe gingival inflammation and progression toward destructive periodontitis. This study demonstrates that oral PMN activation states are reduced in gingivitis and suggest that only in periodontitis do PMNs become hyperactivated and tissue damaging. Knowledge Transfer Statement: Our article creates a paradigm for future studies of the evolution of essential oral and circulatory biomarkers to identify individuals at risk to develop periodontitis at an early stage of periodontal disease, which is reversible upon proper oral hygiene practices and dental treatments.
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Affiliation(s)
- N.C. Wellappuli
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - N. Fine
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - H.P. Lawrence
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - M. Goldberg
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
- Severe and Refractory Periodontal Disease Research and Treatment, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - H.C. Tenenbaum
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
- Mt. Sinai Hospital, Center for Advanced Dental Research and Care, Toronto, ON, Canada
| | - M. Glogauer
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
- Mt. Sinai Hospital, Center for Advanced Dental Research and Care, Toronto, ON, Canada
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25
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Naorungroj S, Slade GD, Divaris K, Heiss G, Offenbacher S, Beck JD. Racial differences in periodontal disease and 10-year self-reported tooth loss among late middle-aged and older adults: the dental ARIC study. J Public Health Dent 2017; 77:372-382. [PMID: 28585323 DOI: 10.1111/jphd.12226] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 04/28/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To investigate racial differences in the associations between periodontitis and 10-year self-reported incident tooth loss in a biracial, community-based cohort of US late middle-aged and older adults. METHODS Subjects were 3,466 dentate men and women aged 53-74 who underwent dental examinations from 1996 to1998. In 2012-2013, telephone interviewers asked participants about tooth loss in the preceding 10 years. Separate multivariable ordinal logistic regression models were used to calculate proportional odds ratios (OR) and 95% confidence intervals (CI) as estimates of association between periodontitis and tooth loss for Whites and African-Americans (AAs). RESULTS The majority of participants were White (85 percent) and female (57 percent) with 23 teeth on average at enrollment. Approximately half the Whites (56 percent) and AAs (49 percent) had periodontitis. At follow-up, approximately 44 percent of AAs and 38 percent of Whites reported having lost ≥1 tooth. In multivariable models, severe periodontitis (OR = 3.03; 95% CI = 2.42-3.80) and moderate periodontitis (OR = 1.64; 95% CI= 1.39-1.94) were significant risk factors of incident tooth loss among Whites. For AAs, severe but not moderate periodontitis increased the odds of incident tooth loss (OR = 2.22; 95% CI = 1.37-3.59). In the final model, education was inversely associated with incident tooth loss among AAs, while lower income was associated with greater odds of tooth loss among Whites. CONCLUSIONS In this population-based cohort, there is racial heterogeneity in the association between periodontitis and tooth loss. Interventions to reduce the impact of periodontitis on tooth loss need to consider these differences.
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Affiliation(s)
- S Naorungroj
- Department of Conservative Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai, Thailand.,Common Oral Diseases and Epidemiology Research Center, Prince of Songkla University, Hat Yai, Thailand
| | - G D Slade
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, NC, USA
| | - K Divaris
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, NC, USA.,Department of Epidemiology, Gilling School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - G Heiss
- Department of Epidemiology, Gilling School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - S Offenbacher
- Department of Periodontology, School of Dentistry, University of North Carolina at Chapel Hill, NC, USA
| | - J D Beck
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, NC, USA
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27
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Wu F, Chen Y, Demmer RT, Parvez F, Paul RR, Shaheen I, Sarwar G, Ahmed A, Eunus M, Ahsan N, Habibullah NM, Islam T, Rundek T, Ahsan H, Desvarieux M. Periodontal diseases and carotid intima-media thickness in Bangladesh. J Clin Periodontol 2016; 43:909-917. [PMID: 27394059 DOI: 10.1111/jcpe.12597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 12/17/2022]
Abstract
AIM To evaluate the relationship between periodontal diseases and subclinical atherosclerosis in a younger and lean South Asian population. METHODS We conducted a cross-sectional study in 917 subjects (mean age 46 years and mean body mass index 21.1 kg/m2 ) from the Health Effects of Arsenic Longitudinal Study in Bangladesh. Multivariate linear regression models were used to assess the associations between multiple clinical measures of periodontal diseases and carotid intima-media thickness (IMT). RESULTS Mean attachment loss (AL) and percentage of sites with AL ≥ 4 mm (% AL ≥ 4) were associated with increased IMT. The IMT was 20.0-μm (95% CI: 2.2, 37.8) and 26.5-μm (95% CI: 8.9, 44.1) higher in subjects in the top quartile of mean AL (>3.72 mm) and % AL ≥ 4 (>58.4%), respectively, compared to those in the bottom quartile. In a subset of 366 subjects, mean AL was positively associated with plasma levels of matrix metalloproteinase-9 (p < 0.05) and soluble intercellular adhesion molecule-1 (p < 0.01). CONCLUSIONS Attachment loss was associated with subclinical atherosclerosis in this young and lean Bangladeshi population. Future prospective studies are needed to confirm this association.
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Affiliation(s)
- Fen Wu
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Yu Chen
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA.
| | - Ryan T Demmer
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Faruque Parvez
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | - Golam Sarwar
- U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh
| | | | - Mahbub Eunus
- U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh
| | - Nafiz Ahsan
- U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh
| | | | - Tariqul Islam
- U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh
| | - Tatjana Rundek
- Departments of Neurology and Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Habibul Ahsan
- Department of Health Studies, Center for Cancer Epidemiology and Prevention, The University of Chicago, Chicago, IL, USA
| | - Moise Desvarieux
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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28
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Schenkein HA, Loos BG. Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. J Clin Periodontol 2016; 40 Suppl 14:S51-69. [PMID: 23627334 DOI: 10.1111/jcpe.12060] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/17/2022]
Abstract
AIMS In this article, inflammatory mechanisms that link periodontal diseases to cardiovascular diseases are reviewed. METHODS This article is a literature review. RESULTS Studies in the literature implicate a number of possible mechanisms that could be responsible for increased inflammatory responses in atheromatous lesions due to periodontal infections. These include increased systemic levels of inflammatory mediators stimulated by bacteria and their products at sites distant from the oral cavity, elevated thrombotic and hemostatic markers that promote a prothrombotic state and inflammation, cross-reactive systemic antibodies that promote inflammation and interact with the atheroma, promotion of dyslipidemia with consequent increases in pro-inflammatory lipid classes and subclasses, and common genetic susceptibility factors present in both disease leading to increased inflammatory responses. CONCLUSIONS Such mechanisms may be thought to act in concert to increase systemic inflammation in periodontal disease and to promote or exacerbate atherogenesis. However, proof that the increase in systemic inflammation attributable to periodontitis impacts inflammatory responses during atheroma development, thrombotic events or myocardial infarction or stroke is lacking.
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Affiliation(s)
- Harvey A Schenkein
- Department of Periodontics, Virginia Commonwealth University, Richmond, VA 23298-0566, USA.
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29
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D'Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Clin Periodontol 2016; 40 Suppl 14:S85-105. [PMID: 23627337 DOI: 10.1111/jcpe.12061] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/11/2022]
Abstract
AIM The aim of this review was to critically appraise the evidence on the impact of periodontal treatment of cardiovascular diseases (CVDs) biomarkers and outcomes. METHODS A systematic search was performed in Cinhal, Cochrane, Embase and Medline for relevant articles up to July 2012. Duplicate screening and reference hand searching were performed. Data were then summarized and evidence graded in tables. RESULTS The search resulted in: (a) no evidence on the effects of periodontal therapy on subclinical atherosclerosis, serum levels of CD40 ligand, serum amyloid A and monocyte chemoattractant protein-1, (b) limited evidence on the effects of periodontal therapy on arterial blood pressure, leucocyte counts, fibrinogen, tissue necrosis factor-α, sE-selectin, von Willebrand factors, d-dimers, matrix metalloproteinases, oxidative stress and CVD events, and (c) moderate evidence suggesting a negligible effect of periodontal therapy in reducing interleukin-6 and lipids levels, whilst a positive effect in reducing serum C-reactive protein levels and improving endothelial function. CONCLUSIONS Periodontal therapy triggers a short-term inflammatory response followed by (a) a progressive and consistent reduction of systemic inflammation and (b) an improvement in endothelial function. There is however limited evidence that these acute and chronic changes will either increase or reduce CVD burden of individuals suffering from periodontitis in the long term.
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Affiliation(s)
- Francesco D'Aiuto
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, London, UK.
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30
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D'Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Periodontol 2016; 84:S85-S105. [PMID: 23631587 DOI: 10.1902/jop.2013.134007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM The aim of this review was to critically appraise the evidence on the impact of periodontal treatment of cardiovascular diseases (CVDs) biomarkers and outcomes. METHODS A systematic search was performed in Cinhal, Cochrane, Embase and Medline for relevant articles up to July 2012. Duplicate screening and reference hand searching were performed. Data were then summarized and evidence graded in tables. RESULTS The search resulted in: (a) no evidence on the effects of periodontal therapy on subclinical atherosclerosis, serum levels of CD40 ligand, serum amyloid A and monocyte chemoattractant protein-1, (b) limited evidence on the effects of periodontal therapy on arterial blood pressure, leucocyte counts, fibrinogen, tissue necrosis factor-a, sE-selectin, von Willebrand factors, d-dimers, matrix metalloproteinases, oxidative stress and CVD events, and (c) moderate evidence suggesting a negligible effect of periodontal therapy in reducing interleukin-6 and lipids levels, whilst a positive effect in reducing serum C-reactive protein levels and improving endothelial function. CONCLUSIONS Periodontal therapy triggers a short-term inflammatory response followed by (a) a progressive and consistent reduction of systemic inflammation and (b) an improvement in endothelial function. There is however limited evidence that these acute and chronic changes will either increase or reduce CVD burden of individuals suffering from periodontitis in the long term.
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Affiliation(s)
- Francesco D'Aiuto
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, University College London, UK.
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31
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Chatzopoulos GS, Tsalikis L. Periodontal treatment needs and systemic diseases in an older population in Greece. J Clin Exp Dent 2016; 8:e32-7. [PMID: 26855703 PMCID: PMC4739365 DOI: 10.4317/jced.52763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/02/2015] [Indexed: 11/22/2022] Open
Abstract
Background To evaluate the relationship between systemic diseases, body mass index and periodontal treatment needs in an older population in Greece. Material and Methods A total of 262 older people were clinically examined about their periodontal status and medical histories were recorded using a health history questionnaire. Additionally, weight and height measurements as well as demographic data were obtained from the participants in the study. Results Older people exhibited mean age of 63.98 years, weight of 78.76 kg and height of 1.64 m. The mean CPITN score was 2.84. 31.7% of the study population were smokers and 53.8% females. No statistically significant difference was observed in seniors between periodontal treatment needs and systemic diseases. Females exhibited statistically significant more often osteoporosis, thyroid disorders (p<0.001) and hypercholesterolemia (p=0.014) than males. High CPTIN scores were not associated with higher levels of BMI. Conclusions Within the limitation of this study, older adults’ periodontal treatment needs are not associated significantly with a great number of systemic diseases and body mass index. Key words:Seniors, periodontitis, systemic diseases, body mass index (BMI), smoking, Greece.
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Affiliation(s)
- Georgios S Chatzopoulos
- DDS, Resident Advanced Education Program in Periodontology, School of Dentistry, University of Minnesota, USA
| | - Lazaros Tsalikis
- DDS, Dr med dent, Associate Professor, Department of Preventive Dentistry, Periodontology and Implant biology, School of Dentistry, Aristotle University of Thessaloniki, Greece
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32
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Links between atherosclerotic and periodontal disease. Exp Mol Pathol 2016; 100:220-35. [DOI: 10.1016/j.yexmp.2016.01.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/08/2016] [Indexed: 02/06/2023]
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33
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C-Reactive Protein in Peripheral Blood of Patients with Chronic and Aggressive Periodontitis, Gingivitis, and Gingival Recessions. Mediators Inflamm 2015; 2015:564858. [PMID: 26346216 PMCID: PMC4539496 DOI: 10.1155/2015/564858] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/18/2015] [Accepted: 06/02/2015] [Indexed: 02/01/2023] Open
Abstract
CRP is a plasma protein that reflects a measure of the acute phase response to inflammation and is one of the markers of choice in monitoring this response. CRP can be used for the prediction and early detection of periodontal disease. The aim of this study was to compare and evaluate the systemic levels of CRP in the peripheral blood samples of patients with chronic and aggressive periodontitis, gingivitis, and gingival recessions and compare them with periodontal clinical parameters. All patients (N = 158) were examined prior to the initiation of periodontal treatment. Patients were divided into four groups. Group A consisted of 26 patients with aggressive periodontitis, Group B consisted of 111 patients with chronic periodontitis, Group C consisted of 13 patients with gingivitis, and Group D consisted of 8 patients with gingival recessions. Our study results indicate that CRP levels increase subsequently with the severity of the periodontal disease and that the bleeding on probing index showed much better positive correlation with the CRP levels compared to the pocket depth index in both periodontitis patients groups, especially in aggressive periodontitis patients.
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34
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Kinane DF, Zhang P, Benakanakere M, Singleton J, Biesbrock A, Nonnenmacher C, He T. Experimental gingivitis, bacteremia and systemic biomarkers: a randomized clinical trial. J Periodontal Res 2015; 50:864-9. [PMID: 25960104 DOI: 10.1111/jre.12280] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Bacteremia and systemic inflammatory markers are associated with periodontal and systemic diseases and may be linking mechanisms between these conditions. We hypothesized that in the development of gingival inflammation, systemic markers of inflammation and bacteremia would increase. MATERIAL AND METHODS To study the effect of bacteremia on systemic inflammatory markers, we recruited 80 subjects to participate in an experimental gingivitis study. Subjects were stratified based on gender, smoking and the number of bleeding sites and then randomized to one of two groups: control group (n = 40) or experimental gingivitis group (n = 40). Subjects in the control group conducted an oral hygiene regimen: brushing twice daily with a regular sodium fluoride cavity protection dentifrice and a standard manual toothbrush, flossing twice daily, and mouth rinsing with an anti-cavity fluoride rinse once daily. The experimental group stopped brushing and flossing, and used only the fluoride anti-cavity mouth rinse for 21 d. RESULTS Seventy-nine of 80 subjects were evaluable. One subject in the control group was excluded from the results due to antibiotic use during the study. Our data showed the experimental gingivitis group exhibited a significant (p < 0.05) increase in dental plaque level and gingival inflammatory indices relative to baseline and the control group but a decrease in bacteremia and soluble intercellular adhesion molecule-1 levels vs. baseline. Bacteremia was negatively correlated with gingival inflammatory indices and soluble intercellular adhesion molecule-1 levels in the experimental gingivitis group, thus negating our hypothesis. CONCLUSION We conclude that there are marked differences in systemic cytokine levels over the course of short-term experimentally induced gingivitis and further conclude that a long-term periodontitis study must be considered to address mechanisms whereby oral diseases may affect systemic diseases.
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Affiliation(s)
- D F Kinane
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - P Zhang
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M Benakanakere
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J Singleton
- Department of Periodontics, Endodontics and Dental Hygiene, Center for Oral Health and Systemic Disease, University of Louisville School of Dentistry, Louisville, KY, USA
| | - A Biesbrock
- Health Care Research Center, Procter & Gamble Company, Mason, OH, USA
| | - C Nonnenmacher
- Institute of Medical Microbiology and Hygiene, Philipps University Marburg, Marburg, Germany
| | - T He
- Health Care Research Center, Procter & Gamble Company, Mason, OH, USA
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Boillot A, Bouchard P, Moss K, Offenbacher S, Czernichow S. Periodontitis and retinal microcirculation in the Atherosclerosis Risk in Communities study. J Clin Periodontol 2015; 42:342-9. [PMID: 25728988 DOI: 10.1111/jcpe.12388] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2015] [Indexed: 12/30/2022]
Abstract
AIM The aim of this cross-sectional study is to explore if periodontitis is associated with alterations of the retinal microcirculation, a predictive marker of cardiovascular events. MATERIAL AND METHODS Of 457 subjects aged 52 years and more from the ARIC cohort were included. Retinal vascular diameters were measured and summarized as central retinal arteriolar/venular equivalents (CRAE/CRVE). Periodontitis was determined by using the CDC/AAP definition. Multivariable linear regression models were used to estimate the relationships between CRAE, CRVE and periodontitis. RESULTS No association was found between CRAE and periodontal status. However, CRVE and severe periodontitis were positively and significantly associated. Mean CRVE (±SD) was 187.0 ± 17.2 μm in the health-gingivitis group, and, respectively, 188.5 ± 16.3 μm (p = 0.39) and 191.6 ± 16.8 μm (p = 0.04) in moderate and severe periodontitis groups, after adjustment for a propensity score based on confounders. Results were consistent when analyses were restricted to participants with diabetes mellitus (n = 66), but not diabetes-free subjects. CONCLUSIONS Severe periodontitis is associated with larger retinal venular diameter in patients with type 2 diabetes. Further studies are needed to explore the impact of diabetes mellitus on the association between periodontitis and retinal microcirculation.
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Affiliation(s)
- Adrien Boillot
- Department of Periodontology, Rothschild Hospital (AP-HP), UFR of Odontology, University of Paris Diderot, Paris, France; INSERM UMS 011, Population-Based Cohort Platform, Villejuif, France
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López NJ, Uribe S, Martinez B. Effect of periodontal treatment on preterm birth rate: a systematic review of meta-analyses. Periodontol 2000 2014; 67:87-130. [DOI: 10.1111/prd.12073] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 01/08/2023]
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Goyal L, Bey A, Gupta ND, Sharma VK. Comparative evaluation of serum C-reactive protein levels in chronic and aggressive periodontitis patients and association with periodontal disease severity. Contemp Clin Dent 2014; 5:484-8. [PMID: 25395764 PMCID: PMC4229757 DOI: 10.4103/0976-237x.142816] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE C-reactive protein (CRP) is an acute-phase reactant and has been proved to be a significant predictor of future cardiovascular events. Recent studies have demonstrated a correlation between periodontitis and elevated CRP levels. However, most of the studies have focused on chronic periodontitis and very few studies are done in patients with aggressive periodontitis. The aim of this study was to determine and compare the relative levels of serum CRP in aggressive and chronic periodontitis patients. MATERIALS AND METHODS A total of 75 systemically healthy subjects were divided into three groups: Group I, nonperiodontitis subjects; group II, chronic generalized periodontitis patients and group III, generalized aggressive periodontitis patients. All participants were subjected to quantitative CRP analysis using enzyme-linked immunosorbent assay. RESULTS Mean CRP levels were significantly greater in both group II and III as compared to group I and group III having greater level than group II. Furthermore, CRP levels positively correlated with the amount of periodontal destruction as measured by probing depth and clinical attachment loss. CONCLUSION The present study indicates a positive correlation between CRP and periodontal disease severity with particular concern in younger individuals that could be a possible underlying pathway in the association between periodontal disease and the observed higher risk for cardiovascular disease in periodontitis patients.
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Affiliation(s)
- Lata Goyal
- Departments of Periodontics and Community Dentistry, Dr. Z. A. Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Afshan Bey
- Departments of Periodontics and Community Dentistry, Dr. Z. A. Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - N D Gupta
- Departments of Periodontics and Community Dentistry, Dr. Z. A. Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Vivek Kumar Sharma
- Departments of Periodontics and Community Dentistry, Dr. Z. A. Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Lula ECO, Ribeiro CCC, Hugo FN, Alves CMC, Silva AAM. Added sugars and periodontal disease in young adults: an analysis of NHANES III data. Am J Clin Nutr 2014; 100:1182-7. [PMID: 25240081 DOI: 10.3945/ajcn.114.089656] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Added sugar consumption seems to trigger a hyperinflammatory state and may result in visceral adiposity, dyslipidemia, and insulin resistance. These conditions are risk factors for periodontal disease. However, the role of sugar intake in the cause of periodontal disease has not been adequately studied. OBJECTIVE We evaluated the association between the frequency of added sugar consumption and periodontal disease in young adults by using NHANES III data. DESIGN Data from 2437 young adults (aged 18-25 y) who participated in NHANES III (1988-1994) were analyzed. We estimated the frequency of added sugar consumption by using food-frequency questionnaire responses. We considered periodontal disease to be present in teeth with bleeding on probing and a probing depth ≥3 mm at one or more sites. We evaluated this outcome as a discrete variable in Poisson regression models and as a categorical variable in multinomial logistic regression models adjusted for sex, age, race-ethnicity, education, poverty-income ratio, tobacco exposure, previous diagnosis of diabetes, and body mass index. RESULTS A high consumption of added sugars was associated with a greater prevalence of periodontal disease in middle [prevalence ratio (PR): 1.39; 95% CI: 1.02, 1.89] and upper (PR: 1.42; 95% CI: 1.08, 1.85) tertiles of consumption in the adjusted Poisson regression model. The upper tertile of added sugar intake was associated with periodontal disease in ≥2 teeth (PR: 1.73; 95% CI: 1.19, 2.52) but not with periodontal disease in only one tooth (PR: 0.85; 95% CI: 0.54, 1.34) in the adjusted multinomial logistic regression model. CONCLUSION A high frequency of consumption of added sugars is associated with periodontal disease, independent of traditional risk factors, suggesting that this consumption pattern may contribute to the systemic inflammation observed in periodontal disease and associated noncommunicable diseases.
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Affiliation(s)
- Estevam C O Lula
- From the Departments of Public Health (ECOL and AAMS) and Dentistry (CCCR and CMCA), Federal University of Maranhão, São Luís, Brazil, and the Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (FNH)
| | - Cecilia C C Ribeiro
- From the Departments of Public Health (ECOL and AAMS) and Dentistry (CCCR and CMCA), Federal University of Maranhão, São Luís, Brazil, and the Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (FNH)
| | - Fernando N Hugo
- From the Departments of Public Health (ECOL and AAMS) and Dentistry (CCCR and CMCA), Federal University of Maranhão, São Luís, Brazil, and the Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (FNH)
| | - Cláudia M C Alves
- From the Departments of Public Health (ECOL and AAMS) and Dentistry (CCCR and CMCA), Federal University of Maranhão, São Luís, Brazil, and the Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (FNH)
| | - Antônio A M Silva
- From the Departments of Public Health (ECOL and AAMS) and Dentistry (CCCR and CMCA), Federal University of Maranhão, São Luís, Brazil, and the Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (FNH)
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Bokhari SAH, Khan AA, Butt AK, Hanif M, Izhar M, Tatakis DN, Ashfaq M. Periodontitis in coronary heart disease patients: strong association between bleeding on probing and systemic biomarkers. J Clin Periodontol 2014; 41:1048-54. [PMID: 24946826 DOI: 10.1111/jcpe.12284] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 11/28/2022]
Abstract
AIM Few studies have examined the relationship of individual periodontal parameters with individual systemic biomarkers. This study assessed the possible association between specific clinical parameters of periodontitis and systemic biomarkers of coronary heart disease risk in coronary heart disease patients with periodontitis. MATERIALS AND METHODS Angiographically proven coronary heart disease patients with periodontitis (n = 317), aged >30 years and without other systemic illness were examined. Periodontal clinical parameters of bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) and systemic levels of high-sensitivity C-reactive protein (CRP), fibrinogen (FIB) and white blood cells (WBC) were noted and analyzed to identify associations through linear and stepwise multiple regression analyses. RESULTS Unadjusted linear regression showed significant associations between periodontal and systemic parameters; the strongest association (r = 0.629; p < 0.001) was found between BOP and CRP levels, the periodontal and systemic inflammation marker, respectively. Stepwise regression analysis models revealed that BOP was a predictor of systemic CRP levels (p < 0.0001). BOP was the only periodontal parameter significantly associated with each systemic parameter (CRP, FIB, and WBC). CONCLUSION In coronary heart disease patients with periodontitis, BOP is strongly associated with systemic CRP levels; this association possibly reflects the potential significance of the local periodontal inflammatory burden for systemic inflammation.
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Gocke C, Holtfreter B, Meisel P, Grotevendt A, Jablonowski L, Nauck M, Markus MRP, Kocher T. Abdominal obesity modifies long-term associations between periodontitis and markers of systemic inflammation. Atherosclerosis 2014; 235:351-7. [DOI: 10.1016/j.atherosclerosis.2014.05.926] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/08/2014] [Accepted: 05/13/2014] [Indexed: 12/12/2022]
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Heaton B, Applebaum KM, Rothman KJ, Brooks DR, Heeren T, Dietrich T, Garcia RI. The influence of prevalent cohort bias in the association between periodontal disease progression and incident coronary heart disease. Ann Epidemiol 2014; 24:741-6. [PMID: 25169680 DOI: 10.1016/j.annepidem.2014.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/08/2014] [Accepted: 07/21/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE In longitudinal studies, the onset of the index condition (e.g. exposure) does not always coincide with the start of a study's observation period, leading to the possibility of bias in estimation that derives from studying prevalent exposure rather than new exposure. We investigate the possible role of this bias in the relationship between periodontitis progression and coronary heart disease (CHD) among a cohort of men participating in the Veterans Administration Dental Longitudinal Study. METHODS At baseline, there were 298 men with existing (i.e., prevalent) periodontitis. During follow-up, routine dental inspection identified 163 new (i.e., incident) cases of periodontitis. Change in mean alveolar bone loss score (MBLS) served as the measure of disease progression. Tabular analyses were performed to obtain crude, stratified, and adjusted measures of the association for periodontitis cases overall and separately for prevalent and incident cases. Potential bias was evaluated by comparing estimates across these subcohorts. RESULTS Among all periodontitis cases, increasing MBLS was associated with increasing risk of CHD event. Subdividing periodontal cases into new and prevalent cases revealed that the relationship was most pronounced among incident periodontitis cases (incident rate ratio for MBLS change >0.5 = 5.4), compared with prevalent cases (incident rate ratio for MBLS change >0.5 = 2.5). CONCLUSIONS Studying prevalent cases of periodontitis underestimates the association between incidence periodontitis and CHD.
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Affiliation(s)
- Brenda Heaton
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA.
| | - Katie M Applebaum
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA; Department of Environmental and Occupational Health, School of Public Health and Health Services, George Washington University, Washington, DC
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Thomas Dietrich
- Department of Oral Surgery, The School of Dentistry, University of Birmingham, Birmingham, UK
| | - Raul I Garcia
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA
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Moosani A, Sigal MJ, Glogauer M, Lawrence HP, Goldberg M, Tenenbaum HC. Evaluation of periodontal disease and oral inflammatory load in adults with special needs using oral neutrophil quantification. SPECIAL CARE IN DENTISTRY 2014; 34:303-12. [DOI: 10.1111/scd.12077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Anita Moosani
- Staff Pediatric Dentist; Department of Dentistry; Holland Bloorview Kids Rehabilitation Hospital, Toronto; MSc Pediatric Dentistry Graduate; Faculty of Dentistry; University of Toronto; Former Dental Resident; Department of Dentistry; Mount Sinai Hospital; Toronto Ontario Canada
| | - Michael J. Sigal
- Dentist-in-Chief; Department of Dentistry; Mount Sinai Hospital, Toronto; Professor and Head Pediatric Dentistry and Director of Pediatric Dentistry Graduate Program; Faculty of Dentistry; University of Toronto; Toronto Ontario Canada
| | - Michael Glogauer
- Canadian Institutes of Health Research Group in Matrix Dynamics; Associate Professor of Periodontology; Faculty of Dentistry; University of Toronto; Cross appointed to Faculty of Medicine; University of Toronto, Staff; Division of Research; Department of Dentistry; Mount Sinai Hospital; Toronto Ontario Canada
| | - Herenia P. Lawrence
- Associate Professor; Department of Biological and Diagnostic Sciences; Dental Public Health; Faculty of Dentistry; University of Toronto; Toronto Ontario Canada
| | - Michael Goldberg
- Assistant Professor of Periodontology; Faculty of Dentistry; University of Toronto; Head, Division of Periodontology; Department of Dentistry; Mount Sinai Hospital, Staff; Wasser and Orofacial Pain Clinics; Mount Sinai Hospital; Toronto Ontario Canada
| | - Howard C. Tenenbaum
- Professor of Periodontology; Faculty of Dentistry; University of Toronto; Professor, Laboratory Medicine and Pathobiology; Faculty of Medicine; University of Toronto, Head; Division of Research; Department of Dentistry; Mount Sinai Hospital; Toronto Ontario Canada
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Christian LM, Iams J, Porter K, Leblebicioglu B. Self-rated health among pregnant women: associations with objective health indicators, psychological functioning, and serum inflammatory markers. Ann Behav Med 2014; 46:295-309. [PMID: 23765366 DOI: 10.1007/s12160-013-9521-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Biobehavioral correlates of self-rated health in pregnancy are largely unknown. PURPOSE The goals of this study were to examine, in pregnant women, associations of self-rated health with (1) demographics, objective health status, health behaviors, and psychological factors, and (2) serum inflammatory markers. METHODS In the second trimester of pregnancy, 101 women provided a blood sample, completed measures of psychosocial stress, health status, and health behaviors, and received a comprehensive periodontal examination. RESULTS The following independently predicted poorer self-rated health: (1) greater psychological stress, (2) greater objective health diagnoses, (3) higher body mass index, and (4) past smoking (versus never smoking). Poorer self-rated health was associated with higher serum interleukin-1β (p = 0.02) and marginally higher macrophage migration inhibitory factor (p = 0.06). These relationships were not fully accounted for by behavioral/psychological factors. CONCLUSIONS This study provides novel data regarding factors influencing subjective ratings of health and the association of self-rated health with serum inflammatory markers in pregnant women.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA,
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Abstract
During pregnancy profound perturbations in innate and adaptive immunity impact the clinical course of a number of infectious diseases, including those affecting periodontal tissues. Conversely, it has been suggested that periodontal infections may increase the risk of adverse pregnancy outcomes. In this review, a summary of the literature associated with the bidirectional relationship between pregnancy and periodontal disease as well as the possible mechanisms behind this interaction were examined.
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Meisel P, Kroemer HK, Nauck M, Holtfreter B, Kocher T. Tooth loss, periodontitis, and statins in a population-based follow-up study. J Periodontol 2013; 85:e160-8. [PMID: 24304227 DOI: 10.1902/jop.2013.130456] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Statins, frequently prescribed in lipid-lowering therapies, seem to have additional beneficial effects on periodontitis and tooth loss. If this is true, then chronic treatment with statins should also result in diminished tooth loss as a long-term response. METHODS A 5-year population-based follow-up study of tooth loss was performed comparing participants treated with statins (n = 134) with those not on the drugs (Study of Health in Pomerania). Negative binomial regression models were used to analyze the count variable of the outcome, including risk factors for tooth loss and measures of cholesterol metabolism. RESULTS When adjusted for age and sex, statins were associated with reduced tooth loss during the follow-up period (incidence risk ratio [IRR] = 0.70, 95% confidence interval [CI] = 0.50 to 0.99, P = 0.04). When additionally adjusted for risk factors of periodontal breakdown, IRR was 0.72 (95% CI = 0.52 to 1.01). There was significant interaction with low-density lipoprotein cholesterol (LDL-c) at baseline. After stratification by LDL-c, statins were associated with reduced tooth loss, resulting in IRR = 0.89 (95% CI = 0.44 to 1.83) and 0.64 (95% CI = 0.43 to 0.95), P = 0.03, at LDL-c concentrations ≤100 mg/dL and >100 mg/dL (2.58 mmol/L), respectively. The data also showed reduced tooth loss associated with the 5-year reduction in LDL-c levels on a mmol/L basis and independently of statins (IRR = 0.87, 95% CI = 0.80 to 0.96, P = 0.004). CONCLUSION Long-term treatment with systemically administered statins may have the beneficial effect of protecting against tooth loss.
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Affiliation(s)
- Peter Meisel
- Dental Clinics, Unit of Periodontology, Ernst Moritz Arndt University Greifswald, Greifswald, Germany
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Local and systemic inflammatory responses to experimentally induced gingivitis. DISEASE MARKERS 2013; 35:543-9. [PMID: 24227893 PMCID: PMC3817648 DOI: 10.1155/2013/948569] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 09/10/2013] [Accepted: 09/30/2013] [Indexed: 11/25/2022]
Abstract
This study profiled the local and systemic inflammatory responses to experimentally induced gingivitis. Eight females participated in a 21-day experimental gingivitis model followed by a 14-day resolution phase. Bleeding on probing and plaque index scores were assessed before, during, and after resolution of gingival inflammation, and samples of saliva, GCF, and plasma were collected. Samples were assessed for biomarkers of inflammation using the BioPlex platform and ELISA. There were no significant changes in GCF levels of cytokines during the experimental phase; however, individual variability in cytokine profiles was noted. During resolution, mean GCF levels of IL-2, IL-6, and TNF-α decreased and were significantly lower than baseline levels (P = 0.003, P = 0.025, and P = 0.007, resp.). Furthermore, changes in GCF levels of IL-2, IL-6, and TNF-α during resolution correlated with changes in plaque index scores (r = 0.88, P = 0.004; r = 0.72, P = 0.042; r = 0.79, P = 0.019, resp.). Plasma levels of sICAM-1 increased significantly during the experimental phase (P = 0.002) and remained elevated and significantly higher than baseline levels during resolution (P < 0.001). These results support the concept that gingivitis adds to the systemic inflammatory burden of an individual.
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Vernon LT, Demko CA, Babineau DC, Wang X, Toossi Z, Weinberg A, Rodriguez B. Effect of Nadir CD4+ T cell count on clinical measures of periodontal disease in HIV+ adults before and during immune reconstitution on HAART. PLoS One 2013; 8:e76986. [PMID: 24146949 PMCID: PMC3795634 DOI: 10.1371/journal.pone.0076986] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/04/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The contribution of HIV-infection to periodontal disease (PD) is poorly understood. We proposed that immunological markers would be associated with improved clinical measures of PD. METHODS We performed a longitudinal cohort study of HIV-infected adults who had started highly active antiretroviral therapy (HAART) <2 years. PD was characterized clinically as the percent of teeth with ≥ 1 site with periodontal probing depth (PPD) ≥ 5.0mm, recession (REC) >0mm, clinical attachment level (CAL) ≥ 4.0mm, and bleeding on probing (BOP) at ≥ 4 sites/tooth and microbiologically as specific periodontopathogen concentration. Linear mixed-effects models were used to assess the associations between immune function and PD. RESULTS Forty (40) subjects with median 2.7 months on HAART and median nadir CD4+ T-cell count of 212 cells/μl completed a median 3 visits. Over 24 months, CD4+ T-cell count increased by a mean 173 cells/µl (p<0.001) and HIV RNA decreased by 0.5 log10 copies/ml (p<0.001); concurrently, PPD, CAL and BOP decreased by a mean 11.7%, 12.1%, and 14.7% respectively (all p<0.001). Lower nadir CD4+ T-cell count was associated with worse baseline REC (-6.72%; p=0.04) and CAL (9.06%; p<0.001). Further, lower nadir CD4+ T-cell count was associated with a greater relative longitudinal improvement in PPD in subjects with higher baseline levels of Porphyromonas gingivalis (p=0.027), and BOP in subjects with higher baseline levels of Porphyromonas gingivalis or Treponema denticola (p=0.001 and p=0.006 respectively). Longitudinal changes from baseline in CD4+ T-cell count and level of HIV RNA were not independently associated with longitudinal changes in any clinical markers of PD. CONCLUSION Degree of immunosuppression was associated with baseline gingival recession. After HAART initiation, measures of active PD improved most in those with lower nadir CD4+ T-cell counts and higher baseline levels of specific periodontopathogens. Nadir CD4+ T-cell count differentially influences periodontal disease both before and after HAART in HIV-infected adults.
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Affiliation(s)
- Lance T. Vernon
- Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
| | - Catherine A. Demko
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
| | - Denise C. Babineau
- Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Xuelei Wang
- Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Zahra Toossi
- Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Aaron Weinberg
- Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
| | - Benigno Rodriguez
- Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio, United States of America
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Macedo JF, Ribeiro RA, Machado FC, Assis NMSP, Alves RT, Oliveira AS, Ribeiro LC. Periodontal disease and oral health-related behavior as factors associated with preterm birth: a case-control study in south-eastern Brazil. J Periodontal Res 2013; 49:458-64. [DOI: 10.1111/jre.12124] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2013] [Indexed: 11/27/2022]
Affiliation(s)
- J. F. Macedo
- Postgraduate Program in Dental Clinic; School of Dentistry; Federal University of Juiz de Fora; Juiz de Fora MG Brazil
| | - R. A. Ribeiro
- Department of Social and Child Dentistry; School of Dentistry; Federal University of Juiz de Fora; Juiz de Fora MG Brazil
| | - F. C. Machado
- Estácio de Sá College; Juiz de Fora MG Brazil
- Postgraduate Program in Health; School of Medicine; Federal University of Juiz de Fora; Juiz de Fora MG Brazil
| | - N. M. S. P. Assis
- Department of Dental Clinic; School of Dentistry; Federal University of Juiz de Fora; Juiz de Fora MG Brazil
| | - R. T. Alves
- Estácio de Sá College; Juiz de Fora MG Brazil
- Postgraduate Program in Health; School of Medicine; Federal University of Juiz de Fora; Juiz de Fora MG Brazil
| | - A. S. Oliveira
- Postgraduate Program in Health; School of Medicine; Federal University of Juiz de Fora; Juiz de Fora MG Brazil
| | - L. C. Ribeiro
- Department of Statistics; Exact Sciences Institute; Federal University of Juiz de Fora; Juiz de Fora MG Brazil
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Schenkein HA, Loos BG. Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. J Periodontol 2013; 84:S51-69. [DOI: 10.1902/jop.2013.134006] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Chopra R, Patil SR, Mathur S. Comparison of cardiovascular disease risk in two main forms of periodontitis. Dent Res J (Isfahan) 2012; 9:74-9. [PMID: 22363367 PMCID: PMC3283982 DOI: 10.4103/1735-3327.92953] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND C-reactive protein (CRP) is an acute phase reactant and has been proved to be a significant predictor of future cardiovascular events. Recent studies have demonstrated a correlation between periodontitis and elevated CRP levels. However, comparison between the levels of CRP in two main forms of periodontitis is ambiguous. This study aims at determining and comparing the relative levels of serum CRP in aggressive and chronic periodontitis patients. MATERIALS AND METHODS A total of 240 systemically healthy subjects were divided into three groups of 80 based on having generalized aggressive periodontitis, chronic generalized periodontitis and non-periodontitis (NP; controls). Venous blood samples were collected for quantitative CRP analysis using turbidimetric immunoassay. RESULTS Mean CRP levels were significantly greater in both generalized aggressive periodontitis (7.49±2.31 mg/l) and chronic generalized periodontitis (4.88±1.80 mg/l) groups as compared to NP (0.68±0.23 mg/l) controls. Moreover, CRP levels were significantly higher in aggressive periodontitis as compared to chronic periodontitis patients. Also, CRP levels positively correlated with the amount of periodontal destruction as measured by probing depth and clinical attachment loss for both chronic generalized periodontitis and generalized aggressive periodontitis. CONCLUSION Findings of the present study indicated that periodontitis should be of particular concern in younger individuals, where elevated levels of CRP may contribute to early or more rapid cardiovascular disease in susceptible patients. Thus, further research should be carried out at a community level to ascertain these findings.
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Affiliation(s)
- Rahul Chopra
- Department of Periodontics, Government Dental College and Hospital, Rohtak, Haryana, India
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