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Cherry-Peppers G, Fryer C, Jackson AD, Ford D, Glascoe A, Smith D, Dunmore-Griffith J, Iris M, Woods D, Robinson-Warner G, Davidson A, McIntosh C, Sonnier J, Slade L, Downer G, Mundey S, Darden-Wilson J, Dawson N, Downes A, Rizkalla A, Bellamy A, Mahone I, Tompkins S, Kiffin G, Mncube-Barnes F, Peppers G, Watkins-Bryant T. A review of the risks and relationships between oral health and chronic diseases. J Natl Med Assoc 2024:S0027-9684(24)00008-7. [PMID: 38326141 DOI: 10.1016/j.jnma.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 09/25/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024]
Abstract
Advances in medical science and in preventive dentistry have changed the context of oral health. The American population is living longer with numerous complex chronic diseases. This paper is to raise awareness about the impact of multiple chronic diseases and their associations with oral diseases. Comorbidities can worsen the course of dental treatment. Inflammation has been the connecting factor in the bidirectional pattern of oral and systemic diseases. High occurrences of chronic diseases generally occur in aging as well as disadvantaged populations. Serious infections, slow healing, prolonged bleeding, and hospitalizations can escalate in patients with uncontrolled chronic diseases. A multidisciplinary team-based approach to patient management can minimize complications and unexpected challenges.
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Affiliation(s)
| | - Cheryl Fryer
- Academic Affairs, Howard University College of Dentistry, USA
| | | | - Debra Ford
- Academic Affairs, Howard University College of Medicine, USA
| | - Alison Glascoe
- Comprehensive Care, Chair, Howard University College of Dentistry, USA
| | - Dawn Smith
- Department of Dental Hygiene, Howard University College of Dentistry, USA
| | | | - Morton Iris
- Comprehensive Care, Howard University College of Dentistry, USA
| | - Dexter Woods
- Comprehensive Care, Howard University College of Dentistry, USA
| | | | | | - Crystal McIntosh
- Department of Periodontics, Howard University College of Dentistry, USA
| | - Jezelle Sonnier
- Department of Restorative Dentistry, Howard University College of Dentistry, USA
| | - Lisa Slade
- Department of Endodontics, Howard University College of Dentistry, USA
| | | | - Shakeya Mundey
- Comprehensive Care, Howard University College of Dentistry, USA
| | | | - Nyree Dawson
- Comprehensive Care, Howard University College of Dentistry, USA
| | - Arielle Downes
- Summer Research Project, Howard University College of Dentistry
| | - Adel Rizkalla
- Comprehensive Care, Howard University College of Dentistry
| | - Ashleigh Bellamy
- Research Summer Project, Howard University College of Dentistry, USA
| | - Ian Mahone
- Research Summer Project, Howard University College of Dentistry, USA
| | - Sydney Tompkins
- Summer Research Project, Howard University College of Dentistry, USA
| | - Gawain Kiffin
- Summer Research Project, Howard University College of Dentistry, USA
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Li B, Du M, Sun Q, Cao Z, He H. m 6 A demethylase Fto regulates the TNF-α-induced inflammatory response in cementoblasts. Oral Dis 2023; 29:2806-2815. [PMID: 36227651 DOI: 10.1111/odi.14396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/21/2022] [Accepted: 10/04/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Apical periodontitis is the most frequently occurring pathological lesion. Fat mass and obesity-associated protein (Fto) is the first identified RNA N6-methyladenosine demethylase. However, whether Fto regulates apical periodontitis remains unclear. This study aimed to explore the mechanisms of Fto in the tumor necrosis factor-α (TNF-α)-induced inflammatory response. MATERIALS AND METHODS We established an apical periodontitis model. An immortalized cementoblast cell line (OCCM-30) cells were exposed to TNF-α. Fto, Il6, Mcp1, and Mmp9 expressions were assessed by qRT-PCR. We knocked down Fto using lentiviruses and detected TNF-α-induced inflammation-related gene expressions and mRNA stability. RESULTS Mice with apical periodontitis showed downregulation of Fto expression. OCCM-30 cells exposed to TNF-α showed an upregulation of inflammation-related genes with a decrease in Fto. Furthermore, knockdown of Fto promoted the expressions of Il6, Mcp1, and Mmp9 in TNF-α-treated OCCM-30 cells as compared with negative control cells, whereas it did not affect the mRNA stability. Interestingly, Fto knockdown activated the p65, p38, and ERK1/2 pathways, and it slightly activated the JNK signaling pathway after TNF-α administration in OCCM-30 cells. CONCLUSION A TNF-α-induced decrease in the expression of Fto might play a critical role in the inflammatory response in cementoblasts, and knockdown of Fto might upregulate the inflammatory response.
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Affiliation(s)
- Biao Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Mingyuan Du
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Qiao Sun
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhengguo Cao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Periodontology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Hong He
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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Sanikop M, Aspalli S, Nagappa G, Jabeen R, Aspalli N, Babu CH. Assessment of serum parameters in stable coronary artery disease patients in correlation with healthy and chronic periodontitis patients. Contemp Clin Dent 2022; 13:50-55. [PMID: 35466295 PMCID: PMC9030312 DOI: 10.4103/ccd.ccd_659_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 08/29/2020] [Accepted: 12/22/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Periodontitis is a chronic inflammatory disease and has been strongly associated with elevation of systemic markers such as C-reactive protein (CRP), fibrinogen (FIB), and lipid profile, which have also been significantly associated with coronary heart disease (CHD). Hence, there is a need to assess the possible association between chronic periodontitis and coronary artery disease. Materials and Methods: A study included 100 subjects divided into four groups. Group I: stable coronary artery disease with chronic periodontitis, Group II: stable coronary artery disease without chronic periodontitis, Group III: chronic periodontitis without coronary artery disease, and Group IV: healthy controls. Gingival index, Russell's periodontal index, pocket depth, and clinical attachment level were recorded. Venous blood was collected from the patients, and serum fibrinogen, CRP, and lipid profile levels were estimated. Results: The intragroup comparison of biochemical and periodontal parameters showed statistically significant results with P < 0.05. The intergroup comparison of serum FIB, total cholesterol, high density lipoprotein, low density lipoprotein, and clinical attachment level showed statistical significant results (P = 0.000, P = 0.000, P = 0.001, P = 0.025, and P = 0.000, respectively) between Groups I and III. Conclusion: The results of the study indicate that there might a possible correlation between coronary artery disease and chronic periodontitis, but periodontitis-cardiovascular link is complex and difficult to define though there is sufficient evidence for their association. Leakage of pro-inflammatory cytokines from the ulcerated periodontium causes the production of acute-phase proteins by the liver. To prove the relationship, further studies should be considered making use of other markers of inflammation with prospective randomized controlled studies involving large population.
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Bodanese LC, Louzeiro GC, Magnus GA, Baptista ÂH, Salum FG, Mattiello R. Association between Periodontitis and Myocardial Infarction: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Qin X, Zhao Y, Guo Y. Periodontal disease and myocardial infarction risk: A meta-analysis of cohort studies. Am J Emerg Med 2021; 48:103-109. [PMID: 33866268 DOI: 10.1016/j.ajem.2021.03.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The objective of this meta-analysis was to systematically assess the association between periodontal disease (PD) and myocardial infarction (MI). METHODS We searched the EMBASE, PubMed, and Cochrane Library databases for eligible cohort studies from inception to August 31st, 2020 that reported the association between PD and MI. Data extraction was conducted after screening the literature. The risk of bias of the included studies was evaluated by using the Newcastle-Ottawa Scale (NOS). The combined OR value and 95% confidence interval (CI) were calculated by using STATA 11.0 software, and the source of any heterogeneity was determined by performing subgroup analysis and sensitivity analysis. RESULTS A total of 10 cohort studies involving 5,369,235 participants fulfilled the inclusion criteria. The meta-analysis showed an increased risk for MI in patients with PD [RR = 1.13, 95% CI (1.04, 1.21), P = 0.004], and this result was robust according to sensitivity analysis. Subgroup analyses indicated that the results were affected by sex, effect value, study quality, survey form and investigation type. DISCUSSION This meta-analysis suggests that PD is modestly associated with MI, especially in women, which is similar to the conclusions of earlier meta-analyses of case-control or observational studies. PD may be an untraditional risk factor for cardiovascular diseases, including MI; thus, maintaining periodontal health may be an effective measure to prevent MI. More cohort studies are still needed to further explore the relationship between the incidence of MI and PD.
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Affiliation(s)
- Xiaoru Qin
- Fenyang College, Shanxi Medical University, Fenyang, China.
| | - Yifeng Zhao
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Yuxuan Guo
- Department of Management, Shanxi Medical University, Taiyuan, China
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Patel J, Kulkarni S, Doshi D, Poddar P, Srilatha A, Reddy KS. Periodontal disease among non-diabetic Coronary Heart Disease patients. A case-control study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021030. [PMID: 33682819 PMCID: PMC7975955 DOI: 10.23750/abm.v92i1.8891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/04/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is well documented scientific evidence supporting the association between Coronary Heart Disease (CHD) and periodontitis. It is however, uncertain if this association is causal or is mediated by the common inflammatory pathways. Hence, the study assessed and compared the Periodontal Health Status among CHD patients with age and gender matched controls. METHODS A total of 808 medically confirmed CHD patients were compared with 808 age and gender matched controls. Oral examination was conducted using Simplified Oral Hygiene Index (OHI-S) and modified World Health Organization (WHO) Oral Health Assessment form, 1997. Mean scores were compared using Mann- Whitney-U test and Analysis of Variance (ANOVA). Logistic regression analysed the association between the risk factors and CHD. RESULTS Cases had significantly higher mean sextants with pockets and attachment loss ≥4mm compared to controls (p≤0.05). The cases also had significantly poor oral hygiene mean scores compared to controls (p=0.0001*). There was a lower and insignificant association between age (p=0.99), gender (p=0.84) and CHD. Risk factors education (p=0.001), lesser frequency of dental visit (p=0.001) also showed a lower, yet significant association. Risk of CHD was higher among tobacco (Odds ratio (OR) - 2.26) and alcohol (OR-1.83) users. Presence of poor oral hygiene (OR-5.20), pocket of ≥6 mm (6.70) and attachment loss of ≥9 mm (OR-11.31) also showed higher risk of CHD. CONCLUSION The study results support the association between periodontal disease and CHD. To halt the epidemic of CHD, emphasis on screening of wide age range, reinforcement of public health systems and early detection is recommended. (www.actabiomedica.it).
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Affiliation(s)
- Jenisha Patel
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, India.
| | - Suhas Kulkarni
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, India.
| | - Dolar Doshi
- Government Dental College and Hospital, Hyderabad, India.
| | - Pawan Poddar
- Department of Cardiology, Yashoda Hospital, Hyderabad, India.
| | - Adepu Srilatha
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, India.
| | - Kommuri Sahithi Reddy
- Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, India.
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Zardawi F, Gul S, Abdulkareem A, Sha A, Yates J. Association Between Periodontal Disease and Atherosclerotic Cardiovascular Diseases: Revisited. Front Cardiovasc Med 2021; 7:625579. [PMID: 33521070 PMCID: PMC7843501 DOI: 10.3389/fcvm.2020.625579] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/17/2020] [Indexed: 01/15/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ACVD) is an inflammatory disease of the coronary arteries associated with atheroma formation, which can cause disability and often death. Periodontitis is ranked as the sixth most prevalent disease affecting humans affecting 740 million people worldwide. In the last few decades, researchers have focused on the effect of periodontal disease (PD) on cardiovascular disease. The aim of this review was to investigate the association between these two diseases. PD is a potential risk factor that may initiate the development, maturation, and instability of atheroma in the arteries. Two mechanisms were proposed to explain such association, either periodontal pathogens directly invade bloodstream or indirectly by increasing systemic level of inflammatory mediators. Interestingly, it has been suggested that improvement in the condition of one disease positively impact the condition of the other one. Highlighting the association between these two diseases, the importance of early diagnosis and treatment of PD and its impact on cardiovascular status may be of great value in reducing the complications associated with ACVDs. Further in vitro and in vivo studies with longer follow up are necessary to confirm the causal relationship between PD and ACVDs.
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Affiliation(s)
- Faraedon Zardawi
- Periodontics Department, College of Dentistry, University of Sulaimani, Sulaymaniyah, Iraq
| | - Sarhang Gul
- Periodontics Department, College of Dentistry, University of Sulaimani, Sulaymaniyah, Iraq
| | - Ali Abdulkareem
- Department of Periodontics, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Aram Sha
- Periodontics Department, College of Dentistry, University of Sulaimani, Sulaymaniyah, Iraq
| | - Julian Yates
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
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Kim SR, Nam SH. Association between Periodontal Disease and Levels of Triglyceride and Total Cholesterol among Korean Adults. Healthcare (Basel) 2020; 8:E337. [PMID: 32932647 PMCID: PMC7551387 DOI: 10.3390/healthcare8030337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 11/23/2022] Open
Abstract
Although the correlation between periodontal condition and hyperlipidemia was shown by previous researches, it remains disputed. This study was based on data from the seventh Korea National Health and Nutrition Examination Survey 2016-2018. Data included 14,068 subjects' demographic characteristics, total cholesterol levels, triglyceride levels, and periodontal conditions. We analyzed the correlation between periodontal disease and blood lipid levels using complex-sample chi square tests and complex-sample logistic regression. The results of chi square tests showed a significant difference in demographic characteristics according to total cholesterol level and triglyceride level. The results of logistic regression, adjusted for the subjects' demographic characteristics such as age, gender, house income, marital status, home ownership, number of persons living together, health insurance coverage, and economic activity, showed that prevalence of periodontal disease was 1.048-fold (confidence interval (CI) 0.827-1.133) higher in the high-total-cholesterol group and 1.499-fold (CI 1.576-1.983) higher in high-triglyceride group. We found that not high total cholesterol but high triglyceride level was connected with periodontal disease. Therefore, management of triglyceride level could be a possible precaution of periodontal disease.
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Affiliation(s)
- Seon-Rye Kim
- Department of Pharmacy, College of Pharmacy, Kangwon National University, Chuncheon-si 24341, Korea;
| | - Seoul-Hee Nam
- Department of Dental Hygiene, College of Health Science, Kangwon National University, Samcheok-si 25945, Korea
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9
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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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Kumari M, Patthi B, Jankiram C, Singla A, Malhi R, Rajeev A. Risk of having myocardial infarction in periodontal disease patients: A systematic review. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2019. [DOI: 10.4103/jiaphd.jiaphd_15_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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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Chandy S, Joseph K, Sankaranarayanan A, Issac A, Babu G, Wilson B, Joseph J. Evaluation of C-Reactive Protein and Fibrinogen in Patients with Chronic and Aggressive Periodontitis: A Clinico-Biochemical Study. J Clin Diagn Res 2017; 11:ZC41-ZC45. [PMID: 28511507 DOI: 10.7860/jcdr/2017/23100.9552] [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: 07/26/2016] [Accepted: 11/21/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Periodontal disease is characterised by chronic infection and inflammation in periodontal tissues leading to destruction of alveolar bone with subsequent tooth loss. Periodontal infections are the result of an interaction between tooth associated microbial biofilms and the host defences. Periodontal pathogens can affect local and systemic immune and inflammatory responses. AIM The aim of the present study was to evaluate serum C-Reactive Protein (CRP), plasma fibrinogen and peripheral blood levels in healthy subjects, chronic and aggressive periodontitis patients. MATERIALS AND METHODS A total of 55 subjects, 27 males and 28 females were selected for the study. Blood samples were taken from healthy controls (n=20) and patients with chronic periodontitis (n=20) and aggressive periodontitis (n=15). The periodontal status of each patient was assessed by recording Oral Hygiene Index-Simplified (OHI-S), Bleeding Index (BI), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). The levels of serum CRP were measured using high sensitivity Enzyme Linked Immunosorbent Assay (ELISA) and levels of plasma fibrinogen were measured using Quantitative Immunoturbidimetric assay. Data description was done in the form of mean and standard deviation and analysis of data was done using one way ANOVA (Analysis of Variance) and Students t-test to test the statistical significance between groups. RESULTS The levels of serum CRP and plasma fibrinogen was increased in patients with chronic and aggressive periodontitis when compared to healthy controls (p<0.001). A positive correlation was found to exist between levels of clinical parameters like OHI-S, BI, PPD and CAL when compared with CRP and fibrinogen as well as with the study groups. CONCLUSION The finding of the present study suggests the role of serum as a diagnostic marker in inflammatory conditions and indicates that levels of CRP and fibrinogen may serve as important biomarkers for evaluating the association between periodontitis and cardiovascular diseases.
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Affiliation(s)
- Swaroop Chandy
- Senior Lecturer, Department of Periodontics, St Gregorios Dental College, Cochin, Kerala, India
| | - Kiran Joseph
- Professor, Department of Periodontics, St Gregorios Dental College, Cochin, Kerala, India
| | - Anila Sankaranarayanan
- Professor, Department of Periodontics, St Gregorios Dental College, Cochin, Kerala, India
| | - Annie Issac
- Senior Lecturer, Department of Periodontics, St Gregorios Dental College, Cochin, Kerala, India
| | - George Babu
- Senior Lecturer, Department of Paedodontics, St Gregorios Dental College, Cochin, Kerala, India
| | - Bobby Wilson
- Reader, Department of Paedodontics, Coorg Institute of Dental Sciences, Coorg, Karnataka, India
| | - Jumol Joseph
- Senior Lecturer, Department of Prosthodontics, Coorg Institute of Dental Sciences, Coorg, Karnataka, India
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Xu S, Song M, Xiong Y, Liu X, He Y, Qin Z. The association between periodontal disease and the risk of myocardial infarction: a pooled analysis of observational studies. BMC Cardiovasc Disord 2017; 17:50. [PMID: 28143450 PMCID: PMC5286862 DOI: 10.1186/s12872-017-0480-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/20/2017] [Indexed: 02/07/2023] Open
Abstract
Background Several meta-analyses have indicated that periodontal disease (PD) are related to cardiovascular diseases (CVDs). However, the association between PD and myocardial infarction (MI) remains controversial. Here we aimed to assess the association between PD and MI by meta-analysis of observational studies. Methods PubMed, EMBASE and the Cochrane Library were searched through July, 2016. Observational studies including cohort, cross-sectional and case–control studies reporting odds ratio (OR) or relative risk (RR) with 95% confidence intervals (CIs) were included in the analysis. Either fixed or random-effects model were applied to evaluate the pooled risk estimates. Sensitivity and subgroup analyses were also carried out to identify the sources of heterogeneity. Publication bias was assessed by the Begg’s, Egger’s test and funnel plot. Results We included 22 observational studies with 4 cohort, 6 cross-sectional and 12 case–control studies, including 129,630 participants. Patients with PD have increased risk of MI (OR 2.02; 95% CI 1.59-2.57). Substantial heterogeneity in risk estimates was revealed. Subgroup analyses showed that the higher risk of MI in PD patients exists in both cross-sectional studies (OR 1.71; 95% CI 1.07-2.73) and case–control studies (OR 2.93; 95% CI 1.95-4.39), and marginally in cohort studies (OR 1.18; 95% CI 0.98-1.42). Further, subgroup meta-analyses by location, PD exposure, participant number, and study quality showed that PD was significantly associated with elevated risk of MI. Conclusion Our meta-analysis suggested that PD is associated with increased risk of future MI. However, the causative relation between PD and MI remains not established based on the pooled estimates from observational studies and more studies are warranted. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0480-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shuai Xu
- Department of Stomatology, Xinqiao Hospital, Third Military Medical University, 400037, Chongqing, China
| | - Mingbao Song
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, 183 Xinqiaozhengjie St., Shapingba District, 400037, Chongqing, China
| | - Yu Xiong
- Department of Stomatology, Southwest Hospital, Third Military Medical University, 400038, Chongqing, China
| | - Xi Liu
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, 183 Xinqiaozhengjie St., Shapingba District, 400037, Chongqing, China
| | - Yongming He
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, 183 Xinqiaozhengjie St., Shapingba District, 400037, Chongqing, China
| | - Zhexue Qin
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, 183 Xinqiaozhengjie St., Shapingba District, 400037, Chongqing, China.
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Kurahashi T, Kitagawa M, Matsukubo T. Factors Associated with Number of Present Teeth in Adults in Japanese Urban City. THE BULLETIN OF TOKYO DENTAL COLLEGE 2017; 58:85-94. [DOI: 10.2209/tdcpublication.2016-2200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Miki Kitagawa
- Department of Epidemiology and Public Health, Tokyo Dental College
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15
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Shi Q, Zhang B, Huo N, Cai C, Liu H, Xu J. Association between Myocardial Infarction and Periodontitis: A Meta-Analysis of Case-Control Studies. Front Physiol 2016; 7:519. [PMID: 27867362 PMCID: PMC5095113 DOI: 10.3389/fphys.2016.00519] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 10/20/2016] [Indexed: 01/01/2023] Open
Abstract
Background and Objective: Many clinical researches have been carried out to investigate the relationship between myocardial infarction (MI) and periodontitis. Despite most of them indicated that the periodontitis may be associated with an increased risk of MI, the findings and study types of these studies have been inconsistent. The goal of this meta-analysis was to critically assess the strength of the association between MI and periodontitis in case-control studies. Methods: PubMed and the Cochrane Library were searched for eligible case-control studies reporting relevant parameters that compared periodontal status between MI and control subjects. The odds ratios (ORs) and 95% confidence intervals (CIs) from each study were pooled to estimate the strength of the association between MI and periodontitis. The mean differences and 95% CIs for periodontal-related parameters were calculated to determine their overall effects. Results: Seventeen studies including a total of 3456 MI patients and 3875 non-MI control subjects were included. The pooled OR for the association between MI and periodontitis was 2.531 (95% CI: 1.927–3.324). The mean differences (95% CIs) for clinical attachment loss, probing depth, bleeding on probing, plaque index, and the number of missing teeth were 1.000 (0.726–1.247), 1.209 (0.538–1.880), 0.342 (0.129–0.555), 0.383 (0.205–0.560), and 4.122 (2.012–6.232), respectively. Conclusion: With the current evidence, the results support the presence of a significant association between MI and periodontitis. Moreover, MI patients had worse periodontal and oral hygiene status and fewer teeth than did control subjects. More high-quality and well-designed studies focusing on the casual relationship between MI and periodontitis should be conducted in the future.
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Affiliation(s)
- Quan Shi
- Institute of Stomatology, Chinese PLA General Hospital Beijing, China
| | - Bin Zhang
- Institute of Stomatology, Chinese PLA General Hospital Beijing, China
| | - Na Huo
- Institute of Stomatology, Chinese PLA General Hospital Beijing, China
| | - Chuan Cai
- Institute of Stomatology, Chinese PLA General Hospital Beijing, China
| | - Hongchen Liu
- Institute of Stomatology, Chinese PLA General Hospital Beijing, China
| | - Juan Xu
- Institute of Stomatology, Chinese PLA General Hospital Beijing, China
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Abstract
BACKGROUND AND OBJECTIVE Selective killing of pathogens by laser is possible due to the difference in absorption of photon energy by pathogens and host tissues. The optical properties of pathogenic microorganisms are used along with the known optical properties of soft tissues in calculations of the laser-induced thermal response of pathogen colonies embedded in a tissue model. The objective is to define the laser parameters that optimize pathogen destruction and depth of the bactericidal effect. MATERIALS AND METHODS The virtual periodontium is a computational model of the optical and time-dependent thermal properties of infected periodontal tissues. The model simulates the periodontal procedure: Laser Sulcular Debridement.1 Virtual pathogen colonies are placed at different depths in the virtual periodontium to determine the depth for effective bactericidal effects given various laser parameters (wavelength, peak power, pulse duration, scan rate, fluence rate) and differences in pathogen sensitivities. RESULTS Accumulated background heat from multiple passes increases the depth of the bactericidal effect. In visible and near-IR wavelengths the large difference in absorption between normal soft tissue and Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi) results in selective destruction. Diode laser (810 nm) efficacy and depth of the bactericidal effect are variable and dependent on hemin availability. Both pulsed-Nd:YAG and the 810 nm diode lasers achieve a 2-3 mm deep damage zone for pigmented Pg and Pi in soft tissue without surface damage (selective photoantisepsis). The model predicts no selectivity for the Er:YAG laser (2,940 nm). Depth of the bactericidal effect is highly dependent on pathogen absorption coefficient. Highly sensitive pathogens may be destroyed as deep as 5-6 mm in soft tissue. Short pulse durations enable confinement of the thermal event to the target. Temporal selectivity is achieved by adjusting pulse duration based on target size. CONCLUSION The scatter-limited phototherapy model of the infected periodontium is applied to develop a proper dosimetry for selective photoantisepsis. Dosimetry planning is essential to the development of a new treatment modality. Lasers Surg. Med. 48:763-773, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- David M Harris
- Biomedical Consultants & Associates, Inc., Paradise, California 95969.
| | - Lou Reinisch
- Academic Affairs, New York Institute of Technology, Old Westbury, New York 11568
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Otsuka H, Kondo K, Ohara Y, Yasuda M, Kishimoto N, Sunaga M, Endo K, Arakawa S, Kinoshita A, Shinada K. An Inter- and Intraprofessional Education Program in Which Dental Hygiene Students Instruct Medical and Dental Students. J Dent Educ 2016. [DOI: 10.1002/j.0022-0337.2016.80.9.tb06188.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hiromi Otsuka
- Department of Preventive Oral Health Care Sciences; Graduate School; Tokyo Medical and Dental University
| | - Keiko Kondo
- Department of Lifetime Oral Health Care Sciences; Graduate School; Tokyo Medical and Dental University
| | - Yuki Ohara
- Department of Oral Health Care Education; Graduate School; Tokyo Medical and Dental University
| | - Masayo Yasuda
- Oral Health Care Clinic; Dental Hospital; Tokyo Medical and Dental University
| | - Natsuki Kishimoto
- Department of Oral Health Care Education; Graduate School; Tokyo Medical and Dental University
| | - Masayo Sunaga
- Department of Educational Media Development; Institute for Library and Media Information Technology; Tokyo Medical and Dental University
| | - Keiko Endo
- Department of Oral Health Care Education; Graduate School; Tokyo Medical and Dental University
| | - Shinichi Arakawa
- Department of Lifetime Oral Health Care Sciences; Graduate School; Tokyo Medical and Dental University
| | - Atsuhiro Kinoshita
- Department of Educational Media Development; Institute for Library and Media Information Technology; Tokyo Medical and Dental University
| | - Kayoko Shinada
- Department of Preventive Oral Health Care Sciences; Graduate School; Tokyo Medical and Dental University
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18
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Boillot A, Range H, Danchin N, Kotti S, Cosler G, Czernichow S, Meilhac O, Puymirat E, Zeller M, Tchetche D, Bouchard P, Simon T. Periodontopathogens antibodies and major adverse events following an acute myocardial infarction: results from the French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI). J Epidemiol Community Health 2016; 70:1236-1241. [DOI: 10.1136/jech-2015-207043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/20/2016] [Indexed: 01/22/2023]
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Choudhury AR, Choudhury KN, Islam SMS. Relationship of dental diseases with coronary artery diseases and diabetes in Bangladesh. Cardiovasc Diagn Ther 2016; 6:131-7. [PMID: 27054102 DOI: 10.21037/cdt.2016.02.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Evidence suggests that dental diseases might have a role in the development and progression of coronary artery diseases (CAD) and diabetes mellitus (DM). The objective of this study was to determine the relationship of dental diseases with CAD and DM in Bangladesh. METHODS We conducted a cross-sectional study among 216 consecutive patients admitted in a tertiary hospital between March and July 2011. Data were collected on socio-demographic status, smoking, blood pressure (BP), diet, physical activities, and biochemical measurements of lipid profile, glycated hemoglobin (HbA1c), C-reactive protein (CRP), fibrinogen, creatinine kinase MB (CK-MB), troponin, serum creatinine and serum glutamic-pyruvic transaminase (SGPT). CAD was detected using echocardiographic and coronary angiogram (CAG) reports. All patients underwent oral examination for dental disease. Relationship between dental disease with CAD and DM were explored statistically. RESULTS The mean age of the participants was 57.8±12.5 years and almost two-thirds (67.1%) were male. A great majority of the patients had CAD (90.3%) and type 2 DM (83.8%), and only 44% suffered from dental diseases. Less than one-third patients presented with acute myocardial infarction (MI), 23% with old MI, 11% unstable angina (UA) and 26.4% with non-ST elevation MI. Logistic regression results indicated that patients with DM and CAD had approximately 2.6 and 4.6 times more odds of association with dental diseases than those without DM and CAD (both P value <0.001). CONCLUSIONS This study suggests a relationship of dental diseases with CAD and DM among Bangladeshi patients. Further studies are required to confirm these relationships in large clinical studies. Screening for CAD and DM should be considered among those with dental diseases and vice-versa.
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Affiliation(s)
- Arup Ratan Choudhury
- 1 Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders (BIRDEM), Shahbagh, Dhaka, Bangladesh ; 2 National Centre for Control of Rheumatic Fever and Heart Disease, Dhaka, Bangladesh ; 3 Center for Control of Chronic Diseases (CCCD), International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh ; 4 Center for International Health (CIH), Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Kamrun Nahar Choudhury
- 1 Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders (BIRDEM), Shahbagh, Dhaka, Bangladesh ; 2 National Centre for Control of Rheumatic Fever and Heart Disease, Dhaka, Bangladesh ; 3 Center for Control of Chronic Diseases (CCCD), International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh ; 4 Center for International Health (CIH), Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Sheikh Mohammed Shariful Islam
- 1 Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders (BIRDEM), Shahbagh, Dhaka, Bangladesh ; 2 National Centre for Control of Rheumatic Fever and Heart Disease, Dhaka, Bangladesh ; 3 Center for Control of Chronic Diseases (CCCD), International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh ; 4 Center for International Health (CIH), Ludwig-Maximilians-Universität (LMU), Munich, Germany
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Oberoi SS, Harish Y, Hiremath S, Puranik M. A cross-sectional survey to study the relationship of periodontal disease with cardiovascular disease, respiratory disease, and diabetes mellitus. J Indian Soc Periodontol 2016; 20:446-452. [PMID: 28298829 PMCID: PMC5341322 DOI: 10.4103/0972-124x.186946] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Periodontal deterioration has been reported to be associated with systemic diseases such as cardiovascular disease (CVD), diabetes mellitus, respiratory disease, liver cirrhosis, bacterial pneumonia, nutritional deficiencies, and adverse pregnancy outcomes. AIM The present study assessed the periodontal disease among patients with systemic conditions such as diabetes, CVD, and respiratory disease. MATERIALS AND METHODS The study population consisted of 220 patients each of CVD, respiratory disease, and diabetes mellitus, making a total of 660 patients in the systemic disease group. A control group of 340 subjects were also included in the study for comparison purpose. The periodontal status of the patients with these confirmed medical conditions was assessed using the community periodontal index of treatment needs (CPITNs) index. RESULTS The prevalence of CPITN code 4 was found to be greater among the patients with respiratory disease whereas the mean number of sextants with score 4 was found to be greater among the patients with diabetes mellitus and CVD. The treatment need 0 was found to be more among the controls (1.18%) whereas the treatment need 1, 2, and 3 were more among the patients with respiratory disease (100%, 97.73%, and 54.8%), diabetes mellitus (100%, 100% and 46.4%), and CVD (100%, 97.73%, and 38.1%), in comparison to the controls (6.18%). CONCLUSION From the findings of the present study, it can be concluded that diabetes mellitus, CVD, and respiratory disease are associated with a higher severity of periodontal disease.
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Affiliation(s)
- Sukhvinder Singh Oberoi
- Department of Public Health Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
| | - Yashoda Harish
- Department of Public Health Dentistry, Government Dental College and Research Institute, Bengaluru, Karnataka, India
| | - Shivalingaswamy Hiremath
- Department of Public Health Dentistry, Oxford Dental College and Hospital, Bengaluru, Karnataka, India
| | - Manjunath Puranik
- Department of Public Health Dentistry, Oxford Dental College and Hospital, Bengaluru, Karnataka, India
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Bokhari SAH, Khan AA, Leung WK, Wajid G. Association of periodontal and cardiovascular diseases: South-Asian studies 2001-2012. J Indian Soc Periodontol 2015; 19:495-500. [PMID: 26644713 PMCID: PMC4645533 DOI: 10.4103/0972-124x.157876] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/07/2015] [Indexed: 01/22/2023] Open
Abstract
Large proportion of Asian populations have moderate to severe periodontal disease and a substantial number are anticipated to be at high risk of cardiovascular diseases (CVD). This study reviews epidemiology and association of periodontal and CVDs from the South-Asian region. Observational studies and clinical trials published during January 2001-December 2012 focusing association between periodontitis and CVDs in South-Asian countries were retrieved from various databases and studied. Current evidence suggests that both periodontal and CVDs are globally prevalent and show an increasing trend in developing countries. Global data on epidemiology and association of periodontal and CVDs are predominantly from the developed world; whereas Asia with 60% of the world's population lacks substantial scientific data on the link between periodontal and CVDs. During the search period, 14 studies (5 clinical trials, 9 case-controls) were reported in literature from South-Asia; 100% of clinical trials and 77% case-control studies have reported a significant association between the oral/periodontal parameters and CVD. Epidemiological and clinical studies from South-Asia validate the global evidence on association of periodontal disease with CVDs. However, there is a need for meticulous research for public health and scientific perspective of the Periodontal and CVDs from South-Asia.
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Affiliation(s)
- Syed Akhtar Hussain Bokhari
- Department of Periodontology and Preventive Dental Sciences, University Medical and Dental College, Faisalabad, Pakistan
| | - Ayyaz Ali Khan
- Department of Oral Health Sciences, Sheikh Zayed Medical Complex, Lahore, Pakistan
| | - Wai Keung Leung
- Department of Oral Diagnosis and Polyclinics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Gohar Wajid
- Department of Medical Education, University of Dammam, Dammam, Saudi Arabia
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Major Adverse Cardiovascular Events in Treated Periodontitis: A Population-Based Follow-Up Study from Taiwan. PLoS One 2015; 10:e0130807. [PMID: 26114433 PMCID: PMC4482590 DOI: 10.1371/journal.pone.0130807] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/26/2015] [Indexed: 02/07/2023] Open
Abstract
Background The aim of the present study was to identify the long-term major adverse cardiovascular events (MACE) in treated periodontitis patients in Taiwan. Methods From the National Health Insurance Research Database (2001-2010), adult patients (≥ 18 years) with treated periodontitis were identified. Comparison was made between patients with mild form and severe form of treated periodontitis after propensity score matching. The primary end point was the incidence of MACE. Results A total of 32,504 adult patients with treated periodontitis were identified between 2001 and 2010. After propensity score matching, 27,146 patients were preserved for comparison, including 13,573 patients with mild form and 13,573 patients with severe form of treated periodontitis. During follow-up, 728 individuals in mild treated periodontitis group and 1,206 individuals in severe treated periodontitis group had at least 1 MACE event. After adjustment for gender, hyperlipidemia, hypertension and diabetes mellitus, severe treated periodontitis was associated with a mildly but significantly increased risk of MACE among older patients > 60 years of age (incidence rate ratio, 1.26; 95% confidence interval, 1.08–1.46). No association was found among younger patients ≤ 60 years of age. Conclusions Severe form of treated periodontitis was associated with an increased risk of MACE among older Taiwanese patients, but not among younger Taiwanese patients. We should put more efforts on the improvement of periodontal health to prevent further MACE.
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Lee YL, Hu HY, Chou P, Chu D. Dental prophylaxis decreases the risk of acute myocardial infarction: a nationwide population-based study in Taiwan. Clin Interv Aging 2015; 10:175-82. [PMID: 25609934 PMCID: PMC4293300 DOI: 10.2147/cia.s67854] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose To investigate the association between periodontal disease (PD) and acute myocardial infarction (AMI), and evaluate the effect of dental prophylaxis on the incidence rate (IR) of AMI. Methods The Longitudinal Health Insurance Database 2000 from the National Health Insurance program was used to identify 511,630 patients with PD and 208,713 without PD during 2000–2010. Subjects with PD were grouped according to treatment (dental prophylaxis, intensive treatment, and PD without treatment). The IRs of AMI during the 10-year follow-up period were compared among groups. Cox regression analysis adjusted for age, sex, socioeconomic status, residential urbanicity, and comorbidities was used to evaluate the effect of PD treatment on the incidence of AMI. Results The IR of AMI among subjects without PD was 0.19%/year. Among those with PD, the IR of AMI was lowest in the dental prophylaxis group (0.11%/year), followed by the intensive treatment (0.28%/year) and PD without treatment (0.31%/year; P<0.001) groups. Cox regression showed that the hazard ratio (HR) for AMI was significantly lower in the dental prophylaxis group (HR =0.90, 95% confidence interval =0.86–0.95) and higher in the intensive treatment (HR =1.09, 95% confidence interval =1.03–1.15) and PD without treatment (HR =1.23, 95% confidence interval =1.13–1.35) groups than in subjects without PD. Conclusion PD is associated with a higher risk of AMI, which can be reduced by dental prophylaxis to maintain periodontal health.
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Affiliation(s)
- Ya-Ling Lee
- Department of Dentistry, Taipei City Hospital, Taipei, Taiwan ; Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Yun Hu
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan ; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Dachen Chu
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan ; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan ; Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan
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Flores MF, Montenegro MM, Furtado MV, Polanczyk CA, Rösing CK, Haas AN. Periodontal Status Affects C-Reactive Protein and Lipids in Patients With Stable Heart Disease From a Tertiary Care Cardiovascular Clinic. J Periodontol 2014; 85:545-53. [DOI: 10.1902/jop.2013.130255] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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25
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Kizildag A, Arabaci T, Dogan GE. Relationship between periodontitis and cardiovascular diseases: A literature review. World J Stomatol 2014; 3:1-9. [DOI: 10.5321/wjs.v3.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 08/14/2013] [Accepted: 11/16/2013] [Indexed: 02/06/2023] Open
Abstract
Periodontitis and cardiovascular disease have a complex etiology and genetics and share some common risk factors (i.e., smoking, age, diabetes, etc.). In recent years, the relationship between periodontal disease and cardiovascular disease has been investigated extensively. This research mostly focused on the fact that periodontitis is an independent risk factor for cardiovascular disease. Our aim in this article is to investigate the etiological relationship between periodontal disease and cardiovascular disease and the mechanisms involved in this association. According to the current literature, it is concluded that there is a strong relationship between these chronic disorders.
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Mahendra J, Mahendra L, Felix J, Romanos G. Prevelance of periodontopathogenic bacteria in subgingival biofilm and atherosclerotic plaques of patients undergoing coronary revascularization surgery. J Indian Soc Periodontol 2014; 17:719-24. [PMID: 24554879 PMCID: PMC3917199 DOI: 10.4103/0972-124x.124476] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 09/24/2013] [Indexed: 12/19/2022] Open
Abstract
Aim: The objective of the present study was to detect the presence of specific periodontopathogenic bacteria in the coronary plaque of patients with coronary artery disease and to find out the significant association between the periodontal status and the presence of pathogenic bacteria in the coronary plaque. Materials and Methods: The study population consisted of 51 patients with chronic generalized periodontitis undergoing coronary artery bypass grafting. Periodontal parameters were recorded and deoxyribonucleic acid was extracted from the subgingival plaque and coronary atherosclerotic plaque samples of the same patients. Polymerase chain reaction was used to amplify the part of 16S ribosomal ribonucleic acid (rRNA) gene to detect the presence of Aggregatibacter actinomycetemcomitans (Aa), Tannerella forsythia (Tf), Porphyromonas gingivali (Pg), Porphyromonas gingivalis (fimA) gene and Treponema denticola (Td). Results: Aa, Tf, Pg, Pg (fimA) gene and Td were detected in 0%, 31.4%, 45.1% 39.2% and 51% of atherosclerotic plaque samples, respectively. Tf was detected in 19.6%, Pg in 39.2%, Pg (fimA) gene in 33.3% and Td in 35.3% of both, subgingival plaque and atherosclerotic plaque samples. Periodontal parameters correlated with the presence of bacteria in coronary plaque. Aa could not be detected in coronary plaque samples. Conclusions: The study confirmed the detection of Red complex bacteria in coronary plaque samples and these bacteria correlated with the severity of periodontal destruction.
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Affiliation(s)
- Jaideep Mahendra
- Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Chennai, India
| | - Little Mahendra
- Department of Periodontics, Rajah Muthaiah Medical College and Hospital, Annamalai University, Annamalai Nagar, Chidambaram, Tamil Nadu, India
| | - John Felix
- Department of Bio-Statistics, Rajah Muthaiah Medical College and Hospital, Annamalai University, Annamalai Nagar, Chidambaram, Tamil Nadu, India
| | - Georgios Romanos
- Department of Clinical Dentistry, Department of Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, USA
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Parkar SM, Modi GN, Jani J. Periodontitis as risk factor for acute myocardial infarction: A case control study. Heart Views 2013; 14:5-11. [PMID: 23580918 PMCID: PMC3621229 DOI: 10.4103/1995-705x.107113] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To assess the periodontal status among the patients suffering from acute myocardial infarction (AMI) and to investigate whether periodontitis is a risk factor for AMI or not. MATERIALS AND METHODS A cross-sectional study of 60 subjects, 30 subjects in each AMI group and control group was conducted. Details of risk factors like age, sex, smoking, and alcohol consumption were obtained through a personal interview. Medical history was retrieved from the medical file. The oral hygiene status was assessed by using a simplified oral hygiene index (OHI-S) and the periodontal status was assessed by community periodontal index (CPI) and loss of attachment (LOA) as per World Health Organization (WHO) methodology 1997. Chi-square test was used to analyze qualitative data whereas t-test and one way analysis of variance (ANOVA) test was used for quantitative data. Multiple regression model was applied to check the risk factors for AMI. RESULTS The mean OHI-S score for case and control group was 3.98 ± 0.70 and 3.11 ± 0.68, respectively, which was statistically highly significant ( P < 0.001). There was high severity of periodontitis (for both in terms of CPI and LOA) in the case group as compared with control group, that was found to be statistically highly significant ( P < 0.001). There was a significant result for OHI-S and LOA score with odds ratio of 0.13 and 0.79, respectively, when the multiple logistic regression model was applied. CONCLUSION The results of the present study show evidence that those patients who have experienced myocardial infarction exhibit poor periodontal conditions in comparison to healthy subjects and suggest an association between chronic oral infections and myocardial infarction.
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Affiliation(s)
- Sujal M. Parkar
- Department of Public Health Dentistry, Ahmedabad Dental College and Hospital, Gujarat, India
| | - Gunjan N. Modi
- Department of Public Health Dentistry, Ahmedabad Dental College and Hospital, Gujarat, India
| | - Jalak Jani
- Department of Oral Medicine and Radiology, Ahmedabad Dental College and Hospital, Gujarat, India
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Abstract
PURPOSE To examine the differences in oral health status among residents of high-poverty counties, as compared to residents of other rural or urban counties, specifically on the prevalence of edentulism. METHODS We used the 2005 Behavioral Risk Factor Surveillance System (BRFSS) and the 2006 Area Resource File (ARF). All analyses were conducted with SAS and SAS-callable SUDAAN, in order to account for weighting and the complex sample design. FINDINGS Characteristics significantly related to edentulism include: geographic location, gender, race, age, health status, employment, insurance, not having a usual source of care, education, marital status, presence of chronic disease, having an English interview, not deferring care due to cost, income, and dentist saturation within the county. CONCLUSIONS Significant associations between high-poverty rural and other rural counties and edentulism were found, and other socioeconomic and health status indicators remain strong predictors of edentulism.
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Affiliation(s)
- Jordan Mitchell
- Healthcare Administration, School of Business, University of Houston, Clear Lake, Houston, TX, USA.
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Machuca G, Segura-Egea JJ, Jiménez-Beato G, Lacalle JR, Bullón P. Clinical indicators of periodontal disease in patients with coronary heart disease: a 10 years longitudinal study. Med Oral Patol Oral Cir Bucal 2012; 17:e569-74. [PMID: 22173486 PMCID: PMC3476017 DOI: 10.4317/medoral.17848] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 09/28/2011] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES There is evidence about a possible relationship existing between periodontal diseases and coronary heart disease. The aim of the present longitudinal study was to investigate the changes in periodontal evolution after etiological periodontal treatment, comparing a healthy control group with another having coronary heart disease. STUDY DESIGN The study included initially 55 patients of which 44 finished it. They were placed into two groups: Healthy Control Group (HCG) n =9, and Coronary Heart Disease Group (CHDG) n=35. The gingival level (GL), probing depth (PD), clinical attachment level (CAL), plaque index (PI) and bleeding on probing (BOP) were measured to compare the periodontal status in both groups. The patients were examined and etiological periodontal treatment was performed and they were then examined at the end of 1 and 10 years. STATISTICAL METHOD A one way-ANOVA and a MR-ANOVA were established; significance p<0.05. RESULTS No significant differences between both groups were detected on the first visit (p>0.5). However, at the second visit the CHDG presented a significantly higher PD (p<0.05) and PI (p<0.01). CHDG patients gradually increase PD through time and in comparison to the control group (p<0.041). CHDG patients present a significantly higher CAL loss (p<0.0385) and a significant increase in PI (p<0.0041) at the end of one year, while on the third visit no significant differences were detected in any of these indices. Likewise, a similar fact can be observed on evaluating BOP at the end of ten years causal treatment, a smaller decrease in the cardiac group was observed in regards to the initial values (p<0.001). CONCLUSION Patients with coronary heart disease showed a worse evolution of periodontal indices than healthy ones, when referring to probing depth, plaque index and bleeding on probing index.
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Affiliation(s)
- Guillermo Machuca
- Department of Special Patients, Faculty of Odontology, University of Seville, Spain.
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Ziebolz D, Priegnitz A, Hasenfuss G, Helms HJ, Hornecker E, Mausberg RF. Oral health status of patients with acute coronary syndrome--a case control study. BMC Oral Health 2012; 12:17. [PMID: 22727119 PMCID: PMC3444382 DOI: 10.1186/1472-6831-12-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 06/22/2012] [Indexed: 11/07/2022] Open
Abstract
Background The aim of this investigation was to assess the state of oral health of patients with acute coronary syndrome (ACS) and to compare this with that of a provably healthy control group (H). Methods 33 patients who were receiving treatment as inpatients following acute myocardial infarction or unstable angina pectoris took part in the study (ACS-group). A healthy control group (H-group) made up of blood donors, was formed following matching for age, gender, and smoking habit with the study patient group. The dental investigation consisted of the dental status (DMF-T), a plaque-Index (PI), an assessment of gingival inflammation (GI) and periodontal situation (Periodontal Screening Index: PSR®/PSI), and attachment loss (AL). Statistical evaluation: t-test, Mann–Whitney-test and chi- squared test (level of significance p < 0.05). Results The mean DMF-T of the ACS-group (18.7 ± 6.8) and the H-group (19.4 ± 5.1) showed no difference (p = 0.7). Although, in the ACS-group the average loss of teeth (M-T: 8.4 ± 5.2) was higher than in the H-group (M-T: 5.8 ± 6.6) the difference was not significant (p = 0.2). Whereas with the PI no difference between the two groups was found (p = 0.9), the ACS-group showed significantly more signs of inflammation (GI) than the H-group (p = 0.045). In the case of PSR®/PSI, there was no difference between the two groups (p = 0.7). With regard to AL, no difference was revealed between ACS- and H-group (p = 0.2). Conclusion Although, the state of oral health of the ACS-group differed only insignificantly from that of control, patients with ACS showed more signs of gingival inflammation and a higher loss of teeth.
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Affiliation(s)
- Dirk Ziebolz
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Centre Goettingen, Goettingen, Germany.
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Emtiazy M, Keshavarz M, Khodadoost M, Kamalinejad M, Gooshahgir SA, Shahrad Bajestani H, Hashem Dabbaghian F, Alizad M. Relation between Body Humors and Hypercholesterolemia: An Iranian Traditional Medicine Perspective Based on the Teaching of Avicenna. IRANIAN RED CRESCENT MEDICAL JOURNAL 2012; 14:133-8. [PMID: 22737569 PMCID: PMC3372029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 01/11/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular diseases are among the most important causes of morbidity and mortality in the world. One of the important risk factors of cardiovascular disease is hyperlipidemia especially high levels of serum cholesterol. Due to the importance of hypercholesterolemia, being a serious condition, various treatments are used to control it, regardless of the cause, most of treatments, focused on reducing the level of serum lipids. This study aims to determine various view points for hypercholesterolemia in Iranian traditional medicine. METHODS We used several Iranian traditional medicine resources and literatures; then based on these texts; a pilot study was designed to assess their effects in 10 patients with high plasma cholesterol. The sign and symptoms in main digestive organs (Stomach and liver) were also evaluated. RESULTS Some patients showed hepatic temperament but all patients had gastric temperament. CONCLUSION With reference to Iranian traditional medical texts and literatures, the organs involved in the process of digestion, particularly the stomach and the liver play the most important role. Yet the proper function of stomach as the first step involved in the digestion chain should be emphasized.
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Affiliation(s)
- M Emtiazy
- School of Iranian Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran,Research Institute for Islamic and Complementary Medicine, Tehran University of Medical Sciences, Tehran, Iran,Correspondence: Majid Emtiazy, MD, PhD Student of Iranian Traditional Medicine, School of Iranian Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran. Tel.: +98-21-55601274, E-mail:
| | - M Keshavarz
- School of Iranian Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - M Khodadoost
- Department of Traditional Medicine, School of Medicine, Shahed University, Tehran, Iran
| | - M Kamalinejad
- Department of Pharmacognosy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S A Gooshahgir
- Research Institute for Islamic and Complementary Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - H Shahrad Bajestani
- Department of Endocrine and Metabolism, Rasoole Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - F Hashem Dabbaghian
- Research Institute for Islamic and Complementary Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - M Alizad
- School of Iranian Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Kodovazenitis G, Pitsavos C, Papadimitriou L, Deliargyris EN, Vrotsos I, Stefanadis C, Madianos PN. Periodontal disease is associated with higher levels of C-reactive protein in non-diabetic, non-smoking acute myocardial infarction patients. J Dent 2011; 39:849-54. [PMID: 21946158 DOI: 10.1016/j.jdent.2011.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 09/08/2011] [Accepted: 09/13/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES A link between periodontal disease (PD) and cardiovascular events has been proposed, but confounding by shared risk factors such as smoking and diabetes remains a concern. We examined the prevalence of PD and its contribution to C-reactive protein (CRP) levels in acute myocardial infarction (AMI) patients and in subjects without AMI and with angiographically nonobstructive coronary disease in the absence of these confounding risk factors. METHODS Periodontal status and admission CRP levels were evaluated in 87 non-diabetic and non-smoking subjects undergoing cardiac catheterization. The study group comprised of 47 patients with documented AMI, and 40 subjects without AMI and with angiographically nonobstructive coronary disease (ANCD group). RESULTS Both the prevalence of PD and CRP levels were significantly higher in AMI patients compared with ANCD subjects (38.3% vs. 17.5%, p=0.03 and 44.3 vs. 8.5 mg/L, p<0.001 respectively). PD was associated with higher CRP levels in AMI patients (52.5 vs. 36.1 mg/L, p=0.04) as well as in ANCD subjects, however, in this group this was not significant (12.6 vs. 7.6 mg/L, p=0.5). Multivariable regression analysis confirmed two separate measures of PD as strong and independent contributors to elevated CRP levels in AMI patients (R2 = 0.28, R2 = 0.30, p=0.001). CONCLUSIONS PD contributes to elevated CRP levels in non-diabetic, non-smoking AMI patients, independently of other confounding factors. These findings imply that periodontitis may emerge as a novel target for reducing future risk in AMI survivors.
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Affiliation(s)
- George Kodovazenitis
- Department of Periodontology, School of Dentistry, University of Athens, Athens, Greece.
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Nagahama Y, Obama T, Usui M, Kanazawa Y, Iwamoto S, Suzuki K, Miyazaki A, Yamaguchi T, Yamamoto M, Itabe H. Oxidized low-density lipoprotein-induced periodontal inflammation is associated with the up-regulation of cyclooxygenase-2 and microsomal prostaglandin synthase 1 in human gingival epithelial cells. Biochem Biophys Res Commun 2011; 413:566-71. [PMID: 21925143 DOI: 10.1016/j.bbrc.2011.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 09/01/2011] [Indexed: 11/28/2022]
Abstract
Periodontitis is characterized by chronic gingival tissue inflammation, and inflammatory mediators such as IL-8 and prostaglandin E(2) (PGE(2)) are associated with disease progression. Previously we showed that oxidatively modified low-density lipoprotein (oxLDL) was present in gingival crevicular fluid. In this study, the role of oxLDL in the gingival epithelial cell inflammatory response was further investigated using Ca9-22 cells and primary human oral keratinocytes (HOK). Treatment of Ca9-22 cells and HOK with oxLDL induced an up-regulation of IL-8 and the PGE(2)-producing enzymes, cyclooxygenase-2 and microsomal PGE(2) synthase-1. These responses induced by oxLDL were significantly suppressed by a nuclear factor-kappa B (NF-κB) inhibitor. However, unlike the result in macrophages, oxLDL did not lead to an increase in CD36 expression in these two cells. These results suggest that oxLDL elicits gingival epithelial cell inflammatory responses through an activation of the NF-κB pathway. These data suggest a mechanistic link between periodontal disease and lipid metabolism-related disorders, including atherosclerosis.
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Affiliation(s)
- Yu Nagahama
- Department of Periodontology, School of Dentistry, Showa University Dental Hospital, Tokyo, Japan
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34
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Buduneli E, Mäntylä P, Emingil G, Tervahartiala T, Pussinen P, Barış N, Akıllı A, Atilla G, Sorsa T. Acute Myocardial Infarction is Reflected in Salivary Matrix Metalloproteinase-8 Activation Level. J Periodontol 2011; 82:716-25. [DOI: 10.1902/jop.2010.100492] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ying Ouyang X, Mei Xiao W, Chu Y, Ying Zhou S. Influence of periodontal intervention therapy on risk of cardiovascular disease. Periodontol 2000 2011; 56:227-57. [DOI: 10.1111/j.1600-0757.2010.00368.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Gunupati S, Chava VK, Krishna BP. Effect of phase I periodontal therapy on anti-cardiolipin antibodies in patients with acute myocardial infarction associated with chronic periodontitis. J Periodontol 2011; 82:1657-64. [PMID: 21486181 DOI: 10.1902/jop.2011.110002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Serum anti-cardiolipin (aCL) antibodies are prevalent in patients with periodontal diseases. These increased aCL concentrations were identified to play a modulating role in cardiovascular diseases. The present study aims to explore the effect of phase I periodontal therapy on immunoglobulin (Ig)M and IgG aCL antibodies in patients with acute myocardial infarction (AMI) associated with chronic periodontitis. METHODS A cross-sectional randomized clinical study was conducted within two groups comprising a sample size of 72 patients (n = 36 each). Group 1 had clinical features of AMI, and group 2 had clinical features of AMI associated with chronic periodontitis. After a thorough clinical and oral examination, the plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (AL) were recorded. Serum sample collection by venipuncture was done for estimation of serum IgM and IgG aCL concentration by using an enzyme-linked immunosorbent assay method. In group 2, phase I periodontal therapy was performed, and clinical and biochemical parameters were reanalyzed after 1 month. RESULTS In group 2, the mean PI, GI, PD, clinical AL, and serum IgM and IgG aCL antibody levels were significantly higher than in group 1 patients. In addition, study results showed significant alterations in concentrations of serum IgM (P = 0.008) and IgG (P <0.001) aCL along with periodontal parameters after phase I periodontal therapy. CONCLUSION The phase I periodontal therapy altered levels of serum IgG and IgM aCL antibodies in patients with AMI associated with chronic periodontitis.
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Affiliation(s)
- Sumanth Gunupati
- Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
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Pejcic A, Kesic L, Milasin J. Association between Periodontopathogens and CRP Levels in Patients with Periodontitis in Serbia. J Dent Res Dent Clin Dent Prospects 2011; 5:10-6. [PMID: 23019501 PMCID: PMC3429984 DOI: 10.5681/joddd.2011.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Accepted: 03/08/2011] [Indexed: 12/16/2022] Open
Abstract
Background and aims
Recent epidemiological studies have shown that individuals with periodontitis have a significantly higher risk of developing coronary heart disease, which might be attributed to the complex microbiota in the dental plaque. Periodontopathogens have been reported as risk factors for cardiovascular disease. This study evaluated association of chronic periodontitis and periodontopathogens with CRP in systemically healthy Serbian adults.
Materials and methods
Serum C-reactive protein levels were measured in 24 patients with moderate periodontitis, 26 patients with severe periodontitis, and 25 periodontally healthy subjects. Periodontal health indicators included gingival bleeding on probing and periodontal disease status. Patients with moderate periodontitis had low attachment loss and pocket depths of <4 mm. Patients with severe periodontitis had high AL and pocket depth of >5 mm. The control group with healthy gingiva had gingival sulcus of <2 mm and no attachment loss. Presence of periodontopathogens in subgingival plaque samples was analyzed by polymerase chain reaction.
Results
The periodontal parameters and CRP levels were significantly higher in the patients with periodontitis. Patients who had both severe and moderate periodontitis had higher mean CRP levels. The percentage of subjects with elevated CRP leves of >5 mol/L was greater in the higher clinical AL group compared to the group with less attachment loss. Presence of periodontopathogens was also associated with elevated CRP levels and poor periodontal status.
Conclusion
PD and subgingival periodontopathogens are associated with increased CRP levels. These findings suggest that periodontal infection may contribute to systemic inflammatory burden in otherwise healthy individuals.
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Affiliation(s)
- Ana Pejcic
- Teaching assistent, Department of Periodontology and Oral Medicine, Medical Faculty, University of Nis, Serbia
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Pejcic A, Kesic LJ, Milasin J. C-reactive protein as a systemic marker of inflammation in periodontitis. Eur J Clin Microbiol Infect Dis 2010; 30:407-14. [PMID: 21057970 DOI: 10.1007/s10096-010-1101-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Accepted: 10/18/2010] [Indexed: 02/06/2023]
Abstract
Periodontitis has been identified as a potential risk factor for systemic pathologies such as cardiovascular disease (CVD). The aims of this investigation were to assess the relationship between periodontitis and systemic inflammatory factor, as well as to discover whether there is a relation to the severity of periodontitis and to the periodontopathogens. Periodontal examinations and serum C-reactive protein (CRP) level measurements were performed in 50 patients with periodontitis. Periodontal health indicators included the gingival bleeding on probing index and periodontal disease status. The patients with moderate periodontitis had low attachment loss and pocket depth <4 mm. The patients with severe periodontitis had high attachment loss and pocket depth >5 mm. The control group comprised 25 volunteers with healthy gingiva, gingival sulcus <2 mm and no attachment loss. The presence of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in subgingival plaque samples was analysed by the polymerase chain reaction (PCR) method. The periodontal parameters and CRP levels were significantly higher in the patients with periodontitis. Patients who had severe periodontitis, with high levels of mean clinical attachment loss, and subjects with moderate periodontitis had higher mean CRP levels. The percentage of subjects with elevated levels of CRP >5 mg/l was greater in the higher clinical attachment loss group compared to the group with lower attachment loss. The presence of P. gingivalis and A. actinomycetemcomitans were also associated with elevated CRP levels and poor periodontal status. Periodontitis and the presence of P. gingivalis are associated with an enhanced inflammatory response expressed by higher CRP levels. The association of periodontitis with CRP levels appears to be a contributing factor for CVD and might be a possible intermediate pathway in this association.
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Affiliation(s)
- A Pejcic
- Department of Periodontology and Oral Medicine, Medical Faculty, University of Nis, Nade Tomic 3/5, 18000, Nis, Serbia.
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Griffiths R, Barbour S. Lipoproteins and lipoprotein metabolism in periodontal disease. CLINICAL LIPIDOLOGY 2010; 5:397-411. [PMID: 20835400 PMCID: PMC2933935 DOI: 10.2217/clp.10.27] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A growing body of evidence indicates that the incidence of atherosclerosis is increased in subjects with periodontitis - a chronic infection of the oral cavity. This article summarizes the evidence that suggests periodontitis shifts the lipoprotein profile to be more proatherogenic. LDL-C is elevated in periodontitis and most studies indicate that triglyceride levels are also increased. By contrast, antiatherogenic HDL tends to be low in periodontitis. Periodontal therapy tends to shift lipoprotein levels to a healthier profile and also reduces subclinical indices of atherosclerosis. In summary, periodontal disease alters lipoprotein metabolism in ways that could promote atherosclerosis and cardiovascular disease.
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Affiliation(s)
- Rachel Griffiths
- Department of Biochemistry & Molecular Biology, Virginia Commonwealth University School of Medicine, Box 980614, Richmond, VA 23298-0614, USA
| | - Suzanne Barbour
- Department of Biochemistry & Molecular Biology, Virginia Commonwealth University School of Medicine, Box 980614, Richmond, VA 23298-0614, USA
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Dorn JM, Genco RJ, Grossi SG, Falkner KL, Hovey KM, Iacoviello L, Trevisan M. Periodontal Disease and Recurrent Cardiovascular Events in Survivors of Myocardial Infarction (MI): The Western New York Acute MI Study. J Periodontol 2010; 81:502-11. [DOI: 10.1902/jop.2009.090499] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Stein JM, Kuch B, Conrads G, Fickl S, Chrobot J, Schulz S, Ocklenburg C, Smeets R. Clinical periodontal and microbiologic parameters in patients with acute myocardial infarction. J Periodontol 2010; 80:1581-9. [PMID: 19792846 DOI: 10.1902/jop.2009.090170] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of clinical periodontal parameters and the presence of periodontal pathogens in patients with acute myocardial infarction (AMI). METHODS A total of 104 subjects (54 patients with AMI and 50 healthy controls) were included. Subgingival plaque samples were analyzed for periodontal pathogens Aggregatibacter actinomycetemcomitans (Aa; previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf; previously T. forsythensis), and Prevotella intermedia (Pi) using dot-blot hybridization. RESULTS Patients with AMI had a significantly higher frequency of probing depths (PDs) >or=4 mm than controls (39.2% versus 14.9%; P <0.0001). Among different cutoff levels, the frequency of >50% sites with PDs >or=4 mm showed the highest discrepancy between both groups (33% versus 0%; P <0.001). All periodontal pathogens were overrepresented in patients with AMI and positively correlated with increased periodontal PD and clinical attachment level (CAL). After adjustment for age, gender, smoking, body mass index, hypertension, plaque index, statin intake, and ratio of cholesterol to high-density lipoprotein, Pg remained a significant predictor for AMI (odds ratio [OR]: 13.6; 95% confidence interval [CI]: 3.1 to 59.8; P = 0.0005). Furthermore, the simultaneous presence of Aa + Pg (P = 0.0005) and Aa + Pg + Tf (P = 0.0018) were found with significantly higher frequency in patients with AMI than controls. CONCLUSIONS The results of our study confirm an association between periodontitis and AMI in which periodontal destruction was correlated with the presence of periodontal pathogens. In particular, Pg might be considered a potential risk indicator for AMI.
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Affiliation(s)
- Jamal M Stein
- Department of Operative Dentistry, Perdiodontology, and Dentistry, University Hospital Aachen, Aachen, Germany.
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42
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Akalin FA, Baltacioğlu E, Alver A, Karabulut E. Total antioxidant capacity and superoxide dismutase activity levels in serum and gingival crevicular fluid in pregnant women with chronic periodontitis. J Periodontol 2009; 80:457-67. [PMID: 19254130 DOI: 10.1902/jop.2009.080218] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is evidence of reduced antioxidant (AO) defense in periodontitis and pregnancy and adverse interactions between periodontitis and pregnancy. METHODS In this study, serum and gingival crevicular fluid (GCF) total AO capacity (TAOC) and superoxide dismutase (SOD) enzyme concentrations in pregnant patients with chronic periodontitis (CP) were compared to those in non-pregnant patients. Periodontal examinations were performed and GCF/serum samples were obtained from 33 pregnant patients with CP (PCP), 18 pregnant patients with gingivitis (PG), and 21 periodontally healthy pregnant controls (P-controls), monitored in the first and third trimesters; 27 non-pregnant women with CP; and 25 non-pregnant control women. The concentrations of TAOC (automated measurement method) and SOD (spectrophotometric method) were determined. RESULTS Periodontal parameters were higher in pregnant patients versus non-pregnant patients and in the CP group compared to controls, whereas TAOC and SOD concentrations were lower (P <0.05). All parameters, except plaque index, increased in pregnant subjects in the third trimester compared to the first trimester, whereas TAOC and SOD levels decreased (P <0.05). Periodontal parameters were highest and TAOC and SOD levels were lowest in the PCP group in the third trimester (P <0.05). CONCLUSIONS Systemic and local GCF AO levels decreased in pregnancy and periodontitis, and AO defense reached the lowest levels in the last phase of pregnancy, whereas periodontal status deteriorated. These results suggest that reduced AO capacity may be associated with adverse periodontitis-pregnancy interactions, and each situation can be a provocative risk factor for the other.
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Affiliation(s)
- Ferda Alev Akalin
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
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Sridhar R, Byakod G, Pudakalkatti P, Patil R. A study to evaluate the relationship between periodontitis, cardiovascular disease and serum lipid levels. Int J Dent Hyg 2009; 7:144-50. [DOI: 10.1111/j.1601-5037.2008.00318.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Emekli-Alturfan E, Basar I, Malali E, Elemek E, Oktay S, Ayan F, Emekli N, Noyan U. Plasma Tissue Factor Levels and Salivary Tissue Factor Activities of Periodontitis Patients with and without Cardiovascular Disease. PATHOPHYSIOLOGY OF HAEMOSTASIS AND THROMBOSIS 2009; 37:77-81. [DOI: 10.1159/000323418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 12/08/2010] [Indexed: 01/24/2023]
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45
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Association between periodontal disease and coronary artery disease. Open Med (Wars) 2008. [DOI: 10.2478/s11536-008-0007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe etiology of coronary artery disease (CAD) is multifunctional. There is increasing evidence that dental infections could play a role in the initiation and development of CAD. In a case control double blind study, one hundred male and female (mean age 51 ± 9.4) angiographically documented CAD, compared with one hundred male and female patients (mean age 50.6 ± 9) with angiographically negative coronary artery. All the patients (cases and control) underwent dental examination for the presence and severity of periodontitis by a dentist who was oblivious the result of the angiography performed. The association between periodontal disease status and CAD was significant (P=0.011); periodontitis was apparently more frequent in CAD positive patients than in control (86% versus 61%). Adjustment of coronary risk factors (smoking, DM, hypertension and hyperlipidemia) in both cases and control groups suggests that the association between periodontitis and CAD in our study was independent of coronary risk factors. There is increasing evidence that dental infection, especially aerobic organisms which have capability of aggregation of platelets, is the most important cause. Dental infection would be an independent risk factor for CAD.
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Couper DJ, Beck JD, Falkner KL, Graham SP, Grossi SG, Gunsolley JC, Madden T, Maupome G, Offenbacher S, Stewart DD, Trevisan M, Van Dyke TE, Genco RJ. The Periodontitis and Vascular Events (PAVE) pilot study: recruitment, retention, and community care controls. J Periodontol 2008; 79:80-9. [PMID: 18166096 DOI: 10.1902/jop.2008.070216] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Population-based clinical and laboratory studies have reported findings providing support for a possible relationship between periodontal disease and cardiovascular disease. The Periodontitis and Vascular Events (PAVE) pilot study was conducted to investigate the feasibility of a randomized secondary prevention trial to test whether treatment of periodontal disease reduces the risk for cardiovascular disease. METHODS Five clinical centers recruited participants who had documented coronary heart disease and met study criteria for periodontal disease. Eligible participants were randomized to receive periodontal therapy provided by the study or community dental care. Follow-up telephone calls and clinic visits were planned to alternate at 3-month intervals after randomization, with all participants followed until at least the 6-month clinic visit. Participants were followed for adverse events and periodontal and cardiovascular outcomes. RESULTS A total of 303 participants were randomized. Recruitment that involved active participation of a cardiologist with responsibility for the patients worked best among the strategies used. Of those who had not withdrawn, 93% completed the 6-month contact. During follow-up, 11% of the 152 subjects in the community dental care group reported receiving periodontal therapy outside of the study. CONCLUSIONS If appropriate recruitment strategies are used, this pilot study demonstrated that it is feasible to conduct a secondary prevention trial of periodontal therapy in patients who have had coronary heart disease. If a community dental care group is used, sample size estimation needs to take into account that a non-trivial proportion of participants in this group may receive periodontal therapy outside of the study.
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Affiliation(s)
- David J Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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Akalin FA, Baltacioğlu E, Alver A, Karabulut E. Lipid peroxidation levels and total oxidant status in serum, saliva and gingival crevicular fluid in patients with chronic periodontitis. J Clin Periodontol 2007; 34:558-65. [PMID: 17555410 DOI: 10.1111/j.1600-051x.2007.01091.x] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Increased levels of reactive oxygen species lead to oxidative stress. Recent data suggest increased lipid peroxidation (LPO) levels and oxidative stress in periodontitis. Malondialdehyde (MDA), a significant LPO product, increases in oxidative stress. In this study, MDA levels and total oxidant status (TOS) in serum, saliva and gingival crevicular fluid (GCF) were investigated in patients with chronic periodontitis (CP). MATERIALS AND METHODS Thirty-six CP patients and 28 periodontally healthy controls were included in the study. Following clinical measurements and samplings, MDA and TOS levels were measured by high-performance liquid chromatography and a novel automatic colorimetric method, respectively. RESULTS While the saliva and GCF MDA levels, and serum, saliva and GCF TOS values were significantly higher in the CP group than the control group (p<0.05), no significant difference in serum MDA levels was found (p>0.05). Strong positive correlations were observed between periodontal parameters and MDA and TOS levels (p<0.05). CONCLUSIONS The results revealed that LPO significantly increased locally in the periodontal pocket/oral environment, while TOS displayed both systemic and local increases in periodontitis. The findings suggest that increased LPO and TOS may play an important role in the pathology of periodontitis, and are closely related to the clinical periodontal status.
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Affiliation(s)
- Ferda Alev Akalin
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
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Andriankaja OM, Genco RJ, Dorn J, Dmochowski J, Hovey K, Falkner KL, Trevisan M. Periodontal disease and risk of myocardial infarction: the role of gender and smoking. Eur J Epidemiol 2007; 22:699-705. [PMID: 17828467 DOI: 10.1007/s10654-007-9166-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Accepted: 07/09/2007] [Indexed: 01/08/2023]
Abstract
BACKGROUND Studies examining the association between periodontal disease and coronary heart disease have shown a consistent but weak to moderate relationship. Limited data have been reported in women and the role of smoking has not been fully clarified. METHODS/RESULTS A population-based case-control study examining the association between periodontal disease (PD) and acute non-fatal myocardial infarction (MI) was conducted in Erie and Niagara counties in Western New York State. Cases (574) were discharged alive from local hospitals with MI diagnosis. Controls (887) were county residents randomly selected from the NY State Department of Motor Vehicles rolls and Health Care Financing Administration files. Periodontal disease was assessed using clinical attachment loss (CAL). Among men (415 cases), the odds ratio (OR) of the association between mean CAL (mm) and MI, adjusting for the effects of age, body mass index (BMI), physical activity, hypertension, cholesterol, diabetes, and total pack-years of cigarette smoking was 1.34 (1.15-1.57). In women (120 cases), the corresponding OR was 2.08 (1.47-2.94). The estimate of this association among non-smokers, also adjusting for age, gender, BMI, physical activity, hypertension, cholesterol, diabetes, and total pack-years of cigarette smoking, was 1.40 (1.06-1.86), while it was 1.49 (1.26-1.77) among smokers. CONCLUSIONS This study provides evidence of an association between PD and incident MI in both genders. This association appears to be independent from the possible confounding effect of smoking.
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Kaisare S, Rao J, Dubashi N. Periodontal disease as a risk factor for acute myocardial infarction. A case-control study in Goans highlighting a review of the literature. Br Dent J 2007; 203:E5; discussion 144-5. [PMID: 17694042 DOI: 10.1038/bdj.2007.582] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aim of the present study was to investigate the possible association between periodontal health and acute myocardial infarction (AMI) in a case-control design. MATERIALS AND METHODS A total of 500 patients, 250 with AMI and 250 with coronary heart disease (CHD) were included in this study. The patients in the AMI group were admitted in the department of Medicine, Goa Medical College and Hospital, Bambolim-Goa because of AMI. The patients in the CHD group had no documented history of recent acute coronary events. Medical history was taken and data on serum lipid values, decayed teeth, missing teeth, filled teeth, probing depth (PD), simplified oral hygiene index (OHI-S) and bleeding on probing (BOP) were recorded. Sample proportions were compared by Pearson's chi-square test and quantitative variables with Student's t-test. The relation of clinical parameters and conventional risk factors with AMI was assessed with multivariate logistic regression analysis. RESULTS All the serum lipids and dental parameters were statistically different between AMI and CHD groups (p <0.05). Logistic regression analysis showed that serum lipids, number of decayed teeth, mean PD, percentage of sites with BOP, and oral hygiene were significantly associated with AMI (p <0.05). CONCLUSION The results of this study indicate that periodontal disease may be associated with AMI. We propose that prospective randomised studies are needed to determine whether periodontal disease is a risk factor in the occurrence of AMI.
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Affiliation(s)
- S Kaisare
- Department of Periodontics, Goa Dental College and Hospital, Bambolim, Goa, India.
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Genctoy G, Ozbek M, Avcu N, Kahraman S, Kirkpantur A, Yilmaz R, Kansu O, Arici M, Altun B, Erdem Y, Bakkaloğlu M, Yasavul U, Turgan C, Kansu H. Gingival health status in renal transplant recipients: relationship between systemic inflammation and atherosclerosis. Int J Clin Pract 2007; 61:577-82. [PMID: 17244192 DOI: 10.1111/j.1742-1241.2007.01283.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality in renal transplant recipients (RTR). Systemic and periodontal inflammation has been suggested to have a possible role in the development of atherosclerosis. In the present study, we aimed to investigate the relationship between gingival health status, inflammation and atherosclerosis in RTRs. Eighty-three RTR (50 male, 33 female) were enrolled in the study. Routine biochemical analyses, serum lipoproteins, C-reactive protein, fibrinogen, homocystein, parathyroid hormone (PTH) and cyclosporin A (CsA) trough levels were studied. All patients had 24-h ambulatory blood pressure monitoring and B-mode ultrasound of the common carotid arteries. Gingival status was evaluated by the Löe and Silness gingival index (GI). Mean GI value was 2.3 +/- 0.5. Fifty patients (60.3%) had GI value >or= 2.1 (severe gingivitis; group A). Thirty-three patients (39.7%) had GI value < 2.1 (no or moderate gingivitis; group B). Age, carotid intima-media thickness (CIMT) and mean time on dialysis before transplantation were significantly higher in group A than in B. Systemic inflammation markers were not different between group A and group B. Mean CIMT was positively correlated with GI (r = 0.425; p = 0.001) and negatively correlated with high-density lipoprotein cholesterol (r = -0.256; p = 0.023). After the correction for confounding variables, mean CIMT was still significantly correlated with GI (r = 0.376, p = 0.02). In RTR, gingival inflammation seems to be associated with CIMT in the absence of systemic inflammation. Thus, gingivitis may, in part, play a role in the development of systemic atherosclerosis without causing any aggravation in systemic inflammatory response.
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Affiliation(s)
- G Genctoy
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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