[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE Shortened leukocyte telomere length (LTL) and diagnosis of periodontitis are associated with an increased risk of complications and mortality in diabetes. This study investigated the association between LTL, endotoxemia, and severity of periodontitis in a large cohort of people with diabetes. RESEARCH DESIGN AND METHODS Six hundred thirty individuals (371 with type 2 and 259 with type 1 diabetes) were recruited from the University College Hospital in London, U.K. During a baseline visit, blood was collected for standard biochemical tests and DNA extraction, while a dental examination was performed to determine diagnosis and extent of periodontitis. LTL was measured by real-time PCR, and endotoxemia was assessed by the limulus amoebocyte lysate method. RESULTS Two hundred fifty-five individuals were diagnosed with gingivitis, 327 with periodontitis (114 with moderate and 213 with severe disease), and 48 with edentulous. Diagnosis of periodontitis was associated with shorter LTL (P = 0.04). A negative association between LTL and endotoxemia was found in the severe periodontitis and type 2 diabetes groups (P = 0.01 for both). Shorter LTL was associated with increased extent of periodontitis (P = 0.01) and increased insulin resistance (homeostatic model assessment). Multiple adjustments for biochemical, anthropometric, and medication-use variables did not affect the results. CONCLUSIONS LTL is associated with endotoxemia and diagnosis of periodontitis in people with diabetes. LTL shortening might represent a novel biological pathway accounting for previous epidemiological data that documented higher prevalence of diabetes and its complications in people with periodontitis and vice versa.
Diabetes care 04/2014; 37(4):1140-7. · 7.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to investigate bone regeneration following application of a novel biphasic calcium phosphate (BCP I) composed of microstructured granules of 90% β-tricalcium phosphate (β-TCP)/10% hydroxyapatite (HA) compared to BCP non-microstructured biphasic calcium phosphate with a composite of 60% hydroxyapatite/40% β-TCP (BCP II) and a deproteinized bovine bone mineral (DBBM) at surgically created defects in the mandible of minipigs in a combined approach with guided bone regeneration (GBR).
Sixteen minipigs were used for the study. Lower premolars P2, P3, P4 and first molar M1 were extracted. Following 3 months of healing, two defects with a width and depth of 7 mm were created bilaterally in the mandible. The different grafting materials were randomly placed in the created defects and covered by means of a collagen membrane. After 3 and 8 weeks, biopsies were sampled. All specimens were evaluated with descriptive histology and histomorphometric evaluations complemented by micro-CT scan analysis.
All three biomaterials presented with higher bone volume at 8 weeks compared to 3 weeks (P < 0.0442). BCP I and DBBM demonstrated a significant higher amount of bone formation compared to BCP II at 8 weeks (P < 0.0328). BCP I also demonstrated a significant higher percentage of remaining graft volume compared to the other test groups both at 3 and 8 weeks (P < 0.0001 to P < 0.0003). Congruently, defects containing BCP I showed a significant higher amount of mineralized tissue compared to the other groups.
All the three test materials performed well with regard to bone formation at 8 weeks. BCP I showed significant higher amounts of newly formed bone despite a higher remaining graft volume compared to the other groups. With regard to the regenerative outcome, all the three materials can be recommended for clinical use.
Clinical Oral Implants Research 03/2014; · 3.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this pilot study was to investigate associations between IL-6 and COX-2 expression in gingival biopsies and both clinical diagnosis and genotypes in the IL-6 and COX-2 genes.
A case-control study included 41 gingival biopsies obtained from Caucasian patients grouped according to clinical diagnosis of gingival health (n = 10), gingivitis (n = 15) or chronic periodontitis (n = 16). Immunohistochemistry analyses were performed to determine COX-2 expression in lamina propria, IL-6 expression in lamina propria and gingival epithelium and level of inflammatory cell infiltrate. Individual DNA was extracted and genotyped by real-time PCR for IL6 SNPs rs 2069827 and rs 2069825 and for COX-2 rs 6681231.
The percentage of cellular COX-2 expression was associated with the extent of periodontal disease (Arbes index p = 0.026) and inflammatory infiltrate (p<0.0001). No association was observed between IL6 haplotypes and cells positive to IL-6 or COX-2 in gingival tissues. The COX-2 rs 6681231 was associated with cells positive to IL-6 in the connective tissue (p = 0.032).
COX-2 expression in gingival tissues may be a marker of periodontal disease severity. COX-2 rs 6681231 may be associated with IL-6 local production in gingival tissues.
PLoS ONE 01/2014; 9(2):e87023. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Thousands of bacterial phylotypes colonise the human body and the host response to this bacterial challenge greatly influences our state of health or disease. The concept of infectogenomics highlights the importance of host genetic factors in determining the composition of human microbial biofilms and the response to this microbial challenge. We hereby introduce the term 'genetic dysbiosis' to highlight the role of human genetic variants affecting microbial recognition and host response in creating an environment conducive to changes in the normal microbiota. Such changes can, in turn, predispose to, and influence, diseases such as: cancer, inflammatory bowel disease, rheumatoid arthritis, psoriasis, bacterial vaginosis and periodontitis. This review presents the state of the evidence on host genetic factors affecting dysbiosis and microbial misrecognition (i.e. an aberrant response to the normal microbiota) and highlights the need for further research in this area.
[Show abstract][Hide abstract] ABSTRACT: Oral health is important both for well-being and successful elite sporting performance. Reports from Olympic Games have found significant treatment needs; however, few studies have examined oral health directly. The aim of this study was to evaluate oral health, the determinants of oral health and the effect of oral health on well-being, training and performance of athletes participating in the London 2012 Games.
Cross-sectional study at the dental clinic within the Polyclinic in the athletes' village. Following informed consent, a standardised history, clinical examination and brief questionnaire were conducted.
302 athletes from 25 sports were recruited with data available for 278. The majority of athletes were from Africa, the Americas and Europe. Overall, the results demonstrated high levels of poor oral health including dental caries (55% athletes), dental erosion (45% athletes) and periodontal disease (gingivitis 76% athletes, periodontitis 15% athletes). More than 40% of athletes were 'bothered' by their oral health with 28% reporting an impact on quality of life and 18% on training and performance. Nearly half of the participants had not undergone a dental examination or hygiene care in the previous year.
The oral health of athletes attending the dental clinic of the London 2012 Games was poor with a resulting substantial negative impact on well-being, training and performance. As oral health is an important element of overall health and well-being, health promotion and disease prevention interventions are urgently required to optimise athletic performance.
British journal of sports medicine 09/2013; · 3.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previous research has suggested that deterioration in oral health can occur following hospitalisation. The impact of such deterioration could increase the risk of oral disease, reduce quality of life and increase the potential for healthcare-associated infections (HCAI) such as Healthcare-associated pneumonia (HAP). However, the strength of the evidence is limited by, amongst other factors, the few observational studies published that assess oral health longitudinally. In view of the microbiological component of oral diseases and HCAIs, the objective of this study was to investigate the microbiological changes in dental plaque following hospitalisation in a Critical Care Unit (CCU) by studying: 1) the total number of cultivable bacteria and 2) the presence and changes in specific HAP pathogens.
We conducted a prospective, longitudinal observational study in the CCU of University College Hospital, London. Study participants were recruited within 24 hours of admission. Dental plaque samples were collected from up to six sites per patient. The primary outcome was microbiological change from baseline to seven days with additional analysis for participants still present at day 14.
50 patients were recruited with 36 available for review at one week, with early discharge accounting for much of the loss to follow-up. The median total viable count of the plaque microbiota at baseline was 4.40 x 105 cfu/ml and increased at week one to 3.44 x 106 cfu/ml. The total viable microbe counts increased by a median of 2.26 x 106 cfu/ml from baseline to week one (95% CI: 3.19 x 106, 1.24 x 107) and this was statistically significant (p<0.01). Specific HAP bacteria were detected in 26% of participants sampled, although accounted for a relatively low proportion of the total viable bacteria.
Total bacterial count of dental plaque increases during hospitalisation in CCU. This finding, together with the colonisation of dental plaque by HAP bacteria strengthens the evidence for a deterioration in oral health in CCU and a risk factor for negative health and quality of life outcomes.
Critical care (London, England) 09/2013; 17(5):R189. · 4.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:Several epidemiological studies have reported an association between metabolic syndrome (MetS) and periodontal diseases (PDs). The aim of this systematic review was to investigate the existence and magnitude of this association.Materials and Methods:A systematic search of the literature was conducted looking for case-control, cross-sectional, cohort studies and population surveys including patients with measures of MetS and PD. Ovid MEDLINE, EMBASE, LILACS, and Cochrane library databases were used for the search by 2 independent reviewers. A meta-analysis was conducted to investigate the association for coexistence of MetS and PD.Results:A total of 20 studies were included in the review, from an initial search of 3486 titles. Only 1 study reported longitudinal data on the onset of MetS components in association with periodontal measures. However, several studies investigated coexistence. A random effects meta-analysis showed that the presence of MetS is associated with the presence of periodontitis in a total of 36 337 subjects (odds ratio = 1.71; 95% confidence interval = 1.42 to 2.03). When only studies with "secure" diagnoses were included (n = 16 405), the magnitude of association increased (odds ratio = 2.09; 95% confidence interval = 1.28 to 3.44). Moderate heterogeneity was detected (I(2) = 53.6%; P = .004).Conclusions:This review presents clear evidence for an association between MetS and periodontitis. The direction of the association and factors influencing it should be investigated by longitudinal and treatment studies. Periodontal diagnostic procedures should be routinely carried out in MetS patients.
The Journal of clinical endocrinology and metabolism 02/2013; · 6.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Periodontal diseases are common inflammatory conditions of the supporting apparatus of the teeth which lead to early tooth loss. This review discusses the evidence for a role of reactive oxygen species in inducing periodontal tissue damage and focuses on recent evidence showing increased local and systemic alterations in the redox balance of periodontitis. An appraisal of the methods for analysis of oxidative stress in periodontal disease research is provided, showing an increase in oxidative stress measures and oxidative damage fingerprints detected in studies investigating periodontitis cases compared to healthy controls. Hypotheses on the relationships between oxidative stress and inflammatory responses and on the role of redox status in periodontal medicine are discussed. Finally, the review provides an overview of possible intervention pathways for the use of antioxidants as adjuncts to mechanical biofilm removal for the treatment of periodontitis.
Current pharmaceutical design 10/2012; · 4.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the effect of hospitalization on oral health as assessed by dental plaque.
Observational study in a critical care unit (CCU). Participants were recruited within 24 h of admission. Dental plaque amount was assessed at baseline, 1 and 2 weeks using the Debris index-soft deposits (Greene & Vermillion 1960).
Fifty participants were recruited with 36 available for outcome assessment at 1 week and 10 at 2 weeks. The principal reason for losses was early discharge with no evidence of a difference between patients present only at baseline and those present at 1 week. The median value for dental plaque at baseline was 4 (95% CI: 4, 6). The median dental plaque increase from baseline to week 1 was 1.5 (95% CI: -1, 4), and this was statistically significant (p = 0.04). The median increase from week 1 to week 2 was 1.0 (95% CI -8, 6) and not statistically significant (p = 0.68).
Oral health as assessed by dental plaque deteriorates following hospitalization in CCU. Such change could lead to impairment of quality of life and well-being as well as to increasing the risk of important healthcare-associated infections such as nosocomial pneumonia.
Journal Of Clinical Periodontology 07/2012; 39(11):1011-6. · 3.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: The objective of this paper is to examine the effect of alveolar ridge preservation (ARP) compared to unassisted socket healing. METHODS: Systematic review with electronic and hand search was performed. Randomised controlled trials (RCT), controlled clinical trials (CCT) and prospective cohort studies were eligible. RESULTS: Eight RCTs and six CCTs were identified. Clinical heterogeneity did not allow for meta-analysis. Average change in clinical alveolar ridge (AR) width varied between -1.0 and -3.5 ± 2.7 mm in ARP groups and between -2.5 and -4.6 ± 0.3 mm in the controls, resulting in statistically significantly smaller reduction in the ARP groups in five out of seven studies. Mean change in clinical AR height varied between +1.3 ± 2.0 and -0.7 ± 1.4 mm in the ARP groups and between -0.8 ± 1.6 and -3.6 ± 1.5 mm in the controls. Height reduction in the ARP groups was statistically significantly less in six out of eight studies. Histological analysis indicated various degrees of new bone formation in both groups. Some graft interfered with the healing. Two out of eight studies reported statistically significantly more trabecular bone formation in the ARP group. No superiority of one technique for ARP could be identified; however, in certain cases guided bone regeneration was most effective. Statistically, significantly less augmentation at implant placement was needed in the ARP group in three out of four studies. The strength of evidence was moderate to low. CONCLUSIONS: Post-extraction resorption of the AR might be limited, but cannot be eliminated by ARP, which at histological level does not always promote new bone formation. RCTs with unassisted socket healing and implant placement in the ARP studies are needed to support clinical decision making. CLINICAL RELEVANCE: This systematic review reports not only on the clinical and radiographic outcomes, but also evaluates the histological appearance of the socket, along with site specific factors, patient-reported outcomes, feasibility of implant placement and strength of evidence, which will facilitate the decision making process in the clinical practice.
[Show abstract][Hide abstract] ABSTRACT: Hereditary gingival fibromatosis (HGF) and amelogenesis imperfecta (AI) are two rare oral conditions with genetic etiologies. The case of a 17-year-old boy affected by HGF, AI, anterior open bite, and pyramidal impaction of the maxillary molars is reported. Internal bevel gingivectomies were carried out to reduce gingival overgrowth. Clinical examination of the family revealed the presence of HGF and AI in his 12-year-old sister (both in milder forms) and of HGF in his older half brother. Genetic sequencing analyses were performed to detect any of the known mutations leading to HGF and AI. Histologic analysis revealed the presence of fibroepithelial hyperplasia, consistent with a diagnosis of GF. Sequencing genetic analysis failed to identify any of the common mutations leading to HGF (SOS-1) or AI (enamelin and amelogenin genes). This phenotype, similar to what has been described in other families, may represent a new syndrome caused by an as-yet unknown genotype.
[Show abstract][Hide abstract] ABSTRACT: Only a few studies have attempted to detect differences in microbiologic profiles of patients with chronic periodontitis (CP) and aggressive periodontitis (AgP). The aim of this analysis was to assess if clinical diagnosis or other subject factors showed association with the presence of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in a cohort of periodontitis patients.
Statistical analysis for association between bacterial detection and clinical diagnosis was performed on a total of 267 consecutive periodontitis cases diagnosed with either CP (n = 183) or AgP (n = 84). All subjects had microbiologic samples collected from the four deepest pockets and analyzed by nested polymerase chain reaction.
A actinomycetemcomitans was detected in 54% and 48% of CP and AgP subjects, respectively. A slightly higher detection of P gingivalis was found in CP (67% ) compared with AgP (52%) cases. The detection of P gingivalis was associated with older age (P = .002), less disease severity (P = .015), and IL6-1480 genotypes (P = .026), while A actinomycetemcomitans was associated with IL6-1480 genotypes (P = .001).
Detection of known periodontopathogenic bacteria is not able to discriminate different forms of periodontitis.
[Show abstract][Hide abstract] ABSTRACT: There is a lack of consensus on measures to assess implant performance in clinical research.
To investigate the outcomes measures and reference groups employed to evaluate and compare implant success and failure.
MEDLINE (OVID) and Web of Science with searching reference lists of included papers.
Inclusion: root form, titanium implants in dentate or edentulous individuals. Longitudinal studies reporting survival or success outcomes on at least 20 participants ≥ mean 5 years.
Two-hundred and sixteen studies were included. Implant survival was the most commonly reported primary outcome (60%) with success at 15.7%. Success constituted a wide variety of measures with little consistency. A percentage of 98.6% of studies employed the implant as the unit of analysis with little consideration of clustering within patients. The status of periodontal and general heath of study groups was unclear for more than 80% studies. The proportion of studies comprising randomized trials or using appropriate analytical methods increased from 1980 to 2011.
Considers only English language and there was no author contact.
In view of the disparate outcome measures employed to assess dental implant performance, agreement is needed both on a core set of implant outcomes and their statistical management.
[Show abstract][Hide abstract] ABSTRACT: To evaluate by histology the effect of loading on the regenerated bone at dehiscence type defects around implants when treated with a combined approach of bone grafting and guided bone regeneration (GBR).
In twelve Göttingen mini-pigs, the lower premolars and first molars were extracted and the alveolar process was reduced in width. After 3 months, two Straumann SLActive (Straumann AG, Basel, Switzerland) implants were placed in each hemi-mandible. Twelve implants were placed into the reduced alveolar ridge (group P) with no further defect or treatment on the site, while on 36 implants, buccal dehiscence defects were created and treated as follows: Group T1: synthetic bone substitute (Straumann Bone Ceramic, SBC, Straumann AG). Group T2: SBC with a polyethylene glycol membrane (Straumann MembraGel, Straumann AG); Group N: the dehiscence remained untreated. Three months following implantation, long, custom-made, healing abutments were placed in one hemi-mandible only to ensure functional loading. After 2 months, histological analysis was performed.
A trend for lower residual defect height and higher bone-to-implant contact was observed in the loaded sites compared with non-loaded sites in groups P, T1 and N. In group T2, the opposite effect was observed. In terms of bone formation, sites treated with SBC grafting and GBR (group T2) exhibited the largest surface area of regenerated bone followed by T1 and N. Significant resorption of the graft particles was noted in group T2 and the graft surface area occupied by SBC was significantly higher in group T1 compared with group T2 (P < 0.05).
Loading may have a positive effect on bone-to-implant contact in implants inserted in pristine bone or inserted in dehiscence sites and treated by grafting/no grafting.
Clinical Oral Implants Research 09/2011; 23(5):591-601. · 3.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: It is reported that peri-implantitis does not heal favorably following nonsurgical therapy. In this case study, three consecutive peri-implantitis patients with concomitant history of periodontitis were treated with nonsurgical therapy and reassessed up to 12 months following treatment. All treated peri-implantitis sites showed a considerable reduction in probing pocket depth, attachment loss, and bleeding on probing. This was also associated with bone fill of the vertical bony defects around the previously exposed implant threads. This case report shows that a degree of clinical resolution and radiographic bone fill can occur without the use of adjunctive antibiotics in peri-implantitis lesions of patients with periodontitis.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine leukocyte telomere length (LTL) in individuals with periodontitis and controls, exploring its relationship with systemic inflammation and oxidative stress. Five hundred sixty-three participants were recruited for this case-control study: 356 subjects with and 207 subjects without periodontitis. LTL was measured by a qPCR technique from leukocytes' DNA. Global measures of oxidative stress (reactive oxygen metabolites) and biological antioxidant potential in plasma were performed together with high-sensitivity assays for C-reactive protein (CRP). Leukocyte counts and lipid profiles were performed using standard biochemistry. Cases had higher levels of CRP (2.1±3.7mg/L vs 1.3±5.4mg/L, P<0.001) and reactive oxygen metabolites (378.1±121.1 U Carr vs 277.4±108.6 U Carr, P<0.001) compared to controls. Overall, cases had shorter LTL with respect to controls (1.23±0.42 vs 1.12±0.31T/S ratio, P=0.006), independent of age, gender, ethnicity, and smoking habit. When divided by subgroup of periodontal diagnosis (chronic, n=285; aggressive, n=71), only chronic cases displayed shorter LTL (P=0.01). LTL was negatively correlated with age (P=0.001; R=-0.2), oxidative stress (P=0.008; R=-0.2), and severity of periodontitis (P=0.003; R=-0.2) in both the whole population and the subgroups (cases and controls). We conclude that shorter telomere lengths are associated with a diagnosis of periodontitis and their measures correlate with the oxidative stress and severity of disease.
[Show abstract][Hide abstract] ABSTRACT: Overweight and obesity have been suggested to be associated with periodontitis as published in studies and narrative summaries. This project presents results of a systematic review investigating the association between overweight or obesity (as defined by the World Health Organization) and periodontitis. Search strategy included electronic and hand searching to December 2009. Ovid MEDLINE, EMBASE, LILACS, and SIGLE were searched. RCTs, cohort, case-control and cross-sectional study designs that included measures of periodontitis and body composition were eligible. Duplicate, independent screening and data abstraction were performed. Meta-analyses were performed when appropriate. A total of 526 titles and abstracts were screened, resulting in 61 full text articles and abstracts assessed for eligibility with 33 being included. Nineteen studies provided sufficient information for inclusion in meta-analyses. Meta-analyses indicated statistically significant associations between periodontitis and body mass index (BMI) category obese OR 1.81(1.42, 2.30), overweight OR 1.27(1.06, 1.51) and obese and overweight combined OR 2.13(1.40, 3.26). In conclusion, these results support an association between BMI overweight and obesity and periodontitis although the magnitude is unclear. Additional prospective studies to further quantify, or understand the mechanisms, of this association are merited. There is insufficient evidence to provide guidelines to clinicians on the clinical management of periodontitis in overweight and obese individuals.
[Show abstract][Hide abstract] ABSTRACT: Inflammation of the gingivae (periodontitis) has been associated with raised serum biomarkers of inflammation, sub-clinical markers of atherosclerosis, and increased risk of and/or mortality from cardiovascular disease (CVD). There remain little information regarding the association between other common oral inflammatory disease, systemic inflammation, and CVD. The objective of the study was to assess the association between common oral mucosal diseases, circulating markers of inflammation, and increased prevalence of CVD in a cross-sectional survey of a nationally representative sample of the noninstitutionalized civilians in the United States.
Data for this study are from 17,223 men and women aged ≥ 17 years who received oral examination as part of the Third National Health and Nutrition Examination Survey. The primary and secondary outcome measures were the association of oral mucosal diseases with raised serum levels of C-reactive protein/fibrinogen and increased prevalence of CVD, respectively. Adjustment for common confounding factors was performed.
Having oral mucosal disease was associated with systemic inflammation (serum levels of C-reactive protein ≥ 10 mg/dL) (odds ratio 1.41, 95% CI 1.02-1.94). Individuals with oral mucosal disease were 1.36 times (95% CI 1.02-1.80) more likely to have history of myocardial infarction and 1.33 times (95% CI 1.03-1.71) more likely to report angina than unaffected individuals. All associations were independent of common confounding factors.
This is the first study to suggest that common oral mucosal diseases are independently associated with raised markers of systemic inflammation and history of CVD.
American heart journal 02/2011; 161(2):344-50. · 4.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this retrospective study was to analyse the clinical and radiographic response of infrabony defects following non-surgical therapy and to detect the factors associated with such a response.
Clinical and radiographic data were retrieved from 143 consecutive patients treated with non-surgical periodontal therapy and re-assessed by the same clinician. Linear radiographic measurements of infrabony periodontal defects were performed on baseline and follow-up (12-18 months post-treatment) radiographs. Multilevel analysis was performed to analyse the associations between subject and site factors and healing of infrabony defects.
A total of 126 infrabony defects from 68 of these patients were identified at baseline and included in the analysis. Statistically significant reductions in probing pocket depth, clinical attachment loss, radiographic defect depth and a widening of the radiographic infrabony defect angle were detected following treatment. Initial defect depth and use of adjunctive antibiotics were positively associated with a reduction of radiographic defect depth, whereas smoking showed a negative association.
Within the limitations of a retrospective analysis with no control group, this study shows favourable clinical and radiographic outcomes in periodontal infrabony defects following non-surgical therapy, with complete bone fill in some cases.
Journal Of Clinical Periodontology 01/2011; 38(1):50-7. · 3.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There is incomplete and inconclusive evidence for the association between periodontal disease markers and arterial blood pressure, particularly from large national epidemiological studies. This study assessed the relationship between different markers of periodontal inflammation and disease with arterial blood pressure in people aged 17 years and over in USA. We analysed data from the Third National Health and Nutrition Examination Survey on 6617 men and 7377 women who received a periodontal examination. Blood pressure was analysed in both a continuous format and a binary variable for case definition of hypertension. Periodontal disease markers (extent of gingival bleeding, pocket depth, and loss of attachment, and a case definition of periodontitis) were associated on the arterial blood pressure outcomes through a series of regression models, incrementally adjusting for confounders (demographic, inflammation markers, chronic conditions, smoking, BMI, socio-economic status). All periodontal measures had significant crude associations with SBP and hypertension. Gingival bleeding, a marker of current periodontal inflammation, was the only measure consistently and significantly associated with raised SBP and an increased odds of hypertension in the US adult population throughout the adjustment process. For a 10% greater extent of gingival bleeding, the average SBP was higher by 0.5 (0.3, 0.6) mmHg in the fully adjusted model. By referring to the general population and the whole distribution of blood pressure, not only to those at higher risk for hypertension, this association might have some important implications for clinical practice and public health strategies.
Journal of Hypertension 12/2010; 28(12):2386-93. · 4.22 Impact Factor