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Denture-Related Stomatitis Is Associated with Endothelial Dysfunction

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Unlabelled: Oral inflammation, such as periodontitis, can lead to endothelial dysfunction, accelerated atherosclerosis, and vascular dysfunction. The relationship between vascular dysfunction and other common forms of oral infections such as denture-related stomatitis (DRS) is unknown. Similar risk factors predispose to both conditions including smoking, diabetes, age, and obesity. Accordingly, we aimed to investigate endothelial function and major vascular disease risk factors in 44 consecutive patients with dentures with clinical and microbiological features of DRS (n = 20) and without DRS (n = 24). While there was a tendency for higher occurrence of diabetes and smoking, groups did not differ significantly in respect to major vascular disease risk factors. Groups did not differ in main ambulatory blood pressure, total cholesterol, or even CRP. Importantly, flow mediated dilatation (FMD) was significantly lower in DRS than in non-DRS subjects, while nitroglycerin induced vasorelaxation (NMD) or intima-media thickness (IMT) was similar. Interestingly, while triglyceride levels were normal in both groups, they were higher in DRS subjects, although they did not correlate with either FMD or NMD. Conclusions: Denture related stomatitis is associated with endothelial dysfunction in elderly patients with dentures. This is in part related to the fact that diabetes and smoking increase risk of both DRS and cardiovascular disease.
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Research Article
Denture-Related Stomatitis Is Associated with
Endothelial Dysfunction
Joanna Macidg,1Grzegorz Osmenda,2Daniel Nowakowski,1Grzegorz Wilk,2Anna Macidg,3
Tomasz MikoBajczyk,2Ryszard Nosalski,2Agnieszka Sagan,2,4 Magdalena Filip,2
MirosBaw Dróhdh,2Jolanta Loster,5Tomasz J. Guzik,2,4 and Marta CzeVnikiewicz-Guzik1,4
1Department of Prophylaxis and Experimental Dentistry, Institute of Dentistry,
Jagiellonian University Medical College, Cracow, Poland
2Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, Cracow, Poland
3Zbigniew ˙
Zak Voivodeship Dental Clinic, Cracow, Poland
4Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
5Department of Dental Prosthetics, Institute of Dentistry at Jagiellonian University Medical Collage, Cracow, Poland
Correspondence should be addressed to Marta Cze´
snikiewicz-Guzik; marta.czesnikiewicz-guzik@glasgow.ac.uk
Received  March ; Revised  May ; Accepted  May ; Published  June 
Academic Editor: Grant Drummond
Copyright ©  Joanna Maciąg et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Oral inammation, such as periodontitis, can lead to endothelial dysfunction, accelerated atherosclerosis, and vascular dysfunction.
e relationship between vascular dysfunction and other common forms of oral infections such as denture-related stomatitis (DRS)
is unknown. Similar risk factors predispose to both conditions including smoking, diabetes, age, and obesity. Accordingly, we aimed
to investigate endothelial function and major vascular disease risk factors in  consecutive patients with dentures with clinical and
microbiological features of DRS (𝑛=20)andwithoutDRS(𝑛=24). While there was a tendency for higher occurrence of diabetes
and smoking, groups did not dier signicantly in respect to major vascular disease risk factors. Groups did not dier in main
ambulatory blood pressure, total cholesterol, or even CRP. Importantly, ow mediated dilatation (FMD) was signicantly lower in
DRS than in non-DRS subjects, while nitroglycerin induced vasorelaxation (NMD) or intima-media thickness (IMT) was similar.
Interestingly, while triglyceride levels were normal in both groups, they were higher in DRS subjects, although they did not correlate
with either FMD orNMD. Conclusions. Denture related stomatitis is associated with endothelial dysfunct ion in elderly patients with
dentures. is is in part related to the fact that diabetes and smoking increase risk of both DRS and cardiovascular disease.
1. Introduction
Oral inammation is an important element in the patho-
genesis of vascular disease. In particular, large body of
evidence has accumulated recently that chronic periodon-
titis is a potential novel risk factor for atherosclerosis and
endothelial dysfunction []. Indeed, intensive treatment
of chronic periodontitis alleviates endothelial dysfunction
in a long-term follow-up, with clinical benet lasting up
to  months aer intensive treatment []. e mechanisms
of this association are not clearly dened but are most
likely dependent on systemic inammatory response, involv-
ing increased levels of IL-, CRP, TNF-alpha, and other
cytokines, which accompany periodontitis [,]. Moreover,
cellular immunity is also activated in periodontitis, including
monocytesubpopulationshiaswellasTcellactivationwith
overproduction of interferon gamma and IL- [].
While numerous studies have focused on the links
between periodontitis and endothelial dysfunction, little
is known about the links between other forms of oral
infection and inammation in the context of cardiovascular
risk. In particular, denture-related stomatitis (DRS) is an
inammatory process of the oral mucosa in contact with a
denture and is one of the most common diseases in elderly
patients, aecting up to % of patients in the course of life
[,]. It is most common in complete prosthesis wearers,
Hindawi Publishing Corporation
BioMed Research International
Volume 2014, Article ID 474016, 9 pages
http://dx.doi.org/10.1155/2014/474016
BioMed Research International
edentulous subjects []. e potential links are particularly
worth addressing, as major risk factors for DRS include
smoking, diabetes, age, and obesity, which coincide with risk
of atherosclerosis and vascular disease [,,]. us it
is even more surprising that this problem of concomitant
incidence of both conditions has not been studied up to
date. Interestingly, the relationship of DRS to dyslipidemia is
not known and female sex appears to predispose to higher
occurrence []. Clinical symptoms of DRS include erythema
and swelling of palatal mucosa, sometimes combined with
subjective symptoms, such as dysgeusia or burning sensation.
eaetiologyoftheDRSismultifactorial[]. Long-term
and continuous use of dentures and poor denture and oral
hygiene habits promote the development of a biolm, called
denture plaque, on the surface of the prosthesis [,].
Candida albicans is fungal component of the physiological
microora of the human oral cavity [,]; however, factors
mentioned above may promote its excessive growth and,
consequently, the development of infection and DRS.
While in periodontitis systemic activation of the immune
system is very important in mediating increased cardiovas-
cular risk, the extent of systemic response to DRS is poorly
characterized. Systemic inammation may aect vascular
dysfunction in number of ways, which include activation of
monocytes and T cells with overproduction of cytokines such
as interferon 𝛾, TNF-alpha, interleukin , or  [], sub-
sequently leading to atherosclerosis and hypertension [
] and increased cardiovascular risk. Interestingly, increased
cardiovascular risk has been shown also for caries [],
as well as endodontic infection []. ese diseases are
all caused by bacterial infections, but, other microorganisms
are also able to infect oral tissues. Relationship between
fungal infection in oral cavity and systemic inammatory
response in context of vascular risk has not yet been studied.
erefore, the aim of this study was to determine whether
the presence of DRS coincides with the clinical measures of
vascular dysfunction, such as impaired endothelial function
or elevated blood pressure.
2. Methods
2.1. Patients. Using  consecutive patients with dental pros-
theses for at least  months were included in this study.
eir oral mucosa was examined by the dentist to clinically
identify inammation and DRS. e clinical signs of oral
mucosa inammation in DRS include erythema and swelling
of palatal mucosa, sometimes combined with subjective
symptoms, such as dysgeusia or burning sensation. ese
observations were conrmed by routine microbiological
laboratory diagnostic tests for Candida species presence.
Based on clinical and microbiological investigations, patients
were divided into DRS (𝑛=20)groupandnon-DRS
(𝑛=24) group. Diagnosis was conrmed by an independent
observer. Control, non-DRS patients had clinically healthy
oral mucosa and negative oral Candida swabs. Clinically
healthy oral mucosa was a pale pink, smooth mucosal
membrane without redness or swelling and with no pain or
discomfort reported by patient. Exclusion criteria included
acute inammatory disorders other than DRS, neoplastic
disease relapses or chemotherapy courses less than  years
before the enrolment, and using antibiotics in less than 
weeks or anti-inammatory drugs (steroids and nonsteroidal,
excluding aspirin in doses less than  mg) in less than
 months before the enrolment. Patients with history of
myocardial infarction, acute coronary incident or vascular
inammation in  weeks or less before the enrolment, chronic
haematological disorders, and immunodeciency or major
medicationchangesduringlessthanweeksbeforeor
during study were also excluded. e study was approved by
local ethics committee of Jagiellonian University. Informed
consent was obtained from all patients and all work was
conducted in accordance with the Declaration of Helsinki
().
2.2. Microbiological Investigations. Swabs were taken from
the hard palate (between the second and third palatal fold).
Samples were collected aer an overnight fast and aer
at least  hours of continous denture usage, without the
use of adhesives or rinsing the mouth with disinfectants.
e material was collected in accordance with the general
principles of microbial material collection.
2.3. Clinical Data. Patients’ blood pressure (systolic, dias-
tolic) was monitored for  hours using ambulatory blood
pressure monitoring system (ABPM; SpaceLabs , Ultra-
lite device). Systolic diastolic and mean arterial pressures
were recorded every  minutes for  hours. Day and night
averages were calculated. One patient in control group did
not agree to wear the ABPM monitor. Major risk factors
for both atherosclerosis and DRS were recorded based on
patient medical records and detailed patient history. Clinical
risk factors were dened as follows: hyperlipidemia (total
plasma cholesterol level > mmol/L and/or triglycerides level
>, mmol/L), diabetes (fasting glucose level  mmol/L
or HbAc >.% or current treatment with insulin or
oral hypoglycemic agents), hypertension (blood pressure
/ mmHg or current treatment with antihypertensive
agents), and smoking (current or within last  months) based
on []. Blood samples were obtained from antecubital vein
and lipoprotein prole was assessed by routine diagnostic
measurements of triglycerides, total cholesterol, low-(LDL),
and high-(HDL) density lipoprotein cholesterol fractions. C-
reactive protein (CRP) concentration was also assessed as in
routine diagnostics.
2.4. Endothelial Function Measurement. Flow-mediated dil-
atation (FMD) method was used to determine the vascular
endothelial function and NMD (nitroglycerine-mediated
dilatation) for measuring endothelial-independent vasodi-
latation. Measurements were conducted using Toshiba Xario
Diagnostic Ultrasound System aer , , and - minutes
aer manometer cu deation or sublingual administration
of nitroglycerine and presented as percentage of the diameter
of the artery before intervention. Method validation in our
laboratory has been described elsewhere []. Observers were
blinded regarding oral status of the patients.
BioMed Research International
T : Patient clinical characteristics.
DRS group
𝑛=20 Control group
𝑛=24
Gender (M : F)  :  𝑃>,  : 
Age [mean (SD)] , (,) 𝑃>, , (,)
BMI [median (𝑄1;𝑄2)] , (,; ,) 𝑃>, , (,; ,)
Smoking (%)  (%) 𝑃>,  (,%)
Diabetes mellitus (%)  (%) 𝑃>,  (,%)
Hypertension (%)  (%) 𝑃>,  (,%)
Hyperlipidemia (%)  (%) 𝑃>,  (%)
Medications (%)
ACE inhibitor  (%) 𝑃>,  (%)
Acetylsalicylic acid  (%) 𝑃>,  (%)
𝛽-blocker  (%) 𝑃>,  (%)
Ca antagonist  (%) 𝑃>,  (%)
Diuretic  (%) 𝑃>,  (%)
Statin  (%) 𝑃>,  (%)
Insulin  (%) 𝑃>,  (,%)
Oral antidiabetic agents  (%) 𝑃>,  (,%)
ACE: angiotensin converting enzyme, BMI: body mass index, DM: diabetes mellitus, SD: standard deviation.
2.5. Subclinical Atherosclerosis Assessment. e measure-
ments of intima-media thickness were performed in 
dierent points (cm below common carotid arteries bulbs,
ca. every  cm, omitting visible coronary plaques), on right
and le common carotid artery, measuring the distance
between the border between artery lumen and carotid artery
intima and second bright line-m (border between media and
adventitia) as described previously [].
2.6. Statistical Analysis. Analysis was performed using Stat-
so Statistica soware. Compliance of the distribution of
variables with normal distribution was tested by Shapiro-
Wilk test. Most of the variables did not have normal distri-
butions,andthereforetheresultsarepresentedasmedians
and th (Q), th (Q) percentiles. For those variables
nonparametric statistical tests were used, Mann-Whitney 𝑈
test for continuous variables or, for dichotomous variables, 𝜒2
for the expected frequencies >or𝜒2with Yates’ correction
for the expected frequencies < with conrmation of Fisher’s
exact test and Spearman correlation. For variables with
normal distribution Student’s 𝑡-test was applied and data are
presentedasmeanwithstandarddeviation(SD).Methodof
presentation of results is given for each variable in the text.
Values of 𝑃 < 0, 05 were considered statistically signicant.
3. Results
3.1. Clinical Risk Factors in Studied Groups. Both groups
were balanced in terms of age, sex, body mass index (BMI)
value, and antihypertensive treatment. ere were more
smokers and patients with diabetes mellitus (DM) in DRS
group than in control group, although these dierences were
not statistically signicant. Higher prevalence of DM and
0
40
80
120
160
Systolic blood
pressure Diastolic blood
pressure Mean arteria l
pressure
Blood pressure (mmHg)
Control group
DRS group
F : Ambulatory blood pressure parameters in control and
DRS patients. Blood pressure parameters were assessed by  h
measurement with ambulatory blood pressure monitoring system.
Results are presented as mean (SD); 𝑛control group = , 𝑛DRS
group = .
smoking in DRS group is consistent with epidemiologic data
and is understandable, as both are recognized as a risk factor
for developing DRS []. e proportion of males in both
study groups was lower than expected for general population,
which is consistent with the epidemiology of DRS, which
is more common in females []. Patients characteristics are
summarized in Tab l e  .
3.2. Blood Pressure in Denture Related Stomatitis. Ambula-
tory blood pressure monitoring has shown no signicant
dierences in both mean systolic and mean diastolic blood
pressure in DRS and control non-DRS group (Figure ).
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0
5
10
15
20
25
FMD NMD
Vascular function (% of artery dilation)
Control group
DRS group
F : Vascular dysfunction in control and DRS. Vascular
endothelium-dependent ow-mediated dilatation (FMD) and en-
dothelium-independent nitroglycerin-mediated dilatation (NMD)
parameters were assessed by ultrasonography. Results presented as
median (Q; Q); 𝑃 < 0,005;𝑛control group = , 𝑛DRS group =
.
Moreover, subsequent analysis of blood pressures during
activity and rest periods did not show signicant dierences
either (data not shown).
3.3. Vascular Function. Flow-mediated dilatation measure-
ments showed a signicantly reduced median percentage of
arterial dilation in response to ow in the DRS group in
comparison with control patients (Figure ). At the same
time there was no dierence between groups in endothelium-
independent vasodilatation, NMD (Figure ). ere was no
dierence in baseline vessel diameter between control and
DRS group (3, 7 ± 0, 8mm versus 3, 8 ± 0,7 mm; 𝑃=0,4).
3.4. Subclinical and Clinical Atherosclerosis. Intima-media
thickness evaluation showed no signicant dierences in
either maximal or mean IMT in studied groups. It is impor-
tant to point out that neither of the groups showed very
high values of mean IMT (Figure ). Moreover, presence of
the atherosclerotic lesions of common carotid artery was
equally distributed between groups; it was detected in .%
of patients from control group and in % of DRS group,
𝑃 = 0,86.
3.5. Plasma Lipid Prole and CRP. As the elevated blood
triglycerides, LDL and total cholesterol levels and low HDL
cholesterol levels are recognized as cardiovascular risk fac-
tors; we compared their concentrations in blood samples
collected from patients with oral fungal infection and with
healthyoralmucosa.Wefoundthatplasmalevelsoftotal,
LDL, and HDL cholesterol were similar in both groups;
however, triglycerides levels were signicantly elevated in
DRS group (Figure (a)). Surprisingly, CRP levels were sim-
ilar between studied groups, indicating lack of signicant
component of systemic inammation in DRS (Figure (b)).
As the level of triglycerides was dierent between groups and
this parameter may impact vascular function, we checked if
there is a correlation between FMD or NMD and triglycerides
levels. We found that these parameters were not correlated in
case of FMD (𝑅Spearman = ,, 𝑃 = 0, 42)andNMD(𝑅
Spearman = ,, 𝑃 = 0, 87)(Figure ).
3.6. Subgroup Analysis in Female Subpopulation Only. As
there was a much lower proportion of males in our study
population, we performed an additional subgroup analysis
in female population. It revealed that all studied vascular
phenomena were observed to the same extent as in total
studied population, including the dierence in endothelium
derived vasorelaxations (FMD (mean ±SD): 5,95 ± 3, 80%
in female DRS patients and 9,72 ± 3, 31%incontrolsubjects;
𝑃 = 0,0032) and TG levels (median [Q; Q]: , [,; ,]
in DRS versus , [,; ,]in non-DRS; 𝑃 = 0,01).
4. Discussion
e oral health impact on the general health is evident.
Oral infections and inammation have been implicated in
many disease entities, such as rheumatoid arthritis [],
obesity [], negative pregnancy outcomes [], DM [],
andeveninepilepsy[]. In particular, the role of oral
inammation and infection in the modulation of the risk
of cardiovascular disorders has been well dened [].
ese studies have, however, focused mainly on periodontal
inammation and gingival bleeding. In the present study
we investigated the relationships between denture-related
stomatitis, a common oral inammatory condition in elderly
patients with endothelial dysfunction, blood pressure, and
lipid prole. We observed that denture-related stomatitis
which occurs in ca. % of patients wearing dentures, is
associated with signicant reduction of endothelial function,
measured as nitric oxide bioavailability in a clinical ow-
mediated dilatation study. Importantly, control, nitroglycerin
induced endothelium-independent vasodilatation was not
changed. As it is known that the severity of endothelial dys-
function correlates with the development of coronary artery
disease and predicts future cardiovascular events [], our
resultsimplicatethatthepresenceofDRSmaybeassociated
with negative cardiovascular outcomes. us, such patients
should be particularly carefully monitored in relation to their
cardiovascular risk. Considering that DRS is one of the most
common oral disorders in the elderly, occurring in –%
of subjects wearing dentures [,], our nding may have
important implications for clinical care of denture wearing
patients. It is important to note, however, that majority of
patients studied here were females which is consistent with
the epidemiology of DRS, that is, more common in females
[]. We have also performed an additional analysis in female
subpopulation only, which conrmed all major observations
of this study.
While numerous previous studies have shown increased
cardiovascular risk in subjects with oral inammatory condi-
tions such as periodontitis [], endodontic infections [
], and even caries [], this is the rst study focusing
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0
0.4
0.8
1.2
Control group DRS group
Mean IMT value (mm)
Mean IMT value
(a)
0
0.4
0.8
1.2
Control group DRS group
Maximal IMT value (mm)
Maximal IMT value
(b)
F : IMT measurements in DRS and control group. (a) Mean common carotid artery intima-media thickness. Results are presented as
mean (SD); (b) maximal common carotid artery intima-media thickness. Results presented as median (Q; Q). (a) and (b): 𝑛control group
=,𝑛DRS group = .
0
2
4
6
8
Tot a l
cholesterol
Triglycerides LDL
cholesterol
HDL
cholesterol
Concentration (mmol/L)
Control group
DRS group
(a)
0
2
4
6
8
CRP
Concentration (mg/L)
Control group
DRS group
(b)
F : Plasma lipid prole and C-reactive protein levels in control and DRS patients. (a) Comparison of lipid proles. Results are presented
as median (Q; Q); 𝑃 < 0,05; (b) comparison of plasma CRP concentrations. Results are presented as median (Q; Q). (a) and (b): 𝑛control
group = , 𝑛DRS group = .
on vascular dysfunction in elderly population of patients
wearing dentures. is is important, while previous studies
focused on bacteria-mediated, resulting from disturbances
of physiological oral microora diseases, we have primarily
studied fungal infection, as DRS is most commonly associ-
ated with Candida infection.
Previous studies focused on a positive association
between periodontitis and vascular endothelial dysfunction.
Amar et al. and Blum et al. observed that subjects with
advanced periodontal disease exhibit worse endothelial func-
tion when compared to the healthy controls [,]. Blum
et al. [], along with others [,], reported also an
improvement of endothelial function as a long-term outcome
of periodontal treatment. Tonetti et al. []inalandmark
studyhasshowninaproperrandomizedcontrolledtrial
that such improvement provides clinical benet for up to 
months aer intensive treatment.
e mechanisms of increased cardiovascular risk in oral
inammatory conditions are multifactorial and range from
chronic systemic inammation (periodontitis) to the eects
of risk factors such as diabetes, hyperlipidemia, smoking,
andagewhichpredisposetobothcardiovasculardiseases
and oral disorders, such as periodontitis [], caries [],
endodontic infections [], or DRS [,,]. is coin-
cidence of risk factors is visible in the population of patients
we have studied. Although the dierence in occurrence of
smoking or diabetes did not reach statistical signicance,
we can clearly see increased occurrence of these factors
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0 4 8 12 16 20 24
FMD (% of artery dilation)
0
1
2
3
4
Triglycerides (mmol/L)
(a)
0 5 10 15 20 25 30
NMD (% of artery dilation)
0
1
2
3
4
Triglycerides (mmol/L)
(b)
F : Spearman correlation between parameters of vascular function parameters and triglycerides levels. (a) Spearman correlation
between FMD and triglycerides levels: 𝑅Spearman = ,, 𝑃=0,;(b)SpearmancorrelationbetweenNMDandtriglycerideslevels:
𝑅Spearman = −0,025,𝑃 = 0, 87;(a)and(b):𝑛=42.
in DRS. is can in part explain the increased degree of
endothelial dysfunction in DRS subjects. Measurement of
baseline FMD prior to developing DRS in a long-term follow-
up study would unquestionably strengthen the conclusions
of t h is stu dy. Alte rnat ivel y, a f utur e int e r vent iona l s tudy
in which the eect of treatment of DRS on endothelial
function could also help to address this issue in a more cause-
eect manner. Importantly, as the population we studied
was relatively young for denture carriers, no signicant
increase in intima-media thickness was detected yet. is is
in agreement with numerous cardiovascular studies which
show that endothelial dysfunction precedes the development
of severe atherosclerosis [].
e role of systemic inammation, very well dened in
periodontitis, is not known in DRS. e mechanisms through
which DRS could aect endothelial dysfunction are unclear.
In periodontitis, bacteria lead to the activation of the local
immune response, leading to systemic inammation. Simi-
larly, immune stimulation of T cells and monocytes has been
reported in response to fungal C. albicans antigens [,].
However, in our study we did not nd signicantly increased
levels of total CRP, which could suggest that local Candida-
evoked oral mucosal inammation is not causing signicant
activation of systemic inammatory response. e CRP levels
among edentulous were assessed by Ajwani et al. at Helsinki
Aging Study involving over  patients older than  years
old []. ey identied mucosal lesions in the edentulous as
an important factor associated with elevated CRP le vel among
elderly individuals and observed that it was signicantly more
common among the edentulous with complete dentures.
Importantly, patients having clinical signs of oral candidosis
or denture stomatitis also showed elevated levels of CRP,
and authors suggested that it may be the explanation of the
elevatedCRPlevelsseenintheedentulous.Inourstudy,we
have also seen a trend toward higher CRP values in DRS
patients, but it did not reach statistical signicance, probably
because of small numbers of patients involved and the fact
that we have not measured high sensitivity hsCRP which
would better characterize cardiovascular risk []. In the
light of our results, assessing other markers of the systemic
inammation becomes a very interesting aspect for further
studies. Taking into account our results, at present our data
donotsupportthehypothesisthatsystemicinammation
is involved. Rather, the eect of concomitant risk factors on
DRS and vascular function is most likely.
De Oliveira et al. and Rodriguez-Archilla et al. have found
that oral Candida infection may impact peripheral blood
mononuclear cells state, measured by amount of cytokines
produced in vitro in response to Candida antigens [,].
Direct impact of Candida cells on the vascular system is
unlikely, since systemic fungal infections are characterized, in
contrast to the DRS, by extremely serious symptoms; more-
over, fungal DNA has not been detected in atherosclerotic
lesions [].
Howeverourresultsmaypointustothepotentialroleof
vascular risk factors such as diabetes, smoking, and hyper-
triglyceridemia in mediating vascular dysfunction. Although
no relationship was found between triglyceride levels and
endothelial dysfunction in a simple correlation analysis,
when multivariate linear regression was introduced including
diabetes, smoking, and/or triglyceride levels, the dierence
in endothelial function was no longer signicant (data not
shown). One has to however bear in mind that statistical
power of such analysis in the studied group was relatively
modest.
While the nding that classical risk factors may be
main mediators of endothelial dysfunction may not sound
exceptionally interesting, it is very important to show that
this is the case in DRS subjects, and therefore this group of
patients should be carefully studied in larger epidemiological
trials. is is particularly important in the light of ageing
population.
Despite the lack of dierences in the levels of total, HDL,
andLDLcholesterolinthebloodofhealthysubjectsand
BioMed Research International
DRS, we observed signicantly higher levels of triglycerides
in patients with DRS. Our surprising nding that DRS is
associatedwithselectiveincreaseintriglyceridelevelsis
quiteintriguingandcouldberelatedtothefactthatdenture
wearing can change dietary habits. It could also suggest that
increased triglyceride levels could be a risk factor of DRS,
although our study was not powered to answer this question.
ere are no studies looking at lipid parameters in DRS, while
conicting data are available regarding periodontitis. Sandi et
al. and Penumarthy et al. observed higher concentrations of
total cholesterol and LDL cholesterol in the blood of patients
with periodontal disease than in healthy group, but the
dierences in the levels of triglycerides and HDL cholesterol
were shown only by Penumarthy et al., despite the smaller
sample sizes [,]. Simultaneously, Elter et al. did not
demonstrate changes in the total cholesterol and HDL levels
aer treatment of periodontitis []. Altogether, these results
can point to a potential relationship between oral infection
andbloodlipidprole,butconclusiveevidenceisstillneeded.
We did not observe the tendency towards elevated blood
pressure in patients with DRS as compared to healthy
subjects. is shows potential important dierence in oral
inammatory conditions as periodontitis is potentially asso-
ciated with elevated blood pressure, which was frequently
observed []. e relationship between the use of dental
prostheses and the prevalence of cardiovascular diseases,
includingelevatedbloodpressure,wasdiscussedbyBuhlin
et al. []. ey found positive association between dentures
and all cardiovascular diseases but not for elevated blood
pressure, myocardial infarction, or stroke. However, the
group dened as “dentures” was very heterogeneous. e
authors gathered together edentulous and partially eden-
tulous denture wearers and edentulous without dentures.
is creates potential bias of the presence of periodontitis
in partially edentulous patients. Importantly, in our study
virtually all subjects were completely edentulous ( out of
).
5. Conclusions
In conclusion, our study shows that patients with denture-
related stomatitis are characterized by more pronounced
systemic endothelial dysfunction than denture subjects with-
out stomatitis. is dierence in vascular function is likely
linked with increased cardiovascular risk in DRS and indi-
cates that such patients should be carefully monitored for
cardiovascular disease. While our study identies certain
very interesting and potentially very important cardiovas-
cular aspects of denture-related stomatitis, a larger study is
warranted to nally conrm these observations. is may
be very important for clinical practice considering ageing
population.
Abbreviations
CRP: C-reactive protein
DM: Diabetes mellitus
DRS: Denture-related stomatitis
FMD: Flow-mediated dilatation
HDL: High density lipoprotein cholesterol
LDL: Low density lipoprotein cholesterol
NMD: Nitroglycerine-mediated dilatation
QandQ: th (Q) and th (Q) percentiles
SD: S tandard deviation.
Conflict of Interests
e authors declare that there is no conict of interests
regarding the publication of this paper.
Authors’ Contribution
Joanna Maciąg and Grzegorz Osmenda contributed equally
to this study.
Acknowledgments
is study was supported by Public Funds for Science
of Republic of Poland Grant no. /B/P// and
the Foundation for Polish Science Welcome Grant (FNP/
Welcome/) (TJG, TM, GO, AS).
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... Local inflammation associated, or not, with a biofilm, which is a complex structure formed by microorganisms held together by a mucus-like matrix of carbohydrate that adheres to different surfaces, including the denture surface [10], may trigger activation of monocytes and T cells, with overproduction of cytokines, such as interleukin (IL)-6, interferon γ, C-reactive protein (CRP) [17], tumor necrosis factor (TNF)-α and other proinflammatory cytokines, subsequently leading to atherosclerosis and hypertension, with increased cardiovascular risk [17,18]. ...
... Maciag et al. [16] analyzed peripheral blood immune cell activation to evaluate whether antifungal treatment of local inflammation caused by DS would influence the systemic immune response [16]. The authors did not find evidence of response complex immune mechanisms involved in the defense against oral fungal infection, though they verified a possible systemic inflammatory response to the topical application of nystatin, a macrolide polyene antifungal agent [17,18]. Although transient and not intense, this effect should be considered a clinically important finding, since patients with DS are generally elderly, and as such, more susceptible to changes in the immune function. ...
... DS has been recently associated with systemic implications (variations in blood pressure and endothelial dysfunction) that precede the development of serious cardiovascular disorders, such as atherosclerosis and hypertension, which are changes in general health with high mortality/morbidity rates [16][17][18]. However, the mechanisms that are related to correlation between oral inflammation and cardiovascular effects are not yet fully described; one of the most important hypotheses is the pre-activation of the immune system [17]. ...
Article
Full-text available
Background: Denture-related stomatitis (DS) is chronic multifactorial inflammation, strongly related to the presence of the biofilm that is the complex structure formed by microorganisms held together by a mucus-like matrix of carbohydrate that adheres to different surfaces, including the denture surface. DS has recently been correlated with deleterious cardiovascular alterations. The potential effect of hygiene protocols in the control of DS and randomized clinical trials that address this oral condition with cardiovascular complications are important in clinical decision-making. Material/design: A clinical trial, randomized, double-blind, and with parallel groups, will be conducted in Brazil The sample will consist of 100 patients without teeth in both arches, users of at least maxillary complete dentures, and diagnosed with DS, who will be allocated to groups (n = 25 per group) according to the different hygiene protocols: (1) brushing of the palate and immersion of the prosthesis in 0.25% sodium hypochlorite solution (positive control); (2) brushing of the palate and immersion of the prosthesis in 0.15% triclosan solution; (3) brushing of the palate and immersion of the prosthesis in lactose monohydrate; or (4) brushing the palate with citric acid and immersing the prosthesis in lactose monohydrate. The response variables will be heart rate variability and alteration of blood pressure (systemic level), remission of DS, removal of biofilm, reduction of microbial load (colony-forming units (CFU)), mouth and prosthesis odor level, expression of MUC1, proinflammatory cytokines, C-reactive protein (CRP), viscosity, pH and salivary flow (locally); patient-centred qualitative analysis will also be undertaken. Measurements will be performed at baseline and 10 days after the interventions. The results obtained will be statistically analyzed as pertinent, with a level of significance of 0.05. Discussion: This study will provide a guideline for clinical practice regarding the use of hygiene protocols in the treatment of oral diseases (DS) mediated by biofilm. Also, it may provide evidence of correlation of oral manifestation with cardiac risk. Trial registration: Brazilian Registry of Clinical Trials, RBR-4hhwjb. Registered on 9 November 2018.
... 4 plus faible chez les patients âgés atteints d'une stomatite par rapport à celle des patients témoins. Dans cette situation, la stomatite est associée à un dysfonctionnement endothélial en relation avec le vieillissement des patients porteurs de prothèses amovibles [12]. Le traitement de la stomatite revêt ici deux objectifs : assainir la cavité buccale et améliorer localement muqueuse linguale ( figure 4). ...
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Aim: The purpose of this work is to analyze the effects of removable dental prostheses and aging on blood microcirculation in the palatal mucosa. Settings and Design: Blood flow was measured in two groups using the Laser Doppler Flowmeter at three specific anatomical sites: Retro incisive papilla, medial raphe, and Schroeder area. Materials and Methods: Group 1 included young, healthy dentulous individuals (mean age: 23 ± 3 years), and Group 2 contained elderly edentulous individuals (mean age: 62 ± 11.69 years). For Group 1, measurements were taken in a single session; for Group 2, the measurements were taken in two sessions: The first just before the prosthetic load (E1) and again 1 week after new dentures were provider (E2). Statistical Analysis Used: Statistical analyses were performed using SAS software, Version 9.4 of the SAS System for Windows, Copyright © 2017 SAS Institute Inc. (Cary, NC, USA). A P < 0.05 was classified as statistically significant. Results: Measurements of blood flow of the palatal mucosa showed that the healthy young dentulous participants had significantly lower perfusion unit values than the elderly edentulous participants at all three anatomical sites (P < 0.05). For Group 2, the comparisons between the measurements taken before (E1) and after (E2) new dentures were provided showed no significant differences. Conclusion: Our results indicate that the process of aging significantly modifies the blood flow of the palatal mucosa while wearing removable dental prostheses does not modify the blood flow of the palatal mucosa in a 1week period. These results are not influenced by systemic pathology (e.g., diabetes, cardiovascular diseases) or smoking.
... and bacterial colonization that may be associated with denture stomatitis (DS) 4,5 and systemic diseases. [6][7][8][9] Therefore, effective oral biofilm control is necessary to prevent these diseases, 5 especially for an aging population. However, when indicating the ideal biofilm control method, one must consider the effectiveness and if it is well accepted and used by the patient so that disease prevention can positively impact the satisfaction and quality of life of individuals. ...
Article
Purpose: This randomized controlled trial compared four denture hygiene protocols in terms of patient satisfaction, oral health-related quality of life (OHRQoL), and salivary parameters in complete denture wearers with denture stomatitis. Material and methods: For this randomized, double-blind controlled clinical trial, 108 participants were assigned to soak their dentures in one of the following solutions: (1) 0.25% sodium hypochlorite (positive control), (2) 0.15% Triclosan, (3) denture disinfecting tablets, or (4) denture disinfecting tablets plus palatine mucosa brushing solution. The outcomes of patient satisfaction, OHRQoL, and salivary parameters (salivary flow rate and pH) were measured at baseline and after 10 days. Results were compared by Kruskal-Wallis, between-group by the Dunn test, and Wilcoxon tests between times (α = 0.05). Results: After the hygiene protocols, and when compared with baseline, the overall patient satisfaction, maxillary denture satisfaction, maxillary denture comfort, and maxillary denture retention were ameliorated. A significant improvement was noted in OHRQoL in 3 of 4 domains evaluated (orofacial pain and discomfort, masticatory discomfort and disability, and psychological disability and discomfort). The salivary flow rate (unstimulated and stimulated); and pH were not significantly affected at the times evaluated. Conclusions: Complete denture wearers may feel more satisfied with their complete dentures when treated for denture stomatitis. The tested treatments lead to similar improvement in terms of patient satisfaction and OHRQoL. This article is protected by copyright. All rights reserved.
... 2,3 DS has been reported to result from inadequate denture cleaning, denture plaque, mucosal damage from poorly fitting dentures, wearing removable dentures overnight, and overgrowth of commensal Candida albicans. [4][5][6][7][8][9][10] Many patients are asymptomatic, whereas for others, symptoms can include oral pain and mouth ulcers 2,8 which may require individuals to stop using their dentures, thereby impairing diet and quality of life. 2,8,11 Although considered largely preventable and manageable with effective oral hygiene, DS nevertheless affects healthcare resources in terms of office visits and prescription costs. ...
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Statement of problem Denture stomatitis is a prevalent condition in denture wearers. Economic evaluations of health care can help stakeholders, including patients, make better decisions about treatments for a given condition. Economic models to assess the costs and benefits of different options for managing denture stomatitis are lacking. Purpose The purpose of this study was to explore the feasibility of developing a cost-effectiveness model to assess denture cleaning strategies aimed at preventing denture stomatitis from a denture-wearer perspective in the United Kingdom. Material and methods A model was developed to identify and estimate the costs and effects associated with 3 denture cleaning strategies. These were low care (LC)—cleaning by brushing and soaking overnight in water; medium care (MC)—brushing with toothpaste and soaking overnight in water; and optimum care (OC)—brushing and soaking overnight in water and antimicrobial denture cleanser. Costs, outcome measures (denture stomatitis–free days), and probabilities (incidence of stomatitis, unscheduled dentist visits, prescription charges, self-medication) associated with each strategy were defined. A sensitivity analysis was used to identify key drivers and test the robustness of the model. Results The model showed that the total costs for 2015 ranged from £1.07 (LC) to £18.42 (OC). Costs associated with LC were derived from unscheduled dentist visits and use of medication and/or prescription charges. Incremental costs per denture stomatitis–free day were £0.64 (MC) and £1.81 (OC) compared with LC. A sensitivity analysis showed that varying either or both key parameters (baseline incidence of denture stomatitis and relative effectiveness of MC and OC strategies) had a substantial effect. Incremental cost-effectiveness ratios ranged from £4.11 to £7.39 (worst-case scenario) and from £0.21 to £0.61 (best-case scenario). Conclusions A model was developed to assess the relative cost-effectiveness of different denture cleaning strategies to help improve denture hygiene. An important finding of the study was the lack of evidence on the relative effectiveness of different cleaning strategies, meaning that several assumptions had to be incorporated into the model. The model output would therefore likely be considerably improved and more robust if these evidence gaps were filled.
... In addition to mechanical properties, the ability of an RPD material to resist oral biofilm attachment and colonization is important. For the denture-wearing population, microbial biofilm growth on dentures has the following effects: affecting gingival health, risk of caries, enamel demineralization [9,10], risk of oral inflammation in the form of denture stomatitis [11], and risk of oral-inflammationassociated systemic illnesses such as cardiovascular disease [12], endothelial dysfunction [13], and aspiration pneumonia [14]. Treatment includes antifungal medication [15], denture disinfection, and continued good oral hygiene [16]. ...
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Control of denture plaque biofilms is a practical approach to preventing persistent oral infections such as denture stomatitis. Objectives. This study compared in vitro biofilm attachment and growth on a new denture material, Ultaire® AKP, with that on traditional denture materials including cobalt chrome (CoCr), polymethyl methacrylate (PMMA), and polyoxymethylene (POM). Methods. Microbial biofilms were grown with cultures of Candida albicans, Streptococcus mutans UA159, or a mixed Streptococcus spp. (S. mutans 700610/Streptococcus sanguinis BAA-1455) for 6 hours in a static protocol or 24 hours in a dynamic protocol for each material. Adherent biofilm cells were removed, and viable colony-forming units (CFUs) were enumerated. Confocal microscopy of the 24-hour Streptococcus spp. biofilms was used to determine biofilm mass and roughness coefficients. Results. The rank order of C. albicans attachment after 6 hours was CoCr > PMMA∗ > Ultaire® AKP∗ (∗vs CoCr, p≤0.05), and that for 24-hour biofilm growth was CoCr > Ultaire® AKP∗ > PMMA∗ (∗vs CoCr, p≤0.05). The rank order of S. mutans biofilm attachment was CoCr > POM > Ultaire® AKP∗ > PMMA∗ (∗vs CoCr, p≤0.05), and that for the 24-hour Streptococcus spp. biofilm growth was POM > Ultaire® AKP > PMMA > CoCr∗ (∗vs POM, p≤0.05). Confocal images revealed structural differences in Streptococcus spp. biofilms on CoCr compared with the other test materials. Significantly lower roughness coefficients of Streptococcus spp. biofilms on Ultaire® AKP were noted, suggesting that these biofilms were less differentiated. Ultaire® AKP promoted significantly less C. albicans and S. mutans biofilm attachment than CoCr at 6 hours and C. albicans growth at 24 hours. Streptococcus spp. biofilms on Ultaire® AKP were less differentiated than those on other test materials. Conclusion. In addition to its material strength, Ultaire® AKP represents an attractive option for denture material in removable partial dentures.
... However, the abiotic surface based on acrylic resin can contribute to the deposition and formation of oral biofilm, a contamination source acting as a reservoir of infection (PARANHOS et al., 2019). Oral infection can lead to local diseases and further aggravate or trigger systemic diseases (MACIAG et al., 2014;MACIAG et al., 2017;OSMENDA et al., 2017). Therefore, it is essential to provide prosthetic treatment, but that the patient knows how to use it with the knowledge of proper maintenance and hygiene (PARANHOS et al., 2019;BADARÓ et al., 2020). ...
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Objectives: This study aimed to compare color change, after the action of disinfectant solutions (Listerine®, Cepacol®, Periogard®, Riozyme®, sodium hypochlorite a 1%, and tap water as a control), and the action of the vat ultrasonic. Methods: Sixty specimens were obtained, included in cylindrical bases of thermopolymerizable resin, originating 12 groups (n = 5). Of these, six groups were randomly subjected to the ultrasonic vat's action with disinfectant solutions for 180 minutes each, and six groups were immersed in the solutions for an equal period. The values of color change in the resin of the prostheses' base were evaluated using the PCB Spectrophotometer 6807, using the CIE L * a * b * scale to determine the color, by comparing the samples before and after the test. For the statistical analysis, the two-way ANOVA test was used. Results: There was no statistically significant change in the color of acrylic prostheses' bases, indicating that the method is safe for disinfecting the prostheses, with any of the solutions and situations tested. Conclusions: The tested solutions associated or not with the ultrasonic vat did not change the color of the acrylic bases and can be used for a specified period of time.
... In some cases of oral candidiasis, symptoms may disappear spontaneously except for the cases of the use of antibiotics or topical corticosteroids. In other cases, treatment is Although there are many studies and data on the related factors of oral candidiasis, large, single-centred retrospective studies are still not enough to identify common risk factors for oral candidiasis and to evaluate oral candidiasis compared to those identified in other studies [4][5][6][7]. Therefore, to characterize the clinical features of oral candidiasis, one-year retrospective study was conducted on patients diagnosed and treated with oral candidiasis who visited the Department of Oral Medicine at Chosun University Dental Hospital in Gwangju. ...
... 43 Although usually asymptomatic, denture stomatitis can occasionally cause oral discomfort, altered taste or a burning sensation of the oral mucosa. 44 First line treatment involves detailed patient instruction on removing dentures at night and daily mechanical cleaning with a soft brush to remove the biofilm and subsequent disinfection. over the counter effervescent tablets may be used, but their efficacy at removing candida is questionable. ...
Article
With the projected increase to 1.3 billion people aged 65 years or older by 2040, healthcare professionals are faced with significant challenges in managing this population of patients. In the oral cavity, oral mucosal disease is a significant problem found in older populations. Several facial pain conditions are more likely to be seen in this cohort of patients. Although management of this group of patients may not always be appropriate in general practice, an awareness of the range of oral medicine conditions that may be encountered in older patients is essential to allow prompt referral and treatment.
Article
Denture stomatitis (DS) is an example of a biofilm-mediated condition. ‘Biofilm’ is a complex microbial structure which adheres to a surface and comprises of densely packed bacteria encased in a polysaccharide matrix. The common causes for onset of this condition are - colonisation and proliferation of yeast cells in denture surface irregularities, denture relining materials, continued poor denture hygiene and various systemic factors. The most crucial aspect of treatment is improvement in denture hygiene which involves denture removal at night followed by rigorous cleaning and overnight immersion in a disinfecting solution. This is essential to prevent re-infection if not removed properly since denture is commonly infected with C. Albicans. The pharmacological treatment comprises of use of topical or systemic antifungal drug therapy to halt the growth of yeast and resolve the mucosal infection. This review article provides an overview of multifactorial etiology and treatment modalities for denture-induced stomatitis
Article
Statement of problem Denture stomatitis affects complete denture wearers and is frequently treated with antifungals drugs, as well as treating the denture with sodium hypochlorite. Whether the limitations of these treatments can be overcome with local hygiene protocols that do not damage the denture materials or adversely affect the patient is unclear. Purpose The purpose of this randomized controlled trial was to evaluate the effect of denture hygiene protocols on complete denture wearers with denture stomatitis. Material and methods For this randomized, double-blind controlled clinical trial, 108 participants were assigned to parallel groups: 0.25% sodium hypochlorite (positive control) 0.15% Triclosan, denture cleaning tablets, or denture cleaning tablets plus gingival cleaning tablets. The participants were instructed to brush the dentures and the palate and immerse the denture in the solutions. The outcomes of denture stomatitis remission, biofilm removal, decrease of microbial load (colony-forming units), and odor level of the mouth and denture were measured at baseline and after 10 days. Descriptive analyses were used for sociodemographic characterization of the participants; the Pearson chi-square test was used to compare participant frequency with different degrees of denture stomatitis. The data were not normally distributed (Shapiro-Wilks test) or homogeneous (Levene test). So, the Kruskal-Wallis and Dunn post hoc tests and Wilcoxon test were used to compare the effects of solutions and time on the variables (α=.05). Results The frequency of the highest to lowest denture stomatitis scores was significantly different for the 0.15% Triclosan and denture cleaning tablets groups. No significant difference was found among the groups in terms of denture stomatitis scores, biofilm, or colony-forming unit count of Candida spp. or C. albicans and S. mutans; a significant reduction was found in these parameters. The 0.25% sodium hypochlorite and 0.15% Triclosan treatments caused a significant reduction in Gram-negative microorganisms; these 2 protocols, and the denture cleaning tablets showed a significant reduction in Staphylococcus spp.; all protocols had similar effects. Only the S. mutans count of the palate decreased after 10 days. The odor level of the mouth and the denture was not significantly different (P=.778). Conclusions The evaluated protocols can be recommended for the hygiene of complete dentures, since they were effective for all the variables studied.
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The endothelium plays a vital role in maintaining circulatory homeostasis by the release of relaxing and contracting factors. Any change in this balance may result in a process known as endothelial dysfunction that leads to impaired control of vascular tone and contributes to the pathogenesis of some cardiovascular and endocrine/metabolic diseases. Reduced endothelium-derived nitric oxide (NO) bioavailability and increased production of thromboxane A2, prostaglandin H2 and superoxide anion in conductance and resistance arteries are commonly associated with endothelial dysfunction in hypertensive, diabetic and obese animals, resulting in reduced endothelium-dependent vasodilatation and in increased vasoconstrictor responses. In addition, recent studies have demonstrated the role of enhanced overactivation ofβ-adrenergic receptors inducing vascular cytokine production and endothelial NO synthase (eNOS) uncoupling that seem to be the mechanisms underlying endothelial dysfunction in hypertension, heart failure and in endocrine-metabolic disorders. However, some adaptive mechanisms can occur in the initial stages of hypertension, such as increased NO production by eNOS. The present review focuses on the role of NO bioavailability, eNOS uncoupling, cyclooxygenase-derived products and pro-inflammatory factors on the endothelial dysfunction that occurs in hypertension, sympathetic hyperactivity, diabetes mellitus, and obesity. These are cardiovascular and endocrine-metabolic diseases of high incidence and mortality around the world, especially in developing countries and endothelial dysfunction contributes to triggering, maintenance and worsening of these pathological situations.
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Purpose: To assess serum cholesterol, triglycerides, high and low density lipoprotein (HDL and LDL) levels (serum lipid profile) in subjects with chronic periodontitis and the possible association for risk of cardiovascular disease (CVD). Materials and methods: Total of 80 participants (42 males and 38 females) who were in the age range of 30-65 years were divided into test group (group I- 40 subjects with chronic periodontitis) and control group (group II- 40 subjects with healthy periodontium), based on their periodontal disease statuses. Three ml of venous blood samples were taken for measurement of parameters of lipid metabolism [serum cholesterol (chol); triglycerides (Tg); HDL and LDL. Results: Significant increase in serum cholesterol and LDL (P<0.05) were observed in test group (group I), whereas serum triglycerides and HDL (P>0.66) showed no significant increase in test group (group I) as compared to their values in the control group (group II). A P-value of < 0.05 was considered for statistical significance. Conclusions: Subjects with chronic periodontitis showed increased serum cholesterol and LDL levels. This may suggest that these subjects are potentially at a risk of getting CVD.
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This review is to examine the current literatures on the relationship between periodontitis and hypertension as well as to explore the possible biological pathways underlying the linkage between these health conditions. Hypertension is one of the major risk factors for cardiovascular diseases. Oxidative stress and endothelial dysfunction are among the critical components in the development of hypertension. Inflammation has received much attention recently and may contribute to a pivotal role in hypertension. Periodontitis, a chronic low-grade inflammation of gingival tissue, has been linked to endothelial dysfunction, with blood pressure elevation and increased mortality risk in hypertensive patients. Inflammatory biomarkers are increased in hypertensive patients with periodontitis. Over the years, various researches have been performed to evaluate the involvement of periodontitis in the initiation and progression of hypertension. Many cross-sectional studies documented an association between hypertension and periodontitis. However, more well-designed prospective population trials need to be carried out to ascertain the role of periodontitis in hypertension.
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Purpose: Periodontal diseases are common in most populations and affect people at all socioeconomic levels. Evidence suggests that patients with epilepsy actually have higher risks of dental disease and increased oral health needs, but the frequency and consequences of poor controlled seizures on dental and periodontal health have not been reported before. We aimed to assess the impact of seizure frequency on periodontal status and oral hygiene in a sample of epilepsy patients. Methods: One hundred and nine consecutive patients treated for epilepsy at the outpatient clinic of our University Hospital were invited to take part in an oral examination to determine their periodontal disease status, together with a control group. In addition, seizure frequency and use of medication were documented. Results: In logistic regression model, patients were significantly more susceptible to bad oral hygiene, gingivitis and periodontitis that controls (p<0.001); seizure frequency was significantly related to bad oral hygiene (p=0.010), gingivitis (p<0.001) and periodontitis (p<0.001). Tooth brushing habits and presence of caries were associated with oral health in patients group. Conclusion: Our study found a significant positive correlation between periodontal disease and seizure severity. Epilepsy patients need to focus more on their oral health and quality of oral hygiene.
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Chronic apical periodontitis (CAP) appears to be a risk factor for coronary heart disease. The aims of the study were to estimate the significance of AP for the atherosclerotic burden and to examine the potential effect of endodontic treatment. The whole-body computed tomography (CT) examinations of 531 patients with a mean age of 50 ± 15.7 years were evaluated retrospectively. The atherosclerotic burden of the abdominal aorta was quantified using a calcium scoring method. The parameters of periodontitis were measured using the CT scan. The patients had a total of 11,191 teeth. The volume of the aortic atherosclerotic burden for patients with at least one CAP lesion was 0.32 ± 0.92 ml, higher than for patients with no CAP (0.17 ± 0.51 ml; p < 0.05). The atherosclerotic burden increased with age and number of CAP lesions without root canal treatment, but not with number of CAP lesions with endodontic treatments (p < 0.05 each). In logistic regression models, age (Wald 90.8), CAP without endodontic treatment (Wald 39.9), male gender (Wald 9.8), and caries per tooth (Wald 9.0) correlated positively and the number of fillings (Wald 11) correlated negatively with the atherosclerotic burden (p < 0.05 each). Apical radiolucencies in teeth with endodontic treatment were irrelevant with respect to atherosclerosis. CAP correlated positively with the aortic atherosclerotic burden. In regression models, CAP without endodontic treatment was found to be an important factor, not however apical radiolucencies in teeth with endodontic treatment. Further research is needed to clarify the possible clinical significance of these associations.
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In periodontal diseases, inflammatory mediators, including interleukin (IL)-6, IL-8 and tumor necrosis factor-α (TNF-α), may promote the degeneration of inflamed periodontal tissues. In previous studies, levels of these three cytokines were demonstrated to be elevated in inflammatory gingival tissues and gingival crevicular fluid. The aim of the present study was to quantify IL-6, IL-8 and TNF-α levels in the human gingival tissues of patients with periodontitis and to assess the correlation of these three cytokines with each other. In this study, human gingival tissues from 19 patients with periodontitis (male, n=14; female, n=5) were collected. The tissues were homogenized, centrifuged and the protein in the supernatant was quantified. Enzyme-linked immunosorbent assay (ELISA) was used in the measurement of the IL-6, IL-8 and TNF-α levels, and the mean levels were observed to be 8.41±0.25, 34.01±1.09 and 20.70±0.31 pg/ml, respectively. The mean levels of IL-8 were higher than those of the other two cytokines. In each sample, the level of TNF-α expression was consistently high, with little difference between the results, which contrasted with the fluctuations in IL-6 and IL-8 levels. The expression of the two ILs (IL-6 and IL-8) showed a positive correlation (r=0.932, P=0.01), whereas TNF-α levels were not correlated with IL-6 or IL-8 levels. These results suggest that IL-6, IL-8 and TNF-α may be relevant in the pathophysiology of periodontitis, and the measurement of these cytokines may be beneficial in the identification of patients with periodontitis.
Article
Background— Many studies have reported the association between poor oral health and coronary heart disease or stroke, but few of them evaluated peripheral arterial disease (PAD). Hence, in this study we examined the associations between oral health and PAD. Methods and Results— In the prospective study of 45 136 eligible male health professionals free of cardiovascular diseases at baseline, we identified 342 cases of PAD during a 12-year follow-up period. We evaluated the association between different measures of oral diseases and the occurrence of PAD. Baseline number of teeth was not related to the risk of PAD, but cumulative incident tooth loss was significantly associated with elevated risk of subsequent occurrence of PAD. The relative risk for history of periodontal disease was 1.41 (95% CI, 1.12 to 1.77) and for any tooth loss during the follow-up period was 1.39 (95% CI, 1.07 to 1.82), controlling for traditional risk factors of cardiovascular disease. Among men with a history of periodontal diseases, the relative risk of tooth loss increased to 1.88 (95% CI, 1.27 to 2.77), whereas no association was found between tooth loss and PAD among those without periodontal diseases (RR, 0.92; 95% CI, 0.61 to 1.38). We further explored the potential induction period of tooth loss and found that tooth loss in the previous 2 to 6 years was most strongly associated with PAD. Conclusions— We found that incident tooth loss was significantly associated with PAD, especially among men with periodontal diseases. The results support a potential oral infection–inflammation pathway.
For many years an association between diabetes and periodontitis has been suspected. In more recent times this relationship has been suggested to be bidirectional with each condition being able to influence the other. In this review the two-way relationship between diabetes and periodontitis is considered. For this narrative review a very broad search strategy of the literature was developed using both EMBASE and MEDLINE (via PubMed) databases. The reference lists from the selected papers were also scanned, and this provided an additional source of papers for inclusion and further assessment. The data available suggest that diabetes is a risk as well as a modifying factor for periodontitis. Individuals with diabetes are more likely to have periodontitis and with increased severity when diabetes is uncontrolled/poorly controlled. Possible mechanisms of how diabetes affects periodontitis include adipokine-mediated inflammation, neutrophil dysfunction, uncoupling of bone and advanced glycation end-products-receptor for advanced glycation end-products interaction. Evidence is accruing to support how periodontitis can affect diabetes and complications associated with diabetes. There is some evidence demonstrating that periodontal therapy can result in a moderate improvement in glycaemic control. Available evidence indicates that diabetes and peridontitis are intricately interrelated and that each condition has the capacity to influence clinical features of each other.
Article
Introduction: Endothelial dysfunction, characterized by the loss of nitric oxide bioavailability, is a key element in the pathogenesis of atherosclerosis and an important prognostic factor in cardiovascular diseases. Therefore, the development of reliable, safe, and noninvasive methods of endothelial function assessment is important for their use in cardiovascular risk stratification. Brachial artery flow‑mediated dilation (FMD) is widely used in research but technical difficulties and problems with calibration between laboratories limit its clinical use. Reactive hyperemia-peripheral artery tonometry (RH‑PAT, EndoPAT) has been developed as a simpler, cheaper, and potentially more reproducible method. Objectives: We aimed to investigate associations between RH‑PAT and FMD in relation to atherosclerotic risk factor profile. Patients and methods: The study involved 80 subjects (52 men, 28 women) aged 43.6 ±14.8 years, with moderate‑to‑low cardiovascular risk (mean SCORE, 2.2% ±2%), in whom FMD, RH‑PAT, and intima-media thickness (IMT) were determined. Results: The reactive hyperemia index (RHI) measured by RH‑PAT correlated with FMD (r = 0.35, P <0.01). However, no significant correlation was observed between RHI and IMT, SCORE, or the number of classical atherosclerotic risk factors (hypertension, smoking, diabetes, hypercholesterolemia), while FMD was significantly correlated with IMT (r = -0.53, P <0.001), risk factors (r = -0.55, P <0.05), and SCORE (r = -0.4, P <0.05). Conclusions: Despite its technical requirements, FMD is a more sensitive method than RH‑PAT in evaluating the effect of classical atherosclerotic risk factors on vascular endothelial function. Microvasculature response during RH‑PAT needs to be further studied, including the assessment of nonendothelial factors that may affect the measurements, before RH‑PAT becomes the universal tool for the evaluation of the endothelial cells.