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The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: A meta-analysis
Abstract
Previous studies have shown conflicting results as to whether periodontitis (PD) is associated with increased risk of coronary heart disease (CHD). The aim of the current study was to evaluate whether such an association exists.
A systematic review of the literature revealed 5 prospective cohort studies (follow-up >6 years), 5 case-control studies, and 5 cross-sectional studies that were eligible for meta-analysis. Individual studies were adjusted for confounding factors such as age, sex, diabetes mellitus, and smoking. The 3 study categories were analyzed separately. Heterogeneity of the studies was assessed by Cochran Q test. The studies were homogeneous; therefore, the Mantel-Haenszel fixed-effect model was used to compute common relative risk and odds ratio (OR).
Meta-analysis of the 5 prospective cohort studies (86092 patients) indicated that individuals with PD had a 1.14 times higher risk of developing CHD than the controls (relative risk 1.14, 95% CI 1.074-1.213, P < .001). The case-control studies (1423 patients) showed an even greater risk of developing CHD (OR 2.22, 95% CI 1.59-3.117, P < .001). The prevalence of CHD in the cross-sectional studies (17724 patients) was significantly greater among individuals with PD than in those without PD (OR 1.59, 95% CI 1.329-1.907, P < .001). When the relationship between number of teeth and incidence of CHD was analyzed, cohort studies showed 1.24 times increased risk (95% CI 1.14-1.36, P < .0001) of development of CHD in patients with <10 teeth.
This meta-analysis indicates that both the prevalence and incidence of CHD are significantly increased in PD. Therefore, PD may be a risk factor for CHD. Prospective studies are required to prove this assumption and evaluate risk reduction with the treatment of PD.
... Ten SR [39, 40, 51-53, 70, 74-76, 78] [78] reported that there is an association between CHD and PD. Four SR [53,60,74,78] included reported that there was an association between tooth loss and CHD, but in two SR [75,76] this association was not found. Five SR [53,60,[74][75][76] meta-analyzed the results and found that the RR ranged from 1.04 (CI: 0.85 to 1.28) [75] to 1.52 (CI: 1.37 to 1.69) [60]. ...
... Four SR [53,60,74,78] included reported that there was an association between tooth loss and CHD, but in two SR [75,76] this association was not found. Five SR [53,60,[74][75][76] meta-analyzed the results and found that the RR ranged from 1.04 (CI: 0.85 to 1.28) [75] to 1.52 (CI: 1.37 to 1.69) [60]. Madianos et al. [78] reported that there is an association between CHD and tooth loss. ...
Background
Periodontal disease (PD) is an infectious and inflammatory condition that affects the tissues surrounding and supporting the teeth. It has been suggested that PD may be associated with cardiovascular disease (CVD), one of the leading causes of mortality worldwide. Our study aimed to investigate the association between PD and CVD through an umbrella review.
Methods
A comprehensive search was conducted until April 2024 across various electronic databases, including PubMed, Cochrane Library, Scopus, SciELO, Web of Science, Google Scholar, ProQuest Dissertations and Theses, and OpenGrey. Systematic reviews with or without meta-analysis were considered for inclusion, without any limitations on time or language, provided they examined primary studies linking PD with CVD. The AMSTAR-2 tool was employed to assess the quality and overall confidence of the included studies.
Results
After the initial search, a total of 516 articles were identified. Following the application of selection criteria, 41 articles remained for further consideration. All these studies indicated an association between PD and CVD, with odds ratios and risk ratios ranging from 1.22 to 4.42 and 1.14 to 2.88, respectively.
Conclusions
Systematic reviews with high overall confidence support the association between PD, tooth loss, and cardiovascular diseases. However, it is crucial to interpret these results with caution due to methodological limitations. The potential public health relevance justifies preventive and corrective oral health strategies. Additionally, the need for rigorous future research is highlighted to strengthen the evidence and guide effective public health strategies.
... Our findings support these observations, as we detected a significant association with arterial hypertension in individuals over 45 years old and in those with a CPI between 9 and 13 (p = 0.011) or a CPI of 14 or higher (p = 0.022). A meta-analysis by Bahekar et al. [14], which synthesized data from 5 cohort studies encompassing 86,092 patients, indicated that people with periodontal disease are 1.14 times as likely to develop coronary heart disease compared to periodontally healthy individuals, even when accounting for common risk factors such as smoking. In case-control studies involving 1,423 patients, these researchers observed an even stronger association (OR, 2.22). ...
... However, our study did not establish a significant connection with ischemic events. Upon calculating the ORs, we found that participants with more advanced periodontal disease (specifically, those with a CPI between 9 and 13 and those with a CPI greater than 14) had ORs of 3.53 and 2.91, respectivelyfigures exceeding those reported by Bahekar et al. [14]. Zhao et al. [15] reported similar findings in a cohort of university students, with a positive association between periodontal disease and hypertension (OR, 1.28). ...
Objectives: The objective of this study was to examine the hypothesis that periodontal disease is associated with chronic non-communicable diseases.Methods: In this cross-sectional study, we evaluated the periodontal health condition of the population, based on the community periodontal index, as well as the number of missing teeth and the presence of systemic health conditions. We quantified the association between oral health and the presence of chronic diseases using simple logistic regression, adjusting for confounding factors including age, smoking, and overweight.Results: The study population consisted of 334 volunteers, aged between 19 and 81 years. In patients over 45 years old, periodontal disease was found to be significantly associated with hypertension and diabetes. Furthermore, in female patients, periodontal disease was significantly associated with hypertension, diabetes, and cancer.Conclusion: Our findings indicate that periodontal disease is positively and significantly associated with both arterial hypertension and diabetes, independent of potential confounding factors.
... Mounting evidence suggests that chronic inflammation increases the risk of cardiovascular disease (CVD) [4]. This has led to speculation that periodontitis may be a modifiable risk factor contributing to the development of CVD, with epidemiological studies supporting an association between CVD and periodontitis [5,6]. CVD and its sequalaecoronary artery disease (CAD), acute myocardial infarction, stroke and peripheral arterial diseaseis a leading cause of morbidity and mortality worldwide [7]. ...
... [31] Periodontitis specifically has been theorized to contribute to the low-grade inflammatory state underlying CVD and HTN. [32] The identification of periodontitis as a possible risk factor for HTN could be explained by multiple mechanisms [4,5]. Periodontitis has been linked to systemic inflammatory mediators such as CRP and IL-6, both of which are known to affect endothelial function [4]. ...
... It is a high prevalence disease (45-50%) and its most severe level affects 10-15% of the adult population [1,2]. Periodontitis has been assumed as a possible factor implicated in the etiopathogenesis of atherosclerosis [3][4][5][6] with both disorders presenting some common risk factors such as smoking, age and diabetes mellitus [3]. Within the last decades, a potential association between periodontitis and cardiovascular disease (CVD) has received much attention [7,3,8]. ...
... Severe periodontitis is strongly associated with hypertension [44] and some studies have claimed to notice a decline of blood pressure after periodontal disease therapy [46]. Multiple studies have proven the existence of a close association between periodontal disease and CVD [3][4][5][6][7]9]. On the other hand, the question of causality is still unclear particularly because most of studies have used only stand-in markers/biomarkers as endpoints. ...
Objective : Periodontitis and cardiovascular disease are prevalent entities that often coexist, with a common pro-inflammatory pathway. The objective of this study was to evaluate the association between periodontitis and cardiovascular pro-inflammatory parameters rarely considered within risk factors. Methods : Forty-three participants aged between 38-82 years were examined. An association between mean probing depth (MPD), mean attachment loss (MAL), bleeding on probing (BOP), and periodontal inflamed surface area (PISA) was correlated with the following cardiovascular disease factors and inflammatory promoters: neutrophil-to-lymphocyte ratio (NLR), 24h ambulatory blood pressure, global cardiovascular risk, daily salt intake, night-time systolic blood pressure (nSBP), and pulse wave velocity (PWV). A two-way ANOVA and multiple comparison tests were performed using SPSS statistics software. Results : A highly significant correlation (p<0.05) was found between BOP, MPD, and MAL with high salt intake, global cardiovascular risk estimation, nSBP, and PISA. Also, significantly statistical correlation (p<0.05) was found between BOP, NLR, and PWV while PISA was only associated with NLR. Logistic regression analysis identified absolute values of nSBP, salt intake and NLR as possible independent contributors to the increase in the log odds of developing BOP. Conclusions : Several periodontal disease parameters are linked to cardiovascular risk factors such as hypertension, neutrophil-to-lymphocyte ratio, daily salt intake and night-time systolic blood pressure.
... Cardiovascular pathologies and their correlation with PD have attracted the attention of different researchers, although a direct relationship has not been consensually demonstrated; a metaanalysis by Bahekar et al., 2007 on five cohort studies including a sample of more than 86,000 patients concluded that patients with PD had a 1.14-fold increased risk of developing coronary heart disease (Bahekar et al., 2007). Gao et al., 2021 in a recent metaanalysis including 11 retrospective studies with more than 200,000 participants showed that periodontitis was a risk factor for coronary heart disease and that the number of missing teeth would be directly correlated with the risk of coronary heart disease (Gao et al., 2021). ...
... Cardiovascular pathologies and their correlation with PD have attracted the attention of different researchers, although a direct relationship has not been consensually demonstrated; a metaanalysis by Bahekar et al., 2007 on five cohort studies including a sample of more than 86,000 patients concluded that patients with PD had a 1.14-fold increased risk of developing coronary heart disease (Bahekar et al., 2007). Gao et al., 2021 in a recent metaanalysis including 11 retrospective studies with more than 200,000 participants showed that periodontitis was a risk factor for coronary heart disease and that the number of missing teeth would be directly correlated with the risk of coronary heart disease (Gao et al., 2021). ...
This systematic review with meta-analysis evaluated the antioxidant effect of lycopene as an adjuvant treatment for periodontal disease. PubMed, EMBASE and Web of Science databases were consulted. According to the PICOs strategy, inclusion criteria were established for intervention studies Randomized Controlled Trials in Probing depth subjects (participants) treated with conventional treatment and lycopene (intervention) compared to patients treated with conventional treatment (control) in which periodontal response to treatment (outcome) was assessed. The risk of bias for randomized studies was assessed using the Cochrane Risk of Bias Tool. The methodological quality of the studies included in the meta-analysis was measured using the Jadad scale. Quantitative data were analyzed using six random-effects meta-analyses, taking into account periodontal parameters: Probing Pocket Depth, Clinical Attachment Loss, Bleeding on Probing, Plaque Index, Uric Acid and Gingival Index. Six further meta-analyses were performed, according to the follow-up of the studies (short-, medium- and long-term). Of the 339 studies identified, only 7 met the eligibility criteria. The meta-analysis of the studies according to the parameters evaluated only obtained statistical significance in the assessment of plaque index (p = 0.003). Regarding follow-up periods, PPD was significant (p = 0.03) in the short term. bleeding on probing estimates were significant in the short and medium term (p = 0.008 and p = 0.03, respectively), IP was significant in the short and medium term (p = 0.0003 and p = 0.01, respectively) and gingival index in the short and medium term (p = 0.002 and p = 0.02, respectively). Heterogeneity was high (I² >50%) in all assessments, except for Clinical Attachment Loss (I² = 16.7%). The results demonstrate that antioxidant treatment with lycopene could be useful as an adjunctive treatment for periodontal disease.
... Various factors are reported to be associated with periodontal in ammation. Systemic conditions, such as cardiovascular disease and stroke have been reported to be associated with periodontal in ammation [13,14]. Other factors include diabetes, oxidative stress, and ESRD [15][16][17]. ...
... However, several factors have been reported to be associated with periodontal in ammation in KT patients. Smoking, diabetes and cardiovascular disease have been reported to be associated with periodontal in ammation [13,15,26]. Another factor, eGFR was not signi cant in our study [17]. ...
Background: Various factors including diabetes and oxidative stress are associated with periodontal inflammation. In patients with end stage renal disease (ESRD) lead to various systemic abnormalities, including cardiovascular disease, metabolic abnormalities, and infection. Even after kidney transplantation (KT), these factors are known to be associated with inflammation. Our study, therefore aimed to study risk factors associated with of periodontitis in KT patients.
Methods: Patients, who visited Dongsan Hospital, Daegu, Korea, since 2018, of whom have undergone KT were selected. As of November 2021, 923 participants, with full data including hematologic factors were studied. Periodontitis was diagnosed based on residual bone level in panoramic views. Patients were studied by the presence of periodontitis.
Results: From 923 KT patients, 30 were diagnosed with periodontal disease. Fasting glucose levels were higher in patients with periodontal disease, while total bilirubin levels were lower. When divided by fasting glucose levels, high glucose level showed increase of periodontal disease with odds ratio (OR) of 1.031 (95% confidence interval (CI) 1.004-1.060). After adjusting for confounders, results were significant with OR 1.032 (95% CI 1.004-1.061).
Conclusions: Our study have shown that KT patients, of whom uremic toxin clearance has been revolted, are yet at risk of periodontitis by other factors, such as high blood glucose levels.
... Type 2 (noninsulin dependent or adult-onset) diabetes mellitus, is characterized by defective insulin secretion and action. 3,4 It doubles the incidence and severity of chronic periodontitis, 5 and conversely, the presence of periodontitis may also negatively impact the cardiovascular risk status in type 2 diabetes mellitus (T2DM) patients. 6 Furthermore, as compared to those without periodontitis, periodontitis patients have elevated levels of resting plasma glucose. ...
Background and Objectives: Chronic periodontitis is an infectious disease characterized by inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss. C-reactive protein, are acute phase proteins monitored as a marker of inflammatory status. The present study was performed to determine whether presence of periodontitis and non-surgical periodontal therapy could influence the serum levels of CRP in type II diabetes mellitus disease patients. Materials and methods: A total of 60 subjects were selected for study. Venous blood samples were taken at base line and 3 months after non-surgical periodontal therapy for the type II diabetic patients with the clinical signs of chronic periodontitis (group I, n=30) and patients with chronic periodontitis having no diabetic mellitus (group II, n=30) to estimate serum C-reactive protein (CRP) level. Clinical parameters such as glycated hemoglobin (HBA1c ≥ 6.5%), random blood sugar (RBS) and clinical periodontal parameters (Gingival Index, Probing pocket depth, Clinical attachment level and Plaque Index) for the group I and II were measured. Results: at base line, type II diabetes mellitus patients group I (T2DMCP) were compared to the non-diabetic patients with chronic periodontitis group II (NDMCP) based on the clinical periodontal parameters (GI,PPD, CAL and PI)scores and CRP level, HBA1c , (RBS) with the 3months after treatment. All the result was statically significant except for the GI and PPD scores at base line which was statically non-significant. The result also shows significant decrease in all the periodontal parameters and CRP level at base line as compared to 3months after treatment when group I was compared to group II while there was no significant change in the CRP level in group I and HBA1c in group II at base line as compared to 3months treatment. Conclusion: The present study concludes that total CRP level were decreased after non-surgical periodontal therapy.
... The findings from our study add to the evidence of the adjunctive systemic benefits of daily flossing and strengthen the importance of including both toothbrushing and interdental cleaning as part of daily OHS measures. Although the independent causal relationship between PD and CVD is debated, 64 the results of several systematic reviews and meta-analyses have confirmed that PD is a risk factor for CVD, and both the prevalence and incidence of CVD are significantly increased in people with PD. [15][16][17] Preventing PD by means of maintaining good oral hygiene through OHS measures like toothbrushing and flossing and regular dental visits could moderate the risk of developing CVD events and mortality. [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] There is now robust evidence from prospective observational studies that decreased duration and frequency of toothbrushing is significantly associated with endothelial dysfunction and with higher risk of experiencing future CVD events. ...
... Over 700 types of bacteria are present in the oral cavity, with 10⁸-10⁹ cfu/mL present in saliva, 1010-1011 cfu/mL present on the tooth surface, and 1011-1012 cfu/mL present in periodontal pockets [1]. It has been reported that oral bacteria are associated not only with oral diseases such as dental caries and periodontal disease but also with various systemic diseases such as diabetes [2], atherosclerosis [3], and aspiration pneumonia [4]. In recent years, the importance of controlling the growth of oral bacteria through oral care has been recognized, not only from the perspective of preventing dental diseases but also systemic diseases. ...
Background: The oral cavity hosts numerous bacteria that are associated with various systemic diseases. The Oral Bacteria Counter (PHC Corporation, Tokyo, Japan), a microorganism quantitative analyzer that utilizes dielectrophoretic impedance measurements, enables rapid bacterial counting and is widely used in dental practice in Japan. However, it may also detect nonviable bacteria. This study aimed to assess the impact of disinfectants, electrolytes, and viscosity on the accuracy of the Oral Bacteria Counter and to determine whether it measures non-viable bacteria similarly to viable bacteria.
Methods: To evaluate the effect of the disinfectants, samples of 7% povidone-iodine (PV-I), 0.2% benzethonium chloride, 5% chlorhexidine (CHX), 0.2% CHX, 0.05% CHX, sterile water, and saline were measured using the Oral Bacteria Counter. The effect of viscosity was assessed by mixing sterile water with glycerol in various ratios and measuring the dielectrophoretic impedance of the bacterial counts at different viscosities. For the electrolyte effects, samples of Staphylococcus aureus diluted in sterile water or saline were measured using the Oral Bacteria Counter. Additionally, samples of 7% PV-I or 5% CHX diluted in sterile water or saline were measured. Bacterial counts were then measured and compared using the Oral Bacteria Counter, our developed delayed real-time polymerase chain reaction (DR-PCR) method (which quantifies only viable bacteria), and culture methods.
Results: Disinfectants such as 5% CHX and 7% PV-I produced high readings on the Oral Bacteria Counter, even when no viable bacteria were present. Higher glycerol concentrations, which increased the viscosity, resulted in lower bacterial counts. The presence of electrolytes, particularly saline, led to higher readings on the Oral Bacteria Counter, which detected both viable and non-viable bacteria, whereas DR-PCR and culture methods did not detect non-viable bacteria.
Conclusion: The Oral Bacteria Counter may be influenced by disinfectants, viscosity, and electrolytes, leading to potential inaccuracies in bacterial quantification. For accurate bacterial measurements, it is essential to consider these factors and ideally combine the results from the Oral Bacteria Counter with methods such as DR-PCR for more reliable assessment.
... In the latter case, a clearer genomic molecular picture of the associated mechanisms has even been proposed [71]. Heart conditions with molecular links to periodontitis also include atrial fibrillation [72][73][74] and coronary heart disease [75][76][77][78][79], as well as vascular maladies such as essential hypertension [80][81][82][83][84][85] and peripheral arterial disease [86][87][88][89][90]. ...
Periodontal disease, a multifactorial inflammatory condition affecting the supporting structures of the teeth, has been increasingly recognized for its association with various systemic diseases. Understanding the molecular comorbidities of periodontal disease is crucial for elucidating shared pathogenic mechanisms and potential therapeutic targets. In this study, we conducted comprehensive literature and biological database mining by utilizing DisGeNET2R for extracting gene–disease associations, Romin for integrating and modeling molecular interaction networks, and Rentrez R libraries for accessing and retrieving relevant information from NCBI databases. This integrative bioinformatics approach enabled us to systematically identify diseases sharing associated genes, proteins, or molecular pathways with periodontitis. Our analysis revealed significant molecular overlaps between periodontal disease and several systemic conditions, including cardiovascular diseases, diabetes mellitus, rheumatoid arthritis, and inflammatory bowel diseases. Shared molecular mechanisms implicated in the pathogenesis of these diseases and periodontitis encompassed dysregulation of inflammatory mediators, immune response pathways, oxidative stress pathways, and alterations in the extracellular matrix. Furthermore, network analysis unveiled the key hub genes and proteins (such as TNF, IL6, PTGS2, IL10, NOS3, IL1B, VEGFA, BCL2, STAT3, LEP and TP53) that play pivotal roles in the crosstalk between periodontal disease and its comorbidities, offering potential targets for therapeutic intervention. Insights gained from this integrative approach shed light on the intricate interplay between periodontal health and systemic well-being, emphasizing the importance of interdisciplinary collaboration in developing personalized treatment strategies for patients with periodontal disease and associated comorbidities.
... Several conditions related to metabolic disruption have been discussed regarding their connections with periodontal disease, such is the case of Dyslipidemias [57][58][59][60], and Non-alcoholic fatty liver disease (now renamed Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)) [61][62][63][64], in the latter case a clearer genomic molecular picture of the associated mechanisms has even been proposed [65]. Heart conditions with molecular links to Periodontitis also include Atrial fibrillation [66][67][68], Coronary heart disease [69][70][71][72][73], as well as vascular maladies such as Essential hypertension [74][75][76][77][78][79] and Peripheral arterial disease [80][81][82][83][84]. ...
Periodontal disease, a multifactorial inflammatory condition affecting the supporting structures of the teeth, has been increasingly recognized for its association with various systemic diseases. Understanding the molecular comorbidities of periodontal disease is crucial for elucidating shared pathogenic mechanisms and potential therapeutic targets. In this study, we conducted comprehensive literature and biological database mining utilizing tools such as DisGeNET2R, Romin, and Rentrez R libraries to identify diseases sharing associated genes, proteins, or molecular pathways with periodontitis. Our analysis revealed significant molecular overlaps between periodontal disease and several systemic conditions, including cardiovascular diseases, diabetes mellitus, rheumatoid arthritis, and inflammatory bowel diseases. Shared molecular mechanisms implicated in the pathogenesis of these diseases and periodontitis encompassed dysregulation of inflammatory mediators, immune response pathways, oxidative stress pathways, and alterations in the extracellular matrix. Furthermore, network analysis unveiled key hub genes and proteins that play pivotal roles in the crosstalk between periodontal disease and its comorbidities, offering potential targets for therapeutic intervention. Insights gained from this integrative approach shed light on the intricate interplay between periodontal health and systemic well-being, emphasizing the importance of interdisciplinary collaboration in developing personalized treatment strategies for patients with periodontal disease and associated comorbidities.
... Since 1989, the association between periodontitis and cardiovascular diseases (CVD) has been continually investigated, and a meta-analysis indicated that periodontitis is a risk factor for CVD 19 . Atherosclerosis, an in ammatory disorder of the arteries, is a well-known leading cause of CVD. ...
Few epidemiological studies have explored the longitudinal relationship between atherosclerosis and periodontitis. This 3-year cohort study aimed to investigate the longitudinal relationship between atherosclerosis and the progression of periodontitis in community-dwelling individuals in Japan. Progression of periodontitis was defined as the presence of two or more teeth demonstrating a longitudinal loss of proximal attachment ≥ 3 mm during the study period, among the included participants. Oral examinations and subclinical atherosclerosis assessments were performed in Goto City, Japan. The surrogate markers of early-stage atherosclerosis used in this study were increased carotid intima-media thickness (cIMT), low ankle-brachial index (ABI), and cardio-ankle vascular index (CAVI). The study included 222 Japanese adults. While CAVI increased significantly in both groups, the prevalence of CAVI ≥ 8 was significantly increased in only the progression group during the study period. Logistic regression analysis indicated that the progression of periodontitis was significantly associated with cIMT. Additionally, CAVI positively correlated with changes in probing pocket depth, while ABI negatively correlated with changes in clinical attachment loss. These results suggest that subclinical markers of early-stage atherosclerosis are significantly associated with a greater risk of periodontitis progression in community-dwelling Japanese participants.
... Diabetes mellitus, for instance, is known to impair immune response and wound healing, thereby exacerbating inflammatory conditions, including peri-implantitis (5). Similarly, cardiovascular diseases have been associated with increased inflammatory markers, which may contribute to periimplant tissue breakdown (6). Autoimmune disorders, characterized by an overactive immune system, can also influence the onset and progression of peri-implantitis (7). ...
... general population has been confirmed in existing metaanalyses, and the pooled RRs ranged from 1.14 to 2.52 [60][61][62]. Our results showed that the presence of periodontitis increased the risk of ASCVD by 13%~36% in people with MetS components. ...
Objectives
Prevention of atherosclerotic cardiovascular disease (ASCVD) is important in individuals with metabolic syndrome components (MetS), and periodontitis may play an important role in this process. This study aims to evaluate the association between periodontitis and ASCVD in participants with the components of MetS, including obesity, dysglycemia, hypertension, and dyslipidemia.
Materials and methods
This study conducted followed the MOOSE reporting guidelines and the PRISMA 2020 guidelines. EMBASE, MEDLINE, Web of Science, Cochrane Library, PubMed and OpenGrey were searched for observational studies about the linkage of periodontitis to ASCVD in people with MetS components up to April 9, 2023. Cohort, case-control and cross-sectional studies were included after study selection. Quality evaluation was carried out using the original and modified Newcastle-Ottawa Scale as appropriate. Random-effects model was employed for meta-analysis.
Results
Nineteen studies were finally included in the quality analysis, and all of them were assessed as moderate to high quality. Meta-analyses among fifteen studies revealed that the participants with periodontitis were more likely to develop ASCVD in those who have dysglycemia (RR = 1.25, 95% CI = 1.13–1.37; p < 0.05), obesity (RR = 1.13, 95% CI = 1.02–1.24; p < 0.05), dyslipidemia (RR = 1.36, 95% CI = 1.13–1.65; p < 0.05), or hypertension (1.20, 95% CI = 1.05–1.36; p < 0.05).
Conclusions
Periodontitis promotes the development of ASCVD in participants with one MetS component (obesity, dysglycemia, hypertension or dyslipidemia).
Clinical relevance
In people with MetS components, periodontitis may contribute to the ASCVD incidence.
... In the majority of periodontitis cases, the bacterium Porphyromonas gingivalis is the causative agent [3,4], and in chronic cases, it leads to periodontal tissue wasting [5,6] due to stimulated inflammatory response and plaque formation [5]. However, periodontitis has also been reported to be a significant risk factor for a wide spectrum of diseases far beyond the oral cavity, such as cardiovascular diseases (CVD) and stroke [7][8][9][10]. Investigations studying the biological mechanisms by which periodontitis poses a risk for other systemic diseases hold that periodontitis induces an inflammatory burden by evoking bacteremia [11,12], systemic inflammatory responses [13,14], and cross-reaction, which results in autoimmune responses [15]. ...
... Numerous reviews and meta-analyses based on epidemiological studies have consistently indicated a relationship between periodontitis and CVD with an increased risk of periodontitis patients developing CVD [14,[18][19][20][21] or its acute event-myocardial infarction [12,[22][23][24][25]. Periodontitis and its major sequela-edentulism-increased the risk of all-cause mortality and mortality due to CVD, coronary heart disease, or cerebrovascular diseases [26]. However, so far, it has not been possible to establish the nature of the association between the two diseases [27]. ...
Introduction: Periodontitis, an infectious inflammatory condition, is a key contributor to sustained systemic inflammation, intricately linked to atherosclerotic cardiovascular disease (CVD), the leading cause of death in developed nations. Treating periodontitis with subgingival mechanical instrumentation with or without adjunctive antimicrobials reduces the microbial burden and local inflammation, while also potentially bringing systemic benefits for patients with both periodontitis and CVD. This review examines systemic effects of subgingival instrumentation with or without antimicrobial products in individuals with periodontitis and CVD, and explores intricate pathogenetic interactions between periodontitis and CVD. Material and Methods: English-language databases (PubMed MEDLINE and Cochrane Library) were searched for studies assessing the effects of nonsurgical periodontal therapies in periodontitis patients with or without CVD. Results: While the ability of periodontal therapy to reduce mortality- and morbidity-related outcomes in CVD patients with periodontitis remains uncertain, some studies indicate a decrease in inflammatory markers and blood cell counts. Subgingival mechanical instrumentation delivered over multiple short sessions carries lower risks of adverse effects, particularly systemic inflammation, compared to the full-mouth delivery, making it a preferable option for CVD patients. Conclusions: Subgingival mechanical instrumentation, ideally conducted in a quadrant-based therapeutic approach, to decontaminate periodontal pockets has the potential to reduce both local and systemic inflammation with minimal adverse effects in patients suffering from periodontitis and concurrent CVD.
... In the majority of periodontitis cases, the bacterium Porphyromonas gingivalis is the causative agent [3,4], and in chronic cases, it leads to periodontal tissue wasting [5,6] due to stimulated inflammatory response and plaque formation [5]. However, periodontitis has also been reported to be a significant risk factor for a wide spectrum of diseases far beyond the oral cavity, such as cardiovascular diseases (CVD) and stroke [7][8][9][10]. Investigations studying the biological mechanisms by which periodontitis poses a risk for other systemic diseases hold that periodontitis induces an inflammatory burden by evoking bacteremia [11,12], systemic inflammatory responses [13,14], and cross-reaction, which results in autoimmune responses [15]. ...
Introduction
Through plausible biological mechanisms, periodontitis causes systemic inflammatory burden and response, thus resulting in damage far beyond the oral cavity. Studies have demonstrated periodontitis to be a significant risk factor for coronary heart disease (CHD) and stroke. The larger the quantum of periodontal inflamed tissue, the greater the chances of periodontitis eliciting bacteremia and systemic inflammatory responses. Studies have reported that periodontitis and other common oral infections play an important role in the development of atherosclerosis. Therefore, the quantity of inflamed periodontal tissue assumes significance in determining the severity of atherosclerosis. Hence, this study investigates the impact of periodontal inflamed surface area (PISA) on the severity of coronary atherosclerosis.
Materials and methods
In this cross-sectional study, a total of 160 patients who presented at the department of periodontics of The British University in Egypt (BUE) from 1 January 2023 to 30 September 2023 were enrolled. Patients were only enrolled if they had undergone coronary angiography within the last six months, were less than 60 years of age, shared their previous medical history and coronary angiographic report, and gave informed written consent. Data on classic coronary risk factors and periodontal inflammatory status and angiographic findings were recorded and subjected to appropriate statistical analysis.
Results
The results revealed that the periodontal inflamed surface area (p = 0.002) apart from age (p < 0.047) and low-density lipoprotein cholesterol (LDL-C) (p < 0.001) is a significant independent predictor of the severity of coronary atherosclerosis.
Conclusions
The periodontal inflamed surface area is an independent predictor of the severity of coronary atherosclerosis.
... Periodontal pathogens modulate the immune response causing imbalances not only in the site they are colonizing but also at a systemic level. Indeed, periodontal infections have been linked to several pathologies in distant organs, such as gastrointestinal and colorectal cancers, diabetes, insulin resistance, and cardiovascular diseases, and increased risk of development of non-alcoholic fatty liver disease, type 2 diabetes, and atherosclerotic vascular diseases [9,[15][16][17][18][19][20]. ...
The microbiota in the oral cavity has a strict connection to its host. Its unbalance may determine oral diseases and can also have an impact on the systemic health. Probiotic strains may help in the restoration of a balanced condition. For this purpose, we screened the antibacterial and antiadhesive activities of many viable probiotic strains (Lactobacillus acidophilus PBS066, Lactobacillus crispatus LCR030, Lactobacillus gasseri LG050, Lactiplantibacillus plantarum PBS067, Limosilactobacillus reuteri PBS072, Lacticaseibacillus rhamnosus LRH020, Bifidobacterium animalis subsp. lactis BL050, Lacticaseibacillus paracasei LPC 1101, L. paracasei LPC 1082, and L. paracasei LPC 1114) against two main oral pathogens, Streptococcus mutans and Aggregatibacter actinomycetemcomitans, involved in dental caries and periodontal disease development and progression. Our results, obtained through agar overlay assay, plate count method, and scanning electron microscope imaging, indicate that the tested probiotics prevent the growth and adhesion of oral pathogens in a strain-specific manner, improving oral health. L. plantarum PBS067, L. rhamnosus LRH020, L. paracasei LPC 1101, L. paracasei LPC 1082, and L. paracasei LPC 1114 performed in a significant way against both pathogens in all the tests used. They can be considered as an effective adjuvant to guarantee oral and systemic well-being.
... Systematic health concerns are often known to affect the efficacy of such treatments and hence should be considered before the implementation of the treatment plan. Oral infections and other diseases found in the human body usually have similar risk factors and, hence, can be associated with each other (13,14). One notable aspect of this relationship is the shared risk factors and associations between dental diseases and systemic diseases. ...
Oral diseases encompass various conditions affecting teeth, gums, and oral structures and, although preventable, their increasing prevalence and associated issues like pain and aesthetics are concerning. Root canal treatment is a type of treatment that becomes necessary when dental caries reach the dental pulp, causing inflammation and severe pain and impacting oral function. Systemic health conditions are known to influence treatment efficacy, with diabetes being a significant comorbidity affecting oral health. Diabetic individuals must prioritize oral hygiene and regular dental care due to delayed healing and infection complications. Investigating surgical and non-surgical root canal outcomes in diabetic patients is vital, considering the interplay between diabetes and endodontic results. This study, initiated on October 3rd, 2023, conducted a comprehensive literature review using databases like PubMed, Web of Science, and Cochrane. The study discussed that root canal treatment involves two primary types: non-surgical RCT and surgical RCT. The choice depends on the case, with non-surgical being the initial preference. Surgical RCT is considered when non-surgical options fail or in cases of persistent apical periodontitis. In diabetic patients, complexity arises due to an elevated risk of complications, primarily delayed wound healing, necessitating a comprehensive approach. This involves meticulous blood sugar control, judicious antibiotic use, post-operative care, and collaboration with healthcare providers to enhance overall health and well-being
... Periodontitis, in turn, may also influence diabetes mellitus. For example, the risk of diabetics dying from coronary heart disease or nephropathy is significantly higher if they have advanced periodontitis [7]. 2 of 12 In addition to diabetes, many studies have also shown an association between periodontitis and coronary heart disease [2,8,9]. ...
The link between periodontitis and systemic diseases has increasingly become a focus of research in recent years. In this context, it is reasonable—especially in vulnerable patient groups—to minimize bacteremia during periodontal treatment. The aim of the present in vivo feasibility study was to investigate the possibility of laser-based bacteremia prevention. Patients with stage III, grade B generalized periodontitis were therefore treated in a split-mouth design either with prior 445 nm laser irradiation before nonsurgical periodontal therapy or without. During the treatments, clinical (periodontal measures, pain sensation, and body temperature), microbiological (sulcus samples and blood cultures before, 25 min after the start, and 10 min after the end of treatment), and immunological parameters (CRP, IL-6, and TNF-α) were obtained. It was shown that periodontal treatment-related bacteremia was detectable in both patients with the study design used. The species isolated were Schaalia georgiae, Granulicatella adiacens, and Parvimonas micra. The immunological parameters increased only slightly and occasionally. In the laser-assisted treatments, all blood cultures remained negative, demonstrating treatment-related bacteremia prevention. Within the limitations of this feasibility study, it can be concluded that prior laser disinfection can reduce bacteremia risk during periodontal therapy. Follow-up studies with larger patient numbers are needed to further investigate this effect, using the study design presented here.
... Studies have elucidated the bidirectional relationship between diabetes and periodontal disease, necessitating holistic management approaches for affected individuals [32,33]. The cardiovascular arena, too, bears the brunt of periodontal disease, with associations surfacing not only in myocardial infarction but also in conditions like abdominal aortic aneurysm, cardiovascular death, and atherosclerosis [37][38][39][40][41]. An increasing number of preclinical animal models and epidemiological studies undoubtedly indicate a close relationship between rheumatoid arthritis (RA) and periodontal disease [42]. ...
Periodontitis involves the inflammation of the periodontal tissue, leading to tissue loss, while coronavirus disease 2019 (COVID-19) is a highly transmissible respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is amplified by poor systemic health. Key facilitators of SARS-CoV-2’s entry into host cells are angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2). This review reveals that periodontal pockets can serve as a hotspot for virus accumulation, rendering surrounding epithelia more susceptible to infection. Given that ACE2 is expressed in oral mucosa, it is reasonable to suggest that poor periodontal health could increase the risk of COVID-19 infection. However, recent studies have not provided sufficient evidence to imply a significant effect of COVID-19 on periodontal health, necessitating further and more long-term investigations. Nevertheless, there are hypotheses linking the mechanisms of the two diseases, such as the involvement of interleukin-17 (IL-17). Elevated IL-17 levels are observed in both COVID-19 and periodontitis, leading to increased osteoclast activity and bone resorption. Lastly, bidirectional relationships between periodontitis and systemic diseases like diabetes are acknowledged. Given that COVID-19 symptoms may worsen with these conditions, maintaining good oral health and managing systemic diseases are suggested as potential ways to protect against COVID-19.
... [1][2][3] Ağız hastalıkları ile diyabet, hipertansiyon, metabolik sendrom, obezite ve kardiyovasküler hastalıklar gibi sistemik hastalıklar arasında yakın bir ilişki vardır. [4][5][6][7] Ağız hastalıkları sistemik hastalıkların gelişmesine neden olabileceği gibi, 8,9 ağız hastalıklarının gelişmesinden de sistemik hastalıklar sorumlu tutulabilmektedir. 10,11 Toplumların genelinde tıp hekimlerine başvuran bireylerin sayısı, diş hekimlerine başvuran bireylerin sayısından fazladır. ...
Genel sağlığın ayrılmaz bir parçası olan ağız-diş sağlığının korunmasında diş hekimlerine olduğu kadar tıp hekimlerine de büyük görev düşmektedir. Bu çalışmanın amacı tıp fakültesi 1. sınıf ve 6. sınıf öğrencilerinin ağız-diş sağlığına ilişkin bilgi, tutum ve davranışlarını değerlendirmektir. Gereç ve Yöntemler: Çalışmaya Çanakkale Onsekiz Mart Üniversitesi Tıp Fakültesi’nde öğrenim gören 112 1. sınıf ve 92 6. sınıf öğrencisi dahil edilmiştir. Tıp fakültesi öğrencilerine ağız-diş sağlıklarına ilişkin bilgi düzeyleri ve oral hijyen alışkanlıklarını değerlendirmek amacıyla 23 sorudan oluşan anket formu online olarak gönderilmiştir. İstatistiksel analizde Frekans ve Ki-kare analizleri kullanılmış, p<0,05 istatistiksel olarak anlamlı kabul edilmiştir. Bulgular: Tıp fakültesi öğrencilerinin öğrenim yılı ile diş hekimine gitme sıklığı (p=0,011), ağız-diş sağlığı ile ilgili eğitim alma durumu (p=0,023), diş çürüklerinin ve fırçalama sırasında dişeti kanamasının olası nedenleri (p<0,001), diş plağının etkileri (p=0,014), ağız hastalıklarıyla ilişkili olabilecek sistemik hastalıklar ve diş hekimi konsültasyonu gerektiren hasta gruplarına verdikleri yanıtlar (p<0,001) arasında anlamlı ilişki bulunmuştur. Tıp fakültesi öğrencileri ağız-diş sağlığıyla ilgili en sık diş hassasiyeti, diş çürüğü ve dişeti kanaması problemleri yaşamaktadır. Sonuç: Tıp fakültesi eğitimi, öğrencilerin ağız-diş sağlığıyla ilgili bilgi düzeylerinde olumlu anlamda katkı yapsa da bunun yeterli düzeyde olmadığı görülmektedir. Tıp fakültelerinde ağız-diş sağlığı eğitimine gereken önem verilmelidir.
... Periodontal disease (PD) is defined as a bacterially induced, chronic inflammation of the supporting tissues of the teeth [4]. It is among the most common diseases worldwide, with up to 11% prevalence in its severe form [5]. PD and cardiovascular diseases are both related to several common risk factors, and an increasing number of epidemiological studies seem to support the hypothesis of a possible association between periodontal disease and atherosclerosis [6][7][8]. The role of inflammatory processes is well documented in the pathogenesis of both atherosclerosis and periodontal disease, most likely proving to be the link between the two diseases. ...
Introduction: There is a well-documented association between coronary artery disease (CHD) and periodontal disease (PD) mediated by common inflammatory pathways. This association, however, has not been investigated extensively in the special context of in-stent restenosis. This study aimed to investigate the periodontal status of patients undergoing percutaneous coronary intervention (PCI) for restenotic lesions. Methods and Results: We enrolled 90 patients undergoing percutaneous coronary intervention and 90 age- and gender-matched healthy controls in the present study. All subjects received a full-mouth examination by a periodontist. Plaque index, periodontal status, and tooth loss were determined. The periodontal state was significantly worse (p < 0.0001) in the PCI group, and each periodontal stage increased the odds of belonging to the PCI group. This effect of PD was independent of diabetes mellitus, another strong risk factor for CAD. The PCI group was further divided into two subgroups: PCI for restenotic lesions (n = 39) and PCI for de novo lesions (n = 51). Baseline clinical and procedural characteristics were comparable between the two PCI subgroups. A significant (p < 0.001) association was found between the PCI subgroup and the severity of periodontal disease, with the incidence of severe PD reaching 64.1%. Conclusions: Patients undergoing PCI for in-stent restenosis exhibit more severe forms of periodontal disease not only as compared to healthy controls but also as compared to patients stented for de novo lesions. The potential causality between PD and restenosis must be studied in larger prospective studies.
... Periodontal disease has been associated with vascular diseases in several studies [22][23][24][25][26][27]. After considering significant confounders, including gender, smoking, habit, and socioeconomic status, the majority of these clinical and epidemiologic research indicated a 20%-30% association between periodontal disease and cardiovascular outcomes [27]. ...
Background
In this cohort study, the association between periodontal disease (PD) and recurrent vascular events was determined among the subjects with ischemic stroke/transient ischemic attack (TIA), and the extent and severity of periodontal disease were estimated among these subjects.
Methods
This prospective, longitudinal, hospital-based cohort study included 153 individuals who had a stroke or TIA. They were divided into two groups: high periodontal disease (HPD) (N=55, mean age: 59.40±12.21) and low periodontal disease (LPD) (N=98, mean age: 53.03±12.82). Clinical attachment loss (CAL) and probing pocket depth (PPD) were used to measure the severity of the periodontal disease. TOAST criteria were used to determine the ischemic stroke etiology, and the NIH Stroke Scale (NIHSS) was used to determine the ischemic stroke severity. A follow-up survey found that vascular incidents recurred.
Results
HPD individuals exhibited a higher median NIHSS (eight) than LPD patients (seven) in a subset of stroke population (N=23). Thirty-eight cardiovascular events occurred in the first three months after enrollment, including 23 strokes and seven TIAs, and five myocardial infarctions (MIs). There were three deaths from vascular causes. There was a non-significant association between PD and composite vascular events (HR 1.06, 95% CI, 1.03 to 1.09, p=0.71). Compound vascular events were not related to severe HPD (HR 1.31, 95 % CI 0.54 to 3.16, p=0.07).
Conclusion
In stroke/TIA patients, there is no link between high periodontal disease and recurrent vascular episodes. The proportions of stroke subtypes were not substantially different between HPD and LPD.
... Periodontitis has been associated with a wide variety of chronic conditions including both type 1 and type 2 diabetes, rheumatoid arthritis, inflammatory bowel disease, 14 cardiovascular diseases, kidney disease, 28 and depression as well as adverse pregnancy outcomes. 3,[29][30][31] This study highlights the known association between periodontitis and several individual chronic conditions (Table 3). Diabetes, heart failure and cardiovascular disease were all independently associated with periodontitis after adjusting for confounders. ...
Introduction:
Often misperceived as solely a dental disease, periodontitis is a chronic condition characterized by inflammation of the support structures of the tooth and associated with chronic systemic inflammation and endothelial dysfunction. Despite affecting almost 40% of US adults 30 years of age or older, periodontitis is rarely considered when quantifying the multimorbidity (the presence of 2 or more chronic conditions in an individual) burden for our patients. Multimorbidity represents a major challenge for primary care and is associated with increasing health care expenditure and increased hospitalizations. We hypothesized that periodontitis was associated with multimorbidity.
Methods:
To interrogate our hypothesis, we performed a secondary data analysis of a population-based cross-sectional survey, the NHANES 2011 to 2014 dataset. The study population included US adults aged 30 years or older who underwent a periodontal examination. Prevalence of periodontitis in individuals with and without multimorbidity was calculated using likelihood estimates and adjusting for confounding variables with logistic regression models.
Results:
Individuals with multimorbidity were more likely than the general population and individuals without multimorbidity to have periodontitis. However, in adjusted analyses, there was no independent association between periodontitis and multimorbidity. Given the absence of an association, we included periodontitis as a qualifying condition for the diagnosis of multimorbidity. As a result, the prevalence of multimorbidity in US adults 30 years and older increased from 54.1% to 65.8%.
Discussion:
Periodontitis is a highly prevalent, preventable chronic inflammatory condition. It shares many common risk factors with multimorbidity but was not independently associated with multimorbidity in our study. Further research is required to understand these observations and whether treating periodontitis in patients with multimorbidity may improve health care outcomes.
... There are systematic reviews and meta-analysis, on the association [4,5] between periodontitis and cardio-vascular disease (CVD) , [ 6 ] [ 7 ] cerebrovascular disease , metabolic syndrome , arterial [8] [9] [10] hypertension , chronic renal failure , obesity and autoimmune [11] disease such as rheumatoid arthritis and systemic lupus erythematosus. Increased adverse pregnancy outcomes (APO), mainly the risk of preterm birth and low birthweight are linked to periodontitis [12] [ 13] . ...
Background & Objective: An association between oral conditions such as periodontal diseases and systemic conditions is noted. As such, periodontal disease is associated with an increased risk of systemic illnesses such as cardiovascular disease, diabetes, adverse pregnancy outcome and stroke. Keeping this in view, the present survey was designed to evaluate the acquaintance, orientation and behaviour of general medical practitioners; concerning the effects of periodontal disease on systemic health. Materials and Methods: A typed questionnaire carrying sets of questions was distributed among general dental practitioners and non-dental practitioners of Gujarat government and private set ups. Questionnaire was developed to assess the acquaintance, orientation and behaviour of doctors towards periodontal disease. Results: Dental practitioners have knowledge regarding the inter-relationship of periodontal disease and systemic conditions. And most of the non-dental practitioners have knowledge regarding the inter-relationship of periodontal disease and diabetes mellitus. However, majority of them do not know about the potential effect of periodontal disease on other organ systems. Conclusion: General medical practitioners have inadequate knowledge regarding inter-relationship. Hence, oral health related training should be an integral part of the medical curriculum
... De nombreuses études épidémiologiques transversales, cas-témoins et de cohorte suggèrent que la parodontite est associée à la MVAS, indépendamment des facteurs de confusion tels que le tabagisme et l'obésité (22,23). Mais il est important de souligner qu'à l'heure actuelle, aucun rapport n'a été publié indiquant que la thérapie parodontale peut réduire l'incidence des critères d'évaluation « durs » tels que les événements MVAS ou la mortalité. ...
Affections d'origine dentaire et non cardiaques : maladie vasculaire athérosclérotique, altérations immunométaboliques, maladie rénale, maladie d'Alzheimer, polyarthrite rhumatoïde, ostéoporose, maladies inflammatoires chroniques de l'intestin et cancer colrectal, maladies respiratoires, grossesse, aspect psychosocial, prothèses orthopédiques, prothèses vasculaires, tendinopathies
BACKGROUND: This cross-sectional study aimed to examine the relationship between oral hygiene and a history of myocardial infarction or stroke in elderly individuals. METHOD: The study was conducted in Matsudo City, Chiba Prefecture, and included 664 individuals aged 88 who underwent dental check-ups between 2019 and 2021. Data on oral health, demographics, and medical history, including infarction and stroke, were collected through dental check-ups and questionnaires administered by dentists. RESULTS: Results showed that 24.5% of participants had poor oral hygiene, while 75.5% had good oral hygiene. A higher incidence of poor oral hygiene was found in those with a history of myocardial infarction or stroke, with a 1.6-fold increase compared to those without such a history. Multivariate logistic regression analysis revealed that females were significantly less likely to have poor oral hygiene (OR: 0.50, 95% CI: 0.32–0.77), whereas individuals with a history of infarction were more likely to have poor oral hygiene (OR: 1.63, 95% CI: 1.03–2.57). CONCLUSION: The study highlights the importance of oral hygiene management in elderly individuals, particularly those with a history of cardiovascular events, as poor oral hygiene is linked to systemic conditions such as aspiration pneumonia. These findings support the promotion of dental check-up programs for the elderly, as part of broader efforts to enhance quality of life and prevent systemic diseases in aging populations.
Periodontitis is a severe gum infection that begins as gingivitis and can lead to gum recession, bone loss, and tooth loss if left untreated. It is primarily caused by bacterial infection, which triggers inflammation and the formation of periodontal pockets. Notably, periodontitis is associated with systemic health issues and has been linked to heart disease, diabetes, respiratory diseases, adverse pregnancy outcomes, and cancers. Accordingly, the presence of chronic inflammation and immune system dysregulation in individuals with periodontitis significantly contributes to the initiation and progression of various cancers, particularly oral cancers. These processes promote genetic mutations, impair DNA repair mechanisms, and create a tumor-supportive environment. Moreover, the bacteria associated with periodontitis produce harmful byproducts and toxins that directly damage the DNA within oral cells, exacerbating cancer development. In addition, chronic inflammation not only stimulates cell proliferation but also inhibits apoptosis, causes DNA damage, and triggers the release of pro-inflammatory cytokines. Collectively, these factors play a crucial role in the progression of cancer in individuals affected by periodontitis. Further, specific viral and bacterial agents, such as hepatitis B and C viruses, human papillomavirus (HPV), Helicobacter pylori (H. pylori), and Porphyromonas gingivalis, contribute to cancer development through distinct mechanisms. Bacterial infections have systemic implications for cancer development, while viral infections provoke immune and inflammatory responses that can lead to genetic mutations. This review will elucidate the link between periodontitis and cancers, particularly oral cancers, exploring their underlying mechanisms to provide insights for future research and treatment advancements.
The gut ecosystem, termed microbiota, is composed of bacteria, archaea, viruses, protozoa, and fungi and is estimated to outnumber human cells. Microbiota can affect the host by multiple mechanisms, including the synthesis of metabolites and toxins, modulating inflammation and interaction with other organisms. Advances in understanding commensal organisms' effect on human conditions have also elucidated the importance of this community for cardiovascular disease (CVD). This effect is driven by both direct CV effects and conditions known to increase CV risk, such as obesity, diabetes mellitus (DM), hypertension, and renal and liver diseases. Cardioactive metabolites, such as trimethylamine N ‐oxide (TMAO), short‐chain fatty acids (SCFA), lipopolysaccharides, bile acids, and uremic toxins, can affect atherosclerosis, platelet activation, and inflammation, resulting in increased CV incidence. Interestingly, this interaction is bidirectional with microbiota affected by multiple host conditions including diet, bile acid secretion, and multiple diseases affecting the gut barrier. This interdependence makes manipulating microbiota an attractive option to reduce CV risk. Indeed, evolving data suggest that the benefits observed from low red meat and Mediterranean diet consumption can be explained, at least partially, by the changes that these diets may have on the gut microbiota. In this article, we depict the current epidemiological and mechanistic understanding of the role of microbiota and CVD. Finally, we discuss the potential therapeutic approaches aimed at manipulating gut microbiota to improve CV outcomes. © 2024 American Physiological Society. Compr Physiol 14:5449‐5490, 2024.
Objective This study aimed to describe the development and implementation of a co-designed value-based healthcare (VBHC) framework within the public dental sector in Victoria. Methods A mixed-method study was employed. Explorative qualitative design was used to examine patient, workforce and stakeholder perspectives of implementing VBHC. Participatory action research was used to bring together qualitative narrative-based research and service design methods. An experience-based co-design approach was used to enable staff and patients to co-design services. Quantitative data was sourced from Titanium (online patient management system). Results Building a case for VBHC implementation required intensive work. It included co-designing, collaborating, planning and designing services based on patient needs. Evidence reviews, value-stream mapping and development of patient reported outcomes (PROMs) and patient reported experience measures (PREMs) were fundamental to VBHC implementation. Following VBHC implementation, a 44% lower failure to attend rate and 60% increase in preventive interventions was reported. A higher proportion of clinicians worked across their top scope of practice within a multi-disciplinary team. Approximately 80% of services previously provided by dentists were shifted to oral health therapists and dental assistants, thereby releasing the capacity of dentists to undertake complex treatments. Patients completed baseline International Consortium for Health Outcomes Measurement PROMs (n = 44,408), which have been used for social/clinical triaging, determining urgency of care based on risk, segmentation and tracking health outcomes. Following their care, patients completed a PREMs questionnaire (n = 15,402). Patients agreed or strongly agreed that: the care they received met their needs (87%); they received clear answers to their questions (93%); they left their visit knowing what is next (91%); they felt taken care of during their visit (94%); and they felt involved in their treatment and care (94%). Conclusion The potential for health system transformation through implementation of VBHC is significant, however, its implementation needs to extend beyond organisational approaches and focus on sustaining the principles of VBHC across healthcare systems, policy and practice.
The type IX secretion system (T9SS) is a large multi-protein transenvelope complex distributed into the Bacteroidetes phylum and responsible for the secretion of proteins involved in pathogenesis, carbohydrate utilization or gliding motility. In Porphyromonas gingivalis, the two-component system PorY sensor and response regulator PorX participate to T9SS gene regulation. Here, we present the crystal structure of PorXFj, the Flavobacterium johnsoniae PorX homolog. As for PorX, the PorXFj structure is comprised of a CheY-like N-terminal domain and an alkaline phosphatase-like C-terminal domain separated by a three-helix bundle central domain. While not activated and monomeric in solution, PorXFj crystallized as a dimer identical to active PorX. The CheY-like domain of PorXFj is in an active-like conformation, and PorXFj possesses phosphodiesterase activity, in agreement with the observation that the active site of its phosphatase-like domain is highly conserved with PorX.
The extracellular matrix (ECM) is a complex non-cellular three-dimensional macromolecular network present within all tissues and organs, forming the foundation on which cells sit, and composed of proteins (such as collagen), glycosaminoglycans, proteoglycans, minerals, and water. The ECM provides a fundamental framework for the cellular constituents of tissue and biochemical support to surrounding cells. The ECM is a highly dynamic structure that is constantly being remodeled. Matrix metalloproteinases (MMPs) are among the most important proteolytic enzymes of the ECM and are capable of degrading all ECM molecules. MMPs play a relevant role in physiological as well as pathological processes; MMPs participate in embryogenesis, morphogenesis, wound healing, and tissue remodeling, and therefore, their impaired activity may result in several problems. MMP activity is also associated with chronic inflammation, tissue breakdown, fibrosis, and cancer invasion and metastasis. The periodontium is a unique anatomical site, composed of a variety of connective tissues, created by the ECM. During periodontitis, a chronic inflammation affecting the periodontium, increased presence and activity of MMPs is observed, resulting in irreversible losses of periodontal tissues. MMP expression and activity may be controlled in various ways, one of which is the inhibition of their activity by an endogenous group of tissue inhibitors of metalloproteinases (TIMPs), as well as reversion-inducing cysteine-rich protein with Kazal motifs (RECK).
The microbiota in the oral cavity has a strict connection to its host. Its imbalance may determine oral diseases and can also have an impact on the systemic health. Probiotic strains may help in the restoration of a balanced condition. For this purpose, we screened the antibacterial and antiadhesive activities of many viable probiotic strains (Lactobacillus acidophilus PBS066, Lactobacillus crispatus LCR030, Lactobacillus gasseri LG050, Lactiplantibacillus plantarum PBS067, Limosilactobacillus reuteri PBS072, Lacticaseibacillus rhamnosus LRH020, Bifidobacterium animalis subsp. lactis BL050, Lacticaseibacillus paracasei LPC 1101, L. paracasei LPC 1082, and L. paracasei LPC 1114) against two main oral pathogens, Streptococcus mutans and Aggregatibacter actinomycetemcomitans, involved in dental caries and periodontal disease development and progression. Considering both the agar overlay preventive and treatment models, seven probiotics determined greater inhibition zones against the tested pathogens. This behavior was further analyzed by the plate count method and scanning electron microscope imaging. L. plantarum PBS067, L. rhamnosus LRH020, L. paracasei LPC 1101, L. paracasei LPC 1082, and L. paracasei LPC 1114 prevent the growth and adhesion of oral pathogens in a strain-specific manner (p < 0.0001). These probiotics might be considered as an alternative effective adjuvant to improve oral and systemic well-being for future personalized treatments.
Les études épidémiologiques identifient la parodontite, maladie inflammatoire chronique des tissus de soutien des dents, comme un facteur contribuant au risque cardiovasculaire. Bien que la nature de l’association entre parodontite et maladies cardio-vasculaires (MCV) reste à définir (causalité ou corrélation), l’inflammation systémique de bas grade et les bactériémies chroniques qui sont associées aux parodontites apparaissent impliquées dans le développement de l’athérosclérose et des maladies cardio-vasculaires associées. Le traitement parodontal semble contribuer à l’amélioration des paramètres de la santé cardiovasculaire. Dès lors, une approche de prévention bidirectionnelle, impliquant à la fois la gestion de la parodontite et des facteurs de risque cardiovasculaire, pourrait permettre une réduction de la morbidité et de la mortalité liées aux MCV.
Several studies have examined a potential relationship between periodontal disease and cardiovascular disease. This article aims to update the evidence for a potential association by summarizing the evidence for causality between periodontitis and comorbidities linked to cardiovascular disease, including hypertension, atrial fibrillation, coronary artery disease, diabetes mellitus and hyperlipidemia. We additionally discuss the evidence for periodontal therapy as a means to improved management of these comorbidities, with the larger goal of examining the value of periodontal therapy on reduction of cardiovascular disease risk.
Background
In recent years, clinical studies have shown an association between leptin and periodontal disease. The present study aimed to estimate and compare the serum leptin levels in chronic periodontitis patients with cardiovascular diseases.
Materials and Methods
A total of 30 subjects were included in the study and are divided into three groups, i.e. Group 1: ten healthy subjects, Group 2: ten subjects with chronic periodontitis, and Group 3: ten subjects with periodontitis and cardiovascular disease. Two millimeters of the venous blood sample was collected from the antecubital fossa of all the sixty subjects under aseptic conditions. Serum was obtained from the blood by centrifuging at 2500 rpm for 10 min. Now, this collected serum is used to estimate leptin using a leptin enzyme-linked immunosorbent assay (ELISA) kit (Clementia biotech). Leptin levels were assessed in an ELISA reader. Statistical analysis was conducted using SPSS software version 24.
Results
A significant correlation was observed with serum leptin levels and clinical parameters in the chronic periodontitis + cardiovascular disease group, i.e. plaque index ( r = −0.96, P = 0.0003*), gingival index ( r = −0.89; P = 0.0005*), probing depth ( r = −0.82; P = 0.003*), and clinical attachment level ( r = −0.84; P = 0.001*) * is Statistically Significant.
Conclusion
The study found a statistically significant increase in serum leptin levels in the Group III compared to Groups II and I which suggest an increase in inflammatory state increases the serum levels of leptin.
Objective
The study aims to investigate whether patients with ST‐elevation myocardial infarction (STEMI)‐related periodontitis will experience any changes in asprosin levels.
Background
Periodontitis is a common, chronic infection of the periodontium that is epidemiologically associated with cardiovascular disease. Although asprosin, a hormone released from adipose tissue, is a protective role in cardiovascular diseases, its effectiveness in periodontitis is unknown.
Methods
The study was conducted on a total of 120 patients, divided into four groups; the group of healthy control ( n = 35), the group of periodontitis ( n = 35), the group of periodontitis+STEMI ( n = 25), and the group of STEMI ( n = 25). In each patient, age, serum asprosin, CRP, troponin‐I, and clinical periodontal parameters [plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL)] were evaluated. The results were analyzed statistically.
Results
Serum asprosin, CRP, and troponin‐I levels were statistically higher in the STEMI+periodontitis group compared to the other groups. In addition, as a result of the study, it was observed that there was a correlation between serum asprosin levels, clinical periodontal parameters, and CRP levels.
Conclusions
The results of this study show that STEMI and periodontitis are associated with high asprosin levels. Since the risk of periodontitis is high in STEMI patients, periodontitis should also be considered when evaluating asprosin levels in STEMI patients.
Background: Atherosclerosis is the primary cause of cardiovascular death, wherein plaque accumulates in the carotid artery, resulting in the formation of carotid artery calcification (CAC). Chronic infections emulate atherosclerosis development. Periodontitis is a chronic disease commenced by biofilm aggregation on the surface of teeth, which then progresses via deregulated local and inflammatory immune responses. Aim: The aim of this study was to determine the prevalence of calcification in periodontitis patients and to determine if there is a relationship between carotid calcification and periodontitis with risk factors such as age, gender, hypertension, diabetes, smoking. Methods: The data and panoramic radiographs (PR) of 3000 patients from January 2017 to February 2022 were examined. On the basis of the inclusion and exclusion criteria, 500 patients were selected for determining carotid calcification. Non-periodontitis patients, patients <40 years of age, patients without any medical data or incomplete medical records and cases where the OPG was not clear were not included in this study. The data were analyzed using R and GraphPad Prism software version 4.1.2 and Microsoft Excel Worksheet Office 2019. Chi-square tests were used to check the dependency among the categorical variables. Mann–Whitney U-tests were used to compare the distribution of the variables across the groups, and p-values < 0.05 were interpreted as statistically significant. Result: Twenty-five (5%) patients showed carotid calcification. Carotid calcification was seen more in females than in males, which was statistically significant. Gender, percentage of alveolar bone loss and periodontal risk were found to be statistically significantly related to carotid artery calcification. Factors such as age, diabetes and hypertension were found to be statistically nonsignificant. Conclusions: More periodontal destruction was present in the CAC patients. Within the limitations of this study, it can be concluded that CAC is associated with periodontitis. Early recognition of carotid calcification is important, and patients in whom carotid artery calcification is observed via their PR should be referred to medical practitioners for further investigation and treatment care.
Background
In patients with periodontal disease, various symptoms are observed along with inflammation. The impact of local and systemic inflammation on periodontal tissue is well‐known; however, the impact of periodontal disease on the individual's quality of life is unclear. This study aimed to assess oral health‐related and general health‐related quality of life in patients undergoing maintenance treatment following treatment for periodontitis (RP‐CPH), patients with gingivitis (G) and patients with Stage I periodontitis (SI‐P) and to compare this with individuals with clinical periodontal health (IP‐CPH).
Method
This study was comprised of cross‐sectional periodontal assessment along with questionnaires. Oral health‐related quality of life and general health‐related quality of life were assessed using, respectively, the Oral Health Impact Profile‐14 (OHIP‐14) and Short‐Form‐36 (SF‐36) questionnaires. Study participants were classified according to the classification of periodontal and peri‐implant diseases and conditions established by the 2017 World Workshop.
Results
The OHIP‐14 total scores for the 166 study participants (age range: 22–57) of the G (11.61 ± 3.21) and SI‐P (13.03 ± 3.47) groups were significantly higher than the OHIP‐14 total scores of the IP‐CPH (1.09 ± 1.58) and RP‐CPH (2.95 ± 2.58) groups. SF‐36 scores were found to be significantly lower in the SI‐P group in all subgroups compared to the G and IP‐CPH groups.
Conclusions
A correlation was found between early‐stage periodontal disease and low levels of OHRQoL and GHRQoL. The health of periodontal tissues may have a positive effect on the quality of life.
Objectives:
A meta-analytic review was performed to critically synthesize the evidence of oil pulling on improving the parameters of gingival health, plaque control and bacteria counts against chlorhexidine and other mouthwash or oral hygiene practices.
Methods:
Databases including Medline, Embase and bibliographies were searched from inception to 1 April 2023. Randomized controlled trials (RCTs) with 7 days or longer duration of oil pulling with edible oils in comparison to chlorhexidine or other mouthwashes or oral hygiene practice concerning the parameters of plaque index scores (PI), gingival index scores (GI), modified gingival index scores (MGI) and bacteria counts were included. Cochrane's Risk of Bias (ROB) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework were employed to determine the quality of evidence. Two authors independently conducted study selection and data extraction. Meta-analyses of the effect of oil pulling on the parameters were conducted using an inverse-variance random-effects model.
Results:
Twenty-five trials involving 1184 participants were included. Twenty-one trials comparing oil pulling (n = 535) to chlorhexidine (n = 286) and non-chlorhexidine intervention (n = 205) were pooled for meta-analysis. More than half of the trials (n = 17) involved participants with no reported oral health issues. The duration of intervention ranged from 7 to 45 days, with half of the trials using sesame oil. When compared to non-chlorhexidine mouthwash interventions, oil pulling clinically and significantly improved MGI scores (Standardized mean difference, SMD = -1.14; 95% confidence interval [CI]: -1.31, -0.97). Chlorhexidine was more effective in reducing the PI scores compared to oil pulling, with an SMD of 0.33 (95% CI: 0.17, 0.49). The overall quality of the body of evidence was very low.
Conclusions:
There was a probable benefit of oil pulling in improving gingival health. Chlorhexidine remained superior in reducing the amount of plaque, compared to oil pulling. However, there was very low certainty in the evidence albeit the clinically beneficial effect of oil pulling intervention.
Aim:
To investigate the association between previous periodontal treatment and recurrent events after first-time myocardial infarction (MI).
Materials and methods:
From the Danish nationwide registries, patients with first-time MI between 2000 and 2015 were divided into three groups according to oral health care within 1 year prior to first-time MI. A multiple logistic regression model provided adjusted odds ratios (ORs) with 95% confidence intervals (CIs) to assess the 3-year risk of major adverse cardiovascular events (MACE).
Results:
A total of 103,949 patients were included. Patients with treated periodontitis (PD) prior to first-time MI had an adjusted 3-year risk of MACE similar to patients presumed periodontally healthy (OR 0.97 [95% CI 0.92-1.03]). Patients with no prior dental visits were significantly older, had more comorbidities and showed significantly increased adjusted 3-year risks of MACE (OR 1.47 [95% CI 1.42-1.52]), cardiovascular death (OR 1.71 [95% CI 1.64-1.78]) and heart failure (OR 1.13 [95% CI 1.07-1.20]) compared with patients presumed periodontally healthy.
Conclusions:
Patients with treated PD 1 year prior to first-time MI had a similar risk of recurrent cardiovascular events as patients presumed periodontally healthy. No dental visit prior to first-time MI was an independent risk factor for recurrent events.
Amaç: Orak hücre hastalığı (OHH), hastaların yaşam kalitelerini hayatlarının erken dönemlerinden itibaren etkileyen multisistemik bir hastalıktır. Çalışmamızın amacı; OHH hastalarımızın primer bakım veren ebeveyninin (anne) OHH’a bağlı ağız, diş ve çene bölgesinde gelişen komplikasyonlar ile ilgili bilgi düzeyini değerlendirmektir. Yöntem: Çalışmaya çocuk ve genç erişkinlerden oluşan 50 OHH tanılı hasta ile primer bakım veren ebeveynleri dahil edildi. Ebeveynlere anket uygulanarak OHH’da ağız, diş sağlığı konusundaki bilgi düzeyleri ve çocuklarının ağız, diş, çene bölgesinde deneyimlediği klinik belirtiler sorgulandı. Bulgular: Ebeveynin bilgi düzeyi değerlendirildiğinde; 28’i (%56) OHH’nın ağız, diş, çene sağlığına etkisi olduğunu belirtti. Günde bir kez diş fırçalayan hastalarda hiç fırçalamayanlara göre damar tıkayıcı kriz (DTK) sıklığının daha nadir (%5’e karşı %58), günde ≥2 diş fırçalayanların ise hiç fırçalamayanlara göre transfüzyon sıklığının daha az (%6’ya karşı %32) olduğu saptandı. Sonuç: Çalışmamız; ebeveynlerin %44’ünün OHH’nın ağız, diş ve çene bölgesindeki komplikasyonları bilmediğini gösterdi. Ayrıca diş fırçalamanın DTK ve kan transfüzyon sıklığına etkisi olabileceğini saptadık. Ağız, diş hijyeninin önemi ile OHH’nın bu bölgedeki komplikasyonları konusunda hastaların ve ebeveynlerin farkındalığı artırılmalıdır.
Background:
Inflammatory processes in the oral cavity have been linked to the pathogenesis of cardiovascular diseases while periodontitis and dental caries are some of the most common inflammatory diseases worldwide. The aim of this study was to determine the association between dental caries and periodontitis with cardiovascular disease among a cohort of Nigerian patients.
Methods:
This was a descriptive study conducted at the Cardiology clinic of the Lagos State University Teaching Hospital (LASUTH), Nigeria. Information was obtained directly from patients and their clinical notes using structured interviewer-administered, pretested, close-ended questionnaires. Demographic data, cardiovascular disease risk factors and specific diagnosis, anthropometric measures, periodontal and caries status were determined. Univariate and multivariate logistic regression analysis using the sociodemographic and clinical variables were used to estimate Odds ratios (ORs), adjusted odds ratios (aORs) and 95% confidence intervals (95% CI) of individual-level factors. Statistical significance was set at p <0.05, and all tests were two-tailed.
Results:
Respondents who had diabetes, those with low HDL, those with a primary level of education, those who smoke cigarettes (OR: 9.69; CI: 3.27,14.83) and those with poor systolic and diastolic blood pressure control had higher odds of caries experience. Respondents who were aged above 35 years (OR: 1.43; CI: 1.26,3.12), overweight or obese (OR: 1.31; CI: 1.22,2.98), diabetic (OR: 7.40; CI: 1.24,17.03]), those with a primary level of education (OR: 3.24; CI: 2.42, 10.42), those who smoke cigarettes (OR: 10.54; CI: 2.44,18.19) and those who drink alcohol (OR: 10.54; CI: 2.44,18.19] also had significantly higher odds of clinical attachment loss.
Conclusion:
A common risk-factor-approach, which is in line with the WHO Global policy for improving oral health in the 21st century, is advocated, because health risks are linked, preventable, and related to lifestyle. Thus, oral and general health promotion should be integrated.
Noncommunicable diseases (NCDs) have played a critical role in shaping human evolution and societies. Despite the exceptional impact of NCDs economically and socially, little is known about the prevalence or impact of these diseases in the past as most do not leave distinguishing features on the human skeleton and are not directly associated with unique pathogens. The inability to identify NCDs in antiquity precludes researchers from investigating how changes in diet, lifestyle, and environments modulate NCD risks in specific populations and from linking evolutionary processes to modern health patterns and disparities. In this review, we highlight how recent advances in ancient DNA (aDNA) sequencing and analytical methodologies may now make it possible to reconstruct NCD-related oral microbiome traits in past populations, thereby providing the first proxies for ancient NCD risk. First, we review the direct and indirect associations between modern oral microbiomes and NCDs, specifically cardiovascular disease, diabetes mellitus, rheumatoid arthritis, and Alzheimer's disease. We then discuss how oral microbiome features associated with NCDs in modern populations may be used to identify previously unstudied sources of morbidity and mortality differences in ancient groups. Finally, we conclude with an outline of the challenges and limitations of employing this approach, as well as how they might be circumvented. While significant experimental work is needed to verify that ancient oral microbiome markers are indeed associated with quantifiable health and survivorship outcomes, this new approach is a promising path forward for evolutionary health research.
Background:
Various factors including diabetes and oxidative stress are associated with periodontal inflammation. End-stage renal disease causes various systemic abnormalities in patients, including cardiovascular disaese, metabolic abnormalities, and infection. Even after kidney transplantation (KT), these factors are known to be associated with inflammation. Our study, therefore, aimed to study risk factors associated with periodontitis in KT patients.
Methods:
Patients who visited Dongsan Hospital, Daegu, Korea since 2018 and have undergone KT were selected. As of November 2021, 923 participants, with full data including hematologic factors were studied. Periodontitis was diagnosed based on residual bone level in panoramic views. Patients were studied by the presence of periodontitis.
Results:
From 923 KT patients, 30 were diagnosed with periodontal disease. Fasting glucose levels were higher in patients with periodontal disease, and total bilirubin levels were lower. When divided by fasting glucose levels, high glucose level showed increase of periodontal disease with odds ratio of 1.031 (95% confidence interval 1.004-1.060). After adjusting for confounders, the results were significant with odds ratio of 1.032 (95% CI 1.004-1.061).
Conclusions:
Our study showed that KT patients, of whom uremic toxin clearance has been revolted, are yet at risk of periodontitis by other factors, such as high blood glucose levels.
The study aimed to assess the association of different indicators of socioeconomic status with levels of cardiovascular disease risk factors in men and women aged 25-64 years.
This was a cross sectional survey, using a community based random sample.
The provinces of North Karelia and Kuopio in eastern Finland and the cities of Turku and Loimaa and surrounding communities in southwestern Finland in 1987.
Altogether 2164 men and 2182 women aged 25-64 years took part.
Data were collected using self administered questionnaires and the measurement of height, body weight, and blood pressure and blood sampling for lipid determinations were done at the survey site. The risk of cardiovascular disease was determined by calculating a simple risk factor score based on the observed values of HDL and total cholesterol, leisure time, physical activity, blood pressure, medication for hypertension, body mass index, and smoking. Indicators of socioeconomic position used were years of education, family income, marital status, and the person's occupation. Lower levels of education, occupation, and income were all significantly associated with an unfavorable risk factor profile in men and women. Education and occupation showed the strongest associations with the risk factor score in both men and women. The results changed little when adjusting for income and marital status. Family income was more strongly associated with the risk factor score in women than men. When adjusting for occupation and education, income was no longer significantly associated with the risk factor score in men. Marital status was not significantly associated with the risk factor score in either sex.
Using the strength of the association with the cardiovascular risk factor score as the criterion for a good socioeconomic indicator, the present study suggests that education and occupation may be equally good indicators in both men and women. Family income may have some additional importance, especially in women.
To investigate a reported association between dental disease and risk of coronary heart disease.
National sample of American adults who participated in a health examination survey in the early 1970s.
Prospective cohort study in which participants underwent a standard dental examination at baseline and were followed up to 1987. Proportional hazards analysis was used to estimate relative risks adjusted for several covariates.
Incidence of mortality or admission to hospital because of coronary heart disease; total mortality.
Among all 9760 subjects included in the analysis those with periodontitis had a 25% increased risk of coronary heart disease relative to those with minimal periodontal disease. Poor oral hygiene, determined by the extent of dental debris and calculus, was also associated with an increased incidence of coronary heart disease. In men younger than 50 years at baseline periodontal disease was a stronger risk factor for coronary heart disease; men with periodontitis had a relative risk of 1.72. Both periodontal disease and poor oral hygiene showed stronger associations with total mortality than with coronary heart disease.
Dental disease is associated with an increased risk of coronary heart disease, particularly in young men. Whether this is a causal association is unclear. Dental health may be a more general indicator of personal hygiene and possibly health care practices.
The authors collected dietary intake data about the food and nutrient intake of 49,501 male health professionals. Edentulous participants consumed fewer vegetables, less fiber and carotene, and more cholesterol, saturated fat and calories than participants with 25 or more teeth. These factors could increase the risks of cancer and cardiovascular disease. Mean differences in intake ranged from 2 to 13 percent, independent of age, smoking, exercise and profession. Longitudinal analyses suggest that tooth loss may lead to detrimental changes in diet.
A few recent studies have shown associations between poor oral health and coronary heart disease (CHD). The objective of this study was to examine the incidence of CHD in relation to number of teeth present and periodontal disease, and to explore potential mediators of this association, in a prospective cohort study. This study is a part of the ongoing Health Professionals Follow-Up Study (HPFS). Participants included a US national sample of 44,119 male health professionals (58% of whom were dentists), from 40 to 75 years of age, who reported no diagnosed CHD, cancer, or diabetes at baseline. We recorded 757 incident cases of CHD, including fatal and non-fatal myocardial infarction and sudden death, in six years of follow-up. Among men who reported pre-existing periodontal disease, those with 10 or fewer teeth were at increased risk of CHD compared with men with 25 or more teeth (relative risk = 1.67; 95% confidence interval, 1.03 to 2.71), after adjustment for standard CHD risk factors. Among men without pre-existing periodontal disease, no relationship was found (relative risk = 1.11; 95% confidence interval, 0.74 to 1.68). The associations were only slightly attenuated after we controlled for dietary factors. No overall associations were found between periodontal disease and coronary heart disease. Tooth loss may be associated with increased risk of CHD, primarily among those with a positive periodontal disease history; diet was only a small mediator of this association.
Strains of the periodontal pathogen Actinobacillus actinomycetemcomitans are variable with respect to display of phosphorylcholine (PC)-bearing antigens. We have examined strains ofA. actinomycetemcomitans with and without PC to assess their ability to invade endothelial cells via the receptor for platelet-activating factor (PAF).
Results of antibiotic protection assays indicate that PC-bearing A. actinomycetemcomitansinvade human vascular endothelial cells by a mechanism inhibitable by CV3988, a PAF receptor antagonist, and by PAF itself.
The invasive phenotype was verified by transmission electron microscopy. A PC-deficient strain of this organism was not invasive.
This property, in addition to the established ability of A. actinomycetemcomitans to invade epithelial cells, may provide this organism with access to the systemic circulation. The ability of PC-bearing
oral bacteria to access the circulation may also explain the elevated levels of anti-PC antibody in serum found in patients
with periodontitis.
Our purpose was to test the hypotheses that cigar and pipe smoking have significant associations with periodontal disease and cigar, pipe, and cigarette smoking is associated with tooth loss. We also investigated whether a history of smoking habits cessation may affect the risk of periodontal disease and tooth loss.
A group of 705 individuals (21 to 92 years-old) who were among volunteer participants in the ongoing Baltimore Longitudinal Study of Aging were examined clinically to assess their periodontal status and tooth loss. A structured interview was used to assess the participants' smoking behaviors with regard to cigarettes, cigar, and pipe smoking status. For a given tobacco product, current smokers were defined as individuals who at the time of examination continued to smoke daily. Former heavy smokers were defined as individuals who have smoked daily for 10 or more years and who had quit smoking. Non-smokers included individuals with a previous history of smoking for less than 10 years or no history of smoking.
Cigarette and cigar/pipe smokers had a higher prevalence of moderate and severe periodontitis and higher prevalence and extent of attachment loss and gingival recession than non-smokers, suggesting poorer periodontal health in smokers. In addition, smokers had less gingival bleeding and higher number of missing teeth than non-smokers. Current cigarette smokers had the highest prevalence of moderate and severe periodontitis (25.7%) compared to former cigarette smokers (20.2%), and non-smokers (13.1%). The estimated prevalence of moderate and severe periodontitis in current or former cigar/pipe smokers was 17.6%. A similar pattern was seen for other periodontal measurements including the percentages of teeth with > or = 5 mm attachment loss and probing depth, > or = 3 mm gingival recession, and dental calculus. Current, former, and non- cigarette smokers had 5.1, 3.9, and 2.8 missing teeth, respectively. Cigar/pipe smokers had on average 4 missing teeth. Multiple regression analysis also showed that current tobacco smokers may have increased risks of having moderate and severe periodontitis than former smokers. However, smoking behaviors explained only small percentages (<5%) of the variances in the multivariate models.
The results suggest that cigar and pipe smoking may have similar adverse effects on periodontal health and tooth loss as cigarette smoking. Smoking cessation efforts should be considered as a means of improving periodontal health and reducing tooth loss in heavy smokers of cigarettes, cigars, and pipes with periodontal disease.
Fibrinogen is one of the acute-phase proteins whose levels are elevated during periodontal disease. Recent studies suggest that excessive fibrinogen production might play a role in upregulating host immune responses. In addition, there is a relationship between the -455G/A polymorphism (HaeIII) in the 5' flanking region of the beta-fibrinogen gene promoter and increased fibrinogen levels. In this study, we investigated the distribution of the -455G/A polymorphism and the relationship of this specific genotype to fibrinogen levels in periodontitis patients.
In order to assess the -455G/A polymorphism, restriction fragment length polymorphism (RFLP) analysis with HaeIII enzyme was performed in the promoter region of the beta-fibrinogen gene. This was carried out on 79 chronic periodontitis patients as compared to 75 periodontally healthy subjects, matched to age, gender, and race. Fibrinogen levels were determined by the radial immunodiffusion assay (RID).
The frequency of homozygocity for the rare allele of the beta-fibrinogen gene (H2H2) was 13% for the periodontitis patients and 3% for the control group (P = 0.01). The distributions of H1H1 and H1H2 genotypes were 48% and 39% in the patient group and 70% and 27% in the control group, respectively. Chi-square analysis indicated that the distribution of these genotypes between the 2 groups was significantly different (P = 0.01). Fibrinogen levels were significantly higher in the patient group (2,496.5 mg/l +/- 105) compared to the control group (2,250.0 mg/l +/- 118.3) after adjusting for age, gender, and smoking status (P = 0.04). Consistent with previous reports, in our study population, those subjects with the H2H2 genotype had significantly higher fibrinogen levels (3,005.7 mg/l +/- 182.5) compared to subjects with the H1H1 genotype (2,325.0 mg/l +/- 91.6) or H1H2 genotype (2,438.0 mg/l +/- 117.4) (P = 0.001). Furthermore, the H1H2 and H2H2 genotypes were found at a higher frequency among periodontitis patients than controls. The odds ratios (OR) for these genotypes were 3.26 (95% confidence interval [CI]: 1.25 to 8.53) for the H1H2 genotype and 6.41 (95% CI: 1.15 to 35.83) for the H2H2 genotype as compared to individuals with the H1H1 genotype, after adjusting for age, gender, and smoking status.
The results indicate that a higher percentage of chronic periodontitis patients exhibit genotypes associated with higher plasma fibrinogen levels than healthy individuals. Furthermore, periodontitis patients have significantly higher fibrinogen levels compared to healthy individuals. The presence of H1H2 or H2H2 genotypes as well as elevated fibrinogen levels, in conjunction with other factors, may put individuals at higher risk of having periodontal disease, or may result from periodontal infection-genetic interactions.
Several studies have reported that impaired dentition status is associated with poor nutritional intake. However, most of these studies are cross-sectional and thus are unable to clarify the temporal sequence.
We assessed the longitudinal relation between tooth loss and changes in consumption of fruits and vegetables and of nutrients important for general health among 31,813 eligible male health professionals.
Subjects who lost five or more teeth had a significantly smaller reduction in consumption of dietary cholesterol and vitamin B12, greater reduction in consumption of polyunsaturated fat and smaller increase in consumption of dietary fiber and whole fruit than did subjects who had lost no teeth. Men who had lost teeth also were more likely to stop eating apples, pears and raw carrots.
The results support the temporal association between tooth loss and detrimental changes in dietary intakes, which could contribute to increased risk of developing chronic diseases.
Dietary evaluation and recommendations can be incorporated into dental visits to provide a greater benefit to patients.
This meta-analysis was conducted to examine the relationship between periodontal diseases and coronary heart diseases (CHD) and cerebrovascular diseases (CVD) in observational studies.
This study was based on seven cohort studies and four studies of other designs that met prestated inclusion criteria. Information on study design, year of publication, study location, sample size, study population, participant characteristics, measurement of risk factors, exposure and outcome measures, matching, controlling for confounders, and risk estimates was abstracted independently by two investigators using a standard protocol.
Subjects with periodontitis had an overall adjusted risk of CHD that was 1.15 times (95% confidence interval [CI]: 1.06 to 1.25; P = 0.001) the risk for healthy subjects. There was no heterogeneity among the studies in the overall relative risk estimate (P = 0.472). As compared to healthy subjects, those with periodontitis had an overall adjusted relative risk of CVD of 1.13 (95% CI: 1.01 to 1.27; P = 0.032).
Findings indicated that periodontal infection increases the risk of CHD and CVD. However, this meta-analysis provided no evidence for the existence of strong associations between periodontitis and CHD and CVD. Larger and better-controlled studies involving socially homogeneous populations and measuring specific periodontal pathogens are required to identify a definite association between periodontal disease and the risk of coronary heart disease and cerebrovascular disease.
Editor's Note: This article is a reprint of a previously published article. For citation purposes, please use the original publication details: Harris RP, Helfand M, Woolf SH, et al. Current methods of the U.S. Preventive Services Task Force: a review of the process. Am J Prev Med. 2001;20(3S):21-35. The U.S. Preventive Services Task Force (USPSTF/Task Force) represents one of several efforts to take a more evidence-based approach to the development of clinical practice guidelines. As methods have matured for assembling and reviewing evidence and for translating evidence into guidelines, so too have the methods of the USPSTF. This paper summarizes the current methods of the third USPSTF, supported by the Agency for Healthcare Research and Quality (AHRQ) and two of the AHRQ Evidence-based Practice Centers (EPCs). The Task Force limits the topics it reviews to those conditions that cause a large burden of suffering to society and that also have available a potentially effective preventive service. It focuses its reviews on the questions and evidence most critical to making a recommendation. It uses analytic frameworks to specify the linkages and key questions connecting the preventive service with health outcomes. These linkages, together with explicit inclusion criteria, guide the literature searches for admissible evidence. Once assembled, admissible evidence is reviewed at three strata: (1) the individual study, (2) the body of evidence concerning a single linkage in the analytic framework, and (3) the body of evidence concerning the entire preventive service. For each stratum, the Task Force uses explicit criteria as general guidelines to assign one of three grades of evidence: good, fair, or poor. Good or fair quality evidence for the entire preventive service must include studies of sufficient design and quality to provide an unbroken chain of evidence-supported linkages, generalizable to the general primary care population, that connect the preventive service with health outcomes. Poor evidence contains a formidable break in the evidence chain such that the connection between the preventive service and health outcomes is uncertain. For services supported by overall good or fair evidence, the Task Force uses outcomes tables to help categorize the magnitude of benefits, harms, and net benefit from implementation of the preventive service into one of four categories: substantial, moderate, small, or zero/negative. The Task Force uses its assessment of the evidence and magnitude of net benefit to make a recommendation, coded as a letter: from A (strongly recommended) to D (recommend against). It gives an I recommendation in situations in which the evidence is insufficient to determine net benefit. The third Task Force and the EPCs will continue to examine a variety of methodologic issues and document work group progress in future communications.
The U.S. Preventive Services Task Force (USPSTF/Task Force) represents one of several efforts to take a more evidence-based approach to the development of clinical practice guidelines. As methods have matured for assembling and reviewing evidence and for translating evidence into guidelines, so too have the methods of the USPSTF. This paper summarizes the current methods of the third USPSTF, supported by the Agency for Healthcare Research and Quality (AHRQ) and two of the AHRQ Evidence-based Practice Centers (EPCs). mThe Task Force limits the topics it reviews to those conditions that cause a large burden of suffering to society and that also have available a potentially effective preventive service. It focuses its reviews on the questions and evidence most critical to making a recommendation. It uses analytic frameworks to specify the linkages and key questions connecting the preventive service with health outcomes. These linkages, together with explicit inclusion criteria, guide the literature searches for admissible evidence. mOnce assembled, admissible evidence is reviewed at three strata: (1) the individual study, (2) the body of evidence concerning a single linkage in the analytic framework, and (3) the body of evidence concerning the entire preventive service. For each stratum, the Task Force uses explicit criteria as general guidelines to assign one of three grades of evidence: good, fair, or poor. Good or fair quality evidence for the entire preventive service must include studies of sufficient design and quality to provide an unbroken chain of evidence-supported linkages, generalizable to the general primary care population, that connect the preventive service with health outcomes. Poor evidence contains a formidable break in the evidence chain such that the connection between the preventive service and health outcomes is uncertain. For services supported by overall good or fair evidence, the Task Force uses outcomes tables to help categorize the magnitude of benefits, harms, and net benefit from implementation of the preventive service into one of four categories: substantial, moderate, small, or zero/negative. mThe Task Force uses its assessment of the evidence and magnitude of net benefit to make a recommendation, coded as a letter: from A (strongly recommended) to D (recommend against). It gives an I recommendation in situations in which the evidence is insufficient to determine net benefit. mThe third Task Force and the EPCs will continue to examine a variety of methodologic issues and document work group progress in future communications.
Objective:
The purpose of the present study was to assess the relation between dental health and cardiovascular disease in an adult Swedish population.
Material and method:
A questionnaire was sent to 4811 randomly selected Swedes. It contained 52 questions about dental care habits, oral health, cardiovascular disease and their socio-economic situation. Odd ratios for all cardiovascular diseases (CVD) and the subgroup myocardial infarction, stroke and high blood pressure were calculated with a logistic regression model adjusted for age, gender, smoking, income, civil status and education. These ratios were calculated for subjects > or =41 years since few people suffer from CVD before this.
Results:
The national questionnaire was answered by 2839 (59%) people between 20-84 years of age and, of them, 1577 were 41 years of age or more. We found a significant association between self-reported bleeding gums (odds ratio 1.60, p=0.0017), presence of dentures (odds ratio 1.57, p=0.0076) and known CVD, which has also been reported in international studies. However, no association between loose teeth, deep pockets and known CVD was detected.
Conclusion:
The results indicate that oral health and, especially gingival inflammation is associated with CVD.
Several recent studies have shown a link between dental disease and coronary heart disease. The authors studied 320 U.S. veterans in a convenience sample to assess the relationship between oral health and systemic diseases among older people. They present cross-sectional data confirming that a statistically significant association exists between a diagnosis of coronary heart disease and certain oral health parameters, such as the number of missing teeth, plaque benzoyl-DL-arginine-naphthylamide test scores, salivary levels of Streptococcus sanguis and complaints of xerostomia. The oral parameters in these subjects were independent of and more strongly associated with coronary heart disease than were recognized risk factors, such as serum cholesterol levels, body mass index, diabetes and smoking status. However, because of the convenience sample studied, these findings cannot be generalized to other populations.
Bias is any systematic error in the design, conduct, analysis, or interpretation of a study that tends to produce an incorrect assessment of the nature of the association between an exposure or risk factor and the occurrence of disease. It is evident that a major emphasis in an epidemiologic study should be to minimize any biases that may occur at any stage of the study. Since by definition, biases will produce an incorrect assessment of the nature and magnitude of an association, avoidance of bias will be particularly important when the association under investigation is already presumed to be weak. The major biases important for evaluating weak associations are described in the context of how they may occur and how they may be avoided at each stage of an epidemiologic study.
To assess the association between a measure of extensive tooth loss (functional edentulism) and obesity with non-insulin-dependent diabetes mellitus (NIDDM) in a racially heterogeneous sample.
A cross-sectional survey (370 subjects) was performed by reviewing the medical and dental records of dependently or independently living individuals who were treated as inpatients and/or outpatients at a Department of Veterans Affairs facility. Frequencies and descriptive measures were derived; univariate and multiple logistic regression analyses were conducted to test for associations, confounding, effect modification, and interaction using functional edentulism and obesity as the independent variables and NIDDM as the dependent measure.
Functionally edentulous individuals were at significantly greater risk for NIDDM (estimated odds ratio [OR] = 4.06), than the obese (OR = 3.29). These relationships were not confounded by age or race in this sample. Obesity did confound functional edentulism in the multivariable model, suggesting that they act independently on the outcome variable (NIDDM).
Dentist-assessed functional edentulism and physician-diagnosed obesity were significantly associated with NIDDM in this sample of predominantly older men. This finding ought to be considered by primary care providers in formulating dietary strategies in order to facilitate the realization of their therapeutic goals.
Several recent studies have suggested that dental infections are associated with coronary artery disease. To further elucidate
this association, we conducted a prospective 7-year follow-up study of 214 individuals (182 males and 32 females; mean age,
49 years) with proven coronary artery disease who had undergone a dental examination and evaluation for the classic coronary
risk factors at entry. The main outcome measures were the incidence of fatal and nonfatal coronary events and overall mortality.
Fifty-two patients met the endpoint criteria during follow-up. Dental health was a significant predictor of coronary events
when controlled for the following factors: age, sex, socioeconomic status, smoking, hypertension, the number of previous myocardial
infarctions, diabetes, body mass index, and serum lipids. Other significant predictors were the presence of diabetes, the
number of previous myocardial infarctions, and the body mass index. Our results give further support to the hypothesis that
dental infections are a risk factor for coronary events.
During episodes of dental bacteremia, viridans group streptococci encounter platelets. Among these microorganisms, certain Streptococcus sanguis induce human and rabbit platelets to aggregate in vitro. In experimental rabbits, circulating streptococci induced platelets to aggregate, triggering the accumulation of platelets and fibrin into the heart valve vegetations of endocarditis. At necropsy, affected rabbit hearts showed ischemic areas. We therefore hypothesized that circulating S. sanguis might cause coronary thrombosis and signs of myocardial infarction (MI). Signs of MI were monitored in rabbits after infusion with platelet-aggregating doses of 4 to 40 x 10(9) cells of S. sanguis 133-79. Infusion resulted in dose-dependent changes in electrocardiograms, blood pressure, heart rate, and cardiac contractility. These changes were consistent with the occurrence of MI. Platelets isolated from hyperlipidemic rabbits showed an accelerated in vitro aggregation response to strain 133-79. Cultured from immunosuppressed children with septic shock and signs of disseminated intravascular coagulation, more than 60% of isolates of viridans streptococci induced platelet aggregation when tested in vitro. The data are consistent with a thrombogenic role for S. sanguis in human disease, contributing to the development of the vegetative lesion in infective endocarditis and a thrombotic mechanism to explain the additional contributed risk of periodontitis to MI.
Recent reports have implicated periodontal disease as a risk factor for coronary heart disease (CHD).
A retrospective cohort study was conducted using participants in the 1970-1972 Nutrition Canada Survey (NCS). The mortality experience of male and female NCS participants aged 35-84 years without self-reported CHD (n = 10,368) or cerebrovascular disease (CVD) (n = 11,251) was determined through 1993. The relation between dental health and the risk of fatal CHD and CVD was assessed using Poisson regression modeling.
In total, 466 CHD and 210 CVD deaths were observed; missing confounder data reduced these numbers to 416 CHD and 182 CVD deaths. Adjusted for age, sex, diabetes status, serum total cholesterol, smoking, hypertensive status, and province, we found a statistically significant association between periodontal disease and risk of fatal CHD. Rate ratios (RR) of 2.15 [95% confidence interval (CI) 1.25-3.72) and 1.90 (95% CI 1.17-3.10) were observed for severe gingivitis and edentulous status, respectively. Non-statistically significantly increased RRs of 1.81 and 1.63 were observed for severe gingivitis and edentulous status for CVD.
These data indicate that poor dental health is associated with an increased risk of fatal CHD.
Chlamydia pneumoniae, cytomegalovirus, herpes simplex virus, and recently, periodontal disease, have been associated with human atherosclerosis. Porphyromonas gingivalis and Streptococcus sanguis are major pathogens associated with periodontitis, a common chronic inflammatory condition in adults. Investigators have found that these infectious agents may influence vascular cell functions by inducing thrombus formation, vascular cell proliferation, apoptosis, and cell death.
The main purpose of our study was to investigate the relation between the presence of multiple infectious agents in human carotid endarterectomy specimens and pathoanatomic features of the corresponding carotid plaques. Histologically, plaque rupture of the fibrous cap and communication of the luminal thrombus with the central necrotic lipid core was seen in or at proximity to the macrophage-rich shoulder (unstable plaque region). Thrombus within the lipid core without plaque rupture was occasionally found near the internal elastic lamina, associated with increased vascularity and lymphocytic infiltrate. Apoptosis, as detected by both the immunohistochemical staining of apoptosis-related proteins and in situ labeling of internucleosomally degraded DNA, was common in atherosclerotic plaques. Immunostainings for C pneumoniae, cytomegalovirus, herpes simplex virus-1, P gingivalis, and S sanguis were positive in the carotid plaques. From 1 to 4 organisms were found in the same specimen. The micro-organisms were immunolocalized in plaque shoulders and lymphohistiocytic infiltrate, associated with ulcer and thrombus formation, and adjacent to areas of strong labeling for apoptotic bodies.
Our data provide evidence that multiple infectious agents may be found in atherosclerotic plaques, and sometimes in the same specimen. The current study is the first to report the detection of 2 major odontopathogens, P gingivalis and S sanguis, in atherosclerotic plaques. The immunolocalization of these micro-organisms within unstable plaque regions and their association with plaque ulceration, thrombosis, and apoptosis in vascular cells are intriguing. Multiple infectious agents may alter vascular cell function and provide a "trigger" for acute ischemic stroke events. Further evidence from human studies and animal models will be needed.
Coronary heart disease is responsible for one of every five deaths in the United States. Recent epidemiological studies have shown an association between periodontal disease and coronary heart disease. The purpose of this cross-sectional study was to verify this association using data from the third National Health and Nutrition Examination Survey (NHANES III). Data for 5564 people 40 years of age and older who had complete periodontal assessments and information on heart attack were evaluated. The outcome was the self-reported history of heart attack (yes vs. no). The main independent variable was the percent of periodontal sites per person with attachment loss of 3 mm or greater (categorized as 0%, > 0-33%, > 33-67%, and > 67%). Periodontal attachment loss was measured at two sites per tooth in randomly assigned half-mouths, one upper and one lower quadrant. The covariables included sociodemographic variables and established risk factors for cardiovascular disease. Relative to the 0% category, the unadjusted odds of heart attack increased with each higher category of attachment loss-2.2 (95% confidence interval = 1.3-3.8), 5.5 (3.4-9.1), and 9.8 (4.5-21.0), respectively. Adjustment for age, sex, race, poverty, smoking, diabetes, high blood pressure, body mass index, and serum cholesterol decreased these odds to 1.4 (0.8-2.5), 2.3 (1.2-4.4), and 3.8 (1.5-9.7), respectively. This study supports findings from previous studies of an association between periodontal disease and coronary heart disease.
Periodontitis is a common, often undiagnosed, chronic infection of the supporting tissues of the teeth, epidemiologically associated with cardiovascular diseases. Since C-reactive protein (CRP) and other systemic markers of inflammation have been identified as risk factors for cardiovascular diseases, we investigated whether these factors were elevated in periodontitis.
Consecutive adult patients with periodontitis (localized n = 53; generalized n = 54), and healthy controls (n = 43), all without any other medical disorder, were recruited and peripheral blood samples were taken.
Patients with generalized periodontitis and localized periodontitis had higher median CRP levels than controls (1.45 and 1.30 versus 0.90 mg/L, respectively, P = 0.030); 52% of generalized periodontitis patients and 36% of the localized periodontitis patients were sero-positive for interleukin-6 (IL-6), compared to 26% of controls (P= 0.008). Plasma IL-6 levels were higher in periodontitis patients than in controls (P = 0.015). Leukocytes were also elevated in generalized periodontitis (7.0 x 10(9)/L) compared to localized periodontitis and controls (6.0 and 5.8 x 10(9)/L, respectively, P= 0.002); this finding was primarily explained by higher numbers of neutrophils in periodontitis (P= 0.001). IL-6 and CRP correlated with each other, and both CRP and IL-6 levels correlated with neutrophils. The current findings for periodontitis were controlled for other known factors associated with cardiovascular diseases, including age, education, body mass index, smoking, hypertension, cholesterol, and sero-positivity for CMV, Chlamydia pneumoniae, and Helicobacter pylori.
Periodontitis results in higher systemic levels of CRP, IL-6, and neutrophils. These elevated inflammatory factors may increase inflammatory activity in atherosclerotic lesions, potentially increasing the risk for cardiac or cerebrovascular events.
We sought to prospectively assess whether self-reported periodontal disease is associated with subsequent risk of cardiovascular disease in a large population of male physicians.
Periodontal disease, the result of a complex interplay of bacterial infection and chronic inflammation, has been suggested to be a predictor of cardiovascular disease.
Physicians' Health Study I was a randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene in 22,071 U.S. male physicians. A total of 22,037 physicians provided self-reports of presence or absence of periodontal disease at study entry and were included in this analysis.
A total of 2,653 physicians reported a personal history of periodontal disease at baseline. During an average of 12.3 years of follow-up, there were 797 nonfatal myocardial infarctions, 631 nonfatal strokes and 614 cardiovascular deaths. Thus, for each end point, the study had >90% power to detect a clinically important increased risk of 50%. In Cox proportional hazards regression analysis adjusted for age and treatment assignment, physicians who reported periodontal disease at baseline had slightly elevated, but statistically nonsignificant, relative risks (RR) of nonfatal myocardial infarction, (RR, 1.12; 95% confidence interval [CI], 0.92 to 1.36), nonfatal stroke (RR, 1.10; CI, 0.88 to 1.37) and cardiovascular death (RR, 1.20; CI, 0.97 to 1.49). Relative risk for a combined end point of all important cardiovascular events (first occurrence of nonfatal myocardial infarction, nonfatal stroke or cardiovascular death) was 1.13 (CI, 0.99 to 1.28). After adjustment for other cardiovascular risk factors, RRs were all attenuated and nonsignificant.
These prospective data suggest that self-reported periodontal disease is not an independent predictor of subsequent cardiovascular disease in middle-aged to elderly men.
No abstract available.
The U.S. Preventive Services Task Force (USPSTF/Task Force) represents one of several efforts to take a more evidence-based approach to the development of clinical practice guidelines. As methods have matured for assembling and reviewing evidence and for translating evidence into guidelines, so too have the methods of the USPSTF. This paper summarizes the current methods of the third USPSTF, supported by the Agency for Healthcare Research and Quality (AHRQ) and two of the AHRQ Evidence-based Practice Centers (EPCs). The Task Force limits the topics it reviews to those conditions that cause a large burden of suffering to society and that also have available a potentially effective preventive service. It focuses its reviews on the questions and evidence most critical to making a recommendation. It uses analytic frameworks to specify the linkages and key questions connecting the preventive service with health outcomes. These linkages, together with explicit inclusion criteria, guide the literature searches for admissible evidence. Once assembled, admissible evidence is reviewed at three strata: (1) the individual study, (2) the body of evidence concerning a single linkage in the analytic framework, and (3) the body of evidence concerning the entire preventive service. For each stratum, the Task Force uses explicit criteria as general guidelines to assign one of three grades of evidence: good, fair, or poor. Good or fair quality evidence for the entire preventive service must include studies of sufficient design and quality to provide an unbroken chain of evidence-supported linkages, generalizable to the general primary care population, that connect the preventive service with health outcomes. Poor evidence contains a formidable break in the evidence chain such that the connection between the preventive service and health outcomes is uncertain. For services supported by overall good or fair evidence, the Task Force uses outcomes tables to help categorize the magnitude of benefits, harms, and net benefit from implementation of the preventive service into one of four categories: substantial, moderate, small, or zero/negative. The Task Force uses its assessment of the evidence and magnitude of net benefit to make a recommendation, coded as a letter: from A (strongly recommended) to D (recommend against). It gives an I recommendation in situations in which the evidence is insufficient to determine net benefit. The third Task Force and the EPCs will continue to examine a variety of methodologic issues and document work group progress in future communications.
The association between periodontal disease and coronary artery disease (CAD) has been investigated in numerous studies with inconsistent results. Resolving these differences is complicated by the use of varying definitions of CAD. The aim of this study was to investigate the association between angiographically-defined CAD and periodontal disease.
Non-smoking, non-diabetic patients, over 40 years of age, with no history of a myocardial infarction in the previous 6 months and who had undergone cardiac catheterization within the previous 12 months were enrolled in this study. Subjects were classified as having CAD (CAD+) if they had 50% stenosis in at least one major epicardial artery and classified as CAD negative (CAD-) if they had <50% stenosis in all identified arteries. Periodontal disease severity was measured through bleeding on probing, probing depth, clinical attachment level (CAL), gingival recession, number of missing teeth, and radiographic bone loss.
One hundred (53 = CAD+; 47 = CAD-) patients were examined. CAD+ patients were more likely to be male (CAD+ 83.0% male; CAD- 40.4% male; P= 0.001), and were older (CAD+ 65.3 years; CAD- 60.8 years; P= 0.0138). Although all patients reported they were currently non-smokers and had not smoked for at least 5 years, the fraction who were former smokers was greater for CAD+ patients (66% versus 24.4%; P = 0.0001) and mean pack/year history of smoking was higher for CAD+ patients (15.8 versus 4.5; P = 0.0003). Mean CAL (3.13 mm versus 2.78 mm; P 0.0227), number of sites with CAL > or = 6 mm (6.85 versus 3.32; P = 0.0242), radiographic bone loss (3.60 mm versus 3.18 mm; P = 0.0142) were greater for CAD+ patients than for CAD- patients. However, after adjustment for age and previous smoking history, factors common to both diseases, the associations of CAD and periodontal disease were reduced and were not statistically significant (odds ratio [OR]: mean CAL OR = 1.06; number of sites with CAL > or = 6 mm OR = 1.03; mean radiographic bone loss OR = 1.31; P > or = 0.2055).
After accounting for factors common to both periodontal disease and CAD, there was no significant association between periodontal disease and chronic CAD as assessed angiographically. Further investigations into the relationship between periodontal disease and CAD should clearly separate chronic CAD and acute coronary events.
The purpose of this study was to analyze published studies and abstracts in order to provide a quantitative summary of periodontal disease as a risk factor for cardiovascular disease and to explore the possible causes for conflicting results in the literature.
We searched all published literature on the Medline literature search engine since 1980. An additional search was performed with bibliographic citations from each article. Nine cohort studies (8 prospective and 1 retrospective), in which relative risks (RRs), CIs, and P values were reported or could be calculated were included. Four researchers independently extracted RRs, CIs, and P values from each study and evaluated the degree of confounding adjustment. The combined result was calculated with weighted average, and sources of disparity were tested with regression analyses.
The summary RR was 1.19 (95% CI, 1.08 1.32), indicating a higher risk of future cardiovascular events in individuals with periodontal disease compared with those without. In an analysis stratified to individuals of </=65 years of age, the RR was 1.44 (95% CI, 1.20 to 1.73). When the outcome was restricted to stroke only, the RR was 2.85 (95% CI, 1.78 to 4.56). In the metaregression analysis, the effects of residual confounding caused an overestimate of the results by 12.9% and, with a proxy for periodontal disease, caused an underestimate of 29.7%.
Periodontal disease appears to be associated with a 19% increase in risk of future cardiovascular disease. This increase in RR is more prominent (44%) in persons aged </=65 years. Although the increment of risk between subjects with or without periodontal disease in the general population is modest, at around 20% because nearly 40% of population has periodontal disease, this modest increase may have a profound public health impact.
Studies relating periodontal disease to coronary heart disease (CHD) have provided equivocal results using tooth loss and/or clinical signs of periodontal disease as measures of periodontal exposure.
The purpose of this cross-sectional study was to evaluate the relationship of tooth loss and periodontitis to prevalent CHD at the Atherosclerosis Risk in Communities (ARIC) visit 4 using both tooth loss and clinical signs of disease in a population-based sample of 8,363 men and women aged 52 to 75 years from four U.S. communities. Each subject participated in a complete periodontal examination, assessment of missing teeth, assessment of prevalent CHD, and a number of laboratory tests and questionnaires. High attachment loss was defined as > or = 10% of sites with attachment loss > 3 mm and high tooth loss was defined as fewer than 17 remaining teeth.
Individuals with both high attachment loss and high tooth loss (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1 to 2.0) and edentulous individuals (OR 1.8, CI 1.4 to 2.4) had elevated odds of prevalent CHD compared to individuals with low attachment loss and low tooth loss, while controlling for a number of traditional risk factors for CHD.
These results suggest that tooth loss and periodontal disease are associated with prevalent CHD, but only when both are present. The weaker relationships between periodontal disease and CHD that have been found among older adults may be due to older adults having fewer teeth. Future longitudinal studies should be designed to ascertain the cause of tooth loss during follow-up.
There is increasing evidence that chronic infections, such as periodontal diseases, could play a role in the initiation and development of coronary artery disease (CAD). The present study was intended to test for a possible association between presence and severity of periodontitis and coronary artery disease in a Belgian population.
A total of 108 CAD patients (mean age 59.2 +/- 11 years) and 62 presumably healthy controls (mean age 57.7 +/- 9 years) were enrolled in the study. Probing depth, periodontal pocket bleeding index (PPBI), plaque index, furcation involvements, and tooth mobility were evaluated to compare periodontal health in both groups. The subjects were also ranked according to a novel index of periodontitis severity, the periodontal index for risk of infectiousness (PIRI), aimed at quantifying the risk of release of proinflammatory mediators from the periodontal sites.
Periodontitis was significantly more frequent in CAD patients than in controls (CAD patients: 91%; controls: 66%). The mean number of pockets was 18 +/- 17.1 in cardiac patients versus 7.6 +/- 12.7 in controls (P < 0.0001), despite the fact that the mean number of missing teeth was significantly greater in cases than in controls (14 +/- 7.1 versus 9 +/- 5.2; P < 0.0001). Furthermore, proportions of mobile teeth, bleeding sites, periodontal pockets, and involved furcations were significantly higher in CAD patients than in controls. In addition, the extent of the periodontal disease present was also greater in cases than in controls. A logistic model, adjusted for known cardiovascular risk factors, showed a strong association between CAD and periodontitis (odds ratio [OR] = 6.5). Moreover, there was a significant dose-response relationship between increasing scores of the periodontal risk of infectiousness and the presence of CAD (adjusted OR = 1.3 per PIRI unit).
In the present study, periodontitis was revealed to be a significant risk factor for CAD after adjusting for other confounding factors, with the level of association increasing with the individual extent of the periodontal lesions.
The primary aim was to investigate the oral health; oral care habits and the ability of the participants to afford dental care in an adult Swedish population. A secondary aim was to study whether there is a relationship between dental care habits, self-reported oral health status and cardiovascular disease (CVD).
The participants answered a questionnaire about the frequencies of diseases, the need for treatment and the effects of socio-economic factors on oral care habits. A questionnaire was mailed to 893 persons in 3 age groups (20-29, 50-59, and 75-84 years of age) of whom 723 replied (81.0%).
The answers indicated that 16% had experienced dental problems without seeking help and more then 10% reported problems with chewing. In the group as a whole, 31.5% had sought no dental treatment, partly for financial reasons. When using a logistic regression model, as regards bleeding gums as a risk indicator of CVD, correcting for diabetes, education, gender, age and tobacco use, the estimated odds ratio (OR) was 1.70 (p = 0.05). The OR for those 50 years old or more was 1.79 (p = 0.05). For the oldest group alone, the OR was 2.69 (p = 0.05). The model showed an increased risk of CVD among those who had problems with their teeth without seeking help, OR 2.45 (p = 0.05).
The study indicates that a large proportion of those answering the questionnaire had experienced dental problems without seeking help, partly for financial reasons. This group is more likely to have CVD and bleeding gums. It shows a relationship between the presence of bleeding gums and CVD, especially amongst the oldest participants.
Over the last few decades, oral diseases including periodontitis, have been discussed as a possible risk factor for cardiovascular disease. The purpose of this study was to compare the oral health of age-matched women with or without coronary heart disease (CHD).
A total of 143 consecutive women, aged 43 to 79 years, with diagnosed CHD underwent a thorough dental examination including a panoramic radiograph and were compared to 50 women, aged 45 to 77 years without CHD.
The number of remaining teeth and pathological periodontal pockets (> or =4 mm) between the groups differed. The women with CHD had 18.9 +/- 8.5 remaining teeth versus 23.4 +/- 6.3 teeth in the control group (P < 0.001). The CHD group had more pathological periodontal pockets compared to the controls, 14.2 +/- 12.4 versus 9.6 +/- 13.3 (P = 0.002), respectively. The mean marginal bone level assessed on radiographs was the same in both groups, while the number of vertical bone defects differed (P = 0.022). Dentures were more frequent in the CHD group than in the controls (27% versus 6%, P = 0.022), as was edentulousness, 10.5% versus 0% (P = 0.017), respectively. Multiple regression analysis adjusted for age, smoking, body mass index (BMI), diabetes, education, and place of birth showed a relation between the number of periodontal pockets and CHD with an odds ratio (OR) of 3.8 (1.68 to 8.74), and a tendency between dentures and CHD, with an OR of 4.6 (0.99 to 21.28).
This study indicates that women with CHD have worse oral health than those in a comparable group with no history of CHD.
Pathogenic mechanisms in infective endocarditis, disseminated intravascular coagulation, and cardiovascular events involve the aggregation of platelets into thrombi. Attendant infection by oral bacteria contributes to these diseases. We have been studying how certain oral streptococci induce platelet aggregation in vitro and in vivo. Streptococcus sanguis expresses a platelet aggregation-associated protein (PAAP), which contributes little to adhesion to platelets. When specific antibodies or peptides block PAAP, S. sanguis fails to induce platelet aggregation in vitro or in vivo.
We used subtractive hybridization to identify the gene encoding for PAAP.
After subtraction of strain L50 (platelet aggregation-negative), four strain 133-79 specific sequences were characterized. Sequence agg4 encoded a putative collagen-binding protein (CbpA), which was predicted to contain two PAAP collagen-like octapeptide sequences. S. sanguis CbpA- mutants were constructed and tested for induction of platelet aggregation in vitro. Platelet aggregation was substantially inhibited when compared to the wild-type using platelet-rich plasma from the principal donor, but adhesion was unaffected. Other donor platelets responded normally to the CbpA- strain, suggesting additional mechanisms of response to S. sanguis. In contrast, CshA- and methionine sulfoxide reductase-negative (MsrA-) strains neither adhered nor induced platelet aggregation.
CbpA was suggested to contribute to site 2 interactions in our two-site model of platelet aggregation in response to S. sanguis. Platelet polymorphisms were suggested to contribute to the thrombogenic potential of S. sanguis.
Chronic inflammation from any source is associated with increased cardiovascular risk. Periodontitis is a possible trigger of chronic inflammation. We investigated the possible association between periodontitis and coronary heart disease (CHD), focusing on microbiological aspects.
A total of 789 subjects (263 patients with angiographically confirmed, stable CHD and 526 population-based, age- and sex-matched controls without a history of CHD) were included in the Coronary Event and Periodontal Disease (CORODONT) study. Subgingival biofilm samples were analyzed for periodontal pathogens Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, Prevotella intermedia, and Treponema denticola using DNA-DNA hybridization. The need for periodontal treatment in each subject was assessed using the Community Periodontal I