ArticleLiterature Review

The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: A meta-analysis

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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.

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... The dysbiosis in the oral microflora is the main causative agent of periodontitis [5]. An association between periodontitis and cardiovascular events such as stroke, myocardial infarction, abdominal aortic aneurysm and cardiovascular death has been observed [6][7][8][9]. ...
... Japanese Dental Science Review 59 (2023) [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] precursor of atherosclerosis [13,56]. Ox-LDL alters the balance of nitric oxide, activates the innate immune system through the expression of TLR pathways and NLRs, to promote an inflammatory response [57]. ...
... Japanese Dental Science Review 59 (2023) [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] chemokines. The activated Th1 cells, either by macrophages or by dendritic cells, promote the release of cytokines such as interferongamma (INFy), IL12, IL15, IL18 and TNF. ...
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The mechanisms modulated by periodontal pathogens in atherosclerosis are not fully understood. Aim: to perform an integrative analysis of gene and protein expression modulated by periodontal pathogens in cells and animal models for atherosclerosis. Methods Cochrane, PRISMA and AMSTAR2 guidelines for systematic reviews were followed. Data search was conducted in Pub-med, LILACS and Science Direct databases. Gene and protein expression data were collected from the included papers to perform an overrepresentation analysis using the Reactome Pathway Analysis tool and the KEGG database. Results Thirty-two papers were included in the review, they analyzed the effect of Fusobacterium nucleatum, Porphyromonas gingivalis, Streptococcus anginosus, Streptococcus sanguinis, Tannerella forsythia, and Treponema denticola or/and their virulent factors on gene and protein expression in human cells and animal models of atherosclerosis. Some of the modulated pathways include the immune system, programmed cell death, cellular responses to external stimuli, transport of small molecules, and signal transduction (p < 0.05). Those pathways are known to be involved in different stages of atherosclerosis progression. Conclusion Based on the performed analysis, it is possible to state that periodontal pathogens have the potential to be a contributing factor for atherosclerosis even in absence of a high-fat diet or high shear stress.
... 9 Chronic inflammation is characterized by an increase in the inflammatory cytokines' level, which causes a weakening of the immune system function, thus increasing the risk of atherosclerosis and insulin resistance, which are the main triggers for developing CVd. 10 in literature, the association between Pd and diabetes is well-documented in an umbrella review by Seitz et al., 11 whereas the association between Pd and CVd is currently less investigated. Since diabetes is also an important CVd 17, 21, 22 microbiological, 17, 23, 24 immunological, 17,18,[25][26][27] pathophysiological, [28][29][30][31][32][33][34][35][36][37][38][39] risk of onset 22 and treatment 19,40,41 ) and different manifestations of cardiovascular diseases (coronary heart disease, 9,18,25,42,43 ...
... 9 Chronic inflammation is characterized by an increase in the inflammatory cytokines' level, which causes a weakening of the immune system function, thus increasing the risk of atherosclerosis and insulin resistance, which are the main triggers for developing CVd. 10 in literature, the association between Pd and diabetes is well-documented in an umbrella review by Seitz et al., 11 whereas the association between Pd and CVd is currently less investigated. Since diabetes is also an important CVd 17, 21, 22 microbiological, 17, 23, 24 immunological, 17,18,[25][26][27] pathophysiological, [28][29][30][31][32][33][34][35][36][37][38][39] risk of onset 22 and treatment 19,40,41 ) and different manifestations of cardiovascular diseases (coronary heart disease, 9,18,25,42,43 ...
... among the 31 selected articles, 11 are systematic reviews, 8 are meta-analyses, and 12 are both systematic reviews and meta-analyses, for a total of 507 studies and over 3,549,966 patients included (Supplementary Table i-iV). The search results pointed out the association between Pd and cardiovascular diseases ( Figure 2). in this regard, Pd may be a CVd risk factor 18,19 and, at the same time, the worse cases of Pd and tooth loss are more frequent in patients affected by atherosclerosis 17 hypertension 20 and peripheral arterial disease than in controls. The evidence shows links between various issues of periodontal dis- ...
Article
Introduction: Periodontal disease (PD) and cardiovascular diseases (CVD) are among the most common pathologies in the world and their relationship has long been studied. Both conditions lead to a chronic inflammatory process with degenerative characteristics and their bi-univocal correlation is now well established. The aim of this umbrella review on cardiovascular and periodontal disease was to evaluate the real degree of association between these two pathological conditions. Evidence acquition: We conducted a comprehensive literature search on PubMed/Medline and in the Cochrane Library for systematic reviews focused on clinical evidence regarding the relationship between PD and CVD. The internal validity of systematic reviews and meta-analyses was formally analyzed using the Overview Quality Assessment Questionnaire (OQAQ) tool. The umbrella review was planned in accordance with current international recommendations and was described as specified by the PRISMA guidelines. Evidence synthesis: Thirty-one systematic reviews, including 8 meta-analyses for a total of 507 clinical studies and over 3,549,966 patients were included. PD resulted to be associated with a higher risk of developing CVD (acute coronary syndrome, acute myocardial infarction) and cerebrovascular diseases (ischemic stroke); however, if the treatment of periodontitis reduces the risk of CVD events related is yet to be investigated. Conclusions: To date, the relationship between CVD and PD provides heterogeneous data. There is an association between PD and CVD but a causal relationship cannot be established. Further research with properly designed long-term follow-up studies are needed in order to examine various physiopathological aspects of their association.
... 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]. ...
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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.
... A meta-analysis of five comprehensive studies (86,092 patients) collectively showed that individuals with periodontal disease had a 1.14-times higher risk of coronary heart disease than those without [27]. Case-control studies with 1423 patients showed a 2.22-times higher risk of developing coronary heart disease among those with periodontal diseases compared to controls [27]. ...
... A meta-analysis of five comprehensive studies (86,092 patients) collectively showed that individuals with periodontal disease had a 1.14-times higher risk of coronary heart disease than those without [27]. Case-control studies with 1423 patients showed a 2.22-times higher risk of developing coronary heart disease among those with periodontal diseases compared to controls [27]. Studies have also shown there may be a link between edentulousness and serum antibodies against P. gingivalis and A. actinomycetemcomitans. ...
Article
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Periodontitis is a chronic inflammatory disease of the gums. The incidence of periodontitis is increasing all over the world. In patients with periodontitis, there is gradual destruction of the periodontal ligament and the alveolar bone, and later, in advanced stages, there is tooth loss. Different microorganisms, the host’s immune response, and various environmental factors interact in the progression of this chronic inflammatory disease. In the present review, we discuss the epidemiology, clinical features, diagnosis, and complications of periodontitis. We also discuss the association of chronic inflammation found in periodontitis with various other systemic diseases, which include cardiovascular, respiratory, diabetes, Alzheimer’s, cancer, adverse pregnancy, and multiple myeloma, and also highlight microbial carcinogenesis and the microRNAs involved. The latest updates on the molecular mechanism, possible biomarkers, and treatment procedures may be beneficial for diagnostic and therapeutic purposes.
... 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]. ...
Preprint
Full-text available
Background: Various factors including diabetes and oxidative stress are associated with periodontal inflammation. In patients with end stage renal disease (ESRD), accumulation of uremic toxin leads to various systemic abnormalities, including cardiovascular disease, metabolic abnormalities, and infection. Even after kidney transplantation (KT), various 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, and diagnosed of periodontal disease were selected. As of November 2021, 923 participants, with full data including hematologic factors were studied. 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.
... Une méta-analyse combinant 5 études de cohorte (86 092 patients) a montré que les personnes atteintes de parodontite présentaient un risque de développer une coronaropathie plus de 1,14 fois supérieure à celui des témoins, indépendamment des facteurs de confusion (215 (221), suggérant que seul P. gingivalis exprime des facteurs de virulence pouvant induire l'agrégation plaquettaire. ...
... De plus, une association entre l'édentement et les anticorps sériques contre P. gingivalis et A. actinomycetemcomitans a été observée dans une étude portant sur 1163 hommes atteints de coronaropathie (216). De plus, des ADN d'agents pathogènes parodontaux, tels que P. gingivalis, A. actinomycetemcomitans, P. intermedia et T. forsythia, ont été trouvés dans des plaques d'athérosclérose humaine, ce qui suggère que ces agents pathogènes oraux pourraient migrer de la cavité buccale vers des sites distants du patient(215,216).Plus récemment, des études sur un modèle animal d'athérosclérose utilisant des souris hyperlipidémiques infectées par P. gingivalis et T. denticola ont montré que l'infection par cette bactérie était associée à une perte d'os alvéolaire et à une athérosclérose aortique(217,218). Après infection orale, P. gingivalis et T. denticola ont induit une réponse immunitaire systémique et un ADN génomique bactérien a été trouvé dans l'épithélium oral, l'aorte ainsi que dans les organes systémiques(217,218). De plus, P. gingivalis échappe à la détection immunitaire innée via le récepteur de type Toll (TLR) 4, facilitant ainsi l'inflammation chronique dans le système vasculaire(219). ...
Thesis
Le microbiote commensal de la sphère buccale, écosystème complexe, joue un rôle essentiel dans le maintien de la santé orale et systémique. Une relation homéostatique s’établit entre l’hôte et son microbiote résidant. Une perturbation de cet équilibre finement régulé, appelée dysbiose, favorise l’apparition de pathologies bucco-dentaires. A l’intérieur de cette sphère, les espaces interdentaires sont des niches écologiques riches en microorganismes commensaux et pathogènes. Ils restent un défi majeur pour la garantie d’une prophylaxie individuelle de qualité, car inaccessibles aux méthodes traditionnelles de désorganisation du biofilm par voie mécanique et/ou chimique. Notre recherche porte sur l’évaluation clinique de l’efficacité de mesures de prophylaxie orale individuelle des espaces interdentaires chez l’adulte jeune. Elle s’articule autour de deux axes : la désorganisation mécanique du biofilm et l’action chimique. Ainsi, sont évaluées l’efficacité de l’utilisation de brossettes interdentaires calibrées et l’efficacité d’un dentifrice/bain de bouche à base d’extrait de feuille de Carica papaya contenant des flavonoïdes antioxydants, sur la réduction de l’inflammation du parodonte interdentaire cliniquement sain, objectivée par l’évolution du saignement gingival. De même est évaluée la mise en oeuvre de modules d’enseignement théoriques et pratiques auprès des étudiants nécessaires à la transmission d’une connaissance de qualité. En conclusion, ce travail apporte des recommandations pour une orientation novatrice de la valorisation et de l’efficience de la prophylaxie individuelle en santé bucco-dentaire.
... Research shows increasing evidence shows an association exists between periodontal health and systemic diseases (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). In return, periodontal disease (PD) is a potential risk factor for diabetes mellitus (DM) (9,10,13,18,(21)(22)(23)(24)(25)(26)(27)(28)(29), cardiovascular disease (CVD) (10,18,23,24,30) and adverse pregnancy outcomes (APO) (31)(32)(33)(34). Studies suggest periodontal disease worsens glycemic control and increases the likelihood of negative cardiovascular events. ...
... Studies suggest periodontal disease worsens glycemic control and increases the likelihood of negative cardiovascular events. The literature also suggests a correlation between periodontal systemic bacteria, increased serum C-reactive protein levels (11,17,22), an increased risk of stroke (19,(21)(22)(23)(24)(25)(26), and coronary heart disease (7, 12, 14, 15, 17-19, 21, 22, 24-29). In addition, studies show an increase in cytokine production in mothers, a direct result of the inflammatory process related to periodontal disease, putting the patient at risk for adverse outcomes such as preterm low-birth weight (PLBW) (35). ...
Thesis
http://deepblue.lib.umich.edu/bitstream/2027.42/122730/1/Messenger_FullThesis.pdf
... Multiple studies have demonstrated the linkages between oral health and CVD risk (Buhlin et al. 2002;Meurman, Sanz, and Janket 2004;Jansson et al. 2001;Mattila et al. 1989;Dietrich et al. 2017). For example, the prevalence and incidence of coronary heart disease is significantly increased in periodontitis according to a meta-analysis of five cohort studies and 86,092 patients (Bahekar et al. 2007). Moreover, periodontal interventions have been shown to reduce the risk of CVD (Roca- Millan et al. 2018). ...
Article
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.
... Patients with poor oral hygiene, measured by plaque index, have a higher risk to develop autoimmune diseases [3]. Periodontal disease increases significantly the prevalence and incidence of coronary heart disease [4,5], and also the risk of preterm birth [6] and low birth weight [7]. Experiences in neural therapy (diagnostic and therapeutic applications of local anesthetics) [8] showed that inflammatory and mechanical problems in the teeth/jaw region can lead to referred pain or systemic illnesses [8][9][10][11][12]. ...
Article
Full-text available
Background: Inflammatory and mechanical stimuli in tooth/jaw pathologies can have far-reaching consequences via trigeminal and autonomic circuitry and can cause systemic (e. g. autoimmune) diseases and pain conditions outside the tooth/jaw region. In addition to a case report, we also describe new pathophysiological findings. Case report: We report on a patient with chronic, therapy-resistant neck pain whose cause lied in the tooth/jaw region, specifically, in wisdom teeth with room problems, and partially impacted. The tooth/jaw area itself was not painful; however, neck pain developed via the nucleus spinalis n. trigemini which extends into the cervical medulla. Surgical restoration of the wisdom teeth and subsequent neural therapy treatment of the extraction scars provided permanent pain relief. Conclusion: In case of therapy-resistant neck pain (among others), it is worthwhile to look for pathologies in the dental/jaw area, possibly allowing for a causal therapy.
... Hence, diabetes is a major health-care concern because of its high prevalence and its high social and health costs. [3] Another important aspect of the disease is the high morbidity and mortality rate it produces. Chronic hyperglycemia, the main characteristic of poorly managed DM, is associated with a wide range of acute and chronic complications that can affect all organs and systems of the body, including gum tissues. ...
... Both periodontitis and CVD are similar in that they are chronic processes and multifactorial in nature and certain risk factors such as age and gender, smoking, stress and lower socioeconomic status [20]. Studies have also shown that individuals with periodontitis had an increased risk of developing coronary heart disease as compared to the control group, independent of the other precipitating factors [5,21,22]. Microbiological studies of human atherosclerotic plaques have shown the presence of a variety of periodontal pathogens such as T. forsythia, A. actinomycetemcomitans, P. gingivalis and Prevotella intermedia (P. intermedia), indicating that these organisms reach distant sites from the oral cavity [23][24][25][26]. ...
Article
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The scope of dentistry is ever-changing and dynamic in all fields of dentistry including periodontal health and disease. Recent studies show that oral health and systemic health are interdependent, particularly in the way that poor oral hygiene and periodontal health affect the systemic health of an individual and vice versa. Periodontal diseases are multifactorial in nature in which the role of bacterial infections is inevitable. Furthermore, high-throughput sequencing technologies have shed light on the dysregulation of the growth of oral microbial flora and their environment, including those that are associated with periodontitis and other oral and non-oral diseases. Under such circumstances, it becomes important to explore oral microbiota and understand the effects of periodontal pathogens in the pathogenesis of systemic diseases. In addition, it may strengthen our view that a better understanding of oral microbial flora and proper examination of the oral cavity may aid in the early diagnosis and possible treatment of systemic diseases and conditions. This will eventually lead to providing better care to our patients. Therefore, in this research, we attempt to outline the periodontal pathophysiology along with the role of periodontal pathogens in some commonly encountered systemic conditions.
... In multiple studies, periodontal conditions have been related to other systemic diseases such as diabetes [101], cardiovascular diseases [102], Alzheimer's disease [103,104], and rheumatoid arthritis [105] and also to certain types of cancer [3,5,23,26,27,95]. It is increasingly being proven that the dissemination of pathobionts from the oral cavity to distal areas of the human body implies that these bacteria can exert harmful functions on human cells by colonizing these new ecological niches. ...
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Background: The carcinogenesis of colorectal cancer (CRC) is a multifactorial process involving both environmental and host factors, such as human genetics or the gut microbiome, which in CRC patients appears to be enriched in oral microorganisms. The aim of this work was to investigate the presence and activity of Parvimonas micrain CRC patients. To do that, samples collected from subgingival sulcus and neoplastic lesions were used for culturomics. Then, samples from different body locations (saliva, gingival crevicular fluid, feces, non-neoplastic colon mucosa, transition colon mucosa, adenocarcinoma, adenomas, metastatic and non-neoplastic liver samples) were used for 16S rRNA metabarcoding and metatranscriptomics. Whole genome sequencing was conducted for all P. micrastrains obtained. Results: Several P. micraisolates from the oral cavity and adenocarcinoma tissue from CRC patients were obtained. The comparison of oral and tumoral P. micra genomes identified that a pair of clones (PM89KC) were 99.2% identical between locations in one CRC patient, suggesting that the same clone migrated from oral cavity to the gut. The 16S rRNA metabarcoding analysis of samples from this patient revealed that P. micra cohabits with other periodontal pathogens such as Fusobacterium, Prevotella or Dialister, both in the intestine, liver and the subgingival space, which suggests that bacterial translocation from the subgingival environment to the colon or liver could be more efficient if these microorganisms travel together forming a synergistic consortium. In this way, bacteria might be able to perform tasks that are impossible for single cells. In fact, RNA-seq of the adenocarcinoma tissue confirmed the activity of these bacteria in the neoplastic tissue samples and revealed that different oral species, including P. micra, were significantly more active in the tumor compared to non-neoplastic tissue from the same individuals. Conclusion: P. micra appears to be able to translocate from the subgingival sulcus to the gut, where oral bacteria adapt to the new niche and could have a relevant role in carcinogenesis. According to our findings, periodontal disease, which increases the levels of these pathogens and facilitates their dissemination, could represent a risk factor for CRC development and P. micra could be used as a non-invasive CRC biomarker.
... 9 Results of a recent meta-analysis showed that periodontal disease as well as poor oral health could act as risk factors in the pathogenesis of cardiovascular disease. 10 The association between Cardiovascular disease & dental hygiene risk factors has been reported by Frisbee et al. with a drawback that study was based on selfreported oral hygiene behaviourand did not consider the clinical oral examination to investigate the association of different risk factors for both coditions. 1 Destructive periodontal disease involving various bacterial species including the Gramnegative ones have been reported to be a significant predictor of coronary heart disease 11 . ...
Article
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The fact that oral health is associated with cardiovascular disease has been established in a substantial number of studies, although we still do not know if the relationship between the two is causal in nature.There is increasing evidence on the basis of recent studieswhich supports the fact that oral infectionto be associated with cardiovascular disease development. The advent of the inflammation paradigm in coronary pathogenesis stimulated research in chronic infections caused by a variety of microorganisms such as Helicobacter pylori, Chlamydia pneumoniae and cytomegalovirus-and various other dental pathogens, since these chronic infections are thought to be involved in the etiopathogenesis of cardiovascular disease by releasing cytokines and other pro-inflammatory mediators.Evidence also suggests poor oral health in general to be associated with atherosclerotic cardiovascular disease; however, this relationship has not been a major focus in clinical practice of cardiology. Here, we have tried to review and find connection between various conditions of oral health related to the cardiovascular diseases.
... En cavidad oral existen múltiples patógenos relacionados con alteraciones sistémicas. Actualmente se conoce que existe una fuerte relación entre microrganismo periodontales y enfermedades sistémicas 280 , entre ellas tenemos enfermedades cardiovasculares 281 , diabetes 282,283 , Alzheimer 284 entre otras. También se ha relacionado la obesidad con alteraciones gingivales en adultos y en niños 285,286 . ...
Article
SECCION X. Prevención y control de la infección por SARS – COV-2/COVID-19
... Although the pathophysiological mechanism has not been fully explained, oral problems could have serious effects on the body through the dissemination of pathogenic bacteria in blood and bones and by causing a pro-inflammatory state in which systemic diseases could develop (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). In fact, since the mouth can be both a window and a gateway to the body, systemic conditions and side effects of medical therapies can lead to early manifestations in the mouth. ...
Article
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Background Even though various studies recognize the importance of the oral cavity to have general health, in multidisciplinary professional practice it is almost always excluded and on an individual basis, very commonly neglected. Oral diseases are preventable, still, they are highly prevalent. Although some studies consider oral health within integral health, currently, there is no model in which the mouth is integrated within other levels for the achievement of well-being. The objective of this article was to review the importance of oral health and its connection with well-being and, based on these findings, propose a complex and comprehensive perspective for approach and care.Methods The databases MEDLINE, PubMed, and Google Scholar were revised for randomized controlled trials and reviews that included search terms related to oral health and its relationship with the general health in its different levels (physical, psychological, social and environmental).ResultsThe review shows that oral health is critical, as the teeth and mouth are not only an integral part of the body, but also, they also support and enable essential human functions. That is, oral health has a multidimensional nature, as it includes the physical, psychological, social, and environmental domains that are essential for overall health and well-being. Likewise, the mouth is the psychological seat of the first physiological needs and emotional gratifications, with it we take a taste of the world around us. Thus, the mouth plays an important role in the feeling of unity and in the constitution of the self. Based on these results we propose an integrative model in which the mouth is the first step for well-being and from this integrative model we build a multidisciplinary approach which could be used in the clinical practice for the promotion of oral care and general health.Conclusion The effort on the part of oral health professionals is essential for people's well-being and must be integrated as part of health promotion. Dental treatments alone cannot solve this problem, it requires a comprehensive and approach in which the bio-psychological, behavioral, and socio-environmental determinants are included to face this global oral health challenge. That is, without a comprehensive and multidisciplinary approach to medical science that includes dental and oral health, our public policies cannot provide the best answers to health promotion, disease prevention, early detection, and treatment.
... So zeigten sich in Studien Zusammenhänge von Parodontitis mit koronaren Herzerkrankungen, rheumatoider Arthritis oder Diabetes (de Molon et al., 2019;Sanz et al., 2020c;Sgolastra et al., 2013). Diese Erkrankungen und die Parodontitis können sich zudem gegenseitig negativ verstärken (Bahekar et al., 2007;Chapple et al., 2013;Hajishengallis, 2015). Die Parodontitis ist somit keine isolierte Erkrankung des Zahnhalteapparats, sondern eine multifaktorielle Erkrankung, deren Ätiologie, Diagnostik, Klassifizierung und Therapie im Folgenden näher dargestellt werden soll (Hoffmann, 2006;Löe, 1973 (Chapple et al., 2015;Lertpimonchai et al., 2017). ...
Thesis
Während „mechanische“ Therapien zur Parodontitis gut untersucht sind, fehlen zusammenfassende Untersuchungen darüber, ob adjunktive Ernährungsinterventionen zur Parodontitistherapie einen zusätzlichen Vorteil bringen. Ziel der Untersuchung war es daher, eine systematische Literaturübersicht zu dieser Fragestellung durchzuführen. Dabei wurde der Einfluss von Ernährungsinterventionen als alleinige Therapie oder kombiniert mit subgingivalem Instrumentieren bei Probanden mit Parodontitis untersucht. Die Suche ergab insgesamt 3307 Treffer, davon wurden nach Prüfung der Ein- und Ausschlusskriterien fünf Studien eingeschlossen. Die Interrater-Reliabilität ergab einen guten Wert von 0,8 (Cohen’s Kappa). Acht zusätzliche Studien wurden durch eine erweiterte manuelle Suche identifiziert. Insgesamt zeigten acht der 13 Studien einen positiven Effekt durch die Ernährungstherapie in Form von signifikant reduzierten Sondierungstiefen, sowie einem signifikant erniedrigten BOP in vier der eingeschlossenen Studien. Vier Studien zeigten keine signifikanten Effekte der Ernährungsinterventionen auf die parodontalen Indizes und eine Studie zeigte zum Endzeitpunkt ein besseres Outcome in der Kontrollgruppe. In der Bewertung hinsichtlich des Bias erreichten die Studien eine Güte von 64-92%, im Durchschnitt 79,4% und lagen damit in einem guten Bereich. Es konnte geschlussfolgert werden, dass die überwiegende Anzahl der hier erfassten Untersuchungen einen positiven Effekt durch die Ernährungsinterventionen auf klinische Parodontitisparameter und auf systemische Entzündungsindizes feststellen konnten.
... Epidemiological studies have provided evidence for a positive association between periodontitis and incidence of CVD [30][31][32][33][34]. Moreover, the level of certain inflammatory mediators such as C-reactive protein and interleukin (IL)-6 were found to be associated with both diseases [35][36][37][38]. ...
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Tissue concentrations of advanced glycation end product (AGE) and peripheral soluble receptor of AGE (sRAGE) levels may be associated with periodontitis severity. Both parameters and periodontitis might serve as outcome predictors for patients undergoing coronary artery bypass grafting (CABG). This study aimed to investigate possible associations between periodontitis and AGE/sRAGE. Ultimately, we wanted to examine whether AGE, sRAGE, and severe periodontitis are associated with the incidence of new cardiovascular events within 3 years of follow-up after CABG. Ninety-five patients with coronary vascular disease (CVD) (age 69 years, 88.3% males) needing CABG surgery were included. Periodontal diagnosis was made according to the guidelines of the “Centers for Disease Control and Prevention (CDC)” (2007) and staged according to the new classification of periodontal diseases (2018). AGE tissue concentrations were assessed as skin autofluorescence (sAF). sRAGE levels were determined by using a commercially available enzyme-linked immunoabsorbance assay (ELISA) kit. Univariate and multivariate baseline and survival analyses were carried out with Mann–Whitney U test, Chi² test, Kaplan–Meier curves with Log-Rank test, and logistic and Cox regression. sAF was identified as an independent risk indicator for severe periodontitis with respect to the cofactors age, gender, plaque index, and diabetes (adjusted odds ratio [OR] = 2.9, p = 0.028). The degree of subgingival inflammation assessed as a percentage of sites with bleeding on probing (BOP) was inversely correlated with sRAGE concentration (r = −0.189, p = 0.034). Both sAF (Hazard Ratio [HR] = 2.4, p = 0.004) and sRAGE (HR = 1.9, p = 0.031) increased the crude risk for new adverse events after CABG. The occurrence of severe periodontitis trends towards a higher risk for new cardiovascular events (HR = 1.8, p = 0.115). Applying multivariate Cox regression, only peripheral arterial disease (adjusted HR = 2.7, p = 0.006) and history of myocardial infarction (adjusted HR = 2.8, p = 0.010) proved to be independent risk factors for cardiovascular outcome. We conclude that sAF may represent a new, independent risk indicator for severe periodontitis. In contrast, sAF, sRAGE, and severe periodontitis were not independent prognostic factors for postoperative outcome in patients undergoing CABG.
... 3 Previous studies have demonstrated that the presence of periodontitis is associated with adverse impacts on systemic health, mainly in diseases with a chronic inflammatory component, such as diabetes, 4 rheumatoid arthritis, 5,6 and atherosclerotic cardiovascular disease. 7,8 Interestingly, epidemiological studies have also demonstrated an association between periodontitis and IBD. [9][10][11][12] A recent, large-scale, questionnaire-based, case-control study-the first of its kind in a European population-investigated the possible association between IBD and periodontitis specifically, as well as other oral health-related aspects. ...
Article
Background Inflammatory bowel disease (IBD) and periodontitis are chronic, progressive, inflammatory diseases with similarly complex pathogeneses that involve an interplay between dysbiotic microbiota and dysregulated immune-inflammatory responses. However, whether the presence of periodontitis is associated with IBD activity and/or its severity remains unknown. Methods An online, questionnaire-based study was answered by 1093 patients with IBD, comprising 527 patients with Crohn’s disease and 566 patients with ulcerative colitis. The survey included questions on social demographics; oral health, including the Periodontal Screening Score (PESS); and IBD-related characteristics, including validated disease indices. Results Irrespective of disease subtype, patients with a reduced number of teeth and those with self-reported severe periodontitis scored significantly higher on the IBD disability index (number of teeth: coefficient, 4.93 [95% confidence interval {CI}, 1.21–8.66; P = .010]; periodontitis: coefficient, 3.54 [95% CI, 0.27–6.80; P = .034]) and reported increased disease activity in the preceding 12 months (number of teeth: odds ratio [OR], 1.91 [95% CI, 1.36–2.69; P < .001]; periodontitis: OR, 1.71 [95% CI, 1.27–2.31; P < .001]). There was also evidence of a weak association between self-reported severe periodontitis and current disease activity (OR, 1.33; 95% CI, 0.95–1.86; P = .099). However, IBD severity, as a composite parameter of a history of surgery due to IBD and/or treatment with biological therapy, was not associated with possessing a reduced number of teeth (OR, 1.18; 95% CI, 0.77–1.80; P = .451), nor with self-reported severe periodontitis (OR, 1.15; 95% CI, 0.79–1.66; P = .467). Conclusions Periodontitis and tooth loss were significantly associated with increased IBD-related disability and more disease activity in the preceding 12 months. Our results suggest that greater attention should be paid to IBD patients’ oral health.
... Given that sour signals recognize food is spoiled and that bitter signals recognize non-food substances or dangerous substances, the downregulated expression of these genes may be related to the infectious oral environment in diabetes. Evidence suggests that periodontal infection is associated with an increased risk of diseases such as atherosclerotic vascular diseases and type 2 diabetes (28)(29)(30)(31). Further studies are warranted to elucidate the association between the oral environment such as periodontal infection and taste impairment, including taste gene expression. ...
Article
Dysgeusia is not only associated with zinc deficiency but also with certain drugs or diseases, including diabetes and renal failure. It often lowers the patient's quality of life and hinders access to proper nutrition. The underlying mechanism is unclear and there is a lack of awareness among patients. Here, we focused on lingual taste receptor gene expression in diabetes and elucidated the relationship between taste receptor gene expression and renal function. Forty-seven patients with diabetes and 10 healthy subjects (control group) were enrolled. Lingual foliate papillae were scraped and the derived cDNA was quantified by real-time polymerase chain reaction. Dysgeusia was assessed using SALSAVE?. All statistical analyses were performed using JMP? software 13. The expression of T1R1 and T1R2 was significantly upregulated in type 2 diabetes patients as compared with that in healthy subjects (P<0.01) but did not change in type 1 diabetes patients. T1R3 expression positively correlated and Scnn1 expression negatively correlated with estimated glomerular filtration rate, suggesting that altered taste receptor gene expression could reflect impaired renal function. Thus, alterations in T1R3 and Scnn1 expression in diabetes correlated with renal function. Taste receptor gene expression dysregulation could indicate dysgeusia associated with impaired renal function in patients with diabetes. J. Med. Invest. 69 : 120-126, February, 2022.
... Bacteremia due to periodontal pathogens induce multipotent progenitors such as myeloid potential and granulocyte-macrophage progenitors, which promotes inflammation in other organs [10]. Oral inflammation has a deteriorative effect on several organ systems and increases the risk of developing systemic diseases, such as diabetes [11][12][13], cardiovascular diseases [14], low-weight birth [15], atherosclerosis [16], amyotrophic lateral sclerosis [17], and respiratory tract infection [18]. A previous case-control study demonstrated that people suffering from periodontitis had a three times higher risk for the development of hospital-acquired pneumonia compared with inpatients without periodontitis [19]. ...
Article
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Background: Periodontal pathogens are related to the incidence of systemic diseases. This study aimed to examine whether periodontal pathogen burden is associated with the risk of fever onset in older adults. Methods: Older adults in nursing homes, aged ≥65 years, were enrolled. The study was set in Kitakyushu, Japan. The body temperatures of participants were ≥37.2 °C and were recorded for eight months. As periodontal pathogens, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia were qualified by a real-time polymerase chain reaction at the baseline. For statistical analysis, the number of bacterial counts was logarithmically conversed to 10 as a base. Results: Data from 56 participants with a median age of 88 (62-98) years were available for analysis. The logarithmic-conversed bacterial counts of T. forsythia, but not P. gingivalis or T. denticola, were associated with the onset of fever in older residents. The Kaplan-Meier method revealed that the group with <104 of T. forsythia had significantly less cumulative fever incidence than the group with ≥104 of T. forsythia. The group with ≥104 of T. forsythia was associated with an increased risk of fever onset (hazard ratio, 3.7; 98% confidence interval, 1.3-10.2; p = 0.012), which was adjusted for possible confounders. Conclusions: Bacterial burden of T. forsythia in the oral cavity was associated with the risk of the onset of fever in older nursing homes residents.
... Systemic complications of PD for example, cardiac complications, low birth weight and glycemic control issues in diabetics also impose a burden on the health system [3]. A study conducted by Bahekar et al. found that those with less than ten teeth had a 1.24 times increased risk of developing coronary heart disease, when compared to those with more than ten teeth [4]. A further study concluded that the odds ratio of mothers with periodontitis and pre-term births or low birth rates was 2.83, compared to those that were periodontally healthy [5]. ...
Article
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The aim of this systemic review was to collate and analyze existing data from published literature sources to identify the current understanding of the role of epigenetic and biological biomarkers in periodontal disease and diagnostics. A comprehensive searching strategy was undertaken in Embase, Medline, The Dentistry and Oral Sciences and CINAHL databases. Grey literature searching strategies were also employed. Articles published in the English language between 2017–2020 were included. A total of 1014 studies were returned of which 15 studies were included. All included articles were cross-sectional, case–control studies. Relevant data were extracted according to various demographic and methodological factors including cohort size, oral biofluid sampled, number of examiners, smoking status and reported outcomes. A measure of the biomarker levels and corresponding significance were documented where possible. This review identified that exRNA has the greatest diagnostic potential, with four biomarkers (SPRR1A, lnc-TET3-2:1, FAM25A, CRCT1) displaying sensitivity of >71% and specificity of 100% in the assessed samples (p < 0.001) for gingivitis. This work also identifies the need for a unified approach to future research to draw meaningful comparison. Further investigations are warranted to definitively validate exRNA data and for the development of an exRNA-specific point-of-care diagnostic test.
... Several epidemiological studies have demonstrated that periodontitis, which is also considered an NCD, is associated with atherosclerosis and CVDs such as myocardial infarction or stroke. [6][7][8] Ahn et al. 9 revealed an association between clinical attachment loss, which was measured by radiographic alveolar bone loss (BL) and peripheral arterial disease. Further, regarding subclinical cardiovascular disease, several studies have reported that carotid intima-media thickness (IMT) is related to periodontal disease. ...
Article
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Objective: We aimed to explore the association between regular dental visits and atherosclerosis and between periodontitis, number of remaining teeth, and atherosclerosis among community dwellers in Japan. Background: Few studies have examined the association between regular dental visits, periodontitis, tooth loss, and atherosclerosis in community dwellers in Japan. Methods: The participants of this cross-sectional study included community dwellers aged ≥55 years and residing in Ohasama. Exposure variables were regular dental visits; periodontitis, defined as radiographic alveolar bone loss (BL); the Centers for Disease Control/American Academy of Periodontology (CDC/AAP) classification; and number of remaining teeth. The primary outcome was atherosclerosis, defined as maximum carotid intima-media thickness ≥1.1 mm or confirmation of atheromatous plaque. Results: Of 602 participants, 117 had atherosclerosis. In the multivariate model, compared to those with regular dental visits, the odds ratio (OR) (95% confidence intervals [CIs]) of atherosclerosis among those with the absence of regular dental visits was 2.16 (1.03-4.49). Regarding BL-max, compared with those in the first quartile, ORs (95% CIs) of those in the second, third, and fourth quartiles were 1.15 (0.65-2.30), 0.65 (0.32-1.35), and 1.57 (0.81-3.01), respectively. Regarding CDC/AAP classification, compared to those with no or mild periodontitis, ORs (95% CIs) for those with moderate and severe periodontitis were 2.48 (0.61-10.1) and 4.26 (1.01-17.5), respectively. Regarding the number of remaining teeth, compared to those with ≥20 teeth, ORs (95%CIs) for those with 10-19 and 1-9 teeth were 1.77 (1.004-3.12) and 0.96 (0.52-1.80), respectively. Conclusion: The absence of regular dental visits and presence of periodontitis are associated with atherosclerosis among community dwellers in Japan.
... 으로 나타났다 6,7) . 이렇듯 Difficulty in continuous preventive service operation (6) Activity (11) Low activity of preventive dental services Lack of dedicated preventive service staff (4) The gap between revenue generation and dental preventive service (1) The philosophy focused on treatment rather than prevention (4) Problems of dental professionals (23) Obstacles of dental professionals to participate in preventive dental services Lack of dental preventive service representative (5) Low satisfaction with preventive dental service (3) Lack of success model with preventive dental services (2) Poor systematic process of preventive dental services (5) Non-help for working career in a preventive service team (3) Low awareness of dental preventive service (8) Problems of patients (17) Obstacles of patients to participate in preventive dental services Less visible effects than treatment (5) Lack of time to communicate (1) Relatively low demand for preventive dental services (3) Effect of preventive service (8) Importance (18) The essential importance of preventive service in dentistry Satisfaction (10) Improving awareness of dental preventive service (2) Improvement (22) Activation plan of preventive dental service Development and supplementation of dental preventive service programs (4) Securing of dedicated personnel for preventive service (5) Devise appropriate cost (2) Educating staff and patients and building intimacy (9) Activation of preventive dental services (11) Increase activity of preventive dental services ...
... Then, periodontitis becomes a cause of, rather than just a condition that coexists with cardiovascular disease. [21,25] The DNA from P. gingivalis and Aggregatibacter actinomycetemcomitans has been identified in arterial plaques further support that there is a link between the oral microflora and cardiovascular disease. [26] Together with studies in which periodontal intervention influenced inflammatory markers of cardiovascular risk for up to 6 months after the intervention, [27,28] these findings were taken as evidence of a causal relationship. ...
Article
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Background: Periodontitis is a chronic inflammatory disease and has been strongly associated with elevation of systemic markers such as C-reactive protein (CRP), fibrinogen (FIB), and lipid profile, which have also been significantly associated with coronary heart disease (CHD). Hence, there is a need to assess the possible association between chronic periodontitis and coronary artery disease. Materials and methods: A study included 100 subjects divided into four groups. Group I: stable coronary artery disease with chronic periodontitis, Group II: stable coronary artery disease without chronic periodontitis, Group III: chronic periodontitis without coronary artery disease, and Group IV: healthy controls. Gingival index, Russell's periodontal index, pocket depth, and clinical attachment level were recorded. Venous blood was collected from the patients, and serum fibrinogen, CRP, and lipid profile levels were estimated. Results: The intragroup comparison of biochemical and periodontal parameters showed statistically significant results with P < 0.05. The intergroup comparison of serum FIB, total cholesterol, high density lipoprotein, low density lipoprotein, and clinical attachment level showed statistical significant results (P = 0.000, P = 0.000, P = 0.001, P = 0.025, and P = 0.000, respectively) between Groups I and III. Conclusion: The results of the study indicate that there might a possible correlation between coronary artery disease and chronic periodontitis, but periodontitis-cardiovascular link is complex and difficult to define though there is sufficient evidence for their association. Leakage of pro-inflammatory cytokines from the ulcerated periodontium causes the production of acute-phase proteins by the liver. To prove the relationship, further studies should be considered making use of other markers of inflammation with prospective randomized controlled studies involving large population.
... Moreover, a more recent study of P. intermedia placed its relationship with periodontitis and AMI closer to the spotlight [78]. A meta-analysis by Bahekar et al. of five cohort studies showed that people with periodontal disease had a 1.14 times higher risk of developing CAD compared to controls independent of confounding factors [79]. Some relevant sample studies are shown in Table 2. ...
Article
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By 2030, non-communicable diseases will have accounted for more than three-quarters of deaths worldwide. Cardiovascular diseases (CVDs) have been the leading cause of death worldwide for several years. Acute myocardial infarction (AMI) is a CVD characterized by necrosis of the heart at the myocardial level due to prolonged ischemia caused by the reduction or sudden absence of coronary blood supply. The prevalence of AMI is higher in men at all ages. The incidence of AMI has decreased in industrialized nations; however, it has been on the rise in Latin America (LATAM) due to lifestyle changes. These changes have caused the combined incidence of CVDs and unresolved health concerns in LATAM, such as infections and malnutrition. It is well known that periodontitis, a highly prevalent chronic infectious inflammatory disease, has been associated with systemic diseases, such as diabetes, kidney diseases, and AMI. This review addresses proposed aspects of the correlation between periodontitis and AMI, explains the importance of preventing periodontitis and CVDs, and analyzes the preventative measures being implemented in LATAM, particularly in Mexico.
... Since then, many other systematic reviews and meta-analyses highlighted this idea. Periodontitis patients had 19%, 15% and 14% increased risk of developing CVD, respectively [36][37][38]. ...
Chapter
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Due to the important advancement and the accumulation of new evidence on the periodontitis-cardiovascular disease (CVD) relationship as well as the major medical, economic and social burden caused by both diseases this chapter aims to review existing epidemiological and pathogenetic links related to this topic. Also, this chapter aims to highlight the impact of the periodontitis-CVD relationships on clinical practice and on the preventive approaches targeting to decrease the impact of periodontitis on CVD. Periodontitis is an infectious disease eliciting local and general inflammation, which leads to periodontal destruction and systemic involvement. Several pathways could explain the link between periodontitis and CVD such as bacteraemia, chronic persistent systemic inflammation and oxidative stress. The first step in the treatment of periodontitis addresses the elimination of microbial components, which lead to a decrease in local and systemic inflammation. Periodontal therapy seems to positively impact CVD. Specialists should inform patients with CVD on the negative impact of periodontitis on their systemic status and refer patients to the periodontist for an extensive examination as routine management of CVD. Some possible risks of periodontal therapy should be considered in patients undergoing antithrombotic medication.
... Conditions linked to oral infections include diabetes; [16][17][18][19][20] cardiovascular diseases such as atherosclerosis, acute myocardial infarction and stroke; [21][22][23][24][25][26][27] rheumatoid arthritis; [28,29] obstructive pulmonary disease; [30,31] osteopenia [32,33] and low birth-weight preterm pregnancies [34][35][36]. There are indirect benefits of periodontal therapy (PT) for these patients including lower health care costs and fewer hospital visits [37]. ...
Article
Full-text available
Background: Periodontal disease is linked to numerous systemic diseases and it is known that periodontal therapy (PT) is effective in reducing the severity of those diseases. We tested the idea that PT also has a positive effect on quality of life and general wellness.
... In their review, they concluded that CAD was more prevalent in patients who underwent dental extractions owing to the presence of dental infections. Furthermore, at least four meta-analyses reviewing prospective cohort and case control studies have associated periodontitis with atherosclerotic vascular diseases, including stroke, myocardial infarction, peripheral vascular disease, abdominal aortic aneurysm, coronary heart disease and cardiovascular deaths [13][14][15][16] . A recent, national, retrospective cohort study conducted in the Taiwanese population found that males with chronic periodontitis had a significantly higher incidence risk of carotid atherosclerosis than males without chronic periodontitis 17 . ...
Article
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It has been hypothesised that oral bacteria can migrate, through the blood, from the mouth to the arterial plaques, thus exacerbating atherosclerosis. This study compared bacteria present in the peripheral blood of individuals with and without coronary artery disease (CAD). RNA sequences obtained from blood were downloaded from GEO (GSE58150). Eight patients with coronary artery calcification (CAC) scoring > 500 and eight healthy individuals were analysed. After conducting quality control, the sequences were aligned to the hg38 reference genome using Hisat2. Bacterial taxa were analysed by inputting the unmapped sequences into Kraken. Ecological indices were calculated using Vegan. The package DESeq2 was used to compare the counts of bacteria per standard rank between groups. A total of 51 species were found only in patients with CAD and 41 were exclusively present in healthy individuals. The counts of one phylum, one class, three orders, two families and one genus were significantly different between the analysed groups (p < 0.00032, FDR < 10%), including the orders Cardiobacteriales, Corynebacteriales and Fusobacteriales. Twenty-three bacterial species belonging to the subgingival plaque bacterial complexes were also identified in the blood of individuals from both the groups; Fusobacterium nucleatum was significantly less frequent in patients with CAD (p = 0.0012, FDR = 4.8%). Furthermore, the frequency of another 11 bacteria differed significantly among patients with CAD than that among healthy individuals (p < 0.0030, FDR < 10%). These bacteria have not been previously reported in patients with atherosclerosis and periodontitis. The presence of members of the subgingival plaque bacterial complexes in the blood of patients with CAC supports the hypothesis that the periodontopathogens can be disseminated through the blood flow to other body parts where they may enhance inflammatory processes that can lead to the development or exacerbation of atherosclerosis.
... Porphyromonas gingivalis, an anaerobic, nonmotile gramnegative bacterium, is the major human oral pathogen associated with periodontal diseases (1,2). Chronic P. gingivalis infection is also linked to rheumatoid arthritis, heart disease, diabetes, Alzheimer disease, and other systemic diseases (3)(4)(5)(6)(7)(8)(9). Virulence factors responsible for P. gingivalis pathogenesis are secreted through the Bacteroidetes-specific type IX secretion system (T9SS) (10)(11)(12). ...
Article
Full-text available
Porphyromonas gingivalis, the major human pathogen bacterium associated with periodontal diseases, secretes virulence factors through the Bacteroidetes-specific type IX secretion system (T9SS). Effector proteins of the T9SS are recognized by the complex via their conserved C-terminal domains (CTD). Among the 18 proteins essential for T9SS function in P. gingivalis, PorN is a periplasmic protein that forms large ring-shaped structures in association with the PorK outer membrane lipoprotein. PorN also mediates contacts with the PorM subunit of the PorLM energetic module, and with the effector’s CTD. However, no information is available on the PorN structure and on the implication of PorN domains for T9SS assembly and effector recognition. Here we present the crystal structure of PorN at 2.0-Å resolution, which represents a novel fold with no significant similarity to any known structure. In agreement with in silico analyses, we also found that the N- and C-terminal regions of PorN are intrinsically disordered. Our functional studies showed that the N-terminal disordered region is involved in PorN dimerization while the C-terminal disordered region is involved in the interaction with PorK. Finally, we determined that the folded PorN central domain is involved in the interaction with PorM, as well as with the effector’s CTD. Altogether, these results lay the foundations for a more comprehensive model of T9SS architecture and effector transport.
... Direct oral microbial effects on the vascular system have also been suggested to affect BP via potential interactions of circulating bacteria with the vascular endothelium (23). Regarding the relationship existing on the triad: imbalance (dysbiosis) of the oral microbiome structure-periodontitis-cardiovascular disease, a number of cross-sectional, case-control, and cohort studies suggest that periodontitis is associated with CVD, specifically with atherosclerosis, by mechanisms involving microbial dysbiosis (24,25). ...
Article
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Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. High blood pressure in particular, continues to increase throughout the global population at an increasingly fast pace. The relationship between arterial hypertension and periodontitis has been recently discussed in the context of its origins and implications. Particularly relevant is the role of the periodontal microbiome linked to persistent local and systemic inflammation, along with other risk factors and social determinants of health. The present protocol will investigate/assess the association between periodontal disease and its microbiome on the onset of hypertension, within a cohort from Mexico City. One thousand two hundred twelve participants will be studied during a 60-month period. Studies will include analysis of periodontal conditions, sampling and sequencing of the salivary and subgingival microbiome, interviews on nutritional and lifestyle habits, social determinants of health, blood pressure and anthropometric measurements. Statistical associations and several classic epidemiology and machine learning approaches will be performed to analyze the data. Implications for the generation of public policy—by early public health interventions or epidemiological surveillance approaches—and for the population empowerment—via the establishment of primary prevention recommendations, highlighting the relationship between oral and cardiovascular health—will be considered. This latter set of interventions will be supported by a carefully planned science communication and health promotion strategy. This study has been registered and approved by the Research and Ethics Committee of the School of Dentistry, Universidad Nacional Autónoma de México (CIE/0308/05/2019) and the National Institute of Genomic Medicine (CEI/2020/12). The umbrella cohort was approved by the Institutional Bioethics Committee of the National Institute of Cardiology-Ignacio Chavez (INC-ICh) under code 13-802.
... ;Bahekar, Singh, Saha, Molnar, & Arora, 2007;Cornelissen, Van Kleef, Mekhail, Day, & Van Zundert, 2009). ...
Article
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Primary headaches (PHs) are common health complaints with a high impact on health-related quality of life (HRQOL). Treatment is multifactorial, including pharmacological and non-pharmacological strategies. Neural therapy (NT) is a regulatory treatment system that uses local anesthetic injections in chosen points to treat pain. This study aims to evaluate the effect of NT on the HRQOL of patients with PHs. Quasi-experimental prospective study involving 93 patients treated. The impact on HRQOL was evaluated through the SF-36 health, before and after treatment. Seven out of the eight items measured on the SF-36 scale improved after the intervention (p<0.001).
... ;Bahekar, Singh, Saha, Molnar, & Arora, 2007;Cornelissen, Van Kleef, Mekhail, Day, & Van Zundert, 2009). ...
Article
Primary headaches (PHs) are common health complaints with a high impact on health-related quality of life (HRQOL). Treatment is multifactorial, including pharmacological and non-pharmacological strategies. Neural therapy (NT) is a regulatory treatment system that uses local anesthetic injections in chosen points to treat pain. This study aims to evaluate the effect of NT on the HRQOL of patients with PHs. Quasi-experimental prospective study involving 93 patients treated. The impact on HRQOL was evaluated through the SF-36 health, before and after treatment. Seven out of the eight items measured on the SF-36 scale improved after the intervention (p<0.001).
... Numerous mechanisms have been proposed as links between periodontitis and atherosclerotic CVD, but the most important include systemic inflammation, molecular mimicry and direct plaque colonization by periodontal pathogens [38]. Several systematic reviews and meta-analyses have reported an association between periodontal disease and ischaemic heart disease [43][44][45][46][47]. Some authors have suggested that at clinical exploration level, periodontitis and CVD have a weak association, and that, actually, systemic bacterial exposure from periodontitis could be a more plausible risk factor. ...
Article
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Essential oils from different plant species were found to contain different compounds exhibiting anti-inflammatory effects with the potential to be a valid alternative to conventional chemotherapy that is limited in long-term use due to its serious side effects. Generally, the first mechanism by which an organism counteracts injurious stimuli is inflammation, which is considered a part of the innate immune system. Periodontitis is an infectious and inflammatory disease caused by a dysbiosis in the subgingival microbiome that triggers an exacerbated immune response of the host. The immune–inflammatory component leads to the destruction of gingival and alveolar bone tissue. The main anti-inflammation strategies negatively modulate the inflammatory pathways and the involvement of inflammatory mediators by interfering with the gene’s expression or on the activity of some enzymes and so affecting the release of proinflammatory cytokines. These effects are a possible target from an effective and safe approach, suing plant-derived anti-inflammatory agents. The aim of the present review is to summarize the current evidence about the effects of essentials oils from derived from plants of the Lamiaceae family as complementary agents for the treatment of subjects with periodontitis and their possible effect on the cardiovascular risk of these patients.
... The main reason for the reduction in CVD mortality is improvements in the prevalence of the disease. In the WHO MONICA project, the incidence of the coronary incident resulted in a 79% decrease in the overall CHD mortality in men and 65% for women [3] . The cumulative vulnerability is determined both by the prevalence and death rate. ...
... (1) Several investigations revealed that periodontal disease is commonly related to atherosclerosis (2,3) , myocardial infarction, cerebrovascular disease, and peripheral vascular diseases. (4,5) Cardiovascular diseases remain the main cause of death worldwide and especially in developed countries. (6) Atherosclerosis is the disease mechanism that causes most of cardiovascular diseases. ...
Article
EFFECT OF NONSURGICAL PERIODONTAL THERAPY ON SYSTEMIC PRO-INFLAMMATORY AND VASCULAR ENDOTHELIAL BIOMARKERS AND SERUM LIPID PROFILE IN CHRONIC PERIODONTITIS PATIENTS
... The studies carried on investigating the role of PCSK9 in bacterial infections other than sepsis or septic shock involved mainly periodontitis. Periodontitis is a highly prevalent infectious disease genetically associated with coronary heart disease [104]. ...
Article
Background In recent years, many aspects of the physiological role of PCSK9 have been elucidated, particularly regarding its role in lipid metabolism, cardiovascular risk, and its role in innate immunity. Increasing evidence is available about the involvement of PCSK9 in the pathogenesis of viral infections, mainly HCV, and the regulation of host response to bacterial infections, primarily sepsis and septic shock. Moreover, the action of PCSK9 has been investigated as a crucial step in the pathogenesis of malaria infection and disease severity. Objective This paper aims to review the available published literature on the role of PCSK9 in a wide array of infectious diseases. Conclusion Besides the ongoing investigation on PCSK9 inhibition among HIV-infected patients to treat HIV- and ART-related hyperlipidemia, preclinical studies indicate how PCSK9 is involved in reducing the replication of HCV. Interestingly, high plasmatic PCSK9 levels have been described in patients with sepsis. Moreover, a protective role of PCSK9 inhibition has also been proposed against dengue and SARS-CoV-2 viral infections. Finally, a loss of function in the PCSK9-encoding gene has been reported to reduce malaria infection mortality.
... The link between oral health and CVD has yet to be confirmed, although Frisbee et al. found a link between dental hygiene and CVD risk variables. This study relied on self-reported oral hygiene behavior [12][13][14] and did not include a clinical oral examination to look into the relationship between various risk factors for both disorders [15][16][17][18][19][20]. ...
Article
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A population-based cluster sampling method was used to recruit 5900 Kerman residents aged 15 to 75 years old. Participants were interviewed for CVD risk factors after providing informed consent. Some oral health markers were evaluated, including DMFT, Gingival Inflammation Index, and Community Periodontal Index. Multivariate regression models were used to investigate the link between oral health indicators and CVD risk variables. Results. The participants' average age was 33.5 years, and 45.1 percent of them were men. In 67.6% of the subjects, there was moderate gingival irritation. Participants were more likely to have sub- or supragingival calculus (90 percent). Cigarette smoking, increased with age (RR from 2.7 to 3.88). (RR = 1.49), and high blood glucose (RR = 1.41) showed an increased risk for oral diseases after adjustment for different covariates including established CVD risk factors. In the presence of some CVD risk factors, the study found an increase in periodontal disorders. As a result, both illnesses may have a bilateral but independent relationship, and a joint risk factor approach preventive program is strongly recommended. Keywords: Periodontal disease, cardiovascular disease (CVD), atherosclerotic cardiovascular disease (ASCVD).
Article
Background and objective: Soluble ST2 (sST2) is a current biomarker of cardiovascular disease. It is used to predict susceptibility to cardiovascular diseases and to analyze their prognosis. Serum sST2 level increases in inflammatory diseases such as periodontitis. However, the level of sST2 in peri-implant diseases and crevicular fluid has not been investigated yet. Thus, the aim of this cross-sectional study is to analyze the level of sST2 in peri-implant health and diseases. Methods: Sixty-nine participants were divided into 3 groups as peri-implant health (PH), peri-implant mucositis (PM), and peri-implantitis (P-I). Peri-implant crevicular fluid (PICF) and serum samples were collected from each participant. The levels of sST2 and IL-6 in PICF and sST2, IL-6, and CRP in serum were compared between the groups. Pocket depth (PD), modified bleeding index (mBI), modified plaque index (mPI), keratinized mucosa index (KTW), and gingival/mucosal recession (REC) were recorded as clinical parameters. Biomarkers in the serum and PICF were analyzed by ELISA kit. Results: Sixty-nine patients were included in the study. The differences in the following parameters were statistically significant between groups: age (p = .009), implant function time (p = .027), PD (p < .001), mBI (p < .001), mPI (p < .001), and KTW (p = .043). The PICF volume of P-I and PM groups were statistically higher than PH (p < .001). The amount of sST2 in P-I and PM groups were higher than PH (p = .043). Serum CRP was higher in the P-I group than in other groups (p = .034). There were no significant differences in serum sST2 (p = .247) and IL-6 (p = .110) levels between groups. Conclusion: The PICF levels of sST2 were significantly higher in PM and P-I groups compared to the healthy group. However, no significant difference was observed between the groups in terms of serum sST2 level.
Preprint
Qionggui Power (QP), a classic prescription in Traditional Chinese Medicine (TCM), has shown potential in the treatment of atherosclerosis during the past decades. However, the mechanism that mediates these cardiovascular benefits remains to be fully elucidated. Here, we investigated the effects and mechanisms of QP against atherosclerosis with network pharmacology approaches and in vitro model. The active ingredients and related targets of QP were collected from public databases. The hub targets and signaling pathways of QP against AS were defined by extensive application of bioinformatics approaches, including the protein-protein interaction (PPI) network, Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG). The predicted major targets were validated in LPS-stimulated murine macrophages RAW264.7. The anti-inflammatory properties of QP were also evaluated in this model. In silico investigation of QP resulted in the identification of 18 active ingredients and 49 chemical targets intersecting with AS-related genes. And KEGG pathway analysis revealed a high enrichment in the Lipid and Atherosclerosis pathway of these chemical targets. Biochemical analysis showed marked effects of QP on the expression of predicted chemical targets (PPARr, CAT, PTGS2) and LPS-induced inflammatory genes (IL1, IL6, and TNFα). And these inhibitory effects were linked to the suppression of the NF-κB signaling pathway, which was activated by the LPS stimulus. Our findings revealed the therapeutic potential of QP in the prevention and treatment of atherosclerosis. Graphical Abstract
Article
Objective: The aim of this study was to evaluate the efficacy of diode laser (DL) therapy as an adjunct to nonsurgical periodontal therapy in the treatment of periodontitis in patients after myocardial infarction (MI). Methods: After given permission by Ethics Commission of the Pomeranian Medical University (KB-0012/06/12), 36 patients <65 years of age (mean: 56.3 ± 7.9) with periodontitis, 6 weeks to 6 months after MI were enrolled for the study. The control group (n = 18) received nonsurgical periodontal therapy, whereas the test group (n = 18) received nonsurgical periodontal therapy followed by laser therapy of the periodontal pockets with 980 nm DL, 1 W, continuous wave mode, and 20 sec per tooth side. Procedures were repeated twice at 5-7 day intervals. Clinical periodontal parameters and inflammatory markers in gingival crevicular fluid (GCF) [elastase, aspartate transaminase (AST), alanine transaminase (ALT) and interleukin (IL)-6, proteins], bloodstream [fibrinogen, high-sensitivity CRP (hs-CRP), IL-6, AST and ALT], and lipid fractions (triglycerides, high-density lipoprotein, low-density lipoprotein, and total cholesterol) were measured before treatment, 2 weeks, and 3 months after treatment. Results: The difference between groups in the reduction of periodontal pocket depth (PPD) in pockets ≥7 mm was found to be significant in the test group (p < 0.05). There was also a statistically significant reduction in the volume of GCF and hs-CRP concentration in blood 2 weeks after the completion of treatment in the test group (p < 0.05). Conclusions: Within the limits of this study, it can be concluded that in the nonsurgical treatment of periodontitis with patients after MI, the additional use of DL enables greater reduction of PPD in pockets ≥7 mm. In addition, a faster reduction of GCF volume and hs-CRP was noted in the laser group.
Chapter
Most pathogenic bacteria species form biofilm as their protective mode of growth, which helps them survive from the bactericidal effect of the antimicrobials or the killing activity of the host immune cells. The bacteria cells’ survivability via biofilm formation creates challenges in the medical field in terms of the device and also disease-related to biofilm. The impact of the bacterial biofilm issue is worsening over time, and the association to the high tolerance to the antimicrobial agents leads to increased morbidity and mortality worldwide. This review will highlight the main characteristics of the biofilm, the issue of biofilm in clinical practice, which also covered the pertinence of the biofilm in clinical practice, device-related biofilm disease, oral disease, and the significant bacterial species involved in the biofilm-related infections. Knowledge about the vital role of bacterial biofilm in related disorders will give new insight into the best approaches and alternative treatments for biofilm-related disease.
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Periodontitis is one of the most common infectious diseases in humans. It is characterized by a chronic inflammation of the tooth-supporting tissue that results in bone loss. However, the role and source of the pro-inflammatory cytokine interleukin-17 (IL-17) and of the cells producing it locally in the gingiva is still controversial. Th17 αβ T cells, CD4 ⁺ exFoxP3 ⁺ αβ T cells, or IL-17-producing γδ T cells (γδ17 cells) seem to be decisive cellular players in periodontal inflammation. To address these issues in an experimental model for periodontitis, we employed genetic mouse models deficient for either γδ T cells or IL-17 cytokines and assessed the bone loss during experimental periodontal inflammation by stereomicroscopic, histological, and μCT-analysis. Furthermore, we performed flow-cytometric analyses and qPCR-analyses of the gingival tissue. We found no γδ T cell- or IL-17-dependent change in bone loss after four weeks of periodontitis. Apart from that, our data are complementary with earlier studies, which suggested IL-17-dependent aggravation of bone loss in early periodontitis, but a rather bone-protective role for IL-17 in late stages of experimental periodontitis with respect to the osteoclastogenicity defined by the RANKL/OPG ratio.
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Extensive research in humans and animal models has begun to unravel the complex mechanisms that drive the immunopathogenesis of periodontitis. Neutrophils mount an early and rapid response to the subgingival oral microbiome, producing destructive enzymes to kill microbes. Chemokines and cytokines are released that attract macrophages, dendritic cells, and T cells to the site. Dendritic cells, the focus of this review, are professional antigen‐presenting cells on the front line of immune surveillance. Dendritic cells consist of multiple subsets that reside in the epithelium, connective tissues, and major organs. Our work in humans and mice established that myeloid dendritic cells are mobilized in periodontitis. This occurs in lymphoid and nonlymphoid oral tissues, in the bloodstream, and in response to Porphyromonas gingivalis. Moreover, the dendritic cells mature in situ in gingival lamina propria, forming immune conjugates with cluster of differentiation (CD) 4+ T cells, called oral lymphoid foci. At such foci, the decisions are made as to whether to promote bone destructive T helper 17 or bone‐sparing regulatory T cell responses. Interestingly, dendritic cells lack potent enzymes and reactive oxygen species needed to kill and degrade endocytosed microbes. The keystone pathogen P. gingivalis exploits this vulnerability by invading dendritic cells in the tissues and peripheral blood using its distinct fimbrial adhesins. This promotes pathogen dissemination and inflammatory disease at distant sites, such as atherosclerotic plaques. Interestingly, our recent studies indicate that such P. gingivalis–infected dendritic cells release nanosized extracellular vesicles called exosomes, in higher numbers than uninfected dendritic cells do. Secreted exosomes and inflammasome‐related cytokines are a key feature of the senescence‐associated secretory phenotype. Exosomes communicate in paracrine with neighboring stromal cells and immune cells to promote and amplify cellular senescence. We have shown that dendritic cell–derived exosomes can be custom tailored to target and reprogram specific immune cells responsible for inflammatory bone loss in mice. The long‐term goal of these immunotherapeutic approaches, ongoing in our laboratory and others, is to promote human health and longevity.
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Background Previous studies have linked growth retardation with ambient fine particulate matter (PM2.5) exposure. However, few studies explored such association from the perspective of microbiota, such as oral microbiota. We aimed to identify the potential role of oral microbiota in the links between PM2.5 exposure and infant growth. Methods Baseline information of 335 recruited mother-child pairs was collected by structured questionnaires. Growth indicators (weight, length) of one-year-old infants were abstracted from medical records when they had physical examination and corresponding z scores were calculated. 16S rRNA gene amplicon sequencing was performed to assess oral microbiota of infants and co-abundance groups (CAGs) were further calculated. We assessed PM2.5 levels by inverse distance weighting (IDW). Generalized linear regression and mediation analysis were performed to determine associations between PM2.5 exposure, oral microbiota and growth indicators. Results Per 10 μg m⁻³ increment of PM2.5 in the period of 10th month-examination was associated with decreased length z score (β = −1.97, 95%CI: −3.83, −0.11). Oral microbiota correlated with weight z score and body mass index (BMI) z score was identified by Spearman correlation analysis. CAG4 was statistically associated with increased weight z score (β = 3.40, 95%CI: 0.29, 6.51) and BMI z score (β = 5.44, 95%CI: 1.00, 9.87). Several bacteria in the level of genus and CAG associated with PM2.5 exposure were additionally identified (P < 0.05). Mediation analysis revealed that PM2.5 in the period of birth-3rd month impacted the z scores of weight and BMI by altering relative abundance of Megasphaera (P < 0.05). Conclusion PM2.5 exposure from 10th to 12th month after birth could retard infant linear growth. PM2.5 might impact oral microbiota of one-year-old infants. Growth-related bacteria and CAGs were identified. Megasphaera might function as mediator between PM2.5 exposure during birth-3rd month and infant z scores of weight and BMI.
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Background:This study aimed to investigate the effect of periodontal disease (PD) on the outcomes of patients with coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI). Methods and Results:The study included 77 consecutive non-smoking patients with de novo coronary lesions treated with a drug-eluting stent (DES). Periodontal measurements, including the community periodontal index (CPI), were performed by independent periodontists. A CPI score of ≥3 was used to define PD. The occurrence of major adverse cardiac events (MACEs), which were defined as a composite of cardiovascular death, non-fatal myocardial infarction, target lesion revascularization, or non-target lesion revascularization, was compared between patients with and without PD. Of the 77 patients, 49 (63.6%) exhibited a CPI score of 3 or 4 and were assigned to the PD group. The remaining 28 patients (36.4%) were assigned to the non-PD group. Baseline clinical characteristics and angiographic findings were comparable between the 2 groups. MACEs occurred in 13 (26.5%) of the PD patients and 2 (7.1%) of the non-PD patients. Kaplan-Meier analysis showed a significantly lower MACE-free survival rate in the PD group than for the non-PD group (P=0.034). Conclusions:PD at baseline was associated with an increased risk of MACEs in CAD patients who were treated with a DES for de novocoronary lesions.
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Diversas enfermedades sistémicas como la diabetes, el hipertiroidismo, la osteoporosis y la dislipidemia pueden influir en la enfermedad periodontal (EP). Poco se conoce acerca de la relación entre la hipertensión arterial (HTA) y la periodontitis. La EP es una condición inflamatoria que destruye las fibras de los ligamentos periodontales y el hueso alveolar. La respuesta del hospedero incluye la producción de especies reactivas del oxígeno (EROs). Si las EROs se producen en exceso inducen reacciones en cadena, capaces de dañar a moléculas de importancia biológica. Se sabe que la angiotensina II (ANGII) puede actuar como un agente pro-inflamatorio y pro-oxidante, pero su participación en la EP inducida durante la hipertensión es elusiva. Por ello, se evaluó la actividad de las enzimas antioxidantes y el papel de la ANGII/RAT 1 en la EP experimental en ratas espontáneamente hipertensas (SHR) y ratas Wistar Kyoto (WKY). Se emplearon ratas macho WKY y SHR con EP-inducida mediante la inyección de lipopolisacárido (LPS), y se determinó el efecto del antagonista del receptor AT 1 sobre la presión arterial, el recuento de leucocitos y la actividad de tres enzimas antioxidantes de la mucosa bucal: la catalasa (CAT), la superóxido dismutasa (SOD) y la glutatión peroxidasa (GPx). Los animales fueron divididos en cuatro grupos: 1: WKY+LPS sin tratamiento; 2: SHR+LPS sin tratamiento; 3: WKY + LPS+VAL (11 días); 4: SHR + LPS+ VAL (11 días). Se determinó la presión arterial al comienzo y al final del tratamiento. Los animales fueron sacrificados mediante decapitación y se tomaron muestras de sangre para el recuento de leucocitos. La actividad de la CAT, la SOD y la GPx fue determinada por espectrofotometría. Los maxilares inferiores fueron disecados, fijados, desmineralizados y deshidratados para el estudio histológico. Nuestros resultados demuestran la presencia de EP más marcada en las ratas SHR que se manifestó por la pérdida ósea. La EP se acompañó de un aumento en el número total de leucocitos y de la actividad de la CAT y SOD, lo que sugiere un incremento del estrés oxidativo. Igualmente se observó una disminución de la actividad de la GPx, posiblemente debido a la reducción de la concentración de glutatión en las ratas hipertensas. Todos estos efectos fueron revertidos por el tratamiento con VAL, indicando un papel de la ANGII/RAT 1 en la patogénesis de la EP asociada a la hipertensión. Palabras clave: Enfermedad periodontal, enzimas antioxidantes, hipertensión arterial, valsartán, receptores AT 1 de angiotensina.
Article
Periodontal disease has come to be recognized as one of the risk factors for the development of cardiovascular disease. However, few previous studies have investigated the cardiovascular risk associated with periodontal disease after adjusting for the wide range of factors that could confound this association. The purpose of this study was to examine the effects of periodontal disease and its treatment on the risk of cardiovascular disease using health insurance receipt data. This study was conducted using the data of 235,779 subjects retrieved from the database of the National Health Insurance Association, Hokkaido Branch. They underwent a specific health examination and did not receive a dental examination in 2014, and were analyzed using health examination data and medical and dental receipt data. The subjects were classified into 3 groups based on the 2015 dental receipts, as follows: 1) "No dental visits"; 2) "1 to 4 dental visits"; 3) "5 or more dental visits." Logistic regression analyses were conducted to determine whether periodontal disease represents a risk factor for the development of cerebral infarction and myocardial infarction. In these analyses, the outcomes were cerebral infarction and myocardial infarction in 2015 and 2016, and the explanatory variables were the periodontal disease classification (explained above) and confounding factors in 2015. The results of the logistic regression analysis using the 2015 cerebral infarction data showed that the incidence of cerebral infarction was significantly associated with the presence of periodontal disease ( "1 to 4 dental visits" OR: 1.95; "5 or more dental visits" OR: 1.63), suggesting the increased risk of cerebral infarction associated with periodontal disease. Similar results were obtained using the 2016 cerebral infarction data ( "1 to 4 dental visits" OR: 1.63; "5 or more dental visits" OR: 1.61), suggesting that the risk of development of cerebral infarction in patients with periodontal disease may not have changed one year after the start of periodontal treatment.
Article
Aims The purpose of the present systematic review and meta-analysis was to assess the impact of periodontal treatment on the glomerular filtration rate (GFR) of individuals with chronic kidney disease (CKD). Methods Searches were conducted in five databases. Restrictions on publication date or language were not imposed. Studies reporting the GFR of CKD individuals before and after periodontal treatment were included. Studies’ selection, extraction of data and assessment of risk of bias were performed by two reviewers independently. The Methodological Index for non-randomized studies was employed for risk of bias assessment. Meta-analysis was carried out. Results One hundred ninety-two references were retrieved and three studies were included. In all studies included, the periodontal intervention performed was non-surgical therapy. The three studies together assessed 77 individuals. The follow-up of participants after periodontal treatment varied between 3 and 6 months. Meta-analysis demonstrated that the GFR of individuals with CKD increased (improvement) after periodontal treatment (mean difference = 7.01, confidence interval = 0.66 – 13.36, I2 = 0%). Overall, included studies presented low risk of bias. Conclusion Despite the limited evidence of this systematic review and meta-analysis, periodontal treatment seems to improve the GFR of CKD individuals, with positive repercussions on their renal function.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.