Higher prevalence of periodontitis in patients with refractory arterial hypertension: a case-control study

Oral Diseases (2011) 17 , 560–563 Objective: The aim of this study was to assess the association of periodontitis with refractory arterial hypertension. Study design: A total of 137 patients were examined. Seventy patients (mean age of 55.2 ± 9.2 years) were included in the case group, while 67 non‐hypertensive subjects (mean age of 50.0 ± 7.2) served as a control group. Periodontal clinical examination included plaque index, bleeding on probing, probing pocket depth and clinical attachment loss (CAL). Patients with at least five sites with CAL ≥6 mm were considered as severe periodontitis, and with at least 30% of the sites with CAL ≥4 mm generalized chronic periodontitis. Results: The mean (±s.d.) number and percentage of sites with CAL ≥6 mm were 11 (±14) and 16.6 (±14) in the case group, and 5.7 (±9.5) and 5.8 (±9.7) in the control group (P < 0.05). The mean (±s.d.) percentage of sites with CAL ≥4 mm was 37 (±29.6) in the case group and 21.2 (±20) in the control group (P < 0.05). The significant associations with arterial hypertension were severe chronic periodontitis (OR = 4.04, 95% CI: 1.92; 8.49) and generalized chronic periodontitis (OR = 2.18, 95% CI: 1.04; 4.56). Conclusions: Severe and generalized chronic periodontitis seem to play a role as risk indicators for hypertensive patients.     

Biological foundation for periodontitis as a potential risk factor for atherosclerosis

OBJECTIVES: Links between periodontal diseases and systemic diseases have been well documented by epidemiological studies. Recently, research has shifted to elucidating the biologic mechanism for a causal relationship. One focus of interest is atherosclerosis, the underlying event of cardiovascular diseases due to its serious health impact. However, it is still not clear whether periodontopathic pathogens are truly etiologic agents or ubiquitous bystanders. This article reviews the current understanding about the molecular biological interactions between periodontal disease and atherosclerosis and the biological plausibility of periodontitis as a potential risk factor for cardiovascular disease. MATERIALS AND METHODS: The current literature regarding periodontal diseases and atherosclerosis and coronary vascular disease was searched using the Medline and PubMed databases. RESULTS: In vitro experiments and animal models are appropriate tools to investigate the biological interactions between periodontal disease and atherosclerosis at the cell molecular level. The concepts linking both pathologies refer to inflammatory response, immune responses, and hemostasis. In particular, Porphyromonas gingivalis appears to have unique, versatile pathogenic properties. Whether or not these findings from isolated cells or animal models are applicable in humans with genetic and environmental variations is yet to be determined. Likewise, the benefit from periodontal therapy on the development of atherosclerosis is unclear. Approaches targeting inflammatory and immune responses of periodontitis and atherosclerosis simultaneously are very intriguing. CONCLUSION: An emerging concept suggests that a pathogenic burden from different sources might overcome an individual threshold culminating in clinical sequela. P. gingivalis contributes directly and indirectly to atherosclerosis.     

Severe periodontitis in young adults is associated with sub-clinical atherosclerosis

Aim: The aim of this study was to evaluate the association between severe periodontitis and sub‐clinical atherosclerosis in young (40 years) systemically healthy individuals. Material and Methods: Ninety systemically healthy subjects, 45 affected by severe periodontitis (mean age 36.35±3.65 years) and 45 controls without a history of periodontal disease (mean age 33.78±3.28 years), were enrolled in this study. Patients and controls were paired for age, gender, body mass index and smoking habits. Carotid intima‐media thickness (IMT) was bilaterally assessed by ultrasonography at the level of common carotid artery. Traditional cardiovascular risk factors for atherosclerosis were also evaluated. Results: The overall mean carotid IMT was 0.82±0.13 mm in the test group and 0.72±0.07 mm in the control group ( p<0.0001). Stepwise regression analysis showed that periodontitis ( p<0.0001) and regular physical activity ( p=0.0009) were predictor variables of overall mean carotid IMT. When considering an IMT0.82 mm as the critical index of increased cardiovascular risk, periodontal patients overcame this threshold compared with healthy patients by an odds ratio=8.55 [confidence interval 95%: 2.38; 39.81]. No investigated haemostatic variable was associated with increased carotid IMT. Conclusion: Severe periodontitis is associated with sub‐clinical atherosclerosis in young systemically healthy patients.     

The severity and extent of periodontitis is associated with cardio-ankle vascular index,a novel arterial stiffness parameter

Clinical Oral Investigations - To evaluate the association between the severity and extent of periodontitis and arterial stiffness using the cardio-ankle vascular index (CAVI). A cross-sectional...     

The effect of initial treatment of periodontitis on systemic markers of inflammation and cardiovascular risk: a randomized controlled trial

Taylor B, Tofler G, Morel‐Kopp M‐C, Carey H, Carter T, Elliott M, Dailey C, Villata L, Ward C, Woodward M, Schenck K. The effect of initial treatment of periodontitis on systemic markers of inflammation and cardiovascular risk: a randomized controlled trial. Eur J Oral Sci 2010; 118: 350–356. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci Observational studies indicate that chronic periodontal disease is associated with adverse cardiovascular outcomes. The aim of this study was to determine whether initial periodontal treatment has a beneficial effect on systemic markers of inflammation and cardiovascular risk. One hundred and thirty‐six adults with chronic periodontitis were allocated to either intervention or control groups in a 3‐month randomized controlled intervention study. The intervention group received initial periodontal treatment, whereas the control group did not receive that treatment until after the study. Blood levels of cardiovascular risk factors, and of hematological, inflammatory, and metabolic markers, were measured at the beginning and the end of the study, and differences were calculated. Fibrinogen level was the primary outcome measure. Data for 61 persons in the intervention group and for 64 persons in the control group were available for statistical analysis. Compared with the control group, the intervention group showed a non‐significant trend for a lower fibrinogen level. Significant increases in hemoglobin and hematocrit were seen after treatment, showing that initial periodontal treatment, a relatively simple and cost‐effective intervention, has systemic effects.     

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目的通过观察血清超敏C反应蛋白(high-sensitivity C-reactive protein,hsCRP)水平的变化探讨牙周基础治疗对伴或不伴高脂血症的慢性牙周炎(chronic periodontitis,CP)大鼠动脉粥样硬化(atherosclerosis,As)发生的影响。方法本研究于2011年5—9月在山西医科大学口腔医学院完成。将24只6周龄雄性SD大鼠随机分为4组,即正常对照组(A组)、高脂血症组(B组)、CP组(C组)和高脂血症+CP组(D组),每组6只。各组接受相应的建模及牙周干预处理,同时定期进行牙周临床检查,酶联免疫吸附(ELISA)法检测牙周干预前及每次干预后1周(共2次)3个取样时间点的血清hsCRP水平。结果牙周临床检查结果显示,整个实验过程中A、B组大鼠实验牙牙龈未见炎症性改变;C、D组大鼠建模后实验牙牙龈炎症明显,有深牙周袋,部分实验牙松动度达Ⅱ~Ⅲ度,基础治疗后炎症明显减轻,牙齿均无松动。同一时间点上,B、C及D组大鼠血清hsCRP水平均显著高于A组,差异有统计学意义(P<0.01)。在不同时间点上,B、C及D组大鼠治疗后血清hsCRP水平均较治疗前显著增高,差异有统计学意义(P<0.01)。其中,C组大鼠2次治疗后血清hsCRP水平趋于稳定,D组大鼠在2次治疗后1周血清hsCRP水平显著增高。结论对于慢性牙周炎大鼠,无高脂血症情况存在时,牙周基础治疗可能会在短期内增高As的发生风险;在存在高脂血症状态下,直接牙周基础治疗可能会在较长时间内增高As的发生风险。     

Prospective evaluation of the systemic inflammatory marker C-reactive protein in patients with end-stage periodontitis getting teeth replaced with dental implants: a pilot investigation

OBJECTIVES: Serum C-reactive protein (CRP) has been shown to be a risk predictor for cardiovascular disease. Periodontal treatment reduces elevated CRP levels. The aim of this pilot investigation was to evaluate if dental implants placed after extractions in patients with end-stage periodontitis affect the serum CRP levels. MATERIAL AND METHODS: Serum CRP levels in 10 subjects with end-stage periodontitis were measured prior to tooth extraction and placement of dental implants, and at 3-month intervals for a year post-operatively. Univariate repeated measures analysis of variance was used to estimate and test the changes in CRP levels over time. RESULTS: Mean CRP levels decreased significantly following tooth extraction and replacement with dental implants from 3.45 to 1.55 mg/dl after 12 months (P < 0.01). Six-, 9-, and 12-month post-implant placement mean CRP values were statistically significantly different from the mean pre-operative CRP value (P < 0.01). CONCLUSIONS: The pilot data suggest that extraction of advanced periodontally involved teeth and their replacement with dental implants lead to a decrease in CRP levels, and dental implant placement does not change the lowered CRP levels over a 12-month period.     

Preventive effects of thymoquinone in a rat periodontitis model: a morphometric and histopathological study

Ozdemir H, Kara MI, Erciyas K, Ozer H, Ay S. Preventive effects of thymoquinone in a rat periodontitis model: a morphometric and histopathological study. J Periodont Res 2012; 47: 74–80. © 2011 John Wiley & Sons A/S Background and Objective: Thymoquinone has a variety of pharmacologic properties, including antihistaminic, antibacterial, antihypertensive, hypoglycemic, anti‐inflammatory and anti‐oxidative activities. Through its anti‐inflammatory and antioxidant properties, thymoquinone may play an important role in preventing periodontal diseases. The aim of this study was to evaluate the effectiveness of thymoquinone in preventing the initiation and progression of periodontitis in a rat periodontitis model. Material and Methods: Twenty‐four rats were randomly divided into three experimental groups: a nonligated (NL) treatment group (n = 8), a ligature‐only (LO) treatment group (n = 8) and a ligature plus thymoquinone (10 mg/kg, daily for 11 d) (TQ) treatment group. In order to induce experimental periodontitis, a 4/0 silk suture was placed at the gingival margin of the right‐mandibular first molars of the rats. Thymoquinone was administered by gastric feeding until the animals were killed on day 11. Changes in the alveolar bone levels of rats in each group were measured clinically, and tissues of rats in each group were examined histopathologically to determine inflammatory cell infiltration (ICI), osteoblast and osteoclast activities, and osteoclast morphology. Results: Alveolar bone loss around the mandibular molar tooth was significantly higher in the LO group compared with NL and TQ groups (p < 0.05). The ratio of the presence of ICI and osteoclast numbers was significantly higher in the LO group than in the NL and TQ groups (p < 0.05). Osteoblastic activity was significantly lower in the LO group than in the NL and TQ groups (p < 0.05). Conclusion: The present study showed that the oral administration of thymoquinone diminishes alveolar bone resorption in a rat periodontitis model.     

辅以抗生素的牙周机械治疗对伴动脉粥样硬化牙周炎大鼠的颈动脉及血清超敏C-反应蛋白的影响

目的 研究伴动脉粥样硬化（As）的慢性牙周炎（CP）大鼠模型中血清超敏C反应蛋白（hsCRP）的表达及颈动脉血管的病理变化,探讨牙周基础治疗辅以抗生素对As的影响。方法 35只SD大鼠随机分为两大组：A组（正常对照）和B组（CP+As）,建立CP+AS模型后再将B组分为4组,自然进程组（B1）、牙周机械治疗组（B2）、机械治疗+局部药物组（B3）、机械治疗+局部药物+抗生素组（B4）,每组7只,接受相应的牙周干预治疗。通过酶联免疫吸附（ELISA）法检测血清中hsCRP的质量浓度,光镜下观察颈动脉血管组织的病理变化。结果 随着时间推移,B1组hsCRP质量浓度逐渐升高,在第2次干预后5周（第5次取样时间点）明显高于其他组（P<0.001）;B2、B3、B4组hsCRP先逐渐升高,在第2次干预后1周（第3次取样时间点）达到高峰,之后逐渐下降,低于其基线水平,但仍高于A组（P<0.05）。第2次干预后3周（第4次取样时间点）起,B3、B4组hsCRP显著低于B2组（P<0.001）。病理结果：B1组可见炎症细胞浸润及大量泡沫细胞,弹性纤维明显紊乱破坏;B2组血管壁厚薄不均,可见泡沫细胞,弹性纤维紊乱;B3组血管壁轻度增厚,弹性纤维排列较整齐;B4组血管壁厚度较均匀,弹性纤维排列整齐。结论 对于伴有As+CP的大鼠,牙周基础治疗短期内可能会增加As的发展风险,而从长期作用来看可能会改善As病变;在牙周机械治疗的基础上增加局部抗炎、全身抗生素治疗可优化其疗效。