Evidence that periodontal treatment improves biomarkers and <scp>CVD</scp> outcomes

D’Aiuto, Francesco; Orlandi, Marco; Gunsolley, John C.

doi:10.1111/jcpe.12061

Cited by 177 publications

(102 citation statements)

References 237 publications

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“…However this statement is not supported in periodontal literature. In a recent review, D´Aiuto et al reported a consistent effect of periodontal therapy in improvement of endothelial-dependent function [54]. …”

Section: Discussionmentioning

confidence: 99%

Periodontitis Is Associated with Endothelial Dysfunction in a General Population: A Cross-Sectional Study

et al. 2013

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A large body of evidence underlines an association between periodontal disease and cardiovascular disease. In contrast, data on its relation with endothelial dysfunction as a marker of early subclinical atherosclerosis is inconclusive and limited to patient-cohort studies. We therefore investigated the association between periodontal disease and flow-mediated dilation of the brachial artery (FMD) as a measure of endothelial dysfunction in a general population, and also addressed a possible mediation via inflammation. The study population comprised 1,234 subjects (50.5% men) aged 25–85 years from the 5-year follow-up of the Study of Health in Pomerania, a population-based cohort study. Clinical attachment loss (CAL) and pocket probing depth (PPD) as measures of periodontal disease were assessed half-mouth at four sites per tooth. Subjects were classified according to the periodontitis case definition proposed by Tonetti and Claffey (2005). Measurements of FMD and nitroglycerin-mediated dilation (NMD) were performed using standardized ultrasound techniques. High-sensitive C-reactive protein, fibrinogen and leukocyte count were measured. Fully adjusted multivariate linear regression analyses revealed significant associations of the percentage of sites with PPD ≥6 mm with FMD (ptrend=0.048), with subjects within the highest category having a 0.74% higher FMD compared to subjects within the lowest category (p<0.05). Consistently, FMD values increased significantly across categories of the percentage of sites with CAL ≥6 mm (ptrend=0.01) and the periodontitis case definition (ptrend=0.006). Restrictions to subjects without antihypertensive or statin medication or current non-smokers confirmed previous results. Systemic inflammation did not seem to mediate the relation. Both PPD and CAL were not consistently associated with NMD. In contrast to previous studies, high levels of periodontal disease were significantly associated with high FMD values. This association was not mediated via systemic inflammation. This study revives the discussion on whether and how periodontitis contributes to endothelial dysfunction.

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Section: Discussionmentioning

confidence: 99%

Periodontitis Is Associated with Endothelial Dysfunction in a General Population: A Cross-Sectional Study

et al. 2013

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“…According to the World Health Organisation, 31% of all deaths globally are due to CVD [2]. Contributing risk factors of CVD include family history, diabetes, hypertension, hyperlipidaemia, tobacco use, limited physical activity, obesity and poor dietary intake [3].…”

Section: Introductionmentioning

confidence: 99%

Oral health and cardiovascular care: Perceptions of people with cardiovascular disease

et al. 2017

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Main objectiveThe aim of this study was to explore the perception of patients with cardiovascular disease towards oral health and the potential for cardiac care clinicians to promote oral health.MethodA needs assessment was undertaken with twelve patients with cardiovascular disease attending cardiac rehabilitation between 2015 and 2016, in three metropolitan hospitals in Sydney, Australia. These patients participated in face-to-face semi-structured interviews. Data was analysed using thematic analysis.ResultsResults suggested that while oral health was considered relevant there was high prevalence of poor oral health among participants, especially those from socioeconomic disadvantaged background. Awareness regarding the importance of oral health care its impact on cardiovascular outcomes was poor among participants. Oral health issues were rarely discussed in the cardiac setting. Main barriers deterring participants from seeking oral health care included lack of awareness, high cost of dental care and difficulties in accessing the public dental service. Findings also revealed that participants were interested in receiving further information about oral health and suggested various mediums for information delivery. The concept of cardiac care clinicians, especially nurses providing education, assessment and referrals to ongoing dental care was well received by participants who felt the post-acute period was the most appropriate time to receive oral health care advice. The issues of oral health training for non-dental clinicians and how to address existing barriers were highlighted by participants.Relevance to clinical practiceThe lack of oral health education being provided to patients with cardiovascular disease offers an opportunity to improve care and potentially, outcomes. In view of the evidence linking poor oral health with cardiovascular disease, cardiac care clinicians, especially nurses, should be appropriately trained to promote oral health in their practice. Affordable and accessible dental care services for people with cardiovascular disease should be considered and offered by health services in Australia.

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“…By contrast, analysis of incident events that accrue during the course of a prospective observational study often provides a better measure of exposure duration and hence a more accurate estimate of risk. Research efforts examining effects of periodontal therapy on subclinical cardiovascular disease (CVD) surrogates such as endothelial function and carotid artery intima-media thickness (Jung, et al, 2014; Tonetti, et al, 2007), or reducing inflammatory markers were abundant (Bokhari, et al, 2012; Caula, et al, 2014); however, evidence is still limited to support the relief of CVD burden after periodontal treatment (D'Aiuto, Orlandi, & Gunsolley, 2013). To date, analyses of incident periodontal disease as a determinant of future vascular risk have been sparse (Dietrich, et al, 2008; Jimenez, et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular risks associated with incident and prevalent periodontal disease

Chasman

Buring

et al. 2015

J Clinic Periodontology

106

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Aim While prevalent periodontal disease associates with cardiovascular risk, little is known about how incident periodontal disease influences future vascular risk. We compared effects of incident versus prevalent periodontal disease in developing major cardiovascular diseases (CVD), myocardial infarction (MI), ischemic stroke and total CVD. Material and Methods In a prospective cohort of 39863 predominantly white women, age ≥ 45 years and free of cardiovascular disease at baseline were followed for an average of 15.7 years. Cox proportional hazard models with time-varying periodontal status (prevalent [18%], incident [7.3%] vs. never [74.7%]) were used to assess future cardiovascular risks. Results Incidence rates of all CVD outcomes were higher in women with prevalent or incident periodontal disease. For women with incident periodontal disease, risk factor adjusted hazard ratios (HRs) were 1.42 (95% CI, 1.14–1.77) for major CVD, 1.72 (1.25–2.38) for MI, 1.41(1.02–1.95) for ischemic stroke, and 1.27(1.06–1.52) for total CVD. For women with prevalent periodontal disease, adjusted HRs were 1.14 (1.00–1.31) for major CVD, 1.27 (1.04–1.56) for MI, 1.12(0.91–1.37) for ischemic stroke, and 1.15(1.03–1.28) for total CVD. Conclusion New cases of periodontal disease, not just those that are pre-existing, place women at significantly elevated risks for future cardiovascular events.

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Evidence that periodontal treatment improves biomarkers and CVD outcomes

Cited by 177 publications

References 237 publications

Periodontitis Is Associated with Endothelial Dysfunction in a General Population: A Cross-Sectional Study

Periodontitis Is Associated with Endothelial Dysfunction in a General Population: A Cross-Sectional Study

Oral health and cardiovascular care: Perceptions of people with cardiovascular disease

Cardiovascular risks associated with incident and prevalent periodontal disease

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