Incidence of Arterial Hypertension in People With Periodontitis and Characterization of the Oral and Subgingival Microbiome: A Study Protocol

Abstract

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.

Relationship between the Social Development Index and Self-Reported Periodontal Conditions

“…Volunteers who wished to participate were contacted by email to inform them of the study's purpose and obtain their consent to complete a standardized questionnaire on general health. The questionnaire included questions about the presence of concomitant systemic diseases, the daily intake of medication prescribed by a treating physician, a selfreport of their periodontal condition, their self-perception of gingivitis, dental care, and oral hygiene habits, and diet changes due to chewing problems, among others [53]. The questions related to oral and periodontal health had already been included in validated questionnaires in different populations before [54][55][56][57][58][59][60][61][62][63][64][65][66].…”

“…The present work is part of a broader research framework that includes studying the associations of periodontal disease with other diseases, such as hypertension [53] and diabetes, as well as the association of PD with social determinants of health and risk factors and its relationships with chronic inflammation and immunological factors (a work in progress). Regarding this particular branch project, our following steps would be to validate the self-report periodontal symptoms via clinical exploration and measurement sessions.…”

Potential Impact of Prosthetic Biomaterials on the Periodontium: A Comprehensive Review

“…Key components in the pathophysiology of PD and its associated clinical features include gingival inflammation, periodontal ligament destruction, bone loss, bacterial colonization and invasion, increased numbers of polymorphonuclear (PMN) and epithelial cells, increased volume and decreased pH of the gingival crevicular fluid (GCF), as well as increased periodontal and gingival indices [4][5][6]. PD has a high prevalence worldwide, which is estimated to be 30-50% [7,8]. Currently, the most recent Molecules 2023, 28, 1075 2 of 25 classification of PD is based on the severity (stages I-IV) and progression (grade A-C) of the disease [9]; however, for practical purposes, we can divide it into gingivitis, which refers to inflammation of the gums, and periodontitis, where in addition to inflammation there is also the destruction of periodontal tissues [10].…”