Periodontal disease and its association to endothelial dysfunction and clinical changes in limited systemic sclerosis: A case–control study

Abstract

Objectives Periodontal disease occurs frequently in patients with limited cutaneous systemic sclerosis (lcSSc) while data about underlying pathways contributing to periodontal changes are scarce. The aim of this study was to evaluate periodontal disease and to investigate its association with endothelial dysfunction and clinical changes in patients with lcSSc. Methods In 38 lcSSc patients and 38 controls, periodontal status was evaluated by disease‐specific questionnaire, dental examination including bleeding on probing (BOP), pocket depth, and plaque index, and dental panoramic radiograph. Periodontopathogen bacteria were collected subgingivally using paper points and interleukin‐1 (IL‐1) gene polymorphisms were evaluated using buccal swabs. Endothelial dysfunction was measured by flow‐mediated dilatation, pulse‐wave velocity and biochemical analysis, including arginine metabolites and endothelial microparticles. Additionally, lcSSc‐specific clinical changes and parameters were recorded. Results Periodontitis was present in 31 patients with lcSSc (81.6%) and in 27 controls (71.1%) (p = .280). LcSSc patients had a lower teeth number (p = .039) and Eikenella corrodens was to a higher degree detectable in patients with lcSSc (p = .041) while the remaining periodontal parameters revealed no differences between both cohorts. Significant correlations between parameters of arterial stiffness, EUSTAR index, number of teeth and BOP were observed (all p < .05). Detection of Prevotella intermedia was associated with selected IL‐1 gene polymorphisms (p = .032) and Porphyromonas gingivalis was associated with severe periodontitis (p = .041). Conclusion Periodontal disease may occur frequently in patients with lcSSc and may be associated with arterial stiffness and with SSc activity.

Association of amino acids and parameters of bone metabolism with endothelial dysfunction and vasculopathic changes in limited systemic sclerosis

“…Patients' characteristics have been described elsewhere (9,12). Median uric acid levels were 4.6 mg/dL (3.9-5.4 mg/dl 25th-75th percentile) in patients with lcSSc and 4.3 mg/dL (3.7-5.3 mg/dL 25th-75th percentile) in controls (p = 0.313).…”

“…Parameters of periodontal disease, including pocket depth, plaque index, bleeding on probing (BOP), bone loss and bone support ratio were evaluated by dental and oral examinations with a dentist's mirror and a periodontal probe as well as by digital dental panoramic radiograph (Orthophos XG 3D, Dentsply Sirona, Charlotte, USA) (35,36). Detailed information about the measurement methods of vasculopathy-related and SSc-specific clinical changes have been previously published (9,12).…”

“…They lead to clinical manifestations of SSc, including Raynaud's phenomenon, capillary changes or pulmonary arterial hypertension (PAH) (3)(4)(5). Besides these commonly vasculopathy-driven symptoms and complications, vasculopathy and endothelial dysfunction may also contribute to other manifestations of SSc, like skin, renal and gastrointestinal involvement or periodontal disease (6)(7)(8)(9).…”

Insights into the Relationship between Periodontitis and Systemic Sclerosis Based on the New Periodontitis Classification (2018): A Cross-Sectional Study

“…Reported data have indicated a relationship between periodontitis and SSc [ 2 ], mostly with the latter’s diffuse form [ 9 ]. Twelve case-control studies investigating periodontal conditions and their related risk factors in SSc patients were identified [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Only six studies revealed an association between the two diseases, with SSc being positively correlated with periodontitis [ 9 , 13 , 16 , 19 , 20 ] or periodontitis-related parameters [ 14 ].…”

“…Twelve case-control studies investigating periodontal conditions and their related risk factors in SSc patients were identified [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Only six studies revealed an association between the two diseases, with SSc being positively correlated with periodontitis [ 9 , 13 , 16 , 19 , 20 ] or periodontitis-related parameters [ 14 ]. A very recent meta-analysis including some of the above-mentioned reports highlighted that periodontitis was more common in SSc patients [odds ratio (OR) 7.007; 95% confidence interval (CI) 3.529, 13.915)] and was associated with more changes of clinical parameters such as probing depth (PD) [standard mean difference (SMD) 3.101; 95% CI 1.374, 4.829] and clinical attachment loss (CAL) (SMD 2.584; 95% CI 0.321, 4.846) [ 2 ].…”