Periodontitis: A Risk Factor for Coronary Heart Disease?

Abstract

This paper evaluates the current information on the relationship between oral disease (specifically periodontitis) and atherosclerosis/coronary heart disease (CHD) to determine whether the information is sufficient to conclude that periodontitis is a risk factor for atherosclerosis/CHD. As background for this evaluation, the term "risk factor" is defined, and the 3 criteria used to establish exposures as risk factors are reviewed. In addition, epidemiologic criteria for defining an exposure as causal are presented. The available evidence then is evaluated according to the criteria for causality, which are extensions of the criteria for establishing a risk factor. This review is done in the context of the relationship between atherosclerosis/CHD and inflammation. A number of findings are briefly reviewed that link inflammation and atherosclerosis/CHD, such as: 1) prior flu-like symptoms were more common in cases of myocardial infarction than in concurrently sampled controls; 2) high levels of cytomegalovirus antibody titers were associated with elevated carotid intimal-medial wall thickness 18 years later; 3) prior infection with cytomegalovirus was a strong independent risk factor for restenosis after coronary atherectomy; 4) dental infections were more common in cases of cerebral infarction compared to community controls matched on age and sex; and 5) the gingival index was significantly correlated with fibrinogen and white cell counts in periodontal patients and controls, adjusted for age, smoking, and socioeconomic status. Three case-control studies and 5 longitudinal studies investigating the relationship between dental conditions and atherosclerosis/CHD are reviewed in terms of strength of associations, consistency of associations, specificity. of associations, time sequence between exposure and outcome, and degree of exposure and outcome. Related to the last criterion, new findings are presented which indicate that the extent of the periodontal infection, a measure reflecting microbial burden, also is related to onset of new CHD events. Our previously published model describing the potential biological mechanisms underlying the associations found is reviewed. This model places the associations into a context of an intrinsic or acquired hyperinflammatory monocyte trait that results in a more intense inflammatory response to lipopolysaccharide (LPS) challenges, such as periodontal infections. This hyperinflammatory response may promote atheroma formation and thromboembolic events. finally, new findings from ongoing animal studies are presented, indicating that high fat diets in atherosclerotic-susceptible mice induce greater inflammatory responses to Porphyromonas gingivalis challenges. We conclude that the available evidence does allow an interpretation of periodontitis being a risk factor for atherosclerosis/CHD. This conclusion, however. is made with some qualifications. While the associations found across a wide variety of subjects are remarkably consistent, for the most part they are represented by incid...

Periodontal Disease and its Association with Angiographically Verified Coronary Artery Disease

“…Posljedica je aktivacija upalne reakcije domaćina koja pridonosi nastanku ateroma, njegova sazrijevanja i konačno oslobađanja, što rezultira nastankom krvnog ugruška (tromba) koji vodi prema CHD-u. Zajednički rizični čimbenici poput dijabetesa, pušenja, genetike, stresa, depresije, fizičke neaktivnosti i pretilosti otežavaju potvrdu povezanosti parodontitisa i CHD-a (10,11), no dosadašnja istraživanja pokazala su da je bez obzira na zajedničke rizične čimbenike ta povezanost moguća (12 -14). Štoviše, nedavne metaanalize potvrdile su parodontitis kao čimbenik rizika u slučaju CHDa, ili marker neovisan o tradicionalnim rizičnim čimbenicima za CAD, s relativnim rizicima u rasponu od 1,24 do 1,35 (15).…”

“…The activation of host inflammatory response contributes to the atheroma formation, followed by maturation and finally exacerbation which results in formation of blood cloth (thrombus) leading to CHD. Common risk factors such as diabetes mellitus, smoking, genetics, stress, depression, physical inactivity and obesity make it difficult to positively associate periodontitis and CHD (10,11). However, studies have shown such association regardless of common risk factors to be possible (12)(13)(14).…”

Adaptation of Porphyromonas gingivalis to microaerophilic conditions involves increased consumption of formate and reduced utilization of lactate

“…This disease is a chronic inflammatory condition of the supporting tissues of the teeth, and affects 10-15 % of adults (Fox, 1992). Studies have also indicated that chronic periodontitis may be associated with increased risk of cardiovascular diseases (Beck et al, 1998;Miyakawa et al, 2004), diabetes (Pucher & Stewart, 2004), rheumatoid arthritis (Mercado et al, 2003), and spontaneous preterm birth and preterm low birth weight (Lin et al, 2007). Finally, recent studies have shown increased numbers of several oral bacteria, including Porphyromonas spp.…”

Factors Affecting Oral Health in Non-Commissioned Soldiers of Bangladesh Army attended the Dhaka Combined Military Hospital

“…17 In Bangladesh, more than 80 percent of the population has at least one or more oral and dental diseases. 1 Many suffer from periodontitis, gingivitis, dental caries, pulpitis, alveolar abscess, etc. Dental cysts and carcinoma of the oral cavity are also common oral health problems in Bangladesh.The people of rural areas are comparatively much ignorant regarding their oral hygiene.…”