Treatment of denture-related stomatitis improves endothelial function assessed by flow-mediated vascular dilation

Abstract

IntroductionThe presence of oral inflammation has recently been linked with the pathogenesis of cardiovascular diseases. While numerous studies have described links between periodontitis and endothelial dysfunction, little is known about the influence of denture-related stomatitis (DRS) on cardiovascular risk. Therefore, the aim of this study was to determine whether the treatment of DRS can lead to improvement of the clinical measures of vascular dysfunction.Material and methodsThe DRS patients were treated with a local oral antifungal agent for 3 weeks. Blood pressure, flow-mediated dilatation (FMD) and nitroglycerine-mediated vascular dilatation (NMD) were measured during three study visits: before treatment, one day and two months after conclusion of antifungal therapy.ResultsFlow-mediated dilatation measurements showed significant improvement of endothelial function 2 months after treatment (FMD median 5%, 95 CI: 3–8.3 vs. 11%, 95% CI: 8.8–14.4; p < 0.01), while there was no difference in control, endothelium-independent vasorelaxations (NMD; median = 15.3%, 95% CI: 10.8–19.3 vs. 12.7%, 95% CI: 10.6–15; p = 0.3). Other cardiovascular parameters such as systolic (median = 125 mm Hg; 95% CI: 116–129 vs. 120 mm Hg, 95% CI: 116–126; p = 0.1) as well as diastolic blood pressure and heart rate (median = 65.5 bpm, 95% CI: 56.7–77.7 vs. 71 bpm, 95% CI: 66.7–75; p = 0.5) did not change during or after the treatment.ConclusionsTreatment of DRS is associated with improvement of endothelial function. Since endothelial dysfunction is known to precede the development of severe cardiovascular disorders such as atherosclerosis and hypertension, patients should be more carefully screened for DRS in general dental practice, and immediate DRS treatment should be advised.

Hygiene protocols for the treatment of denture-related stomatitis: local and systemic parameters analysis

“…The DS has been recently associated with systemic implications (variations in blood pressure and endothelial dysfunction) that precede the development of serious cardiovascular disorders, such as atherosclerosis and hypertension, which are changes in general health with high mortality / morbidity rates [16][17][18]. However, the mechanisms that correlate oral inflammation and cardiovascular effects are not yet fully described, but one of the most important hypotheses is the pre-activation of the immune system [17].…”

Hygiene protocols for the treatment of denture-related stomatitis: local and systemic parameters analysis - a randomized, double-blind trial protocol.

“…However, in some patients, non-specificity of symptoms makes this disease often undiagnosed and untreated for long periods [15]. Furthermore, although considered to have a little overall impact in terms of mortality/morbidity, early diagnosis and correct treatment may avoid potentiation of the immune response at other sites and/or systemic consequence [1,16,17].…”

“…Local inflammation associated, or not, with a biofilm that is the complex structure formed by microorganism held together by a mucus-like matrix of carbohydrate that adheres to different surfaces, including denture surface [10], may trigger activation of monocytes and T cells, with overproduction of cytokines, such as interleukin (IL) -6, interferon γ, C-reactive protein (CRP) [17], tumor necrosis factor (TNF) -α and other proinflammatory cytokines; subsequently leading to atherosclerosis and hypertension, with increased cardiovascular risk [17,18].…”

“…Maciag et al [16] evaluated, through the analysis of peripheral blood immune cell activation, whether the antifungal treatment of local inflammation, caused by DS, would influence the systemic immune response [16]. The authors did not find evidence of response complex immune mechanisms involved in the defense against oral fungal infection though, verified a possible systemic inflammatory response to the topical application of nystatin, a macrolide polyene antifungal [17,18]. Although transient and not intense, this effect should be considered a clinically important finding; since patients with DS are generally elderly, and as such, more susceptible to changes in the immune function.…”

“…Osmenda et al [17] The evaluation of the pre-disposition of the individual with local inflammation to develop systemic diseases can be assessed through the detection of salivary mucins, which play an important role in the protection of buccal mucosa against mechanical and microbial aggressions, and the residual saliva presenting higher amounts of mucins compared to total saliva. Recently, the correlation between salivary glycoprotein expression (MUC1, MUC5B, and MUC7) and buccal candidiasis has been suggested.…”