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Ren Z, Xue Y, Zhang H, Guo T, Yi W, Li L, Wang M, Xie J, Li Y. Systemic Immune-Inflammation Index and Systemic Inflammation Response Index are Associated With Periodontitis: Evidence From NHANES 2009 to 2014. Int Dent J 2024:S0020-6539(24)00104-7. [PMID: 38688802 DOI: 10.1016/j.identj.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/27/2024] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION AND AIMS Periodontitis, a chronic inflammatory condition affecting the supporting structures of the teeth, is a substantial public health burrden whilst impacting the life quality of those affected. Elevated levels of systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) have been implicated in various inflammatory conditions. This study aimed to investigate the relationship between SII and SIRI with periodontitis. METHODS The study examined a total of 8666 participants in the 2009 to 2014 National Health and Nutrition Examination Survey (NHANES). The study compared the weighted prevalence of periodontitis among various groups. The association between SII, SIRI levels, and periodontitis was analyzed using binary logistic regression. Additionally, we explored nonlinear relationships between SII, SIRI, and the prevalence of periodontitis using restricted cubic spline (RCS) plots. RESULTS Among participants in the fourth quartile (Q4) of SII and SIRI, the highest prevalence of periodontitis was observed, with rates of 44.87% and 48.41%, respectively. After adjusting for all covariates, the odds ratio (OR) for periodontitis associated with SII Q4 was 1.19 (95% CI 1.02, 1.39, P = .03), while for SIRI Q4, it was 1.18 (95% CI 1.01, 1.39, P = .04). In addition, the results of sensitivity analysis revealed consistent findings, indicating that after adjusting for all covariates, the OR for periodontitis associated with SII Q4 and SIRI Q4 remained statistically significant. Specifically, the OR for periodontitis associated with SII Q4 was 1.19 (95% CI 1.02, 1.39, P = .03), while for SIRI Q4, it was 1.19 (95% CI 1.01, 1.40, P = .04). CONCLUSIONS These results indicate that elevated SII and SIRI levels are associated with an increased prevalence of periodontitis. CLINICAL RELEVANCE These findings suggest a potential connection between systemic inflammation and periodontitis, highlighting the importance of periodontitis patients being aware of their systemic diseases that are inflammatory in nature such as chronic cardiovascular afflictions.
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Affiliation(s)
- Zhengyun Ren
- Department of General Surgery, Center of Gastrointestinal and Minimally Invasive Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, Sichuan, China; Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Yan Xue
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Hui Zhang
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Tailin Guo
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Wei Yi
- Department of General Surgery, Center of Gastrointestinal and Minimally Invasive Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, Sichuan, China; Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Linke Li
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Mengyuan Wang
- Department of stomatology, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Jiang Xie
- Department of pediatrics, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, Sichuan, China.
| | - Yi Li
- Department of Radiology, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, Sichuan, China.
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Zeng X, Wang X, Guan X, Feng X, Lu R, Meng H. The long-term effect of periodontitis treatment on changes in blood inflammatory markers in patients with generalized aggressive periodontitis. J Periodontal Res 2024. [PMID: 38501229 DOI: 10.1111/jre.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/20/2023] [Accepted: 02/15/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Periodontitis is characterized by local inflammatory conditions in the periodontium, its severe form has been associated with elevated systemic inflammatory markers. However, the long-term effects of periodontal inflammation control on systemic inflammatory markers are unclear. OBJECTIVE This study aimed to investigate the long-term effects of periodontal therapy on the levels of peripheral venous blood inflammatory markers in patients with generalized aggressive periodontitis (GAgP), all of whom were now diagnosed as Stage III or IV Grade C periodontitis. METHODS Patients with GAgP were consecutively recruited from April 2013 to August 2014 (T0). Active periodontal treatment (APT) was provided, and follow-ups were conducted over a 3- to 5-year period (T1). Clinical parameters were assessed and fasting venous blood was collected at T0 and T1. Complete blood cell counts were obtained, and biochemical analyses were performed to evaluate the levels of serum components. The correlations between probing depth (PD) and hematological parameters were analyzed. RESULTS A total of 49 patients with GAgP completed APT and follow-ups. Probing depth (PD) reduced from 5.10 ± 1.07 mm at T0 to 3.15 ± 0.65 mm at T1. For every 1-mm reduction in PD after treatment, the neutrophil count, neutrophil-lymphocyte ratio, and total protein concentration were reduced by 0.33 × 109 /L, 0.26, and 1.18 g/L, respectively. In contrast, the albumin/globulin ratio increased by 0.10. CONCLUSION This study indicated that periodontal therapy may have beneficial effects on peripheral venous blood inflammatory markers in patients with GAgP during long-term observation.
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Affiliation(s)
- Xiancheng Zeng
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Xiane Wang
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Xiaoyuan Guan
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Xianghui Feng
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Ruifang Lu
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Huanxin Meng
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
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Farhad S, Reisie B, Sadeh S. Evaluation and comparison number of gingival fibroblast and osteosarcoma cell (MG-63 cell line) adhesive to mocugraft, alloderm, and collagen membrane with or without advanced platelet-rich fibrin. Dent Res J (Isfahan) 2021. [DOI: 10.4103/1735-3327.328750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chang J, Meng HW, Lalla E, Lee CT. The impact of smoking on non-surgical periodontal therapy: A systematic review and meta-analysis. J Clin Periodontol 2020; 48:60-75. [PMID: 33022758 DOI: 10.1111/jcpe.13384] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/17/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
AIM Smoking is a risk factor for periodontitis. This study aimed to evaluate the impact of smoking on clinical outcomes of non-surgical periodontal therapy. MATERIALS AND METHODS Electronic databases were searched to screen studies published before May 2020. The included studies had to have two groups: smokers (S) and non-smokers (NS) with periodontitis. The outcomes evaluated were differences between groups in probing depth (PD) reduction and clinical attachment level (CAL) gain after non-surgical periodontal therapy. Meta-regressions were conducted to evaluate correlations between outcomes and other contributing factors. RESULTS Seventeen studies were included. The post-treatment PD reduction in the S group was smaller than in the NS group (weighted mean difference in PD reduction: -0.33 mm, 95% confidence interval (CI): [-0.49, -0.17], p < .01). The CAL gain in the S group was also smaller than in the NS group (weighted mean difference in CAL gain: -0.20 mm, CI: [-0.39, -0.02], p < .01). Additionally, baseline PD significantly affected the difference in PD reduction between two groups. CONCLUSIONS Smoking negatively impacts clinical responses to non-surgical periodontal therapy. Smokers with periodontitis have significantly less PD reduction and CAL gain than non-smokers.
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Affiliation(s)
- Jennifer Chang
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX, USA
| | - Hsiu-Wan Meng
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX, USA
| | - Evanthia Lalla
- Division of Periodontics, Columbia University College of Dental Medicine, New York, NY, USA
| | - Chun-Teh Lee
- Department of Periodontics and Dental Hygiene, The University of Texas Health Science Center at Houston School of Dentistry, Houston, TX, USA
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Fine N, Tasevski N, McCulloch CA, Tenenbaum HC, Glogauer M. The Neutrophil: Constant Defender and First Responder. Front Immunol 2020; 11:571085. [PMID: 33072112 PMCID: PMC7541934 DOI: 10.3389/fimmu.2020.571085] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/24/2020] [Indexed: 12/21/2022] Open
Abstract
The role of polymorphonuclear neutrophils (PMNs) in biology is often recognized during pathogenesis associated with PMN hyper- or hypo-functionality in various disease states. However, in the vast majority of cases, PMNs contribute to resilience and tissue homeostasis, with continuous PMN-mediated actions required for the maintenance of health, particularly in mucosal tissues. PMNs are extraordinarily well-adapted to respond to and diminish the damaging effects of a vast repertoire of infectious agents and injurious processes that are encountered throughout life. The commensal biofilm, a symbiotic polymicrobial ecosystem that lines the mucosal surfaces, is the first line of defense against pathogenic strains that might otherwise dominate, and is therefore of critical importance for health. PMNs regularly interact with the commensal flora at the mucosal tissues in health and limit their growth without developing an overt inflammatory reaction to them. These PMNs exhibit what is called a para-inflammatory phenotype, and have reduced inflammatory output. When biofilm growth and makeup are disrupted (i.e., dysbiosis), clinical symptoms associated with acute and chronic inflammatory responses to these changes may include pain, erythema and swelling. However, in most cases, these responses indicate that the immune system is functioning properly to re-establish homeostasis and protect the status quo. Defects in this healthy everyday function occur as a result of PMN subversion by pathological microbial strains, genetic defects or crosstalk with other chronic inflammatory conditions, including cancer and rheumatic disease, and this can provide some avenues for therapeutic targeting of PMN function. In other cases, targeting PMN functions could worsen the disease state. Certain PMN-mediated responses to pathogens, for example Neutrophil Extracellular Traps (NETs), might lead to undesirable symptoms such as pain or swelling and tissue damage/fibrosis. Despite collateral damage, these PMN responses limit pathogen dissemination and more severe damage that would otherwise occur. New data suggests the existence of unique PMN subsets, commonly associated with functional diversification in response to particular inflammatory challenges. PMN-directed therapeutic approaches depend on a greater understanding of this diversity. Here we outline the current understanding of PMNs in health and disease, with an emphasis on the positive manifestations of tissue and organ-protective PMN-mediated inflammation.
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Affiliation(s)
- Noah Fine
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Nikola Tasevski
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | | | - Howard C Tenenbaum
- Centre for Advanced Dental Research and Care, Mount Sinai Hospital, Toronto, ON, Canada
| | - Michael Glogauer
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,Centre for Advanced Dental Research and Care, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Dental Oncology, Maxillofacial and Ocular Prosthetics, Princess Margaret Cancer Centre, Toronto, ON, Canada
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6
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Khoury W, Glogauer J, Tenenbaum HC, Glogauer M. Oral inflammatory load: Neutrophils as oral health biomarkers. J Periodontal Res 2020; 55:594-601. [PMID: 32372438 DOI: 10.1111/jre.12758] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/05/2020] [Accepted: 04/10/2020] [Indexed: 01/13/2023]
Abstract
Periodontal diseases present a significant challenge to our healthcare system in terms of morbidity from the disease itself as well as their putative and deleterious effects on systemic health. The current method of diagnosing periodontal disease utilizes clinical criteria solely. These are imprecise and are somewhat invasive. There is thus significant benefit to creating a non-invasive test as a method of screening for and monitoring of periodontal diseases, and, in particular, chronic periodontitis. Oral polymorphonuclear neutrophil (oPMN) counts have been found to correlate with extent of oral inflammation and the presence and severity of periodontal diseases. Potentially then, quantification of oPMNs might be used to identify and measure the severity of oral inflammation (oral inflammatory load; OIL) in subjects with healthy and inflamed periodontal tissues, demonstrating a positive correlation between higher oPMN counts and the extent/severity of OIL. These findings support the development and utilization of a non-invasive chair-side test enabling rapid, accurate, and objective screening of OIL based on measurement of oPMN numbers (similar to white blood cell levels in blood as used in medicine for assessment of infection). The use of such a test before, during, and after treatment of gingivitis and periodontitis could lead to improvements in timing of intervention (ie, when inflammation is active) thereby reducing long-term morbidity.
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Affiliation(s)
- William Khoury
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,Queen's University School of Medicine, Kingston, ON, Canada
| | - Judah Glogauer
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,Michael G. DeGroote School of Medicine, Hamilton, ON, Canada
| | - Howard C Tenenbaum
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,Department of Dentistry, Centre for Advanced Dental Research and Care, Sinai Health System, Toronto, ON, Canada
| | - Michael Glogauer
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.,Department of Dentistry, Centre for Advanced Dental Research and Care, Sinai Health System, Toronto, ON, Canada.,Princess Margaret Cancer Centre, Department of Dental Oncology, Toronto, ON, Canada
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7
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Acharya AB, Shetty IP, Jain S, Padakannaya I, Acharya S, Shettar L, Thakur S. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in chronic periodontitis before and after nonsurgical therapy. J Indian Soc Periodontol 2019; 23:419-423. [PMID: 31543614 PMCID: PMC6737853 DOI: 10.4103/jisp.jisp_622_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Various biomarkers have been evaluated for understanding the systemic inflammatory response (SIR) to periodontitis. Hematological markers have been reported to be useful biomarkers in a variety of diseases, including periodontal diseases. The role of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in periodontitis and their possible role in the SIR are not extensively documented. Therefore, this study assessed NLR and PLR in chronic periodontitis (CP) patients before and after periodontal treatment, which to the best of knowledge has not been reported in the literature. Materials and Methods: Sixty participants were grouped as systemically and periodontally healthy (H) (n = 30) and with CP (n = 30). Plaque index, gingival index, probing pocket depth, clinical attachment loss, leukocyte counts, platelet (PLT) counts, NLR, and PLR were estimated at baseline and also after treatment in the CP group. NLR was calculated as total neutrophil count/absolute lymphocyte count, and PLR was calculated as total PLT count/absolute lymphocyte count. The data were statistically analyzed. Results: Periodontal parameters differed significantly between groups H and CP at baseline and posttreatment. A pair-wise comparison of NLR and PLR between CP patients at baseline and posttreatment was significant. Correlation analyses were not remarkable. Receiver operating characteristics analyses provided significant NLR and PLR predictive cutoff values to differentiate between CP patients at baseline and posttreatment. Conclusion: NLR and PLR may serve as potential biomarkers of the SIR to CP to bridge the association between periodontal and systemic conditions.
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Affiliation(s)
- Anirudh Balakrishna Acharya
- Department of Periodontics, S.D.M. College of Dental Sciences and Hospital, SDM University, Dharwad, Karnataka, India
| | | | - Shrinidhi Jain
- Department of Periodontics, S.D.M. College of Dental Sciences and Hospital, SDM University, Dharwad, Karnataka, India
| | | | - Swetha Acharya
- Department of Oral Pathology and Microbiology, S.D.M. College of Dental Sciences and Hospital, SDM University, Dharwad, Karnataka, India
| | - Leena Shettar
- Department of Periodontics, S.D.M. College of Dental Sciences and Hospital, SDM University, Dharwad, Karnataka, India
| | - Srinath Thakur
- Department of Periodontics, S.D.M. College of Dental Sciences and Hospital, SDM University, Dharwad, Karnataka, India
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8
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Al-Isa M, Alotibi M, Alhashemi H, Althobiani F, Atia A, Baz S. Effect of non-surgical periodontal therapy on the fibrinogen levels in chronic periodontitis patients. Saudi Dent J 2018; 31:188-193. [PMID: 30983828 PMCID: PMC6445522 DOI: 10.1016/j.sdentj.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/28/2018] [Accepted: 12/02/2018] [Indexed: 01/22/2023] Open
Abstract
Objective This study aimed to evaluate the effect of non-surgical periodontal therapy on the fibrinogen levels in chronic periodontitis patients when compared to the levels seen in healthy subjects. Materials and methods A total of 30 subjects, with an average age of 38 ± 25 years, were enrolled in the present study. They were divided into two groups, namely Group 1 (15 periodontally healthy subjects) and Group 2 (15 moderate to severe chronic periodontitis patients). The periodontal condition of each periodontitis patient was assessed by recording the probing pocket depth (PD), clinical attachment level (CAL), plaque index (PI), and bleeding index (BI) both before and after periodontal therapy had been administered for one month. Additionally, blood samples were collected from the healthy subjects and the periodontitis patients before and after the periodontal treatment in order to assay the plasma fibrinogen levels. Results The clinical parameters were found to be improved after one month of periodontal therapy, with the statistical difference in the mean values of the BI and PD being highly significant (P < 0.01), while the statistical differences concerning the PI and CAL were significant (P < 0.05). The fibrinogen levels (mg/dL) for the periodontitis patients before and after treatment were 342.26 ± 69.00 and 352.93 ± 64.3 mg/dL, respectively. The level was 269.85 ± 43.68 mg/dL for the healthy subjects. In terms of the between-group comparison, the fibrinogen levels of the healthy subjects were observed to be highly significantly lower than the levels of the periodontitis patients before and after the treatment (P < 0.01), in contrast the statistical analysis showed a non-significant difference in the fibrinogen levels (P > 0.05) before and after the periodontal treatment. In addition, the statistical analysis revealed non-significant correlation between the fibrinogen levels and all the periodontal parameters (P > 0.05). Conclusion The non-surgical periodontal therapy proved to be effective in improving the clinical periodontal condition of the periodontitis patients, while the plasma fibrinogen levels were not found to be influenced by the periodontal therapy. Further studies are needed to evaluate the fibrinogen levels over a longer duration after periodontal treatment in patients following a periodontal maintenance program.
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Affiliation(s)
- Mohammad Al-Isa
- Faculty of Dentistry Umm Al-Qura University, Saudi Arabia
- Corresponding author at: College of Dentistry, Umm Al-Qura University, P.O. Box 8117, Makkah 24238, Saudi Arabia.
| | | | | | | | - Alaa Atia
- Faculty of Dentistry Umm Al-Qura University, Saudi Arabia
- Faculty of Dentistry, Al-Azhar University (Assuit Division), Egypt
| | - Sameh Baz
- Faculty of Applied Medical Sciences, Umm Al-Qura University, Saudi Arabia
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9
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Romandini M, Laforí A, Romandini P, Baima G, Cordaro M. Periodontitis and platelet count: A new potential link with cardiovascular and other systemic inflammatory diseases. J Clin Periodontol 2018; 45:1299-1310. [DOI: 10.1111/jcpe.13004] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/27/2018] [Accepted: 08/19/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Mario Romandini
- Institute of Dentistry and Maxillofacial Surgery; Fondazione Policlinico Universitario A. Gemelli IRCCS; Catholic University of the Sacred Heart; Rome Italy
- Currently undertaking the EFP Program in Periodontology at Complutense University; Madrid Spain
| | - Andreina Laforí
- Department of Periodontology and Prosthodontics; Policlinico “Umberto I” - “G. Eastman” Section; Rome Italy
| | - Pierluigi Romandini
- Department of Oral and Maxillo-Facial Sciences; “Sapienza” University of Rome; Rome Italy
| | - Giacomo Baima
- Department of Surgical Sciences; University of Turin; Turin Italy
| | - Massimo Cordaro
- Institute of Dentistry and Maxillofacial Surgery; Fondazione Policlinico Universitario A. Gemelli IRCCS; Catholic University of the Sacred Heart; Rome Italy
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10
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Sim HY, Kim HS, Jung DU, Lee H, Lee JW, Han K, Yun KI. Association between orthodontic treatment and periodontal diseases: Results from a national survey. Angle Orthod 2017; 87:651-657. [PMID: 28686092 DOI: 10.2319/030317-162.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To investigate the association between orthodontic treatment and periodontitis in a nationally representative sample of South Korea. MATERIALS AND METHODS Data from the Fifth and Sixth Korean National Health and Nutrition Examination Survey (KNHANES V, VI-1, and VI-2), conducted from 2012 to 2014, were used in this study. The final sample size consisted of 14,693 adults aged ≥19 years. Logistic regression analysis was performed to assess the association between orthodontic treatment and periodontitis. RESULTS The orthodontic treatment group exhibited a lower prevalence of periodontitis compared with the nonorthodontic treatment group. The adjusted odds ratios for periodontitis in subjects with a history of orthodontic treatment compared with those with no history of orthodontic treatment were 0.553, 0.614, and 0.624, when adjusted for various confounding variables (P < .0001). The subjects with periodontitis were of higher age, body mass index, waist circumference, and white blood cell counts compared with the subjects without periodontitis regardless of history of orthodontic treatment. CONCLUSIONS History of orthodontic treatment was associated with a decreased rate of periodontitis.
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11
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Kwon YJ, Jeon KJ, Chung TH, Lee YJ. Elevated leukocyte count is associated with periodontitis in Korean adults: the 2012-2014 KNHANES. Oral Dis 2016; 23:241-246. [DOI: 10.1111/odi.12601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/26/2016] [Accepted: 10/19/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Y-J Kwon
- Department of Family Medicine; Yonsei University College of Medicine; Seoul Korea
| | - K-J Jeon
- Department of Oral and Maxillofacial Radiology; Yong-in Severance Hospital; Yonsei University College of Dentistry; Yong-in Korea
| | - T-H Chung
- Severance check-up; Severance Hospital; Yonsei University Health System; Seoul Korea
| | - Y-J Lee
- Department of Family Medicine; Yonsei University College of Medicine; Seoul Korea
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12
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Siddeshappa ST, Nagdeve S, Yeltiwar RK, Parvez H, Deonani S, Diwan V. Evaluation of various hematological parameters in patients with periodontitis after nonsurgical therapy at different intervals. J Indian Soc Periodontol 2016; 20:180-3. [PMID: 27143831 PMCID: PMC4847465 DOI: 10.4103/0972-124x.175172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Objective: Chronic low-level bacteremia and a systemic inflammatory response have been suggested as a pathogenetic link between periodontal disease and atherosclerosis. The objective of this study is to evaluate the effect of nonsurgical periodontal therapy on various hematological parameters in patients with periodontitis. Materials and Methods: A total of 30 periodontitis patients were selected for the study. Clinical parameters such as plaque index, gingival index, and probing pocket depth were assessed. For each patient, venous blood sample were collected, and the estimation of total leukocyte count (TLC), differential leukocyte count, platelet count, and erythrocyte sedimentation rate (ESR) was carried out. All the clinical and hematological parameters were measured at baseline, 1 week and 2 weeks after nonsurgical periodontal therapy. Results: The study results showed that there was a statistically significant decrease in TLC, ESR, and platelet count at 1 week and 2 weeks following nonsurgical periodontal therapy. Conclusion: In this study, it has been concluded that there is a decrease in the hematological parameters after nonsurgical periodontal therapy, which may also reduce the risk of atherosclerosis formation in the blood vessel and possibly prevent cardiovascular diseases.
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Affiliation(s)
| | - Sonika Nagdeve
- Department of Periodontology, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
| | | | - Humera Parvez
- Department of Periodontology, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
| | - Sushmita Deonani
- Department of Periodontology, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
| | - Vikas Diwan
- Department of Periodontology, Rungta College of Dental Sciences and Research, Bhilai, Chhattisgarh, India
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13
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D'Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Clin Periodontol 2016; 40 Suppl 14:S85-105. [PMID: 23627337 DOI: 10.1111/jcpe.12061] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/11/2022]
Abstract
AIM The aim of this review was to critically appraise the evidence on the impact of periodontal treatment of cardiovascular diseases (CVDs) biomarkers and outcomes. METHODS A systematic search was performed in Cinhal, Cochrane, Embase and Medline for relevant articles up to July 2012. Duplicate screening and reference hand searching were performed. Data were then summarized and evidence graded in tables. RESULTS The search resulted in: (a) no evidence on the effects of periodontal therapy on subclinical atherosclerosis, serum levels of CD40 ligand, serum amyloid A and monocyte chemoattractant protein-1, (b) limited evidence on the effects of periodontal therapy on arterial blood pressure, leucocyte counts, fibrinogen, tissue necrosis factor-α, sE-selectin, von Willebrand factors, d-dimers, matrix metalloproteinases, oxidative stress and CVD events, and (c) moderate evidence suggesting a negligible effect of periodontal therapy in reducing interleukin-6 and lipids levels, whilst a positive effect in reducing serum C-reactive protein levels and improving endothelial function. CONCLUSIONS Periodontal therapy triggers a short-term inflammatory response followed by (a) a progressive and consistent reduction of systemic inflammation and (b) an improvement in endothelial function. There is however limited evidence that these acute and chronic changes will either increase or reduce CVD burden of individuals suffering from periodontitis in the long term.
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Affiliation(s)
- Francesco D'Aiuto
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, London, UK.
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D'Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Periodontol 2016; 84:S85-S105. [PMID: 23631587 DOI: 10.1902/jop.2013.134007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM The aim of this review was to critically appraise the evidence on the impact of periodontal treatment of cardiovascular diseases (CVDs) biomarkers and outcomes. METHODS A systematic search was performed in Cinhal, Cochrane, Embase and Medline for relevant articles up to July 2012. Duplicate screening and reference hand searching were performed. Data were then summarized and evidence graded in tables. RESULTS The search resulted in: (a) no evidence on the effects of periodontal therapy on subclinical atherosclerosis, serum levels of CD40 ligand, serum amyloid A and monocyte chemoattractant protein-1, (b) limited evidence on the effects of periodontal therapy on arterial blood pressure, leucocyte counts, fibrinogen, tissue necrosis factor-a, sE-selectin, von Willebrand factors, d-dimers, matrix metalloproteinases, oxidative stress and CVD events, and (c) moderate evidence suggesting a negligible effect of periodontal therapy in reducing interleukin-6 and lipids levels, whilst a positive effect in reducing serum C-reactive protein levels and improving endothelial function. CONCLUSIONS Periodontal therapy triggers a short-term inflammatory response followed by (a) a progressive and consistent reduction of systemic inflammation and (b) an improvement in endothelial function. There is however limited evidence that these acute and chronic changes will either increase or reduce CVD burden of individuals suffering from periodontitis in the long term.
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Affiliation(s)
- Francesco D'Aiuto
- Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, University College London, UK.
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Nicu EA, Loos BG. Polymorphonuclear neutrophils in periodontitis and their possible modulation as a therapeutic approach. Periodontol 2000 2016; 71:140-63. [DOI: 10.1111/prd.12113] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 12/24/2022]
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16
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Wytrykowska A, Prosba-Mackiewicz M, Nyka WM. IL-1β, TNF-α, and IL-6 levels in gingival fluid and serum of patients with ischemic stroke. J Oral Sci 2016; 58:509-513. [DOI: 10.2334/josnusd.16-0278] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Anna Wytrykowska
- Department of Dental Techniques and Dysfunction of Masticatory System, Medical University of Gdansk
| | - Maria Prosba-Mackiewicz
- Department of Dental Techniques and Dysfunction of Masticatory System, Medical University of Gdansk
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Doğan B, Fentoğlu Ö, Kırzıoğlu FY, Kemer ES, Köroğlu BK, Aksu O, Çarsancaklı SA, Orhan H. Lipoxin A4 and Neutrophil/Lymphocyte Ratio: A Possible Indicator in Achieved Systemic Risk Factors for Periodontitis. Med Sci Monit 2015; 21:2485-93. [PMID: 26298769 PMCID: PMC4551304 DOI: 10.12659/msm.895115] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background The aim of this study was to evaluate the serum lipoxin A4 (LXA4) and neutrophil/lymphocyte (Ne/Ly) ratio in individuals with achieved systemic risk factors for periodontitis. Material/Methods One hundred and eighty volunteers (69 male, 111 female) who were categorized as systemically healthy control, diabetes, hyperlipidemia, obese and menopause were recruited for this cross-sectional study. Sociodemographic characteristics and oral health behaviors were recorded via questionnaire. Clinical periodontal parameters, including plaque index (PI), gingival index (GI), probing pocket depth (PD), clinical attachment level (CAL), sulcus bleeding index (SBI) and decayed, missing, and filled teeth index (DMFT), were assessed. Systemic parameters and LXA4 levels were evaluated in serum samples. Results Clinical periodontal parameters and DMFT were higher in subjects with achieved systemic risk factors than in healthy subjects. The systemically healthy with periodontitis group had higher serum LXA4 levels than the systemically healthy with non-periodontitis group (P<0.05). The Ne/Ly ratio was higher in the hyperlipidemic group with periodontitis than in the hyperlipidemic group with non-periodontitis (P<0.05). In the control group, serum LXA4 levels were positively correlated with the PD, CAL and SBI. Conclusions In the presence of periodontitis, an increase in LXA4 levels and the Ne/Ly ratio in hyperlipidemic patients could contribute to the hypothesis that these parameters could be an indicator in periodontitis and its systemic risk factors.
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Affiliation(s)
- Burak Doğan
- Department of Periodontology, Faculty of Dentistry, Mustafa Kemal University, Hatay, Turkey
| | - Özlem Fentoğlu
- Department of Periodontology, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - Fatma Yeşim Kırzıoğlu
- Department of Periodontology, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - Esra Sinem Kemer
- Department of Periodontology, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - Banu Kale Köroğlu
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Oğuzhan Aksu
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
| | | | - Hikmet Orhan
- Department of Biostatistics and Medical Informatics, Süleyman Demirel University, Faculty of Medicine, Isparta, Turkey
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Gaddale R, Mudda JA, Karthikeyan I, Desai SR, Shinde H, Deshpande P. Changes in cellular and molecular components of peripheral blood in patients with generalized aggressive periodontitis. ACTA ACUST UNITED AC 2014; 7:59-64. [DOI: 10.1111/jicd.12127] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 08/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Reetika Gaddale
- Department of Periodontology and Implantology; A.M.E Society's Dental College and Hospital; Raichur Karnataka India
| | - Jayashree A. Mudda
- Department of Periodontology; H.K.E Society's S.Nijalingappa Institute of Dental Sciences and Research; Gulbarga Karnataka India
| | - Ilangovan Karthikeyan
- Department of Periodontology; Indira Gandhi Institute of Dental Sciences; Pondicherry Tamil Nadu India
| | - Shrikar R. Desai
- Department of Periodontology; H.K.E Society's S.Nijalingappa Institute of Dental Sciences and Research; Gulbarga Karnataka India
| | - Harshada Shinde
- Department of Periodontology; Bharati Vidyapeeth Deemed University Dental College and Hospital; Wanlesswadi, Sangli-Miraj Road Sangli Maharashtra India
| | - Pavan Deshpande
- Department of Periodontology; Bharati Vidyapeeth Deemed University Dental College and Hospital; Wanlesswadi, Sangli-Miraj Road Sangli Maharashtra India
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Local and systemic immune responses in gingivitis and periodontitis. Open Med (Wars) 2014. [DOI: 10.2478/s11536-013-0328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
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Chaturvedi R, Gupta M, Jain A, Das T, Prashar S. Soluble CD40 ligand: a novel biomarker in the pathogenesis of periodontal disease. Clin Oral Investig 2014; 19:45-52. [PMID: 24595688 DOI: 10.1007/s00784-014-1216-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 02/17/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Periodontitis involves a complex interplay of micro-organisms and host immune response via numerous mediator molecules playing strategic roles in its pathogenesis. Soluble CD40L (sCD40L) is one such co-stimulatory molecule which is essential for T-helper cell activation and is a well-known risk indicator of cardiovascular diseases. The levels of this marker in crevicular fluid of patients of chronic periodontitis have been explored in the present study for the first time along with an analysis of its association with levels in serum in otherwise systemically healthy patients. METHODOLOGY Sixty patients 20 healthy and 40 of chronic periodontitis (18 moderate and 22 severe) participated in the study. Patients of the diseased group underwent non-surgical periodontal therapy. Clinical evaluation and collection of gingival crevicular fluid (GCF) and serum samples was done at baseline, and 6 weeks after phase I periodontal therapy. sCD40L levels were quantified in the fluids using ELISA. RESULTS Levels of sCD40L in GCF were significantly higher in the diseased group (p ≤ 0.001) and strongly correlated not only with increasing severity of disease but also with levels in serum. In post-treatment, the levels decreased significantly in both the biological fluids (p ≤ 0.001). CONCLUSIONS The present study brings to light the role of sCD40L as a novel marker in mediating periodontal destruction and disease progression. Evaluation of local treatment outcomes seems promising in minimizing these effects. CLINICAL RELEVANCE Positive association of its local levels with those in serum further implicates the possibility of widespread systemic effects of this infection.
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Affiliation(s)
- Rashi Chaturvedi
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences & Hospital, Panjab University, Chandigarh, India
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Rao PK, Reddy RV, Mapare SA, Nag VR, Gowtham K, Arora D. An investigation of blood hemogram and estimation of serum iron and protein levels in aggressive periodontitis patients: a clinic biochemical study. J Contemp Dent Pract 2013; 14:852-857. [PMID: 24685787 DOI: 10.5005/jp-journals-10024-1415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aim of this study is to investigate the blood hemogram and estimation of serum iron and proteins level in aggressive periodontitis patients. MATERIALS AND METHODS A total of 85 patients were selected and divided into two groups, 45 patients are with aggressive periodontitis and 40 patients are healthy. Periodontal parameters such as gingival infammation oral hygiene index, Russell's periodontal index and radiograph were taken. Total 10 ml blood was collected and sent for estimation of blood hemogram protein estimation and serum electrophoresis. RESULTS There was statistical signifcant difference observed in relation to gingival infammation oral hygiene hemoglobin and total iron binding capacity level between both the groups. CONCLUSION It has been concluded that periodontitis does not induce anemia like state, as the hematological and biochemical parameters were almost equally affected in periodontally healthy and periodontally diseased individuals, but some parameters showed statistical significant difference between the both groups. CLINICAL SIGNIFICANCE In the present study, the clinical periodontal parameters, red blood cell parameters and serum iron and ferritin levels were compared among control and test groups. It was found that the values of gingival infammation, oral hygiene and periodontal index, hemoglobulin level and total iron binding protein were statistically signifcant between the groups. However, the values of erythrocyte count, white blood cell count, serum iron and serum proteins, serum electrophoresis did not show any signifcant correlation.
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Affiliation(s)
- P Krishna Rao
- Professor and Head, Department of Periodontics, HSRSM Dental College and Hospital, Hingoli, Maharashtra, India, e-mail:
| | - R Vamshidhar Reddy
- Professor and Head, Department of Orthodontics, HSRSM Dental College and Hospital, Hingoli, Maharashtra, India
| | - Sagar Arjun Mapare
- Reader, Department of Orthodontics, HSRSM Dental College and Hospital, Hingoli, Maharashtra, India
| | - Venkat Ratna Nag
- Reader, Department of Prosthodontics, SB Patil Dental College, Bidar Karnataka, India
| | - K Gowtham
- Senior Lecturer, Department of Conservative Dentistry and Endodontics Malla Reddy Dental College, Hyderabad, Andhra Pradesh, India
| | - Dimple Arora
- Assistant Professor, Department of Physiology, CM Medical College Durg, Chhattisgarh, India
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Chauhan AS, Bains VK, Gupta V, Singh GP, Patil SS. Comparative analysis of hyaluronan gel and xanthan-based chlorhexidine gel, as adjunct to scaling and root planing with scaling and root planing alone in the treatment of chronic periodontitis: A preliminary study. Contemp Clin Dent 2013; 4:54-61. [PMID: 23853453 PMCID: PMC3703695 DOI: 10.4103/0976-237x.111619] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The aim of this study was to evaluate the effects of hyaluronan (HA) and chlorhexidine (CHX) gels as adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. MATERIALS AND METHODS Sixty patients within the age group of 30-65 years recruited to participate in the study were randomly equally divided into three groups. Complete SRP and subgingival debridement were performed within 6 h in all the patients. For control (Group I) patients, SRP was the only treatment modality given; for Group II and III patients, at least 8 teeth with 4-8 mm probing pocket depth (PPD) were selected for subgingival application of HA gel and CHX gel, respectively. Clinical periodontal parameters such as gingival index, PPD, and clinical attachment level (CAL) were recorded at baseline and 3 months, whereas plaque index was recorded at baseline, 1 month, and 3 months. For measuring systemic/hematological parameters, blood samples for laboratory tests for total leucocyte count (TLC), differential leucocyte count (DLC), and C-reactive protein (CRP) were obtained using standard 2-mL syringe from each subject in all the three groups at baseline, 24 h, and on the 1 month and 3 months post-baseline. RESULTS In all the three groups, a significant reduction in PPD and gain in CAL were observed between baseline and 3 months follow-up (P< 0.05); however, at 3 months, change in PPD and CAL was more in Group II than Group III, but the difference was non-significant, and Group I (control) showed less changes in PPD and CAL than both experimental groups. Only one patient revealed positive value for CRP at baseline only, and hence could not be statistically analyzed. In all the three groups, the peak values for TLC count were observed at 24 h. At 1-month and 3-month intervals, a significant improvement in TLC and DLC counts was observed among the experimental (HA gel/SRP and Xan-CHX gel) groups as compared to control group (SRP alone).
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Affiliation(s)
- Avinash Singh Chauhan
- Department of Periodontology, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India
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Al-Rasheed A. Elevation of white blood cells and platelet counts in patients having chronic periodontitis. Saudi Dent J 2011; 24:17-21. [PMID: 23960523 DOI: 10.1016/j.sdentj.2011.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/18/2011] [Accepted: 10/22/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND AIM Many risk factors that might contribute to the pathogenesis of atherosclerosis have been proposed, including chronic inflammation and infection. Furthermore, systemic inflammatory responses to periodontal bacteria have been suggested as a pathogenetic link between periodontal disease and atherosclerosis. The purpose of this study was to estimate the white blood cell (WBC) and platelet counts in chronic periodontitis patients. MATERIALS AND METHODS Fifty patients with chronic periodontitis and 50 patients with healthy periodontium were included in this study. Oral hygiene status, pocket probing depth (PPD) and clinical attachment level (CAL) were measured. During clinical evaluation, venous blood samples were taken to analyze the WBC and platelet counts. Statistical analysis was utilized to compare differences across groups. RESULTS Periodontitis patients demonstrated a significantly higher WBC count (7.22 ± 1.42 × 10(9) cells/L) than that of control patients (5.64 ± 1.56 × 10(9) cells/L; P < 0.001). The platelet count of patients with chronic periodontitis (290.73 ± 56.56 × 10(9) cells/L) was also significantly higher compared to the healthy group (223.37 ± 50.27 × 10(9) cells/L; P < 0.001). CONCLUSION Levels of WBCs and platelets are elevated in periodontitis patients compared to healthy controls.
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Affiliation(s)
- Abdulaziz Al-Rasheed
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Ying Ouyang X, Mei Xiao W, Chu Y, Ying Zhou S. Influence of periodontal intervention therapy on risk of cardiovascular disease. Periodontol 2000 2011; 56:227-57. [DOI: 10.1111/j.1600-0757.2010.00368.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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25
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Coimbra LS, Rossa C, Guimarães MR, Gerlach RF, Muscará MN, Spolidorio DMP, Herrera BS, Spolidorio LC. Influence of antiplatelet drugs in the pathogenesis of experimental periodontitis and periodontal repair in rats. J Periodontol 2010; 82:767-77. [PMID: 21073332 DOI: 10.1902/jop.2010.100555] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Platelets contain an array of biologic mediators that can modulate inflammation and repair processes including proinflammatory mediators and growth factors. Previous studies have shown that periodontitis and periodontal repair are associated with platelet activation. We hypothesized that drug-induced platelet inactivation may interfere in the processes of inflammation and repair in experimental periodontitis in rats by suppressing the release of biologic mediators from platelets to the site of injury. METHODS To measure the effects on periodontitis, ligatures were placed around first molars, and aspirin (Asp, 30 mg/kg) or clopidogrel (Clo, 75 mg/kg) was given intragastrically once daily for 15 days. Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and thromboxane A(2) levels were measured by enzyme-linked immunosorbent assay. To evaluate the effects of antiplatelet drugs on periodontal repair, ligatures were removed after 15 days of periodontitis induction, and Asp or Clo were administered beginning the following day for 15 days. Periodontal repair was assessed by microcomputed tomography. RESULTS On periodontitis phase, Asp and Clo significantly reduced levels of TNF-α and Il-6 (P <0.05), but only Asp decreased thromboxane A(2) (P <0.05). Asp and Clo decreased inflammatory infiltration; however, this reduction was more pronounced with Clo treatment (P <0.05). Histometric analysis showed that Asp and Clo impaired alveolar bone resorption. During the repair phase and after removal of the ligatures, microcomputed tomography analysis demonstrated that treatment with Asp and Clo did not impair alveolar bone repair. CONCLUSION Systemic administration of Asp and Clo attenuates the inflammation associated with periodontitis without affecting the repair process when stimulus is removed.
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Affiliation(s)
- Leila S Coimbra
- Department of Physiology and Pathology, Faculdade de Odontologia de Araraquara, UNESP, Universidade Estadual Paulista, Araraquara, SP, Brazil
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Acharya A, Bhavsar N, Jadav B, Parikh H. Cardioprotective Effect of Periodontal Therapy in Metabolic Syndrome: A Pilot Study in Indian Subjects. Metab Syndr Relat Disord 2010; 8:335-41. [DOI: 10.1089/met.2010.0002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Neeta Bhavsar
- Government Dental College and Hospital, Ahmedabad, India
| | - Bhavesh Jadav
- Government Dental College and Hospital, Ahmedabad, India
| | - Hiral Parikh
- Government Dental College and Hospital, Ahmedabad, India
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Unverdorben M, von Holt K, Winkelmann BR. Smoking and atherosclerotic cardiovascular disease: part II: role of cigarette smoking in cardiovascular disease development. Biomark Med 2010; 3:617-53. [PMID: 20477529 DOI: 10.2217/bmm.09.51] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Potential mechanisms and biomarkers of atherosclerosis related to cigarette smoking - a modifiable risk factor for that disease - are discussed in this article. These include smoking-associated inflammatory markers, such as leukocytes, high-sensitivity C-reactive protein, serum amyloid A, ICAM-1 and IL-6. Other reviewed markers are indicative for smoking-related impairment of arterial endothelial function (transcapillary leakage of albumin, inhibition of endogenous nitric oxide synthase activity and reduced endothelium-dependent vasodilation) or point to oxidative stress caused by various chemicals (cholesterol oxidation, autoantibodies to oxidized low-density lipoprotein, plasma levels of malondialdehyde and F(2)-isoprostanes and reduced antioxidant capacity). Smoking enhances platelet aggregability, increases blood viscosity and shifts the pro- and antithrombotic balance towards increased coagulability (e.g., fibrinogen, von Willebrand factor, ICAM-1 and P-selectin). Insulin resistance is higher in smokers compared with nonsmokers, and hemoglobin A1c is dose-dependently elevated, as is homocysteine. Smoke exposure may influence the kinetics of markers with different response to transient or chronic changes in cigarette smoking behavior.
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Affiliation(s)
- Martin Unverdorben
- Clinical Research Institute, Center for Cardiovascular Diseases, Heinz-Meise-Strasse 100, 36199 Rotenburg an der Fulda, Germany.
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Torres de Heens GL, Loos BG, van der Velden U. Monozygotic twins are discordant for chronic periodontitis: white blood cell counts and cytokine production after ex vivo stimulation. J Clin Periodontol 2010; 37:129-36. [DOI: 10.1111/j.1600-051x.2009.01485.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shi D, Meng H, Xu L, Zhang L, Chen Z, Feng X, Lu R, Sun X, Ren X. Systemic inflammation markers in patients with aggressive periodontitis: a pilot study. J Periodontol 2009; 79:2340-6. [PMID: 19053925 DOI: 10.1902/jop.2008.080192] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The association between periodontitis and systemic health is evident; however, until recently, there was a lack of scientific evidence to define the relationship between aggressive periodontitis (AgP) and systemic conditions. The aim of this study was to explore the characteristics of peripheral blood cellular and serum protein parameters in patients with AgP. METHODS Patients with AgP (n = 150) and healthy controls (n = 94) were recruited. Clinical parameters, including probing depth (PD), clinical attachment level (CAL), and percentage of severe sites, were examined. Blood cell variables, including leukocyte, neutrophil, and lymphocyte counts, as well as serum protein parameters, including total protein, albumin, globulin, and albumin/globulin ratio, were analyzed. RESULTS Elevated neutrophil numbers and serum globulin levels were observed in patients with AgP compared to controls (4.22 +/- 1.81 x 10(9)/l versus 3.20 +/- 0.91 x 10(9)/l and 29.20 +/- 3.75 g/l versus 27.17 +/- 3.32 g/l, respectively; P <0.01). Albumin level and albumin/globulin ratio were lower in the AgP group than in the control group (47.65 +/- 2.45 g/l versus 48.88 +/- 2.13 g/l and 1.66 +/- 0.24 versus 1.83 +/- 0.24, respectively; P <0.01). In the AgP group, neutrophil counts and serum globulin levels were positively correlated with clinical parameters, including mean values for PD, CAL, and percentage of severe sites (P <0.05); the albumin level and albumin/globulin ratio were inversely correlated with the clinical parameters as described above (P <0.05). CONCLUSIONS Patients with AgP may have elevated peripheral leukocyte numbers and serum globulin levels as well as decreased serum albumin levels and albumin/globulin ratios compared to controls. These changes might be associated with the severity of periodontal destruction.
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Affiliation(s)
- Dong Shi
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China
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Li P, He L, Sha YQ, Luan QX. Relationship of Metabolic Syndrome to Chronic Periodontitis. J Periodontol 2009; 80:541-9. [DOI: 10.1902/jop.2009.080387] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Persson GR, Persson RE. Cardiovascular disease and periodontitis: an update on the associations and risk. J Clin Periodontol 2009; 35:362-79. [PMID: 18724863 DOI: 10.1111/j.1600-051x.2008.01281.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Associations between periodontitis and cardiovascular diseases have been recognized. MATERIAL AND METHODS New literature since the last European Workshop on Periodontology has been reviewed. RESULTS The lack of reliable epidemiological data on disease prevalence makes an assessment of the associations and risks between periodontitis and cardiovascular diseases difficult. Two recent meta-analysis reports have identified associations between periodontitis and cardiovascular diseases (odds ratios: 1.1-2.2). Different surrogate markers for both disease entities, including serum biomarkers, have been investigated. Brachial artery flow-mediated dilatation, and carotid intima media thickness have in some studies been linked to periodontitis. Studies are needed to confirm early results of improvements of such surrogate markers following periodontal therapy. While intensive periodontal therapy may enhance inflammatory responses and impair vascular functions, studies are needed to assess the outcome of periodontal therapies in subjects with confirmed cardiovascular conditions. Tooth eradication may also reduce the systemic inflammatory burden of individuals with severe periodontitis. The role of confounders remain unclear. CONCLUSIONS Periodontitis may contribute to cardiovascular disease and stroke in susceptible subjects. Properly powered longitudinal case-control and intervention trials are needed to identify how periodontitis and periodontal interventions may have an impact on cardiovascular diseases.
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Bailleul-Forestier I, Monod-Broca J, Benkerrou M, Mora F, Picard B. Generalized Periodontitis Associated With Chédiak-Higashi Syndrome. J Periodontol 2008; 79:1263-70. [DOI: 10.1902/jop.2008.070440] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Periodontitis is associated with platelet activation. Atherosclerosis 2008; 202:605-11. [PMID: 18617175 DOI: 10.1016/j.atherosclerosis.2008.05.035] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 04/22/2008] [Accepted: 05/20/2008] [Indexed: 12/13/2022]
Abstract
There is an epidemiological association between periodontitis and cardiovascular disease (CVD). In periodontitis, low grade systemic inflammation and bacteremia occur regularly. Such events may contribute to platelet activation and subsequent pro-coagulant state. This study aimed to investigate platelet activation in periodontitis patients. The study is composed of two parts. In the first part, plasma levels of soluble(s) P-selectin and sCD40 ligand were measured as general markers of platelet activation in periodontitis patients (n=85) and in healthy controls (n=35). In the second part, surface-exposed P-selectin and the ligand-binding conformation of the glycoprotein IIb-IIIa complex (binding of PAC-1 antibody) were determined on individual platelets in whole blood of periodontitis patients (n=18) and controls (n=16). Patients had significantly elevated plasma levels of sP-selectin (P<0.001) and increased binding of PAC-1 on isolated platelets (P=0.033). Platelet activation was more pronounced in the patients with more severe periodontal disease, showing a severity-dependence. The levels of sCD40 ligand and of platelet-bound P-selectin were not increased. Periodontitis is associated with increased platelet activation. Since platelet activation contributes to a pro-coagulant state and constitutes a risk for atherothrombosis, platelet activation in periodontitis may partly explain the epidemiological association between periodontitis and CVD.
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Nibali L, D'Aiuto F, Griffiths G, Patel K, Suvan J, Tonetti MS. Severe periodontitis is associated with systemic inflammation and a dysmetabolic status: a case–control study. J Clin Periodontol 2007; 34:931-7. [PMID: 17877746 DOI: 10.1111/j.1600-051x.2007.01133.x] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM A cluster of metabolic factors defines a syndrome that predisposes to diabetes and cardiovascular disease. Chronic infections such as periodontitis might alter these individual metabolic factors and the systemic inflammatory burden. The aim of this study was to investigate the association between severe periodontitis and increase in inflammatory and metabolic risk factors for cardiovascular disease. MATERIALS AND METHODS We examined 302 patients with severe periodontitis and 183 healthy controls, and we collected a blood sample from each subject in order to investigate differences in inflammatory (leukocyte numbers and differential counts) and metabolic markers (lipids and glucose). RESULTS After correcting for differences in age, gender, smoking and ethnicity, periodontitis subjects exhibited a low-grade systemic inflammation (increased white cell counts, 1.10+/-1.02 x 10(9)/l, 95%CI 1.05-1.15, p=0.0001), dyslipidemia [lower high-density lipoprotein cholesterol, 1.14+/-1.03 mmol/l, 95%CI 1.08-1.20, p<0.0001 and higher low-density lipoprotein cholesterol, 1.12+/-1.03, 95%CI 1.05-1.19, p<0.0001) and increased non-fasting serum glucose levels (1.04+/-1.01 mmol/l, 95%CI 1.02-1.06, p=0.01) when compared with controls. The associations were confirmed in a subpopulation of Caucasian non-smokers. A trend for a dose dependent effect of the number of periodontal pockets on the tested inflammatory and metabolic markers was observed. CONCLUSIONS These data suggest a possible link between severe generalized periodontitis, systemic inflammation and a dysmetabolic state in otherwise healthy individuals.
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Affiliation(s)
- Luigi Nibali
- Periodontology Unit, Eastman Dental Institute and Hospital, University College London, London, UK.
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Kaner D, Christan C, Dietrich T, Bernimoulin JP, Kleber BM, Friedmann A. Timing Affects the Clinical Outcome of Adjunctive Systemic Antibiotic Therapy for Generalized Aggressive Periodontitis. J Periodontol 2007; 78:1201-8. [PMID: 17608574 DOI: 10.1902/jop.2007.060437] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Systemic antibiotics improve the outcome of scaling and root planing (SRP) in patients exhibiting severe periodontitis. This study evaluated the influence of timing of adjunctive systemic antibiotics in the sequence of periodontal therapy. METHODS Two cohorts of patients with generalized aggressive periodontitis and treated by SRP, adjunctive antibiotics, and supportive periodontal therapy (SPT) were analyzed retrospectively. Cohort A (17 patients; 36 +/- 5 years of age) received systemic amoxicillin/metronidazole immediately after SRP ("immediate"); cohort B (17 patients; 36 +/- 4 years of age) received the same regimen 3 months after SRP, following SPT, including subgingival reinstrumentation ("late"). Clinical parameters, including probing depth (PD), relative attachment level (RAL), bleeding on probing (BOP), and suppuration, were recorded with a pressure-sensitive electronic probe at baseline and 3 and 6 months after SRP. RESULTS Significant time*group interactions were found for all clinical parameters except BOP, i.e., timing of antibiotic therapy affected the course of clinical changes over time. Immediate antibiotic therapy produced significantly higher initial changes (0 to 3 months) in PD and RAL. Late antibiotic therapy at 3 months resulted in additional significant improvements in all clinical parameters between 3 and 6 months. In initially deep sites (baseline PD >6 mm), improvements in PD and RAL over 6 months were significantly higher with immediate antibiotic therapy compared to late antibiotic therapy. CONCLUSION Within the limits of a retrospective analysis, these findings indicate that administration of amoxicillin/metronidazole immediately after initial SRP provides more PD reduction and RAL "gain" in initially deep sites than late administration at SPT with reinstrumentation after 3 months.
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Affiliation(s)
- Doğan Kaner
- Institute for Periodontology and Synoptic Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Moutsopoulos NM, Madianos PN. Low-grade inflammation in chronic infectious diseases: paradigm of periodontal infections. Ann N Y Acad Sci 2007; 1088:251-64. [PMID: 17192571 DOI: 10.1196/annals.1366.032] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Increasing evidence implicates periodontitis, a chronic inflammatory disease of the tooth-supporting structures, as a potential risk factor for increased morbidity or mortality for several systemic conditions including cardiovascular disease (atherosclerosis, heart attack, and stroke), pregnancy complications (spontaneous preterm birth [SPB]), and diabetes mellitus. Cross-sectional, case-control, and cohort studies indicate that periodontitis may confer two- and up to sevenfold increase in the risk for cardiovascular disease and premature birth, respectively. Given the recently acquired knowledge that systemic inflammation may contribute in the pathogenesis of atherosclerosis and may predispose to premature birth, research in the field of periodontics has focused on the potential of this chronic low-grade inflammatory condition to contribute to the generation of a systemic inflammatory phenotype. Consistent with this hypothesis clinical studies demonstrate that periodontitis patients have elevated markers of systemic inflammation, such as C-reactive protein (CRP), interleukin 6 (IL-6), haptoglobin, and fibrinogen. These are higher in periodontal patients with acute myocardial infarction (AMI) than in patients with AMI alone, supporting the notion that periodontal disease is an independent contributor to systemic inflammation. In the case of adverse pregnancy outcomes, studies on fetal cord blood from SBP babies indicate a strong in utero IgM antibody response specific to several oral periodontal pathogens, which induces an inflammatory response at the fetal-placental unit, leading to prematurity. The importance of periodontal infections to systemic health is further strengthened by pilot intervention trials indicating that periodontal therapy may improve surrogate cardiovascular outcomes, such as endothelial function, and may reduce four- to fivefold the incidence of premature birth. Nevertheless, further research is needed to fully discern the underlying mechanisms by which local chronic infections can have an impact on systemic health, and in this endeavor periodontal disease may serve as an ideal disease model.
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Affiliation(s)
- Niki M Moutsopoulos
- Oral Infection and Immunity Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
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Affiliation(s)
- B G Loos
- Department of Periodontology, Academic Centre for Dentistry, Amsterdam, The Netherlands.
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Renvert S, Pettersson T, Ohlsson O, Persson GR. Bacterial Profile and Burden of Periodontal Infection in Subjects With a Diagnosis of Acute Coronary Syndrome. J Periodontol 2006; 77:1110-9. [PMID: 16805672 DOI: 10.1902/jop.2006.050336] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Periodontitis has been identified as a potential risk factor in cardiovascular diseases. It is possible that the stimulation of host responses to oral infections may result in vascular damage and the inducement of blood clotting. The aim of this study was to assess the role of periodontal infection and bacterial burden as an explanatory variable to the activation of the inflammatory process leading to acute coronary syndrome (ACS). METHODS A total of 161 consecutive surviving cases admitted with a diagnosis of ACS and 161 control subjects, matched with cases according to their gender, socioeconomic level, and smoking status, were studied. Serum white blood cell (WBC) counts, high- and low-density lipoprotein (HDL/LDL) levels, high-sensitivity C-reactive protein (hsC-rp) levels, and clinical periodontal routine parameters were studied. The subgingival pathogens were assayed by the checkerboard DNA-DNA hybridization method. RESULTS Total oral bacterial load was higher in the subjects with ACS (mean difference: 17.4x10(5); SD: 10.8; 95% confidence interval [CI]: 4.2 to 17.4; P<0.001), and significant for 26 of 40 species including Porphyromonas gingivalis, Tannerella forsythensis, and Treponema denticola. Serum WBC counts, hsC-rp levels, Streptococcus intermedius, and Streptococcus sanguis, were explanatory factors to acute coronary syndrome status (Nagelkerke r2=0.49). CONCLUSION The oral bacterial load of S. intermedius, S. sanguis, Streptococcus anginosus, T. forsythensis, T. denticola, and P. gingivalis may be concomitant risk factors in the development of ACS.
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Affiliation(s)
- Stefan Renvert
- Department of Health Sciences, Kristianstad University, and Department of Medicine, Central Hospital, Kristianstad, Sweden
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Bouchard P, Boutouyrie P, Mattout C, Bourgeois D. Risk Assessment for Severe Clinical Attachment Loss in an Adult Population. J Periodontol 2006; 77:479-89. [PMID: 16512763 DOI: 10.1902/jop.2006.050128] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study was carried out to identify variables related to severe clinical attachment loss (CAL) in an adult French population. METHODS This cross-sectional survey employed 2,132 subjects of the First National Periodontal and Systemic Examination Survey (NPASES I) aged 35 to 64 years, each with at least six teeth. A nationally representative sample was obtained from September 2002 to June 2003 by a quota method stratified on age, gender, socioeconomic status, and geographic areas. The subjects had a complete full-mouth periodontal examination of four sites per tooth, assessment of missing teeth, and a number of laboratory tests and questionnaires. The periodontal status of each subject was assessed by criteria based on the severity and extent of CAL. The data were analyzed by univariable and multivariable models using logistic regression analyses. RESULTS Nineteen and seven-tenths percent (19.7%) of the subjects had CAL>5 mm. When dental variables were not included in the analysis (model 1), age (odds ratio [OR]=1.8), male gender (OR=1.7), body mass index (OR=1.2), and white blood cell count (OR=2.2) showed significant association with severe CAL. A significantly higher risk was also present in non-drinkers and regular drinkers compared to occasional drinkers (OR=1.6). Model 2, including dental variables in addition to model 1 variables, showed that a significantly higher risk for severe CAL was also present with age (OR=1.6) and in males (OR=1.7). The number of teeth (OR=1.1), and the mean gingival bleeding index (OR=1.7) were the dental variables significantly associated with severe CAL. CONCLUSIONS The results indicated that age and gender are powerful independent predictors of clinical attachment loss, as is the mean gingival bleeding index. To a lesser extent, the number of missing teeth was a good predictive variable. The patient profile for severe clinical attachment loss also included body mass index and white blood cell count. Occasional drinking may be associated with decreased severity of CAL.
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Affiliation(s)
- Philippe Bouchard
- Department of Periodontology, Service of Odontology, Hôtel-Dieu Hospital, AP-HP, Paris 7-Denis Diderot University, UFR of Odontology, Paris, France
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Abstract
This literature review summarizes current knowledge on the systemic levels of selected markers of inflammation in periodontitis. From samples of peripheral blood the following cellular factors are discussed: total number of white blood cells, red blood cells, and thrombocytes. Further, plasma levels of acute-phase proteins, cytokines, and coagulation factors are reviewed. From the available literature it appears that the total numbers of leukocytes and plasma levels of C-reactive protein are consistently higher in periodontitis patients compared to healthy controls. Numbers of red blood cells and levels of hemoglobin are lower in periodontitis and there is a trend towards anemia of chronic disease. Most systemic markers of inflammation discussed in this review are also regarded as predictive markers for cardiovascular diseases. Therefore, changes in these markers in periodontitis may be part of the explanation why periodontitis is associated with cardiovascular diseases and/or cerebrovascular events in epidemiological studies. It is hypothesized that possibly daily episodes of a bacteremia originating from periodontal lesions are the cause for the changes in systemic markers in periodontitis; the cumulative size of all periodontal lesions in the untreated severe patient may amount to 15 to 20 cm2.
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Affiliation(s)
- Bruno G Loos
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije University, Amsterdam, The Netherlands.
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Persson GR, Pettersson T, Ohlsson O, Renvert S. High-sensitivity serum C-reactive protein levels in subjects with or without myocardial infarction or periodontitis. J Clin Periodontol 2005; 32:219-24. [PMID: 15766362 DOI: 10.1111/j.1600-051x.2005.00648.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Serum high-sensitivity C-reactive protein (hsC-rp) is a non-specific marker of inflammation. Elevated hsC-rp levels are found in subjects with cardiovascular diseases (CVDs). Periodontitis may influence hsC-rp levels. OBJECTIVES To assess periodontal status and hsC-rp serum levels in consecutive subjects hospitalized and diagnosed with acute myocardial infarction (AMI) (n=85) and in a group of carefully matched subjects (gender, age social, ethnic, and smoking habits) without clinical evidence of CVD (n=63). METHODS hsC-rp levels, other routine serum values, and clinical periodontal conditions were studied. RESULTS Subjects with AMI had higher hsC-rp levels than control subjects (p<0.001, Mann-Whitney U-test). The odds that subjects in the control group with periodontitis (30% or more sites with>4.0 mm loss of alveolar bone) had serum hsC-rp>1.8 mg/l was 1.5 (95% CI: 1.1-7.3, p<0.05). Stepwise linear regression analysis failed to include periodontal parameters in an explanatory model to hsC-rp values. Only the serum leucocyte (white blood cell (WBC)) counts were explanatory to hsC-rp values (beta standard coefficient=0.45, t=3.2, p<0.001). Serum WBC counts were significantly higher in control subjects with periodontitis (p<0.03) but not in subjects in the AMI group (p<0.57). CONCLUSIONS (1) As expected, elevated serum hsC-rp concentration and serum WBC counts are associated with acute coronary heart disease. (2) Elevated serum hsC-rp values are associated with radiographically defined periodontitis in subjects with no evidence of CVD. (3) Periodontal parameters are not explanatory to elevated serum hsC-rp values if serum WBC and low-density lipoprotein counts are included in the regression model.
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Affiliation(s)
- G Rutger Persson
- Department of Periodontics, University of Washington, Seattle, WA, USA.
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Montebugnoli L, Servidio D, Miaton RA, Prati C, Tricoci P, Melloni C, Melandri G. Periodontal health improves systemic inflammatory and haemostatic status in subjects with coronary heart disease. J Clin Periodontol 2005; 32:188-92. [PMID: 15691350 DOI: 10.1111/j.1600-051x.2005.00641.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES A relationship between poor oral health and coronary heart disease (CHD) and systemic inflammatory and haemostatic factors has been recently documented in an Italian population. The present study was performed to assess whether intensive dental care may produce a periodontal improvement along with a change in systemic inflammatory and haemostatic factors. MATERIAL AND METHODS The study population consisted of 18 males aged 40-65 years with proven CHD and elevated values of systemic inflammatory and haemostatic factors. A detailed description of their oral status was given by using two different dental indices (clinical periodontal sum score and clinical and radiographic sum score). Blood samples were taken for measurement of the following systemic markers of inflammation [(C-reactive protein (CRP), leucocytes, fibrinogen)] and haemostatic factors [(von Willebrand factor, fibrin D-dimer and oxidized-low density lipoprotein (Ox-LDL)]. All parameters were determined in each subject at baseline, after 4 months as a control and 3 months after an intensive protocol of scaling and root planing. anova for repeated measures was used for the statistical analysis. RESULTS No statistical difference was found between values at baseline and at the 4-month-control. All oral indexes showed a significant decrease (p< .01) 3 months after periodontal treatment. All systemic inflammatory indexes decreased but only the decrease in CRP reached statistical significance (p< .05). A significant decrease (p< .01) was also found as regards Ox-LDL among haemostatic factors. CONCLUSIONS Preliminary results from the present study suggest an association between poor oral status and CHD, and provide evidence that the improvement of periodontal status may influence the systemic inflammatory and haemostatic situation.
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Affiliation(s)
- L Montebugnoli
- Department of Oral Science, University of Bologna, Bologna, Italy.
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Säemann MD, Weichhart T, Zeyda M, Staffler G, Schunn M, Stuhlmeier KM, Sobanov Y, Stulnig TM, Akira S, von Gabain A, von Ahsen U, Horl WH, Zlabinger GJ. Immunoregulation in Urinary Tract Inflammation—A Role of Tamm-Horsfall Glycoprotein. J Am Soc Nephrol 2005. [DOI: 10.1681/asn.2005020170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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D'Aiuto F, Parkar M, Andreou G, Brett PM, Ready D, Tonetti MS. Periodontitis and atherogenesis: causal association or simple coincidence? J Clin Periodontol 2004; 31:402-11. [PMID: 15086624 DOI: 10.1111/j.1600-051x.2004.00580.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to assess the systemic effects of treating severe widespread periodontitis in a population of otherwise healthy individuals by examining treatment associated changes in markers of inflammation that are also implicated in cardiovascular atherosclerotic diseases. The potential impact of specific polymorphisms in cytokine genes known to influence both periodontitis and cardiovascular diseases was also examined. MATERIALS AND METHODS A convenience sample of patients affected with severe generalised periodontitis was enrolled into a prospective single blind longitudinal intervention trial with a 6 months follow-up. Serum C-reactive protein (CRP) and interleukin-6 (IL-6) levels were assessed by high-sensitivity assays. Serological and clinical periodontal parameters were evaluated at baseline, 2 and 6 months after completion of non-surgical periodontal therapy. RESULTS In the 94 subjects that completed this pilot trial improvements in all clinical periodontal parameters were achieved. These were accompanied with significant reductions in serum IL-6 and CRP concentrations. In a multivariate model, serum CRP levels were significantly associated with the outcome of periodontal treatment after correcting for potential covariates (age, body mass index, gender, smoking) and polymorphisms in the IL-6 (-174 C/G) and IL-1A (-889) genes. A median decrease in serum CRP of 0.5 mg/l (95% CI 0.4-0.7 mg/l) was observed 6 months after completion of periodontal therapy in this population. Subjects with above average response to periodontal therapy (<30 residual pockets and <30% of sites bleeding on probing) accounted for the observed improvement in serum CRP. CONCLUSIONS Control of periodontitis, achieved with non-surgical periodontal therapy, significantly decreased serum mediators and markers of acute phase response. The significance of the serum response was associated with the half of the population that responded better to non-surgical periodontal therapy. The results of this pilot study indicate that severe generalised periodontitis causes systemic inflammation. This is consistent with a causative role of periodontitis in atherogenesis.
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Affiliation(s)
- Francesco D'Aiuto
- Department of Periodontology, Eastman Dental Institute and Hospital, University College London, UK
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Fokkema SJ, Loos BG, Hart AAM, van der Velden U. Long-term effect of full-mouth tooth extraction on the responsiveness of peripheral blood monocytes. J Clin Periodontol 2003; 30:756-60. [PMID: 12887346 DOI: 10.1034/j.1600-051x.2003.00359.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND As some residual inflammation may remain after periodontal therapy, the present pilot study investigated the long-term effect of full-mouth tooth extraction therapy on the responsiveness of peripheral blood monocytes in a case with generalized terminal adult periodontitis. METHODS Before and 3, 9, 20 and 32 months after therapy, venous blood was collected. Total and differential white blood cell counts were determined and whole blood cell cultures (WBCC) were incubated with lipopolysaccharide (LPS) to stimulate the production of inflammatory mediators by monocytes. RESULTS After full-mouth tooth extraction, the numbers of total peripheral white blood cells and neutrophils decreased over time. The release of the chemokines interleukin (IL)-8 and macrophage chemoattractant protein (MCP)-1 in the cultures decreased twofold over time, whereas no changes were seen for the other studied cytokines, chemokines and prostaglandin E2. CONCLUSION On the basis of previous studies and the present case, the high production of IL-8 and MCP-1 by monocytes in LPS-stimulated WBCC from periodontitis patients is most likely acquired, as their levels decrease over time when the periodontal infection is controlled. The possible connection between periodontitis and atherosclerosis through IL-8 and MCP-1 is discussed.
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Affiliation(s)
- Schelte J Fokkema
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands
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