Prevalence of medical problems in periodontal patients obtained from three different populations

Complications and treatment errors in periodontal therapy in medically compromised patients

Patients who are medically compromised may be at an increased risk of complications and treatment errors following periodontal therapy. A review of the evidence on the topic is presented, in relation to the type of complication reported, of periodontal treatment, and of patients' medical status. Further, a framework for risk assessment and appropriate treatment modifications is introduced, with the aim of facilitating the management of patients with existing comorbidities and reducing the incidence of treatment complications.

Medical Emergency Management in the Dental Office (MEMDO): A Pilot Study Assessing a Simulation-Based Training Curriculum for Dentists

In the event of a medical emergency in the dental office, the dentist must be able to identify a patient in distress, assess the situation, and institute proper management. This study assessed the impact of a simulation-based medical emergency preparedness curriculum on a resident's ability to manage medical emergencies. This interventional and pre-post educational pilot study included 8 participants who completed a standard curriculum and 8 who completed a modified curriculum (N = 16). The intervention consisted of a comprehensive medical emergency preparedness curriculum that replaced lecture sessions in a standard curriculum. Participants completed performance assessments using scenario-based objective structured clinical examinations (OSCEs) that were recorded and evaluated by calibrated faculty reviewers using a customized scoring grid. The intervention group performed significantly better than the control group on their summative OSCEs, averaging 90.9 versus 61.2 points out of 128 (p = .0009). All participants from the intervention group passed their summative OSCE with scores >60%, while none from the control group received passing scores. Completion of a simulation-based medical emergency preparedness curriculum significantly improved resident performance during simulated medical emergencies.

Medical emergencies in the dental school setting

PURPOSE/OBJECTIVES

An aging population with an increasing chronic disease burden may make management of medical emergencies in dental practice more common. Previous research has differed significantly in the reported frequency of medical emergencies in a dental setting, often relying on survey-based protocols. This study examines the incidence and type of emergencies encountered in a dental school setting. Additional examination of contributing medical co-morbidities is provided.

METHODS

A retrospective study was designed to review 121 incident reports at the Ohio State University College of Dentistry (OSU CoD) from July 1, 2013 to January 24, 2019. Sixty-five of the recorded events were classified as medical emergencies and were further analyzed.

RESULTS

The most common emergency encountered was syncope, followed by cardiac events, seizures, and diabetic complications. Emergencies most commonly occurred in the pre-doctoral general dentistry clinics. Many of the affected patients had no significant medical history.

CONCLUSION

Identifying emergencies most encountered by dentists is critical for process improvement, awareness, and targeted educational initiatives. This may reduce the frequency of medical emergencies in dental practices and allow for more efficient management should they occur.

Medical status of patients presenting for treatment at an Australian dental institute: a cross-sectional study

Background

Individuals seeking dental treatment often present with medical conditions which may affect dental treatment provision. The purpose of this study was to determine the prevalence of medical conditions and medication use among individuals attending dental clinics at a Western Australian tertiary institution.

Methods

This observational study examined the general demographics, medical and social histories of 873 subjects presenting for a general dental examination at a Western Australian Tertiary Institution between March 2018 and February 2019. Individual recruited were those presenting to the clinics either as new patients to the Centre or returning patients after an extended period of absence.

Results

Presence of a medical condition was reported by 86% of the participants, with males more commonly affected (p = 0.0448). Medication use was noted by 80% of the participants. Cardiovascular disease (37.9%), allergy (32.3%), mental health disorders (29.4%), musculoskeletal (23.0%), endocrine (22.4%) and respiratory disease (17.8%) were the most common conditions identified. Women were significantly more likely to report allergy (p = 0.0002) or a mental health condition (p = 0.0368).

Conclusion

Medical comorbidities are common among individuals presenting for student dental treatment in Western Australia, highlighting the importance of knowledge and teaching of internal medicine and its application to the dental setting.

Prevalence of Self-reported Medical Conditions among Dental Patients

Background:

In general, it is important to assess the medical history of patients before initiating any treatment. In particular, patients seeking dental treatment could possibly have significant medical conditions that may affect the diagnosis and/or alter the treatment provided. However, many dentists assume that their patients are systemically healthy, and thus they do not record the medical history of their patients.

Aim and Objective:

This study aimed to determine the prevalence of medical conditions in patients seeking periodontal treatment at the dental teaching hospital of King Khalid University.

Materials and Methods:

Upon presentation at the periodontal clinics of the dental teaching hospital of King Khalid University, Asir Region, Saudi Arabia, patients' history from medical records was screened.

Results:

The medical history was taken for 455 periodontal patients. The most frequently encountered medical conditions were diabetes mellitus and hormonal disorders, followed by respiratory diseases and cardiovascular diseases.

Conclusion:

The results of our study found a high prevalence of medical conditions among patients seeking periodontal treatment, thereby highlighting the need to record patients' medical and dental care history in detail.

Investigation of hemorheological parameters in periodontal diseases

Periodontal diseases are frequently associated with cardiovascular diseases (CVD). On the other hand, occurrence of CVD has also been related with increased blood viscosity. This study was planned to investigate four main hemorheological parameters contributing to blood viscosity - hematocrit, erythrocyte deformability, erythrocyte aggregation and plasma viscosity - and also some biochemical parameters (hs-CRP, fibrinogen, globulin etc.) in patients with periodontal disease. We hypothesized that poor periodontal health would be associated with deterioration of hemorheological properties. According to periodontal health status, subjects were divided into three groups as control (healthy), with plaque induced gingivitis and with chronic periodontitis. All groups included 15 males who had not received periodontal therapy in the last six months before the study, were non-smokers, had no systemic diseases and were not on any medication. Erythrocyte deformability and erythrocyte aggregation were measured with laser-assisted optical rotational cell analyzer (LORCA). Plasma viscosity was measured by a cone-plate viscometer. Data were analyzed with Kruskal-Wallis, Mann-Whitney U Test and Spearman Correlation Coefficient. Plasma viscosity (1.36 ± 0.01 mPa.s in the control group and 1.43 ± 0.02 mPa.s in the chronic periodontitis group, P <  0.01), erythrocyte aggregation tendency (aggregation index, amplitude and t½ were 58.82 ± 1.78% , 20.22 ± 0.40 au, 2.80 ± 0.25 s respectively in the control group, and 67.05 ± 1.47% , 22.19 ± 0.50 au, 1.84 ± 0.15 s in the chronic periodontitis group, P <  0.01), hs-CRP, fibrinogen and globulin levels were significantly higher, whereas HDL level was significantly lower in the chronic periodontitis group (P <  0.05) compared to the control group. All of these conditions may contribute to cardiovascular morbidity and mortality observed in people with periodontal disease, via increasing blood viscosity.

Descriptive study of the patients treated at the clinic "integrated dentistry for patients with special needs" at Complutense University of Madrid (2003-2012)

Objectives: To study clinical and epidemiological characteristics of the patients treated at the clinic “Integrated Dentistry for Patients with Special Needs (Special Care Dentistry)” at Complutense University of Madrid (UCM), as well as to know the dental treatments performed in these patients and the modifications from the usual treatment protocol. The information obtained from the results could also be applied in order to assess the needs of dental students education about this type of patients. Study Design: Medical records review of all the patients referred to the clinic of “Integrated Dentistry for Patients with Special Needs”, performing a retrospective cross-sectional study analyzing their main pathology, ASA risk score (Classification system used by the American Society of Anesthesiologists to estimate the risk posed by the anesthesia for various patient conditions), pharmacological treatment, what kind of dental treatment was necessary, whether the patient was treated or not, and if it was required to change any procedure due to the patient health status (sedation or antibiotic prophylaxis). Results: The number of patients referred to the clinic was 447, of whom 426 were included in this study. Out of them, 52,35 % were men and 47,89 were women, with a mean age of 49,20 years. More frequent pathologies were cardiovascular or cerebrovascular diseases (24,29 %), infectious diseases (12,41%), endocrine diseases (11,66%) and intellectual disability (8,85%). 70’18% of the patients were treated, with sedation being necessary in 9,03% of the cases and antibiotic prophylaxis in 11,70%. Conclusions: Given the high number of patients with some kind of pathology and the amount of medicines that they use, it seems necessary for dentistry students to have a specific training regarding how to handle and treat these patients, so they will be able to provide them the best possible care.

Key words:Patients with special needs, medically compromised patients, dental treatment, special care dentistry.

Periodontal innate immune mechanisms relevant to atherosclerosis

Atherosclerosis is a common cardiovascular disease in the USA where it is a leading cause of illness and death. Atherosclerosis is the most common cause for heart attack and stroke. Most commonly, people develop atherosclerosis as a result of diabetes, genetic risk factors, high blood pressure, a high-fat diet, obesity, high blood cholesterol levels, and smoking. However, a sizable number of patients suffering from atherosclerosis do not harbor the classical risk factors. Ongoing infections have been suggested to play a role in this process. Periodontal disease is perhaps the most common chronic infection in adults with a wide range of clinical variability and severity. Research in the past decade has shed substantial light on both the initiating infectious agents and host immunological responses in periodontal disease. Up to 46% of the general population harbors the microorganism(s) associated with periodontal disease, although many are able to limit the progression of periodontal disease or even clear the organism(s) if infected. In the last decade, several epidemiological studies have found an association between periodontal infection and atherosclerosis. This review focuses on exploring the molecular consequences of infection by pathogens that exacerbate atherosclerosis, with the focus on infections by the periodontal bacterium Porphyromonas gingivalis as a running example.

The relationship between periodontitis and systemic diseases - hype or hope?

Investigations have definitely acknowledged a clinically relevant two-way relationship between periodontitis and certain systemic diseases and conditions, which are significant for the dentist in the daily practice and for a physician as well. This review article yields the most up-to-date information on the role of periodontal diseases in systemic diseases, that include cardiovascular diseases and atherosclerosis, diabetes mellitus, respiratory diseases and unfavourable pregnancy outcomes. It debates the role of diabetes and smoking in the periodontal tissues.

The effect of irradiation wavelengths and the crystal structures of titanium dioxide on the formation of singlet oxygen for bacterial killing

Safe and effective methods for oral bacterial disinfection have been desired, since bacteria cause many infectious diseases such as dental caries, periodontal disease, and endodontic infections. Singlet oxygen ((1)O(2)) is attractive, because it is toxic to prokaryotic cells, but not to eukaryotic cells. We selected irradiation of titanium dioxide (TiO(2)) as a source of (1)O(2), because it has been used in sunscreens and cosmetic products without complications. In order to establish the optimal oral photodynamic therapy conditions, we measured the rate of (1)O(2) formation from the irradiated anatase or rutile forms of TiO(2) using 365 or 405 nm lamps. The rate of (1)O(2) formation decreased in the following order: anatase, 365 nm > rutile, 405 nm > rutile, 365 nm > anatase, 405 nm. Therefore, we concluded that irradiation of the rutile form of TiO(2) by a 405 nm lamp is the most favorable photodynamic therapy condition, because visible light is more desirable than UV light from the viewpoint of patient safety. We also confirmed that there was no direct HO(•) formation from the irradiated TiO(2).

High prevalence of cardiovascular diseases among other medically compromised conditions in dental patients: A retrospective study

BACKGROUND

Over the last few decades, oral health care has become a greater priority as people live longer with serious medical conditions and disabilities. As a result, they require more comprehensive dental treatment. We are now, more than ever, at a turning point in history where dental care, or more broadly oral health care, is an integral part of medical care. Therefore, a need was felt to study the prevalence of medically compromised patients seeking dental treatments.

MATERIALS AND METHODS

The present study was a retrospective study conducted by reviewing the patient records starting from 1(st) January 2009 to 31(st) December 2010 for the presence of medically compromised conditions. Demographic data of the patients was also collected.

RESULTS

The prevalence of medically compromised conditions in dental patients of our hospital in the present study was 1.02%. The Cardiovascular diseases accounted to be the most prevalent condition (57.87%) followed by Endocrine disorders (35.73%).

CONCLUSION

Even though the prevalence of medically compromised conditions in dental patients is not high, dentists should bear in mind that some of the patients may harbor such conditions, which are contraindicated for certain dental procedures or medication or require special attention when treating these patients.

Prevalence of systemic diseases among patients requesting dental consultation in the public and private systems

Objectives: To determine the prevalence and aetiology of systemic disease among patients requesting dental treatment in public and private practice. Study Design: A retrospective analysis was performed of the medical histories of 2000 patients requesting dental treatment during the year 2009. One thousand patients came from the Fontiñas Primary Care Oral and Dental Health Unit of the Galician Health Service (SERGAS), Spain, and the other thousand from a private clinic; both clinics were situated in Santiago de Compostela, La Coruña, Spain. The data collected were the following: demographic data (age and sex), presence or absence of systemic diseases and the nosologic categories, and drug history (type and number of drugs). Results: The prevalence of systemic disease was significantly higher among patients seen in the public system (35.2% in the public system versus 28.1% in the private system; p= 0.003). The differences between the two systems were more marked when considering patients aged under 65 years, particularly with respect to rheumatic and endocrine-metabolic (diabetes) disorders. The prevalence of patients receiving polypharmacy (>4 drugs/day) was significantly higher among patients seen in the public system (5.7% in the public system versus 2.7% in the private system; p= 0.009). Conclusions: There is a high prevalence of medical disorders and of patients receiving polypharmacy among individuals requesting dental care, particularly in the public health system. Dentists must have adequate training in medical disease and must be fully integrated into primary care health teams in order to prevent or adequately resolve complications.

Key words: Dentistry, medical history, systemic disease, polypharmacy.

Butyrate enhancement of inteleukin-1β production via activation of oxidative stress pathways in lipopolysaccharide-stimulated THP-1 cells

Safe and effective methods for oral bacterial disinfection have been desired, since bacteria cause many infectious diseases such as dental caries, periodontal disease, and endodontic infections. Singlet oxygen (¹O₂) is attractive, because it is toxic to prokaryotic cells, but not to eukaryotic cells. We selected irradiation of titanium dioxide (TiO₂) as a source of ¹O₂, because it has been used in sunscreens and cosmetic products without complications. In order to establish the optimal oral photodynamic therapy conditions, we measured the rate of ¹O₂ formation from the irradiated anatase or rutile forms of TiO₂ using 365 or 405 nm lamps. The rate of ¹O₂ formation decreased in the following order: anatase, 365 nm > rutile, 405 nm > rutile, 365 nm > anatase, 405 nm. Therefore, we concluded that irradiation of the rutile form of TiO₂ by a 405 nm lamp is the most favorable photodynamic therapy condition, because visible light is more desirable than UV light from the viewpoint of patient safety. We also confirmed that there was no direct HO^• formation from the irradiated TiO₂.

Periodontal microbiota in patients with coronary artery disease measured by real-time polymerase chain reaction: a case-control study

BACKGROUND

Recent data have shown that periodontal disease may increase the risk of occurrence of coronary heart disease in which inflammation initiated by bacteria and their compounds might be a common causal factor. This case-control study aimed at studying the relationship between periodontal disease and coronary artery disease (CAD) based on clinical and periodontal microbiologic parameters.

METHODS

A total of 90 male subjects, 48 to 80 years of age, were included in this study. Forty-five men had CAD (CAD+), which was confirmed by coronary angiography. Forty-five age-matched controls showed no history or symptoms of CAD (CAD-). All subjects underwent a clinical periodontal examination including assessment of tooth loss, probing depth, clinical attachment level, and bleeding on probing. In the CAD+ group, this examination took place 1 day before coronary angiography. Subgingival microbial samples were taken and evaluated by means of real-time polymerase chain reaction (RT-PCR) for the total amount of bacteria and the following periodontopathogens: Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Parvimonas micra (formerly Micromonas micros), Dialister pneumosintes, and Campylobacter rectus.

RESULTS

Compared to control subjects, CAD+ subjects had significantly deeper pockets (2.28 mm versus 2.96 mm; P <0.001) and greater attachment loss (2.85 mm versus 3.65 mm; P <0.001), and this difference remained statistically significant after adjusting for smoking. No significant differences were observed between cases and controls with regard to the number of teeth present. P. intermedia was the only periodontal pathogen that showed significantly higher mean counts in CAD+ subjects compared to CAD- subjects. Higher counts of total bacteria, P. micra, D. pneumosintes, and C. rectus were found in the CAD- group.

CONCLUSION

The results suggest that a relationship between periodontal disease and coronary heart disease exists, although P. intermedia was the only periodontopathogen related to CAD.

Periodontal care may improve endothelial function

BACKGROUND

Periodontitis is a chronic, infectious, insidious disease of the tooth-supporting structures that causes a general inflammatory response. The aims of this study were to determine whether periodontitis is associated with endothelial dysfunction leading to cardiovascular events and whether proper management of periodontal disease would improve endothelial function and prevent cardiovascular events in the future.

METHODS

Twenty-two patients (12 women, 10 men; 40+/-5 years old) took part in the study. All had severe periodontitis (without systemic disorders) and were all treated conservatively. Thirteen patients returned for a second visit after 3 months of treatment. Endothelial function and periodontal status were evaluated on entry into the study and 3 months following treatment. Ten age-matched, healthy volunteers without periodontal disease served as the control group.

RESULTS

There was a significant difference between the patient group and the healthy controls: FMD% 4.12+/-3.96 vs. 16.60+/-7.86% (p=0.0000). Periodontitis improved significantly in all 13 patients who completed 3 months of treatment, and their endothelial function improved as well: FMD% 4.12+/-3.96% vs. 11.12+/-7.22% (p=0.007). No difference was found in FID% before and after 3 months of treatment: 20.97+/-10.66% vs.17.94+/-6.23% (p=NS).

CONCLUSIONS

Periodontitis may be an insidious cause of endothelial dysfunction and cardiovascular events. Treating periodontitis can improve endothelial function and be an important preventive tool for cardiovascular disease.

Periodontal disease as a risk factor for acute myocardial infarction. A case-control study in Goans highlighting a review of the literature

OBJECTIVES

The aim of the present study was to investigate the possible association between periodontal health and acute myocardial infarction (AMI) in a case-control design.

MATERIALS AND METHODS

A total of 500 patients, 250 with AMI and 250 with coronary heart disease (CHD) were included in this study. The patients in the AMI group were admitted in the department of Medicine, Goa Medical College and Hospital, Bambolim-Goa because of AMI. The patients in the CHD group had no documented history of recent acute coronary events. Medical history was taken and data on serum lipid values, decayed teeth, missing teeth, filled teeth, probing depth (PD), simplified oral hygiene index (OHI-S) and bleeding on probing (BOP) were recorded. Sample proportions were compared by Pearson's chi-square test and quantitative variables with Student's t-test. The relation of clinical parameters and conventional risk factors with AMI was assessed with multivariate logistic regression analysis.

RESULTS

All the serum lipids and dental parameters were statistically different between AMI and CHD groups (p <0.05). Logistic regression analysis showed that serum lipids, number of decayed teeth, mean PD, percentage of sites with BOP, and oral hygiene were significantly associated with AMI (p <0.05).

CONCLUSION

The results of this study indicate that periodontal disease may be associated with AMI. We propose that prospective randomised studies are needed to determine whether periodontal disease is a risk factor in the occurrence of AMI.

The association of periodontal disease parameters with systemic medical conditions and tobacco use

OBJECTIVES

The objective of this study was to determine if an association existed between periodontal disease and various systemic medical conditions and tobacco use.

MATERIAL AND METHODS

The study design was a case-controlled, retrospective chart review. Patient charts (n=2006) were selected from more than 13,000 active patients attending the University of Minnesota dental clinics. These charts were examined to determine patient's self-reported systemic condition and smoking history. In addition, the number of missing teeth and bone loss were recorded. Two examiners collected the data. One examiner abstracted patient's medical history from the standard clinic medical questionnaire. The second examiner assessed the radiographs and dental charts to determine bone loss and number of missing teeth. Each examiner was blind to the findings of the other.

RESULTS

After adjusting for age, sex, diabetes and smoking (yes/no) status, seven conditions were significantly (p=0.0003-0.04) related to bone loss or number of missing teeth (vascular disease, heart surgery, vascular surgery, heart attack, thyroid problems, arthritis, stomach ulcers). From these conditions, thyroid problems and arthritis had a negative association with bone loss.

CONCLUSIONS

These findings support the results from previous investigators that a number of systemic conditions and smoking are closely associated with missing teeth or bone loss.

Systemic disorders in patients with periodontal disease

BACKGROUND, AIMS

Over the past 10 years several studies have been published pointing towards a relationship between periodontal disease and various systemic disorders or diseases. The purpose of this retrospective study was to investigate the occurrence of self-reported systemic disorders in patients referred to a specialist clinic for periodontal treatment and to explore possible relationships between general health and periodontal disease severity in this population.

MATERIAL AND METHODS

Data were collected from the dental records and the health questionnaires of 1006 subjects. Stepwise multiple linear regression analyses were adopted to calculate correlations between systemic disorders as independent variables and number of remaining teeth and the relative frequency of periodontal pockets of 5 mm or more, respectively, as the dependent variable.

RESULTS

The number of remaining teeth was significantly and positively correlated to the presence of cardiovascular disease, diabetes and rheumatoid disease after adjustment for age, sex and smoking. The relative frequency of diseased sites, however, was not significantly correlated to any one of the investigated systemic health disorders.

CONCLUSION

No significant associations between investigated systemic disorders and periodontal disease severity were found if the relative frequency of deep periodontal pockets was used as the clinical parameter for periodontal disease severity. However, cardiovascular disease, diabetes and rheumatoid disease were found to be significantly correlated to number of lost teeth, which may represent one aspect of periodontal health. This result held true in nonsmokers only.

Role of infection in atherosclerosis and coronary artery disease: a new therapeutic target?

There is growing evidence that inflammatory processes may be involved in the development of atherosclerosis and its complications. Viral and bacterial pathogens have been implicated as possible causative factors in the pathogenesis of coronary artery disease and postangioplasty restenosis. Antibiotic trials have been completed examining which treatment of infection can prevent the complications of coronary artery disease. In high-risk patients, the results of these most recent studies have not revealed any benefit of treatment.

Coronary artery disease and periodontal disease: is there a link?

BACKGROUND

Cardiovascular disease is the number one killer worldwide. The so-called classic risk factors of coronary heart disease do not account for all of its clinical and epidemiological features. Recent evidence suggests that certain infections, among them dental infections and in particular periodontal disease, are involved in the pathogenesis of coronary artery disease.

AIM

To evaluate the association between periodontal disease and coronary artery disease.

PATIENTS AND METHODS

Fifty patients referred for diagnostic coronary angiography were assessed for periodontal disease. All patients underwent a thorough physical examination, routine laboratory testing, cardiac evaluation and dental examination which included pantomography x-ray evaluation.

RESULTS

Pantomography x-rays and coronary angiograms of the participants were scored blindly by a dentist and cardiologists respectively. The association between periodontal disease and coronary atheromatosis remained significant after adjustment for age, smoking, blood lipids, body mass index, hypertension and the presence of diabetes.

IMPLICATIONS

Periodontal disease was still significantly associated after all the known risk factors were accounted for. The implication here is that periodontal disease could be a potential risk factor for heart disease by predisposing the individual to chronic low-grade infections. If so, then dental health becomes an important parameter for medical health.

The role of inflammatory and immunological mediators in periodontitis and cardiovascular disease

Epidemiological studies have implicated periodontitis (PD) as a risk factor for development of cardiovascular disease (CVD). Persistent infections such as periodontitis induce inflammatory and immune responses which may contribute to coronary atherogenesis, and, in conjunction with other risk factors, may lead to coronary heart disease (CHD). In this review, mechanisms are described that may help explain the association between periodontal infections and CHD. Periodontal diseases are bacterial infections associated with bacteremia, inflammation, and a strong immune response, all of which may represent significant risk factors for the development of atherogenesis, CHD, and myocardial infarction (MI). Several mechanisms may participate in this association, including those induced by oral organisms, and those associated with host response factors. This review will focus on host factors. Oral pathogens and inflammatory mediators (such as interleukin [IL]-1 and tumor necrosis factor [TNF]-alpha) from periodontal lesions intermittently reach the bloodstream inducing systemic inflammatory reactants such as acute-phase proteins, and immune effectors including systemic antibodies to periodontal bacteria. This review will describe the potential role of various inflammatory as well as immunologic factors that may play a role in periodontitis as a possible risk factor for CHD.

Association between periodontal disease and acute myocardial infarction

BACKGROUND

Coronary heart disease is the leading cause of morbidity and mortality throughout the world. Well-known risk factors independently or combined participate in both myocardial infarction and atherosclerosis. Recent data have shown that viral and bacterial infections may also contribute to the acute thromboembolic events. The aim of the present study was to investigate the possible association between periodontal health and coronary heart disease in patients with acute myocardial infarction and chronic coronary heart disease.

METHODS

A total of 120 patients, 60 with acute myocardial infarction (AMI) and 60 with chronic coronary heart disease (CCHD) were included in this study. The patients in the AMI group (50 men and 10 women; mean age 53.8 +/- 9.5 years) were admitted to the Department of Cardiology, University Hospital of Ege because of AMI. The CCHD patients group (42 men and 18 women; mean age 58.5 +/- 11.6 years) had no documented history of recent acute coronary events. All patients were clinically examined and completed a medical questionnaire. Missing teeth, restorations, probing depth (PD) and bleeding on probing (BOP) were recorded. Blood samples were taken on admission for measurements of serum total cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-cholesterol), low density lipoprotein cholesterol (LDL-cholesterol), and fasting blood glucose level. Sample proportions were compared by chi square test, quantitative variables with Student t test. The relation of clinical parameters and conventional risk factors to AMI was assessed with logistic regression analysis.

RESULTS

The number of sites with PD > or = 4 mm, the percentage of sites exhibiting BOP, smoking status, total cholesterol, LDL-cholesterol, and triglycerides were statistically different between AMI and CCHD groups (P <0.05). Logistic regression analysis showed that the percentage of sites exhibiting BOP, the number of sites with PD > or = 4, the number of restorations, smoking status, and triglycerides levels were significantly associated with AMI (P <0.05).

CONCLUSIONS

The results of this study indicate that periodontal disease may be associated with acute myocardial infarction. To our knowledge, this is the first study that reports the importance of periodontal health in the occurrence of acute myocardial infarction in a Turkish population. We propose that prospective randomized studies are needed to determine whether periodontal disease is a risk factor in the occurrence of acute myocardial infarction.

Invasion of aortic and heart endothelial cells by Porphyromonas gingivalis

Invasion of host cells is believed to be an important strategy utilized by a number of pathogens, which affords them protection from the host immune system. The connective tissues of the periodontium are extremely well vascularized, which allows invading microorganisms, such as the periodontal pathogen Porphyromonas gingivalis, to readily enter the bloodstream. However, the ability of P. gingivalis to actively invade endothelial cells has not been previously examined. In this study, we demonstrate that P. gingivalis can invade bovine and human endothelial cells as assessed by an antibiotic protection assay and by transmission and scanning electron microscopy. P. gingivalis A7436 was demonstrated to adhere to and to invade fetal bovine heart endothelial cells (FBHEC), bovine aortic endothelial cells (BAEC), and human umbilical vein endothelial cells (HUVEC). Invasion efficiencies of 0.1, 0.2, and 0. 3% were obtained with BAEC, HUVEC, and FBHEC, respectively. Invasion of FBHEC and BAEC by P. gingivalis A7436 assessed by electron microscopy revealed the formation of microvillus-like extensions around adherent bacteria followed by the engulfment of the pathogen within vacuoles. Invasion of BAEC by P. gingivalis A7436 was inhibited by cytochalasin D, nocodazole, staurosporine, protease inhibitors, and sodium azide, indicating that cytoskeletal rearrangements, protein phosphorylation, energy metabolism, and P. gingivalis proteases are essential for invasion. In contrast, addition of rifampin, nalidixic acid, and chloramphenicol had little effect on invasion, indicating that bacterial RNA, DNA, and de novo protein synthesis are not required for P. gingivalis invasion of endothelial cells. Likewise de novo protein synthesis by endothelial cells was not required for invasion by P. gingivalis. P. gingivalis 381 was demonstrated to adhere to and to invade BAEC (0.11 and 0.1% efficiency, respectively). However, adherence and invasion of the corresponding fimA mutant DPG3, which lacks the major fimbriae, was not detected. These results indicate that P. gingivalis can actively invade endothelial cells and that fimbriae are required for this process. P. gingivalis invasion of endothelial cells may represent another strategy utilized by this pathogen to thwart the host immune response.

Periodontitis: a risk factor for coronary heart disease?

This paper evaluates the current information on the relationship between oral disease (specifically periodontitis) and atherosclerosis/coronary heart disease (CHD) to determine whether the information is sufficient to conclude that periodontitis is a risk factor for atherosclerosis/CHD. As background for this evaluation, the term "risk factor" is defined, and the 3 criteria used to establish exposures as risk factors are reviewed. In addition, epidemiologic criteria for defining an exposure as causal are presented. The available evidence then is evaluated according to the criteria for causality, which are extensions of the criteria for establishing a risk factor. This review is done in the context of the relationship between atherosclerosis/CHD and inflammation. A number of findings are briefly reviewed that link inflammation and atherosclerosis/CHD, such as: 1) prior flu-like symptoms were more common in cases of myocardial infarction than in concurrently sampled controls; 2) high levels of cytomegalovirus antibody titers were associated with elevated carotid intimal-medial wall thickness 18 years later; 3) prior infection with cytomegalovirus was a strong independent risk factor for restenosis after coronary atherectomy; 4) dental infections were more common in cases of cerebral infarction compared to community controls matched on age and sex; and 5) the gingival index was significantly correlated with fibrinogen and white cell counts in periodontal patients and controls, adjusted for age, smoking, and socioeconomic status. Three case-control studies and 5 longitudinal studies investigating the relationship between dental conditions and atherosclerosis/CHD are reviewed in terms of strength of associations, consistency of associations, specificity. of associations, time sequence between exposure and outcome, and degree of exposure and outcome. Related to the last criterion, new findings are presented which indicate that the extent of the periodontal infection, a measure reflecting microbial burden, also is related to onset of new CHD events. Our previously published model describing the potential biological mechanisms underlying the associations found is reviewed. This model places the associations into a context of an intrinsic or acquired hyperinflammatory monocyte trait that results in a more intense inflammatory response to lipopolysaccharide (LPS) challenges, such as periodontal infections. This hyperinflammatory response may promote atheroma formation and thromboembolic events. finally, new findings from ongoing animal studies are presented, indicating that high fat diets in atherosclerotic-susceptible mice induce greater inflammatory responses to Porphyromonas gingivalis challenges. We conclude that the available evidence does allow an interpretation of periodontitis being a risk factor for atherosclerosis/CHD. This conclusion, however. is made with some qualifications. While the associations found across a wide variety of subjects are remarkably consistent, for the most part they are represented by incidence odds ratios around 2.0. While this level of association would result in oral conditions contributing to a large number of CHD cases, it is possible that associations of this magnitude are due to bias in the study designs. In addition, some studies report that periodontitis is associated with all-cause mortality and low birth weight infants. These multiple associations detract from the credibility of periodontitis as a risk factor, as specificity of association is more often related to causality. However, all-cause mortality may largely be driven by mortality from cardiovascular events: and some exposures, such as smoking. are indeed risk factors for multiple conditions. On the other hand, current findings regarding the associations between oral conditions and atherosclerosis/CHD imply that the criteria for causality may be met in the not-too-distant future.

Distribution of bone quality in patients receiving endosseous dental implants

Knowledge of the distribution of bone quality in the various jaw regions assists the clinician in dental implant treatment planning. Bone quality was assessed with radiographs and tactile sensation for 2,839 implants at the time of placement into four anatomic regions of the jaw. The Lekholm-Zarb classification system was used. Overall, bone quality types 1 and 4 were found much less frequently than types 2 and 3. Although variations in density existed in each region, quality 2 bone dominated the mandible, and quality 3 bone was more prevalent in the maxilla. For both anterior and posterior jaw regions, types 2 and 3 bone predominated. The anterior mandible had the densest bone, followed by the posterior mandible, anterior maxilla, and posterior maxilla.

Periodontal disease and cardiovascular disease

It is our central hypothesis that periodontal diseases, which are chronic Gram-negative infections, represent a previously unrecognized risk factor for atherosclerosis and thromboembolic events. Previous studies have demonstrated an association between periodontal disease severity and risk of coronary heart disease and stroke. We hypothesize that this association may be due to an underlying inflammatory response trait, which places an individual at high risk for developing both periodontal disease and atherosclerosis. We further suggest that periodontal disease, once established, provides a biological burden of endotoxin (lipopolysaccharide) and inflammatory cytokines (especially TxA2, IL-1 beta, PGE2, and TNF-alpha) which serve to initiate and exacerbate atherogenesis and thromboembolic events. A cohort study was conducted using combined data from the Normative Aging Study and the Dental Longitudinal Study sponsored by the United States Department of Veterans Affairs. Mean bone loss scores and worst probing pocket depth scores per tooth were measured on 1,147 men during 1968 to 1971. Information gathered during follow-up examinations showed that 207 men developed coronary heart disease (CHD), 59 died of CHD, and 40 had strokes. Incidence odds ratios adjusted for established cardiovascular risk factors were 1.5, 1.9, and 2.8 for bone loss and total CHD, fatal CHD, and stroke, respectively. Levels of bone loss and cumulative incidence of total CHD and fatal CHD indicated a biologic gradient between severity of exposure and occurrence of disease.

Frequency of self-reported medical conditions in periodontal patients

Assessing the medical history of patients before any treatment is provided is an essential aspect of the periodontist's responsibility. A patient's compromised medical state could alter the response to periodontal treatment or worse, contribute to a crisis situation that may prove harmful to his or her well-being. This study examines the frequency of medical conditions in periodontal patients utilizing a self-administered health questionnaire succeeded by directly interviewing the patient for validity. Health histories were taken from 590 periodontal patients in an outpatient setting; 52.5% of these patients reported a positive finding in their medical history, with drug allergies and cardiovascular disorders being by far the most frequently found conditions. The frequency of medical conditions increased with increasing age. Thorough evaluation of a patient's health history is a mandatory first step in the treatment process.

Evaluation of medical consultations in a predoctoral dental clinic

OBJECTIVE

A patient's medical condition can affect the delivery of dental care. Medical consultation is indicated for dental patients whose medical history is uncertain or when physical assessment may indicate an untreated medical problem. The aims of this study were to evaluate the use of medical consultation and determine how it affects dental treatment plans in a predoctoral dental clinic program.

STUDY DESIGN

Reviews of 147 medical consultation requests were performed.

RESULTS

The main reasons for medical consultations were cardiovascular assessment (51.5%) and diabetic status determination (12.6%). In the cardiovascular assessment category, hypertension (48.1%) and heart murmur (17.9%) were primary concerns. Main dental concerns were the need for preoperative antibiotic prophylaxis (33.3%) and the use of vasoconstrictors (20.4%). Overall, 32.1% of medical consultations resulted in an alteration in dental treatment plans. As a result of medical consultations, 8% commenced their medical management.

CONCLUSIONS

These results indicated that medical consultations could reduce the medical risk associated with dental procedures and unnecessary antibiotic prophylaxis. Therefore for many dental patients, good communication between dentists and physicians is essential for adequate care.

Medical and dental status of a culture in transition, the case of the Inuit elderly of Canada

The medical and dental status, and drug utilisation patterns of Canadian Inuit elders (60+ years) were evaluated. Inuit elders averaged 6.3 medical conditions per person, primarily nervous systems-sense organ deficits, respiratory problems and systemic infections. The mean number of drugs being used was 2.5 per person, primarily analgesics, bronchodilators and antibiotics. Poorly fitting dentures, and high levels of tooth decay, periodontal disease, soft tissue and TMJ anomalies were documented. Compared to older southern Canadians, the medical and dental findings for these Inuit elders were different. Drug utilisation rates were consistent with older southern Canadians, but different drugs were taken.

Implications of the changing medical profile of a dental school patient population

Representative adult patient populations seeking treatment at a dental school in 1976 and 1986 were analyzed for the prevalence and the characteristics of medical conditions. Patients' records (N = 3,000) were randomly selected from the examination clinics and reviewed for the presence and types of compromising medical conditions. The results indicated a significant increase in the percentage of dental patients who had medical conditions in 1986 as compared with 1976 (P less than .001), as well as significant changes in the types of medical conditions present. These data indicate an increase in the number of patients with medical problems in the general dental school patient population.