Carotid and popliteal artery intima-media thickness in patients with poor oral hygiene and the association with acute-phase reactants

Current applications for measuring pediatric intima-media thickness

Intima-media thickness is a known subclinical radiologic marker of the early manifestations of atherosclerotic disease. It is the thickness of the vessel wall, most often the carotid artery. Intima-media thickness is measured on conventional US manually or automatically. Other measurement techniques include radiofrequency US. Because there is variation in its measurement, especially in children, several recommendations have been set to increase the measurement's validity and comparability among studies. Despite these recommendations, several pitfalls should be avoided, and quality control should be performed to avoid erroneous interpretation. This article summarizes current literature in relation to the clinical applications for intima-media thickness measurement in children with known risk factors such as obesity, liver steatosis, hypercholesterolemia, diabetes, hypertension, systemic inflammatory diseases, cancer survival, kidney and liver transplant, and sickle cell disease or beta thalassemia major. Most potential indications for intima-media thickness measurement remain in the research domain and should be interpreted combined with other markers. The objective of diagnosing an increased intima-media thickness is to start a multidisciplinary treatment approach to prevent disease progression and its sequelae in adulthood.

The oral health status of patients with peripheral vascular disorders: A systematic review

Objectives

Periodontal disease and tooth loss were found to be associated with several peripheral vascular disorders. Nonetheless, an evaluation of the literature on the broader domains of oral health in individuals with peripheral vascular disorders is lacking. This systematic review aims to collate the current evidence on the oral health status of individuals with peripheral vascular disorders.

Methods

Five electronic databases were searched for studies assessing oral health parameters in individuals with peripheral vascular disorders. Outcome measures considered were periodontal health, dentition status, caries indices, oral prostheses, oral pathologies and oral hygiene behaviours. The Newcastle-Ottawa scale was used to appraise the quality of the studies.

Results

From 3025 records identified, 24 studies involving 1232 participants with peripheral vascular disorders were included in this review. In nine studies, periodontitis was significantly more prevalent in peripheral vascular disorders compared to non-peripheral vascular disorders participants. A further six studies reported individuals with peripheral vascular disorders also had significantly fewer teeth and increased rates of edentulism. Only one study reported a higher incidence of dental caries in peripheral vascular disorders participants. Other aspects of oral health such as oral prosthesis, oral pathology and oral hygiene behaviours were seldom assessed.

Conclusions

The scarcity of studies reporting on broader domains limited our ability to arrive at a conclusion regarding the oral health status of individuals with peripheral vascular disorders. Future studies ought to assess these domains in individuals with peripheral vascular disorders and controls to gain a more complete understanding of oral health and its potential association with peripheral vascular disorders.

Assessment of Periodontal Status Based on Carotid Artery Intima Media Thickness

PURPOSE

Atherosclerosis is a devastating disease worldwide since it is the most frequent cause of myocardial infarction, stroke, renal failure, peripheral vascular disease and perhaps dementia. There is a well-documented evidence supporting the association between clinical/subclinical atherosclerosis and periodontitis. Carotid intima media wall thickness (CIMT) is a histopathologically validated marker of atherosclerosis. This study's purpose was to assess periodontal status based on carotid artery intima media thickness.

MATERIALS AND METHODS

A cross-sectional study was carried out among subjects who visited the Care Hospital, Nampally Hyderabad for CIMT test. Oral hygiene status was evaluated using Simplified Oral Hygiene Index and periodontal health status was measured using modified World Health Organization (WHO) Oral Health Assessment form, 1997. The data was analysed using Statistical Package for Social Sciences (SPSS) version 21.0. The proportions and mean scores were compared using chi-square test, Mann-Whitney U test and analysis of variance (ANOVA). Logistic regression analysis determined the relationship between periodontitis, as an independent variable and other variables with CIMT. P < 0.05 was considered statistically significant.

RESULTS

A total of 600 individuals were classified based on CIMT thickness ≤ 1 mm (292; 48.6%) and CIMT > 1 mm (308; 51.3%) according to variables. Significantly higher mean scores were observed for all oral parameters among subjects with CIMT > 1 mm aged > 45 years and among males (p ≤ 0.05*). Logistic regression analysis showed that increasing age group, ie,> 45 years (OR 3.5), males (OR 2.02), university education (OR 2.99), no history of previous dental visit (OR 3.71); and visit ≥ 1 year (OR 0.76) and previous history of tobacco (OR 1.13) and alcohol use (OR 1.65), poor OHI-S (OR 8.00), Community Periodontal Index (CPI) with Code 3, 4 (OR 4.41) and loss of attachment (LOA) with Code 2 (OR 3.05) and Code 3 (OR 5.80) had significantly higher odds among individuals with subjects with CIMT > 1 mm compared to their counterparts (p ≤ 0.05*).

CONCLUSION

The results of the study concluded that periodontal disease and poor oral hygiene were more severe among the subjects with CIMT > 1 mm. To halt the progression of increasing CIMT, preventive oral health programmes need to be integrated in the cardiac setting with established dental referral which can bring out positive health behaviours.

Association between Bacterial Infection and Peripheral Vascular Disease: A Review

There are an increasing number of data showing a clinically important association between bacterial infection and peripheral artery disease (PAD). Bacteria suspected of being involved in PAD pathogenesis are: periodontal bacteria, gut microbiota, Helicobacter pylori, and Chlamydia pneumoniae. Infectious agents may be involved in the pathogenesis of atherosclerosis via activation of a systemic or local host immunological response to contamination of extravascular tissues or the vascular wall, respectively. A systemic immunological reaction may damage vascular walls in the course of autoimmunological cross-reactions between anti-pathogen antibodies and host vascular antigens (immunological mimicry), pathogen burden mechanisms (nonspecific activation of inflammatory processes in the vascular wall), and neuroendocrine-immune cross-talk. Besides activating the inflammatory pathway, bacterial infection may trigger PAD progression or exacerbation by enhancement of platelet reactivity, by a stimulatory effect on von Willebrand factor binding, factor VIII, fibrinogen, P-selectin activation, disturbances in plasma lipids, increase in oxidative stress, and resistance to insulin. Local inflammatory host reaction and induction of atherosclerotic plaque progression and/or instability result mainly from atherosclerotic plaque colonization by microorganisms. Despite these premises, the role of bacterial infection in PAD pathogenesis should still be recognized as controversial, and randomized, controlled trials are required to evaluate the outcome of periodontal or gut bacteria modification (through diet, prebiotics, and probiotics) or eradication (using antibiotics) in hard and surrogate cardiovascular endpoints.

Association of Carotid Intima-media Thickness and Atherosclerotic Plaque with Periodontal Status

Studies have suggested an association between clinical/subclinical atherosclerosis and periodontal status. The purpose of this study was to investigate the association among maximal carotid intima-media thickness (cIMT), atherosclerotic plaque, and periodontal status in Chinese elderly patients. A cross-sectional study was conducted of 847 participants (age, 70.64 ± 9.03 yr) with ≥10 teeth. A questionnaire survey, routine biochemical tests, a periodontal examination, and maximal cIMT measurement were performed for each. Traditional risk factors for atherogenesis were considered in the statistical analysis. Mean plaque index, which reflects oral hygiene, was correlated with maximal cIMT and atherosclerotic plaque in the study sample overall (β = 0.068, p < .001; OR = 2.051, p < .001) and in euglycemic participants (β = 0.066, p = .008; odds ratio = 2.122, p = .009). In hyperglycemic participants, multiple linear regression analysis (p = .006) and multivariate logistic regression analysis (p = .025) revealed a linear and dose-dependent association between mean clinical attachment loss and maximal cIMT after adjustment for traditional risk factors. Each 1-mm increase in mean clinical attachment loss corresponded to a 0.018-mm increase in maximal cIMT. The risk of atherosclerotic plaque increased by 18.3% with each 1-mm increase in mean clinical attachment loss. Other indicators of periodontal exposure, including percentage of sites with attachment loss ≥ 3 to 5 mm (3%-5%), were also correlated with cIMT and atherosclerotic plaque in hyperglycemic patients. In this elderly population, a linear and dose-dependent association among mean clinical attachment loss, attachment loss 3% to 5%, maximal cIMT, and atherosclerotic plaque was verified in those with hyperglycemia. Poor oral hygiene was correlated with maximal cIMT and atherosclerotic plaque in all participants, including those with normal blood glucose.