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Salminen A, Määttä A, Mäntylä P, Leskelä J, Pietiäinen M, Buhlin K, Suominen A, Paju S, Sattler W, Sinisalo J, Pussinen P. Systemic Metabolic Signatures of Oral Diseases. J Dent Res 2024; 103:13-21. [PMID: 37968796 PMCID: PMC10734208 DOI: 10.1177/00220345231203562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Systemic metabolic signatures of oral diseases have been rarely investigated, and prospective studies do not exist. We analyzed whether signs of current or past infectious/inflammatory oral diseases are associated with circulating metabolites. Two study populations were included: the population-based Health-2000 (n = 6,229) and Parogene (n = 452), a cohort of patients with an indication to coronary angiography. Health-2000 participants (n = 4,116) provided follow-up serum samples 11 y after the baseline. Serum concentrations of 157 metabolites were determined with a nuclear magnetic resonance spectroscopy-based method. The associations between oral parameters and metabolite concentrations were analyzed using linear regression models adjusted for age, sex, number of teeth, smoking, presence of diabetes, and education (in Health-2000 only). The number of decayed teeth presented positive associations with low-density lipoprotein diameter and the concentrations of pyruvate and citrate. Negative associations were found between caries and the unsaturation degree of fatty acids (FA) and relative proportions of docosahexaenoic and omega-3 FAs. The number of root canal fillings was positively associated with very low-density lipoprotein parameters, such as diameter, cholesterol, triglycerides, and number of particles. Deepened periodontal pockets were positively associated with concentrations of cholesterol, triglycerides, pyruvate, leucine, valine, phenylalanine, and glycoprotein acetyls and negatively associated with high-density lipoprotein (HDL) diameter, FA unsaturation degree, and relative proportions of omega-6 and polyunsaturated FAs. Bleeding on probing (BOP) was associated with increased concentrations of triglycerides and glycoprotein acetyls, as well as decreased proportions of omega-3 and omega-6 FAs. Caries at baseline predicted alterations in apolipoprotein B-containing lipoproteins and HDL-related metabolites in the follow-up, and both caries and BOP were associated with changes in HDL-related metabolites and omega-3 FAs in the follow-up. Signs of current or past infectious/inflammatory oral diseases, especially periodontitis, were associated with metabolic profiles typical for inflammation. Oral diseases may represent a modifiable risk factor for systemic chronic inflammation and thus cardiometabolic disorders.
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Affiliation(s)
- A. Salminen
- Oral and Maxillofacial diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A.M. Määttä
- Oral and Maxillofacial diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P. Mäntylä
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Odontology Education, Kuopio University Hospital, Kuopio, Finland
| | - J. Leskelä
- Oral and Maxillofacial diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M. Pietiäinen
- Oral and Maxillofacial diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - K. Buhlin
- Oral and Maxillofacial diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - A.L. Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Odontology Education, Kuopio University Hospital, Kuopio, Finland
- Department of Public Health and Welfare, National Institute for Health and Welfare, Helsinki, Finland
| | - S. Paju
- Oral and Maxillofacial diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - W. Sattler
- Division of Molecular Biology and Biochemistry, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - J. Sinisalo
- HUCH Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland
| | - P.J. Pussinen
- Oral and Maxillofacial diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
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2
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Ferrannini G, Norhammar A, Almosawi M, Kjellstrom B, Buhlin K, De Faire U, Gustafsson A, Nygren LA, Nasman P, Lindahl B, Naslund U, Svenungsson E, Klinge B, Ryden L. Periodontitis and cardiovascular outcome – a prospective follow-up of the PAROKRANK cohort. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There is an association between periodontitis (PD) and myocardial infarction (MI). Whether that is related to shared risk factors or it is causal is debated. The Periodontitis and Its Relation to Coronary Artery Disease (PAROKRANK) case-control study previously reported on an independent association between PD and a first MI.
Purpose
This follow-up of the PAROKRANK study tests the hypothesis that PD increases the risk for new cardiovascular (CV) events.
Methods
Between 2010–2014 805 patients (age <75 years; females 19%) with a first MI and 805 controls without MI, matched for gender, age (mean 62±8 years) and living area underwent a CV and dental examination including panoramic x-ray. The PD was categorised in three grades: healthy (≥80% remaining alveolar bone height), moderate (79–66%) or severe (<66%). The composite primary endpoint was the first of all-cause death, non-fatal MI or stroke, or severe heart failure until December 2018. The first of CV-death, non-fatal MI or stroke, or severe heart failure served as a secondary CV-endpoint. Data on outcomes were provided via linkage to the National Patient Registries and the Cause of Death Registry. Cumulative event rates, stratified by PD status at baseline in the combined cohort of cases and controls, were calculated using logistic regression and the Kaplan-Meier method.
Results
A total of 1587 participants with evaluated PD-status were followed for a mean of 6.2 (range 0.2–8.5) years. The total number of primary events and CV-events was 205 and 158 respectively. The number of deaths was 68. Baseline PD-status was healthy in 985 (mean age 60.4 years), moderate in 489 (mean age 65.1 years) and severe in 113 (mean age 64.3 years) participants. The figure presents the time to primary event by the three PD grades in the combined cohort (patients and controls). Time to the primary endpoint differed between the three PD grades (log-rank test 0.0148), however, significant only for patients (log-rank test patients vs. controls: 0.0382 vs. 0.608). Replacing the primary endpoint with the secondary CV-endpoint just changed the outcome slightly (log-rank 0.0976), possibly due to a low number of CV-deaths within the CV-event. Compared to participants without PD, the presence of PD at baseline was associated with the primary endpoint in the total cohort (Odds Ratio (OR): 1.49; 95% Confidence Interval (CI): 1.11–2.00) as well as the CV-endpoint (OR 1.42; 95% CI 1.02–1.98). PD was not associated with total mortality (OR 1.57; 95% CI 0.97–2.56).
Conclusion
In this up to 8-years follow up of the PAROKRANK cohort there was a graded increase in the risk for new CV-events by the presence of PD. This was in particular seen in the MI-patients. Together with the previous case-control based report from PAROKRANK, on an association between PD and a first MI, the findings during the follow-up supports the assumption that there may be a causal relationship between PD and CV-disease.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The PAROKRANK study was supported by grants from AFA Insurance, Swedish Heart-Lung Foundation, Swedish Research Council, Swedish Society of Medicine, Stockholm County Council (ALF project and Steering committee KI/SLL for odontological research), and The Baltic Child Foundation. Figure 1
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Affiliation(s)
- G Ferrannini
- Karolinska Institute, Medicine, Stockholm, Sweden
| | - A Norhammar
- Karolinska Institute, Medicine, Stockholm, Sweden
| | - M Almosawi
- Karolinska Institute, Medicine, Stockholm, Sweden
| | - B Kjellstrom
- Karolinska Institute, Medicine, Stockholm, Sweden
| | - K Buhlin
- Karolinska Institute, Dental Medicine, Stockholm, Sweden
| | - U De Faire
- Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
| | - A Gustafsson
- Karolinska Institute, Dental Medicine, Stockholm, Sweden
| | - L A Nygren
- Karolinska Institute, Clinical Sciences Danderyd's Hospital, Stockholm, Sweden
| | - P Nasman
- Royal Institute of Technology, Center for Safety Research, Stockholm, Sweden
| | - B Lindahl
- Uppsala University, Medical Sciences, Uppsala, Sweden
| | - U Naslund
- Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden
| | | | - B Klinge
- Karolinska Institute, Dental Medicine, Stockholm, Sweden
| | - L Ryden
- Karolinska Institute, Medicine, Stockholm, Sweden
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Almosawi M, Ferrannini G, Buhlin K, Gustafsson A, Kjellstrom B, Klinge B, Nygren Å, Nasman P, Svenungsson E, Ryden L, Norhammar A. Long term outcome after a first myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Prognosis after a myocardial infarction (MI) have improved consistently over the last decades. In parallel, the incidence of cardiovascular (CV) events has been reduced and life expectancy in people free from CV disease improved.
Purpose
To explore the long-term mortality and burden of cardiovascular disease in patients after a first MI compared to matched controls in a contemporary setting.
Methods
The Swedish case-control study PAROKRANK recruited 805 patients <75 years with a first MI and 805 age-, gender- and area-matched controls from 2010 to 2014. All participants were followed by means of registry-based information. The primary endpoint was the first of a composite of all-cause death, non-fatal MI, non-fatal stroke and heart failure hospitalization. Data on the outcomes were provided via linkage to the National Patient Registries and the Cause of Death Registry. Hazard Ratios (HR) for the first composite event were calculated by means of a Cox regression model, subsequently adjusted for smoking, education level and marital status at baseline. Event curves for the time-to-first event in patients and controls were computed by Kaplan-Meier curves and the two groups were compared by means of the log-rank test.
Results
Data from 804 patients and 800 controls (mean age in both groups 62 years; women 19%) were complete for an average period of 6.2 years (0.2–8.5 years). The total number of events was 211. Patients had a higher event rate than controls (log rank p<0.0001). Unadjusted HR for the primary outcome was 2.08 (95% confidence interval (CI) 1.56–2.77) while the adjusted HR was 2.04 (95% CI 1.52–2.73). Mortality did not differ significantly between patients (n=38; 4.7%) and controls (n=35; 4.4%). In total, 82.5% of the patients and 91.3% of the controls were event-free during follow-up.
Conclusion
This long-term follow-up of a contemporary, nationwide case-control cohort illustrates that the likelihood for CV events is higher in patients with a first MI compared to their matched controls while mortality did not differ. The access to high quality of care and cardiac rehabilitation might explain the low rates of adverse outcomes.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): AFA Insurance, Swedish Heart-Lung Foundation, Swedish Research Council, Swedish Society of Medicine, Stockholm County Council (ALF project and Steering committee KI/SLL for odontological research), and The Baltic Child Foundation. Figure 1. Kaplan-Meier curves
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Affiliation(s)
- M Almosawi
- Karolinska Institutet, Medicine K2, Stockholm, Sweden
| | - G Ferrannini
- Karolinska Institutet, Medicine K2, Stockholm, Sweden
| | - K Buhlin
- Karolinska Institutet, Dental Medicine, Stockholm, Sweden
| | - A Gustafsson
- Karolinska Institutet, Dental Medicine, Stockholm, Sweden
| | - B Kjellstrom
- Karolinska Institutet, Medicine K2, Stockholm, Sweden
| | - B Klinge
- Karolinska Institutet, Dental Medicine, Stockholm, Sweden
| | - Å Nygren
- Karolinska Institutet, Clinical Sciences, Stockholm, Sweden
| | - P Nasman
- Royal Institute of Technology, Center for Safety Research, Stockholm, Sweden
| | - E Svenungsson
- Karolinska Institutet, Medicine K2, Stockholm, Sweden
| | - L Ryden
- Karolinska Institutet, Medicine K2, Stockholm, Sweden
| | - A Norhammar
- Karolinska Institutet, Medicine K2, Stockholm, Sweden
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Paju S, Pietiäinen M, Liljestrand JM, Lahdentausta L, Salminen A, Kopra E, Mäntylä P, Buhlin K, Hörkkö S, Sinisalo J, Pussinen PJ. Carotid artery calcification in panoramic radiographs associates with oral infections and mortality. Int Endod J 2021; 54:638. [PMID: 33720441 DOI: 10.1111/iej.13451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Paju
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Pietiäinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J M Liljestrand
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L Lahdentausta
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Salminen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - E Kopra
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Mäntylä
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute of Dentistry, University of Eastern Finland and Kuopio University Hospital, Oral and Maxillofacial Diseases, Kuopio, Finland
| | - K Buhlin
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Periodontology, Department of Dental Medicine, Division of Oral Diseases, Karolinska Institutet, Huddinge, Sweden
| | - S Hörkkö
- Research Unit of Biomedicine, Medical Microbiology and Immunology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center and Nordlab Oulu, University Hospital and University of Oulu, Oulu, Finland
| | - J Sinisalo
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - P J Pussinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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5
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Liljestrand JM, Salminen A, Lahdentausta L, Paju S, Mäntylä P, Buhlin K, Tjäderhane L, Sinisalo J, Pussinen PJ. Association between dental factors and mortality. Int Endod J 2020; 54:672-681. [PMID: 33275782 DOI: 10.1111/iej.13458] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
AIM To study whether oral parameters such as endodontic infections, root canal fillings, number of teeth or wearing removable dentures at baseline are associated with cardiovascular- and all-cause mortality in a follow-up of approximately 8 years. METHODOLOGY The Finnish Parogene cohort consists of 508 Finnish adults (mean age 63.3 years, SD 9.1) with cardiac symptoms, all of whom had undergone coronary angiography for accurate baseline coronary status. Extensive clinical and radiographic oral examinations were performed, and additional data were acquired from medical records and questionnaires. Root canal fillings and endodontic lesions, as well as their co-occurrence, were determined from panoramic radiographs. The mortality data were assessed via record linkage with the Finnish Causes of Death register (mean follow-up time 7.81 years, SD 1.45 years). A total of n = 471 dentate patients were included in the statistical analyses. RESULTS A total of n = 69 deaths were recorded, of which n = 41 were due to cardiovascular diseases (CVDs, ICD-10 I00-I99). The deceased had fewer root canal fillings (mean 1.57; SD 1.64 vs. mean 2.30; SD 2.34, P = 0.03) than the survivors. The number of missing teeth was associated with smoking, occluded coronary arteries and diabetes. Cox regression with Firth's penalized maximum-likelihood method using age as timescale revealed an inverse association (HR; 95%CI) between mortality and number of teeth (all-cause 0.91; 0.86-0.96, CVD mortality 0.89; 0.83-0.96), use of removable dentures (all-cause 0.24; 0.09-0.62, CVD mortality 0.20; 0.06-0.72), root canal fillings (all-cause 0.82; 0.70-0.94, CVD mortality 0.79; 0.63-0.96) and having root canal fillings in all teeth with apical rarefactions (all-cause 0.27; 0.06-0.79, CVD mortality 0.09; 0.01-0.63), when gender, smoking, occluded coronary arteries, periodontal inflammatory burden index and the number of teeth were adjusted for. CONCLUSIONS The number of missing teeth appeared to be the strongest predictor of mortality in this study, whereas endodontic infections per se had no independent association. Nevertheless, signs of professional intervention in these problems, such as root canal fillings and removable dentures, appeared to be associated with improved survival, which might partly be explained by the utilization of healthcare services.
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Affiliation(s)
- J M Liljestrand
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Salminen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L Lahdentausta
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Paju
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Mäntylä
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Institute of Dentistry, University of Eastern Finland and Kuopio University Hospital, Oral and Maxillofacial Diseases, Kuopio, Finland
| | - K Buhlin
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - L Tjäderhane
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Unit of Oral Health Sciences, and Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - J Sinisalo
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P J Pussinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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6
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Paju S, Pietiäinen M, Liljestrand JM, Lahdentausta L, Salminen A, Kopra E, Mäntylä P, Buhlin K, Hörkkö S, Sinisalo J, Pussinen PJ. Carotid artery calcification in panoramic radiographs associates with oral infections and mortality. Int Endod J 2020; 54:15-25. [PMID: 32865251 DOI: 10.1111/iej.13394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/24/2020] [Indexed: 12/23/2022]
Abstract
AIM To study the prevalence of carotid artery calcification (CAC) in relation to apical and marginal periodontitis, subgingival dysbiotic bacterial species and serum and saliva immune responses against them. In addition, the aim was to analyse the association of CAC with angiographically verified coronary artery disease (CAD) and mortality. METHODOLOGY In the present random Parogene cohort, the patients had an indication for coronary angiography. Apical and marginal periodontitis were diagnosed during clinical and radiographic oral examinations, and CAC on panoramic radiographs (n = 492). Presence and severity of CAD were registered from angiography. Subgingival dysbiotic bacterial species were quantitated using checkerboard DNA-DNA-hybridization, and serum and saliva antibody levels were determined by immunoassays. The cohort was followed-up for 10 years or until death (median 9.9, range 0.21-10.4) via linkage to the national death register. The statistical models were adjusted for age, gender, smoking, hypertension, diabetes and dyslipidemia. RESULTS A total of 102 (20.7%) patients had detectable CAC, which was moderate in 81 (16.4%) and severe in 21 (4.3%). CAC was associated (OR, 95% CI) with severe apical periodontitis (2.25, 1.15-4.41), root canal fillings (1.15, 1.04-1.26), alveolar bone loss (2.66, 1.21-5.84), severe periodontal inflammation (2.23, 1.11-4.47), high level of gram-negative subgingival species (2.73, 1.34-5.50), saliva IgG against dysbiotic species (1.05, 1.01-1.10/unit) and severe (2.58, 1.36-4.90) and chronic (2.13, 1.15-3.93) CAD. A total of 105 (20.7%) patients died during the follow-up and 53 (10.4%) deaths were because of cardiovascular diseases (CVD). Severe CAC predicted worse survival with HRs (95% CI) of 3.08 (1.58-6.06) for all-cause and 3.43 (1.42-8.25) for CVD death. CONCLUSIONS CAC on panoramic tomography was associated with (i) apical and marginal periodontitis and dysbiotic bacterial species giving rise to an immunological response, and with (ii) severe, chronic CAD and increased mortality. The results further emphasize the role of oral infections in CAD and the importance of referring a patient with CAC for a cardiovascular evaluation.
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Affiliation(s)
- S Paju
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Pietiäinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J M Liljestrand
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L Lahdentausta
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Salminen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - E Kopra
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Mäntylä
- Oral and Maxillofacial Diseases, Institute of Dentistry, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - K Buhlin
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Periodontology, Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - S Hörkkö
- Research Unit of Biomedicine, Medical Microbiology and Immunology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center and Nordlab Oulu, University Hospital and University of Oulu, Oulu, Finland
| | - J Sinisalo
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - P J Pussinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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7
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Gustafsson N, Ahlqvist J, Näslund U, Buhlin K, Gustafsson A, Kjellström B, Klinge B, Rydén L, Levring Jäghagen E. Associations among Periodontitis, Calcified Carotid Artery Atheromas, and Risk of Myocardial Infarction. J Dent Res 2019; 99:60-68. [DOI: 10.1177/0022034519885362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Cardiovascular disease is a common cause of morbidity and premature mortality. Cardiovascular disease can be prevented when risk factors are identified early. Calcified carotid artery atheromas (CCAAs), detected in panoramic radiographs, and periodontitis have both been associated with increased risk of cardiovascular disease. This case-control study aimed to 1) investigate associations between periodontitis and CCAA detected in panoramic radiographs and 2) determine the risk of future myocardial infarctions due to CCAA combined with periodontitis. We evaluated 1,482 participants (738 cases and 744 controls) with periodontitis and CCAAs recruited from the PAROKRANK study (Periodontitis and Its Relation to Coronary Artery Disease). Participants were examined with panoramic radiographs, including the carotid regions. Associations between myocardial infarction and periodontitis combined with CCAA were evaluated in 696 cases and 696 age-, sex-, and residential area–matched controls. Periodontitis was evaluated radiographically (as degree of bone loss) and with a clinical periodontal disease index score (from clinical and radiographic assessments). We found associations between CCAA and clinical periodontal disease index score among cases (odds ratio [OR], 1.51; 95% CI, 1.09 to 2.10; P = 0.02) and controls (OR, 1.70; 95% CI, 1.22 to 2.38; P < 0.01), although not between CCAA and the degree of bone loss. In a multivariable model, myocardial infarction was associated with CCAA combined with periodontitis, as assessed by degree of bone loss (OR, 1.75; 95% CI, 1.11 to 2.74; P = 0.01). When the cohort was stratified by sex, only men showed a significant association between myocardial infarction and CCAA combined with periodontitis. Participants with clinically diagnosed periodontitis exhibited CCAA in panoramic radiographs more often than those without periodontitis, irrespective of the presence of a recent myocardial infarction. Participants with combined periodontitis and CCAA had a higher risk of having had myocardial infarction as compared with participants with either condition alone. These findings implied that patients in dental care might benefit from dentists assessing panoramic radiographs for CCAA—particularly, patients with periodontitis who have not received any preventive measures for cardiovascular disease.
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Affiliation(s)
- N. Gustafsson
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden
| | - J. Ahlqvist
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden
| | - U. Näslund
- Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - K. Buhlin
- Periodontology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A. Gustafsson
- Periodontology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - B. Kjellström
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - B. Klinge
- Periodontology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - L. Rydén
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - E. Levring Jäghagen
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden
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8
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Akhi R, Wang C, Nissinen AE, Kankaanpää J, Bloigu R, Paju S, Mäntylä P, Buhlin K, Sinisalo J, Pussinen PJ, Hörkkö S. Salivary IgA to MAA-LDL and Oral Pathogens Are Linked to Coronary Disease. J Dent Res 2019; 98:296-303. [PMID: 30669938 DOI: 10.1177/0022034518818445] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
A large body of literature has established the link between periodontal disease and cardiovascular disease. Oxidized low-density lipoproteins (OxLDLs) have a crucial role in atherosclerosis progression through initiation of immunological response. Monoclonal IgM antibodies to malondialdehyde-modified low-density lipoprotein (MDA-LDL) and to malondialdehyde acetaldehyde-modified low-density lipoprotein (MAA-LDL) have been shown to cross-react with the key virulence factors of periodontal pathogens Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. We have previously shown that salivary IgA antibodies to MAA-LDL cross-react with P. gingivalis in healthy humans. In this study, we aim to assess whether oral mucosal immune response represented by salivary IgA to MAA-LDL and oral pathogens is associated with coronary artery disease (CAD). Also, the molecular mimicry through antibody cross-reaction between salivary IgA to MAA-LDL and oral pathogens was evaluated. The study subjects consisted of 451 patients who underwent a coronary angiography with no CAD ( n = 133), stable CAD ( n = 169), and acute coronary syndrome (ACS, n = 149). Elevated salivary IgA antibody levels to MAA-LDL, Rgp44 (gingipain A hemagglutinin domain of P. gingivalis), and Aa-HSP60 (heat shock protein 60 of A. actinomycetemcomitans) were discovered in stable-CAD and ACS patients when compared to no-CAD patients. In a multinomial regression model adjusted for known cardiovascular risk factors, stable CAD and ACS were associated with IgA to MAA-LDL ( P = 0.016, P = 0.043), Rgp44 ( P = 0.012, P = 0.004), Aa-HSP60 ( P = 0.032, P = 0.030), Tannerella forsythia ( P = 0.002, P = 0.004), Porphyromonas endodontalis ( P = 0.016, P = 0.020), Prevotella intermedia ( P = 0.038, P = 0.005), and with total IgA antibody concentration ( P = 0.002, P = 0.016). Salivary IgA to MAA-LDL showed cross-reactivity with the oral pathogens tested in the study patients. The study highlights an association between salivary IgA to MAA-LDL and atherosclerosis. However, whether salivary IgA to MAA-LDL and the related oral humoral responses play a causal role in the development in the CAD should be elucidated in the future.
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Affiliation(s)
- R Akhi
- 1 Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,2 Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.,3 Nordlab, Oulu University Hospital, Oulu, Finland
| | - C Wang
- 1 Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,2 Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.,3 Nordlab, Oulu University Hospital, Oulu, Finland
| | - A E Nissinen
- 1 Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,2 Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.,3 Nordlab, Oulu University Hospital, Oulu, Finland
| | - J Kankaanpää
- 1 Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,2 Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.,3 Nordlab, Oulu University Hospital, Oulu, Finland
| | - R Bloigu
- 4 Medical Informatics and Statistics Research Group Oulu, University of Oulu, Oulu, Finland
| | - S Paju
- 5 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Mäntylä
- 5 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,6 Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,7 Kuopio University Hospital, Oral and Maxillofacial Diseases, Kuopio, Finland
| | - K Buhlin
- 5 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,8 Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - J Sinisalo
- 9 HUCH Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - P J Pussinen
- 5 Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Hörkkö
- 1 Medical Microbiology and Immunology, Research Unit of Biomedicine, University of Oulu, Oulu, Finland.,2 Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.,3 Nordlab, Oulu University Hospital, Oulu, Finland
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9
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Bjarnsholt T, Buhlin K, Dufrêne YF, Gomelsky M, Moroni A, Ramstedt M, Rumbaugh KP, Schulte T, Sun L, Åkerlund B, Römling U. Biofilm formation - what we can learn from recent developments. J Intern Med 2018; 284:332-345. [PMID: 29856510 PMCID: PMC6927207 DOI: 10.1111/joim.12782] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Although biofilms have been observed early in the history of microbial research, their impact has only recently been fully recognized. Biofilm infections, which contribute to up to 80% of human microbial infections, are associated with common human disorders, such as diabetes mellitus and poor dental hygiene, but also with medical implants. The associated chronic infections such as wound infections, dental caries and periodontitis significantly enhance morbidity, affect quality of life and can aid development of follow-up diseases such as cancer. Biofilm infections remain challenging to treat and antibiotic monotherapy is often insufficient, although some rediscovered traditional compounds have shown surprising efficiency. Innovative anti-biofilm strategies include application of anti-biofilm small molecules, intrinsic or external stimulation of production of reactive molecules, utilization of materials with antimicrobial properties and dispersion of biofilms by digestion of the extracellular matrix, also in combination with physical biofilm breakdown. Although basic principles of biofilm formation have been deciphered, the molecular understanding of the formation and structural organization of various types of biofilms has just begun to emerge. Basic studies of biofilm physiology have also resulted in an unexpected discovery of cyclic dinucleotide second messengers that are involved in interkingdom crosstalk via specific mammalian receptors. These findings even open up new venues for exploring novel anti-biofilm strategies.
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Affiliation(s)
- T Bjarnsholt
- Department of Immunology and Microbiology, Costerton Biofilm Centre, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - K Buhlin
- Department of Dental Medicine, Division of Oral Facial Diagnostics and Surgery, Karolinska Institutet, Huddinge, Sweden
| | - Y F Dufrêne
- Institute of Life Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - M Gomelsky
- Department of Molecular Biology, University of Wyoming, Laramie, WY, USA
| | - A Moroni
- Department of Biology and CNR-Istituto di Biofisica, Università degli Studi di Milano, Milano, Italy
| | - M Ramstedt
- Department of Chemistry, Umeå University, Umeå, Sweden
| | - K P Rumbaugh
- Departments of Surgery & Immunology & Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - T Schulte
- Department of Medicine Solna, Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - L Sun
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - B Åkerlund
- Department of Medicine Huddinge, Unit of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - U Römling
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
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Bertl K, Steiner I, Pandis N, Buhlin K, Klinge B, Stavropoulos A. Statins in nonsurgical and surgical periodontal therapy. A systematic review and meta-analysis of preclinical in vivo trials. J Periodontal Res 2017; 53:267-287. [PMID: 29211309 DOI: 10.1111/jre.12514] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/13/2022]
Abstract
The cholesterol-lowering drugs, statins, possess anti-inflammatory, antimicrobial and pro-osteogenic properties, and thus have been tested as an adjunct to periodontal treatment. The present systematic review aimed to answer the following focused research question: What is the effect of local and/or systemic statin use on periodontal tissues in preclinical in vivo studies of experimentally induced periodontitis (EIP) and/or acute/chronified periodontal defect (ACP) models? A literature search (of Medline/PubMed, Embase/Ovid, CENTRAL/Ovid) using the following main eligibility criteria was performed: (i) English or German language; (ii) controlled preclinical in vivo trials; (iii) local and/or systemic statin use in EIP and/or ACP models; and (iv) quantitative evaluation of periodontal tissues (i.e., alveolar bone level/amount, attachment level, cementum formation, periodontal ligament formation). Sixteen studies in EIP models and 7 studies in ACP models evaluated simvastatin, atorvastatin or rosuvastatin. Thirteen of the EIP (81%) and 2 of the ACP (29%) studies presented significantly better results in terms of alveolar bone level/amount in favor of statins. Meta-analysis based on 14 EIP trials confirmed a significant benefit of local and systemic statin use (P < .001) in terms of alveolar bone level/amount; meta-regression revealed that statin type exhibited a significant effect (P = .014) in favor of atorvastatin. Three studies reported a significantly higher periodontal attachment level in favor of statin use (P < .001). Complete periodontal regeneration was never observed; furthermore, statins did not exert any apparent effect on cementum formation. Neither local nor systemic use of statins resulted in severe adverse effects. Statin use in periodontal indications has a positive effect on periodontal tissue parameters, supporting the positive results already observed in clinical trials. Nevertheless, not all statins available have been tested so far, and further research is needed to identify the maximum effective concentration/dose and optimal carrier.
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Affiliation(s)
- K Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - I Steiner
- Private Practice, Taiskirchen, Austria.,Postgraduate Course Periodontology, Medical University of Vienna, Vienna, Austria
| | - N Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School/Medical Faculty, University of Bern, Bern, Switzerland
| | - K Buhlin
- Division of Periodontology, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - B Klinge
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - A Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
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11
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Ryden L, Buhlin K, Ekstrand E. Periodontitis Increases the Risk of a First Myocardial Infarction: A Report From the PAROKRANK Study. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Liljestrand J, Mäntylä P, Paju S, Buhlin K, Kopra K, Persson G, Hernandez M, Nieminen M, Sinisalo J, Tjäderhane L, Pussinen P. Association of Endodontic Lesions with Coronary Artery Disease. J Dent Res 2016; 95:1358-1365. [DOI: 10.1177/0022034516660509] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
An endodontic lesion (EL) is a common manifestation of endodontic infection where Porphyromonas endodontalis is frequently encountered. EL may associate with increased risk for coronary artery disease (CAD) via similar pathways as marginal periodontitis. The aim of this cross-sectional study was to delineate the associations between EL and CAD. Subgingival P. endodontalis, its immune response, and serum lipopolysaccharide were examined as potential mediators between these 2 diseases. The Finnish Parogene study consists of 508 patients (mean age, 62 y) who underwent coronary angiography and extensive clinical and radiographic oral examination. The cardiovascular outcomes included no significant CAD ( n = 123), stable CAD ( n = 184), and acute coronary syndrome (ACS; n = 169). EL was determined from a panoramic tomography. We combined data of widened periapical spaces (WPSs) and apical rarefactions to a score of EL: 1, no EL ( n = 210); 2, ≥1 WPS per 1 apical rarefaction ( n = 222); 3, ≥2 apical rarefactions ( n = 76). Subgingival P. endodontalis was defined by checkerboard DNA-DNA hybridization analysis, and corresponding serum antibodies were determined by ELISA. In our population, 50.4% had WPSs, and 22.8% apical rarefactions. A total of 51.2% of all teeth with apical rarefactions had received endodontic procedures. Subgingival P. endodontalis levels and serum immunoglobulin G were associated with a higher EL score. In the multiadjusted model (age, sex, smoking, diabetes, body mass index, alveolar bone loss, and number of teeth), having WPSs associated with stable CAD (odds ratio [OR] = 1.94, 95% confidence interval [95% CI] = 1.13 to 3.32, P = 0.016) and highest EL score were associated with ACS (OR = 2.46, 95% CI = 1.09 to 5.54, P = 0.030). This association was especially notable in subjects with untreated teeth with apical rarefactions ( n = 59, OR = 2.72, 95% CI = 1.16 to 6.40, P = 0.022). Our findings support the hypothesis that ELs are independently associated with CAD and in particular with ACS. This is of high interest from a public health perspective, considering the high prevalence of ELs and CAD.
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Affiliation(s)
- J.M. Liljestrand
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P. Mäntylä
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S. Paju
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - K. Buhlin
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - K.A.E. Kopra
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - G.R. Persson
- Departments of Oral Medicine, and Periodontics, University of Washington, Seattle, Washington, USA
| | - M. Hernandez
- Laboratory of Periodontal Biology and Department of Oral Pathology and Medicine, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - M.S. Nieminen
- Department of Cardiology, Heart and Lung Center, Department of Medicine, Helsinki University Hospital, Helsinki, Finland
| | - J. Sinisalo
- Department of Cardiology, Heart and Lung Center, Department of Medicine, Helsinki University Hospital, Helsinki, Finland
| | - L. Tjäderhane
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Unit of Oral Health Sciences, and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - P.J. Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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13
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Vitt A, Sofrata A, Slizen V, Sugars RV, Gustafsson A, Gudkova EI, Kazeko LA, Ramberg P, Buhlin K. Antimicrobial activity of polyhexamethylene guanidine phosphate in comparison to chlorhexidine using the quantitative suspension method. Ann Clin Microbiol Antimicrob 2015; 14:36. [PMID: 26182984 PMCID: PMC4504446 DOI: 10.1186/s12941-015-0097-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 06/25/2015] [Indexed: 12/21/2022] Open
Abstract
Background Polyhexamethylene guanidine phosphate (PHMG-P) belongs to the polymeric guanidine family of biocides and contains a phosphate group, which may confer better solubility, a detoxifying effect and may change the kinetics and dynamics of PHMG-P interactions with microorganisms. Limited data regarding PHMG-P activity against periodontopathogenic and cariogenic microorganisms necessitates studies in this area. Aim is to evaluate polyhexamethylene guanidine phosphate antimicrobial activity in comparison to chlorhexidine. Methods Quantitative suspension method was used enrolling Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Candida albicans, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus mutans and Lactobacillus acidophilus. Results Both tested antiseptics at their clinically-used concentrations, of 0.2% (w/v) and 1% (w/v), correspondingly provided swift bactericidal effects against S. aureus, P. aeruginosa, E. coli andC. albicans, A. actinomycetemcomitans and P. gingivalis with reduction factors higher than 6.0. Diluted polyhexamethylene guanidine phosphate and chlorhexidine to 0.05% continued to display anti-bacterial activity and decreased titers of standard quality control, periopathogens to below 1.0 × 103 colony forming units/ml, albeit requiring prolonged exposure time. To achieve a bactericidal effect against S. mutans, both antiseptics at all concentrations required a longer exposure time. We found that a clinically-used 1% of polyhexamethylene guanidine phosphate concentration did not have activity against L. acidophilus. Conclusion High RF of polyhexamethylene guanidine phosphate and retention of bactericidal effects, even at 0.05%, support the use of polyhexamethylene guanidine phosphate as a biocide with sufficient anti-microbial activity against periopathogens. Polyhexamethylene guanidine phosphate displayed bactericidal activity against periopathogens and S. mutans and could potentially be applied in the management of oral diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12941-015-0097-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Vitt
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Box 4064, 141 04, Huddinge, Sweden. .,First Department of Therapeutic Dentistry, Belarusian State Medical University, Minsk, Belarus.
| | - A Sofrata
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Box 4064, 141 04, Huddinge, Sweden.
| | - V Slizen
- Department of Medical Microbiology and Immunology, Belarusian State Medical University, Minsk, Belarus.
| | - R V Sugars
- Division of Oral Facial Diagnostics and Surgery, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
| | - A Gustafsson
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Box 4064, 141 04, Huddinge, Sweden.
| | - E I Gudkova
- Department of Medical Microbiology and Immunology, Belarusian State Medical University, Minsk, Belarus.
| | - L A Kazeko
- First Department of Therapeutic Dentistry, Belarusian State Medical University, Minsk, Belarus.
| | - P Ramberg
- Division of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - K Buhlin
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Box 4064, 141 04, Huddinge, Sweden.
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Abstract
PURPOSE Both heart rate variability (HRV) and inflammatory markers are carrying prognostic information in coronary heart disease (CHD), however, we know of no studies examining their relation in CHD. The aim of this study, therefore, was to assess the association between HRV and inflammatory activity, as reflected by the levels of interleukin-6 (IL-6), IL-1 receptor antagonist (IL-1ra) and C-reactive protein (CRP). SUBJECTS AND METHODS Consecutive women patients who survived hospitalization for acute myocardial infarction, and/or underwent a percutaneous transluminal coronary angioplasty or a coronary artery bypass grafting were included and evaluated in a stable condition 1 year after the index events. An ambulatory 24-h ECG was recorded during normal activities. SDNN index (mean of the standard deviations of all normal to normal intervals for all 5-min segments of the entire recording) and the following frequency domain parameters were assessed: total power, high frequency (HF) power, low frequency (LF) power and very low frequency (VLF) power. Levels of high-sensitivity CRP were measured by nephelometry, IL-6 and IL-1ra concentrations were determined by enzyme immunoassay. RESULTS Levels of IL-6 showed an inverse relation with HRV measures even after controlling for potential confounding factors. The P-values were 0.02, 0.04, 0.01, 0.03, 0.18 for the multivariate association with SDDN index, total power, VLF power, LF power and HF power respectively. In contrast, the inverse relationship between HRV measures and CRP or IL-1ra levels were weak and nonsignificant. Correlation coefficients for the relationship between IL-6 and HRV measures were both uni- and multivariately higher than for the relationship between HRV measures and any other factors evaluated in this study. CONCLUSION Concentration of IL-6 showed a negative, independent association with HRV in women with CHD. Thus, increased inflammatory activity, as reflected by IL-6 levels, may represent a new auxiliary mechanism linking decreased HRV to poor prognosis in CHD.
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Affiliation(s)
- I Janszky
- Department of Preventive Medicine, Public Health Sciences, Karolinska Institutet, and Center of Public Health, Stockholm County Council, Stockholm, Sweden
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Abstract
OBJECTIVE The purpose of the present study was to assess the relation between dental health and cardiovascular disease in an adult Swedish population. MATERIAL AND METHOD A questionnaire was sent to 4811 randomly selected Swedes. It contained 52 questions about dental care habits, oral health, cardiovascular disease and their socio-economic situation. Odd ratios for all cardiovascular diseases (CVD) and the subgroup myocardial infarction, stroke and high blood pressure were calculated with a logistic regression model adjusted for age, gender, smoking, income, civil status and education. These ratios were calculated for subjects > or =41 years since few people suffer from CVD before this. RESULTS The national questionnaire was answered by 2839 (59%) people between 20-84 years of age and, of them, 1577 were 41 years of age or more. We found a significant association between self-reported bleeding gums (odds ratio 1.60, p=0.0017), presence of dentures (odds ratio 1.57, p=0.0076) and known CVD, which has also been reported in international studies. However, no association between loose teeth, deep pockets and known CVD was detected. CONCLUSION The results indicate that oral health and, especially gingival inflammation is associated with CVD.
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Affiliation(s)
- K Buhlin
- Karolinska Institutet, Institute of Odontology, Department of Periodontology, Stockholm, Sweden
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