Periodontitis and atherogenesis: causal
association or simple coincidence?
( The result of this study shows a potential link between
periodontal (gum) disease and heart disease. This is not
the first study to show the link but supports the current theory.-DFB)
The aim of this study was to assess the systemic effects of treating
severe widespread periodontitis in a population of otherwise healthy
individuals by examining treatment associated changes in markers
of inflammation that are also implicated in cardiovascular atherosclerotic
diseases. The potential impact of specific polymorphisms in cytokine
genes known to influence both periodontitis and cardiovascular
diseases was also examined.
A convenience sample of patients affected with severe generalised
periodontitis was enrolled into a prospective single blind longitudinal
intervention trial with a 6 months follow-up. Serum C-reactive
protein (CRP) and interleukin-6 (IL-6) levels were assessed by
high-sensitivity assays. Serological and clinical periodontal
parameters were evaluated at baseline, 2 and 6 months after completion
of non-surgical periodontal therapy. In the 94 subjects that completed
this pilot trial improvements in all clinical periodontal parameters
were achieved. These were accompanied with significant reductions
in serum IL-6 and CRP concentrations. In a multivariate model,
serum CRP levels were significantly associated with the outcome
of periodontal treatment after correcting for potential covariates
(age, body mass index, gender, smoking) and polymorphisms in the
IL-6 (-174 C/G) and IL-1A (-889) genes. A median decrease in serum
CRP of 0.5 mg/l (95% CI 0.4-0.7 mg/l) was observed 6 months after
completion of periodontal therapy in this population. Subjects
with above average response to periodontal therapy (<30 residual
pockets and <30% of sites bleeding on probing) accounted for
the observed improvement in serum CRP.
Control of periodontitis, achieved with non-surgical periodontal
therapy, significantly decreased serum mediators and markers of
acute phase response. The significance of the serum response was
associated with the half of the population that responded better
to non-surgical periodontal therapy. The results of this pilot
study indicate that severe generalised periodontitis causes systemic
inflammation. This is consistent with a causative role of periodontitis
in atherogenesis.
[D'Aiuto F, Parkar M, Andreaou G, Brett PM, Ready D, Tonetti MS
Periodontitis and atherogenesis: causal association or simple
coincidence? J Clin Periodontol 2004;31(5):402 - 411.]