Thematic Review

The effect of periodontal treatment in patients with atherosclerotic disease

Subject review

DOI: https://doi.org/10.16925/od.v14i27.2345

Vol. 14 No. 27 (2018)

Published: 2018-07-03

Natali Vivas Vidal

Sandra Amaya

Adriana Jaramillo

Andrés Cruz

Introduction: Periodontal disease and atherosclerotic disease have high prevalence rates worldwide. They

are also associated to chronic inflammatory response, in addition to presenting multiple risk factors in com-

mon. Since it has been determined that periodontal treatment improves local inflammatory processes in the

tooth’s supporting tissues and therefore aids local inflammatory response, a possible systemic impact has

been suggested in different illnesses such as, for example, cardiovascular diseases, arthritis and adverse

effects of pregnancy, among others. There is ample evidence that considers the presence of periodontal

disease in atherosclerotic diseases as an independent risk factor, but recent evidences from clinical studies

identify the effects of periodontal treatment in specific cases.

Purpose: To acknowledge existing relevant evidence about the effect of periodontal treatment in patients

with atherosclerotic disease between 2005 and 2016.

Method: Research was conducted in English and Spanish in PubMed, Embase and Lilacs databases. The

keywords employed were: “periodontal disease”, “periodontal diseases treatment”, “atherosclerosis”, “pe-

riodontitis”, and “periodontal disease.”

Results: Fourteen articles were found that showed a significant relationship in the effectiveness of perio-

dontal treatment with plasma levels or inflammatory markers such as C-reactive protein and IL-6, among

others, and a favorable response in endothelial function. The evidence found had a time-lapse greater than

six months after periodontal treatment.

Conclusion: Results emphasize the effectiveness and urge of diagnosis and periodontal treatment in patients

with atherosclerosis, in order to reduce their risk factors.

Keywords: Array, Array, Array, Array

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The effect of periodontal treatment in patients with atherosclerotic disease: Subject review. (2018). Revista Nacional de Odontología, 14(27). https://doi.org/10.16925/od.v14i27.2345

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World Health Organization. Global status report on non-communicable diseases 2011. [Fecha de consulta: 29 de mayo de 2017]. Disponible en: http://www.who.int/nmh/publications/ncd_report2010/es/.

Instituto Nacional de Salud. [Internet] [Fecha de consulta: 5 de septiembre de 2016]. Disponible en: http://www.ins.gov.co/lineas-de-accion/ons/boletin%201/boletin_web_ONS/boletin_01_ONS.pdf

Organizacion Mundial de la Salud. [Internet] [Fecha de consulta: 5 de septiembre de 2016]. Disponible en: http://www.who.int/mediacentre/factsheets/fs317/es/.

Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ: Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747-57. DOI: 10.1016/S0140-6736(06)68770-9

Instituto Nacional de Salud. [Internet] [Fecha de consulta: 5 de septiembre de 2016]. Disponible en: http://www.ins.gov.co/lineas-de-accion/ons/boletin%201/boletin_web_ONS/boletin_01_ONS.pdf

Organizacion Mundial de la Salud. [Internet] [Actualizado Enero de 2015.Fecha de consulta: 5 de septiembre de 2016. Disponible en: http://www.who.int/mediacentre/factsheets/fs317/es/.

Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747-57. DOI: 10.1016/S0140-6736(06)68770-9

Abbas M, Bignamini V, Corea F. Effects of chronic microbial infection on atherosclerosis. Atherosclerosis. 2006; 187:439-40. DOI: 10.1016/j.atherosclerosis.2006.02.022

M Leinonen, P SaikkuEvidence for infectious agents in cardiovascular disease and atherosclerosis.. TheLancetInfectiousDiseases.2002;2(1):11-7. DOI: http://dx.doi.org/10.1016/S1473-3099(01)00168-2

Verdecchia A.,Khader YS, Albashaireh ZS, Alomari MA. Periodontal diseases and therisk of coronaryheart and cerebrovascular diseases: a meta-analysis. J Periodontol. 2004;75:1046e53. DOI: 10.1902/jop.2004.75.8.1046

Moore WE, Moore LV,. The bacteria of periodontal diseases. Periodontol. 1994;5:66-77. DOI: 10.1111/j.1600-0757.1994.tb00019.x

B. Pihlstrom, B. Michalowicz, N. Johnson Las enfermedades periodontales. Lancet. 2005; 366:1809-1820 DOI: 10.1016/S0140-6736(05)67728-8

Wilson W, Taubert K, Gewitz M, Lockhart P, Baddour L, Levison M, et al. Prevention of Infective Endocarditis Guidelines From the American Heart Association: A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007; 116(15):1736-1754. DOI: 10.1161/CIRCULATIONAHA.106.183095

Petersen P, Baehni P. Periodontal health and global public health. Periodontology 2000. 2012; 60:7-14. DOI: 10.1111/j.1600-0757.2012.00452.x

Colombia. Ministerio de Salud. IV Estudio Nacional de Salud Bucal-ENSAB IV. 2014. [Fecha consulta: 13 abril de 2017]. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/ENSAB-IV-Situacion-Bucal-Actual.pdf

Nguyen CM, Kim JWM, Quan VH, Nguyen BH, Tran SD. Periodontal associations in cardiovascular diseases: Thelatestevidence and understanding. J Oral Biol Craniofac Res. 2015;5(3):203-206. DOI: 10.1016/j.jobcr.2015.06.008

Mattila KJ, Nieminen MS, Valtonen VV. Association between dental health and acute myocardial infarction. BMJ. 1989; 298(6676):779-81. DOI:10.1136/bmj.298.6687.1579-c

Ramírez J. ¿Es la enfermedad periodontal un factor de riesgo cardiovascular? Revisión de la evidencia experimental y clínica. Revista Estomatología. 2005;13(2):18-26.

D`estefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. BMJ. 1993;306:688-91. doi: https://doi.org/10.1136/bmj.306.6879.688

Dorn BR, Dunn WA Jr., Progulske-Fox A. Invasion of human coronary artery cells by periodontal pathogens. Infect Immun. 1999;67(11): 5792-8.

Chiu B. Multiple infections in carotid atherosclerotic plaques. Am Heart J. 1999 November; 138(5 Pt 2): S534-S536. DOI: http://dx.doi.org/10.1016/S0002-8703(99)70294-2

Mattila KJ. Viral and bacterial infections in patients with acute myocardial infarction. Journal of Internal Medicine. 1989;225(5):293-296. DOI: 10.1111/j.1365-2796.1989.tb00084.x

Haraszthy VI, Zambon JJ, Trevisan M, Zeid M, Genco RJ. Identification of periodontal pathogens in atheromatous plaques. J. Periodontol. 2000; 71(10): 1554-60. doi: 10.4103/0377-4929.134704

Ross R. Atherosclerosis – an inflammatory disease. N Engl J Med. 1999: 340: 115–126. DOI: 10.1056/NEJM199901143400207

Walldius G, Jungner I. Apolipoprotein B and apolipoprotein A-I: Risk indicators of coronary heart disease and targets for lipid-modifying therapy. J Intern Med. 2004; 255:188–205. DOI: 10.1111/j.1365-2796.1989.tb00084.x

Kolitveit KM, Eriksen HM. Is the observed association between periodontitis and atherosclerosis causal? Eur J Oral Sci. 2001;109:2-7. doi: 10.2174/1573403X10666140416094901

Beck J, Elter J, Heiss G, Couper D, Mauriello S, Offenbacher S. Relationship of periodontal disease to carotid aretery intima-media wall thickness: the atherosclerosis risk in communities (ARIC) study. Arterioscler Thromb Vasc Biol. 2001;21:1816-22. doi: 10.1161/hq1101.097803

Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J ClinPeriodontol. 2013;40(Suppl. 14): S70–S84. DOI: 10.1111/jcpe.12062

Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME, et al. Periodontal disease and atherosclerotic vascular disease: Does the evidence support an independent association? A scientific statement from the American Heart Association. Circulation 2012; 125:2520-4 doi: 10.1161/CIR.0b013e31825719f3.

Scannapieco F and Cantos A. Oral inflammation and infection, and chronic medical diseases: implications for the elderly. Periodontology. 2000. 2016;72:153–175. DOI: 10.1111/prd.12129

Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J ClinPeriodontol. 2013:40(Suppl. 14): S70–S84. DOI: 10.1111/jcpe.12062

Kebschull M, Demmer RT, Papapanou PN. "Gum bug, leave my heart alone!"--epidemiologic and mechanistic evidence linking periodontal infections and atherosclerosis. J Dent Res. 2010:89:879-902. DOI: 10.1177/0022034510375281

Rudney JD, Chen R, Sedgewick GJ. Intracellular Actinobacillusactinomycetemcomitans and Porphyromonasgingivalis in buccal epithelial cells collected from human subjects. Infect Immun. 2001;69:2700–2707. DOI: 10.1128/IAI.69.4.2700-2707.2001

Deshpande RG, Khan MB, Genco CA. Invasion of aortic and heart endothelial cells by Porphyromonasgingivalis. Infect Immun. 1998: 66: 5337–5343.

Arirachakaran P, Apinhasmit W, Paungmalit P, Jeramethakul P, Rerkyen P, Mahanonda R. Infection of human gingival fibroblasts with Aggregatibacteractinomycetemcomitans: an in vitro study. Arch Oral Biol. 2012: 57: 964-972. DOI: 10.1016/j.archoralbio.2012.01.014.

Reyes L, Herrera D, Kozarov E, Rolda S, Progulske-Fox A. Periodontal bacterial invasión and infection: contribution to atheroscleroticpathology. J Periodontol. 2013: 84:S30–S50. DOI: 10.1111/jcpe.12079

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Roth GA, Moser B, Roth-Walter F, Giacona MB, Harja E, Papapanou PN, et al. Infection with a periodontal pathogen increases mononuclear cell adhesion to human aortic endothelial cells. Atherosclerosis. 2007;190(2):271-81. DOI: http://dx.doi.org/10.1016/j.atherosclerosis.2006.03.018

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Seinost G., Wimmer G., Skerget M. et al. Periodontal treatment improves endothelial dysfunction in patients with severe periodontitis. Am Heart J. 2005;149:1050-4. DOI: 10.1016/j.ahj.2004.09.059

Elter J.R, Hinderliter A. Offenbacher S. et al. The effects of periodontal therapy on vascular endothelial function: a pilot trial. Am Heart J. 2006;151:47.e1-47.e6. DOI: 10.1016/j.ahj.2005.10.002

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Tonetti M., D’Aiuto F., Nibali L. et al. Treatment of periodontitis and endothelial function. N Engl J Med. 2007;356:91120. DOI: 10.1056/NEJMoa063186.

Lopez N., Quintero A., Casanova P., Ibieta C., Baelum V., Lopezi R. Effects of periodontal therapy on systemic markers of inflammation in patients with metabolic syndrome: a controlled clinical trial. J Periodontol. 2012;83(3):267-78. DOI: 10.1902/jop.2011.110227

Li X, Tse HF, Yiu KH, Li LSW, Jin L. Effect of periodontal treatment on circulating CD34(+) cells and peripheral vascular endothelial function: a randomized controlled trial.. J Clin Periodontol. 2011;38:148–156. DOI: 10.1111/j.1600-051X.2010.01651.x

Kamil W, Al Habashneh R, Khader Y, Al Bayati L, Taani D. Effects of nonsurgical periodontal therapy on C-reactive protein and serum lipids in Jordanian adults with advanced periodontitis.J Periodont Res. 2011; 46: 616–621. DOI: 10.1111/j.1600-0765.2011.01380.x

Bokhari SAH, Khan AA, Butt AK, Azhar M, Hanif M, Izhar M, Tatakis DN. Non-surgical periodontal therapy reduces coronary heart disease risk markers: a randomized controlled trial. J Clin Periodontol. 2012:1-10. DOI: 10.1111/j.1600-051X.2012.01942.x

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Higashi Y, Goto C, Hidaka T Soga J, Nakamura S, Fujii Y, et al. Oral infection-inflammatory pathway, periodontitis, is a risk factor for endothelial dysfunction in patients with coronary artery disease. Atherosclerosis. 2009;206:604-610. DOI: 10.1161/HYPERTENSIONAHA.107.101535

Vidal F, Figueredo CM, Cordovil I, Fischer R. Periodontal Therapy Reduces Plasma Levels of Interleukin-6, C-Reactive Protein, and Fibrinogen in Patients With Severe Periodontitis and Refractory Arterial Hypertension. J Periodontol. 2009;80(5):786-791. DOI: 10.1902/jop.2009.080471

Kapellas K, Maple-Brown LJ, Jamieson LM, Do LG, O´Dea K, Brown A, et al. Effect of Periodontal Therapyon Arterial Structure and Function Among Aboriginal Australians. Hypertension. 2014;64(4):702-8. DOI: 10.1161/HYPERTENSIONAHA.114.03359

Toregeani JF, Nassar CA, Nassar PO, Toregeani KM, Gonzatto GK, Vendrame R, et al. Evaluation of periodontitis treatment effects on carotid intima-media thickness and expression of laboratory markers related to atherosclerosis. Gen Dent. 2016;64(1):55-62.

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Author Biographies

Natali Vivas Vidal

Periodoncista
Sandra Amaya

Magister en ciencias odontológicas
Adriana Jaramillo

Magister en epidemiología
Andrés Cruz

Magister odontología

References

World Health Organization. Global status report on non-communicable diseases 2011. [Fecha de consulta: 29 de mayo de 2017]. Disponible en: http://www.who.int/nmh/publications/ncd_report2010/es/.

Instituto Nacional de Salud. [Internet] [Fecha de consulta: 5 de septiembre de 2016]. Disponible en: http://www.ins.gov.co/lineas-de-accion/ons/boletin%201/boletin_web_ONS/boletin_01_ONS.pdf

Organizacion Mundial de la Salud. [Internet] [Fecha de consulta: 5 de septiembre de 2016]. Disponible en: http://www.who.int/mediacentre/factsheets/fs317/es/.

Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ: Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747-57. DOI: 10.1016/S0140-6736(06)68770-9

Instituto Nacional de Salud. [Internet] [Fecha de consulta: 5 de septiembre de 2016]. Disponible en: http://www.ins.gov.co/lineas-de-accion/ons/boletin%201/boletin_web_ONS/boletin_01_ONS.pdf

Organizacion Mundial de la Salud. [Internet] [Actualizado Enero de 2015.Fecha de consulta: 5 de septiembre de 2016. Disponible en: http://www.who.int/mediacentre/factsheets/fs317/es/.

Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747-57. DOI: 10.1016/S0140-6736(06)68770-9

Abbas M, Bignamini V, Corea F. Effects of chronic microbial infection on atherosclerosis. Atherosclerosis. 2006; 187:439-40. DOI: 10.1016/j.atherosclerosis.2006.02.022

M Leinonen, P SaikkuEvidence for infectious agents in cardiovascular disease and atherosclerosis.. TheLancetInfectiousDiseases.2002;2(1):11-7. DOI: http://dx.doi.org/10.1016/S1473-3099(01)00168-2

Verdecchia A.,Khader YS, Albashaireh ZS, Alomari MA. Periodontal diseases and therisk of coronaryheart and cerebrovascular diseases: a meta-analysis. J Periodontol. 2004;75:1046e53. DOI: 10.1902/jop.2004.75.8.1046

Moore WE, Moore LV,. The bacteria of periodontal diseases. Periodontol. 1994;5:66-77. DOI: 10.1111/j.1600-0757.1994.tb00019.x

B. Pihlstrom, B. Michalowicz, N. Johnson Las enfermedades periodontales. Lancet. 2005; 366:1809-1820 DOI: 10.1016/S0140-6736(05)67728-8

Wilson W, Taubert K, Gewitz M, Lockhart P, Baddour L, Levison M, et al. Prevention of Infective Endocarditis Guidelines From the American Heart Association: A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007; 116(15):1736-1754. DOI: 10.1161/CIRCULATIONAHA.106.183095

Petersen P, Baehni P. Periodontal health and global public health. Periodontology 2000. 2012; 60:7-14. DOI: 10.1111/j.1600-0757.2012.00452.x

Colombia. Ministerio de Salud. IV Estudio Nacional de Salud Bucal-ENSAB IV. 2014. [Fecha consulta: 13 abril de 2017]. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/ENSAB-IV-Situacion-Bucal-Actual.pdf

Nguyen CM, Kim JWM, Quan VH, Nguyen BH, Tran SD. Periodontal associations in cardiovascular diseases: Thelatestevidence and understanding. J Oral Biol Craniofac Res. 2015;5(3):203-206. DOI: 10.1016/j.jobcr.2015.06.008

Mattila KJ, Nieminen MS, Valtonen VV. Association between dental health and acute myocardial infarction. BMJ. 1989; 298(6676):779-81. DOI:10.1136/bmj.298.6687.1579-c

Ramírez J. ¿Es la enfermedad periodontal un factor de riesgo cardiovascular? Revisión de la evidencia experimental y clínica. Revista Estomatología. 2005;13(2):18-26.

D`estefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. BMJ. 1993;306:688-91. doi: https://doi.org/10.1136/bmj.306.6879.688

Dorn BR, Dunn WA Jr., Progulske-Fox A. Invasion of human coronary artery cells by periodontal pathogens. Infect Immun. 1999;67(11): 5792-8.

Chiu B. Multiple infections in carotid atherosclerotic plaques. Am Heart J. 1999 November; 138(5 Pt 2): S534-S536. DOI: http://dx.doi.org/10.1016/S0002-8703(99)70294-2

Mattila KJ. Viral and bacterial infections in patients with acute myocardial infarction. Journal of Internal Medicine. 1989;225(5):293-296. DOI: 10.1111/j.1365-2796.1989.tb00084.x

Haraszthy VI, Zambon JJ, Trevisan M, Zeid M, Genco RJ. Identification of periodontal pathogens in atheromatous plaques. J. Periodontol. 2000; 71(10): 1554-60. doi: 10.4103/0377-4929.134704

Ross R. Atherosclerosis – an inflammatory disease. N Engl J Med. 1999: 340: 115–126. DOI: 10.1056/NEJM199901143400207

Walldius G, Jungner I. Apolipoprotein B and apolipoprotein A-I: Risk indicators of coronary heart disease and targets for lipid-modifying therapy. J Intern Med. 2004; 255:188–205. DOI: 10.1111/j.1365-2796.1989.tb00084.x

Kolitveit KM, Eriksen HM. Is the observed association between periodontitis and atherosclerosis causal? Eur J Oral Sci. 2001;109:2-7. doi: 10.2174/1573403X10666140416094901

Beck J, Elter J, Heiss G, Couper D, Mauriello S, Offenbacher S. Relationship of periodontal disease to carotid aretery intima-media wall thickness: the atherosclerosis risk in communities (ARIC) study. Arterioscler Thromb Vasc Biol. 2001;21:1816-22. doi: 10.1161/hq1101.097803

Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J ClinPeriodontol. 2013;40(Suppl. 14): S70–S84. DOI: 10.1111/jcpe.12062

Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME, et al. Periodontal disease and atherosclerotic vascular disease: Does the evidence support an independent association? A scientific statement from the American Heart Association. Circulation 2012; 125:2520-4 doi: 10.1161/CIR.0b013e31825719f3.

Scannapieco F and Cantos A. Oral inflammation and infection, and chronic medical diseases: implications for the elderly. Periodontology. 2000. 2016;72:153–175. DOI: 10.1111/prd.12129

Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J ClinPeriodontol. 2013:40(Suppl. 14): S70–S84. DOI: 10.1111/jcpe.12062

Kebschull M, Demmer RT, Papapanou PN. "Gum bug, leave my heart alone!"--epidemiologic and mechanistic evidence linking periodontal infections and atherosclerosis. J Dent Res. 2010:89:879-902. DOI: 10.1177/0022034510375281

Rudney JD, Chen R, Sedgewick GJ. Intracellular Actinobacillusactinomycetemcomitans and Porphyromonasgingivalis in buccal epithelial cells collected from human subjects. Infect Immun. 2001;69:2700–2707. DOI: 10.1128/IAI.69.4.2700-2707.2001

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Published

2018-07-03

Issue

Vol. 14 No. 27 (2018)

Section

Thematic Review

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