Evaluation The Role of Periodontitis As Risk Factor For Cardiovascular Diseas

Walid Altayeb DDS, MSD, PhD Dep.
Of Periodontology Faculty of Dentistry Damascus University
Evaluation the Role of Periodontitis as Risk Factor for Cardiovascular Disease

Periodontal
disease can affect general health...and it can be affected by general health.
Periodontitis
1st International Scientific Conference o fJUST and the 5th Scientific Meeting of IADR-JOR IADR7th -10th May 2008 10th
Why Periodontitis?
I.
II. III.
IV.
Specialty of Oral Cavity. Pathogenic Bacteria. Systemic Inflammatory response. Silent nature of periodontitis.
Atherosclerosis = CVD
FACTOIDS FACTORS

Age Sex Heredity
Smoking Cholesterol Blood Pressure Physical Inactivity Obesity Diabetes Mellitus Stress Socioeconomic Status
Numbers NumbersNumbers ?

Cardiovascular disease is the number one cause of death globally. WHO estimates that more than 17 million people died of CVD in 2005 Around 80% of these deaths occurred in 80% lowlow- and middle-income countries. middleby 2015, an estimated 20 million people 2015, will die from cardiovascular disease every year. approximately 10% to 15% of the 10% 15% worlds population is affected by advanced periodontal disease. more than 50% of adults 55 or older 50% have Periodontitis. 1st International Scientific Conference o fJUST
and the 5th Scientific Meeting of IADR-JOR IADR7th -10th May 2008 10th
Are There Clinical Evidences?
AAP Systematic Review Findings 2003 4/5 case
control studies found a positive association between Periodontitis and CVD. 11/15 studies 11/ found a modest association between periodontitis and CVD
possible mechanisms
Genetics Common Risk Factors
Bacteremia
Systemic inflammatory response
possible explanations

First, First, it may merely reflect confounding by common risk factors that cause both periodontal disease and atherosclerosis, such as:
smoking Diabetes stress obesity

Second, Second, the association may reflect an individual tendency to predisposes to both periodontal disease and atherosclerosis. (Genetic)

Third, Third, Periodontitis stimulate of systemic inflammatory response (Acute-Phase AcuteResponse) as evidenced by increases in CCreactive protein.
Loos 2000, Noack 2001, Craige 2003, Altayeb 2004 2000, 2001, 2003,

Fourth, Fourth, bacteremia Bacteria from the mouth directly/indirectly infect blood vessel walls and contribute to atherosclerosis.
Epidemiological Study
581 patients aged between (30(3070 years), were diagnosed for Atherosclerosis angiographically in department of cardiology, Alasad Hospital, Damascus University.
Vasoangiography
Periodontal Examination
Prevelance of CVD Accordiong to periodontal Disease

100.0 80.0 64.2 35.8 60.0 40.0 20.0 80.1
Prevelance of CVD According to Diabetes mellitus
100.0
82.3
19.9
62.0 38.0
None Diabetes
50.0 0.0 0.0
17.7
Diabetes
None Atherosclerosis
Athesclerosis Patients
None Periodontitis None Atherosclerosis
Periodontitis Athesclerosis Patients
subjects with severe periodontitis had a 2.5 fold higher risk for CVD
Odds Ratio After Statistical Exclusion (0.76) (1.40) 1.83 (1.18) (1.6) 2.59 (1.07) 2.23 2.50
Odds Ratio Risk Factors Family History Smoking Diabetes Mellitus Blood Pressure Physical Inactivity Stress Cholesterol Obesity Periodontitis
(1.04) 1.52 2.25 1.75 2.46 2.56 1.64 3.10 2.85

Is it sufficient ?

Overall, the observational studies support a strong link with atherosclerosis,
but cannot prove causation.

THE PLAYERS

Recurrent P gingivalis bacteremia induces aortic and coronary lesions consistent with atherosclerosis in animal. Li 2002, Lalla 2003, Brodala 2002, 2003, 2005
variable Age BMI N teeth Plaque Index Bleeding Index (%) Pocket Depth (mm) PD>5.0 mm (%) CAL>5.0 mm (%) WBCs (109/l) Triglycerides Cholesterol HDL LDL
Group With Periodontitis (N=10) Mean SD 51 24.09 21.10 2.15 43.20 4.69 45.60 57.30 7.4 1.76 4.20 0.26 15.82 0.55 12.36 15.09
Group Without Periodontitis (N=9) Mean SD 55.8 25.28 22.22 0.69 20 1.96 5.78 10.56 6.83 247.90 232.98 42.13 136.11 5.8 1.59 3.63 0.52 7.42 0.30 5.67 7.63 2.19 96.05 49.24 7.81 34.14
P level (t test) Significance 0.06 0.143 0.544 0.000** 0.001** 0.000** 0.000** 0.000** 0.372 0.450 0.792 0.257 0.972
7.30 3.80 260.25 235.06 40.39 135.91 100.47 45.19 7.27 34.55
Atherosclerotic plaque samples
1st International Scientific Conference o fJUST and the 5th Scientific Meeting of IADR-JOR IADR7th -10th May 2008
Bacteriological examination
Comparison the Frequency of periodontopathic bacterial DNA in subgingival plaque between patients with and without Periodontitis.
10 9 8 7 6 5 4 3 2 1 0 Aa Pg Tf Pi Td Cr Fn Ec Cs En Pm
N. Patients
Periodontitis
No Periodontitis
Comparison the Frequency of periodontopathic bacterial DNA in
Atheromatous plaque between patients with and without

Periodontitis
10 9 8 7 6 5 4 3 2 1 0 Aa Pg Tf Pi Td Cr Fn Ec Cs En Pm Periodontitis

N. Patients
No Periodontitis
Haraszthy 1998, Stelzel 2000, Ishihara 2004, Okuda 2005, Pucar 2007, 2007, Zaremba 2007 detected periodontopathogenic
bacteria in arterial walls.

explanation

The oral cavity represents a potentially large reservoir of Gram-negative pathogenic Gramorganisms that introduced into the bloodstream and could interact with cardiovascular tissues.
The Eyes of the Hippopotamus

Asymptomatic bacteremia due to Periodontitis may be an etiologic factor in cardiovascular disease.
Recommendations
1. Regular dental examinations for all dentate patients Affected with CVD and more work in prevention.

WITHOUT GOOD PERIODONTAL HEALTH, YOU CANT HAVE GOOD GENERAL HEALTH
Recommendations
2. Work more collaboratively with other health professionals.
DENTIST, A magician who, putting metal into your mouth, pulls coins out of your pocket.
Ambrose Bierce (1911), U.S. writer and journalist. 1911),
Recommendation
3. Full periodontal therapy for infections especially high risk persons for CVD.

Periodontal treatment lowered the outcome of CVD in 50-75%. Iwamoto 2003 50-75%. National Institutes of Health has agreed to support of periodontal treatment in patients with both Atherosclerosis and Periodontitis with doxycycline (20 mg twice a day) . Caton 2000 (20 Recommendations for perio treatment on the basis of potential CVD outcomes remains premature. Maas 2005 1st International Scientific Conference o fJUST
and the 5th Scientific Meeting of IADR-JOR IADR7th -10th May 2008 10th
learn from History!! Scientific Evidence

Miller 1891, Belling 1912 (Focal 1891, Infection).

Removing the teeth will cure something, including the foolish belief that removing the teeth will cure everything.

Anonymous. Anonymous.
Samakh, Palestine
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.
JADA, June 2007; Vol. 138: 739-760. http://jada.ada.org
oral organisms are introduced into the bloodstream multiple times daily in individuals with periodontitis the periodontal tissue such as tooth brushing, mastication, periodontal treatment. Tooth brushing 40%, Extractions 60%, Periodontal surgery 88%. Sabine et al 2002
The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with: mitral valve prolapse rheumatic heart disease bicuspid valve disease calcified aortic stenosis congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.
Classification of recommendations and levelsof evidence.*

CLASSIFICATION OF RECOMMENDATIONS Class I Conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective Class II Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness or efficacy of a procedure or treatment IIa Weight of evidence/opinion is in favor of usefulness/efficacy IIb Usefulness/efficacy is less well-established by evidence/opinion Class III Conditions for which there is evidence and/or general agreement that the procedure or treatment is not useful or effective and, in some cases, may be harmful LEVEL OF EVIDENCE A Data derived from multiple randomized clinical trials or meta-analysis B Data derived from a single randomized trial or from nonrandomized studies C Only consensus opinion of experts, case studies or standard of care

Evaluation The Role of Periodontitis As Risk Factor For Cardiovascular Diseas

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Evaluation The Role of Periodontitis As Risk Factor For Cardiovascular Diseas

Hochgeladen von

Copyright:

Verfügbare Formate

Walid Altayeb DDS, MSD, PhD Dep.

Of Periodontology Faculty of Dentistry Damascus University

Evaluation the Role of Periodontitis as Risk Factor for Cardiovascular Disease

disease can affect general health...and it can be affected by general health.

Age Sex Heredity

Are There Clinical Evidences?

AAP Systematic Review Findings 2003 4/5 case

Systemic inflammatory response

Prevelance of CVD Accordiong to periodontal Disease

Prevelance of CVD According to Diabetes mellitus

50.0 0.0 0.0

None Periodontitis None Atherosclerosis

Periodontitis Athesclerosis Patients

(1.04) 1.52 2.25 1.75 2.46 2.56 1.64 3.10 2.85

Overall, the observational studies support a strong link with atherosclerosis,

but cannot prove causation.

Atherosclerotic plaque samples

Comparison the Frequency of periodontopathic bacterial DNA in

Atheromatous plaque between patients with and without

bacteria in arterial walls.

The Eyes of the Hippopotamus

Asymptomatic bacteremia due to Periodontitis may be an etiologic factor in cardiovascular disease.

learn from History!! Scientific Evidence

Miller 1891, Belling 1912 (Focal 1891, Infection).

Prevention of infective Endocarditis: Guidelines from the American Heart Association

JADA, June 2007; Vol. 138: 739-760. http://jada.ada.org

Classification of recommendations and levelsof evidence.*

Das könnte Ihnen auch gefallen