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 Table of Contents  
LETTER TO EDITOR
Year : 2014  |  Volume : 11  |  Issue : 2  |  Page : 153-154

Current views on periodontitis and its theatrical association with coronary heart disease


1 Department of Periodontics, Dental College, Azamgarh
2 Dental Surgeon, Ex-Servicemen Contributory Health Scheme, Varanasi Cantonment, Uttar Pradesh

Date of Web Publication3-Oct-2014

Correspondence Address:
Saurabh Wahi
Department of Periodontics, Dental College, Azamgarh - 276 001, Uttar Pradesh

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-7969.142148

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How to cite this article:
Pathak R, Wahi S, Sinha A, Wahi S. Current views on periodontitis and its theatrical association with coronary heart disease. Nig J Cardiol 2014;11:153-4

How to cite this URL:
Pathak R, Wahi S, Sinha A, Wahi S. Current views on periodontitis and its theatrical association with coronary heart disease. Nig J Cardiol [serial online] 2014 [cited 2019 Dec 10];11:153-4. Available from: http://www.nigjcardiol.org/text.asp?2014/11/2/153/142148

Periodontitis (PD) is a bacterially-induced, localized chronic inflammatory disease destroying both the connective tissue and the supporting bone of the teeth. In the general population, severe forms of the disease demonstrate a prevalence of almost 5%; whereas, initial epidemiological evidence suggests an association between PD and coronary artery disease (CAD). Both the infectious nature of PD and the yet etiologically unconfirmed infectious hypothesis of CAD, question their potential association. [1] Atherosclerosis is a chronic risk factor for cardiovascular diseases (CVDs) and thrombosis is an acute one which obstructs the heart vessels leading to heart ischemia and finally cardiac infarction. [2] Additionally, microorganisms involved in periodontal diseases can play a role in the formation of atheromatous plaques and given that periodontal disease is one the most common infectious diseases, as a chronic infection, it can be considered as an important risk factor for CVD. [3] Meanwhile, PD is common with some manifestations of CVD including being prevalent in adult men, smokers, diabetics, people with stress, and people with low socioeconomic level. [4] Case-control, cross-sectional, and longitudinal studies have found that PD is associated with coronary heart disease (CHD) and cerebrovascular disease. [5] Established risk factors such as arterial hypertension, smoking, hyperlipidemia, obesity, and diabetes mellitus may explain at least partially the development of CAD. [6] However, many cases of CAD develop in the absence of traditional cardiovascular risk factors and among these lines additional contributing factors such as genetic predisposition, have been proposed to culminate the partially unexplained etiology of CVDs. [7] The first study that evaluated the association between CAD and periodontal damage was the study by Mattila et al. [8] Researchers studied males admitted in the hospital for myocardial infarction and compared their periodontal status with healthy controls from the same urban population. However, since 1989, a spectacular increase in publications on this topic has been tracked in more than 180 peer-reviewed English language journals. [9] Most of them have shown the relationship between oral conditions, atherosclerosis, and CHD. [10] PD and atherosclerosis have complex etiologies, genetic and gender predispositions, and may share pathogenic mechanisms as well as common risk factors.

Atherosclerosis starts early in life, since disease progression is usually slow, clinical symptoms with or without hospitalization is rare before 45 years of age. It is becoming more and more obvious that infections and chronic inflammatory conditions such as PD can accelerate the atherosclerotic process. The apparent connection between PD and CHD has proved difficult to study especially with regards to the dental infections, as they share common multifactor. These include smoking, low social economic status, and unfavorable healthcare practices of the individual. [11] Literature search with this perspective reveals only few publications addressing the relation between PD and CHD. [12],[13],[14] However, one very recent study founded no evidence of influence of periodontal health in preventing or modifying the outcome of CHD. [3] Some of the prominent risk factors are smoking, genetics, stress, and increasing age, that could autonomously escort to PD and to CVD, possibly leading to the incorrect postulation that the two diseases are linked. Similarly, the matrix metalloprotienases (MMPs) also play a crucial role in CVD including the deleterious changes in extracellular matrix in the myocardium.

Nevertheless, one can perceive parallelisms between periodontal tissue demolition and CVD as both mediated by a similar pathway via MMPs. In actual fact, there is increasing evidence that inhibition of MMPs, already shown to be effective for inhibition of periodontal attachment loss, can also inhibit the development of cardiac failure. [15] One of the recent study demonstrated imperative association of periodontal disease with markers of subclinical CHD, such as cardiac calcium. [16] Moreover, the oral cavity provides a doorway between the environment and oral cavity, and it facilitates both food ingestion, mastication, and digestion. Poor oral hygiene and subsequent tooth loss can potentially affect gastrointestinal flora and nutritional status, and they have implications for the development of chronic diseases. Blaizot and colleagues explored 215 epidemiological studies and found the risk of developing CVD significantly (34%) higher in subjects with periodontal disease compared to those without periodontal disease (P < 0.0001). [17] Samani and associates further showed imperative relationship between mean attachment loss and CAD in the patients who lost more than 10 teeth. [18] This was somewhat similar to the study results of Ramesh and coworkers who reported PD in 11 patients of the acute coronary syndrome group and 10 patients in the healthy group. [19] Rutger Persson and associates also suggested that patients who at routine dental visits demonstrate evidence of bone loss around several teeth can predictably be identified as being at risk for future CAD. [13] Overall, PD seems to be associated with no more than a modest increase (~20%) in cardiovascular risk in the general population. [20],[21],[22] Although etiological association between PD and CAD is not supported by the present evidence, future investigation should not be discouraged given that these two entities are highly prevalent in both developed and developing countries and adversely contribute to the overall public health.

 
  References Top

1.Thomopoulos C, Tsioufis C, Soldatos N, Kasiakogias A, Stefanadis C. Periodontitis and coronary artery disease: A questioned association between periodontal and vascular plaques. Am J Cardiovasc Dis 2011;1:76-83.  Back to cited text no. 1
    
2.Beck JD, Offenbacher S, Williams R, Gibbs P, Garcia R. Periodontitis: A risk factor for coronary heart disease? Ann Periodontol 1998;3:127-41.  Back to cited text no. 2
    
3.Yang J, Feng L, Ren J, Wu G, Chen S, Zhou Q, et al. Correlation between the severity of periodontitis and coronary artery stenosis in a Chinese population. Aust Dent J 2013;58:333-8.  Back to cited text no. 3
    
4.Wo¿akowska-Kap³on B, W³osowicz M, Gorczyca-Michta I, Górska R. Oral health status and the occurrence and clinical course of myocardial infarction in hospital phase: A case-control study. Cardiol J 2013;20:370-7.  Back to cited text no. 4
    
5.Beck J, Garcia R, Heiss G, Vokonas PS, Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol 1996;67:1123-37.  Back to cited text no. 5
    
6.Hennekens CH. Increasing burden of cardiovascular disease: Current knowledge and future directions for research on risk factors. Circulation 1998;97:1095-102.  Back to cited text no. 6
    
7.Marenberg ME, Risch N, Berkman LF, Floderus B, de Faire U. Genetic susceptibility to death from coronary heart disease in a study of twins. N Engl J Med 1994;330:1041-6.  Back to cited text no. 7
    
8.Mattila KJ, Nieminen MS, Valtonen VV, Rasi VP, Kesäniemi YA, Syrjälä SL, et al. Association between dental health and acute myocardial infarction. BMJ 1989;298:779-81.  Back to cited text no. 8
    
9.Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME, et al. American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, and Council on Clinical Cardiology. Periodontal disease and atherosclerotic vascular disease: Does the evidence support an independent association? A scientific statement from the American Heart Association. Circulation 2012;125:1-2520-44.  Back to cited text no. 9
    
10.De Stefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. BMJ 1993;306:688-91.  Back to cited text no. 10
    
11.Marshall JR, Graham S, Haughey BP, Shedd D, O′Shea R, Brasure J, et al. Smoking, alcohol, dentition and diet in the epidemiology of oral cancer. Eur J Cancer B Oral Oncol 1992;28B: 9-15.  Back to cited text no. 11
    
12.Buhlin K, Gustafsson A, Pockley AG, Frostegård J, Klinge B. Risk factors for cardiovascular disease in patients with periodontitis. Eur Heart J 2003;24:2099-107.  Back to cited text no. 12
    
13.Rutger Persson G, Ohlsson O, Pettersson T, Renvert S. Chronic periodontitis, a significant relationship with acute myocardial infarction. Eur Heart J 2003;24:2108-15.  Back to cited text no. 13
    
14.Gum Disease Links to Heart Disease and Stroke. Available from: http://www.perio.org/consumer/mbc.heart.htm. [Last accessed on 2012 May 18].  Back to cited text no. 14
    
15.Matsumura S, Iwanaga S, Mochizuki S, Okamoto H, Ogawa S, Okada Y. Targeted deletion or pharmacological inhibition of MMP-2 prevents cardiac rupture after myocardial infarction in mice. J Clin Invest 2005;115:599-609.  Back to cited text no. 15
    
16.Pressman GS, Qasim A, Verma N, Miyamae M, Arishiro K, Notohara Y, et al. Periodontal disease is an independent predictor of intracardiac calcification. Biomed Res Int 2013;2013:854340.  Back to cited text no. 16
    
17.Blaizot A, Vergnes JN, Nuwwareh S, Amar J, Sixou M. Periodontal diseases and cardiovascular events: Meta-analysis of observational studies. Int Dent J 2009;59:197-209.  Back to cited text no. 17
    
18.Khosravi Samani M, Jalali F, Seyyed Ahadi SM, Hoseini SR, Dabbagh Sattari F. The relationship between acute myocardial infarction and periodontitis. Caspian J Intern Med 2013;4:667-71.  Back to cited text no. 18
    
19.Ramesh A, Thomas B, Rao A. Evaluation of the association between chronic periodontitis and acute coronary syndrome: A case control study. J Indian Soc Periodontol 2013;17:210-3.  Back to cited text no. 19
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20.Dhadse P, Gattani D, Mishra R. The link between periodontal disease and cardiovascular disease: How far we have come in last two decades? J Indian Soc Periodontol 2010;14:148-54.  Back to cited text no. 20
[PUBMED]  Medknow Journal  
21.Trevisan M, Dorn J. The relationship between periodontal disease (pd) and cardiovascular disease (cvd). Mediterr J Hematol Infect Dis 2010;2:e2010030.  Back to cited text no. 21
    
22.Fisher MA, Borgnakke WS, Taylor GW. Periodontal disease as a risk marker in coronary heart disease and chronic kidney disease. Curr Opin Nephrol Hypertens 2010;19:519-26.  Back to cited text no. 22
    




 

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