Periodontitis and atherogenesis: causal association or simple coincidence?
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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
Francesco
F
Department of Periodontology, Eastman Dental Institute and Hospital, University College London, UK.
Parkar
Mohammed
M
Andreou
Georgios
G
Brett
Peter M
PM
Ready
Derren
D
Tonetti
Maurizio S
MS
D000367:Age Factors; D001161:Arteriosclerosis / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis; D015850:Interleukin-6 / Q000097:blood / Q000235:genetics; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010512:Periodontal Index; D010518:Periodontitis / Q000150:complications* / Q000276:immunology / Q000628:therapy; D010865:Pilot Projects; D011110:Polymorphism, Genetic / Q000235:genetics; D011446:Prospective Studies; D012737:Sex Factors; D016037:Single-Blind Method; D012907:Smoking
D018836:Inflammation Mediators; D015850:Interleukin-6; D002097:C-Reactive Protein