Radiographic measures of chronic periodontitis and carotid artery plaque.
OBJECTIVE
Chronic periodontitis (CP) is associated with stroke and subclinical atherosclerosis, but clinical measurement of CP can be time consuming and invasive. The purpose of this study was to determine whether radiographically assessed CP is associated with nonstenotic carotid artery plaque as an ultrasound measure of subclinical atherosclerosis.


METHODS
Panoramic oral radiographs were obtained from 203 stroke-free subjects ages 54 to 94 during the baseline examination of the Oral Infections and Vascular Disease Epidemiology Study (INVEST). CP exposure among dentate subjects was defined either categorically (periodontal bone loss > or =50% [severe] versus <50% bone loss) or via tertile formation (for dose-response investigation), with edentulous subjects categorized separately. In all subjects, high-resolution B-mode carotid ultrasound was performed. Carotid plaque thickness (CPT) and prevalence (present/absent) were recorded. Covariates included age, sex, smoking, diabetes, hypertension, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein cholesterol.


RESULTS
Among dentate subjects with severe periodontal bone loss, mean CPT was significantly greater (1.20+/-1.00 mm versus 0.73+/-0.89 mm; P=0.003). CPT increased with more severe bone loss (upper versus lower tertile bone loss; P=0.049; adjusted for age, sex, and hypertension). This apparent dose-response effect was more evident among never-smokers. In a fully adjusted multivariate logistic regression model, severe periodontal bone loss was associated with a nearly 4-fold increase in risk for the presence of carotid artery plaque (adjusted odds ratio, 3.64; CI, 1.37 to 9.65).


CONCLUSIONS
Severe periodontal bone loss is associated independently with carotid atherosclerosis. Panoramic oral radiographs may thus provide an efficient means to assess CP in studies of atherosclerosis risk.
Engebretson
Steven P
SP
Division of Periodontics, College of Physicians and Surgeons, Columbia University Medical Center, 630 W 168th St, PH7 E 125A New York, NY 10032, USA. spe3@columbia.edu
Lamster
Ira B
IB
Elkind
Mitchell S V
MS
Rundek
Tatjana
T
Serman
Neill J
NJ
Demmer
Ryan T
RT
Sacco
Ralph L
RL
Papapanou
Panos N
PN
Desvarieux
Moïse
M
D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000000981:diagnostic imaging* / Q000209:etiology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010518:Periodontitis / Q000150:complications / Q000000981:diagnostic imaging*; D011862:Radiography, Panoramic / Q000379:methods; D014463:Ultrasonography