title: Treatment of periodontitis and endothelial function.
abstract: Systemic inflammation may impair vascular function, and epidemiologic data suggest a possible link between periodontitis and cardiovascular disease.
  
  
  
  We randomly assigned 120 patients with severe periodontitis to community-based periodontal care (59 patients) or intensive periodontal treatment (61). Endothelial function, as assessed by measurement of the diameter of the brachial artery during flow (flow-mediated dilatation), and inflammatory biomarkers and markers of coagulation and endothelial activation were evaluated before treatment and 1, 7, 30, 60, and 180 days after treatment.
  
  
  
  Twenty-four hours after treatment, flow-mediated dilatation was significantly lower in the intensive-treatment group than in the control-treatment group (absolute difference, 1.4%; 95% confidence interval [CI], 0.5 to 2.3; P=0.002), and levels of C-reactive protein, interleukin-6, and the endothelial-activation markers soluble E-selectin and von Willebrand factor were significantly higher (P<0.05 for all comparisons). However, flow-mediated dilatation was greater and the plasma levels of soluble E-selectin were lower in the intensive-treatment group than in the control-treatment group 60 days after therapy (absolute difference in flow-mediated dilatation, 0.9%; 95% CI, 0.1 to 1.7; P=0.02) and 180 days after therapy (difference, 2.0%; 95% CI, 1.2 to 2.8; P<0.001). The degree of improvement was associated with improvement in measures of periodontal disease (r=0.29 by Spearman rank correlation, P=0.003). There were no serious adverse effects in either of the two groups, and no cardiovascular events occurred.
  
  
  
  Intensive periodontal treatment resulted in acute, short-term systemic inflammation and endothelial dysfunction. However, 6 months after therapy, the benefits in oral health were associated with improvement in endothelial function.
authors.affiliation: Department of Oral Health and Diagnostic Sciences, University of Connecticut Health Center, Farmington, USA. maurizio.tonetti@ergoperio.eu
authors.forename: Maurizio S
authors.initials: MS
authors.lastname: Tonetti
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Aiuto
authors.forename: Luigi
authors.initials: L
authors.lastname: Nibali
authors.forename: Ann
authors.initials: A
authors.lastname: Donald
authors.forename: Clare
authors.initials: C
authors.lastname: Storry
authors.forename: Mohamed
authors.initials: M
authors.lastname: Parkar
authors.forename: Jean
authors.initials: J
authors.lastname: Suvan
authors.forename: Aroon D
authors.initials: AD
authors.lastname: Hingorani
authors.forename: Patrick
authors.initials: P
authors.lastname: Vallance
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001916:Brachial Artery / Q000502:physiology; D002097:C-Reactive Protein / Q000032:analysis; D012534:Dental Scaling; D019040:E-Selectin / Q000097:blood; D004730:Endothelium, Vascular / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D005996:Nitroglycerin / Q000494:pharmacology; D010518:Periodontitis / Q000145:classification / Q000503:physiopathology / Q000628:therapy*; D016037:Single-Blind Method; D014664:Vasodilation / Q000187:drug effects; D014665:Vasodilator Agents / Q000494:pharmacology
chemical_list: D015415:Biomarkers; D019040:E-Selectin; D015850:Interleukin-6; D014665:Vasodilator Agents; D002097:C-Reactive Protein; D005996:Nitroglycerin