Treatment of periodontitis and endothelial function.
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.
Tonetti
Maurizio S
MS
Department of Oral Health and Diagnostic Sciences, University of Connecticut Health Center, Farmington, USA. maurizio.tonetti@ergoperio.eu
D'Aiuto
Francesco
F
Nibali
Luigi
L
Donald
Ann
A
Storry
Clare
C
Parkar
Mohamed
M
Suvan
Jean
J
Hingorani
Aroon D
AD
Vallance
Patrick
P
Deanfield
John
J
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
D015415:Biomarkers; D019040:E-Selectin; D015850:Interleukin-6; D014665:Vasodilator Agents; D002097:C-Reactive Protein; D005996:Nitroglycerin