title: Association between periodontal disease and its treatment, flow-mediated dilatation and carotid intima-media thickness: a systematic review and meta-analysis.
abstract: OBJECTIVE
  This meta-analysis sought to investigate the association between carotid intima-media thickness (c-IMT), flow-mediated dilation (FMD) and periodontitis (PD) and to assess the effect of periodontal treatment on c-IMT and FMD.
  
  
  METHODS
  Electronic database searching, hand searching of bibliographic references of included papers, related reviews, and journals in relation to oral, cardiovascular and ultrasound imaging field was carried out. Random effects meta-analyses were performed to investigate the association of co-existence of increased c-IMT, impaired FMD and PD with potential changes in these variables following periodontal intervention.
  
  
  RESULTS
  2009 citations and 101 full text articles were screened, with 35 meeting the review inclusion criteria of which 22 suitable for quantitative analysis. Meta-analysis demonstrated that the diagnosis of PD was associated with a mean increase in c-IMT of 0.08 mm (95% C.I. = 0.07-0.09) and a mean difference in FMD of 5.1% compared to controls (95% C.I. = 2.08-8.11%). A meta-analysis of the effects of periodontal treatment on FMD showed a mean improvement of 6.64% between test and control (95% C.I. = 2.83-10.44%).
  
  
  CONCLUSIONS
  This review demonstrated an association between increased c-IMT, impaired FMD and PD. Data from intervention studies suggested a beneficial effect of periodontal treatment on FMD indicating an improvement in endothelial function. The findings support investigation of periodontitis treatment on cardiovascular outcomes.
authors.affiliation: Unit of Periodontology, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, United Kingdom. Electronic address: m.orlandi@ucl.ac.uk.
authors.forename: Marco
authors.initials: M
authors.lastname: Orlandi
authors.affiliation: Unit of Periodontology, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, United Kingdom.
authors.forename: Jeanie
authors.initials: J
authors.lastname: Suvan
authors.affiliation: Biostatistics Unit, UCL Eastman Dental Institute, 256 Gray's Inn Road, London, United Kingdom.
authors.forename: Aviva
authors.initials: A
authors.lastname: Petrie
authors.affiliation: Unit of Periodontology, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, United Kingdom.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Donos
authors.affiliation: Vascular Physiology Unit, Great Ormond Street Hospital, 34 Great Ormond Street, London, United Kingdom.
authors.forename: Stefano
authors.initials: S
authors.lastname: Masi
authors.affiliation: Faculty of Population Health Sciences, Institute of Cardiovascular Science, UCL, 1-19 Torrington Place, London, United Kingdom.
authors.forename: Aroon
authors.initials: A
authors.lastname: Hingorani
authors.affiliation: Vascular Physiology Unit, Great Ormond Street Hospital, 34 Great Ormond Street, London, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
authors.affiliation: Unit of Periodontology, UCL Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, United Kingdom.
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Aiuto
mesh_terms: D001916:Brachial Artery / Q000503:physiopathology; D002340:Carotid Artery Diseases / Q000453:epidemiology* / Q000473:pathology; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D015984:Causality; D015897:Comorbidity; D018849:Controlled Clinical Trials as Topic; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004198:Disease Susceptibility; D004730:Endothelium, Vascular / Q000503:physiopathology*; D018056:Hemorheology; D006801:Humans; D010510:Periodontal Diseases / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D010518:Periodontitis / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D058226:Plaque, Atherosclerotic / Q000453:epidemiology / Q000473:pathology; D014664:Vasodilation / Q000502:physiology*
keywords: Cardiovascular disease; Carotid intima-media thickness; Endothelial function; Flow-mediated dilatation; Periodontitis