title: Pathological periodontal pockets are associated with raised diastolic blood pressure in obese adolescents.
abstract: BACKGROUND
  Obesity, a well-known risk factor for developing cardiovascular disease (CVD), is associated with chronic periodontitis in adults. This cross-sectional pilot study on obese adolescents was designed to investigate whether periodontal disease in terms of pathological periodontal pockets is associated with raised blood pressure and other risk markers for CVD.
  
  
  METHODS
  The study included 75 obese subjects between 12 to 18 years of age, mean 14.5. Subjects answered a questionnaire regarding health, oral hygiene habits and sociodemographic factors. A clinical examination included Visible Plaque Index (VPI %), Gingival inflammation (BOP %) and the occurrence of pathological pockets exceeding 4 mm (PD ≥ 4 mm). Blood serum were collected and analyzed. The systolic and diastolic blood pressures were registered.
  
  
  RESULTS
  Adolescents with pathological periodontal pockets (PD ≥ 4 mm; n = 14) had significantly higher BOP >25% (P = 0.002), higher diastolic blood pressure (P = 0.008), higher levels of Interleukin (IL)-6 (P < 0.001), Leptin (P = 0.018), Macrophage Chemoattractant Protein-1 (MCP-1) (P = 0.049) and thyroid stimulating hormone (TSH) (P = 0.004) in blood serum compared with subjects without pathological periodontal pockets (PD ≥ 4 mm; n = 61). The bivariate linear regression analysis demonstrated that PD ≥ 4 mm (P = 0.008) and systolic blood pressure (P < 0.001) were significantly associated with the dependent variable "diastolic blood pressure". The association between PD ≥ 4 mm and diastolic blood pressure remained significant (P = 0.006) even after adjusting for potential confounders BMI-sds, age, gender, mother's country of birth, BOP >25%, IL-6, IL-8, Leptin, MCP-1, TSH and total cholesterol in the multiple regression analysis.
  
  
  CONCLUSIONS
  In conclusion, this study indicates an association between pathological periodontal pockets and diastolic blood pressure in obese adolescents. The association was unaffected by other risk markers for cardiovascular events or periodontal disease. The results call for collaboration between pediatric dentists and medical physicians in preventing obesity development and its associated disorders.
authors.affiliation: Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-141 04, Huddinge, Stockholm, Sweden. Cecilia.Zeigler@ki.se.
authors.forename: Cecilia C
authors.initials: CC
authors.lastname: Zeigler
authors.affiliation: Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-141 04, Huddinge, Stockholm, Sweden. Biniyam.Wondimu@ki.se.
authors.forename: Biniyam
authors.initials: B
authors.lastname: Wondimu
authors.affiliation: National Childhood Obesity Centre, Division of Pediatrics Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Claude.Marcus@ki.se.
authors.forename: Claude
authors.initials: C
authors.lastname: Marcus
authors.affiliation: Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-141 04, Huddinge, Stockholm, Sweden. Thomas.Modeer@ki.se.
authors.forename: Thomas
authors.initials: T
authors.lastname: Modéer
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015992:Body Mass Index; D018932:Chemokine CCL2 / Q000097:blood; D002648:Child; D003430:Cross-Sectional Studies; D003774:Dental Plaque Index; D003971:Diastole; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications*; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D020738:Leptin / Q000097:blood; D008297:Male; D009765:Obesity / Q000097:blood / Q000150:complications*; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000097:blood / Q000150:complications*; D010865:Pilot Projects; D012737:Sex Factors; D013599:Systole; D013972:Thyrotropin / Q000097:blood
chemical_list: C111835:CCL2 protein, human; C508606:CXCL8 protein, human; D018932:Chemokine CCL2; C508600:IL6 protein, human; D015850:Interleukin-6; D016209:Interleukin-8; D020738:Leptin; D013972:Thyrotropin