title: Longitudinal effects of systemic inflammation markers on periodontitis.
abstract: OBJECTIVE
  Systemic low-grade inflammation represents a central hallmark of chronic diseases and has been proposed as the underlying mechanism linking factors like obesity or diabetes with periodontitis. However, the impact of inflammatory markers on periodontitis has not yet been investigated.
  
  
  METHODS
  The study population comprised 1784 subjects from the Study of Health in Pomerania with complete 11-year follow-up. Fibrinogen and white blood cell (WBC) counts were measured as markers of inflammation. Periodontitis was assessed by probing depth (PD), clinical attachment loss (CAL) and the CDC/AAP case definition.
  
  
  RESULTS
  Multilevel regression analyses revealed significant coefficients for the impact of both inflammation markers on the percentage of sites with PD/CAL ≥ 3 mm. Increases in fibrinogen about 1 g/l were associated with 3.0% and 2.7% more sites with PD/CAL ≥ 3 mm respectively. Consistent associations were found using mean values of PD/CAL but not using missing teeth or caries. Regarding the CDC/AAP case definition, 11-year changes in fibrinogen and WBC counts were significantly associated with ≥1 category progression (OR: 1.36 and 1.11).
  
  
  CONCLUSIONS
  Fibrinogen levels and WBC counts showed consistent long-term associations with PD, CAL and the CDC/AAP case definition. Results indicate that systemic low-grade inflammation might indeed represent one possible pathway for effects of obesity, diabetes or other chronic inflammatory conditions on periodontitis.
authors.affiliation: Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, Pedodontics and Primary Prevention, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Christiane
authors.identifier: http://orcid.org/0000-0001-5950-2716
authors.initials: C
authors.lastname: Pink
authors.affiliation: Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, Pedodontics and Primary Prevention, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kocher
authors.affiliation: Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, Pedodontics and Primary Prevention, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Meisel
authors.affiliation: Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.|DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Dörr
authors.affiliation: Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.|DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.|Department Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.|DZD (German Center for Diabetes Research), Partner Site Greifswald, Greifswald, Germany.
authors.forename: Marcello R P
authors.initials: MR
authors.lastname: Markus
authors.affiliation: Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, Pedodontics and Primary Prevention, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Jablonowski
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Grotevendt
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Nauck
authors.affiliation: Unit of Periodontology, Department of Restorative Dentistry, Periodontology, Endodontology, Pedodontics and Primary Prevention, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Birte
authors.initials: B
authors.lastname: Holtfreter
mesh_terms: D015415:Biomarkers; D006801:Humans; D007249:Inflammation; D007958:Leukocyte Count; D017622:Periodontal Attachment Loss; D010518:Periodontitis; D016388:Tooth Loss
chemical_list: D015415:Biomarkers
keywords: cohort studies; diabetes mellitus; fibrinogen; inflammation; leukocyte count; obesity; periodontitis