Offenbacher Steven, Beck James D, Moss Kevin, Mendoza Luisito, Paquette David W, Barrow David A, Couper David J, Stewart Dawn D, Falkner Karen L, Graham Susan P, Grossi Sara, Gunsolley John C, Madden Theresa, Maupome Gerardo, Trevisan Maurizio, Van Dyke Thomas E, Genco Robert J
Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Periodontol. 2009 Feb;80(2):190-201. doi: 10.1902/jop.2009.080007.
In the Periodontitis and Vascular Events (PAVE) pilot study, periodontal therapy was provided as an intervention in a secondary cardiac event prevention model through five coordinated cardiac-dental centers.
Subjects were randomized to either community care or protocol provided scaling and root planing to evaluate effects on periodontal status and systemic levels of high-sensitivity C-reactive protein (hs-CRP).
After 6 months, there was a significant reduction in mean probing depth and extent of 4- or 5-mm pockets. However, there were no significant differences in attachment levels, bleeding upon probing, or extent of subgingival calculus comparing subjects assigned to protocol therapy (n = 151) to those assigned to community care (n = 152). Using intent-to-treat analyses, there was no significant effect on serum hs-CRP levels at 6 months. However, 48% of the subjects randomized to community care received preventive or periodontal treatments. Secondary analyses demonstrated that consideration of any preventive or periodontal care (i.e., any treatment) compared to no treatment showed a significant reduction in the percentage of people with elevated hs-CRP (values >3 mg/l) at 6 months. However, obesity nullified the periodontal treatment effects on hs-CRP reduction. The adjusted odds ratio for hs-CRP levels >3 mg/l at 6 months for any treatment versus no treatment among non-obese individuals was 0.26 (95% confidence interval: 0.09 to 0.72), adjusting for smoking, marital status, and gender.
This pilot study demonstrated the critical role of considering obesity as well as rigorous preventive and periodontal care in trials designed to reduce cardiovascular risk.
在牙周炎与血管事件（PAVE）试点研究中，通过五个协作的心脏牙科中心，将牙周治疗作为二级心脏事件预防模型的一种干预措施。
将受试者随机分为接受社区护理或接受规范的龈上洁治和根面平整，以评估对牙周状况和高敏C反应蛋白（hs-CRP）全身水平的影响。
6个月后，平均探诊深度和4至5毫米牙周袋的范围显著减小。然而，将接受规范治疗的受试者（n = 151）与接受社区护理的受试者（n = 152）相比，在附着水平、探诊出血或龈下牙石范围方面没有显著差异。采用意向性分析，6个月时对血清hs-CRP水平没有显著影响。然而，随机分配到社区护理组的受试者中有48%接受了预防性或牙周治疗。二次分析表明，与未治疗相比，考虑任何预防性或牙周护理（即任何治疗）显示6个月时hs-CRP升高（值>3 mg/l）的人群百分比显著降低。然而，肥胖抵消了牙周治疗对hs-CRP降低的效果。在非肥胖个体中，6个月时接受任何治疗与未治疗相比hs-CRP水平>3 mg/l的校正比值比为0.26（95%置信区间：0.09至0.72），校正了吸烟、婚姻状况和性别因素。
这项试点研究表明，在旨在降低心血管风险的试验中，考虑肥胖以及严格的预防性和牙周护理具有关键作用。
