Donders H C M, Veth E O, Edens M A, van 't Hof A W J, de Lange J, Loos B G
Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, Netherlands.
Department of Oral and Maxillofacial Surgery, Isala Hospital, Zwolle, Netherlands.
Front Cardiovasc Med. 2022 Apr 14;9:851397. doi: 10.3389/fcvm.2022.851397. eCollection 2022.
Periodontitis is a chronic multifactorial inflammatory disease of the supportive tissues of the teeth. In more recent years, remarkable epidemiological and pathophysiological associations between periodontitis and cardiovascular disease (CVD) have been presented. Whether or not treatment of periodontitis is valuable for primary or secondary prevention of cardiovascular disease, has not yet been fully established. In this practice-based pilot study we focused on primary prevention of cardiovascular disease, by investigating the effect of periodontal treatment on the earliest detectable stage of CVD; endothelial dysfunction.
Otherwise healthy periodontitis and non-periodontitis participants 45-70 years of age were included in the study. One year after completing periodontal (non-surgical and surgical) treatment of the periodontitis patients and 1 year after inclusion of the controls, all baseline measurements were repeated. Full-mouth examinations were performed by a periodontist to determine their Periodontal Inflamed Surface Area (PISA) score and other dental parameters. To assess the cardiovascular conditions, endothelial function through the reactive hyperemia index (RHI) assessed by the EndoPAT™, and several physical and biochemical parameters were measured.
21 patients with diagnosed, untreated periodontitis and 21 participants without periodontitis were included in this follow-up study. After periodontal therapy in the periodontitis patients, the PISA reduced significantly. The RHI did not show a significant improvement after treatment of the periodontitis patients (-0.1 ± 0.8, = 0.524). Similarly, other secondary cardiovascular outcome measurements, hsCRP, total cholesterol, HDL cholesterol, triglycerides, HbA1c, and systolic blood pressure did not improve significantly after periodontal treatment. Controls did not show any significant changes in the RHI, in other CVD parameters and in the PISA after 1-year follow-up.
In this practice-based pilot study, periodontal treatment did not improve the endothelial function in otherwise healthy adults with periodontitis. Future studies are needed to be of larger size and could focus on periodontitis patients with co-morbidities to investigate whether periodontal treatment has secondary preventive effect on endothelial function and other CVD parameters.
[www.ClinicalTrials.gov], identifier [ISRCTN55656827].
牙周炎是一种牙齿支持组织的慢性多因素炎症性疾病。近年来，牙周炎与心血管疾病（CVD）之间已呈现出显著的流行病学和病理生理学关联。牙周炎治疗对于心血管疾病的一级或二级预防是否有价值，尚未完全明确。在这项基于实践的试点研究中，我们通过研究牙周治疗对心血管疾病最早可检测阶段——内皮功能障碍的影响，聚焦于心血管疾病的一级预防。
45至70岁的健康牙周炎患者和非牙周炎参与者被纳入本研究。牙周炎患者完成牙周（非手术和手术）治疗一年后，以及对照组纳入一年后，重复所有基线测量。由牙周病医生进行全口检查，以确定他们的牙周炎症表面积（PISA）评分和其他牙齿参数。为评估心血管状况，通过EndoPAT™评估的反应性充血指数（RHI）来评估内皮功能，并测量了一些身体和生化参数。
本随访研究纳入了21例已确诊但未治疗的牙周炎患者和21例无牙周炎的参与者。牙周炎患者接受牙周治疗后，PISA显著降低。牙周炎患者治疗后RHI未显示出显著改善（-0.1±0.8，P = 0.524）。同样，其他次要心血管结局指标，如hsCRP、总胆固醇、高密度脂蛋白胆固醇、甘油三酯、糖化血红蛋白和收缩压，在牙周治疗后也未显著改善。对照组在1年随访后，RHI、其他心血管疾病参数和PISA均未显示出任何显著变化。
在这项基于实践的试点研究中，牙周治疗并未改善健康牙周炎成年患者的内皮功能。未来需要开展更大规模的研究，并可聚焦于合并症的牙周炎患者，以研究牙周治疗对内皮功能和其他心血管疾病参数是否具有二级预防作用。
