The impact of non-surgical therapy of periodontal disease on surrogate markers for cardiovascular disease: A literature review
Periodontal medicine is a newly emerging field of periodontal research. It focuses on the correlation between chronic periodontitis, aggressive periodontitis, and several systemic conditions, such as cardiovascular disease, diabetes mellitus, preterm pregnancy, and obesity just to name a few. In a recent literature review published in August 2019 in the American Journal of Dentistry the authors evaluated the literature published on the effects of non-surgical periodontal treatment on surrogate markers of cardiovascular disease.1
Most of the studies included in this review examined the following markers: homocysteine, endothelial progenitor cells, IL-6, CRP, HDL/LDL cholesterol, endothelial dysfunction, and carotid intima media thickness (CIMT). Only one study included in the review evaluated homocysteine plasma levels. The results of that study found 12 weeks after non-surgical periodontal treatment homocysteine plasma levels decreased.
Two studies included in the review evaluated the levels of circulating endothelial progenitor cells. In one study they found endothelial progenitor cells were 2.3 times higher in patients with chronic periodontitis when compared to healthy controls. The second study also determined that moderate to severe chronic periodontitis is associated with increased levels of circulating endothelial progenitor cells.
Nine studies included in the review assessed IL-6 as a systemic marker. All nine studies indicated decreased levels of IL-6 serum levels after non-surgical periodontal treatment. This lower level was evaluated for up to 6 months, none of the studies evaluated results for longer than 6 months.
Eighteen studies included in the review evaluated CRP levels, several included LDL/HDL as a systemic marker in addition to CRP levels. In all the studies CRP levels were decreased following non-surgical periodontal treatment. Additionally, the studies that included LDL/HDL levels showed a significant reduction in LDL and an increase in HDL. These results indicate that non-surgical periodontal treatment might be considered an additional control of hyperlipidemia.
Only one study included in the review evaluated endothelial dysfunction as a systemic marker. This study evaluated endothelial-dependent dilation and endothelial-independent dilation (use of sublingual nitroglycerin). The study concluded that 6 weeks after non-surgical periodontal treatment endothelial-dependent dilation and endothelial-independent dilation significantly improved. Additionally, the authors note that there was evidence of endothelial impairment in patients with chronic periodontal disease even before there was evidence of atherosclerosis.
Eleven studies included in the review evaluated CIMT as a systemic marker. These studies all show that periodontal disease is a predictor for CIMT. Furthermore, non-surgical periodontal treatment promoted a reduction in CIMT in the initial phase of treatment.
This review showed a clear association between non-surgical periodontal treatment and the reduction of systemic markers that play an important role in angiogenesis and decreased levels of systemic inflammatory markers in the blood. Within the limits of the studies included in this review, there is clear evidence of the involvement of periodontal disease in the onset of cardiovascular disease.
In conclusion, the authors state, “within the limitations of the present review, it is possible to conclude that the initial phase of periodontal therapy has a positive impact on the short-term reduction of a series of systemic surrogate markers of CVD. This effect may be positive in controlling the levels of systemic inflammation. It is, however, in the opinion of the authors that the current scientific evidence is not conclusive with regard to the long-term effects of non-surgical periodontal therapy on the surrogate markers of AVD.”
Does this evidence give you hope that we will see more studies linking oral and systemic health? We have been aware of the correlation for years; however, we have not seen clear causation would you like to see studies that show a causal factor in regard to the oral-systemic link? Do you have a hypothesis for the mechanism of action that links periodontal disease and CVD?
- D’Isidoro O, Perrotti V, Hui WL, Piattelli A, Iaculli F, Quaranta A. The impact of non-surgical therapy of periodontal disease on surrogate markers for cardiovascular disease: A literature review. Am J Dent. 2019;32(4):191-200.
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