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Oral Health Research Periodontics

Periodontitis and atherosclerotic cardiovascular disease: what does the consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases say?

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This is the summary of the report issued by the Joint European Federation of Periodontology and the American Academy of Periodontology Workshop on Periodontitis and Systemic Diseases: Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases (April 2013) 

Context

This consensus report is concerned with the association between periodontitis and atherosclerotic cardiovascular disease (ACVD). Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth-supporting apparatus leading to tooth loss; as such, it is a major public health issue.

Periodontitis leads to entry of bacteria in the blood stream. The bacteria activate the host inflammatory response by multiple mechanisms. The host immune response favors atheroma formation, maturation, and exacerbation.

In longitudinal studies assessing incident cardiovascular events, statistically significant excess risk for ACVD was reported in individuals with periodontitis. This was independent of established cardiovascular risk factors. The amount of the adjusted excess risk varies by type of cardiovascular outcome and across populations by age and gender. Given the high prevalence of periodontitis, even low to moderate excess risk is important from a public health perspective.

Key Messages

  • There is moderate evidence that periodontal treatment:
    • Reduces systemic inflammation as evidenced by reduction in C-reactive protein (CRP) and improvement of both clinical and surrogate measures of endothelial function. However, there is no effect on lipid profiles–supporting specificity.
    • Limited evidence shows improvements in coagulation, biomarkers of endothelial cell activation, arterial blood pressure and subclinical atherosclerosis after periodontal therapy.
    • The available evidence is consistent and speaks for a contributory role of periodontitis to ACVD.
    • There are no periodontal intervention studies on primary ACVD prevention and there is only one feasibility study on secondary ACVD prevention.
  • There is consistent and strong epidemiologic evidence that periodontitis imparts increased risk for future cardiovascular disease.
  • While in vitro, animal and clinical studies do support the interaction and biological mechanism, intervention trials to date are not adequate to draw further conclusions.
  • Well-designed intervention trials on the impact of periodontal treatment on prevention of ACVD hard clinical outcomes are needed.

 

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1 Comment

  1. JCDA Oasis October 18, 2013

    On behalf of Anonymous:

    The following was titled American Heart Association Scientific Statement.

    UPDATED May 15, 2012. Despite popular belief, gum disease hasn’t been proven to cause atherosclerotic heart disease or stroke, and treating gum disease hasn’t been proven to prevent heart disease or stroke, according to a new scientific statement published in Circulation, an American Heart Association journal.

    Statements that imply a cause-and-effect relationship between periodontal disease and cardiovascular disease, or claim that dental treatment may prevent heart attack or stroke are “unwarranted” at this time, the statement authors said.

    The American Dental Association Council on Scientific Affairs agrees with the conclusions of this report and the World Heart Federation endorsed the statement.

    Reply

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