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Impact of Gum Infection on Heart Disease

2014-08-27 03:54:00 | BioPortfolio

Summary

The purpose of this study is to determine the effect of gum infection on parameters of cardio-vascular disease.

Description

Epidemiological studies indicate that individuals with severe periodontal disease have significantly increased risk for cardiovascular disease. Periodontal disease, a chronic bacterial infection of the gums, is associated with recurrent bacteremia and a state of systemic inflammation that may convert endothelial cells to a pro-atherogenic phenotype with increased expression of inflammatory factors and loss of the anti-thrombotic, growth inhibitory, and vasodilator properties of the endothelium, including a decrease in the biological activity of nitric oxide. In human subjects, endothelial dysfunction has evolved into a well-accepted indicator of early atherosclerosis and predictor of increased cardiovascular disease risk. We have recently demonstrated a strong association between severe periodontal disease and endothelial vasomotor dysfunction in a case control study of otherwise healthy human subjects. In that study, periodontal disease was also associated with higher plasma levels of the acute phase reactant C-reactive protein (CRP). These results support the hypothesis that severe periodontal disease induces a state of systemic inflammation that impairs endothelial function, however, the cross-sectional design leaves open the possibility that confounding factors explain the results. We now propose to determine whether effective treatment of periodontal disease improves endothelial function (Aim 1) and reduces inflammation (Aim 2) in a randomized intervention study. Patients will receive comprehensive periodontal treatment designed to produce a state of periodontal health (scaling and root planing and periodontal surgery with re-treatment as needed) or routine oral hygiene and will be followed for 24 weeks. The study will examine endothelium-dependent brachial artery flow-mediated dilation, systemic markers of inflammation and endothelial activation (CRP, IL-6, myeloperoxidase, and ICAM-1), and oral markers of periodontitis (PGE2, myeloperoxidase, and pathogen DNA) before and after treatment. Compared to oral hygiene (which will stabilize, but not reverse periodontal disease), we hypothesize that comprehensive treatment of periodontal disease will improve endothelium-dependent dilation and reduce local and systemic inflammation. Further, we suggest that the degree of improvement in endothelial function will relate to the degree of reduction in specific markers of inflammation. Such results would provide much stronger evidence for causal links between periodontal disease, systemic inflammation, and endothelial dysfunction, a recognized surrogate for cardiovascular risk. The proposed studies will provide new insights into how periodontal disease contributes to cardiovascular disease risk in human subjects and may lead to new approaches to therapy.

Study Design

Allocation: Randomized, Control: Placebo Control, Endpoint Classification: Efficacy Study, Intervention Model: Factorial Assignment, Masking: Single Blind (Investigator), Primary Purpose: Treatment

Conditions

Cardiovascular Disease

Intervention

Periodontal therapy

Location

Boston University Medical Campus
Boston
Massachusetts
United States
02118

Status

Recruiting

Source

Boston University

Results (where available)

View Results

Links

Published on BioPortfolio: 2014-08-27T03:54:00-0400

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PubMed Articles [25330 Associated PubMed Articles listed on BioPortfolio]

Associations between self-reported periodontal disease, assessed using a very short questionnaire, cardiovascular disease events and all-cause mortality in a contemporary multi-ethnic population: The Multi-Ethnic Study of Atherosclerosis (MESA).

Periodontal disease (PD) is believed to be associated with cardiovascular disease (CVD) events. Nevertheless, the additive prognostic value of PD for the prediction of CVD events beyond traditional ri...

Periodontal treatment limits platelet activation in patients with periodontitis - a controlled-randomized intervention trial.

Periodontitis results in platelet activation and enhanced risk for cardiovascular disease. As it is currently unknown if periodontal treatment reverses platelet hyper-reactivity we aimed to investigat...

Periodontal therapy and endothelial function in coronary artery disease: a randomized controlled trial.

To assess the effects of periodontal treatment on endothelial function in patients with coronary artery disease.

Validity of self-reported periodontal measures, demographic characteristics and systemic medical conditions.

The objective of the present study was to assess self-reported periodontal screening questions, demographic characteristics, systemic medical conditions and tobacco use for predicting periodontal dise...

The prediction of therapy-benefit for individual cardiovascular disease prevention: rationale, implications, and implementation.

We aim to outline the importance and the clinical implications of using predicted individual therapy-benefit in making patient-centered treatment decisions in cardiovascular disease (CVD) prevention. ...

Medical and Biotech [MESH] Definitions

Any restorative and replacement device that is used as a therapeutic aid in the treatment of periodontal disease. It is an adjunct to other forms of periodontal therapy and does not cure periodontal disease by itself. (Boucher's Clinical Dental Terminology, 3d ed)

Loss or destruction of periodontal tissue caused by periodontitis or other destructive periodontal diseases or by injury during instrumentation. Attachment refers to the periodontal ligament which attaches to the alveolar bone. It has been hypothesized that treatment of the underlying periodontal disease and the seeding of periodontal ligament cells enable the creating of new attachment.

The co-occurrence of pregnancy and a cardiovascular disease. The disease may precede or follow FERTILIZATION and it may or may not have a deleterious effect on the pregnant woman or FETUS.

A numerical rating scale for classifying the periodontal status of a person or population with a single figure which takes into consideration prevalence as well as severity of the condition. It is based upon probe measurement of periodontal pockets and on gingival tissue status.

Restoration of functions to the maximum degree possible in a person or persons suffering from a CARDIOVASCULAR DISEASE. It also includes cardiac conditioning and SECONDARY PREVENTION in patients with elevated cardiovascular risk profile.

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