In recent years that has been increasing interest in the associations between periodontal disease and a range of systematic diseases.  Towards the end of last year a joint workshop organized by the European Federation of Periodontology (EFP) and the American Academy of Periodontology (AAP) took place in Spain.  The full papers from that meeting are available form the Journal of Periodontology and the Journal of Clinical Periodontology.  The associations between cardiovascular disease and periodontal disease were one of areas that were discussed.

This new review aimed to study the robustness of observations that treatment of periodontitis improves the atherosclerotic profile.

The Medline-PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and Embase databases were searched for randomised controlled trials (RCTs) or controlled clinical trials (CCTs) conducted in humans that compared periodontal treatment with no periodontal treatment where the outcome variables were cardiovascular disease (CVD) clinical parameters or risk markers.  Titles were independently screened and data abstracted by two reviewers Study quality was assessed.  Where appropriate meta-analyses were performed.

• 20 publications reporting 25 trials (involving 1748 patients) were included.
• Seven trials enrolled periodontitis patients that were otherwise healthy, 18 trials recruited periodontal patients with various co-morbidities, such as CVD or diabetes.
• None of the trials used hard clinical endpoints of CVD only bio-markers of atherosclerotic disease.
• Meta-analyses demonstrated significant WMD for:-
  • hsCRP (-0.50mg/L, 95%CI:-0.78;-0.22),
  • IL-6 (-0.48ng/L, 95%CI:-0.90;-0.06),
  • TNF-α (-0.75pg/mL, 95%CI:-1.34;-0.17),
  • fibrinogen (-0.47g/L, 95%CI:-0.76;-0.17),
  • Total cholesterol (-0.11mmol/L, 95%CI:-0.21;-0.01), and
  • HDL-C (0.04mmol/L, 95%CI:0.03;0.06) favouring periodontal intervention.

The authors concluded

This systematic review and meta-analyses demonstrate that periodontal treatment improves endothelial function and reduces biomarkers of atherosclerotic disease, especially in those already suffering from CVD and/or diabetes.

Comment

The multifactorial nature of both cardiovascular disease and periodontal disease present challenges to those investigating links between the two diseases.  The studies to date have also used risk markers rather than hard clinical outcomes such as angina, or myocardial infarction and some of these markers themselves have been questioned in terms of their ability to predict CVD.   Tonetti & Van Dyke in their consensus report from the periodontitis and atherosclerotic cardiovascular disease working group at the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases concluded:-

  (i) there is consistent and strong epidemiologic evidence that periodontitis imparts increased risk for future cardiovascular disease; and (ii) 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.

Links

Teeuw WJ, Slot DE, Susanto H, Gerdes VE, Abbas F, D’Aiuto F, Kastelein JJ, Loos BG. Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis. J Clin Periodontol. 2013 Sep 30. doi: 10.1111/jcpe.12171. [Epub ahead of print] PubMed PMID: 24111886.

Periodontitis and Systemic Diseases – Proceedings of a workshop jointly held by the European Federation of Periodontology and American Academy of Periodontology

Tonetti MS, VanDyke TE and on behalf of working group 1 of the joint EFP/AAP workshop and. Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Clin Periodontol 40 (suppl. 14): S24–S29. doi: 10.1111/jcpe.12089