Does Oral Hygiene Trigger Carotid Artery Intima-Media Thickness?
Background and Purpose: The aim of this study was to evaluate whether poor oral hygiene is associated with the intima-media thickness of the carotid arteries, which is one of the predictors of future progression of subclinical atherosclerosis.
Methods: We selected 108 patients during periodontal examinations according to their oral hygiene. The patients had no history of atherosclerotic disease. The results of carotid artery B-mode ultrasonography examinations were analyzed at baseline and after a mean of 7.8 months. Patients were scored on the DMFT index for the number of decayed (D), missing (M), and filled (F) teeth (T). We also used the Silness-Loe plaque index (SLI) to evaluate oral hygiene and dental plaque. The patients were divided into 2 groups according to DMFT and SLI criteria. Group I had a DMFT index of 0 to 3 and an SLI score of 0 or 1; group II had a DMFT index of 4 to 28 and an SLI score of 2 or 3.
Results: Dental status and oral hygiene were significantly associated with carotid artery intima-media thickness. Patients with increasing DMFT and SLI indices were correlated with intima-media thickness of the carotid artery.
Conclusions: Chronic poor oral hygiene and tooth loss are related to subclinical atherosclerotic changes in the carotid arteries and might be indicative of future progression of atherosclerosis.
Bartels S, Franco AR, Rundek T, et al. 2012. Carotid intima-media thickness and plaque from risk assessment and clinical use to genetic discoveries. Perspect Med 1:139-45.nBeck JD, Eke P, Heiss G, et al. 2005. Periodontal disease and coronary heart disease: a reappraisal of the exposure. Circulation 112:19-24.nBeck JD, Pankow J, Tyroler HA, et al. 1999. Dental infections and atherosclerosis. Am Heart J 138:528-33.nBlum A, Kryuger K, Eizenberg MM, et al. 2007. Periodontal care may improve endothelial function. Eur J Intern Med 18:295-8.nCotti E, Dessi C, Piras A, Mercuro G. 2011. Can a chronic dental infection be considered a cause of cardiovascular disease? A review of the literature. Int J Cardiol 148:4-10.nDesvarieux M, Demmer RT, Rundek T, et al. 2003. Relationship between periodontal disease, tooth loss, and carotid artery plaque: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). Stroke 34:2120-5.nDesvarieux M, Demmer RT, Rundek T, et al. 2005. Periodontal microbiota and carotid intima-media thickness: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). Circulation 111:576-82.nDesvarieux M, Schwahn C, Völzke H, et al. 2004. Gender differences in the relationship between periodontal disease, tooth loss, and atherosclerosis. Stroke 35:2029-35.nEbersole JL, Machen RL, Steffen MJ, Willmann DE. 1997. Systemic acute phase reactants, C reactive protein and haptoglobin, in adult periodontitis. Clin Exp Immunol 107:347-52.nElter JR, Hinderliter AL, Offenbacher S, et al. 2006. The effects of periodontal therapy on vascular endothelial function: a pilot trial. Am Heart J 151:47.nHoke M, Schillinger T, Mlekusch W, Wagner O, Minar E, Schillinger M. 2011. The impact of dental disease on mortality in patients with asymptomatic carotid atherosclerosis. Swiss Med Wkly 141:w13236.nKiechl S, Egger G, Mayr M, et al. 2001. Chronic infections and the risk of carotid atherosclerosis: prospective analysis from a large population study. Circulation 103:1064-70.nLorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. 2007. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 115:459-67.nNiessner A, Sato K, Chaikof EL, Colmegna I, Goronzy JJ, Weyand CM. 2006. Pathogen-sensing plasmacytoid dendritic cells stimulate cytotoxic T-cell function in the atherosclerotic plaque through interferon-alpha. Circulation 114:2482-9.nPessoa L, Galvão V, Santos L. 2011. Periodontal disease as a risk factor for cardiovascular disease: suggestion of a further link in systemic lupus erythematosus. Med Hypotheses 77:286-9.nSabeti S, Exner M, Mlekusch W, et al. 2005. Prognostic impact of fibrinogen in carotid atherosclerosis: unspecific indicator of inflammation or independent predictor of disease progression. Stroke 36:1400-4.nSanz M, D'Aiuto F, Deanfield J, Fernandez-Avile F. 2010. European workshop in periodontal health and cardiovascular disease scientific evidence on the association between periodontal and cardiovascular diseases: a review of the literature. Eur Heart J 12(suppl):B3-12.nSaremi A, Nelson RG, Tulloch-Reid M, et al. 2005. Periodontal disease and mortality in type 2 diabetes. Diabetes Care 28:27-32.nSchillinger M, Exner M, Mlekusch W, et al. 2005. Inflammation and Carotid Artery Risk for Atherosclerosis Study (ICARAS). Circulation 111:2203-9.nSchillinger T, Kluger W, Exner M, et al. 2006. Dental and periodontal status and risk for progression of carotid atherosclerosis: the Inflammation and Carotid Artery Risk for Atherosclerosis Study dental substudy. Stroke 37:2271-6.nSoutherland JH, Moss K, Taylor GW, et al. 2012. Poor oral hygiene and diabetes associations with measures of atherosclerosis and CHD. Atherosclerosis 22:196-201.nTonetti MS, D'Aiuto F, Nibali L, et al. 2007. Treatment of poor oral hygiene and endothelial function. N Engl J Med 356:911-20.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).