It is our central hypothesis that periodontal diseases, which are chronic Gramnegative infections, represent a previously unrecognized risk factor for atherosclerosis and thromboembolic events. Previous studies have demonstrated an association between periodontal disease severity and risk of coronary heart disease and stroke. We hypothesize that this association may be due to an underlying inflammatory response trait, which places an individual at high risk for developing both periodontal disease and atherosclerosis. We further suggest that periodontal disease, once established, provides a biological burden of endotoxin (lipopolysaccharide) and inflammatory cytokines (especially TxA2 , IL-1β, PGE2 , and TNF-α) which serve to initiate and exacerbate atherogenesis' and thromboembolic events. A cohort study was conducted using combined data from the Normative Aging Study and the Dental Longitudinal Study sponsored by the United States Department of Veterans Affairs. Mean bone loss scores and worst probing pocket depth scores per tooth were measured on 1,147 men during 1968 to 1971. Information gathered during follow-up examinations showed that 207 men developed coronary heart disease (CHD), 59 died of CHD, and 40 had strokes. Incidence odds ratios adjusted for established cardiovascular risk factors were 1.5, 1.9, and 2.8 for bone loss and total CHD, fatal CHD, and stroke, respectively. Levels of bone loss and cumulative incidence of total CHD and fatal CHD indicated a biologic gradient between severity of exposure and occurrence of disease. J Periodontol 1996;67:1123-1137.

Periodontal Disease and Cardiovascular Disease

Effects of infection and inflammation on lipid and lipoprotein metabolism: mechanisms and consequences to the host.

Background: Recent studies suggest that chronic infections including those associated with periodontitis increase the risk for coronary vascular disease (CVD) and stroke. We hypothesize that oral microorganisms including periodontal bacterial pathogens enter the blood stream during transient bacteremias where they may play a role in the development and progression of atherosclerosis leading to CVD. Methods: To test this hypothesis, 50 human specimens obtained during carotid endarterectomy were examined for the presence of Chlamydia pneumoniae, human cytomegalovirus, and bacterial 16S ribosomal RNA using specific oligonucleotide primers in polymerase chain reaction (PCR) assays. Approximately 100 ng of chromosomal DNA was extracted from each specimen and then amplified using standard conditions (30 cycles of 30 seconds at 95°C, 30 seconds at 55°C, and 30 seconds at 72°C). Bacterial 16S rDNA was amplified using 2 synthetic oligonucleotide primers specific for eubacteria. The PCR product generated with the e...

Identification of periodontal pathogens in atheromatous plaques.

Question Set 1. What are the important destructive mechanisms in periodontal diseases? 2. What are the important protective mechanisms in periodontal diseases? 3. What are the important genetic factors and what is the state-of-the art relative to assessing these genetic factors in periodontal diseases? 4. What do we know about the mechanism of action of possible risk factors, such as smoking and diabetes on the host? 5. What is the evidence that host modulating agents will be effective in prevention or treatment ofperiodontal diseases?

Periodontal diseases: pathogenesis.

Recently, it has been recognized that oral infection, especially periodontitis, may affect the course and pathogenesis of a number of systemic diseases, such as cardiovascular disease, bacterial pneumonia, diabetes mellitus, and low birth weight. The purpose of this review is to evaluate the current status of oral infections, especially periodontitis, as a causal factor for systemic diseases. Three mechanisms or pathways linking oral infections to secondary systemic effects have been proposed: (i) metastatic spread of infection from the oral cavity as a result of transient bacteremia, (ii) metastatic injury from the effects of circulating oral microbial toxins, and (iii) metastatic inflammation caused by immunological injury induced by oral microorganisms. Periodontitis as a major oral infection may affect the host9s susceptibility to systemic disease in three ways: by shared risk factors; subgingival biofilms acting as reservoirs of gram-negative bacteria; and the periodontium acting as a reservoir of inflammatory mediators. Proposed evidence and mechanisms of the above odontogenic systemic diseases are given.

/pdf/systemic-diseases-caused-by-oral-infection-50js6dl1a5.pdf

Systemic Diseases Caused by Oral Infection

OBJECTIVE--To investigate a reported association between dental disease and risk of coronary heart disease. SETTING--National sample of American adults who participated in a health examination survey in the early 1970s. DESIGN--Prospective cohort study in which participants underwent a standard dental examination at baseline and were followed up to 1987. Proportional hazards analysis was used to estimate relative risks adjusted for several covariates. MAIN OUTCOME MEASURES--Incidence of mortality or admission to hospital because of coronary heart disease; total mortality. RESULTS--Among all 9760 subjects included in the analysis those with periodontitis had a 25% increased risk of coronary heart disease relative to those with minimal periodontal disease. Poor oral hygiene, determined by the extent of dental debris and calculus, was also associated with an increased incidence of coronary heart disease. In men younger than 50 years at baseline periodontal disease was a stronger risk factor for coronary heart disease; men with periodontitis had a relative risk of 1.72. Both periodontal disease and poor oral hygiene showed stronger associations with total mortality than with coronary heart disease. CONCLUSION--Dental disease is associated with an increased risk of coronary heart disease, particularly in young men. Whether this is a causal association is unclear. Dental health may be a more general indicator of personal hygiene and possibly health care practices.

https://www.bmj.com/content/bmj/306/6879/688.full.pdf

Dental disease and risk of coronary heart disease and mortality.

In some studies recumbent anthropometric measures are more appropriate than standing measures. There is little published information, however, on the precision of recumbent measures. To estimate the interobserver precision of recumbent anthropometry, 22 men and 29 women volunteers 35-64 years of age were each measured on the same day by four trained nurses previously inexperienced in anthropometry. Fourteen recumbent measurements were taken, including abdominal sagittal diameter measured with a new type of caliper. The nurses also measured standing waist and hip girths. Various indicators of interobserver precision were estimated including the intraclass correlation coefficient (ICC). The ICC ranged from 98.5% for calf girth to 56.2% for the suprailiac skinfold in men, while it ranged from 95.8% for upper arm girth to 67.0% for the suprailiac skinfold in women. The abdominal sagittal diameter measurement had very high precision as estimated by the ICC in both men and women, 95.8% and 96.3%, respectively. Recumbent waist girth was, on average, only 0.3 cm larger than standing girth. In contrast, recumbent hip girth was 3.8 cm smaller than standing girth. These findings suggest that studies using recumbent anthropometry can achieve levels of precision similar to those obtained with standing anthropometry. For both sexes, however, the suprailiac skinfold appears to have much lower precision in the recumbent than in the standing position. In addition, prevalence estimates of abdominal obesity derived from the ratio of waist-to-hip girths will be higher in studies using recumbent anthropometry than in studies using standing anthropometry. © 1993 Wiley-Liss, Inc.

http://anthropology.emory.edu/home/documents/worthman-lab/journal_articles_2/1993WilliamsonRecumbentAnthropometry.pdf

Precision of recumbent anthropometry.

AIM: The purpose of this analysis was to estimate the magnitude of weight change required in the six-year period between 1994 and the Year 2000 if Americans are to reach the Healthy People 2000 goal for reduction of overweight among those ages 20-74 to no more than 20% among all adults and no more than 30% among black women. Prevention of weight gain among the non-overweight is compared with that of weight loss among the overweight as strategies for reaching this goal. DESIGN: Data from the First National Health and Nutrition Examination Survey (NHANES I) and the Nutrition Examination Survey Epidemiologic Follow-up Study (NHEFS) were used to estimate 6-year weight change of persons aged 20 to 72 at the Year 2000. Men, white women, and black women were examined in addition to the overall population. Given a baseline prevalence of 24.7%, overweight in the year 2000 was projected for three simulated interventions: no weight gain among non-overweight persons (prevention-only), weight loss among overweight persons (weight-loss-only), and prevention-plus-weight-loss. In addition, the Year 2000 overweight prevalence was projected under different baseline prevalence scenarios of 26% and 34%. OUTCOME MEASURE: Prevalence of overweight; overweight determined by body mass index (≥27.3 kg/m 2 for women and ≥27.8 kg/m 2 for men). RESULTS: Prevention-only was successful in reducing the overall prevalence of overweight from 24.7% to 20%. Weight-loss-only required a 5.3 kg weight loss to achieve the overall goal of 20% and 8.4 kg weight loss to achieve the goal within all three race-sex strata. Prevention-plus-weight-loss required only 3.8 kg of weight loss to achieve the goals within the three race-sex strata. Prevention-only was not successful in reducing the overall prevalence of overweight to 20% when the 26% and 34% baseline scenarios were used. Weight-loss-only required 6.3 and 11.2 kg; prevention-plus-weight-loss required 1.2 and 6.6 kg of weight loss using the 26% and 34% baselines, respectively. CONCLUSIONS: Prevention of weight gain among those who are not already overweight could achieve substantial changes in the prevalence of overweight, even in a 6-year time period. However, given the increasing trend in overweight, the Year 2000 goal for the reduction in prevalence of overweight will not be reached

Carl M. Russell

Papers

Dental disease and risk of coronary heart disease and mortality.

Precision of recumbent anthropometry.

Can the Year 2000 objective for reducing overweight in the United States be reached?: a simulation study of the required changes in body weight.

Can the Year 2000 Objective for Reducing Overweight in the United States be Reached?: A Simulation Study of the Required Changes in Body Weight