BANGALORE INSTITUTE OF DENTAL SCIENCES AND HOSPITAL AND POST GRADUATE RESEARCH CENTRE, BANGALORE-560029.
Course of study and subject
MASTER OF DENTAL SURGERY(MDS),
Date of Admission
Title of the Topic
“Evaluation of association between Periodontitis and Early Carotid Atherosclerosis – A Clinico – Biochemical study ”.
BRIEF RESUME OF THE INTENDED WORK:
Need for the study:
Periodontitis is a chronic infection by Gram –negative bacteria that affects the supporting structures of the teeth . A mechanism has been proposed whereby periodontitis creates a burden of bacterial pathogens, antigens, endotoxins, and inflammatory cytokines that contribute to the process of atherogenesis and thromboembolic events. This Atherogenesis and thromboembolic events precipitate myocardial infarction or stroke.
With this background, the purpose of the present study is to evaluate the association between periodontitis and early carotid atherosclerosis in systemically healthy individuals1.
Review of literature:
A clinical study determined whether periodontitis is associated with carotid artery intima- media wall thickness (IMT) in 6017patients aged 52 to75years . Clinical examination included B –mode ultrasound of the carotid arteries to determine the wall thickness and atherosclerotic lesions, anthropometery including waist –to- hip ratio, blood pressure, cognitive function , ECG, clinical chemistries, plasma lipids, medications , health questionnaires and oral examination for assessing probing depth and clinical attachment loss . Result showed mean IMT for severe periodontitis remained significantly higher than for no periodontitis 2.
An animal study assessed the impact of oral inoculation with the periodontal pathogen Porphyromonas gingivalis on the atherogenesis in 50 hypercholesterolemic apolipoprotein E- null mice. Generalized activation of host inflammatory responses was evidentin infected mice, as demonstrated by serum IgG response to P.gingivalis and elevated levels of interleukin-6. P. gingivalisDNA was localized in the aortic tissue from a limited numberof infected mice but not in any non-infected controls. Infectedmice displayed enhanced vascular activation, as suggested byincreased aortic expression of vascular cell adhesion molecule-1and tissue factor .It was concluded that Oral infection with P. gingivalis acceleratesearly atherosclerosis3 .
A clinical study evaluated the involvement of periodontal disease in the development of early atherosclerotic vascular lesions in 82 patients. Common carotid artery intima-media thickness(IMT) and lumen diameter were measured and intima-media area(cIMA) Oral infection with P gingivalis acceleratesearly atherosclerosis. was calculated. The relationship between IMT and cIMAas dependent variables and periodontal disease, age, gender,body mass index, heredity for atherosclerosis, diabetes mellitus,hypertension, plasma cholesterol, smoking, and education asindependent variables was evaluated in a multiple logistic regressionmodel . Results showed that the mean values of IMT and cIMA were significantlyhigher in patients with periodontal disease than in controls4 .
An epidemiological study investigated the relationship between periodontal microbiota and subclinical atherosclerosis in 1056 patients aged 69± 9 years. Among these subjects,4561 subgingival plaque samples were collected (average of 7samples/subject) and quantitatively assessed for 11 known periodontalbacteria by DNA-DNA checkerboard hybridization. Extensive in-personcardiovascular risk factor measurements, a carotid scan withhigh-resolution B-mode ultrasound, white blood cell count, andC-reactive protein values were obtained .Results showed that overall periodontal bacterial burden was relatedto carotid IMT. This relationship was specific to causativebacterial burden and the dominance of etiologic bacteria inthe observed microbiological niche .Data from this study provided an evidence of a direct relationshipbetween periodontal microbiology and subclinical atherosclerosis 5 . A clinical study evaluated the association between severe periodontitis and sub-clinical atherosclerosis in young (≤40 years) systemically healthy individuals. Patients and controls were paired for age, gender, body mass index and smoking habits. Carotid intima-media thickness (IMT) was bilaterally assessed by ultrasonography at the level of common carotid artery. Traditional cardiovascular risk factors for atherosclerosis were also evaluated . Results have shown that severe periodontitis is associated with sub-clinical atherosclerosis in young systemically healthy patients1.
Objectives of the study:
1. To evaluate the association of periodontitis with Carotid Intima- Media
To compare the values in Lipid Profile and Body Mass Index (BMI) between