Annexure II proforma for registration of subjects for dissertation



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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION


1

Name of the candidate and address (In Block Letters)

DR. HARINI.K.

DEPARTMENT OF PERIODONTICS,

BANGALORE INSTITUTE OF DENTAL SCIENCES, 5/3, HOSUR MAIN ROAD, BANGALORE-560029.


2

Name of the Institution

BANGALORE INSTITUTE OF DENTAL SCIENCES AND HOSPITAL AND POST GRADUATE RESEARCH CENTRE, BANGALORE-560029.

3

Course of study and subject

MASTER OF DENTAL SURGERY(MDS),

PERIODONTICS.



4

Date of Admission

JUNE 2008

5

Title of the Topic

Evaluation of association between Periodontitis and Early Carotid Atherosclerosis – A Clinico – Biochemical study ”.


6

BRIEF RESUME OF THE INTENDED WORK:




    1. 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.

.





    1. 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 evident in infected mice, as demonstrated by serum IgG response to P. gingivalis and elevated levels of interleukin-6. P. gingivalis DNA was localized in the aortic tissue from a limited number of infected mice but not in any non-infected controls. Infected mice displayed enhanced vascular activation, as suggested by increased aortic expression of vascular cell adhesion molecule-1 and tissue factor .It was concluded that Oral infection with P. gingivalis accelerates early 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 accelerates early atherosclerosis. was calculated. The relationship between IMT and cIMA as dependent variables and periodontal disease, age, gender, body mass index, heredity for atherosclerosis, diabetes mellitus, hypertension, plasma cholesterol, smoking, and education as independent variables was evaluated in a multiple logistic regression model . Results showed that the mean values of IMT and cIMA were significantly higher 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 7 samples/subject) and quantitatively assessed for 11 known periodontal bacteria by DNA-DNA checkerboard hybridization. Extensive in-person cardiovascular risk factor measurements, a carotid scan with high-resolution B-mode ultrasound, white blood cell count, and C-reactive protein values were obtained .Results showed that overall periodontal bacterial burden was related to carotid IMT. This relationship was specific to causative bacterial burden and the dominance of etiologic bacteria in the observed microbiological niche .Data from this study provided an evidence of a direct relationship between 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

Thickness(IMT) .


  1. To compare the values in Lipid Profile and Body Mass Index (BMI) between

test group and control group.



7

MATERIAL AND METHODS




    1. Source of data:

Patients visiting the Department of Periodontics, Bangalore Institute of Dental Sciences and Hospital, Bangalore.




    1. Method of collection of data (including sampling procedures, if any)

Patients coming to the Department of Periodontics will be screened for Periodontal status by using following parameters :

1. Plaque Index by Sillness and Loe in 1964.

2. Bleeding Index by Muhlemann .H.R. and Son.S. in 1971.

3. Mean probing pocket depth.

4. Mean clinical attachment level.

After screening 50 patients will be selected for the study and segregated into

test group and control group consisting 25 patients in each .

Criteria for test group and control group will be as follows .

Test group – Generalized chronic Periodontitis.


        • With probing depth ≥ 5mm.

        • With clinical attachment loss .

Control group – Periodontally healthy individuals.

  • With probing depth < 3mm.

  • With no clinical attachment loss.

Both the groups will be subjected for ultrasonography for the assessment

of Carotid Intima-Media Thickness (IMT), Lipid Profile and Body Mass

Index(BMI) will be compared .








7.3 Inclusion Criteria:

1. Both male and female patients aged 18-50 years will be participating in the study.

2. Patients having BMI ranging between 25-30kg/ m2 .

3. Systemically healthy subjects.

4. Normal blood pressure.
7.4 Exclusion Criteria

1. Presence of systemic diseases .

2. A recent history or the presence of any other acute or chronic infection.

3. Pregnant or Lactating women .

4. Patients with history of any antibiotics therapy 3 months prior to study enrolled or any other regular medication.

5. Patients who under went periodontal therapy for last six months.

6. Smokers .

7. Patients under stress and intense physical activity .






    1. Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

Yes. Following investigations will be done:

  1. Carotid Intima-Media Thickness by ultrasonography.

  2. Lipid Profile.

3. Body Mass Index (BMI).




    1. Has ethical clearance been obtained from your institution in case of 7.5?

Yes

Ethical approval has been sought and obtained for the study from the institution.



8

LIST OF REFERENCES:





8.1 Journal References:




1. Cario F,Castellani S. Gori AM, Nieri M, Baidelli G , Abbate R, Pini- Prato GP



(2008) Severe Periodontitis In Young Adults is Associated With Sub – Clinical

Atherosclerosis . J Clin Periodontol 35, 465-472 .

2. James D.Beck, John R.Elter,Gerardo Heiss, David Couper, Sally M. Mauriello

and Steven Offenbacher (2001) Relationship of periodontal disease to Carotid

Artery Intima- Media Wall Thickness: The Atherosclerosis risk in Communities

(AIRC) study . Arterioscler. Thromb. Vasc. Biol 2 ,1816-1822.

3. Evanthia Lalla, Ira B.Lamster, Marion A.Hofmann, Loredana Bucciarelli,

Adrienne P. Jerud, Sid Tucker, Yan Lu, Panos N. Papapanou and Ann

Marie Schmidt (2003) Oral Infection With a Periodontal Pathogen Acclerates

Early Atherosclerosis in Apolipoprotein E- Null Mice. Arterioscler. Thromb.



Vasc. Biol 23 ,1405-1411.

4. Per-Osten Soder, Birgitta Soder, Jacek Nowak and Tomas Jogestrand (2005)

Early Carotid Atherosclerosis in Subjects With Periodontal Diseases . Stroke 36,

1195-1200.

5. Moise Desvarieux, Ryan T. Demmer, Tatjana Rundeck , Bernadette Boden–

Albala, David R.Jacobs,Jr, Ralph L. Sacco and Panos N.Papapanou (2005)

Periodontal Microbiota and Carotid Intima – Media Thickness; The Oral

Infections and Vascular disease Epidemiology Study (INVEST) .Circulation

111,576-582 .










S9

Signature of the candidate





10

Remarks of the Guide





11

Name and designation of

Guide (In Block Letters)







11.1 Guide:

DR APARNA RAHUL,

PROFESSOR AND HEAD,

DEPARTMENT OF PERIODONTICS,

BANGALORE INSTITUTE OF DENTAL SCIENCES AND HOSPITAL,

BANGALORE,560029





    1. Signature










    1. Co-guide










    1. Signature










    1. Head of the Department




DR APARNA RAHUL,

PROFESSOR AND HEAD,

DEPARTMENT OF PERIODONTICS,

BANGALORE INSTITUTE OF DENTAL SCIENCES AND HOSPITAL,



BANGALORE,560029




    1. Signature







12

    1. Remarks of Chairman and Principal










    1. Signature













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