Original Article

Beneficial Effects of Periodontal Treatment on Metabolic Control of Hypercholesterolemia

Authors: S. Gul Oz, MD, Ozlem Fentoglu, DDS, Alpaslan Kilicarslan, MD, Gulay Sain Guven, MD, Mine Durusu Tanrover MD, Yasar Aykac, DDS, Tumay Sozen, MD

Abstract

Background: The authors aimed to evaluate whether local periodontal therapy may influence plasma lipid levels in patients with periodontitis.


Methods: Fifty patients (31 females and 19 males, age 36-66 yr) were randomly assigned to the treatment and control groups. Lipid profile and dental variables were measured at baseline and at the end of the study in both groups.


Results: In the third month, there was a significant decrease in total and low density lipoprotein (LDL) cholesterol levels of the treatment group compared with baseline values. Also, the reduction in bleeding on probing, pocket depth, attachment loss, plaque index and gingival index were statistically significant in the treatment group.


Conclusions: The present study indicates that periodontitis causes changes in total and LDL cholesterol levels and local periodontal treatment resulted in a significant decrease in these markers. These results suggest a potential effect of periodontitis-driven systemic inflammation on lipid metabolism.


Key Points


* Periodontitis is a chronic, inflammatory, destructive disease which is often associated with enhanced concentrations of proatherogenic plasma lipids.


* Patients with periodontitis have an increased risk of cardiovascular disease.


* Local periodontal treatment resulted in a significant decrease in total and LDL cholesterol levels.

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References

1. Göran KH. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005;352:1685–1695.
 
2. Danesh J, Collins R, Peto R. Chronic infection and coronary heart disease: is there a link? Lancet 1997;350:430–436.
 
3. Alvarez C, Ramos A. Lipids, lipoproteins, and apoproteins in serum during infection. Clin Chem 1986;32:142–145.
 
4. Prabu A, Michalowicz BS, Mathur A. Detection of local and systemic cytocines in adult periodontitis. J Periodontol 1996;67:515–522.
 
5. Lösche W, Marshal GJ, Apatzidou DA, et al. Lipoprotein-associated phospholipase A2 and plasma lipids in patients with destructive periodontal disease. J Clin Periodontol 2005;32:640–644.
 
6. Cutler CW, Shinedling EA, Nunn M, et al. Association between periodontitis and hiperlipidemia: cause or effect? J Periodontol 1999;70:1429–1434.
 
7. Danesh J, Collins R, Appleby P, et al. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA 1998;279:1477–1482.
 
8. Haraszthy VI, Zambon JJ, Trevisan M, et al. Identification of periodontal pathogens in atheromatous plaques. J Periodontol 2000;71:1554–1560.
 
9. Loos BG, Craandijk J, Hoek FJ, et al. Elevation of systemic markers related to cardiovascular diseases in the peripheral blood of periodontitis patients. J Periodontol 2000;71:1528–1534.
 
10. Noack B, Jachmann I, Roscher S, et al. Metabolic diseases and their possible link to risk indicators of periodontitis. J Periodontol 2000;71:898–903.
 
11. Lösche W, Karapetow F, Pohl A, et al. Plasma lipids and blood glucose levels in patients with destructive periodontal disease. J Clin Periodontol 2000;27:537–541.
 
12. Noack B, Genco RJ, Trevisan M, et al. Periodontal infections contribute to elevated systemic C-reactive protein level. J Periodontol 2001;72:1221–1227.
 
13. Katz J, Flugelman MY, Goldberg A, et al. Association between periodontal pockets and elevated cholesterol and low density lipoprotein cholesterol levels. J Periodontol 2002;73:494–500.
 
14. Craig RG, Yip JK, So MK, et al. Relationship of destructive periodontal disease to the acute-phase response. J Periodontol 2003;74:1007–1016.
 
15. Mattila KJ, Valle MS, Nieminen MS, et al. Dental infections and coronary atherosclerosis. Atherosclerosis 1993;103:205–211.
 
16. Beck J, Garcia R, Heiss G, et al. Periodontal disease and cardiovascular disease. J Periodontol 1996;67(Suppl 10):1123–1137.
 
17. Iacopino AM, Cutler CW. Pathophysiological relationships between periodontitis and systemic disease: recent concepts involving serum lipids. J Periodontol 2000;71:1375–1384.
 
18. Kinane DF. Periodontal diseases’ contributions to cardiovascular disease: an overview of potential mechanisms. Ann Periodontol 1998;3:127–141.
 
19. Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997;349:1436–1442.
 
20. Ross R. Atherosclerosis: an inflammatory disease. N Engl J Med 1999;340:115–126.
 
21. Grover SA, Dorais M, Coupal L. Improving the prediction of cardiovascular risk: interaction between LDL and HDL cholesterol. Epidemiology 2003;14:315–320.
 
22. Kannel WB, Wilson PW. Efficacy of lipid profiles in prediction of coronary disease. Am Heart J 1992;124:768–774.
 
23. Leinonen M, Saikku P. Evidence for infectious agents in cardiovascular disease and atherosclerosis. Lancet Infect Dis 2002;2:11–17.
 
24. Epstein SE, Zhou YF, Zhu J. Infection and atherosclerosis: emerging mechanistic paradigms.Circulation 1999;100:e20–e28.
 
25. Katz J, Chaushu G, Sharabi Y. On the association between hypercholesterolemia, cardiovascular disease and severe periodontal disease. J Clin Periodontol 2001;28:865–868.
 
26. Cutler CW, Iacopino AM. Periodontal disease: links with serum lipid/triglyceride levels? Review and new data. J Int Acad Periodontol 2003;5:47–51.
 
27. Wu T, Trevisan M, Genco RJ, et al. Examination of the relation between periodontal health status and cardiovascular risk factors: serum total and high density lipoprotein cholesterol, C-reactive protein, and plasma fibrinogen. Am J Epidemiol 2000;151:273–282.
 
28. De Stefano F, Anda RF, Kahn HS, et al. Dental disease and risk of coronary heart disease and mortality. Br Med J 1993;306:688–691.
 
29. Janket S, Baird A, Chuang S, et al. Heart of the matter/a response letter to the article by Hujoel Petal Examining the link between coronary heart disease and the elimination of chronic dental infections. J Am Dent Assoc 2001;132:1648–1650.
 
30. Mattila KJ, Asikainen S, Wolf J, et al. Age, dental infections, and coronary heart disease. J Dent Res 2000;79:756–760.
 
31. Pussinen PJ, Jauhiainen M, Vilkuna-Rautiainen T, et al. Periodontitis decreases the antiatherogenic potency of high density lipoprotein. J Lipid Res 2004;45:139–147.
 
32. Beck JD, Offenbacher S, Williams R, et al. Periodontitis: a risk factor for coronary heart disease? Ann Periodontol 1998;3:127–141.
 
33. Valtonen VV. Infection as a risk factor for infarction and atherosclerosis. Ann Med 1991;23:539–543.
 
34. Fried SK, Zechner R. Cachetin tumor necrosis factor decreases human adipose tissue lipoprotein lipase mRNA levels, synthesis and activity. J Lipid Res 1989;30:1917–1923.
 
35. Lanza-Jacoby S, Tabares A. Triglyceride kinetics, tissue lipoprotein lipase, and liver lipogenesis in septic rats. Am J Physiol 1990;258:678–685.
 
36. Feingold KR, Staprans I, Memon RA. Endotoxin rapidly induces changes in lipid metabolism that produce hypertriglyceridemia: low doses stimulate hepatic triglyceride production and inhibit clearance.J Lipid Res 1992;33:1765–1776.
 
37. Uchiumi D, Kobayashi M, Tachikawa T, et al. Subcutaneous and continuous administration of lipopolysaccharide increases serum levels of triglyceride and monocyte chemoattractant protein-1 in rats. J Periodontal Res 2004;39:120–128.
 
38. Pussinen PJ, Vilkuna-Rautiainen T, Alfthan G, et al. Severe periodontitis enhances macrophage activation via increased serum lipopolysaccharide. Arterioscler Thromb Vasc Biol 2004;24:2174–2180.
 
39. Meurman JH, Sanz M, Janket SJ. Oral health, atherosclerosis, and cardiovascular disease. Crit Rev Oral Biol Med 2004;15:403–413.
 
40. Feil PH, Grauer JS, Gadbury-Amyot CC, et al. Intentional use of the Hawthorne effect to improve oral hygiene compliance in orthodontic patients. J Dent Edu 2002;66:1129–1135.
 
41. D’aiuto F, Nibali L, Parkar M, et al. Short-term effects of intensive periodontal therapy on serum inflammatory markers and cholesterol. J Dent Res 2005;84:269–273.
 
42. D’Aiuto F, Parkar M, Nibali L, et al. Periodontal infections cause changes in traditional and novel cardiovascular risk factors: results from a randomized controlled clinical trial. Am Heart J 2006;151:977–984.