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TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS

TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS. UCLA School of Dentistry. Presents. Dr. E. Barrie Kenney Professor & Chairman Section of Periodontics. Periodontal Disease as a Predictor of Atherosclerosis. E. Barrie Kenney B.D.Sc., D.D.S., M.S., F.R.A.C.D.S.

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TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS

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  1. TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS

  2. UCLA School of Dentistry

  3. Presents Dr. E. Barrie KenneyProfessor & ChairmanSection of Periodontics

  4. Periodontal Disease as a Predictor of Atherosclerosis E. Barrie Kenney B.D.Sc., D.D.S., M.S., F.R.A.C.D.S. Tarrson Family Endowed Chair in Periodontics. Professor and Chairman Division of Associated Clinical Specialties UCLA School of Dentistry

  5. CoronaryArtery Disease

  6. Epidemiological connection between coronary artery disease and periodontal disease

  7. 6.9 Million people have coronary heart disease in USA

  8. Atherosclerosis Leading Cause of Death in USA

  9. Coronary Artery Disease (C.A.D) kills 500,000 people a year. One of every 4.6 deaths due to C.A.D

  10. Periodontal Disease in the United States • 54% of U.S. population 13 years and older has gingival bleeding on probing • In adults an average 19.6% of teeth have periodontal attachment loss of 3mm or more • Based on data from NHANES III survey 1988-19994

  11. Association between dental health and acute myocardial infarction Matilla KJ et al Brit. Med. J. 1989 298: 774

  12. Used index based on caries, periodontal disease, periapical lesions, pericoronitis. Patients admitted for acute myocardial infarction had higher scores than matched controls.

  13. Patients above the upper quartile had twice the risk of acute myocardialinfarction than did thosewith a score of zero.

  14. This was comparable to risk of cigarette smoking, hypercholesterolemia and hypertension.

  15. Dental Disease and Risk of Coronary Heart Disease and Mortality De Stefano F et al Brit. Med. J. 1993, 306: 688

  16. Analyzed data from National Health and Nutrition examination study I. 1971 – 1974. 20,249 subjects aged 25 to 74 followed up in 1982 – 1985 (only 55 years and older at entry) and 1986 – 1987.

  17. Excluded subjects with history of heart disease stroke or cancer.Not all subjects were evaluated for smoking so had a subset with known history of smoking (1163 subjects)

  18. Admitted for Coronary Artery Disease or died of Coronary Artery Disease as indicators of disease

  19. Dental evaluation at baseline • Number of carious teeth • Periodontal status healthy, gingivitis periodontitis no teethoral hygiene index 6 teeth 0-3 for debris0-3 for calculus combined to give OHI.Also periodontal index 0 to 8 for each tooth and average for each patient.

  20. Percentage of subjects death from CHD 2.6 4.1 8.4 11.9 admission for CHD 6.5 7.4 14.4 19.2 No No Disease Gingivitis Periodontitis Tooth De stefano

  21. ODDS Ratios Risk Women Men Factors 25-49 Mortality 25-49 No disease 1.00 1.00 1.00 1.00 Gingivitis 1.05 0.98 1.23 1.42 Periodontitis 1.25 1.72 1.46 2.12 No teeth 1.23 1.71 1.46 2.60 Periodontal index 1.04 1.09 1.09 1.11 Oral hygiene index 1.12 1.11 1.15 1.23 adjusted for age, sex education, poverty level, marital status, blood pressure, cholesterol, diabetes, weight, physical activity, alcohol, smoking De Stefano

  22. Analysis of these with data on smoking showed the same pattern.

  23. No association between active caries and CHD

  24. Periodontal Disease and Coronary Heart Disease Risk Hujoel P.P., et al J.A.M.A. 2000, 284:1406

  25. Used NHANES population 8032 dentate adults aged 25 to 74 years with no history of cardiovascular disease. 1859 had periodontitis, 2421 had gingivitis, 3752 healthy. Russel index used. Subjects with prior history of cardiovascular disease eliminated.

  26. At follow up 1265 subjects had at least 1 coronary heart disease event, either death, hospitalization or coronary revascularization therapy.

  27. Periodontal Disease and Myocardial Disease have common risk factors, age, smoking, stress, social economics status, body fat, and so potential for confounding is substantial.

  28. Periodontitis Gingivitis Healthy Diabetes 5.2% 2.7% 2.0% Alcohol glass per day 0.81 0.73 0.55 Pack years smoking 15.9 10.4 8.8 Total cholesterol 222.1 215.4 212.74 Age 52.4 43.0 42.0 Male 50.4% 38.4% 30.5% White 70.2% 77.5% 88.7% African American 28.0% 21.1% 10.4% Education years 9.6 11.1 12.4 Hujoel et al.

  29. Hazard RatiosCompared to Healthy Unadjusted Adjusted for Confounders periodontitis 2.66 1.14 gingivitis 1.20 1.05

  30. “While this study did provide convincing evidence regarding the absence of a moderate to large association between periodontitis and CHD, a small causal association could not be ruled out.”

  31. Oral Health and Systemic Disease: Periodontitis and Cardiovascular Disease Beck J.D. Offenbacher S. J. Dent. Edu. 1998, 62:859

  32. Odds ratio with more or less sites p.d > 3mm CHD Fatal Stroke CHD 3·1 2·8 1·9 1147 Male Veterans from Boston Beck

  33. Number of sites with 20%or more bone loss ODDS Ratio for CHD 1-2 0.8 3-5 1.4 6-10 1.9 11-20 2.1 • Beck et al

  34. Periodontal Disease and prevalent Coronary Heart Disease in the ARIC study Beck J.D et al J. Dent. Res. 2000. 79. abst. #2269

  35. ODDS Ratio for C.H.D. per cent sites with attachment loss 3mm or more Males Females 0 – 6.4 1.0 1.0 6.5 – 15.1 1.7 0.7 15.2 – 31.0 1.5 0.8 31.1 – 100 1.7 0.9

  36. Atherosclerosis Risk in Communities study 13.6% of males 5.5% of females had coronary heart disease

  37. Investigation of the Association Between Angiographically Defined Coronary Artery Disease and Periodontal Disease Matthaner, S. S. et al. J. Periodontol 73:1169 2002

  38. 100 patients 53 with coronary artery disease (50% stenosis of at least one vessel) 47 no coronary artery disease (less than 50% stenosis in all arteries 53 CAD +ve 83% male average 65.3 years 47 CAD -ve 40.4% male average 60.8 years All non diabetics, non smokers for at least 5 years CAD +ve 66% former smokers 15.8 pack years CAD -ve 24.4% former smokers 4.5 pack years Matthaner,

  39. CAD +ve CAD -ve Sites with CAL>6mm 6.85 3.32 Radiographic bone loss 3.60mm 3.18mm Mean probing depth 2.67mm 2.59mm Tooth loss 8.9 9.1 When corrected for age previous smoking history Odds ratio 1.06 Mean CAL Odds ratio 1.03 CAL>6mm Odds ratio 1.31 Radiographic bone loss Odds ratio 2.54 Mean probing depth These patients had minimal periodontal disease so CAL may be recession or pocket related Matthaner,

  40. Ratio of Cigarette Smoking in the Association Between Periodontal Disease and Coronary Heart Disease Hyman, J. J. et al. J. Periodontol 73:988 2002

  41. 5285 Subjects from NHANES 1988-94,40 years or older Loss of Attachment Odds ratio for heart attack history 2.00 - 2.99mm 2.64 3.00-3.99mm 3.84 4mm or more 5.87 Hyman,

  42. Oral Health and Peripheral Arterial Disease • Hung, H.C. et al • Circulation 2003:107:1152 • 45,136 male health workers free of cardiovascular disease followed for 12 years. • 342 cases of peripheral arterial disease. • Patient repords and diagnosis or treatment of claudication of leg arteries. • Self report of periodontal disease

  43. Odds RatioPeripheral Cardiovascular DiseaseAnd • Periodontal Disease 1.41 • Tooth Loss 1.39 • Periodontal Disease & Tooth Loss 1.88 • No Periodontal Disease and Tooth Loss 0.92Controlled for traditional risk factors for cardiovascular disease. Hung, H.C. et al

  44. Severity of Periodontal Disease and number of remaining teeth are related to the prevalence of Infarction and Myocardial Hypertension in a study based on 4254 subjects. Holmlund. A. et al J. Periodontol 2006 77: 1173

  45. Odds Ratio Periodontal bone lossAnd Myocardial Infarction • Periodontal Disease 2.69 • Smoking 0.69 • Gender 0.62 • Age 1.09 Controlled for traditional risk factors for cardiovascular disease.Aged 40 to 60 years old.

  46. TREATMENT OF PERIODONTITIS AND ENDOTHELIAL FUNCTION. TONETTI M S et al NEJMED.356:911, 2007 59 PATIENTS SEVERE PERIODONTITIS GOT PROPHY TYPE CARE 61 GOT ROOT PLANING +ARESTIN AND EXTRACTION HOPELESS TEETH MEASURED BRACHIAL ARTERY FLOW BEFORE AT 1, 7, 30, 60, 180 DAYS AFTER • AT 1 DAY INTENSIVE GROUP LOWER VESSEL DILATION THAN PROPHY GROUP AT 60 , 180 DAYS INTENSIVE GREATER DILATION THANPROPHY ENDOTHELIAL FUNCTION IMPROVEMENTS CORRELATED WITH PERIODONTAL TREATMENT SUCCESS

  47. CORRELATIONS BETWEEN CLINICAL MEASUREMENTS OF PERIODONTAL DISEASE AND PRESENCE OF BACTERIAL ANTIGENS IN HUMAN ATHEROSCLEROSIS. PUCAR A KENNEY EB etal 2007 36 patients got vascular surgery for atheroma 10 ext carotid 3 aorta 5 femoral or iliac 18 coronary P.C. R on vessels and dental plaque forP.gingivalis P,intermedia, Aa .T.forsythensis,C. pneumoniae. C.M.V

  48. 10 ARTERIES --VE, 14 +VE FOR 1 PERIO BACTERIA. 10 +VE FOR 2, 2+VE FOR3 20 HAD C.M.V 10 HAD CHLAMYDIA POSITIVE CORRELATION BETWEEN POCKETS 6MM. OR GREATER AND PRESENCE OF P. gingivalis AND P.intermedia. C.M.V AND CHLAMYDIA NEGATIVE CORRELATION WITH PERIODONTAL INDEX

  49. Coronary Artery DiseaseIn Women

  50. Lipid managementand control of othercoronary risk factors inpost menopausal women J. Women’s Health and Gender related Med. 9:235,2000

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