Periodontal Infection and Endothelial Dysfunction

Universidad del Valle, Colombia102 enrolled

Overview

The purpose of this study is to determine the effect of periodontal therapy on endothelial function and other biomarkers of cardiovascular disease

Periodontitis is one of the most prevalent chronic diseases and a frequent cause of tooth loss. Accumulation of subgingival dental biofilm in susceptible individuals is associated with an inflammatory host response characterized by the production of Matrix Metalloproteinases, reduction in collagen synthesis, increase in cytokine gene expression, and apoptosis of gingival fibroblasts. Finally, inflammation leads to destruction of periodontal ligament, alveolar bone resorption, and chronic periodontitis. Periodontitis is associated with increased serum levels of inflammatory cytokines and acute phase reactants. Multiple case-control and cohort studies have suggested that periodontitis is an independent risk factor for cardiovascular events, diabetic end-organ damage, pregnancy complications and respiratory diseases. Recent interventional studies have found that periodontal therapy could increase endothelium-dependent brachial artery flow-mediated dilation. The purpose of this controlled clinical trial is to determine the effect of periodontal therapy on endothelial function in subjects with moderate to severe chronic periodontitis. Furthermore, the relationship between putative periodontal pathogens and endothelial function will be also evaluated.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

BASIC_SCIENCE

Masking

DOUBLE

Enrollment

102

Conditions

Periodontitis

Interventions

One-Stage Full-Mouth DisinfectionPROCEDURE

* Scaling and root planing, four quadrants in one session * Tongue brushing with a 1% chlorhexidine gel (1 minute) * Mouth rinsing with a 0.2% chlorhexidine solution for (2 minutes) * Subgingival chlorhexidine (1%) irrigation in all pockets * Twice daily rinsing with clorhexidine (1 minute) during fourteen days after the periodontal intervention * Basic oral hygiene instructions * Dental extractions will be performed at the end of patient followup (only in cases of teeth that could not be saved)

Periodontal carePROCEDURE

* Basic oral hygiene instructions * Supragingival plaque removal

Eligibility

Sex: ALLMin age: 25 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Subjects must be 25 years of age or older * Three or more periodontal pockets with a probing depth (PD) \> 5mm * Have at least 20 natural teeth * Provide informed consent and willingness to cooperate with the study protocol Exclusion Criteria: * History of antibiotic use in the previous three months * Pregnant or lactating females * Treatment with antihypertensive, antilipemic, antiarrhythmic, and other cardiovascular drugs * Systemic diseases such as diabetes, HIV/AIDS, liver disease, chronic renal failure, tuberculosis, and autoimmune diseases * Previous history of cardiovascular disease: Acute myocardial infarct, stable angina, unstable angina, heart failure, atrial fibrillation, atrioventricular block, peripheral vascular disease, cerebrovascular accident * Patients who received periodontal treatment within the last 3 months * Patients who require antibiotic prophylaxis before examination or treatment * Patients with mental retardation and dementia

Locations (2)

Red de Salud de Ladera E.S.E. Servicio de Odontología

Cali, Valle del Cauca Department, Colombia

Universidad del Valle, Facultad de Salud, Escuela de Odontología

Cali, Valle del Cauca Department, Colombia

Outcomes

Primary Outcomes

Brachial Artery Flow-mediated Dilation

All the assessments of vascular function were performed in the morning, in a temperature controlled room, with participants required to fast for at least 8 hours. Flow-mediated, endothelium dependent vasodilatation of the brachial artery (FMD) was measured using the technique described by Celermajer et al. using the guidelines reported by Coretti et al. FMD was calculated as the percentage of change in the diameter of brachial artery measured 45-60 s after cuff release in relation to the baseline measure (FMD%).