TODENTJ-25-03-2019_TODENTJ-13-15 1553507712 Bentham Open doi@benthamopen.net Bentham Open The Open Dentistry Journal TODENTJ 1874-2106 1 31 2019 13 1 Amir Moeintaghavi Hamid Reza Arab Masoud Amiri Moghaddam Reza Shahmohammadi Bahareh Yalood Bardan Zahra Soroush Background: Cardiovascular disease has been associated with multiple risk factors such as dyslipidemia. However, the focus has recently shifted towards some novel risk factors i.e. infection from periodontitis. Given this background, we aimed to assess the effect of periodontal therapy on some CVD risk factors including Total Cholesterol (TC), Low-Density Lipoprotein(LDL), High-Density Lipoprotein(HDL), Triglycerides(TG) and C-Reactive Protein (CRP). Fasting Blood Sugar (FBS) level has also been measured. Methods: Thirty patients (12 male and 18 female) who had severe periodontitis were tested for different blood parameters; namely Total Cholesterol (TC), Low-Density Lipoprotein (LDL), High-Density Lipoprotein(HDL), Triglycerides (TGs), C-Reactive Protein (CRP) and Fasting Blood Sugar (FBS). Enzymatic colorimetric methods were applied to measure all the parameters’ values except for CRP. The first stage of periodontal treatment comprised oral hygiene instruction as well as scaling and root planing. After 1 month, at the next stage, open flap debridement surgery was performed on all 4 quadrants of the mouth. The blood parameters were reassessed and compared with the baseline values after 3 months. Two patients (female) failed to participate in the follow-ups. The Pearson's and Spearman's correlation coefficients were calculated to determine whether changes in laboratory variables are associated with age and average probing depth or not. Results: All the assessed parameters related to 28 patients showed mean reduction which proved to be significant for CRP (p=0.011) and cholesterol (p=0.035). Among all parameters, only CRP level was found to have a significant positive correlation with pocket depth. Other blood parameters' relationship with age and probing depth proved to be insignificant. Conclusion: Considering the results, periodontal treatment may significantly lower lipid profile serum levels and some inflammatory factors. 1 31 2019 15 21 TODENTJ-13-15 1 10.2174/crossmark_policy opendentistryjournal.com benthamopen.com true Peer Reviewed Single blind Checked with iThenticate 2018-07-28 2018-11-23 2018-12-11 2019-1-31 https://creativecommons.org/licenses/by/4.0/legalcode 10.2174/1874210601913010015 1553507712 https://opendentistryjournal.com/VOLUME/13/PAGE/15/ https://opendentistryjournal.com/contents/volumes/V13/TODENTJ-13-15/TODENTJ-13-15.pdf https://opendentistryjournal.com/contents/volumes/V13/TODENTJ-13-15/TODENTJ-13-15.pdf https://opendentistryjournal.com/contents/volumes/V13/TODENTJ-13-15/TODENTJ-13-15.pdf https://opendentistryjournal.com/contents/volumes/V13/TODENTJ-13-15/TODENTJ-13-15.pdf https://opendentistryjournal.com/contents/volumes/V13/TODENTJ-13-15/TODENTJ-13-15.pdf https://opendentistryjournal.com/contents/volumes/V13/TODENTJ-13-15/TODENTJ-13-15.pdf https://opendentistryjournal.com/contents/volumes/V13/TODENTJ-13-15/TODENTJ-13-15.pdf https://opendentistryjournal.com/contents/volumes/V13/TODENTJ-13-15/TODENTJ-13-15.xml PLoS One Velsko I.M. 9 e97811 2014 10.1371/journal.pone.0097811 Velsko IM, Chukkapalli SS, Rivera MF, et al. Active invasion of oral and aortic tissues by Porphyromonas gingivalis in mice causally links periodontitis and atherosclerosis. PLoS One 2014; 9 (5) : e97811. Exp. Clin. Cardiol. Kalofoutis C. 12 17 2007 Kalofoutis C, Piperi C, Kalofoutis A, Harris F, Phoenix D, Singh J. Type II diabetes mellitus and cardiovascular risk factors: Current therapeutic approaches. Exp Clin Cardiol 2007; 12 (1) : 17-28. Acta Chir. Belg. Corrado E. 105 567 2005 10.1080/00015458.2005.11679782 Corrado E, Novo S. Role of inflammation and infection in vascular disease. Acta Chir Belg 2005; 105 (6) : 567-79. Circulation Pearson T.A. 107 499 2003 10.1161/01.CIR.0000052939.59093.45 Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: Application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107 (3) : 499-511. J. Clin. Periodontol. Reyes L. 40 S30 2013 10.1111/jcpe.12079 Reyes L, Herrera D, Kozarov E, Roldán S, Progulske-Fox A. Periodontal bacterial invasion and infection: Contribution to atherosclerotic pathology. J Clin Periodontol 2013; 40 (Suppl. 14) : S30-50. Circulation Stewart R. 133 549 2016 Stewart R, West M. Increasing evidence for an association between periodontitis and cardiovascular disease. Circulation 2016; 133 (6) : 549-51. Lancet Pihlstrom B.L. 366 1809 2005 10.1016/S0140-6736(05)67728-8 Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet 2005; 366 (9499) : 1809-20. J. Clin. Periodontol. Chapple I.L.C. 40 S106 2013 10.1111/jcpe.12077 Chapple ILC, Genco R. Diabetes and periodontal diseases: Consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Clin Periodontol 2013; 40 (Suppl. 14) : S106-12. J. Clin. Periodontol. Socransky S.S. 25 134 1998 10.1111/j.1600-051X.1998.tb02419.x Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent RL Jr. Microbial complexes in subgingival plaque. J Clin Periodontol 1998; 25 (2) : 134-44. Expert Rev. Mol. Med. Yucel-Lindberg T. 15 e7 2013 10.1017/erm.2013.8 Yucel-Lindberg T, Båge T. Inflammatory mediators in the pathogenesis of periodontitis. Expert Rev Mol Med 2013; 15 : e7. Mol. Oral Microbiol. Hajishengallis G. 27 409 2012 10.1111/j.2041-1014.2012.00663.x Hajishengallis G, Lamont RJ. Beyond the red complex and into more complexity: The Polymicrobial Synergy and Dysbiosis (PSD) model of periodontal disease etiology. Mol Oral Microbiol 2012; 27 (6) : 409-19. Eur. J. Dent. Campisciano G. 11 126 2017 10.4103/ejd.ejd_309_16 Campisciano G, Toschetti A, Comar M, Taranto RD, Berton F, Stacchi C. Shifts of subgingival bacterial population after nonsurgical and pharmacological therapy of localized aggressive periodontitis, followed for 1 year by Ion Torrent PGM platform. Eur J Dent 2017; 11 (1) : 126-9. Clin. Oral Investig. Isola G. 22 791 2018 10.1007/s00784-017-2154-7 Isola G, Matarese G, Williams RC, et al. The effects of a desiccant agent in the treatment of chronic periodontitis: A randomized, controlled clinical trial. Clin Oral Investig 2018; 22 (2) : 791-800. Photomed. Laser Surg. Matarese G. 35 702 2017 10.1089/pho.2017.4288 Matarese G, Ramaglia L, Cicciù M, Cordasco G, Isola G. The effects of diode laser therapy as an adjunct to scaling and root planing in the treatment of aggressive periodontitis: A 1-Year randomized controlled clinical trial. Photomed Laser Surg 2017; 35 (12) : 702-9. J. Contemp. Dent. Pract. Moeintaghavi A. 6 78 2005 Moeintaghavi A, Haerian-Ardakani A, Talebi-Ardakani M, Tabatabaie I. Hyperlipidemia in patients with periodontitis. J Contemp Dent Pract 2005; 6 (3) : 78-85. Periodontol. 2000 Cullinan M.P. 62 271 2013 10.1111/prd.12007 Cullinan MP, Seymour GJ. Periodontal disease and systemic illness: Will the evidence ever be enough? Periodontol 2000 2013; 62 (1) : 271-86. Int. J. Cardiol. Fernandes C.P. 174 710 2014 10.1016/j.ijcard.2014.04.201 Fernandes CP, Oliveira FAF, Silva PG, et al. Molecular analysis of oral bacteria in dental biofilm and atherosclerotic plaques of patients with vascular disease. Int J Cardiol 2014; 174 (3) : 710-2. J. Periodontol. Haraszthy V.I. 71 1554 2000 10.1902/jop.2000.71.10.1554 Haraszthy VI, Zambon JJ, Trevisan M, Zeid M, Genco RJ. Identification of periodontal pathogens in atheromatous plaques. J Periodontol 2000; 71 (10) : 1554-60. Am. Heart J. Chiu B. 138 S534 1999 10.1016/S0002-8703(99)70294-2 Chiu B. Multiple infections in carotid atherosclerotic plaques. Am Heart J 1999; 138 (5 Pt 2) : S534-6. J. Clin. Periodontol. Lee J-B. 40 437 2013 10.1111/jcpe.12095 Lee J-B, Yi H-Y, Bae K-H. The association between periodontitis and dyslipidemia based on the Fourth Korea National Health and Nutrition Examination Survey. J Clin Periodontol 2013; 40 (5) : 437-42. J. Clin. Periodontol. Saxlin T. 35 1040 2008 10.1111/j.1600-051X.2008.01331.x Saxlin T, Suominen-Taipale L, Kattainen A, Marniemi J, Knuuttila M, Ylöstalo P. Association between serum lipid levels and periodontal infection. J Clin Periodontol 2008; 35 (12) : 1040-7. J. Dent. Res. D’Aiuto F. 83 156 2004 10.1177/154405910408300214 D’Aiuto F, Parkar M, Andreou G, et al. Periodontitis and systemic inflammation: Control of the local infection is associated with a reduction in serum inflammatory markers. J Dent Res 2004; 83 (2) : 156-60. Evid. Based Dent. Henschel M. 16 17 2015 10.1038/sj.ebd.6401079 Henschel M, Keenan AV. Insufficient evidence of effect of periodontal treatment on prevention or management of cardiovascular disease. Evid Based Dent 2015; 16 (1) : 17-8. J. Clin. Periodontol. D’Aiuto F. 40 S85 2013 10.1111/jcpe.12061 D’Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Clin Periodontol 2013; 40 (Suppl. 14) : S85-S105. J. Clin. Periodontol. Paraskevas S. 35 277 2008 10.1111/j.1600-051X.2007.01173.x Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol 2008; 35 (4) : 277-90. PLoS One Demmer R.T. 8 e77441 2013 10.1371/journal.pone.0077441 Demmer RT, Trinquart L, Zuk A, et al. The influence of anti-infective periodontal treatment on C-reactive protein: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2013; 8 (10) : e77441. J. Periodontal Res. Yamazaki K. 40 53 2005 10.1111/j.1600-0765.2004.00772.x Yamazaki K, Honda T, Oda T, et al. Effect of periodontal treatment on the C-reactive protein and proinflammatory cytokine levels in Japanese periodontitis patients. J Periodontal Res 2005; 40 (1) : 53-8. J. Clin. Diagn. Res. Gupta B. 9 ZC01 2015 Gupta B, Sawhney A, Patil N, et al. Effect of surgical periodontal therapy on serum C-reactive protein levels using ELISA in both chronic and aggressive periodontitis patient. J Clin Diagn Res 2015; 9 (10) : ZC01-5. J. Periodontal Res. D’Aiuto F. 39 236 2004 10.1111/j.1600-0765.2004.00731.x D’Aiuto F, Ready D, Tonetti MS. Periodontal disease and C-reactive protein-associated cardiovascular risk. J Periodontal Res 2004; 39 (4) : 236-41. J. Periodontol. Ioannidou E. 77 1635 2006 10.1902/jop.2006.050443 Ioannidou E, Malekzadeh T, Dongari-Bagtzoglou A. Effect of periodontal treatment on serum C-reactive protein levels: A systematic review and meta-analysis. J Periodontol 2006; 77 (10) : 1635-42. J. Clin. Periodontol. Katz J. 28 865 2001 10.1034/j.1600-051x.2001.028009865.x Katz J, Chaushu G, Sharabi Y. On the association between hypercholesterolemia, cardiovascular disease and severe periodontal disease. J Clin Periodontol 2001; 28 (9) : 865-8. J. Periodontol. Katz J. 73 494 2002 10.1902/jop.2002.73.5.494 Katz J, Flugelman MY, Goldberg A, Heft M. Association between periodontal pockets and elevated cholesterol and low density lipoprotein cholesterol levels. J Periodontol 2002; 73 (5) : 494-500. Iran. Red Crescent Med. J. Golpasand Hagh L. 16 e6577 2014 10.5812/ircmj.6577 Golpasand Hagh L, Zakavi F, Hajizadeh F, Saleki M. The association between hyperlipidemia and periodontal infection. Iran Red Crescent Med J 2014; 16 (12) : e6577. Clin. Oral Investig. Fu Y-W. 20 1263 2016 10.1007/s00784-015-1621-2 Fu Y-W, Li X-X, Xu H-Z, Gong Y-Q, Yang Y. Effects of periodontal therapy on serum lipid profile and proinflammatory cytokines in patients with hyperlipidemia: A randomized controlled trial. Clin Oral Investig 2016; 20 (6) : 1263-9. J. Clin. Periodontol. Lösche W. 32 640 2005 10.1111/j.1600-051X.2005.00725.x Lösche W, Marshal GJ, Apatzidou DA, Krause S, Kocher T, Kinane DF. Lipoprotein-associated phospholipase A2 and plasma lipids in patients with destructive periodontal disease. J Clin Periodontol 2005; 32 (6) : 640-4. J. Clin. Periodontol. Teeuw W.J. 41 70 2014 10.1111/jcpe.12171 Teeuw WJ, Slot DE, Susanto H, et al. Treatment of periodontitis improves the atherosclerotic profile: A systematic review and meta-analysis. J Clin Periodontol 2014; 41 (1) : 70-9. J. Clin. Periodontol. D’Aiuto F. 40 S85 2013 10.1111/jcpe.12061 D’Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Clin Periodontol 2013; 40 (Suppl. 14) : S85-S105. Indian J Med Specialities Tendon S.D.M. 1 19 2010 Tendon SDM, Lamba AK, Verma M, Munjal A, Faraz F. Effect of periodontal therapy on serum lipid levels. Indian J Med Specialities 2010; 1 : 19-25. J. Indian Soc. Periodontol. Kumar N. 20 324 2016 Kumar N, Bhardwaj A, Negi PC, Jhingta PK, Sharma D, Bhardwaj VK. Association of chronic periodontitis with metabolic syndrome: A cross-sectional study. J Indian Soc Periodontol 2016; 20 (3) : 324-9. Medicine (Baltimore) Hong J.W. 95 e3226 2016 10.1097/MD.0000000000003226 Hong JW, Noh JH, Kim D-J. The prevalence and associated factors of periodontitis according to fasting plasma glucose in the korean adults: The 2012-2013 Korea National Health and Nutrition Examination Survey. Medicine (Baltimore) 2016; 95 (14) : e3226. Indian J. Dent. Res. Anitha V. 26 500 2015 10.4103/0970-9290.172048 Anitha V, Nair S, Shivakumar V, Shanmugam M, Priya BM, Rajesh P. Estimation of high sensitivity C-reactive protein in patients with periodontal disease and without coronary artery disease. Indian J Dent Res 2015; 26 (5) : 500-3. Clin. Oral Investig. de Souza A.B. 21 477 2017 10.1007/s00784-016-1817-0 de Souza AB, Okawa RT, Silva CO, Araújo MG. Short-term changes on C-Reactive Protein (CRP) levels after non-surgical periodontal treatment in systemically healthy individuals. Clin Oral Investig 2017; 21 (1) : 477-84. Ital. Heart J. de Maat M.P. 2 189 2001 de Maat MP, Kluft C. Determinants of C-reactive protein concentration in blood. Ital Heart J 2001; 2 (3) : 189-95.