Journal of Occupational
Health and Epidemiology
Rafsanjan university Of medical sciences
Volume 5, Issue 3 (Summer 2016)
J Occup Health Epidemiol 2016, 5(3): 129-134 |
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Bateni E, Rabiei A, Sabzikari N, Ghanbarzadegan A. Comparison of periodontal parameters among cardiovascular patients and healthy controls. J Occup Health Epidemiol 2016; 5 (3) :129-134
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1- Dept. of Periodontology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
2- General Dentist, Rafsanjan, Iran.
3- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran.
4- Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; Dentistry Student, Clinical Research Development Center, Ali ebn Abitaleb Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ,Arash.Ghanbarzadegan@yahoo.com
2- General Dentist, Rafsanjan, Iran.
3- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran.
4- Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; Dentistry Student, Clinical Research Development Center, Ali ebn Abitaleb Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran ,
Article history
Received: 2015/11/13
Accepted: 2016/02/12
ePublished: 2016/09/28
Accepted: 2016/02/12
ePublished: 2016/09/28
Keywords: Cardiovascular Diseases [MeSH], Periodontal Indices [MeSH], Risk Factors [MeSH], Periodontitis [MeSH], Cardiac Disease [MeSH]
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Table 1: Comparison of quantitative variables among the target group and control group
Table 2: Comparison of distribution of qualitative variables in the two study groups
Table 3: Association of quantitative variables associated in patients with CVD
Discussion
The aim of this study was to evaluate periodontal status in patients with CVD and compare them with healthy individuals.
In recent decades, some studies have been done on the relationship between systemic and periodontal diseases (23). Some of these studies were done specifically on the relationship between cardiac and periodontal diseases and reporting a significant correlation between them (4, 24-26).
Although it is believed that controlling the periodontal inflammatory conditions has a positive effect on the health of patients with CVD, there are not enough evidences to show that cardiac disease can increase the risk of periodontal problems (18, 19).
Like other studies (27-29) we found that patients with CVD had worse periodontal status than control group. In other words, PI, CAL and tooth loss in these patients were more than control group. Average PI was significantly higher in the patient group. It may be due to poor oral hygiene in these patients in comparison with the healthy individuals.
Unlike other studies, difference in BOP between the two groups was not significant. This contradiction may be due to the differences in the population of different studies (30).
Also in patients with CVD, there was a significant relation between CAL, systolic and diastolic blood pressure and BOP index.
We also found a significant positive association between plaque index, height, weight, BMI and BPI. So that, as these indicators were more, PI was also higher.
Unlike previous studies (30, 31), number of tooth lost was significantly higher in the patient group. This finding most likely reflects different lifestyle and poor oral hygiene in the patient group. PPD in the patient group was significantly higher than control group.
Conclusion
According to our findings it seems that PI, CAL, PPD and tooth loss are higher in the patients with CVD in comparison with healthy subjects. So it can be concluded that overall periodontal status is worsen in patients with CVD. In addition, a better oral health instruction for patients with CVD is necessary. It is suggested to have more systematic reviews on articles to cover the different research gaps.
Acknowledgement
We should thank all the participants in this study. The authors did not have any conflict of interest. This study was under the funds of Rafsanjan University of Medical Sciences.
The results were presented at 15th international congress of Iranian Academy of Periodontology.
Conflict of interests: None declared.
Full-Text: (1280 Views)
Introduction
Periodontitis is one of the most common infectious diseases that can cause progressive destruction of periodontal ligaments and alveolar bone. Gingivitis is an inflammatory condition limited to gingival tissues. These two diseases are mostly caused by toxic products of subgingival plaque. Also the host response to bacterial plaque and its products could be destructive too (1, 2).
Many epidemiological studies have found statistically meaningful association between established periodontitis and cardiovascular disease (CVD) (3-5).
There are some theories justifying the relationship between periodontal diseases and CVD (6-8). Some of these theories rely on common risk factors of these two types of diseases (9), while others point to direct systemic effects of periodontal diseases (10-12).
Although, several studies in other countries have claimed relationship between CVD and periodontal diseases (13-16), American Heart Association (AHA) claims that periodontal disease is associated with atherosclerosis but further concludes that there is no evidence for such relation, possibly due to several research gaps (17). Other comprehensive researches show an association between periodontitis and CVD, but they also say more research should be conducted to make better evidences (18, 19), and also not enough studies have succeeded to show that CVD may increase the risk of periodontal complications (20). Effects of smoking, high blood pressure and high amount of blood lipids on CVD have been proved. But, these factors do not show all epidemiologic and clinical symptoms of CVD (5, 21).
The present study was performed to evaluate periodontal status in patients who suffer from CVD in comparison with healthy individuals. Relationship between periodontal status of patients with CVD and their body mass index (BMI), blood cholesterol levels and blood pressure were determined.
Moreover, indices including clinical attachment loss, probing pocket depth, plaque index and number of lost teeth were assessed in each individual.
Materials and Methods
In this descriptive cross-sectional study, the target group comprised of 50 patients with CVD who referred to Ali-ibn Abi Talib hospital of Rafsanjan, Iran, and their CVD was confirmed by one particular cardiologist. Our control group also consisted of 50 healthy volunteers with no systemic diseases or any other medical conditions who referred to oral and maxillofacial medicine department of Rafsanjan Dental School.
Individuals were excluded from study if they had any recent (in the last 3 months) history of using antibiotics (such as tetracycline), drugs with gingival enlargement effects (cyclosporine, phenytoin and Ca2+ channel blockers), anti-inflammatory or anti-epileptic drugs. Other exclusion criteria were any known history of systemic diseases (except CVD), pregnancy, any history of periodontal treatment in last 6 months, any need to antibiotic prophylaxis and having less than 15 teeth totally.
This study was approved by Ethics Committee of Rafsanjan University of Medical Sciences. Patients were informed about the research protocol and after getting written informed consent, they underwent comprehensive clinical examinations including determination of plaque index (PI), bleeding point index (BPI), clinical attachment loss (CAL) and periodontal pocket depth (PPD).
These evaluations were performed by a trained dentistry student. Determination of dental plaque was done on the basis of Sillness and Loe method (22), in four line angels of each tooth (mesiobuccal, mesiolingual, distobuccal and distolingual). This index was determined as a percentage: (points with plaque/number of teeth × 4) ×100.
CAL was measured from Cemento enamel junction (CEJ) to the bottom of gingival pocket using a calibrated coded Williams periodontal probe No. 14 (Delab, Treffurt, Germany).
Pocket depth was calculated for two quadrants (one maxillary, one mandibular) in 6 random points (mesiobuccal, midbuccal, distobuccal, mesiolingual, midlingual and distolingual) from gingival margin to the bottom of pocket. Periodontal probes were used with gentle pressure during all examinations.
Bleeding on probing was observed and recorded by touching sulcus wall or periodontal pocket in the 6 points mentioned above (22). This index was also reported as a percentage (number of bleeding points/number of teeth × 4) × 100.
BMI was determined for each participant (kg/m2). Cholesterol level (mg/dl) and blood pressure (mmHg) of each participant were measured by their test sheet and by an experienced cardiology department nurse.
Statistical analyses were performed using SPSS (version 21.0, IBM Corporation, Armonk, NY, USA). Results were reported as “mean ± standard deviation” for quantitative variables and as “percentage” for qualitative variants. Independent two-sample Student’s t-test was used in analyzing and comparing the periodontal parameters between patients and healthy participants, and between men and women.
Chi-square test was used to compare qualitative parameters between evaluated groups. Associations between periodontal parameters and qualitative variables in cardiac patients were evaluated using the Spearman rank order correlation coefficient. The significance level of the test (P-value) was considered 0.05.
Results
This study consisted of a target group with CVD (27 men, 23 women and group mean age of 54.5 ± 9.71 years), and a control group of healthy individual (18 men, 32 women and group mean age of 51.5 ± 10.4 years).
There were no significant differences in education and socioeconomic levels and the number of smokers between the two groups. Other comparison of quantitative variables among the target group and control group is shown in table 1.
Bleeding point index between two groups was similar. Apart from BPI, there were significant differences in other parameters among the two groups (table 1). Mean cholesterol reported by patients test sheets was 182.1 ± 35 for men, and 199.2 ± 8.22 for women, and this item did not have any significant difference between the two gender (P = 0.152).
Periodontitis is one of the most common infectious diseases that can cause progressive destruction of periodontal ligaments and alveolar bone. Gingivitis is an inflammatory condition limited to gingival tissues. These two diseases are mostly caused by toxic products of subgingival plaque. Also the host response to bacterial plaque and its products could be destructive too (1, 2).
Many epidemiological studies have found statistically meaningful association between established periodontitis and cardiovascular disease (CVD) (3-5).
There are some theories justifying the relationship between periodontal diseases and CVD (6-8). Some of these theories rely on common risk factors of these two types of diseases (9), while others point to direct systemic effects of periodontal diseases (10-12).
Although, several studies in other countries have claimed relationship between CVD and periodontal diseases (13-16), American Heart Association (AHA) claims that periodontal disease is associated with atherosclerosis but further concludes that there is no evidence for such relation, possibly due to several research gaps (17). Other comprehensive researches show an association between periodontitis and CVD, but they also say more research should be conducted to make better evidences (18, 19), and also not enough studies have succeeded to show that CVD may increase the risk of periodontal complications (20). Effects of smoking, high blood pressure and high amount of blood lipids on CVD have been proved. But, these factors do not show all epidemiologic and clinical symptoms of CVD (5, 21).
The present study was performed to evaluate periodontal status in patients who suffer from CVD in comparison with healthy individuals. Relationship between periodontal status of patients with CVD and their body mass index (BMI), blood cholesterol levels and blood pressure were determined.
Moreover, indices including clinical attachment loss, probing pocket depth, plaque index and number of lost teeth were assessed in each individual.
Materials and Methods
In this descriptive cross-sectional study, the target group comprised of 50 patients with CVD who referred to Ali-ibn Abi Talib hospital of Rafsanjan, Iran, and their CVD was confirmed by one particular cardiologist. Our control group also consisted of 50 healthy volunteers with no systemic diseases or any other medical conditions who referred to oral and maxillofacial medicine department of Rafsanjan Dental School.
Individuals were excluded from study if they had any recent (in the last 3 months) history of using antibiotics (such as tetracycline), drugs with gingival enlargement effects (cyclosporine, phenytoin and Ca2+ channel blockers), anti-inflammatory or anti-epileptic drugs. Other exclusion criteria were any known history of systemic diseases (except CVD), pregnancy, any history of periodontal treatment in last 6 months, any need to antibiotic prophylaxis and having less than 15 teeth totally.
This study was approved by Ethics Committee of Rafsanjan University of Medical Sciences. Patients were informed about the research protocol and after getting written informed consent, they underwent comprehensive clinical examinations including determination of plaque index (PI), bleeding point index (BPI), clinical attachment loss (CAL) and periodontal pocket depth (PPD).
These evaluations were performed by a trained dentistry student. Determination of dental plaque was done on the basis of Sillness and Loe method (22), in four line angels of each tooth (mesiobuccal, mesiolingual, distobuccal and distolingual). This index was determined as a percentage: (points with plaque/number of teeth × 4) ×100.
CAL was measured from Cemento enamel junction (CEJ) to the bottom of gingival pocket using a calibrated coded Williams periodontal probe No. 14 (Delab, Treffurt, Germany).
Pocket depth was calculated for two quadrants (one maxillary, one mandibular) in 6 random points (mesiobuccal, midbuccal, distobuccal, mesiolingual, midlingual and distolingual) from gingival margin to the bottom of pocket. Periodontal probes were used with gentle pressure during all examinations.
Bleeding on probing was observed and recorded by touching sulcus wall or periodontal pocket in the 6 points mentioned above (22). This index was also reported as a percentage (number of bleeding points/number of teeth × 4) × 100.
BMI was determined for each participant (kg/m2). Cholesterol level (mg/dl) and blood pressure (mmHg) of each participant were measured by their test sheet and by an experienced cardiology department nurse.
Statistical analyses were performed using SPSS (version 21.0, IBM Corporation, Armonk, NY, USA). Results were reported as “mean ± standard deviation” for quantitative variables and as “percentage” for qualitative variants. Independent two-sample Student’s t-test was used in analyzing and comparing the periodontal parameters between patients and healthy participants, and between men and women.
Chi-square test was used to compare qualitative parameters between evaluated groups. Associations between periodontal parameters and qualitative variables in cardiac patients were evaluated using the Spearman rank order correlation coefficient. The significance level of the test (P-value) was considered 0.05.
Results
This study consisted of a target group with CVD (27 men, 23 women and group mean age of 54.5 ± 9.71 years), and a control group of healthy individual (18 men, 32 women and group mean age of 51.5 ± 10.4 years).
There were no significant differences in education and socioeconomic levels and the number of smokers between the two groups. Other comparison of quantitative variables among the target group and control group is shown in table 1.
Bleeding point index between two groups was similar. Apart from BPI, there were significant differences in other parameters among the two groups (table 1). Mean cholesterol reported by patients test sheets was 182.1 ± 35 for men, and 199.2 ± 8.22 for women, and this item did not have any significant difference between the two gender (P = 0.152).
Table 1: Comparison of quantitative variables among the target group and control group
| P | Healthy subjects (n = 50) |
Patients with CVD (n = 50) |
|
| 0.130 | 51.5 ± 10.4 | 54.5 ± 9.71 | Age (years) |
| 0.470 | 166.2 ± 10 | 167.6 ± 8.92 | Height (cm) |
| *0.003 | 65.2 ± 12.2 | 73.2 ± 13.3 | Weight (kg) |
| *0.010 | 23.7 ± 4.59 | 26 ± 4.09 | BMI (kg/m2) |
| 0.930 | 35.4 ± 16.2 | 35.8 ± 24.4 | BPI (%) |
| *< 0.001 | 1.85 ± 1.92 | 4.10 ± 1.50 | CAL (mm) |
| *0.002 | 1.86 ± 0.53 | 2.26 ± 0.70 | PPD (mm) |
| *0.006 | 76.5 ± 20.6 | 87.3 ± 17.6 | PI (%) |
| *< 0.001 | 3.88 ± 4.09 | 8.54 ± 3.66 | NLT |
Test type: independent two-sample Student’s t-test
CVD: Cardiovascular disease; BMI: Body mass index; BPI: Bleeding point index; CAL: Clinical attachment loss; PPD: Periodontal pocket depth; PI: Plaque index; NLT: Number of lost teeth
*Significant difference: P < 0.05
CVD: Cardiovascular disease; BMI: Body mass index; BPI: Bleeding point index; CAL: Clinical attachment loss; PPD: Periodontal pocket depth; PI: Plaque index; NLT: Number of lost teeth
*Significant difference: P < 0.05
As mentioned in table 2, the sex distribution and the measured quadrant frequency distribution did not present any meaningful differences among the two groups (P = 0.161). The mean height and weight of men were higher than women in patients group (P < 0.001 and P = 0.010, respectively). Other characteristics did not present any significant differences among male and female.
Table 2: Comparison of distribution of qualitative variables in the two study groups
| P | Control group (n = 50) | Patient with CVD (n = 50) | |
0.070 |
32 (64) | 23 (46) | Sex Female |
| 18 (36) | 27 (54) | Male | |
| 0.161 | 23 (46) | 30 (60) | Quadrant 1 and 3 |
| 27 (54) | 20 (40) | 2 and 4 |
CVD: Cardiovascular disease
Test type: chi-square test, Significant difference: P < 0.05
Test type: chi-square test, Significant difference: P < 0.05
Table 3 demonstrates significant differences between findings documented in our study by using Pearson’s correlation coefficient. It shows the association among qualitative variables. In the case of a positive result (also statistically meaningful), demonstrates a direct relationship among the variables and in the case of negative result (also statistically meaningful), demonstrates a reverse association among the variables.
Table 3: Association of quantitative variables associated in patients with CVD
| age | Duration of illness | Height | Weight | BMI | SBP | DBP | Cholesterol | BPI | CAL | PPD | PI | |
| Duration of illness (months) | r = 0.082 P = 0.569 |
- | ||||||||||
| Height (cm) | r = -0.054 P = 0.708 |
r = 0.079 P = 0.585 |
- | |||||||||
| Weight (kg) | r = 0.155 P = 0.282 |
r = -0.016 P = 0.911 |
r = 0.583 P < 0.001 |
- | ||||||||
| BMI (Kg/m2) | r = 0.225 P = 0.117 |
r= -0.071 P = 0.625 |
r = 0.026 P = 0.859 |
r = 0.824 P > 0.001 |
- | |||||||
| SBP (mmHg) | r = 0.292 P = 0.040 |
r = -0.106 P = 0.463 |
r = 0.033 P = 0.818 |
r = 0.015 P = 0.919 |
r = - 0.011 P = 0.938 |
- | ||||||
| DBP (mmHg) | r = 0.318 P = 0.024 |
r = -0.183 P = 0.204 |
r = 0.103 P = 0.478 |
r = 0.145 P = 0.316 |
r = 0.099 P = 0.494 |
r = 0.586 P > 0.001 |
- | |||||
| Cholesterol (mg/dl) |
r = 0.124 P = 0.392 |
r = - 0.227 P = 0.113 |
r = -0.102 P = 0.480 |
r = -0.060 P = 0/681 |
r = - 0.022 P = 0.879 |
r = 0.339 P = 0.016 |
r = 0.351 P = 0.013 |
- | ||||
| BPI (%) | r = 0.190 P = 0.187 |
r = 0.079 P = 0.586 |
r = 0/061 P = 0/672 |
r = 0.123 P = 0.394 |
r = 0.127 P = 0.381 |
r = 0.232 P = 0.105 |
r = 0.228 P = 0.111 |
r = -0.127 P = 0.381 |
- | |||
| CAL (mm) | r = 0.247 P = 0.083 |
r = -0.036 P = 0.805 |
r = -0.157 P = 0.277 |
r = - 0.081 P = 0.575 |
r = 0.010 P = 0.944 |
r = 0.287 P = 0.043 |
r = 0.336 P = 0.017 |
r = 0.143 P = 0.323 |
r = 0.397 P = 0.004 |
- | ||
| PPD (mm) | r = 0.197 P = 0.170 |
r= 0.605 P = 0.655 |
r = 0.097 P = 0.503 |
r = 0.042 P = 0.774 |
r = - 0.013 P = 0.931 |
r = 0.151 P =0.295 |
r = 0.218 P = 0.129 |
r = 0.098 P = 0.496 |
r = 0.681 P > 0.001 |
r = 0.625 P > 0.001 |
- | |
| PI (%) | r = 0.310 P = 0.028 |
r = 0.153 P = 0.288 |
r = 0.284 P = 0.045 |
r = 0.419 P = 0.002 |
r = 0.333 P = 0.018 |
r = 0.209 P = 0.145 |
r = 0.146 P = 0.310 |
r = 0.080 P = 0.579 |
r = 0.287 P =0.044 |
r = - 0.014 P = 0.921 |
r = 0.142 P = 0.324 |
- |
| NLT | r = 0.082 P = 0.571 |
r = 0.034 P = 0.813 |
r = 0.041 P = 0.780 |
r = 0.076 P = 0.601 |
r = 0.075 P = 0.603 |
r = 0.120 P = 0.408 |
r = 0.208 P = 0.147 |
r = 0.072 P = 0.620 |
r = 0.054 P = 0.709 |
r = 0.090 P = 0.534 |
r = - 0.049 P = 0.732 |
r = 0.259 P = 0.069 |
CVD: Cardiovascular disease; BMI: Body mass index; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; BPI: Bleeding point index; CAL: Clinical attachment loss; PPD: Periodontal pocket depth; PI: Plaque index; NLT: Number of lost teeth
Significant difference: P < 0.05, significant differences are shown with colorful cells in the table.
Significant difference: P < 0.05, significant differences are shown with colorful cells in the table.
Discussion
The aim of this study was to evaluate periodontal status in patients with CVD and compare them with healthy individuals.
In recent decades, some studies have been done on the relationship between systemic and periodontal diseases (23). Some of these studies were done specifically on the relationship between cardiac and periodontal diseases and reporting a significant correlation between them (4, 24-26).
Although it is believed that controlling the periodontal inflammatory conditions has a positive effect on the health of patients with CVD, there are not enough evidences to show that cardiac disease can increase the risk of periodontal problems (18, 19).
Like other studies (27-29) we found that patients with CVD had worse periodontal status than control group. In other words, PI, CAL and tooth loss in these patients were more than control group. Average PI was significantly higher in the patient group. It may be due to poor oral hygiene in these patients in comparison with the healthy individuals.
Unlike other studies, difference in BOP between the two groups was not significant. This contradiction may be due to the differences in the population of different studies (30).
Also in patients with CVD, there was a significant relation between CAL, systolic and diastolic blood pressure and BOP index.
We also found a significant positive association between plaque index, height, weight, BMI and BPI. So that, as these indicators were more, PI was also higher.
Unlike previous studies (30, 31), number of tooth lost was significantly higher in the patient group. This finding most likely reflects different lifestyle and poor oral hygiene in the patient group. PPD in the patient group was significantly higher than control group.
Conclusion
According to our findings it seems that PI, CAL, PPD and tooth loss are higher in the patients with CVD in comparison with healthy subjects. So it can be concluded that overall periodontal status is worsen in patients with CVD. In addition, a better oral health instruction for patients with CVD is necessary. It is suggested to have more systematic reviews on articles to cover the different research gaps.
Acknowledgement
We should thank all the participants in this study. The authors did not have any conflict of interest. This study was under the funds of Rafsanjan University of Medical Sciences.
The results were presented at 15th international congress of Iranian Academy of Periodontology.
Conflict of interests: None declared.
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