Etiology And Pathogenesis Of Periodontal Disease – Alexandrina L Dumitrescu

1,147 men during 1968–1971 (norma- tive aging study (NAS) and the dental longitudinal study) 25 years PD, bone loss Incidence odds ratio was 2.8 for bone loss and stroke Not known Signifi cant Morrison et al. 1999 Canada 11,251 participants 1970–1972 nutrition Canada survey (NCS) 20 years Not known Nonstatistically signifi cantly increased RRs of 1.81 and 1.63 were observed for severe gingivitis and edentulous status for CVD Age, sex, diabetes status, serum total cholesterol, smoking, hypertensive status and province Non-signifi cant Wu et al.

9962 adults (fi rst national health and nutrition examination survey Dental examination conducted between 1971 and 1974. Follow-up surveys conducted from 1982 through 1984, 1986, 1987 and 1992 Subjects classifi ed with no periodontal disease, mild gingivitis, gingivitis, gingivitis with pocket formation and advanced destruction with loss of masticatory function Periodontitis is a signifi cant risk factor for total CVA and, in particular, nonhemorrhagic stroke (ICD-9, 433–434 and 436–438). Compared with no periodontal disease, the relative risks (95% CI) for incident nonhemorrhagic stroke were 1.24 (95% CI: 0.74–2.08) for gingivitis, 2.11 (95% CI: 1.30–3.42) for periodontitis, and 1.41 (95% CI: 0.96–2.06) for edentulousness.

For total CVA, the results were 1.02 (95% CI: 0.70–1.48) for gingivitis, 1.66 (95% CI: 1.15–2.39) for periodontitis, and 1.23 (95% CI: 0.91–1.66) for edentulousness Age, race, sex, years of schooling, family income level, smoking status, diabetes status, hypertension, alcohol use, serum total cholesterol levels and Signifi cant Howell et al. 2001 2,653 physicians (physi- cians’ health study I) 12.3 years of follow-up Self-reported periodontal disease Physicians who reported periodontal disease at baseline had slightly elevated, but statistically nonsignifi cant, relative risks (RR) of nonfatal stroke (RR = 1.10; Age and treatment assignment Non-signifi cant Joshipura et al.

41 380 men 12 years of follow-up Tooth loss, Self-reported periodontal disease was assessed by validated questions A modest association was seen between baseline periodontal disease history and ischemic stroke (Hazard Ratio = 1.33; 95% Age, amount smoked, obesity, alcohol, exercise, family history of CVD, multivitamin use, vitamin E use, profession, baseline reported hypertension and hypercholesterolemia Signifi cant PI plaque index; BOP bleeding on probing; PD probing depth; CAL clinical attachment level; GI Gingival Index; RR relative risk; CI confi dence intervals 4.2 Interactions Between Periodontal and Cardiovascular Disease 1.46 (95% CI: 0.80–2.66; P = 0.222); however, this was not signifi cant (Khader et al.

2004). It is possible that periodontitis increases the risk of cerebrovascular disease through bacteria that induce production of pro-infl ammatory cytokines, cause infl am- matory cell proliferation into large arteries, stimulate hepatic synthesis of clotting factors, and thus contribute to atherogenesis and thromboembolic events.

Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2009940105 © Springer-Verlag Berlin Heidelberg 2010 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer.

Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and appli- cation contained in this book.

In every individual case the user must check such information by consulting the relevant literature. Cover design: eStudio Calamar, Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Dr. Alexandrina L. Dumitrescu University of Tromsø Institute of Clinical Dentistry 9037 Tromsø Norway [email protected] v Dedication The important thing is not to stop questioning. Curiosity has its own reason for existing. Albert Einstein, 1879–1955 vii Foreword In his 1968 book, General Systems Theory: Foundations, Development, Applications, Ludwig von Bertalanffy observed that “… science is split into innumerable disciplines continually generating new subdisciplines.

In consequence, the physicist, the biolo- gist, the psychologist and the social scientist are, so to speak, encapsulated in their private universes, and it is diffi cult to get word from one cocoon to the other….” The same might have been true about subdisciplines within the fi elds of medicine and dentistry as well. But times are changing. The concept that oral diseases and disorders refl ect and affect overall health has been gaining wide acceptance, especially over the past decade.

As an illustration, a quick search of PubMed’s electronic data- base of biomedical journals yields approximately 225 research and review articles published any time before 1980 that mention both periodontal diseases and cardio- vascular diseases; in just the last 10 years, that number has nearly quadrupled.

This is a short excerpt from the opening of “” by Unknown, quoted for review and introduction purposes. All rights belong to the copyright holders.

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