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Public Health Implications of Chronic Periodontal Infections in Adults
Difficulties in Evaluating the Relationships between Periodontal
Disease and Cardiovascular Diseases
John Gunsolley, DDS,
Chair, Departments of Periodontics and Endodontics,
University of Maryland Dental School, Baltimore, Maryland
A great deal of controversy exists about whether periodontal
disease is associated with the severity or incidence of cardiovascular
disease. To date, there have been multiple cross-section, cohort, and
case-control studies with conflicting results.
Some studies have reported a moderate relationship, and others have
reported no relationship at all. It has been difficult to compare these
studies because of a lack of consistency in study designs, outcome measures of
cardiovascular disease, and outcome measures of periodontal disease. This
inconsistency is
especially evident in measurement of periodontal disease and could be a
major source of inconsistent findings. If there is a relationship between
cardiovascular disease and periodontal disease, there must be an adequate
exposure of periodontal disease to create cardiovascular disease. It is
even difficult, however, to determine criteria for classifying an
individual as having periodontal disease. In general, numerous criteria
have been used in studies of periodontal disease; no consistent criteria
separate individuals who have disease from those who are periodontally healthy. Further complicating this problem is that periodontal disease
is measured at multiple places on multiple teeth, so criteria are usually
stated as extent and severity of disease (i.e. 3 mm of attachment loss
at four or more sites). Thus, both threshold and number of sites or teeth
may vary.
Moreover, complicating the problem of defining criteria for periodontal
disease is the variety of measures of periodontal disease that have been
used at these multiple locations. In studies relating periodontal disease
to cardiovascular disease, authors have used probing measurements
(attachment level and pocket depth), radiographic measurements, a
combination of bony defect and deep pocket measurements, a combination of periodontal
and gingivitis measurements, and nonprobing indices (Russell’s Index).
Almost all of the studies investigating this relationship have used
different criteria for periodontal disease.
Studies based on nonprobing measures such as Russell’s Index have
generally failed to find a relationship between periodontal disease and
cardiovascular disease. Half the studies that used self-reported history of
periodontal disease failed to show a relationship between periodontal
disease and cardiovascular disease. In contrast, among studies that have
used probing periodontal measurements (such as attachment level), a larger
percentage have found a relationship between periodontal disease and
cardiovascular disease. In some of these studies, the authors used
progressively more severe criteria for periodontal disease; they found a
stronger relationship between periodontal disease and cardiovascular
disease as the criteria became more severe. In contrast, using varying
extent criteria with the Russell Index another author could not find the
same relationship.
In summary, the lack of consistent results in these studies makes it
difficult to determine if an association exists between the two diseases.
The types of measurements used in these studies may have contributed to
this problem. Lack of consistency has also made it difficult to combine the
results of these studies in meta-analysis to further determine the strength
of the potential association of these diseases.
Back to Chronic Periodontal Infections Conference
Historical Document
Page last reviewed: February 2, 2005
Content source:
Division of Oral Health,
National Center for Chronic Disease Prevention and
Health Promotion |
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