Renata Górska

Association of Chronic Periodontitis With Left Ventricular Mass and Central Blood Pressure in Treated Patients With Essential Hypertension

BACKGROUND The aim of the study was to answer the question whether chronic periodontitis (CP) in patients with essential hypertension is associated with increased aortic stiffness and increased central blood pressure (CBP), which may in turn increase left ventricular mass (LVM) in those patients. CP influences LVM in hypertensive and renal patients as well as in healthy subjects; however, mechanisms involved are not clear. METHODS Fifty patients (23 men and 27 women, 51.4 +/- 5.2 years, body mass index (BMI) 29.5 +/- 4.4 kg/m(2)) with severe CP-Community Periodontal Index of Treatment Needs (CPITN) score 3-4, and 49 patients (20 men and 29 women, 49.3 +/- 5.5 years, BMI 29.9 +/- 4.8 kg/m(2)) with no or moderate CP (CPITN 0-2) were included. In all patients LVM, pulse wave velocity (PWV), and CBP were measured, and LVM index (LVMI) calculated. RESULTS Patients with a CPITN of 3-4 had higher LVM (257.3 +/- 67.9 vs. 220.3 +/- 66.4 g, P < 0.01), LVMI (105.8 +/- 23.6 vs. 92.6 +/- 24.8 g/m(2), P < 0.01) and higher central systolic (124 +/- 17 vs. 116 +/- 15 mm Hg, P < 0.05) and pulse pressure (45 +/- 11 vs. 38.7 +/- 9.8 mm Hg, P < 0.05) as compared with patients with a CPITN of 0-2. In the univariate analysis, for the total group a positive association was observed between CPITN values and LVM, LVMI, age, aortic systolic, and pulse pressure, but not with systemic blood pressure. Linear regression analysis showed an association of borderline significance (P = 0.06) between LVMI and the CPITN value. In other model, a significant positive relationship between CBP and CPITN was observed. CONCLUSIONS More severe forms of periodontitis are associated with increased CBP and LVM in patients with primary hypertension.

Blood pressure and left ventricular mass in subjects with type 2 diabetes and gingivitis or chronic periodontitis

INTRODUCTION This study aimed to answer the question of whether chronic periodontitis in subjects with type 2 diabetes mellitus is associated with increased left ventricular mass (LVM) and systemic and central blood pressure (CBP). MATERIAL AND METHODS One hundred and fifty-five subjects with type 2 diabetes (67 F, 88 M, mean age 61.1±6.9 years, BMI 32.7±5.7 kg/m(2)) were divided according to their periodontal status into biofilm-gingival interface - healthy (BGI-H, 14 subjects), BGI-gingivitis (BGI-G, 119 subjects) and BGI-periodontitis (BGI-P, 22 subjects) groups. In all subjects, LVM, systemic and CBP were measured. The LVM index (LVMI) was calculated. RESULTS (1) BGI-P and BGI-G subjects, respectively, had higher (mean; 95% CI) LVM (238.6 g; 206.6-267.4 and 222.8 g; 207.0-238.2) versus BGI-H subjects (170.3 g; 125.5-217.8).
(2) BGI-P and BGI-G subjects, respectively, had higher (mean; 95% CI) LVM1 (95.2 g/m(2) ; 82.9-107.4) and 87.8 g/m(2) ; 81.5-94.1) versus BGI-H subjects (63.7 g/m(2) ; 45.2-62.3).
(3) BGI-P subjects had higher central and systemic systolic and diastolic blood pressure than subjects from BGI-G and BGI-H groups. CONCLUSION In subjects with type 2 diabetes, periodontitis and gingivitis are associated with increased LVM and periodontitis is associated with increased central and systemic blood pressure.

Oral health status and the occurrence and clinical course of myocardial infarction in hospital phase: A case-control study

BACKGROUND Periodontitis may contribute to destabilization of atherosclerotic plaque leading to acute coronary syndrome and myocardial infarction (MI). The aim of the paper was to evaluate the state of the oral cavity and test the association between chosen parameters of acute, hospital phase MI in patients aged 60 and younger. METHODS We examined patients with acute MI, age 60. Control group consisted of matched group of patients with stable angina. Patients enrolled in the study underwent dental, cardiovascular and biochemical examination. Left ventricular ejection fraction (LVEF) was measured during echocardiographic examination, intima-media thickness (IMT) was assessed by ultrasonographic examination at the same time. RESULTS The case group included 112 hospital patients with acute MI. Patients with acute MI were characterized by higher level of cardiovascular disease risk factors and poor oral health status in comparison to the control group. There was higher prevalence of edentulousness (p = 0.0039) and advanced periodontal disease (APD) (p < 0.0001) in the case group than in the control group. Patients with edentulousness and APD were characterized by the highest levels of fi brinogen, interleukine-6, tumor necrosis factor-a, increased IMT and numerous atherosclerotic plaques. Logistic regression analysis revealed association between biomarkers of myocardial injury, LVEF and chosen periodontal parameter (API, CAL, PDI, BI) and edentulousness. CONCLUSIONS Poor oral health status, especially periodontal disease may infl uence on the occurrence and clinical course of MI.

Correlation between clinical parameters of periodontal disease and mean platelet volume in patients with coronary artery disease: a pilot study

BACKGROUND Cardiovascular diseases as well as periodontitis can be regarded as current epidemics and have become a social problem. Mean platelet volume (MPV) is a simple, routinely assessed biochemical parameter, which is becoming regarded asa new, independent risk factor of acute coronary syndromes and stroke. AIM Assessment of a potential relationship between clinical indices of periodontal disease and MPV in relation to the presence of coronary artery disease (CAD) and chronic periodontitis. METHODS The study included 57 individuals aged from 50 to 65 years. Patients were divided into three groups. Group 1 consisted of 19 patients with previously diagnosed CAD and coexisting chronic periodontitis. Group 2 included 18 patients with diagnosed chronic periodontitis with excluded CAD. Group 3 was a control group and consisted of 20 healthy individuals without CAD or periodontitis. RESULTS Unsatisfactory oral hygiene defined by plaque index (PI) was observed in all patients. Mean PI was significantly higher in Groups 1 and 2 than in Group 3 (76.7% vs. 45.7%, p < 0.01). Mean bleeding index (BI) was significantly higher in Group 2 than in Groups 1 and 3 (46.4% vs. 29.8%, p < 0.05). Mean periodontal pocket depths (PD) (2.75 mm, 2.93 mm,1.97 mm, respectively, p < 0.05, p < 0.01) and clinical attachment loss (CAL) were significantly higher in Groups 1 and 2 than in Group 3 (5.13 mm, 4.79 mm, 1.31 mm, respectively, p < 0.01). Mean WBC, fibrinogen and hsCRP were not significantly different among the examined groups (WBC 6.81 G/L vs. 6.71 G/L vs. 6.18 G/L, fibrinogen concentration 4.31 g/L vs. 3.94 g/L vs. 3.67 g/L; hsCRP concentration 4.08 mg/dL vs. 6.61 mg/dL vs. 4.33 mg/dL). In Group 1, MPV was significantly higher than in Group 3 (10.39 fL vs. 9.39 fL, p < 0.01). There was a weak, although significant, correlation between periodontal parameters and MPV and correlations between MPV and PD as well as CAL (MPV-PD: r = 0.45, p < 0.05; MPV-CAL: r = 0.42, p < 0.05). CONCLUSIONS Chronic periodontitis in patients with CAD results in an increased MPV that may suggest increased platelet activity. This observation could indicate a potential pathophysiological link between chronic periodontitis and an increased risk of acute coronary syndromes.

Trichoscopic Hair Evaluation in Patients with Ectodermal Dysplasia

Hair abnormalities in ectodermal dysplasia may be difficult to identify. Among 16 patients with ectodermal dysplasia trichoscopy (hair dermoscopy) revealed predominance of pilosebaceous units with 1 hair (69%), abnormalities of hair shaft pigmentation (gray hair with single dark hairs, 56%), pili torti, trichothiodystrophy, trichorrhexis nodosa, and rarely, cicatricial alopecia.

Elastase and metalloproteinase-9 concentrations in saliva in patients with chronic periodontitis

Elastase and metalloproteinase-9 (MMP-9) are two of numerous proteolytic enzymes released by neutrophilic granulocytes in the course of periodontitis. The aim of the study was to determine the concentrations of elastase and MMP-9 in saliva in patients with chronic periodontitis compared to healthy individuals. The enzyme-linked immunosorbent assay method was employed to determine the concentrations of elastase and MMP-9 in saliva in patients with chronic periodontitis and with pocket depth (PD) ≥ 6 mm and PD < 6 mm, as well as in saliva of healthy individuals. Significantly higher concentrations of elastase and MMP-9 were observed in patients with periodontitis compared to healthy individuals (p < 0.01). Also a significant difference in elastase concentration in saliva was observed between the PD ≥ 4 mm and PD < 6 mm groups and between the PD ≥ 6 mm and control groups, and statistically significant differences in MMP-9 concentrations between the PD ≥ 6 mm and control groups. No statistically significant differences were observed between the PD < 6 mm and control groups for elastase concentrations in saliva as well as between the PD ≥ 6 mm and PD < 6 mm groups, and also between the PD < 6 mm and control groups for MMP-9 concentrations in saliva. Elastase and MMP-9 concentrations in saliva can be considered as biochemical indicators of severity of periodontitis.

Analysis of mutations in the SOS-1 gene in two Polish families with hereditary gingival fibromatosis

OBJECTIVES To establish whether two families from Malopolska and Mazovia provinces in Poland are affected by hereditary gingival fibromatosis type 1, caused by a single-cytosine insertion in exon 21 of the Son-of-Sevenless-1 gene. MATERIAL AND METHODS Six subjects with hereditary gingival fibromatosis and five healthy subjects were enrolled in the study. Gingival biopsies were collected during gingivectomy or tooth extraction and used for histopathological evaluation. Total RNA and genomic DNA were purified from cultured gingival fibroblasts followed by cDNA and genomic DNA sequencing and analysis. RESULTS Hereditary gingival fibromatosis was confirmed by periodontal examination, X-ray, and laboratory tests. Histopathological evaluation showed hyperplastic epithelium, numerous collagen bundles, and abundant-to-moderate fibroblasts in subepithelial and connective tissue. Sequencing of exons 19-22 of the Son-of-Sevenless-1 gene did not reveal a single-cytosine insertion nor other mutations. CONCLUSIONS Patients from two Polish families under study had not been affected by hereditary gingival fibromatosis type 1, caused by a single-cytosine insertion in exon 21 of the Son-of-Sevenless-1 gene. Further studies of the remaining regions of this gene as well as of other genes are needed to identify disease-related mutations in these patients. This will help to unravel the pathogenic mechanism of gingival overgrowth.

The Immune Response in Periodontal Tissues

The uniqueness of periodontal diseases is caused by several factors. This group of diseases is caused by numerous bacterial species formed in the dental biofilm, and one cannot distinguish the specific pathogen that is responsible for the disease initiation or progress (though Gram-negative anaerobic rods are associated with the advanced form of the disease). The disease is both infectious and inflammatory in its nature, and in the state of health there is always a subclinical level of inflammatory response, caused by the so-called harmless bacteria. Negligence in oral hygiene may result in maturation of the biofilm and trigger host response, manifesting clinically as gingivitis or—later and in susceptible subjects—as periodontitis. The article presents the contemporary knowledge of the inflammatory reaction occurring in tissues surrounding the tooth during periodontal inflammation. The most important mechanisms are described, together with implications for clinicists.

The Association Between Dental Status and Systemic Lipid Profile and Inflammatory Mediators in Patients After Myocardial Infarction

BACKGROUND Many epidemiological studies have proven that local infection may influence the levels of systemic lipid profile and inflammatory mediators. OBJECTIVES The aim of this research was to evaluate the association between the state of the oral cavity, lipids and inflammatory mediator concentrations in Poles after acute myocardial infarction (MI). MATERIAL AND METHODS A total of 134 subjects with a mean age of 54.3 years (± 8.1) were included in the study. Sociodemographic and cardiologic variables were gathered. Subsequently, serum samples were collected for estimation of total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), high-sensitivity C-reactive protein (hsCRP), fibrinogen and white blood cell counts (WBC). The periodontal parameters measured included bleeding on probing index (BoP), pocket depth (PD), clinical attachment level (CAL), the number of bleeding periodontal pockets (bPP) and the number of lost teeth. RESULTS Overall, patients shared high levels of periodontal inflammation and tissue breakdown. Multivariate analysis revealed a significant association between the serum concentration of LDL-C and bPP (standardized coefficient b = 0.3179; p = 0.0009) and PD (b = 0.3186; p = 0.0015); the level of fibrinogen and the number of lost teeth (b = 0.3669; p = 0.0013); WBC and bPP (b = 0.2726; p = 0.0035) independent of age, sex, income, education, atherosclerotic disease in the family, tobacco smoking, arterial hypertension, diabetes mellitus and BMI. No correlations were found regarding hsCRP serum concentration. CONCLUSIONS To our knowledge, this study demonstrated for the first time that local inflammatory processes in the oral cavity are positively associated with the systemic levels of LDL-C, fibrinogen and WBC in adult Poles. This may underscore relationships between periodontitis and MI as well as potentially impinge on atherosclerotic processes and MI prognosis.

TIMP-1 association with collagen type I overproduction in hereditary gingival fibromatosis

OBJECTIVES To investigate the processes associated with the excessive production of collagen I in hereditary gingival fibromatosis (HGF). MATERIALS AND METHODS Three HGF subjects and five controls were enrolled in the study. Histomorphological and immunohistological analyses were performed on gingival tissues. The expression of heat-shock protein 47 (HSP47), collagen I, transforming growth factor-β1 (TGF-β1), connective tissue growth factor (CTGF), matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) by gingival fibroblasts isolated from HGF and controls was analysed using qRT-PCR, Western blotting and ELISA. RESULTS Considerable accumulation of fibrotic fibrils and increased synthesis of HSP47 were noted in HGF gingival tissues. The synthesis of collagen I, HSP47, TGF-β1, CTGF and TIMP-1 was significantly elevated in HGF gingival fibroblasts compared with controls, while the production of MMP-1 was decreased. CONCLUSIONS We report that fibrosis in HGF gingival tissues is associated with increased synthesis of HSP47. This finding was confirmed by an in vitro study, where excessive production of collagen I was associated with increased synthesis of HSP47, TGF-β1 and CTGF by HGF gingival fibroblasts. Moreover, the shift in the TIMP-1/MMP-1 ratio identifies increased synthesis of TIMP-1 as one of the processes associated with collagen I overproduction in HGF fibroblasts.