Takehisa Iwai

Association between periodontitis and the development of systemic diseases

Periodontal diseases, common infectious diseases seen in humans, are characterized by gingival inflammation and a loss of connective tissue and bone around the roots of teeth, which leads to eventual tooth exfoliation. In the past decade, the association between periodontal diseases and the development of systemic diseases has received increasing attention. Periodontal pathogens and their products, as well as inflammatory mediators produced in periodontal tissues, can enter the bloodstream, thereby causing and/ or contributing to the development of systemic diseases. A variety of recent studies have compiled various results showing that periodontal infections are implicated in the development of various systemic diseases. This review summarizes the evolution of the focal infection theory to the current understanding of the pathophysiology of periodontal disease and presents an update of the mechanisms and relationships between chronic periodontitis and systemic diseases, including cardiovascular diseases, respiratory infections, preterm delivery of low-birth-weight fetuses and diabetes mellitus.

Impaired Peripheral Circulation in Veterans with Claudication is Associated with Smoking

We compared the peripheral vascular function of veterans and non-veterans with peripheral artery disease (PAD) and claudication. The circulation of the lower extremities was assessed under rest and reactive hyperemia conditions in 413 veterans and in 83 non-veterans. Veterans had more severe PAD as measured by a lower ankle/ brachial index (p<0.001). Following the occlusive test, veterans had a greater relative percentage decrease in ankle systolic blood pressure (p=0.015), a greater percentage decrease in calf transcutaneous oxygen tension (p=0.035), and a blunted percentage increase in calf blood flow (p=0.031). After adjustment for current smoking status, these measures were no longer statistically different between the veterans and non-veterans. We conclude that veterans with PAD and claudication have greater impairments in macrovascular and microvascular function of the lower extremities, and greater severity of PAD than compared to non-veterans, and that these factors were primarily associated with their higher prevalence of smoking. The greater compromise in peripheral vascular measures in veterans is particularly noteworthy given that the prevalence of diabetes, hypertension, and dyslipidemia were not higher.