Relationship between Periodontal Disease (Periodontitis) and Acute Vascular Events a Case-Control Study Enperiva Study

Periodontal disease (POD) is characterized by infection and chronic inflammation. This condition starts with the presence of bacteria in the gingival sulcus (e.g. Streptococcus sanguis, Streptococcus oralis, Actinomyces odontolyticus, Fusobacterium nucleatum) followed by a chronic inflammation process affecting the periodontal pocket apically and leading to the destruction of the tooth-supporting structure [1]. Besides the typical risk factors (RF) for POD (smoking, diabetes, obesity), a complex mechanism involving these factors along with genetic factors and infection have been found to play a role [2]. The result of chronic inflammation can be determined through clinical and radiographic parameters as well as plasma and gingival fluid analysis [3-6]. On the other hand, vascular disease and the events associated with it are one of the leading causes of morbidity and mortality in adults [7,8]. In this context, atheromatous disease constitutes the most common cause of vascular events, with plaque complications being the reason for most acute episodes. Persistent inflammation may explain the pathogenesis, progression and, finally, the rupture of the atheromatous plaque [9,10]. The inflammatory state is triggered and sustained by the vascular disease risk factors first described in the Framingham Study [11]. However, not all vascular events were related to those RF; during the last 15 years, POD has started to be regarded as a risk factor strongly associated with atheromatous disease [1-12]. Periodontal disease and atheromatous disease share not only risk factors such as smoking and diabetes, but also a complex multifactorial process of chronic inflammation stimulating mediators that accelerate endothelial dysfunction and/or mechanisms of cross-reacting antibodies against the periodontal flora and endothelial cell proteins; this may explain the relation between these pathologies [13-15]. The studies which have explored the association between these two diseases were published with different biases as regards the endpoints to determine this relation [16], the design, the population, the sample size and even the different definitions of periodontal disease [17,18]. The aim of our study was to establish the relation between periodontal disease (periodontitis) and vascular disease, using acute vascular events (AVE) as the primary endpoint.