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Association between periodontal disease and its treatment, flow-mediated dilatation and carotid intima-media thickness: A systematic review and meta-analysis
Abstract
Objective This meta-analysis sought to investigate the association between carotid intima-media thickness (c-IMT), flow-mediated dilation (FMD) and periodontitis (PD) and to assess the effect of periodontal treatment on c-IMT and FMD.Methods Electronic database searching, hand searching of bibliographic references of included papers, related reviews, and journals in relation to oral, cardiovascular and ultrasound imaging field was carried out. Random effects meta-analyses were performed to investigate the association of co-existence of increased c-IMT, impaired FMD and PD with potential changes in these variables following periodontal intervention.Results 2009 citations and 101 full text articles were screened, with 35 meeting the review inclusion criteria of which 22 suitable for quantitative analysis. Meta-analysis demonstrated that the diagnosis of PD was associated with a mean increase in c-IMT of 0.08 mm (95% C.I. = 0.07-0.09) and a mean difference in FMD of 5.1% compared to controls (95% C.I. = 2.08-8.11%). A meta-analysis of the effects of periodontal treatment on FMD showed a mean improvement of 6.64% between test and control (95% C.I. = 2.83-10.44%).Conclusions This review demonstrated an association between increased c-IMT, impaired FMD and PD. Data from intervention studies suggested a beneficial effect of periodontal treatment on FMD indicating an improvement in endothelial function. The findings support investigation of periodontitis treatment on cardiovascular outcomes.
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“These patients often present with systemic inflammation and endothelial dysfunction, 22 which improves following successful periodontal treatment.23”
From Periodontitis is associated with hypertension: a systematic review and meta-analysis (2020) · cites this paper as [23]
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Association between subclinical atherosclerosis and oral inflammation: A cross‐sectional study
Papi, P., Pranno, N., Murro, B. D., Pompa, G., Polimeni, A., Letizia, C., Petramala, L., Concistrè, A., Aguilera, E. M., Orlandi, M., et al. (2022) · Journal of Periodontology · doi:10.1002/jper.22-0026 · Cited by 15
“Different systematic reviews of observational studies 24,44 highlighted how patients with periodontitis exhibit higher c-IMT values, although the heterogeneity of definitions adopted for periodontitis and c-IMT measurements could have influenced the results of the included studies and, more…”
Chen, T., Lin, C., Chien, S., Chang, S., & Chen, C. (2017) · Journal of Cellular Physiology · doi:10.1002/jcp.26268 · Cited by 14
“In addition to the earlier meta-analyses (Blaizot, Vergnes, Nuwwareh, Amar, & Sixou, 2009; Chistiakov, Orekhov, & Bobryshev, 2016; Orlandi et al., 2014; Sfyroeras, Roussas, Saleptsis, Argyriou, & Giannoukas, 2012), the evidence supporting the presence of live P. gingivalis or their secreted…”
ResultRegulation of Ghrelin Receptor by Periodontal Bacteria In Vitro and In Vivo
Nokhbehsaim, M., Damanaki, A., Nogueira, A. V. B., Eick, S., Beisel-Memmert, S., Zhou, X., Nanayakkara, S., Götz, W., Cirelli, J. A., Jäger, A., et al. (2017) · Mediators of Inflammation · doi:10.1155/2017/4916971 · Cited by 14
The link between periodontitis and erectile dysfunction: a review
Bizzarro, S., & Loos, B. G. (2019) · BDJ · doi:10.1038/s41415-019-0724-6 · Cited by 14
The Effects of Antimicrobial Mouthwashes on Systemic Disease: What Is the Evidence?
Alrashdan, M. S., Leão, J. C., Doble, A., McCullough, M. J., & Porter, S. R. (2023) · International Dental Journal · doi:10.1016/j.identj.2023.08.012 · Cited by 14
Periodontitis and multiple markers of cardiometabolic risk in the fourth decade: A cohort study
Shearer, D. M., Thomson, W. M., Cameron, C., Ramrakha, S., Wilson, G., Wong, T. Y., Williams, M. J. A., McLean, R. M., Theodore, R. F., & Poulton, R. (2018) · Community Dentistry And Oral Epidemiology · doi:10.1111/cdoe.12414 · Cited by 12
“Circumstantial evidence for a possible causal link between periodontal inflammation and endothelial dysfunction has arisen from cross‐sectional studies,(20,55) a review(56) and a meta‐analysis.(57) In addition, a number of RCTs have provided baseline data on impaired endothelial function in participants with periodont…”
Tong, C., Wang, Y., & Chang, Y. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16152635 · Cited by 12
“Studies have clearly demonstrated that CA was associated with CP by systematic review and meta-analysis [8,9].”
BackgroundNon-pharmacological Strategies Against Systemic Inflammation: Molecular Basis and Clinical Evidence
Pinto, R. D., Pietropaoli, D., Monaco, A., Desideri, G., Ferri, C., & Grassi, D. (2020) · Current Pharmaceutical Design · doi:10.2174/1381612826666200403122600 · Cited by 11
Effects of Obesity on Bone Healing in Rats
Damanaki, A., Beisel-Memmert, S., Nokhbehsaim, M., Abedi, A., Rath-Deschner, B., Nogueira, A. V. B., & Deschner, J. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms222413339 · Cited by 11
Aarabi, G., Raedel, M., Kreutzburg, T., Hischke, S., Debus, E. S., Marschall, U., Seedorf, U., & Behrendt, C. (2020) · VASA · doi:10.1024/0301-1526/a000846 · Cited by 11
Green Tea from the Far East to the Drug Store: Focus on the Beneficial Cardiovascular Effects
Landini, L., Rebelos, E., & Honka, M. (2020) · Current Pharmaceutical Design · doi:10.2174/1381612826666201102104902 · Cited by 11
Could the periodontal therapy improve the cardiologic patient health? A narrative review
Bertoldi, C., Salvatori, R., Pinti, M., & Mattioli, A. V. (2024) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2024.102699 · Cited by 14
Shimizu, Y., Yamanashi, H., Kitamura, M., Miyata, J., Nonaka, F., Nakamichi, S., Saito, T., Nagata, Y., & Maeda, T. (2022) · Journal Of Clinical Periodontology · doi:10.1111/jcpe.13755 · Cited by 10
Fujitani, T., Aoyama, N., Hirata, F., & Minabe, M. (2020) · Clinical and Experimental Dental Research · doi:10.1002/cre2.312 · Cited by 10
“Previous reports have shown associations between endothelial function as judged using other methods and systemic inflammation, cardiovascular diseases, and periodontal disease (Amar et al., 2003; Kitta et al., 2009; Kusunose et al., 2016; Matsuzawa, Sugiyama, Sumida, et al., 2013; Moura et al., 2017; Orlandi et al., 2…”
BackgroundDo Childhood Infections Contribute to Adult Cardiometabolic Diseases?
Burgner, D. P., Liu, R., Wake, M. A., & Uiterwaal, C. S. P. M. (2015) · The Pediatric Infectious Disease Journal · doi:10.1097/inf.0000000000000882 · Cited by 9
“There is evidence that endotoxin and DNA from periodontal pathogens are present in atherosclerotic lesions,(32) and that interventions that aggressively treat periodontitis may reverse adverse inflammatory cardiovascular risk phenotypes.(33,34)”
Dewake, N., Ishioka, Y., Uchida, K., Taguchi, A., Higashi, Y., Yoshida, A., & Yoshinari, N. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9103365 · Cited by 9
“They also described a beneficial effect of periodontal treatment on FMD, indicating an improvement in the endothelial function [13].”
BackgroundAssociations Among Tooth Loss, Periodontitis, and Carotid Intima-Media Thickness: the Nagahama Study
Fukuhara, S., Watanabe, T., Yamazaki, T., Yamanaka, S., Nakao, K., Asai, K., Kashiwagi, M., Yamazaki, A., Umebachi, C., Setoh, K., et al. (2023) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.63801 · Cited by 9
Cross‐sectional association between oral health and retinal microcirculation
Samietz, S., Jürgens, C., Ittermann, T., Holtfreter, B., Pink, C., Schipf, S., Biffar, R., Völzke, H., Kocher, T., & Tost, F. (2018) · Journal Of Clinical Periodontology · doi:10.1111/jcpe.12872 · Cited by 9
“Chronic periodontitis is associated with cardiovascular disease and has systemic effects on large vessels and endothelial function (Orlandi et al., 2014).”
BackgroundUriza, C. L., Roa, N. S., Porras, J. V., Poveda, J. C. V., Otero, L., Ruiz, Á. J., & Arregocés, F. M. E. (2024) · Biomedicines · doi:10.3390/biomedicines12071425 · Cited by 8
“Furthermore, Orlandi et al. (2014), in a systematic review and meta-analysis, evaluated the association between carotid IMT and periodontal disease, reporting that patients with periodontal disease had a higher average carotid IMT (0.08 mm) than those without periodontal disease [4].”
BackgroundInfluentialACE insertion/deletion polymorphism is associated with periodontal disease in Korean population
Kang, S. W., Han, S. Y., Lim, S. B., Cho, K. B., & Ban, J. Y. (2014) · Archives of Oral Biology · doi:10.1016/j.archoralbio.2014.12.003 · Cited by 8
Association of periodontal disease with atherosclerosis in 70-year-old Japanese older adults
Kitamura, M., Ikebe, K., Kamide, K., Gondo, Y., Yamashita, M., Takedachi, M., Nozaki, T., Fujihara, C., Yamada, S., Kashiwagi, Y., et al. (2020) · Odontology · doi:10.1007/s10266-020-00567-z · Cited by 8
Chansawang, K., Lertpimonchai, A., Siripaiboonpong, N., Thienpramuk, L., Vathesatogkit, P., Limpijankit, T., & Charatkulangkun, O. (2020) · Clinical Oral Investigations · doi:10.1007/s00784-020-03670-1 · Cited by 8
Dental Calculus Links Statistically to Angina Pectoris: 26-Year Observational Study
Söder, B., Meurman, J. H., & Söder, P. (2016) · PLoS ONE · doi:10.1371/journal.pone.0157797 · Cited by 8
“[22,23] However, overall scientific evidence is still weak in this regard.”
BackgroundPeriodontal Disease and Cardiovascular Disease
Zeng, X., Li, N., Zhang, L., Rong, R., & Liu, M. (2017) · Heart and Mind · doi:10.4103/hm.hm_19_17 · Cited by 8
“44%).[9] Another systematic review and meta-analysis based on 25 controlled periodontal intervention trials also revealed that periodontal treatment improved endothelial function and reduced biomarkers of atherosclerotic disease.”
BackgroundOral health complications in Brazilian and French diabetic older people: A comparative study
Lima, D. L. F., Saintrain, M. V. D. L., Neri, J. R., Beck, O., Malet, P., Moizan, J. A. H., & Doucet, J. (2019) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2019.103905 · Cited by 7
Exploring the periodontal disease—ischemic stroke link
Sen, S., & Mascari, R. (2020) · Journal of Periodontology · doi:10.1002/jper.20-0138 · Cited by 7
Metadata
- Authors
- Orlandi, M., Suvan, J., Petrie, A., Donos, N., Masi, S., Hingorani, A., Deanfield, J., & D’Aiuto, F.
- Affiliations
- University College London (GB)
- Great Ormond Street Hospital (GB)
- Corresponding author
- Orlandi, Marco
- ORCID
- Venue
- Atherosclerosis
- Publisher
- Elsevier BV
- Published
- 2014-09
- Volume
- 236
- Issue
- 1
- Pages
- 39-46
- ISSN
- 0021-9150 (ISSN-L)
- OpenAlex
- W1999544578
- Cited by
- 164
- References
- 62
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 13 · 2023: 12 · 2022: 13 · 2021: 13 · 2020: 32 · 2019: 19 · 2018: 13 · 2017: 18 · 2016: 8 · 2015: 9 · 2014: 1
- FWCI
- 2.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Atherosclerosis (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- Funders
- Medical Research Council (MR/K006584/1)
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Dentistry › General Dentistry › Dental Health and Care Utilization
- Keywords
- periodontitis, carotid intima-media thickness, flow-mediated dilation, periodontal treatment, endothelial function, cardiovascular risk, oral health and cardiovascular disease
- MeSH terms
- Brachial Artery, Carotid Artery Diseases, Cross-Sectional Studies, Disease Susceptibility, Endothelium, Vascular, Humans, Periodontal Diseases, Periodontitis, Vasodilation, Comorbidity, Causality, Case-Control Studies, Hemorheology, Disease Progression, Controlled Clinical Trials as Topic, Plaque, Atherosclerotic, Carotid Intima-Media Thickness
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