The heart in hypertension
H. Gavras in The Year in Hypertension 2004, 2004
The study featured above evaluates the relationship between periodontal disease and LV mass in 104 patients with essential hypertension who had echocardiographic studies to evaluate LV mass and assessment of periodontal status according to the community periodontal index of treatment needs (CPITN). With increasing severity of periodontitis there was a progressive increase in systolic pressure and LV mass. In addition, LV mass was the only determinant of severe periodontal disease (Table 2.11; Figs. 2.13, 2.14). The underlying mechanisms by which this association occurs remain speculative and were not evaluated in this study. One point not at all considered is that patients with essential hypertension with LVH must have pressures of higher stages and, hence, may have received calcium antagonists in their past. As is generally known, this class of drugs, especially the dihydropyridines, have as their most common side effect the development of gingival hyperplasia. The clinical importance of the study is related to the suggestion that periodontal diseases can provide an easily accessible biological assay for more accurate definition of cardiovascular risk assessment in patients with hypertension.
Dental Disease, Inflammation, Cardiovascular Disease, Nutrition and Nutritional Supplements
Stephen T. Sinatra, Mark C. Houston in Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
Figure 14.4 is from an actual patient who presented with isolated bleeding on probing during periodontal examination, a history of periodontal disease confirmed by prior bone loss and increased periodontal pocketing. Salivary testing was performed to learn the microbial makeup prior to disinfection treatment. Based on the data from the testing, treatment consisted of traditional scaling and root planing and the recommendation to rinse for 2 weeks with chlorhexidine (a common periodontal disease treatment approach taught in most dental schools). (Figure 14.4 left) At the 6-week periodontal recall to evaluate the gingival healing, probing identified less bleeding and the periodontal chart showed improving pocket depths. Salivary testing was performed to check type and levels of pathogenic bacteria post-treatment. Although clinical evidence of periodontal disease and the associated inflammation had improved, the retest report demonstrated no significant changes in the pathogenic bacteria load. (Figure 14.4 right) The retest results confirmed that traditional nonsurgical periodontal treatment methods were not effective in shifting the oral biofilm to levels that would encourage long-term periodontal stability. The goals of periodontal treatment are eliminating or reducing the pathogenic biofilm to levels that do not initiate a host immunoinflammatory response. Squelching the host immunoinflammatory response prevents the release of cytokines that break down connective tissue, supporting bone and induces inflammation and ultimately a dysregulation of bone metabolism resulting in more destruction. Additionally, this patient will continue to have systemic changes in vascular biology with continued exposure to the high-risk periodontal pathogens that are still present after failed conventional therapy.
Bacterial Infections of the Oral Cavity
K. Balamurugan, U. Prithika in Pocket Guide to Bacterial Infections, 2019
Bleeding upon slightest provocation along with clinical signs and symptoms of surface color and texture absence of stippling will denote reactive inflammation. Breakdown of junctional epithelium and deepening of sulcus is known as a periodontal pocket, which is measured using a probing instrument such as a William’s periodontal probe or Community Periodontal Index for Treatment Needs (CPITN) probe, which has got a blunt end. Bone loss can be appreciated with radiographs (i.e., orthopantomography or intra-oral periapical).
Association of Polymorphism in IL-18 Gene with Periodontitis in Uyghur Adults in Xinjiang and Evidence from Six Case‐Control Studies with a Comprehensive Analysis
Published in Immunological Investigations, 2022
Chao Shan, Ting Ma, Ting Ting Wang, Long Wu, Aisaiti Abasijiang, Jin Zhao
The diagnosis of periodontitis is based on a standardized periodontal examination protocol, referring to the community periodontal demand Index (CPITN) standard of Muthukumar and Suresh (2009): Periodontal health was examined under adequate natural light by 3 trained oral practicing doctors (reliability test Kappa = 0.97) using the oral CPI probe. All subjects were assigned 10 sites according to the community periodontal index. The adjacent tooth was selected for examination if the index teeth presented sugingival calculus or poor restoration of the crown of the tooth, or the crown was constructed by hammer, or the tooth was used as a bridge abutment. The CAL of all sites was summed to calculate the average attachment loss (AAL): AAL≤ 3 mm were defined as mild CP, 3< AAL<4 mm as moderate CP, AAL≥ 5 mm as severe CP.
Detection of polyomavirus microRNA-5p expression in saliva shortly after kidney transplantation
Published in Journal of Oral Microbiology, 2021
Ana Carolina Mamana, Maria Stincarelli, Dmitry José De Santana Sarmento, Alexandre Mendes Batista, Tânia Regina Tozetto-Mendoza, Marina Gallottini, José Osmar Medina De Abreu Pestana, Paulo Henrique Braz-Silva, Simone Giannecchini
This is a cohort study conducted in a renal transplant unit of the Federal University of São Paulo Kidney and Hypertension Hospital, São Paulo, Brazil. Patients older than 18 years who underwent single kidney transplantation were initially included. Exclusion criteria were kidney transplants associated with another organ, immunosuppressive therapy before initiation of the study, and HIV positivity. This study was approved by the Research Ethics Committees of the Kidney and Hypertension Hospital and of the Osvaldo Ramos Foundation, according to protocol number 2,362,239, and by the University of São Paulo School of Dentistry, according to protocol number 1,824,857, following the ethical standards set by the Declaration of Helsinki. All the participants signed a free informed consent form before being examined in two different periods, always by the same examiner, as follows: the first examination within 24 hours before renal transplantation and the second 60 days after the surgery. All clinical data in the patients’ charts, including laboratory test values, were assessed. For intraoral examination, the same experienced dentist used the decayed, missing and filled teeth index (DTMF) and community periodontal index of treatment needs (CPITN). Collection of saliva and blood samples was also performed for molecular analysis. Whole saliva samples were obtained without previous stimulation, that is, by asking the patient to spit into a sterile container. Blood samples were collected at the same moment as the saliva collection. After collection and identification, the blood and saliva samples were centrifuged at 800 rpm in a conical tube, and then 500 μL aliquots of the supernatant of each sample obtained after centrifugation were placed into cryotubes for storage in a freezer at −80°C until laboratory analysis.
Longitudinal study on oral shedding of human betaherpesviruses 6 and 7 in renal transplant recipients reveals active replication
Published in Journal of Oral Microbiology, 2020
Jéssica Vasques Raposo, Dmitry José De Santana Sarmento, Rafaela Barbosa Da Silva Pinto, Amanda Oliveira Lopes, Marina Gallottini, Tânia Regina Tozetto-Mendoza, Paulo Henrique Braz-Silva, Vanessa Salete de Paula
The periodontal condition was evaluated by Community Periodontal Index of Treatment Needs (CPITN). Scoring and treatment criteria were defined as follows: 0 = healthy periodontium, 1 = gingival bleeding during probing, 2 = dental calculus, 3 = periodontal pockets (with interproximal attachment loss) 3–5 mm, 4 = periodontal pockets of 6 mm depth [17]. The mean score value was used for statistical analysis.
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