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  1. All, As I've elaborated on elsewhere, I'm rather obsessive about dental hygiene. This is in part because I want to avoid cavities, but also out of a vague awareness of studies linking teeth & gum problems with heart attack risk, likely mediated by systemic inflammation induced by chronic oral infections. So I was happy to see my recall of the linkage between poor dental health and cardiovascular disease supported by this new study [2], as well as this review [1] of many previous studies, both of which were shared by Al Pater (thanks Al!). From the review [1]: [N]ew onset as well as prevalent periodontitis is associated with increased coronary heart disease risk,7 and there is a graded association between tooth loss and stroke, cardiovascular death, and all-cause mortality in patients with stable coronary artery disease.8 From the case-control study [2]: There was an increased risk for [heart attack] among those with [periodontal disease] (OR = 1.49; 95% CI 1.21-1.83), which remained significant (OR =1.28; 95% CI 1.03-1.60) after adjusting for variables that differed between patients and controls (smoking habits, diabetes, years of education and marital status). So we should all be taking good care of our teeth and gums if we want to avoid cardiovascular disease. --Dean ----------------- [1] Circulation. 2016 Jan 13. pii: CIRCULATIONAHA.115.020869. [Epub ahead of print] Increasing Evidence for an Association Between Periodontitis and Cardiovascular Disease. Stewart R, West M. http://circ.ahajournals.org.sci-hub.io/content/early/2016/01/13/CIRCULATIONAHA.115.020869.abstract Abstract Periodontitis is a chronic inflammatory disease caused by bacterial colonisation, which results in destruction of the tissues between the tooth surface and gingiva, loss of connective tissue attachment, erosion of alveolar bone and tooth loss.1 Periodontitis is common and increases with age. In a US survey about half of adults aged over 30 years have some periodontitis and almost 10% have severe disease.2 Evidence for an association between periodontitis and atherosclerotic vascular disease, including stroke, myocardial infarction, peripheral vascular disease, abdominal aortic aneurysm, coronary heart disease and cardiovascular death, comes from more than 50 prospective cohort and case control studies undertaken during the last 25 years.3-6 More recent analyses from large cohort studies suggest new onset as well as prevalent periodontitis is associated with increased coronary heart disease risk,7 and there is a graded association between tooth loss and stroke, cardiovascular death, and all-cause mortality in patients with stable coronary artery disease.8 If causal, these associations would be of great importance because of the potential that preventing or treating periodontal disease could reduce the risk of major adverse cardiovascular events. KEYWORDS: Editorial; cardiovascular disease risk factors; periodontitis; teeth PMID: 26762522 --------------- [2] Circulation. 2016 Jan 13. pii: CIRCULATIONAHA.115.020324. [Epub ahead of print] Periodontitis Increases the Risk of a First Myocardial Infarction: A Report From the PAROKRANK Study. Rydén L, Buhlin K, Ekstrand E, de Faire U, Gustafsson A, Holmer J, Kjellström B, Lindahl B, Norhammar A, Nygren Å, Näsman P, Rathnayake N, Svenungsson E, Klinge B. Abstract BACKGROUND: -The relationship between periodontitis (PD) and cardiovascular disease (CVD) is debated. PD is common in patients with CVD. It has been postulated that PD could be causally related to the risk for CVD, a hypothesis tested in PAROKRANK. METHODS AND RESULTS: -805 patients (age <75 years) with a first MI and 805 age (mean 62±8), gender (male 81%) and area matched controls without MI underwent standardized dental examination including panoramic x-ray. The periodontal status was defined as healthy (=/>80% remaining bone) or as mild-moderate (79-66%) or severe PD (<66%). Great efforts were made to collect information on possibly related confounders (~100 variables). Statistical comparisons included Student's pair-wise t-test and Mc Nemar's test in 2x2 contingency tables. Contingency tables exceeding 2x2 with ranked alternatives were tested by Wilcoxon signed rank test. Odds Ratios (95% CI) were calculated by conditional logistic regression. PD was more common (43%) in patients than in controls (33%; p<0.001). There was an increased risk for MI among those with PD (OR = 1.49; 95% CI 1.21-1.83), which remained significant (OR =1.28; 95% CI 1.03-1.60) after adjusting for variables that differed between patients and controls (smoking habits, diabetes, years of education and marital status). CONCLUSIONS: -In this large case-control study of PD, verified by radiographic bone loss and with a careful consideration of potential confounders, the risk of a first MI was significantly increased in patients with PD even after adjustment for confounding factors. These findings strengthen the possibility of an independent relationship between PD and MI. KEYWORDS: cardiovascular disease risk factors; myocardial infarction; panoramic dental radiography (OPG); periodontitis PMID: 26762521
  2. All, There seems to be growing evidence that systemic inflammation is involved in many diseases of aging, including cardiovascular disease, diabetes and cognitive impairment / Alzheimer's disease. This new study [1] speaks to the latter. It found the rate of cognitive decline in people suffering from mild cognitive impairment or early-stage Alzheimer's disease was 6x higher in those people who also suffered from periodontal disease, likely as a result of the systemic inflammatory effects of the subjects' infected gums. So take care of those teeth and gums! --Dean ---------- [1] PLoS One. 2016 Mar 10;11(3):e0151081. doi: 10.1371/journal.pone.0151081. eCollection 2016. Periodontitis and Cognitive Decline in Alzheimer's Disease. Ide M(1), Harris M(2), Stevens A(3), Sussams R(2,)(3), Hopkins V(3), Culliford D(4), Fuller J(5), Ibbett P(5), Raybould R(6), Thomas R(6), Puenter U(5), Teeling J(5), Perry VH(5), Holmes C(2,)(3). Author information: (1)Dental Institute, Kings College London, Guy's Hospital, London, United Kingdom. (2)University of Southampton, Faculty of Medicine, Clinical Experimental Science, Southampton, United Kingdom. (3)Memory Assessment and Research Centre, Moorgreen Hospital, Southampton, United Kingdom. (4)University of Southampton, Faculty of Health Sciences, NIHR CLAHRC Wessex Methodological Hub, Southampton, United Kingdom. (5)University of Southampton, Faculty of Natural and Environmental Science, Centre for Biological Sciences, Southampton, United Kingdom. (6)Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom. Free full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786266/ Periodontitis is common in the elderly and may become more common in Alzheimer's disease because of a reduced ability to take care of oral hygiene as the disease progresses. Elevated antibodies to periodontal bacteria are associated with an increased systemic pro-inflammatory state. Elsewhere raised serum pro-inflammatory cytokines have been associated with an increased rate of cognitive decline in Alzheimer's disease. We hypothesized that periodontitis would be associated with increased dementia severity and a more rapid cognitive decline in Alzheimer's disease. We aimed to determine if periodontitis in Alzheimer's disease is associated with both increased dementia severity and cognitive decline, and an increased systemic pro inflammatory state. In a six month observational cohort study 60 community dwelling participants with mild to moderate Alzheimer's Disease were cognitively assessed and a blood sample taken for systemic inflammatory markers. Dental health was assessed by a dental hygienist, blind to cognitive outcomes. All assessments were repeated at six months. The presence of periodontitis at baseline was not related to baseline cognitive state but was associated with a six fold increase in the rate of cognitive decline as assessed by the ADAS-cog over a six month follow up period. Periodontitis at baseline was associated with a relative increase in the pro-inflammatory state over the six month follow up period. Our data showed that periodontitis is associated with an increase in cognitive decline in Alzheimer's Disease, independent to baseline cognitive state, which may be mediated through effects on systemic inflammation. PMCID: PMC4786266 PMID: 26963387
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