Pathological periodontal pockets are associated with raised diastolic blood pressure in obese adolescents

BMC Oral Health

Thomas Modéer²  Claude Marcus¹  Biniyam Wondimu²  Cecilia C Zeigler² 

[1] National Childhood Obesity Centre, Division of Pediatrics Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, SE-141 04, Stockholm, Sweden

关键词: Periodontal disease;    Hypertension;    Adolescents;    Obesity;   

Others  :  1142260
DOI  :  10.1186/s12903-015-0026-6

 received in 2015-01-26, accepted in 2015-03-10,  发布年份 2015

【 摘 要 】

Background

Obesity, a well-known risk factor for developing cardiovascular disease (CVD), is associated with chronic periodontitis in adults. This cross-sectional pilot study on obese adolescents was designed to investigate whether periodontal disease in terms of pathological periodontal pockets is associated with raised blood pressure and other risk markers for CVD.

Methods

The study included 75 obese subjects between 12 to 18 years of age, mean 14.5. Subjects answered a questionnaire regarding health, oral hygiene habits and sociodemographic factors. A clinical examination included Visible Plaque Index (VPI %), Gingival inflammation (BOP %) and the occurrence of pathological pockets exceeding 4 mm (PD ≥ 4 mm). Blood serum were collected and analyzed. The systolic and diastolic blood pressures were registered.

Results

Adolescents with pathological periodontal pockets (PD ≥ 4 mm; n = 14) had significantly higher BOP >25% (P = 0.002), higher diastolic blood pressure (P = 0.008), higher levels of Interleukin (IL)-6 (P < 0.001), Leptin (P = 0.018), Macrophage Chemoattractant Protein-1 (MCP-1) (P = 0.049) and thyroid stimulating hormone (TSH) (P = 0.004) in blood serum compared with subjects without pathological periodontal pockets (PD ≥ 4 mm; n = 61). The bivariate linear regression analysis demonstrated that PD ≥ 4 mm (P = 0.008) and systolic blood pressure (P < 0.001) were significantly associated with the dependent variable “diastolic blood pressure”. The association between PD ≥ 4 mm and diastolic blood pressure remained significant (P = 0.006) even after adjusting for potential confounders BMI-sds, age, gender, mother’s country of birth, BOP >25%, IL-6, IL-8, Leptin, MCP-1, TSH and total cholesterol in the multiple regression analysis.

Conclusion

In conclusion, this study indicates an association between pathological periodontal pockets and diastolic blood pressure in obese adolescents. The association was unaffected by other risk markers for cardiovascular events or periodontal disease. The results call for collaboration between pediatric dentists and medical physicians in preventing obesity development and its associated disorders.

【 授权许可】

   
2015 Zeigler et al.; licensee BioMed Central.

【 参考文献 】

• [1]Modeer T, Blomberg C, Wondimu B, Lindberg TY, Marcus C: Association between obesity and periodontal risk indicators in adolescents. Int J Pediatr Obes 2011, 6:264-70.
• [2]Saito T, Shimazaki Y, Sakamoto M: Obesity and periodontitis. N Engl J Med 1998, 339:482-3.
• [3]Suvan J, D'Aiuto F, Moles DR, Petrie A, Donos N: Association between overweight/obesity and periodontitis in adults. A systematic review. Obes Rev 2011, 12:381-404.
• [4]Chaffee BW, Weston SJ: Association between chronic periodontal disease and obesity: a systematic review and meta-analysis. J Periodontol 2010, 81:1708-24.
• [5]Libby P: Inflammation in atherosclerosis. Nature 2002, 420:868-74.
• [6]Brevetti G, Schiano V, Chiariello M: Endothelial dysfunction: a key to the pathophysiology and natural history of peripheral arterial disease? Atherosclerosis 2008, 197:1-11.
• [7]Dervaux N, Wubuli M, Megnien JL, Chironi G, Simon A: Comparative associations of adiposity measures with cardiometabolic risk burden in asymptomatic subjects. Atherosclerosis 2008, 201:413-7.
• [8]Martynowicz H, Janus A, Nowacki D, Mazur G: The role of chemokines in hypertension. Adv Clin Exp Med 2014, 23:319-25.
• [9]Yucel-Lindberg T, Bage T: Inflammatory mediators in the pathogenesis of periodontitis. Expert Rev Mol Med 2013, 15:7.
• [10]Teles R, Wang CY: Mechanisms involved in the association between periodontal diseases and cardiovascular disease. Oral Dis 2011, 17:450-61.
• [11]Gupta M, Chaturvedi R, Jain A: Role of monocyte chemoattractant protein-1 (MCP-1) as an immune-diagnostic biomarker in the pathogenesis of chronic periodontal disease. Cytokine 2013, 61:892-7.
• [12]Ahima RS, Osei SY: Adipokines in obesity. Front Horm Res 2008, 36:182-97.
• [13]Gomes MS, Blattner TC, Sant'Ana Filho M, Grecca FS, Hugo FN, Fouad AF, et al.: Can apical periodontitis modify systemic levels of inflammatory markers? A systematic review and meta-analysis. J Endod 2013, 39:1205-17.
• [14]Leong XF, Ng CY, Badiah B, Das S: Association between Hypertension and Periodontitis: Possible Mechanisms. Sci World J 2014, 2014:768237.
• [15]Higashi Y, Goto C, Hidaka T, Soga J, Nakamura S, Fujii Y, et al.: Oral infection-inflammatory pathway, periodontitis, is a risk factor for endothelial dysfunction in patients with coronary artery disease. Atherosclerosis 2009, 206:604-10.
• [16]Caula AL, Lira-Junior R, Tinoco EM, Fischer RG: The effect of periodontal therapy on cardiovascular risk markers: a 6-month randomized clinical trial. J Clin Periodontol 2014, 41:875-82.
• [17]D'Aiuto F, Parkar M, Nibali L, Suvan J, Lessem J, Tonetti MS: Periodontal infections cause changes in traditional and novel cardiovascular risk factors: results from a randomized controlled clinical trial. Am Heart J 2006, 151:977-84.
• [18]Bresolin AC, Pronsatti MM, Pasqualotto LN, Nassar PO, Jorge AS, da Silva EA, et al.: Effectiveness of periodontal treatment on the improvement of inflammatory markers in children. Arch Oral Biol 2014, 59:639-44.
• [19]Vidal F, Cordovil I, Figueredo CM, Fischer RG: Non-surgical periodontal treatment reduces cardiovascular risk in refractory hypertensive patients: a pilot study. J Clin Periodontol 2013, 40:681-7.
• [20]Sundstrom J, Neovius M, Tynelius P, Rasmussen F: Association of blood pressure in late adolescence with subsequent mortality: cohort study of Swedish male conscripts. BMJ 2011, 342:643.
• [21]Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, et al.: Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. Blood Press 2009, 18:308-47.
• [22]Rolland-Cachera MF, Sempe M, Guilloud-Bataille M, Patois E, Pequignot-Guggenbuhl F, Fautrad V: Adiposity indices in children. Am J Clin Nutr 1982, 36:178-84.
• [23]Ainamo J, Bay I: Problems and proposals for recording gingivitis and plaque. Int Dent J 1975, 25:229-35.
• [24]Franchini R, Petri A, Migliario M, Rimondini L: Poor oral hygiene and gingivitis are associated with obesity and overweight status in paediatric subjects. J Clin Periodontol 2011, 38:1021-8.
• [25]Lurbe E, Alvarez V, Liao Y, Tacons J, Cooper R, Cremades B, et al.: The impact of obesity and body fat distribution on ambulatory blood pressure in children and adolescents. Am J Hypertens 1998, 11:418-24.
• [26]Polderman J, Gurgel RQ, Barreto-Filho JA, Roelofs R, Ramos RE, de Munter JS, et al.: Blood pressure and BMI in adolescents in Aracaju, Brazil. Public Health Nutr 2011, 14:1064-70.
• [27]Camhi SM, Katzmarzyk PT: Prevalence of cardiometabolic risk factor clustering and body mass index in adolescents. J Pediatr 2011, 159:303-7.
• [28]Cao ZQ, Zhu L, Zhang T, Wu L, Wang Y: Blood pressure and obesity among adolescents: a school-based population study in China. Am J Hypertens 2012, 25:576-82.
• [29]McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ: Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 2007, 150:640-4.
• [30]Mourato FA, Lima Filho JL, Mattos SD. Comparison of different screening methods for blood pressure disorders in children and adolescents. J Pediatria. 2014. doi:10.1016/j.jped.2014.08.008.
• [31]Xi B, Zhang M, Zhang T, Li S, Steffen LM: Simplification of childhood hypertension definition using blood pressure to height ratio among US youths aged 8-17years, NHANES 1999–2012. Int J Cardiol 2015, 180:210-3.
• [32]Flynn JT, Daniels SR, Hayman LL, Maahs DM, McCrindle BW, Mitsnefes M, et al.: Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension 2014, 63:1116-35.
• [33]Buchanan S, Orris P, Karliner J: Alternatives to the mercury sphygmomanometer. J Public Health Policy 2011, 32:107-20.
• [34]National High Blood Pressure Education Program Working Group on High Blood Pressure in C, Adolescents: The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents Pediatrics 2004, 114:555-76.
• [35]Westerstahl M, Marcus C: Association between nocturnal blood pressure dipping and insulin metabolism in obese adolescents. Int J Obes (Lond) 2010, 34:472-7.
• [36]Nakajima T, Yamazaki K: Periodontal disease and risk of atherosclerotic coronary heart disease. Odontology 2009, 97:84-91.
• [37]Tonetti MS, Van Dyke TE: working group 1 of the joint EFPAAPw: Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol 2013, 84:24-9.
• [38]Gundala R, Vk C, Ramalingam K: Association of Leptin in Periodontitis and Acute Myocardial Infarction. J Periodontol 2012, 85:917-24.
• [39]Cochran DL: Inflammation and bone loss in periodontal disease. J Periodontol 2008, 79:1569-76.
• [40]Simonds SE, Pryor JT, Ravussin E, Greenway FL, Dileone R, Allen AM, et al.: Leptin mediates the increase in blood pressure associated with obesity. Cell 2014, 159:1404-16.
• [41]Shimada Y, Komatsu Y, Ikezawa-Suzuki I, Tai H, Sugita N, Yoshie H: The effect of periodontal treatment on serum leptin, interleukin-6, and C-reactive protein. J Periodontol 2010, 81:1118-23.
• [42]Nannipieri M, Cecchetti F, Anselmino M, Camastra S, Niccolini P, Lamacchia M, et al.: Expression of thyrotropin and thyroid hormone receptors in adipose tissue of patients with morbid obesity and/or type 2 diabetes: effects of weight loss. Int J Obes (Lond) 2009, 33:1001-6.
• [43]Asvold BO, Bjoro T, Vatten LJ: Associations of TSH levels within the reference range with future blood pressure and lipid concentrations: 11-year follow-up of the HUNT study. Eur J Endocrinol 2013, 169:73-82.
• [44]Klein I, Danzi S: Thyroid disease and the heart. Circulation 2007, 116:1725-35.
• [45]Weiss IA, Bloomgarden N, Frishman WH: Subclinical hypothyroidism and cardiovascular risk: recommendations for treatment. Cardiol Rev 2011, 19:291-9.
• [46]Lee KS, Lee SG, Kim EK, Jin HJ, Im SU, Lee HK, et al.: Metabolic Syndrome Parameters in adolescents may be determinants for the future periodontal diseases. J Clin Periodontol 2015, 42:105-12.
• [47]Tsakos G, Sabbah W, Hingorani AD, Netuveli G, Donos N, Watt RG, et al.: Is periodontal inflammation associated with raised blood pressure? Evidence from a National US survey. J Hypertens 2010, 28:2386-93.