Progression of Periodontal Disease in Cardiovascular Patients

Method: 4,170 patients with a history of CVD were screened and 438 selected (78% males and 22% females: mean age 61.1 +/- 8.5 years) from the Cardiovascular Unit at Prince Charles Hospital.  Six sites per tooth were examined annually for 5 years for probing pocket depth (PPD) and relative attachment level using the Florida Probe. Subgingival plaque was collected from interproximal sites, pooled and RT-PCR used to detect periodontal pathogens.  Data on numbers of sites showing PPD ≥4mm and loss of attachment (LOA) ≥2mm at each examination were analysed using transition modeling and Markov chain modeling of binary responses (<4/≥4 sites with PPD ≥4mm defining healthy/diseased states).

Result: Of the 4170 screened, 38% were edentulous and 31% had <12 teeth and were not included. Of the 438 selected patients, 20% had advanced disease (≥1 pocket ≥6mm) while 4% had 6 or more sites ≥6mm. The number of proximal sites with LOA ≥2mm between visits was significantly associated with the number of sites with PPD ≥4mm at the earlier visit (p< 0.001). Smoking significantly reduced the rate of regression from the diseased state back to the healthy state (p< 0.001); male gender increased both the rate of progression to the diseased state and the rate of regression back to the healthy state (p<0.05). There were no significant effects of the periodontal pathogens (p>0.2).

Conclusion: Findings of the present study indicate that cardiovascular patients have a high level of edentulism and tooth loss and that periodontal pocketing is significantly associated with subsequent attachment loss irrespective of age, smoking or the presence of P. gingivalis. This suggests that cardiovascular patients represent a population susceptible to periodontitis.