Relationship between periodontitis and subclinical risk indicators for chronic non-communicable diseases

Abstract In view of the epidemiological relevance of periodontal disease and chronic noncommunicable diseases, the study aimed to evaluate the relationship between them through subclinical indicators of systemic risk in a population group with healthy habits, including alcohol and tobacco abstinence. A complete periodontal examination of six sites per tooth was performed in a sample of 420 participants from the Advento study (Sao Paulo), submitted to anthropometric and laboratory evaluation. Periodontitis was defined and classified based on the Community Periodontal Index score 3 (periodontal pocket = 4–5 mm) and score 4 (periodontal pocket ≥ 6 mm). The prevalence of mild/moderate and severe periodontitis was 20% and 8.2%, respectively. Both categories of periodontal disease had significantly higher levels of triglycerides, C-reactive protein, calcium score, and calcium percentile, whereas blood glucose after tolerance test was significantly higher among people with severe periodontitis and HDL-c levels were lower (p < 0.05). Young adults with severe periodontitis had significantly higher prevalence of obesity, pre-diabetes, hypertension, and metabolic syndrome. Besides these conditions, the older adults with severe periodontitis had significantly higher prevalence of dyslipidemia and subclinical atherosclerosis. The group with periodontitis had also a higher coronary heart disease risk based on the PROCAM score (p < 0.05). The results indicated associations of periodontitis with several systemic indicators for chronic noncommunicable diseases, and highlighted the need for multiprofessional measures in the whole care of patients.

摘要 鉴于牙周病与慢性非传染性疾病的流行病学相关性，本研究旨在通过全身风险亚临床指标，在具备健康生活习惯（包括戒酒、戒烟）的人群队列中评估二者之间的关联。研究对来自圣保罗Advento研究的420名参与者样本实施了每颗牙齿6个位点的完整牙周检查，所有受试者均接受人体测量学与实验室检测评估。牙周炎依据社区牙周指数（Community Periodontal Index）评分3（牙周袋深度4~5 mm）与评分4（牙周袋深度≥6 mm）进行定义与分类。轻度/中度牙周炎与重度牙周炎的患病率分别为20%与8.2%。两类牙周炎患者的甘油三酯、C反应蛋白、钙化评分及钙化百分位水平均显著升高；而糖耐量试验后血糖水平在重度牙周炎患者中显著更高，高密度脂蛋白胆固醇（HDL-c）水平则更低（p < 0.05）。合并重度牙周炎的年轻成人群体，其肥胖、前驱糖尿病、高血压及代谢综合征的患病率显著更高。除此之外，合并重度牙周炎的老年人群血脂异常与亚临床动脉粥样硬化的患病率同样显著升高。患牙周炎的群体基于PROCAM评分的冠心病发病风险亦显著升高（p < 0.05）。本研究结果表明，牙周炎与多项慢性非传染性疾病的全身指标存在关联，同时强调了在患者全周期照护中采取多学科干预措施的必要性。