CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 8, September 2013
308
AFRICA
Carotid and popliteal artery intima–media thickness in
patients with poor oral hygiene and the association with
acute-phase reactants
IHSAN SAMI UYAR, MEHMET BESIR AKPINAR, VEYSEL SAHIN, ELIF FILIZ YASA, FEYZI ABACILAR,
VOLKAN YURTMAN, FAIK FEVZI OKUR
Abstract
Purpose:
The aim of this study was to evaluate whether poor
oral hygiene is associated with carotid and popliteal arterial
intima–media thickness, which is one of the predictors of
future progression of sub-clinical atherosclerosis, and high-
sensitivity C-reactive protein (hsCRP) and fibrinogen levels.
Methods:
A specialised dentist checked the patients and
selected 550 patients during periodontal examinations,
according to their oral hygiene. The patients had no history
of atherosclerotic disease. Carotid and popliteal artery
B-mode ultrasonographic examinations and hsCRP and
fibrinogen levels were analysed at baseline and after a mean
of 6.2 months. The patients were scored on the DMFT index
for the number of decayed (D), missing (M), and filled (F)
teeth (T). We also used the Silness-Loe plaque index (SLI) to
evaluate oral hygiene and dental plaque. The patients were
divided into two groups using the DMFT and SLI criteria.
Group I had a DMFT index score from 0 to 3 and SLI index
score of 0 or 1. Group II had a DMFT index score from 4 to
28 and SLI index score of 2 or 3.
Results:
A significant association was observed between
dental status, oral hygiene, carotid and popliteal artery inti-
ma–media thickness and hsCRP level. Patients with increas-
ing DMFT and SLI scores correlated with increasing carotid
artery intima–media thickness.
Conclusions:
The results clearly showed that chronic poor
oral hygiene and tooth loss are related to sub-clinical athero-
sclerotic changes in the carotid arteries and may be indicative
of future progression of atherosclerosis.
Keywords:
tooth loss, periodontal disease, infection, atheroscle-
rosis
Submitted 15/5/13, accepted 19/6/13
Published online 12/8/13
Cardiovasc J Afr
2013;
24
: 308–312
DOI: 10.5830/CVJA-2013-051
Cardiovascular diseases (CVDs) have been the most common
cause of death and disability in recent decades. It is not true
that conventional risk factors for atherosclerosis account for
all atherosclerotic entities, and it has been postulated that novel
risk factors such as poor oral hygiene and dental or periodontal
disease are potentially associated with atherosclerosis.
1-3
Several studies have reported a close association between
CVDs and poor oral hygiene.
4,5
In particular, it has been
speculated that chronic inflammation triggered by poor oral
hygiene pathophysiologically plays a role in the aetiology of
atherosclerosis.
6,7
In this study, we investigated whether poorer
oral hygiene and/or periodontal disease indicated sub-clinical
atherosclerosis and whether there was any relationship between
periodontal disease and poor oral hygiene, and carotid–popliteal
arterial intima–media thickness, and hsCRP and fibrinogen
levels.
Methods
In this study, out-patients were evaluated for oral hygiene and
dental status at Sifa University Hospital’s School of Dentistry.
DMFT index scores, which describe dental status, were obtained
by calculating the number of decayed (D), missing (M) and
filled (F) teeth (T). We also used the Silness-Loe plaque index
(SLI index) to evaluate oral hygiene and dental plaque.
1-4
The
mean index was calculated after the evaluation of all teeth and
surfaces. A specialised dentist checked patients and decided who
could join the study.
Ultimately, 550 out-patients with chronic poor oral hygiene
were included in the study. The patients were divided into two
groups using the DMFT and SLI index scores as criteria. Group
I had a DMFT index score from 0 to 3, no to mild periodontal
disease, a SLI index score of 0 or 1, good to mild oral hygiene
(
n
=
125; mean DMFT 1.1
±
1.56; mean SLI 0.56
±
0.32; 74
males, 51 females, mean age 48.75
±
9.72 years, range 29–78
years). Group II had a DMFT index score from 4 to 28, severe
periodontal disease, a SLI index score from 2 to 3, and poor oral
hygiene (
n
=
425; mean DMFT 19.82
±
6.44; mean SLI 2.76
±
3.42; 262 males, 163 females, mean age 50.15
±
9.80 years,
range 30–78 years).
The mean follow-up time for all patients was 6.2 months
(range 4.1–8.6 months). Patients were assessed after diagnosis,
post treatment, and six months later. All patients were treated
conservatively for two months with systemic antibiotics and
local treatment.
The carotid and popliteal arteries were examined with B-mode
ultrasonography, and a carotid or popliteal arterial intima–media
thickness of 1 to 2 mm was considered positive, and of up to 2
mm strongly positive for sub-clinical early atherosclerosis. We
also measured hsCRP and fibrinogen levels in the blood. An
Department of Cardiovascular Surgery, Medical Faculty,
Sifa University, Izmir, Turkey
IHSAN SAMI UYAR, MD,
MEHMET BESIR AKPINAR, MD
VEYSEL SAHIN, MD
FEYZI ABACILAR, MD
VOLKAN YURTMAN, MD
FAIK FEVZI OKUR, MD
Faculty of Dentistry, Sifa University, Izmir, Turkey
ELIF FILIZ YASA, BDS
