Bartłomiej Górski, *Ewa Grabowska, Renata Górska
Stan tkanek przyzębia brzeżnego u pacjentów po zawale serca w Polsce
Status of marginal periodontal tissues in patients after myocardial infarction in Poland
Department of Periodontology and Oral Diseases, Medical University of Warsaw
Head of Department: prof. Renata Górska, DDS, PhD
Summary
Introduction. Periodontitis is associated with numerous risk factors. Many studies have proven the existing relationship between periodontitis and cardiovascular diseases.
Aim. The aim of the study was to assess the state of periodontium in patients after myocardial infarction (MI), as compared to the general population.
Material and methods. The study group consisted of 152 patients after MI. The control group consisted of 160 individuals. Periodontal status was assessed using the classification by Page and Eke. The interview included: gender, age, education, income level and tobacco smoking.
Results. In the study group, periodontitis occurred more frequently than in the control group (84.1 vs 73.1%), including advanced periodontitis (49.7 vs 27.5%) and edentulism (11.3 vs 2.5%). In the study group, correlation was observed between prevalence of periodontitis and gender as well as age.
Conclusions. The periodontal status of patients after MI is clearly worse than that of the general population and not really well-correlated with risk factors.
Introduction
The current classification of periodontitis in Poland is based on the guidelines of the American Academy of Periodontology (AAP) (1). Many authors currently consider the criteria proposed by Page and Eke as the golden standard for epidemiological purposes. This system distinguishes four diagnoses: severe periodontitis, moderate periodontitis, mild periodontitis and no periodontitis or healthy periodontium (2). Special attention is paid to interproximal surfaces as the most critical in the development of periodontitis.
Prevalence of periodontitis in the general population increases with age (3, 4). It is also associated with male gender, low education level, low socioeconomic status and tobacco smoking (5).
Epidemiological studies indicate that patients with periodontitis have an increased risk of myocardial infarction (MI) (6). Until present, no epidemiological studies have been carried out in Poland in patients after MI, using the classification by Page and Eke.
Aim
The aim of the study was to assess the state of periodontium in myocardial infarction (MI), as compared to the general Polish population.
Material and methods
The study included patients (152 individuals: 35 females, 117 males, average age 55.1 years (± 8.0)) with MI hospitalized at the 1st Department and Clinic of Cardiology, Medical University of Warsaw (MUW). The inclusion criteria were: MI history and age below 70 years. All individuals participating in the study granted their consent by signing a declaration approved by the Bioethics Commission at MUW (Opinion No KB-145/2011). Patients diagnosed with cancer, rheumatic disease, autoimmune disease, chronic liver disease, chronic renal disease, stages 4 and 5, and stroke history were excluded. The study control group consisted of individuals aged under 70 years, randomly chosen from the general population (160 individuals: 97 females, 63 males, 55.2 ± 10.0 years).
The periodontal status of each patient was categorized on the basis of the definition by Page and Eke (2).
The prevalence of selected risk factors for periodontal diseases was determined, including:
– education (primary, secondary and higher),
– socioeconomic status (income per family member),
– smoking (current, in the past, never).
Results
Prevalence of periodontitis was significantly higher among patients after MI (84.1 vs 73.1%, p = 0.0005) (tab. 1, fig. 1). The difference was even more pronounced when only severe periodontitis was considered (49.7 vs 27.5%, p < 0.0001). Also edentulism occurred more frequent among patients with MI history (11.3 vs 2.5%, p = 0.0048).
Table 1. Comparison of periodontal state of patients after MI (N = 151) and the general population (N = 160).
| Page and Eke classification | No periodontitis | Mild periodontitis | Moderate periodontitis | Severe periodontitis | Edentulousness | Comparison (χ2 test) |
| MI | 7 (4.6%) | 7 (4.6%) | 45 (29.8%) | 75 (49.7%) | 17 (11.3%) | p = 0.0005 |
| Control group | 39 (24.4%) | 9 (5.6%) | 64 (40.0%) | 44 (27.5%) | 4 (2.5%) |
Fig. 1. The periodontal health of the study group and the control group, according to the Page and Eke classification.
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Piśmiennictwo
1. Armitage GC: Development of a classification system for periodontal diseases and conditions. Ann Periodontol 1999; 4: 1-6. 2. Page RC, Eke PI: Case definitions for use in population-based surveillance of periodontitis. J Periodontol 2007; 78 (suppl. 7): 1387-1399. 3. Demmer RT, Papapanou PN: Epidemiologic patterns of chronic and aggresive periodontitis. Periodontol 2000 2010; 53: 28-44. 4. Zawada Ł, Chrząszczyk D, Konopka T: Definitions of periodontitis in selected group of Wrocław adult residents. Dent Med Probl 2012; 49: 537-542. 5. Thornton-Veans G, Eke P, Wei L et al.: Periodotitis among adults aged ≥ 30 years – United States, 2009-2010. MMWR 2013; 62: 129-135. 6. Dietrich T, Sharma P, Walter C et al.: The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Periodontol 2013; 84 (suppl. 4): 70-84. 7. Górski B, Włososwicz M, Dembowska E et al.: More than 40% of patients after cardiac infarct require immediate appliaction of specialist periodontal treatment. Mag Stom 2014; 1: 95-98. 8. Włosowicz M, Wożakowska-Kapłon B, Górska R: Oral health status in patients with myocardial infarction and patients with stable angina. Now Stom 2012; 2: 75-79. 9. Bochniak M, Sadlak-Nowicka J, Rynkiewicz A, Kusiek A: Relationship between periodontal status and the incidence of acute myocardial infarction. J Stoma 2011; 64: 579-597. 10. Sosińska K: Occurence of periodontitis in patients after acute myocardial infarction. PhD Thesis, Pomorski Uniwersytet Medyczny, Szczecin 2014.
