Self-reported periodontal health and incident hypertension: longitudinal evidence from the NutriNet-Santé e-cohort.

OBJECTIVE: An association between periodontitis and arterial hypertension has been suggested recently. This study aimed at investigating the hypothesis that periodontal health is linked to incident arterial hypertension. METHODS: We analyzed data from the French population-based e-cohort NutriNet-Santé, selecting participants who had completed two oral health questionnaires in 2011-2012. Pregnant women, participants with diabetes, cancer, arterial hypertension and cardiovascular diseases at inclusion were excluded. Incident cases of arterial hypertension were self-reported and/or based on the use of antihypertensive therapy. Periodontal health was evaluated by estimating the modified and validated PEriodontal Screening Score (mPESS), with mPESS at least 5 corresponding to a high probability of severe periodontitis. Descriptive statistics and Cox proportional hazards regression models, taking into account sociodemographic and lifestyle confounders, were used. RESULTS: The study population consisted of 32 285 participants (mean age: 45.79 ±â€Š13.87 years); 78.5% were women. Two thousand one hundred and sixteen incident cases of arterial hypertension were identified during a median follow-up of 8 years (April 2012--December 2019). In the fully adjusted model, an mPESS at least 5 [hazard ratio: 1.84; 95% confidence interval (CI): 1.66-2.03] and the presence of nonreplaced missing teeth (hazard ratio: 1.13; 95% CI: 1.03-1.23) were significantly associated with a greater risk of incident arterial hypertension, whereas a regular annual visit to the dentist was associated with a lower risk (hazard ratio: 0.88; 95% CI: 0.80-0.97). CONCLUSION: Self-reported assessed periodontitis was associated with incident arterial hypertension over an 8-year period. The present results highlight the importance of considering periodontal health when assessing an individual's risk of arterial hypertension. TRIAL REGISTRATION: # NCT03335644.

Modified Coronally Advanced Tunnel Technique with Site-Specific Application of Connective Tissue Graft for the Treatment of Multiple Adjacent Maxillary Gingival Recessions: A Case Series.

The aim of the present case series was to evaluate the outcomes of the modified coronally advanced tunnel technique (MCAT) using the width of keratinized tissue (KTW) as an indicator to apply the connective tissue graft (CTG) specifically. Seven patients requiring treatment for the presence of multiple gingival RT1 recession defects in the maxilla were enrolled in the study. A total of 36 recessions were treated with MCAT, and the CTG was applied in 16 sites presenting < 2 mm of KTW at baseline. The mean root coverage from baseline to 1 year postsurgery was 90% for the sites treated with MCAT alone and 93.7% for those treated with MCAT+CTG. The increase of KTW was higher in the sites treated with CTG than in the sites treated without it. Within the limitations of the present case series, it can be concluded that the proposed surgical technique is extremely effective in gaining root coverage and reducing the amount of connective tissue harvested from the donor site.

Association between periodontitis and pulse wave velocity: a systematic review and meta-analysis.

OBJECTIVES: Severe periodontitis has been associated with endothelial dysfunction and arterial stiffness. The present study aimed to provide a critical appraisal and a meta-analysis of the literature investigating pulse wave velocity (PWV) in patients with and without severe periodontitis and to assess whether treatments influence PWV. MATERIALS AND METHODS: English literature was searched on multiple databases up to April 2020 by two independent reviewers. Studies comparing PWV between patients with and without severe periodontitis or assessing the impact of periodontal treatments on PWV were searched and retrieved. Pool data analyses with random effect models were performed. The risk of bias was assessed using Newcastle-Ottawa Scale and RoB2 tools. RESULTS: Seventeen studies were selected. Of these, 10 were used for the meta-analysis. Twelve were cross-sectional studies and 5 interventional studies, including 3176 patients, of whom 1894 had severe periodontitis and 1282 were considered as the controls (without severe periodontitis). Based on carotid-femoral PWV measurement, patients with severe periodontitis (n = 309) have a significantly higher PVW than patients with non-severe periodontitis (n = 213), with a mean difference of 0.84 m/s (95% CI 0.50-1.18; p < 0.0001; I2 = 5%). Similarly, carotid-radial or brachial-ankle PWV values were significantly higher in patients with severe periodontitis. Results concerning the effect of non-surgical periodontal therapy were not conclusive. Overall, 9 studies (53%) were classified at a low risk of bias. CONCLUSIONS: The present study demonstrates that patients with severe periodontitis have higher PWV compared to patients with non-severe periodontitis. CLINICAL SIGNIFICANCE: Severe periodontitis is associated with arterial stiffness, supporting the mutual involvement of dentists and physicians.

Oral health in relation to all-cause mortality: the IPC cohort study.

We evaluated the association between oral health and mortality. The study population comprised 76,188 subjects aged 16-89 years at recruitment. The mean follow-up time was 3.4 ± 2.4 years. Subjects with a personal medical history of cancer or cardiovascular disease and death by casualty were excluded from the analysis. A full-mouth clinical examination was performed in order to assess dental plaque, dental calculus and gingival inflammation. The number of teeth and functional masticatory units <5 were recorded. Causes of death were ascertained from death certificates. Mortality risk was evaluated using Cox regression model with propensity score calibrated for each oral exposure. All-cause mortality risk were raised with dental plaque, gingival inflammation, >10 missing teeth and functional masticatory units <5. All-cancer mortality was positively associated with dental plaque and gingival inflammation. Non-cardiovascular and non-cancer mortality were also positively associated with high dental plaque (HR = 3.30, [95% CI: 1.76-6.17]), high gingival inflammation (HR = 2.86, [95% CI: 1.71-4.79]), >10 missing teeth (HR = 2.31, [95% CI: 1.40-3.82]) and functional masticatory units <5 (HR = 2.40 [95% CI 1.55-3.73]). Moreover, when ≥3 oral diseases were cumulated in the model, the risk increased for all-cause mortality (HR = 3.39, [95% CI: 2.51-5.42]), all-cancer mortality (HR = 3.59, [95% CI: 1.23-10.05]) and non-cardiovascular and non-cancer mortality (HR = 4.71, [95% CI: 1.74-12.7]). The present study indicates a postive linear association between oral health and mortality.

Oral Health and Blood Pressure: The IPC Cohort.

BACKGROUND: Chronic periodontal diseases involve bacteria-induced inflammation of the tissues supporting the teeth. An inflammatory origin for hypertension has been proposed, and periodontal diseases are associated with an increased risk of vascular disease. The present study was performed to assess whether oral health conditions were associated with the risk of hypertension in adult population. METHODS: The sample comprised 102,330 subjects, who underwent medical and oral examinations between 2002 and 2011. A full-mouth clinical examination was performed using simplified plaque index, calculus index, and simplified modified gingival index to assess dental plaque, dental calculus and gingival inflammation. The number of teeth was recorded. Biological parameters, including blood pressure were assessed. A subset analysis according to age (<65 or ≥65 years) was conducted. The association between blood pressure and oral conditions was explored using a logistic regression approach. RESULTS: In the sample of subject ≥65 years, no significant association was found between oral variables and the risk of hypertension. In subset <65 years, oral variables and risk of hypertension were associated. Insufficient masticatory function and missing teeth (>10) showed odds ratio (OR) = 1.20 [95% CI = 1.08-1.32] and OR = 1.17 [95% CI = 1.04-1.31], respectively. Hypertension was also associated with high level of dental plaque [OR = 1.90, 95% CI = 1.55-2.33], dental calculus [OR = 1.18, 95% CI = 1.07-1.29] and gingival inflammation [OR = 1.56, 95% CI = 1.35-1.80] Moreover, in this subset <65 years, the risk of hypertension increases with the number of dental exposure. CONCLUSIONS: The present study indicates that insufficient masticatory function, poor oral hygiene, and oral inflammation are associated with hypertension in subject <65.