The document summarizes research into the relationship between chronic periodontitis (gum disease) and coronary heart disease (CHD). It first outlines the hypothesis that periodontitis can be statistically and mechanically linked to CHD. It then reviews literature showing a statistical association between dental infections and heart attacks. Studies found higher rates of gum issues in heart patients versus controls. Additional research demonstrated that the bacteria P. gingivalis accelerated atherosclerosis in mice. The conclusion is that periodontitis may be a better predictor of heart disease risk than traditional CHD risk factors.

1. A relationship to the Heart
Chronic Periodontitis
By: Miquise D. Carlton
North Carolina Agricultural & Technical State University
Senior Capstone 469
Drs. White & Lang

2. Introduction
Question &
Hypothesis
Background Mechanical Linkage
Statistical Linkage
Literature
Review
Conclusion
Conclusion
Questions
References

3. Introduction:

4. › Question:
– Focusing on the question is there a correlation between chronic oral infections-
chronic periodontitis- and coronary heart disease?
› Hypothesis:
– If adult periodontitis can be linked to CHD- statistically and mechanically, then the
main disease responsible for cardiovascular morbidity will be evinced. Furthermore,
adult periodontitis can be a more accurate predictor and descriptor of those at risk
for heart disease, rather than traditional risk factors prescribed by the American
Heart Association.
Question & Hypothesis:

5. › Chronic Periodontitis:
– A severe case of inflammation around an individuals’ tooth
– Begins with bacterial growth
› Loosens the gums, while creating pockets between the gum-line and the tooth
› If not treated within a timely fashion, the bones, gums, and the connective
tissue will be destroyed and could possibly lead to the removal of many teeth
due to the destruction.
› The bacteria could enter the bloodstream and effect other areas within the
body.
– Other factors contributing:
› Hormonal changes, illnesses, smoking, medications, bad habits, poor oral
hygiene habits, and family history of dental disease.
Background:

6. › Coronary Heart Disease:
– Leading cause of death
amongst men and women
– Is the narrowing of the small
blood vessels that supply
oxygen-rich blood to the
heart.
– Build-up of plaque in the
arties of the human heart.
Background con’t

7. Literature Review:

8. Statistical Linkage

9. › Investigate whether a statistically significant association between periodontal disease
and coronary heart disease could be established
› Proven in the discovery that dental chronic inflammatory diseases correlate with the
occurrence of acute myocardial infarction (AMI); thusly, periodontal diseases can be
viewed as possible risk factors for CHD.
Group Test
Population
Mean Age
(years)
% Male % Female
Experimental
(Patients with
AMI)
125 61.8 (SD=10.7) 85 15
Control
(Healthy
Patients)
125 63.4 (SD=10.7) 82 18

10. › Official Title:
– Basic Group Characteristics (SD or in Percentage)
and P values for Differences between 125 Patients
with AMI and 125 Healthy Control Patients
› Simplified Title:
– Characteristics and P values for differences between
patients with AMI and healthy patients
– 4 variables that impact Will’s hypothesis are factors
of periodontitis
– 2 variables that impact Will’s hypothesis are
American Heart Association factors of CHD
– **Age & Gender not significant b/c average age and
% male and %female in both control and
experimental groups are so close **See Previous
Slide
P-Value Implications

11. › Official Title:
– Frequency of apical lesions in patients with AMI and
healthy control patients.
› Simplified Title:
– Rate of recurrence of apical lesions in patients with
AMI and healthy control patients.
P-Value Implications: Apical Lesions
Group 0 Apical Lesion 1 Apical Lesion 2 Apical Lesion 3+ Apical Lesion
Experimental
(Patients with
AMI)
35.8%
(44.75 patients)
22.8%
(28.5 patients)
22.0%
(27.5 patients)
19.5%
(24.375 patients)
Control (Healthy
Patients)
48.8%
(61 patients)
34.9%
(43.625 patients)
14.0%
(17.5 patients)
2.3%
(2.875 patients)

12. › PSI = Pathogen (within the Oral Cavity) Severity Index
› Official Title:
– PSI (degree: 0-4) distribution in patients after AMI
and healthy control patients.
› Simplified Title:
– Periodontal screening index of information about
existing
P-Value Implications: PSI
Group PSI 1 PSI 2 PSI 3 PSI 4
Experimental
(Patients with
AMI)
0.8%
(1 patient)
12.5%
(15.625 patients)
45.2%
(56.5 patients)
42.3%
(52.8 patients)
Control (Healthy
Patients)
0.8%
(1 patient)
33.3%
(41.625 patients)
48.8%
(61 patients)
17.1%
(21.375 patients)

13. › Proven: dental chronic inflammatory diseases correlate with the
occurrence of acute myocardial infarction (AMI); thusly, periodontal
diseases can be viewed as possible risk factors for CHD.
– P-Value Significance
– Evidence in Data Analysis (graphs)
Statistical Summary

14. Mechanical Linkage

15. › Atherosclerotic coronary artery disease,
– the main underlying disease responsible for cardiovascular and
cerebrovascular morbidity is a contributing factor in 50% of United
States’ deaths. Yet more than one-third of patients dying from
atherosclerotic coronary vascular disease do not possess any of the
traditional risk factors such as:
› obesity, hyperlipidemia, diabetes, hypertension, and cigarette
smoking.
– Associated with infectious agents and several pathogens such as
› Chlamydia phneumonia
› Herpes simplex virus
› Streptococcus sanguis
› Porphyromonas gingivalis
– Also associated with the most common form of periodontal
disease: adult periodontitis disease- chronic periodontitis
disease

16. › Official Tittle:
– Time schedule of the experiment
› Simplified Title:
– N/A
› Control Groups:
– Regular chow- control diet
– High Fat Diet- experimental diet

17. › Official Tittle:
– Percentage of aortic surface area covered by
lesions.
› Simplified Tittle:
– The percentage of aortic surface area
covered by lesions at all time points.
› Control Groups:
– Vehicle mice
– Regular chow- control group

18. › Official Title:
– Representative results of a face analysis
› Simplified Title:
– A face recognition of results in High Fat diet
group showing absence of lesions at 10
weeks of vehicle injection and the condition
of lesions after 14 and 20 weeks of Pg
inoculations.
› Control Group(s):
– Vehicle injector mice

19. › Official Tittle:
– Mean lesion area per section per animal
› Simplified Tittle:
– The average lesion area per section for every
mice
› Control Group:
– Vehicle mice- control group
– Regular chow- control group

20. › Official Tittle:
– Percentage of total lumen of the proximal
aorta occupied by lesions
› Simplified Tittle:
– The percentage of total lumen of the
proximal aorta occupied by lesions per
section within each animal
› Control Group:
– Vehicle injected mice

21. › Official Title:
– Cross section of aortic lesions in chow-fed
ApoE+/- heterozygous mice challenged with
Pg or vehicle
› Simplified Title:
– N/A
› Control Groups:
– ApoE +/- heterozygous mice challenged with
vehicle.

22. Conclusion:

23. › The inclusion of these factors suggests that the classic American Heart
Association (AHA)-i.e. Age, gender, BMI, diabetes, and ethnicity- factors
of coronary heart disease (CHD) are linked and emphasized, if not merely
symptoms, of chronic periodontitis pathogens as they relate to CHD.
From this symbiosis of factors, it is understood periodontitis may be a
more accurate descriptor of those at risk for heart disease than classic
AHA factors.
Conclusion:

24. Thank you & God Bless!
Question?

25. 1. "Periodontal (Gum) Disease: Causes, Symptoms, and Treatments." Periodontal (Gum) Disease: Causes,
Symptoms, and Treatments. Web. 9 Oct. 2015.
2. "Dentists: Doctors of Oral Health." Dentists: Doctors of Oral Health. Web. 9 Oct. 2015.
3. Willershausen, Brita, et al. "Association between chronic dental infection and acute myocardial
infarction." Journal of endodontics 35.5 (2009): 626-630.
4. Li, Li et. al. “ Poryphyromonas Gingivalis Infection Accelerates the Progression of Atherosclerosis in a
Hetereozygous Apoliprotein E-Deficient Murine Model.” American Heart Association Journal 2002;
105:861-867. Web. 28 Oct. 2015.
References: