Gum Disease and Your Health 

The Mouth and Body Connection

In July of 1998, the American Academy of Periodontology launched an effort to educate the public about new findings which support what dental professionals had long suspected: Infections in the mouth can play havoc elsewhere in the body. Periodontal disease is a bacterial infection, and all infections are cause for concern. Periodontal bacteria can enter the blood stream and travel to major organs and begin new infections. Research is suggesting that this may: Contribute to the development of heart disease, the nation's leading cause of death. Increase the risk of stroke. Increase a woman's risk of having a preterm, low birth weight baby. Pose a serious threat to people whose health is compromised by diabetes, respiratory disease, or osteoporosis. Heart Disease and Stroke Heart Disease Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.

It takes a lot of work from the face to let out a smile, but just think what good smiling can bring to the most important muscle of the body... the heart. Oral Health Translate this page to the language of your choice (ie. SPANISH)

Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries. Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease. Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your dentist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.

Stroke

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.

Preterm Low Birth Weight Births

For a long time we've known that risk factors such as smoking, alcohol use, and drug use contribute to mothers having babies that are born prematurely at a low birth weight. Now evidence is mounting that suggests a new risk factor – periodontal disease. Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small.

It appears that periodontal disease triggers increased levels of biological fluids that induce labor. Furthermore, data suggests that women whose periodontal condition worsens during pregnancy have an even higher risk of having a premature baby.

Diabetes

People with diabetes are more likely to have periodontal disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don't have their diabetes under control are especially at risk.

A study in the Journal of Periodontology found that poorly controlled type 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are. Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.

Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.

Respiratory Diseases

Bacterial respiratory infections are thought to be acquired through aspiration (inhaling) of fine droplets from the mouth and throat into the lungs. These droplets contain germs that can breed and multiply within the lungs to cause damage. Recent research suggests that bacteria found in the throat, as well as bacteria found in the mouth, can be drawn into the lower respiratory tract. This can cause infections or worsen existing lung conditions. People with respiratory diseases, such as chronic obstructive pulmonary disease, typically suffer from reduced protective systems, making it difficult to eliminate bacteria from the lungs.

Scientists have found that bacteria that grow in the oral cavity can be aspirated into the lung to cause respiratory diseases such as pneumonia, especially in people with periodontal disease. This discovery leads researchers to believe that these respiratory bacteria can travel from the oral cavity into the lungs to cause infection.

Chronic obstructive pulmonary diseases (COPD) cause persistent obstruction of the airways. The main cause of this disease is thought to be long-term smoking. Chemicals from smoke or air pollution irritate the airways to cause obstruction. Further damage to the tissue and working function of the lungs can be prevented, but already damaged tissue cannot be restored - untreated or undetected COPD can result in irreversible damage. Scientists believe that through the aspiration process, bacteria can cause frequent bouts of infection in patients with COPD. Studies are now in progress to learn to what extent oral hygiene and periodontal disease may be associated with more frequents bouts of respiratory disease in COPD patients.

Osteoporosis

Researchers have suggested that a link between osteoporosis and bone loss in the jaw. Studies suggest that osteoporosis may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation. However, hormone replacement therapy may offer some protection.

A study in the Journal of Periodontology concludes that estrogen supplementation in women within five years of menopause slows the progression of periodontal disease. Researchers have suspected that estrogen deficiency and osteopenia/osteoporosis speed the progression of oral bone loss following menopause, which could lead to tooth loss. The study concluded that estrogen supplementation may lower gingival inflammation and the rate of attachment loss (destruction of the fibers and bone that support the teeth) in women with signs of osteoporosis,thus helping to protect the teeth.

Some warning signs of gum disease include: tender, bleeding gums, persistent bad breath, receding gums, changes in your bite, and tooth movements such as migration and mobility.

We hope that this information was helpful in better understanding periodontal disease.

Treatment of Periodontal Disease

• If you're diagnosed with periodontal disease, your dentist may recommend periodontal surgery. Periodontal surgery is necessary when your dentist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. An alternative treatment option to conventional periodontal surgery is laser periodontal surgery.

• In 2004, the PerioLase®  Nd:YAG Laser received FDA approval to perform a procedure known as: Laser Assisted New Attachment procedure (LANAP) which has been shown in a university study to regenerate a new periodontal attachment.

Don't Ignore Your Oral Health

If you value your oral as well as your overall health, a periodontal evaluation is a good idea. Sometimes the only way to detect periodontal disease is through a periodontal evaluation. A periodontal evaluation may be especially important if you:

• Notice any symptoms of periodontal disease (bleeding or receding gums, bad breath, etc.)

• Have heart disease, diabetes, respiratory disease or osteoporosis.

• Are thinking of becoming pregnant.

• Have a family member with periodontal disease. Research suggests that the bacteria that cause periodontal disease can pass through saliva. This means the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member.

• Have a sore or irritation in your mouth that does not get better within two weeks.

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Periodontal disease, according to The Guinness Book of world records, is the most common infectious disease affecting mankind. The surgeon General has estimated that 80% of adult Americans have some form of gum disease. Healthcare costs could be reduced by focusing on the mouth. Medical insurance companies are saying we can save 4 to 1. That is, for every dollar invested in dental care they are saving $4 in medical costs.

The cost for treating diabetes is around $174 billion in the U.S. annually. Extrapolate what Columbia University and Aetna Medical found in their research that costs for diabetes care could be reduced by as much as 16 percent by treating gum disease. Take into consideration the Surgeon Generals estimate that gum disease affects approximately 80 percent of the U.S. population. Thus the potential savings by treating gum disease are approximately $22 billion.

This does not include the savings for cardiovascular disease, a probable savings of 11 percent, or another 9 percent for cerebral vascular disease or stroke. The same Aetna and Columbia University studies found that treating gum disease can reduce preterm low birth-weight babies by 50 percent. Preterm low birth-weight births account for more than 12 percent of all births, $13 billion annually in hospitalizations and uncounted social costs since babies born prematurely often require years of care. The whole total of dental expenditures in the U.S is approximately $75 billion annually. Only 3%, according to Dental Insurance statistics, is spent on periodontal disease. In other words only $2 Billion is spent on gum disease annually.

The important thing to take from this is to know your periodontal score. Unfortunately, gum disease does not hurt. When you visit your dentist make sure your gum pockets are being measured. The dentist needs to take six measurements per tooth. This score has been shown to be more important to your general health than your cholesterol level, body mass index, or blood pressure.

Remember that your gums should never bleed when you brush and floss thoroughly, no more than your hands should bleed when you wash them.
A new breakthrough in the treatment of Gum disease is Laser Assisted New Attachment Procedure LANAP. The Laser has been found to regenerate the attachment around the tooth.

Periodontal Gum Disease

Periodontal gum disease is a serious infection of the mouth that, if left untreated, can lead to tooth loss and is known to be a contributing factor in developing numerous serious diseases. Research has shown that chronic oral infections are associated with, and may contribute to life threatening health problems such as heart disease, strokes, diabetes, spontaneous pre-term births and low-weight babies.

Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on everyone's teeth) causes the gums to become infected and inflamed. In the mildest form of the disease, gingivitis, the gums redden, swell and bleed easily.  There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene, especially lack of flossing and is reversible with professional treatment and good oral home care.

Untreated gingivitis can advance to periodontitis.  With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate and inflame the gums.  The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself and the gums, ligaments and bone that support the teeth are broken down and destroyed.  Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected.  As the disease progresses, the pockets deepen and more gum tissue, ligaments and bone are broken down and destroyed.  Initially this destructive process has very mild symptoms and the patient may not be aware he has a serious infection and the damage it is causing below the gum line.  Eventually, teeth can become loose and may be lost or have to be removed.  This pernicious infection can be present for years and is believed to adversely affect the body's immune system making it more susceptible to numerous serious diseases.

More than 300 different types of bacteria exist in the human mouth, either alone or in combination.  This makes treating periodontal disease difficult, time consuming and expensive as the periodontist tries various antibiotics and treatment modalities until an effective treatment plan is developed.
To add to the periodontist's difficulty, the existing manual pick and probe methodology currently used to diagnose periodontal disease and monitor its treatment (described below) is disruptive to the healing process and very inaccurate so the treatment plan's effectiveness may not be readily ascertainable.  This can result in a trial and error approach that can last for many months and be very time consuming and expensive.  In the meantime, as the patient's immune system fights this chronic and perhaps serious infection, it creates an opportunity for other serious diseases to develop.  Like any other serious infection, if not promptly treated with the proper types and amounts of antibiotics, periodontitis can result in severe systemic infection that can even become life-threatening.

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References

Relationship of Periodontal Disease to Systemic Disease

Articles are arranged under subject headings in chronological sequence (descending order) with those published in medical or basic science journals listed first followed by those published in dental journals.


Friedewald VE, Kornman KS, Beck JD, Genco R, Goldfine A, Libby P, Offenbacher S, Ridker PM, Van Dyke TE, Roberts WC. The American Journal of Cardiology and Journal of Periodontology editors’ consensus: Periodontitis and atherosclerotic cardiovascular disease. Am J Cardiol 2009; 104:59–68.

Higashi Y, Goto C, Hidaka T, et al. Oral infection-inflammatory pathway: Periodntitis is a risk factor for endothelial dysfunction in patients with coronary artery disease. Atherosclerosis 2009;206(2):604-610.

Seymour GJ, Ford PJ, Cullinan MP, Leishman S, West MJ, Yamazaki K. Infection or inflammation: The link between periodontal and cardiovascular diseases. Future Cardiology 2009;5(1):5-9.

Oe Y, Soejima H, Nakayama H, et al. Significant association between score of periodontal disease and coronary artery disease. Heart Vessels 2009;24(2):103-107.

Wang Q, Zhou X, Huang D. Role for Porphyromonas gingivalis in the progression of atherosclerosis. Medical Hypotheses 2009;72(1):71-73.

Chen Y-W, Umeda M, Nagasawa T, Takeuchi y, Huang Y, Inoue Y, Iwai T, Izumi Y, Ishikawa I. Periodontitis may increase the risk of peripheral arterial disease. Eur J Vasc Endovas Surg 2008;35:153-158.

Niedzielska I, Janic T, Cierpka S, Swietochowska E. The effect of chronic periodontitis on the development of atherosclerosis: Review of the literature. Med Sci Monitor 2008;14(7):103-106.

Blum A, Front E, Peleg A. Periodontal care may improve systemic inflammation. Clin Investigative Med - Medecine Clinique et Experimentale. 2007;30:e114-e117.

Jacobs DR Jr., Crow RS. Subclinical cardiovascular disease markers applicable to studies of oral health: multiethnic study of atherosclerosis. Ann New York Acad Sci 2007;1098:269-287.

Paju S, Sinisalo J, Pussinen PJ, Valtonen V, Nieminen MS. Is periodontal disease behind the failure of antibiotics to prevent coronary events? Atheroscler 2007;193:193-195.

Roth GA, Moser B, Roth-Walter F, et al. Infection with a periodontal pathogen increases mononuclear cell adhesion to human aortic endothelial cells. Atheroscler 2007;190:271-281.

Tonetti MS, D’Aiuto F, Nibali L, et al. Treatment of periodontitis and endothelial function. N Eng J Med
2007;356:911-920.

Brodala N, Merricks EP, Bellinger DA, et al. Porphyromonas gingivalis bacteremia induces coronary and aortic atherosclerosis in normocholesterolemic and hypercholesterolemic pigs. Arterioscler Thromb Vasc Biol 2005;25:1446-1451.

D=Aiuto F, Tonetti MS. Contribution of periodontal therapy on individual cardiovascular risk assessment. Arch Intern Med 2005;165(16):1920-1921.

Desvarieux M, Demmer RT, Rundek T, Boden-Albala B, Jacobs DR, Sacco RL, Papapanou PN. Periodontal microbiota and carotid intima-media thickness. The oral infections and vascular disease epidemiology study (INVEST). Circulation 2005;111:576-582.

Hannson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med  2005;352:1685-1695.

Kozarov EV, Dorn BR, Shelburne CE, Dunn WA Jr., Progulske-Fox A. Human atherosclerotic plaque contains viable invasive Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. Arterioscler Thrombo Vasc Biol 2005;25:e17-e18.

Offenbacher S, Beck JD. A perspective on the potential cardioprotective benefits of periodontal therapy. Am Heart J 2005;149:950-954.

Rufail ML, Schenkein HA, Barbour SE, Tew JG, van Antwerpen R. Altered lipoprotein subclass distribution and PAF-AH activity in subjects with generalized aggressive periodontitis. J Lipid Res 2005;46:2752-2760.

Schillinger T, Exner M, Mlekusch W, et al. Inflammation and Carotid Artery—Risk for Atherosclerosis Study (ICARAS). Circulation 2005;111:2203-2209.

Seinost G, Wimmer G, Skerget M, et al. Periodontal treatment improves endothelial dysfunction in patients with severe periodontitis. Am Heart J 2005;149:1050-1054.

Chi H, Messas E, Levine RA, Graves DT, Amar S. Interleukin-1 receptor signaling mediates atherosclerosis associated with bacterial exposure and/or a high-fat diet in a murine apolipoprotein-E heterozygote model: Pharmacotherapeutic implications. Circulation 2004;110:1678-1685.

Gibson FC, Hong, C, Chou HH, et al. Innate immune recognition of invasive bacteria accelerates athrerosclerosis in apolipoprotein E-deficient mice. Circulation 2004;109:2801-2806.

Pussinen PJ, Mattila K. Periodontal infections and atherosclerosis: Mere associations? Curr Opinion Lipidol 2004;15(5):583-588.

Desvarieux M, Demmer RT, Rundek T, Boden-Albala B, Jacobs DRJ, Papapanou PN, Sacco RL. Relationship between periodontal disease, tooth loss, and carotid artery plaque: The oral infections and vascular disease epidemiology study (INVEST). Stroke 2003;34:2120-2125.

Gonzalez MA, Selwyn AP. Endothelial function, inflammation, and prognosis in cardiovascular disease. Am J Med 2003;115:S99-S106.

Haynes WG, Stanford C. Periodontal disease and atherosclerosis:  From dental to arterial plaque. Arterioscler Thrombo Vasc Biol  2003;23:1309-1311.

Comment on Above Paper: Arterioscler Thrombo Vasc Biol 2003;23:1245-1249.

Arterioscler Thrombo Vasc Biol 2003;23:1250-1254.

Jain A, Batista EL Jr., Serhan C, Stahl GL, Van Dyke TE.  Role for periodontitis in the progression of lipid deposition in an animal model.  Infect Immun  2003;71:6012-6018.

Lalla E, Lamster IB, Hofmann MA, et al. Oral infection with a periodontal pathogen accelerates early atherosclerosis in apolipoprotein-E null mice. Arterioscler Thromb Vasc Biol 2003;23:1405-1411.

Pearson TA, et al. Markers of inflammation and cardiovascular disease. Circulation  2003;107:499-511.

Pussinen PJ. Vilkuna-Rautiainen T. Alfthan G. Palosuo T. Jauhiainen M. Sundvall J. Vesanen M. Mattila K.

Asikainen S. Severe periodontitis enhances macrophage activation via increased serum lipopolysaccharide.

Arterioscler Thromb Vasc Bio 2004;24(11):2174-2180.

Slade GD, Ghezzi EM, Heiss G, Beck JD, Riche E, Offenbacher S. Relationship between periodontal disease and C-reactive protein among adults in the Atherosclerosis Risk in Communities study. Arch Intern Med 2003;163:1172-1179.

Espinola-Klein C, Rupprecht HJ, Blankenberg S, et al. Impact of infectious burden on progression of carotid atherosclerosis. Stroke 2002;33:2581-2586.

Folsom AR, Aleksic N, Catellier D, Juneja HS, Wu KK. C-reactive protein and incident coronary heart disease in the Atherosclerosis Risk In Communities (ARIC) study. Am Heart J 2002;144:233-238.

Harats D, Yacov N, Gilburd B, et al. Oral tolerance with heat shock protein 65 attenuates Mycobacterium tuberculosis-induced and high fat-diet-driven atherosclerotic lesions. J Am Coll Cardiol  2002;40:1333-1338.

Li L, Messas E, Batista EL Jr., Levine RA, Amar S. Porphyromonas gingivalis infection accelerates the progression of atherosclerosis in a heterozygous apolipoprotein E-deficient murine model. Circulation 2002;105:861-867.

Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002;105:1135-1143.

Beck JD, Elter JR, Heiss G, Couper D, Mauriello SM, Offenbacher S. Relationship of periodontal disease to carotid artery intima-media wall thickness: The Atherosclerosis Risk in Communities (ARIC) Study. Arterioscler Thromb Vasc Biol 2001;21:1816-1822.

Kiechl S, Egger G, Mayr M, et al. Chronic infections and the risk of carotid atherosclerosis: Prospective results from a large population study. Circulation 2001;103:1064-1070.

Fong IW. Emerging relations between infectious diseases and coronary artery disease and atherosclerosis. Can Med Assoc J 2000;163:49-56.

Pussinen PJ, Tumoisto K, Jousilahti P, Havulinna AS, Sundvall J, Salomaa V. Endotoxemia, immune response to periodontal pathogens, and systemic inflammation associated with increased incidence in cardiovascular disease events. Arterioscler Thromb Vasc Biol 2007;27:1433-1439.

Ross R. Atherosclerosis – an inflammatory disease. N Engl J Med 1999;340:115-126.

Deshpande RG, Khan MB, Genco CA. Invasion of aortic and heart endothelial cells by Phorphyromonas gingivalis. Infect Immun 1998;66(11):5337-5343.

Ebersole JL, Machen RL, Steffen MJ, Willmann DE. Systemic acute-phase reactants, C-reactive protein and haptoglobin, in adult periodontitis. Clin Exp Immunol 1997;107:347-352.



Liu J, Wu Y, Ding Y, Meng S, Ge S, Deng H.  Evaluation of serum levels of c-reactive protein and lipid profiles in patients with chronic periodontitis and/or coronary heart disease in an ethnic Han population.  Quintessence Int  2010;41:239-248.

Behle JH, Sedaghatfar MH, Demmer RT, Wolf DL, Celenti R, Kebschull M, Belusko PB, Herrera-Abreu M, Lalla E, Papapanou PN.  Heterogeneity of systemic inflammatory responses to periodontal therapy.  J Clin Periodontol  2009; 36: 287–294.

Bokhari SAH, Khan AA, Tatakis DN, Azhar M, Hanif M, Izhar M.  Non-surgical periodontal therapy lowers serum inflammatory markers: A pilot study.  J Periodontol  2009;80:1574-1580.

Buhlin K, Hultin M, Norderyd O, Persson L, Pockley AG, Rabe P, Klinge B, Gustafsson A.  Risk factors for atherosclerosis in cases with severe periodontitis. J Clin Periodontol  2009; 36: 541–549.

Ekuni D, Tomofuji T, Sanbe T, et al.  Periodontitis-induced lipid peroxidation in rat descending aorta is involved in the initiation of atherosclerosis.  J Periodont Res 2009;44:434-442.

Friedewald VE, Kornman KS, Beck JD, Genco R, Goldfine A, Libby P, Offenbacher S, Ridker PM, Van Dyke TE, Roberts WC.  The American Journal of Cardiology and Journal of Periodontology editors’ consensus: Periodontitis and atherosclerotic cardiovascular disease.  J Periodontol  2009;80:1021-1032.

Inomata M, Ishihara Y, Matsuyama T, et al.  Degradation of vascular endothelial thrombomodulin by arginine- and lysine-specific cysteine proteases from Porphyromonas gingivalis. J Periodontol  2009;80:1511-1517.

Nakano K, Nemoto H, Nomura R, Inaba H, Yoshioka H, Taniguchi K, Amano A, Ooshima T.  Detection of oral bacteria in cardiovascular specimens.  Oral Microbiol Immunol 2009:24:64-68.

Renvert S, Lindahl C, roos-Jans<ker A-M, Lessem J.  Short-term effects of an anti-inflammatory treatment on clinical parameters and serum levels of C-reactive protein and proinflammatory cytokines in subjects with periodontitis.  J Periodontol  2009;80:892-900.

S`der P-_, Meurman JH, Jogestrand T, Nowak J, S`der B.  Matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 in blood as markers for early atherosclerosis in subjects with chronic periodontitis.  J Periodont Res 2009;44:452-458.

Sun XJ, Meng HX, Shi D, Xu L, Zhang L, Chen ZB, Feng XH, Lu RF, Ren XY.  Elevation of C-reactive protein and interleukin-6 in plasma of patients with aggressive periodontitis.  J Periodont Res  2009;44:311–316.

Tonetti MS. Periodontitis and risk for atherosclerosis: an update on intervention trials.  J Clin Periodontol 2009; 36 (Suppl. 10): 15–19.

Cairo F, Castellani S, Gori AM, Nieri M, Baldelli G, Abbate R, Pini-Prato GP.  Severe periodontitis in young adults is associated with sub-clinical atherosclerosis. J Clin Periodontol  2008;35: 465-472.

Colhoun HM, Slaney JM, Rubens MB, Fuller JH, Sheiham A, Curtis MA. Antibodies to periodontal pathogens and coronary artery calcification in type 1 diabetic and nondiabetic subjects. J Periodont Res  2008;43:103-110.

Dong S, Meng HX, Xu L, et al.  Systemic inflammation markers in patients with aggressive periodontitis:  A pilot study.  J Periodontol  2008;79:2340-2346.

ElkaVm R, Dahan M, Kocgozlu L, Werner S, Kanter D, Kretz JG, Tenenbaum H.  Prevalence of periodontal pathogens in subgingival lesions, atherosclerotic plaques and healthy blood vessels: a preliminary study.  J Periodont Res  2008;43: 224-231.

Linden GJ, McClean K, Young I, Evans A, Kee F. Persistently raised C-reactive protein levels are associated with advanced periodontal disease. J Clin Periodontol  2008; 35: 741–747.

Paraskevas S, Huizinga JD, Loos BG.  A systematic review and meta-analyses on C-reactive protein in relation to periodontitis.  J Clin Periodontol  2008;35:277-290.

Pitiphat W, Savetsilp W, Wara-Aswapati N. C-reactive protein associated with periodontitis in a Thai population.  J Clin Periodontol  2008;35:120-125.

Ridker PM, Silvertown JD.  Inflammation, C-reactive protein, and Atherothrombosis.  J Periodontol  2008;79:1544-1551.

Ushida Y, Koshy G, Kawashima Y, Kiji M, Umeda M, Nitta H, Nagasawa T, Ishikawa I, Izumi Y.  Changes in serum interleukin-6, C-reactive protein and thrombomodulin levels under periodontal ultrasonic debridement.  J Clin Periodontol  2008; 35: 969-975.

Zhang M-Z, Li C-L, Jiang Y-T, et al.  Porphyromonas gingivalis infection accelerates intimal thickening in iliac arteries in a balloon-injured rabbit model.  J Periodontol 2008;79:1192-1199.

Soder B, Yakob M.  Risk for the development of atherosclerosis in women with a high level of dental plaque and severe gingival inflammation.  Inter J Dent Hyg 2007;5:133-138.
 
Yl`stalo PV, J@rvelin M-R, Laitinen J, Knuuttila MLE.  Self-reported gingivitis and tooth loss poorly predict C-reactive protein levels: A study among Finnish young adults. J Clin Periodontol  2008;35:114-119.

D’Aiuto F, Parkar M, Tonetti MS.  Acute effects of periodontal therapy on bio-markers of vascular health.

J Clin Periodontol 2007;34:124-129.

Ford PJ, Gemmell E, Timms P, Chan A, Preston FM, Seymour GJ.  Anti-P. gingivalis response correlates with atherosclerosis.  J Dent Res  2007;86:35-40.

Hettne KM, Weeber M, Laine ML, Cate Ht, Boyer S, Kors JA, Loos BG.  Automatic mining of the literature to generate new hypotheses for the possible link between periodontitis and atherosclerosis: lipopolysaccharide as a case study.  J Clin Periodontol  2007; 34: 1016–1024.

Mustapha IZ, Debrey S, Oladubu M, Ugarte R.  Markers of systemic bacterial exposure in periodontal disease and cardiovascular disease risk:  A systematic review and meta-analysis.  J Periodontol  2007;78:2289-2302.

Pischon N, H@gewald S, Kunze M, et al.  Influence of periodontal therapy on the regulation of soluble cell adhesion molecule expression in aggressive periodontitis patients.  J Periodontol  2007;78:683-690.

Pucar A, Milasin J, Lekovic V, Vukadinovic M, Ristic M, Putnik S, Kenney EB.  Correlation between atherosclerosis and periodontal putative pathogenic bacterial infections in coronary and internal mammary arteries.  J Periodontol 2007;78:677-682.

Rufail ML, Schenkein HA, Koertge TE, Best AM, Barbour SE, Tew JG, van Antwerpen R.  Atherogenic lipoprotein parameters in patients with aggressive periodontitis.  J Periodont Res  2007;42:495–502.

Schenkein HA, Best AM, Brooks CN, et al.  Anti-cardiolipin and increased serum adhesion molecule levels in patients with aggressive periodontitis.  J Periodontol  2007;78:459-466.

Tabrizi F, Buhlin K, Gustafsson A, Klinge B.  Oral health of monozygotic twins with and without coronary heart disease:  A pilot study.  J Clin Periodontol  2007;34: 220-225.

Zaremba M, G\rska R, Suwalski P, Kowalski J.  Evaluation of the incidence of periodontitis-associated bacteria in the atherosclerotic plaque of coronary blood vessels.  J Periodontol  2007;78:322-327.

Ford PJ, Gemmell E, Chan A, et al.  Inflammation, heat shock proteins and periodontal pathogens in atherosclerosis:  An immunohistologic study.  Oral Microbiol Immunol  2006;21:206-211.

Ioannidou E, et al.  Effect of periodontal treatment on serum C-reactive protein levels:  A systematic review and meta-analysis.  J Periodontol  2006;77:1635-1642.

Padilla C, Lobos O, Hubert E, et al.  Periodontal pathogens in atheromatous plaques isolated from patients with chronic periodontitis.  J Periodont Res  2006; 41: 350–353.

D=Aiuto F, Nibali L, Parkar M, Suvan J, Tonetti MS.  Short-term effects of intensive periodontal therapy on serum inflammatory markers and cholesterol. J Dent Res 2005;84:269-273.

Feihn E, Larsen T, Christiansen N, Holmstrup P, Schroeder TV.  Identification of periodontal pathogens in atherosclerotic vessels.  J Periodontol  2005;76:731-736.

Leivadaros E, van der Velden U, Bizzarro S, et al.  A pilot study into measurements of markers of atherosclerosis in periodontitis.  J Periodontol  2005;76:121-128.

Loesche W, Marshal GJ, Apatzidou DA, Krause S, Kocher T, Kinane DF.  Lipoprotein-associated phospholipase A2 and plasma lipids in patients with destructive periodontal disease.  J Clin Periodontol  2005;32(6):640-644.

Offenbacher S, et al.  Evidence for periodontitis as a tertiary vascular infection.  J Inter Acad Periodontol 2005;7:39-48.

Yamazaki K, Honda T, Oda T.   Effect of periodontal treatment on the C-reactive protein and proinflammatory cytokine levels in Japanese periodontitis patients.  J Periodont Res  2005;40:53-58.

D=Aiuto F, Parkar M, Andreou G, Brett PM, Ready D, Tonetti MS.  Periodontitis and atherogenesis:  Casual association or simple coincidence.  J Clin Periodontol  2004;31:402-411.

D=Aiuto FD, Parkar M, Andreou G.  Periodontitis and systemic inflammation:  Control of the local infection is associated with a reduction in serum inflammatory markers.  J Dent Res  2004;83:156-160.

Choi JI, Chung SW, Kang HS, et al.  Epitope mapping of Porphyromonas gingivalis heat-shock protein and human heat-shock protein in human atherosclerosis.  J Dent Res  2004;83:936-940.

Geerts SO, Legrand V, Charpentier J, et al.  Further evidence of the association between periodontal conditions and coronary artery disease.  J Periodontol  2004;75:1274-1280.

Mercanoglu F, Oflaz H, _z O, et al.  Endothelial dysfunction in patients with chronic periodontitis and its improvement after initial periodontal therapy.  J Periodontol  2004;75:1694-1700.

Miyakawa H, Honma K, Qi M, Kuramitsu HK.  Interaction of Porphyromonas gingivalis with low-density lipoproteins:  Implications for a role for periodontitis in atherosclerosis.  J Periodont Res  2004;39:1-9.

Morita M, Horiuchi M, et al.  Relationship between blood triglyceride levels and periodontal status.  Community Dent Health  2004;21:32-36.

Nakib SA, Pankow JS, Beck JD, et al.  Periodontitis and coronary artery calcification: The atherosclerosis risk in communities (ARIC) study.  J Periodontol  2004;75:505-510.

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Yamazaki K, Ohsawa Y, Itoh H, et al.  T-cell clonality to Porphyromonas gingivalis and human heat shock protein 60s in patients with atherosclerosis and periodontitis.  Oral Microbiol Immunol  2004;19:160-167.

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Spahr A, Klein E, Khuseyinova N, et al.  Periodontal infections and coronary heart disease.  Arch Intern Med  2006;166:554-559.

Beck JD, Eke P, Heiss G, Madianos P, Couper D, Lin D, Moss K, Elter J, Offenbacher S.  Periodontal disease and coronary heart disease: A reappraisal of the exposure.  Circulation  2005;112:19-24.

Okoro CA, Balluz LS, Eke PI, Adjoin UA, Strine TW, Town M, Mensah GA, Mokadad AH.  Tooth loss and heart disease: Findings from the behavioral risk factor surveillance system.  Am J Prev Med  2005;29(5S1):50-56.

Pussinen PJ, Nyyssönen K, Alfthan G, Salonen R, Laukkanen JA, Salonen JT.  Serum antibody levels to Actinobacillus actinomycetemcomitans predict the risk for coronary heart disease.  Arterioscler Thromb Vas Biol  2005;25:833-838.

Tiong AY, Brieger D. Inflammation and coronary artery disease.  Am Heart J  2005;150(11):11-18.

Brown DL, Desai KK, Vakili BA, Nouneh C, Lee HM, Golub LM.  Clinical and biochemical results of the metalloproteinase inhibition with subantimicrobial doses of doxycycline to prevent coronary syndromes (MIDAS) pilot trial. Arterioscler Thromb Vasc Biol. 2004;24:733–738.

Brown DL, Golub LM, Thomas JG.  Subantimicrobial doses of tetracycline (letter).  Arterioscl Thromb Vas Biol  2004;24:e163.

Deliargyris EN, Madianos PN, Kadoma W, et al.  Periodontal disease in patients with acute myocardial infarction :  Prevalence and contribution to elevated C-reactive protein levels.  Am Heart J  2004;147:1005-1009.

Pai JK, Pischon T, Ma J, et al.  Inflammatory markers and risk of coronary heart disease in men and women.  N Engl J Med  2004;351:2599-2610.

Pussinen PJ. Alfthan G. Tuomilehto J. Asikainen S. Jousilahti P.  High serum antibody levels to Porphyromonas gingivalis predict myocardial infarction.  Eur J Cardiovas Prevent Rehab  2004;11(5):408-411.

Schwahn C, Volzke H, Robinson DM, et al.  Periodontal disease , but not edentulism, is independently associated with increased plasma fibrinogen levels.  Results from a population-based study.  Thromb Haemost 2004;92:244-252.

Persson GR, et al.  Chronic periodontitis a significant relationship with acute myocardial infarction. Eur Heart J  2003;24:2108-2115.

Peters RJ, Boekholdt SM.  Gene polymorphisms and the risk of myocardial infarction - an emerging relation. N Engl J Med  2002;347:1963-1965.

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Angeli F, Verdecchia P, Pellegrino C, et al.  Association between periodontal disease and left ventricle mass in essential hypertension. Hypertension 2003;41:488-492.

Buhlin K, Gustafsson A, Pockley AG, Frostegard J, Klinge B.  Risk factors for cardiovascular disease in patients with periodontitis.  Eur Heart J  2003;24:2099-2107.  

Howell TH, Ridder PM, Adjoin UA, Heineken CH, Christen WG.  Periodontal disease and risk of subsequent cardiovascular disease in U. S. male physicians.  J Am College Cardiology  2001;37:445-450.

Comment on Above Article:  J Am College Cardiology 2001;38:1273-1274.

Danesh J, Whincup P, Walker M, et al.  Low grade inflammation and coronary heart disease:  Prospective study and updated meta-analyses.  Brit Med J  200;321(7255):199-204.

Kiechl S, Egger G, Mayr M, et al.  Chronic infections and the risk of carotid atherosclerosis:  Prospective results from a large population study.  Circulation  2001;103(8):1064-1070.

Wu T, Trevisan M, Genco RJ, et al.  Examination of the relation between periodontal health status and cardiovascular risk factors: Serum total and high density lipoprotein cholesterol,  C-reactive protein, and plasma fibrinogen.  Am J Epidemiol  2000;5:273-282.

Morrison HI, Ellison, LF, Taylor GW.  Periodontal disease and risk of fatal coronary heart and cerebrovascular diseases. J Cardiovasc Risk 1999;6:7-11.




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Nakajima T, Honda T, Domon H, et al. Periodontitis-associated up-regulation of systemic inflammatory mediator level may increase the risk of coronary heart disease.  J Periodont Res  2010;45:116-122.

Marcaccini AM, Meschiari A, Sorgi CA, et al.  Circulating interleukin-6 and high-sensitivity C-reactive protein decrease after periodontal therapy in otherwise healthy subjects.  J Periodontol  2009;80:594-602.

Monteiro AM, Jardini MAN, Alves S, et al.  Cardiovascular disease parameters in periodontitis.  J Periodontol  2009;80:378-388.

Offenbacher S, Beck JD, Moss K, et al.  Results from the Periodontitis and Vascular Events (PAVE) study:  A pilot multicentered, randomized, controlled trial to study effects of periodontal therapy in a secondary prevention model of cardiovascular disease.  J Periodontol 2009;80:190-201.

Stein JM, Kuch B, Conrads G, et al.  Clinical periodontal and microbiologic parameters in patients with acute myocardial infarction.  J Periodontol  2009;80:1581-1589.

Vidal F, Figueredo CMS, Cordovil I, Fischer RG.  Periodontal therapy reduces plasma levels of interleukin-6, C-reactive protein, and fibrinogen in patients with severe periodontitis and refractory arterial hypertension.  J Periodontol 2009;80:786-791.

Yoshii S, Tsuboi S, Morita I, et al.  Temporal association of elevated C-reactive protein and periodontal disease in men.  J Periodontol  2009;80:734-739.

Beck JD, Couper DJ, Falkner KL, et al.  The periodontitis and vascular events (PAVE) pilot study:  Adverse events.  J Periodontol  2008;79:90-96.

Couper DJ, Beck JD, Falkner KL, et al.  The periodontitis and vascular events (PAVE) pilot study:  Recruitment, retention, and community care controls. J Periodontol  2008;79:80-89.

DavJ S, Van Dyke TE.  The link between periodontal disease and cardiovascular disease is probably inflammation.  Oral Dis  2008;14:95-101.

Geismar K, Enevold C, Sørensen LK, Gyntelberg F, Bendtzen K, Sigurd B, Holmstrup P.  Involvement of interleukin-1 genotypes in the association of coronary heart disease with periodontitis.  J Periodontol  2008;79:2322-2330.

Goteiner D, Ashmen R, Lehrman N, Janal MN, Eskin B.  Presence and significance of interleukin-1 polymorphism in patients who present with acute coronary syndrome, angina, and chronic periodontitis:  An epidemiologic pilot study.  J Periodontol  2008;79:138-143.

Hingorani AD, D’Aiuto F.  Chronic inflammation, periodontitis and cardiovascular diseases.  Oral Dis 2008;14:102-104.

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Persson GR, Persson RE.  Cardiovascular disease and periodontitis:  An update on the associations and risk. J Clin Periodontol  2008;35 (Suppl 8);362–379.

Starkhammar JC, Richter A, Lundstr`m C , Thorstensson H, Ravald N.  Periodontal conditions in patients with coronary heart disease:  A case-control study.  J Clin Periodontol  2008;35:199-205.

Gotsman I, Lotan C, Soskolne A, et al.  Periodontal destruction is associated with coronary artery disease and periodontal infection with acute coronary syndrome.  J Periodontol  2007;78:849-858.

Ushida Y, Koshy G, Kawashima Y, et al.  Changes in serum interleukin-6, C-reactive protein and thrombomodulin levels under periodontal ultrasonic debridement.  J Clin Periodontol  2008;35:969-975.

S`der B, Jin LJ, Klinge B, S`der P-_.  Periodontitis and premature death:  A 16-year longitudinal study in a Swedish urban population.  J Periodont Res  2007;42: 361–366.

Tabrizi F, Buhlin K, Gustafsson A, Klinge B.  Oral health of monozygotic twins with and without coronary heart disease:  A pilot study.  J Clin Periodontol  2007;34:April Issue.

Thter G, KurtiÕ B, Serdar M, et al.  Effects of scaling and root planing and sub-antimicrobial dose doxycycline on oral and systemic biomarkers of disease in patients with both chronic periodontitis and coronary artery disease.  J Clin Periodontol  2007;34: 673–681.

Thter G, KurtiÕ B, Serdar M.  Evaluation of gingival crevicular fluid and serum levels of high-sensitivity C-reactive protein in chronic periodontitis patients with and without coronary artery disease.  J Periodontol  2007;78:2319-2324.

Andriankaja OM, Genco RJ, Dorn J, et al.  The use of different measurements and definitions of periodontal disease in the study of the association between periodontal disease and risk of myocardial infarction.  J Periodontol  2006;77:1067-1073.

Briggs JE, McKeown PP, Crawford VL, Woodside JV, Stout RW, Evans A, Linden GJ. Angiographically confirmed coronary heart disease and periodontal disease in middle-aged males.  J Periodontol  2006;77:95-102.

Czerniuk MR, Górska R, Filipiak KJ, Opolski G.  C-reactive protein in patients with coexistent periodontal disease and acute coronary syndromes.  J Clin Periodontol  2006;33:415-419.

Holmlund A, Holm G, Lind L.  Severity of periodontal disease and number of remaining teeth are related to the prevalence of myocardial infarction and hypertension in a study based on 4,254 subjects.  J Periodontol
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Renvert S, Pettersson T, Ohlsson O, Persson GR.  Bacterial profile and burden of periodontal infection in subjects with a diagnosis of acute coronary syndrome.  J Periodontol  2006;77:1110-1119.

Taylor BA, Tofler GH, Carey HMR.  Full-mouth tooth extraction lowers systemic inflammatory markers of cardiovascular risk. J Dent Res  2006;85:74-78.

Beck JD, Offenbacher S.  Systemic effects of periodontitis:  Epidemiology of periodontal disease and cardiovascular disease.  J Periodontol  2005;76:2089-2100.

Buhlin K, Gustafsson A, Ahnve S, Janszky I, Trabrizi F, Klinge B.  Oral health in women with coronary heart disease.  J Periodontol  2005;76(4):544-550.

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Montebugnoli L, Servidio D, Miaton RA, Prati C, Tricoci P, Melloni C, Melandri G.  Periodontal health improves systemic inflammatory and haemostatic status in subjects with coronary heart disease.  J Clin Periodontol  2005;32:188-192.

Persson GR, Pettersson T, Ohlsson O, Renvert S.  High-sensitivity serum C-reactive protein levels in subjects with or without myocardial infarction or periodontitis.  J Clin Periodontol  2005;32:219-224.

Rahman AU, Rashid S, Noon R, Samuel ZS, Lu B, Borgnakke WS, Williams RC.  Prospective evaluation of the systemic inflammatory marker C-reactive protein in patients with end-stage periodontitis getting teeth replaced with dental implants:  A pilot investigation.  Clin Oral Impl Res  2005;16(1):128-131.

Czerniuk MR, Gorska R, Filipiak KJ, Opolski G.  Inflammatory response to acute coronary syndrome in patients with coexistent periodontal disease.  J Periodontol  2004;75:1020-1026.

DavJ S, Batista EL Jr., Van Dyke TE.  Cardiovascular disease and periodontal diseases: Commonality and causation.  Compendium  2004;25:26-37.

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D=Aiuto F, Red D, Tonetti MS.  Periodontal disease and C-reactive protein-associated cardiovascular risk.  J Periodontol Res  2004;39:236-241.

Elter JR, Champagne CM, Offenbacher S, Beck JD.  Relationship of periodontal disease and tooth loss to prevalence of coronary heart disease.  J Periodontol  2004;75:782-790.

Hung HC, Joshipura KJ, Colditz G, Manson JE, Rimm EB, Speizer FE, Willett WC.  The association between tooth loss and coronary heart disease in men and women.  J Pub Health Dent 2004;64:209-215.

Ide M, Jagdev D, Coward PY, Crook M, Barclay GR, Wilson RF.  The short-term effects of treatment of chronic periodontitis on circulating levels of endotoxin, C-reactive protein, tumor necrosis factor-alpha, and interleukin-6.  J Periodontol  2004;75:420-428.

Khader YS, Albashaireh ZS, Alomari MA.  Periodontal disease and the risk of coronary heart and cerebrovascular diseases:  A meta-analysis.  J Periodontol 2004;75:1046-1053.

Montebugnoli L, Servidio D, Miaton RA, Prati C, Tricoci P, Melloni C. Poor oral health is associated with coronary heart disease and elevated systemic inflammatory and haemostatic factors.  J Clin Periodontol  2004;31:25-29.

Renvert S, Ohlsson O, Persson S, Lang NP, Persson GR.  Analysis of periodontal risk profiles in adults with or without a history of myocardial infarction.  J Clin Periodontol  2004;31:19-24.

Shimazaki Y, Saito T, Kiyohara Y, et al.  Relationship between electrocardiographic abnormalities and periodontal disease: The Hisayama study.  J Periodontol  2004;75:791-797.

Janket S-J, Baird AE, Chuang SK, Jones JA.  Meta-analysis of periodontal disease and risk for coronary heart disease and stroke.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod   2003;95:559-569.

Kuramitsu HK, Kang IC, Qi M.  Interactions of Porphyromonas gingivalis with host cells:  Implications for cardiovascular diseases.  J Periodontol  2003;74:85-89.

Lessem J, Drosky C, Greenwald H, et al.  Are cardiac transplant patients more likely to have periodontitis?  A case record study.  J Int Acad Periodontol  2002;4(3):95-100.

Beck JD, Offenbacher S.  The association between periodontal diseases and cardiovascular diseases: a state-of-the-science review.  Ann Periodontol  2001;6:9-15.

De Nardin E. The role of inflammatory and immunological mediators in periodontitis and cardiovascular disease.  Ann Periodontol  2001;6:30-40.

Beck JD, Slade G, Offenbacher S.  Oral disease, cardiovascular disease and systemic inflammation. Periodontol 2000  2000;23:110-120.

Kinane DF, Lowe GD. How periodontal disease may contribute to cardiovascular disease.  Periodontol 2000  2000;23:121-126.

Loos BG, Craandijk J, Hoek FJ, et al.  Elevation of systemic markers related to cardiovascular diseases in the peripheral blood of periodontitis patients.  J Periodontol  2000;71:1528-1534.

Beck J, Garcia R, Heiss G, Vokonas PS, Offenbacher S.  Periodontal disease and cardiovascular disease.  J Periodontol  1996;67(suppl):1123-1137.



Dietrich T.  Periodontitis could be an important marker of risk for cerebrovascular disease, given its relatively high prevalence and the strength of the association.   Ann Neurology 2009: In Press.

Jimenez M, Krall EA, Garcia RI, Vokonas PS, Dietrich T.  Periodontitis and incidence of cerebrovascular disease in men.  Ann Neurol  2009;66(4):505-512.

You Z, Cushman M, Jenny NS, Howard G.  Tooth loss, systemic inflammation and prevalent stroke among participants in the Reasons for Geographic and Racial Difference in Stroke (REGARDS) study.  Atherosclerosis  2009;203(2):615-619.

Chamorro, Ángel MD; Hallenbeck, John MD.  The harms and benefits of inflammatory and immune responses in vascular disease.  Stroke 2006; 37:291-293.

Schillinger T, Kluger W, Exner M, et al.  Dental and periodontal status and risk for progression of carotid atherosclerosis:  The inflammation and carotid artery risk for atherosclerosis study (ICARAS) dental substudy.   Stroke  2006;37:2271-2276.

Comment on Above Article:    Stroke  2007;38:12.

Engebretson SP, et al.  Radiographic measures of chronic periodontitis and carotid artery plaque.  Stroke  2005;36:561-566.

Grau AJ, Becher H, Ziegler CM, et al.  Periodontal disease as a risk factor for ischemic stroke.  Stroke  2004;35:496-501.

Pussinen PJ, Alfthan G, Rissanen H, Reunanen A, Asikainen S, Kneckt P.  Antibodies to periodontal pathogens and stroke risk.  Stroke  2004;35:2020-2023.

Joshipura KJ, Hung H-C, Rimm EB, Willett WC, Ascherio A.  Periodontal disease, tooth loss, and incidence of ischemic stroke.  Stroke  2003;34:47-52.

Wu T, Trevisan M, Genco RJ, Dorn JP, Falkner KL, Sempos CT.  Periodontal disease and risk of cerebrovascular disease:  The First National Health and Nutrition Examination Survey and its follow-up study.  Arch Intern Med  2000;160:2749-2755.

Morrison HI, Ellison, LF, Taylor GW.  Periodontal disease and risk of fatal coronary heart and cerebrovascular diseases. J Cardiovasc Risk 1999;6:7-11.

Grau AJ, Buggle F, Ziegler C, et al.  Association between acute cerebrovascular ischemia and chronic and recurrent infection. Stroke  1997;28:1724-1729.



Pradeep AR, Hadge P, Raju PA, Shetty SR, Shareef K, Guruprasad CN.  Periodontitis as a risk factor for cerebrovascular accident:  A case-control study in the Indian population. J Periodont Res  2010;45:223-228.

Sim S-J, Kim H-D, Moon J-Y, et al.  Periodontitis and the risk for non-fatal stroke in Korean adults.  J Periodontol  2008;79:1652-1658.

Lee H-J, Garcia RI, Janket S-J, et al.  The association between cumulative periodontal disease and stroke history in older adults.  J Periodontol  2006;77:1744-1754.

Dorfer CE, Becher H, Ziegler CM, et al.  The association of gingivitis and periodontitis with ischemic stroke.  J Clin Periodontol  2004;31:396-401.

Khader YS, Albashaireh ZS, Alomari MA.  Periodontal disease and the risk of coronary heart and cerebrovascular diseases:  A meta-analysis.  J Periodontol 2004;75:1046-1053.

Elter JR, Offenbacher S, Toole JF, Beck JD.  Relationship of periodontal disease and edentulism to stroke/TIA.  J Dent Res  2003;82:998-1001.

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Comment on above artice:  Am J Obstet Gynecol  2007;196(2):93-104.

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Comment on Above Article:  Goldenberg RL, Culhane JF.  Preterm birth and periodontal disease.

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Wolcott RD, Ehrlich GD.  Biofilms and chronic infections.  JAMA  2008;299(22):2682-2684.

Barksby HE, Lea SR, Preshaw PM, Taylor JJ.  The expanding family of interleukin-1cytokines and their role in destructive inflammatory disorders.  Clin Exper Immunol  2007;149:217-225.

Seymour GJ, Ford PJ, Cullinan MP, Leishman S, Yamazaki K. Relationship between periodontal infections and systemic disease.  Clin Microbiol Infect 2007;13(Suppl 4):3-10.

Oral and Whole Body Health.  Scientific American   2006, Supplement, October Issue

The Oral-Systemic Disease Connection.  J Am Dent Assoc  2006;137(October Suppl):1S-36S

Hung HC, Willett WC, Merchant A, et al.  Oral health and peripheral artery disease.  Circulation 2003;107(8):1152-1157.

Williams RC, Offenbacher S.  Periodontal medicine:  The emergence of a new branch of periodontology. Periodontol 2000  2000;23:9-12


Literature Reviews:  Periodontal Disease and Systemic Disease

Joshipura K, Zevallos JC, Ritchie CS.  Strength of evidence relating periodontal disease and atherosclerotic disease.  Compendium  2009;30(7):430-439.

Journal of Periodontology.  Proceedings of the 2008 workshop on inflammation.  Inflammation and periodontal

Kinane D, Bouchard P.  Periodontal diseases and health:  Consensus report of the sixth European workshop on periodontology.  J Clin Periodont  2008;35(Suppl 8):333–337.

Wolcott RD, Ehrlich GD.  Biofilms and chronic infections.  JAMA  2008;299(22):2682-2684.

Barksby HE, Lea SR, Preshaw PM, Taylor JJ.  The expanding family of interleukin-1cytokines and their role in destructive inflammatory disorders.  Clin Exper Immunol  2007;149:217-225.

Seymour GJ, Ford PJ, Cullinan MP, Leishman S, Yamazaki K. Relationship between periodontal infections and systemic disease.  Clin Microbiol Infect 2007;13(Suppl 4):3-10.

Oral and Whole Body Health.  Scientific American   2006, Supplement, October Issue

The Oral-Systemic Disease Connection.  J Am Dent Assoc  2006;137(October Suppl):1S-36S

Hung HC, Willett WC, Merchant A, et al.  Oral health and peripheral artery disease.  Circulation 2003;107(8):1152-1157.

Williams RC, Offenbacher S.  Periodontal medicine:  The emergence of a new branch of periodontology. Periodontol 2000  2000;23:9-12

Schematic showing the basic concept of periodontal disease by showing a healthy tooth on the left and one with periodontal disease on the right. The diseased tooth has already lost part of the gum, ligament attachment and bone. If the periodontal condition is not diagnosed and corrected, the tooth may be lost or have to be removed . The Perio-Imager accurately and painlessly measures the depth of the pocket that has been created by the periodontal disease and the loss of gum tissue, the ligament attachment and bone.

Downey Dentist

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