Relation between periodontal disease and ischemic heart disease

The aim of this study was to determine the association between periodontal diseases and ischemic heart disease among 30 exercise tolerance test (ETT) positive and 30 ETT negative of ischemic heart disease patients attending the National Heart Foundation Hospital and Research Institute. The presence of gum swelling for the two groups were statistically significant. The results revealed that 80% ETT positive and 23% ETT negative respondent had gum bleeding, 53% ETT positive and 7% ETT negative had ulceration of gingiva. Furthermore, severely inflamed with spontaneous bleeding was found in 53.3% ETT positive and 6.7% negative respondents. It can be concluded that oral hygiene should be promoted as a part of prevention of ischemic heart disease.


Introduction
Periodontal diseases promote increased blood viscosity and thrombogenesis, leading to an increased risk for the central and peripheral vascular disease.The prevalence in men between the age of 45 to 54 years is 2-5%, and that of the age of 65 to 74 years is 11-20%. 1 The etiology and pathogenesis of periodontal diseases are multi-factorial and negatively influenced by a number of risk factors, such as smoking, stress, diabetes mellitus. 2-5Consequently, both inflammatory periodontal disease and coronary heart disease are chronic diseases with similar etiological factors.Moreover, there is increasing evidence that poor oral hygiene and especially the presence of inflammatory periodontal disease increase the risk of coronary heart disease.7][8][9] There have also been an increasing number of reports of an association between periodontal inflammation and acute myocardial infarction. 10-16[19][20] Periodontal conditions can be influenced by some systemic diseases and they also can act as risk factors for some other systemic disease. 21ecent studies demonstrate that the association between oral health and atherosclerosis is consistent in different population samples and that the oral conditions precede coronary events.In moderate and advanced cases, the endotoxins (for example, LPS) of the microbial wall can stimulate the accumulation of plaque contributing to the formation of thrombi and atheroma plaque. 21Studies have suggested that symptoms of poor oral health and periodontal disease can indicate ischemic heart disease events. 22e aim of this investigation was, therefore, to evaluate the state of oral health in patients with ETT positive and to compare this with that of ETT negative group.

Materials and Methods
This study was done in the National Heart Foundation Hospital and Research Institute, during the period of August to December, 2013.All consecutive adult participants coming to ETT examination were included in the study after meeting inclusion and exclusion criteria.All patients with ischemic heart disease who are willing to participate in this hospital were included.The participants were categorized into two groups such as ETT positive and ETT negative.
A total of 30 ETT positive and 30 ETT negative patients of ischemic heart disease were enrolled for the study.Among them 33.3% were in the age group of 40-49 years.The mean age of the ETT positive participant were 52.8 ± 9.8 years and ETT negative subjects were 47.7 ± 8.1 years.Over all there were 48 men and 12 women were participating in the study.
After taking written informed consent to participate in the study the descriptive analyses

Abstract
The aim of this study was to determine the association between periodontal diseases and ischemic heart disease among 30 exercise tolerance test (ETT) positive and 30 ETT negative of ischemic heart disease patients attending the National Heart Foundation Hospital and Research Institute.
The presence of gum swelling for the two groups were statistically significant.The results revealed that 80% ETT positive and 23% ETT negative respondent had gum bleeding, 53% ETT positive and 7% ETT negative had ulceration of gingiva.Furthermore, severely inflamed with spontaneous bleeding was found in 53.3% ETT positive and 6.7% negative respondents.It can be concluded that oral hygiene should be promoted as a part of prevention of ischemic heart disease.

Results
Residential status of the ETT positive participants were 33% of rural and 67% of urban, whereas among the ETT negative, 23% were rural and 77% were urban.Among the ETT positive, 23.3% were service holder and 43.3% were businessman; whereas among the ETT negative patients 43.3% were service holder and 36.7% were businessman.Furthermore, among the ETT positive, 47% were smokeless tobacco user and among the ETT negative, 20% were smokeless tobacco user.
There were significant changes in the swelling of gum, gum bleeding, ulceration and calculus in case of ETT positive patients in comparison to ETT negative one (Table I).
Table I also shows that regarding plaque index, 40% ETT positive respondents had mild and 53.3% had moderate plaque.Again regarding the gingival index, 53.3% ETT positive respondent was severely inflammed with spontaneous bleeding and 6.7% of ETT negative was severely inflammed.The differences were statistically significant.

Discussion
In this study, patients with ischemic heart disease were taken in terms of age, gender and smoking behavior with a proven generally healthy group and studied with regard to their oral health status.The majority of participants in both groups showed good oral hygiene behavior and control oriented behavior in relation to the use of dental care and treatment.The total number of tooth loss the difference between the ETT positive group and ETT negative group was significant.In relation to oral hygiene practice and behavior, no difference was found between the two groups.In contrast, ischemic heart disease patients showed significantly more signs of gingival inflammation then the healthy subjects.Nevertheless, two-third of the ischemic heart disease-group and approximately one half of the healthy group had moderate to severe periodontitis.
3] Other studies were unable to find a significant difference in the number of missing teeth. 10, 11, 13, 15Moreover, a large prospective study in Sweden showed a close relationship between number of missing teeth and cardiovascular and coronary heart diseases (and even cardiovascular mortality), indicating a link between coronary artery disease and oral health. 24ne participant of each group was toothless.
Considering the results for periodontal index the differences between the groups were not significant, but oral hygiene in the ischemic heart disease-group tended to be worse.This finding has been obtained by two other studies. 15,25 n the case of ischemic heart disease patients, however, gingival inflammation was increased significantly versus healthy subjects.It should be taken into account that 18% of the ischemic heart disease patients in the studies mentioned above had diabetes mellitus, 25 and in addition, there were differences in smoking behavior between the ischemic heart disease patients and the control subjects.taken into account by procedure and exclusion criteria, and can be excluded as a possible confounder.Other research groups used other indices for assessing the state of gingival inflammation such as bleeding on probing. 26, 27they observed that the ischemic heart disease patients showed a worse gingival status than the control subjects.These findings could be confirmed by the results of this study.Only one investigation established no difference between the groups. 20 the present study, no difference was found between ischemic heart disease-group and healthy subjects with regard to the periodontal situation.However, two-third of the ischemic heart disease patients had an increased periodontal treatment need despite regular visits to the dentist.In contrast, Willershausen et al. 28 found a significant higher amount of periodontal index score 4 in their ischemic heart disease patients, it is to mention that there were clearly (significant) more smokers and diabetics in their ischemic heart disease-group than in the corresponding control group.An association between moderate periodontitis and cardiac disease was likewise not found by this research group. 29In contrast to this, some studies have indicated that in ischemic heart disease patients significantly more measurement points with increased probe depths of >4 or >5 mm were present than in control subjects. 19kewise, in the present study, no statistically significant difference was found in relation to loss of attachment.In contrast to this, other studies showed a significant correlation between ischemic heart disease and an increased loss of attachment. 22A number of authors established a correlation between a poor state of oral hygiene and ischemic heart disease.Although the ischemic heart disease patients in this study had poor oral hygiene, the differences in relation to the healthy control group were marginal.Only in relation to signs of gingival inflammation there were significant differences.

Conclusion
There were significant positive associations between several indicators of oral health such as swelling of gum, gum bleeding, calculus along the gingival margin, ulceration of gingival, plaque index and loss of tooth with ischemic heart disease in patents attending the outpatient department of a cardiac care hospital.