96 Stomatologija, Baltic Dental and Maxillofacial Journal, 2006, Vol. 8., No. 3.
The relationship between blood serum lipids and
periodontal condition
Giedre Valentaviciene, Pajauta Paipaliene, Irena Nedzelskiene, Juozas Zilinskas, Ona Vidute
Anuseviciene
Giedre Valentaviciene – D.D.S., ass. prof., Department of Dental and
Oral Diseases, Kaunas Medical University, Lithuania
Pajauta Paipaliene – D.D.S., Ph D, Assoc. Prof., Department of
Dental and Oral Diseases, Kaunas Medical University,
Lithuania
Irena Nedzelskiene – engineer programmer at the Department of
Dental and Oral Diseases, Kaunas Medical University,
Lithuania
Juozas Zilinskas – D.D.S., private practice
Ona Vidute Anuseviciene – assist. Institute of Anatomy, Kaunas Medical
University, Lithuania
Address correspondence to Dr. G. Valentaviciene, Eivieniu 2, Dep. of
Dental and Oral Diseases, Kaunas Medical University, Lithuania
SUMMARY
The aim of the study: the study analyzed he relationship between blood serum lipids and
periodontal condition, as well as the relationship between the left ventricular mass index and the
condition of periodontium. The study included 261 subjects – 140 women and 121 men. Mean age
of the subjects was 38 years. The condition of periodontal tissues during the study was evaluated
with the help of the CPITN index (Community Periodontal Index of Treatment Needs). The study
was performed at Kaunas University of Medicine (KMU) Clinic of Dental and Oral Diseases.
Laboratory blood lipid studies were performed at the laboratory of the Hospital of Kaunas University
of Medicine (HKUM). The studies included the determination of the total blood cholesterol
level, triglyceride level, HDL cholesterol level, and LDL cholesterol level (mmol/l). Patients with
hypertension (102 patients) underwent ultrasound examination of the heart at KMU Clinic of
Cardiology. On the basis of the findings of the ultrasound study, left ventricular mass index (g/m2)
was calculated.
The findings of our study showed that there was no difference in the blood serum concentration
of total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol between people with
healthy periodontium and those with gingivitis or periodontitis. Mean rank of the left ventricular
mass index in subjects with healthy periodontium or gingivitis (CPITN codes 0, 1, 2) was 48.3, and
in subjects with periodontitis (CPITN codes 3, 4) – 61.36 (p<0.05).
Key words: periodontal diseases, cardiovascular diseases, cholesterol, left ventricular mass.
INTRODUCTION
Although a number of studies have been performed
recently on the possible association between cardiovascular
diseases (CVDs) and periodontium, this association
is not thoroughly understood yet [1,2,3,4].
CVDs are common all over the world, and atherosclerosis
of coronary arteries is considered to be the leading
cause of premature death among men [5]. The pathological
background of the atherosclerosis of coronary arteries is
the formation of atherosclerotic plaque, which additionally
induces other cardiovascular diseases [6].
The main risk factors for CVDs are age, male sex, hypercholesterolemia
(especially in case of cholesterol with
low density lipoproteins (LDL)), smoking, systemic hypertension,
and diabetes mellitus [7]. The majority of risk factors
of CVDs are also considered to be risk factors for
periodontal diseases (periodontitis) [8]. The role of inflammation
in the development of atherosclerosis has been
studied as well [9]. Studies found that atherosclerosis may
be caused by several viral (cytomegalo virus and herpes
virus and bacterial (Chlamydia pneumoniae, Helicobacter
pylori) pathogens [10, 11].
A hypothetical relationship between damage to periodontium
and atherosclerosis could be explained by the
effect of a chronic inflammatory process on blood rheology,
and a direct effect of active cytokines and activated
lymphocytes and monocytes on the tissues of blood vessel
walls [12,13]. Periodontitis is a chronic inflammatory
disease that is characterized by a Th1 reaction and the
release of cytokines (such as TNF-a and IL-b) [14,15]. It
was determined that these cytokines also influence the
development and progression of atherosclerosis [16,17].
Hypertension is also a very important risk factor for
CVDs. Despite high prevalence of hypertension (as well
as its immense prognostic value), there are few findings
on the association between elevated blood pressure and
the condition of the periodontium [18].
It was found that 1/3 of patients with hypertension
have an abnormal increase in the left ventricular mass. It
is known that left ventricular (LV) hypertrophy is associated
with an increased risk for various CVD complications
irrespectively of blood pressure and other factors
[19].
The aim of the study: this study analyzed the relationship
between blood serum lipids (as a well known CVD
factor) and the condition of the periodontium, as well as
the relationship between left ventricular mass index and
the condition of the periodontium.
SCIENTIFIC ARTICLES
Stomatologija, Baltic Dental and Maxillofacial Journal, 8:96-100, 2005
Stomatologija, Baltic Dental and Maxillofacial Journal, 2006, Vol. 8., No. 3. 97
Fig. 2. The relationship of the CPITN index with trigliceride
Fig. 3. The relationship of the CPITN index with HDL
Fig. 1. The relationship of the CPITN index with total cholesterol
Fig. 4. The relationship of the CPITN index with LDL
MATERIAL AND METHODS
The study included 261 people – 140 women and 121
men. Mean age of the subjects was 38 years. The examination
of the oral cavity was performed at KMU Clinic of Dental
and Oral Diseases, laboratory blood lipid tests were performed
at HKUM laboratory, and measurements of the subjects’
arterial blood pressure, as well as cardiac ultrasound
studies, were performed at KMU Clinic of Cardiology.
The condition of periodontal tissues was evaluated
with the use of the CPITN (Community Periodontal Index
of Treatment Needs) index [20]. The determination of this
index was performed with the help of a stomatological mirror
and a periodontal probe. The determination of the
CPITN index was performed the following way: teeth in the
lower and upper jaws were divided into sextants. One teeth
of each sextant was examined (16, 11, 26, 36, 31, and 46).
The following codes were used in the evaluation:
Code 0 – healthy periodontal tissues;
Code 1 – bleeding after probing;
Code 2 – supragingival and subgingival calculus;
Code 3 – 4-5 mm deep pathological pockets;
Code 4 – 6 mm and deeper pathological pockets.
The findings of the study were recorded in a table;
the biggest code for the examined tooth was recorded:
16 11 26
46 31 36
During tests at the HKUM laboratory, total blood cholesterol
levels, as well as the blood levels of triglycerides,
high-density cholesterol (HDL) and low-density choles-
G. Valentaviciene et al. SCIENTIFIC ARTICLES
Stomatologija, Baltic Dental and Maxillofacial Journal, 2006, Vol. 8., No. 3. 99
(statistical Package for Social Sciences) for document accumulation
and analysis. The interrelationship of attributes
was evaluated using c2 criterion, and the comparison of
mean values was performed suing Student’s t-criterion.
When evaluating quantitative findings that did not have
normal distribution, comparison tests for non-parametric
values were used. Differences with significance level below
0.05 were considered to be significant.
RESULTS AND DISCUSSION
The statistical analysis of the findings, and the evaluation
of the obtained results showed that in male subjects,
mean total blood cholesterol level was 5.77±0.09,
mean triglyceride level – 1.45±0.13, mean high density
cholesterol (HDL) level – 1.42±0.03, and mean low density
cholesterol (LDL) – 3.79+±0.08. The respective values
in female subjects were 5.83±0.32, 1.1±0.11, 1.52±0.02,
and 3.49±0.08.
The analysis of the relationship of blood serum lipids
with the CPITN index in men yielded the following results:
mean total blood cholesterol level at CPITN Code 0 (healthy
periodontal tissues) – 6.19±0.45, at code 1 (bleeding after
probing) – 5.26±0.2, at code 2 (supragingival and subgingival
calculus) – 5.74±0.13, and at codes 3, 4 (4-6 mm and
deeper periodontal pockets) – 5.86±0.14 (Fig. 1). The respective
values for mean blood triglyceride levels were
the following: CPITN Code 0 – 2.15±0.91, code 1 –
0.92±0.09, code 2 – 1.46±0.18, and codes 3, 4 – 1.27±0.11
(Fig. 2). Mean values for blood HDL levels were the following:
CPITN code 0 – 1.32 ±0.11, code 1 – 1.43±0.12,
code 2 – 1.45±0.04, and codes 3, 4 – 1.39±0.04 (Fig. 3).
Mean values for blood LDL levels were the following:
CPITN code 0 – 4.19±0.43, code 1 – 3.54±0.24, code 2 –
3.73±0.12, and codes 3, 4 – 3.88±0.13 (Fig. 4).
The analysis of the results in the group of female subjects
yielded the following findings:
Mean total blood cholesterol level at CPITN Code 0 –
5.72±0.33, at code 1 – 5.56±0.21, at code 2 – 5.93±0.454, and
at codes 3, 4 – 5.48±0.21 (Fig. 5). The respective values for
mean blood triglyceride levels were the following: CPITN
Code 0 – 0.87±0.1, code 1 – 0.95±0.11, code 2 – 1.17±0.16,
and codes 3, 4 – 0.94±0.07 (Fig. 6). Mean values for blood
HDL levels were the following: CPITN code 0 – 1.6 ±0.09,
code 1 – 1.58±0.19, code 2 – 1.55±0.03, and codes 3, 4 –
1.56±0.06 (Fig. 7). Mean values for blood LDL levels were
the following: CPITN code 0 – 3.84±0.28, code 1 – 3.53±0.3,
code 2 – 3.45±0.09, and codes 3, 4 – 3.49 ±0.22 (Fig. 8).
Literature contains various findings about possible
relationship between blood serum lipids and periodontal
condition. Katz, J. et al. [23] indicate that in men, total
blood cholesterol and LDL levels are significantly higher
in patients with periodontitis (CPITN codes 3, 4), compared
to patients with healthy periodontium and those with
gingivitis (CPITN codes 0, 1, 2). These authors do not
indicate significant findings in the groups of females. The
association between periodontal condition, lipid concentration,
and CVDs is indicated in other articles as well [24,
25]. Loesche, W. et al. [26] determined a significant association
between, periodontal conditions and the concentration
of triglycerides in blood.
Krause, S. et al. [27] states that hyperlipidemia causes
hyperactivity of white blood corpuscles. It was determined
that hyperactivity of white blood cells (e.g. increased production
of oxygen radicals) may be associated with the
development of periodontitis in adults [28].
Cutler, C. W. et al. [29] in their article stated that there
exists a close relationship between damage to the periodontium,
increased concentration of lipids in blood, and
the presence of Porphyromonas gingivalis antibodies. Although
the studied sample was small (26 people), this study
showed that higher triglyceride levels might modulate the
production of IL-Ib polymorphonuclear leucocytes stimulated
by P. gingivalis.
Morrison, H. I. et al. [30] in their article mention total
blood cholesterol level, c-reactive protein, and fibrinogen
as possible intermediate factors that associate periodontitis
with increased risk for CVDs.
However, these findings do not allow for the determination
of causality, i.e. whether periodontal diseases may
increase blood lipid concentration, or hyperlipidemia exists
as the same risk factor for periodontal diseases and
CVDs [23].
Our study did not show any significant differences in
blood concentration of total cholesterol, triglycerides,
HDL, and LDL between people with healthy periodontium
and those with gingivitis or periodontitis (in both male
and female subjects). The results may have been influenced
by the young age of the subjects (38 years) as well
by the fact that this study did not analyze such aspects as
physical activity, nutrition, experienced stress, etc. Similar
findings were obtained in the study performed by Hujoel,
P. P. et al. [31].
Our study also determined the relationship of LV mass
index (in patients with hypertension) with the CPITN index.
The evaluation of the obtained findings showed that
mean LV mass index in subjects with healthy periodontium
or with gingivitis (CPITN codes 0, 1, 2) was 92.92±2.7, while
that in subjects with periodontitis (CPITN codes 3, 4) –
97.54±11.2. The comparison of these mean values did not
yield any significant results. However, the Kolmagorov-
Smirnov test showed an abnormal distribution, and the
non-parameter study method was applied (Mann-Whitney
test).
The results of the test were the following: mean rank
value of the LV mass index in subjects with healthy periodontium
of gingivitis was 48.3, while in subjects with periodontitis
– 61.36 (p<0.05). Similar results were obtained
by Angeli, F. et al. [32]. Possible mechanisms that associate
LV mass index and periodontal condition are not fully
understood. It is thought that in case of patients with hypertension,
both hypertrophied heart and periodontium
may be characterized by common microcirculatory dysfunction
and rarefaction of the network of arterioles and
capillaries.
Elevated pressure may play a role in the development
of LV hypertrophy and general narrowing of the lumen of
micro blood vessels. This may result in ischemia on the
levels of both the heart and the periodontium [33].
Thus, a simple evaluation of the periodontal condition
may be useful for the evaluation and specification of
CVDs when examining patients with hypertension.
G. Valentaviciene et al. SCIENTIFIC ARTICLES
100 Stomatologija, Baltic Dental and Maxillofacial Journal, 2006, Vol. 8., No. 3.
Received: 26 04 2005
Accepted for publishing: 25 09 2005
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2. Emingil G, Buduneli E, Aliyev M, Ahilli A, Atilla G. Association
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3. Genco R, Offenbacher S, Beck J. Periodontal disease and cardiovascular
disease: epidemiology and possible mechanisms. J Am
Dent Assoc 2002; 133: 14–22.
4. Howell TH, Ridker PM, Ajani UA, Hennekens CH, Christen WG.
Periodontal disease and risk of subsequent cardiovascular disease in
US male physicians. J Am Coll Cardiol 2001; 37: 445–50.
5. Ross R. Atherosclerosis – an inflammatory disease. J Med 1999;
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6. Babarskienė R, Bandzienė R, Benetis R, Braždžionytė J, ir kt.
Širdies ligos. – Kaunas; 2001, p. 5–7.
7. Lowl GDO. Etiopathogenesis of cardiovascular disease: Hemostasis,
thrombosis and vascular medicine. Ann Periodontol 1998, 3:
114–127.
8. Beck J, Offenbacher S, Williams R, Gibbs P, Garcia R. Periodontitis:
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9. Epstein SE, Zhou YF, Zhou J. Infection and atherosclerosis. Circulation
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10. Sorlie PD, Adam E, Melnick SL. Cytomegalovirus, herpesvirus and
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33–7.
11. Patel P, Carrington D, Strachan DP. Fibrinogen: a link between
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12. Danesh J, Collins R, Peto R. Chronic infection and coronary heart
disease: Is there a link? Lancet 1997; 350: 430–6.
13. Libby P, Egan D, Sharlatos G. Roles of infections agents in atherosclerosis
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14. Dongari–Bagtzoglou Al, Ebersole JL. Increased presence of
interleukin – 6 (IL – 6) and IL – 8 secreting fibroblast subpopulations
in adult periodontitis. J Periodontol 1998; 69: 899 – 910.
15. Lo YJ, Lui CM, Wong M. Interleukin 1 beta – secreting cells in
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1999; 11: 626–33.
16. McCarty MF. Interleukin – 6 as a central mediator of cardiovascular
risk associated with chronic inflammation, smoking, diabetes
and visceral obesity: Down – regulation with essential fatty acids,
ethanol and pentoxifylline. Med Hypotheses 1999; 52: 465–477.
17. Mendall MA, Patel P, Asante M. Relation of serum cytokine concentrations
to cardiovascular risk factors and coronary disease.
Heart 1997; 78: 273–7.
18. Ioi H, Nakata S, Nakasima A, Counts AL, Nanda RS. Changes in
tooth position in humans in relation to arterial blood pressure.
Arch Oral Biol 2002; 47: 219–26.
19. Devereux RB, Roman MJ. Hypertensive cardiac hypertrophy:
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20. Purienė A, Matulienė D, Ivanauskaitė D. Periodonto ligos:
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prognozė. Vilnius; 2000, p. 36.
21. Babarskienė R, Bandzaitienė R, Benetis R, Braždžionytė J, ir kt.
Širdies ligos. – Kaunas; 2001. p. 332.
22. Vaškelytė J, Jurkevičius R, Ereminienė E, Janėnaitė J.
Echokardiografiniai matavimai. Kaunas; 2000. p. 5–7.
23. Katz J, Flugelman MY, Goldberg A, Heft M. Association between
periodontal pockets and elevated cholesterol and low density lipoprotein
cholesterol levels. J Periodontol 2002: 73: 494–500.
24. Slade GD, Offenbacher S, Beck JD, Heiss G, Pankow JS. Acutephase
inflammatory response to periodontal disease in the US
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25. Beck JD, Pankow J, Tyroler HA, Offenbacher S. Dental infection
and atherosclerosis. Am Heart J 1999; 138: 528–33.
26. Loesche W, Karapetov F, Pohl C. Plasma lipid and blood glucose
levels in patients with destructive periodontal disease. J Clin
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27. Krause S, Pohl A, Pohl C, Liebrenz A, Ruhling K, Losche W.
Increased generation of reactive oxygen species in mononuclear
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28. Shapira L, Borinski R, Sela MN, Soskolne A. Superoxide formation
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in rapidly progressive periodontitis patients. J Clin
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29. Cutler CW, Shinedeling EA, Nunn M. Association between periodontitis
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30. Morrison HJ, Ellison LF, Taylor GW. Periodontal disease and risk
of fatal coronary heart and cerebrovascular diseases. J Cardiovasc
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disease and coronary heart disease risk. JAMA 2000; 284: 1406
– 10.
32. Angeli F, Verdecchia P, Pellegrino C, Pellegrino RG, Pellegrino G,
Prosciutti L, et al. Association between periodontal disease and left
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488–92.
33. Chapple CC, Kumar RK, Hunter N. Vascular remodelling in chronic
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500–6.
SCIENTIFIC ARTICLES G. Valentaviciene et al.
CONCLUSIONS
1. The concentration of total cholesterol, triglycerides,
HDL, and LDL in blood serum did not differ significantly
in people (either males or females) with healthy periodontium,
gingivitis, or periodontitis.
2. The evaluation of the association of the LV mass
index with the CPITN index (in patients with hypertension)
yielded the following results: mean rank value in people
with healthy periodontium or with gingivitis (CPITN codes
0, 1, 2) was 48.3, and in people with periodontitis (CPITN
codes 3, 4) – 61.36 (p<0.05). The LV mass index elevated
with the increase in the degree of damage to periodontium
(the results were significant).
The relationship between blood serum lipids and
periodontal condition
Giedre Valentaviciene, Pajauta Paipaliene, Irena Nedzelskiene, Juozas Zilinskas, Ona Vidute
Anuseviciene
Giedre Valentaviciene – D.D.S., ass. prof., Department of Dental and
Oral Diseases, Kaunas Medical University, Lithuania
Pajauta Paipaliene – D.D.S., Ph D, Assoc. Prof., Department of
Dental and Oral Diseases, Kaunas Medical University,
Lithuania
Irena Nedzelskiene – engineer programmer at the Department of
Dental and Oral Diseases, Kaunas Medical University,
Lithuania
Juozas Zilinskas – D.D.S., private practice
Ona Vidute Anuseviciene – assist. Institute of Anatomy, Kaunas Medical
University, Lithuania
Address correspondence to Dr. G. Valentaviciene, Eivieniu 2, Dep. of
Dental and Oral Diseases, Kaunas Medical University, Lithuania
SUMMARY
The aim of the study: the study analyzed he relationship between blood serum lipids and
periodontal condition, as well as the relationship between the left ventricular mass index and the
condition of periodontium. The study included 261 subjects – 140 women and 121 men. Mean age
of the subjects was 38 years. The condition of periodontal tissues during the study was evaluated
with the help of the CPITN index (Community Periodontal Index of Treatment Needs). The study
was performed at Kaunas University of Medicine (KMU) Clinic of Dental and Oral Diseases.
Laboratory blood lipid studies were performed at the laboratory of the Hospital of Kaunas University
of Medicine (HKUM). The studies included the determination of the total blood cholesterol
level, triglyceride level, HDL cholesterol level, and LDL cholesterol level (mmol/l). Patients with
hypertension (102 patients) underwent ultrasound examination of the heart at KMU Clinic of
Cardiology. On the basis of the findings of the ultrasound study, left ventricular mass index (g/m2)
was calculated.
The findings of our study showed that there was no difference in the blood serum concentration
of total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol between people with
healthy periodontium and those with gingivitis or periodontitis. Mean rank of the left ventricular
mass index in subjects with healthy periodontium or gingivitis (CPITN codes 0, 1, 2) was 48.3, and
in subjects with periodontitis (CPITN codes 3, 4) – 61.36 (p<0.05).
Key words: periodontal diseases, cardiovascular diseases, cholesterol, left ventricular mass.
INTRODUCTION
Although a number of studies have been performed
recently on the possible association between cardiovascular
diseases (CVDs) and periodontium, this association
is not thoroughly understood yet [1,2,3,4].
CVDs are common all over the world, and atherosclerosis
of coronary arteries is considered to be the leading
cause of premature death among men [5]. The pathological
background of the atherosclerosis of coronary arteries is
the formation of atherosclerotic plaque, which additionally
induces other cardiovascular diseases [6].
The main risk factors for CVDs are age, male sex, hypercholesterolemia
(especially in case of cholesterol with
low density lipoproteins (LDL)), smoking, systemic hypertension,
and diabetes mellitus [7]. The majority of risk factors
of CVDs are also considered to be risk factors for
periodontal diseases (periodontitis) [8]. The role of inflammation
in the development of atherosclerosis has been
studied as well [9]. Studies found that atherosclerosis may
be caused by several viral (cytomegalo virus and herpes
virus and bacterial (Chlamydia pneumoniae, Helicobacter
pylori) pathogens [10, 11].
A hypothetical relationship between damage to periodontium
and atherosclerosis could be explained by the
effect of a chronic inflammatory process on blood rheology,
and a direct effect of active cytokines and activated
lymphocytes and monocytes on the tissues of blood vessel
walls [12,13]. Periodontitis is a chronic inflammatory
disease that is characterized by a Th1 reaction and the
release of cytokines (such as TNF-a and IL-b) [14,15]. It
was determined that these cytokines also influence the
development and progression of atherosclerosis [16,17].
Hypertension is also a very important risk factor for
CVDs. Despite high prevalence of hypertension (as well
as its immense prognostic value), there are few findings
on the association between elevated blood pressure and
the condition of the periodontium [18].
It was found that 1/3 of patients with hypertension
have an abnormal increase in the left ventricular mass. It
is known that left ventricular (LV) hypertrophy is associated
with an increased risk for various CVD complications
irrespectively of blood pressure and other factors
[19].
The aim of the study: this study analyzed the relationship
between blood serum lipids (as a well known CVD
factor) and the condition of the periodontium, as well as
the relationship between left ventricular mass index and
the condition of the periodontium.
SCIENTIFIC ARTICLES
Stomatologija, Baltic Dental and Maxillofacial Journal, 8:96-100, 2005
Stomatologija, Baltic Dental and Maxillofacial Journal, 2006, Vol. 8., No. 3. 97
Fig. 2. The relationship of the CPITN index with trigliceride
Fig. 3. The relationship of the CPITN index with HDL
Fig. 1. The relationship of the CPITN index with total cholesterol
Fig. 4. The relationship of the CPITN index with LDL
MATERIAL AND METHODS
The study included 261 people – 140 women and 121
men. Mean age of the subjects was 38 years. The examination
of the oral cavity was performed at KMU Clinic of Dental
and Oral Diseases, laboratory blood lipid tests were performed
at HKUM laboratory, and measurements of the subjects’
arterial blood pressure, as well as cardiac ultrasound
studies, were performed at KMU Clinic of Cardiology.
The condition of periodontal tissues was evaluated
with the use of the CPITN (Community Periodontal Index
of Treatment Needs) index [20]. The determination of this
index was performed with the help of a stomatological mirror
and a periodontal probe. The determination of the
CPITN index was performed the following way: teeth in the
lower and upper jaws were divided into sextants. One teeth
of each sextant was examined (16, 11, 26, 36, 31, and 46).
The following codes were used in the evaluation:
Code 0 – healthy periodontal tissues;
Code 1 – bleeding after probing;
Code 2 – supragingival and subgingival calculus;
Code 3 – 4-5 mm deep pathological pockets;
Code 4 – 6 mm and deeper pathological pockets.
The findings of the study were recorded in a table;
the biggest code for the examined tooth was recorded:
16 11 26
46 31 36
During tests at the HKUM laboratory, total blood cholesterol
levels, as well as the blood levels of triglycerides,
high-density cholesterol (HDL) and low-density choles-
G. Valentaviciene et al. SCIENTIFIC ARTICLES
Stomatologija, Baltic Dental and Maxillofacial Journal, 2006, Vol. 8., No. 3. 99
(statistical Package for Social Sciences) for document accumulation
and analysis. The interrelationship of attributes
was evaluated using c2 criterion, and the comparison of
mean values was performed suing Student’s t-criterion.
When evaluating quantitative findings that did not have
normal distribution, comparison tests for non-parametric
values were used. Differences with significance level below
0.05 were considered to be significant.
RESULTS AND DISCUSSION
The statistical analysis of the findings, and the evaluation
of the obtained results showed that in male subjects,
mean total blood cholesterol level was 5.77±0.09,
mean triglyceride level – 1.45±0.13, mean high density
cholesterol (HDL) level – 1.42±0.03, and mean low density
cholesterol (LDL) – 3.79+±0.08. The respective values
in female subjects were 5.83±0.32, 1.1±0.11, 1.52±0.02,
and 3.49±0.08.
The analysis of the relationship of blood serum lipids
with the CPITN index in men yielded the following results:
mean total blood cholesterol level at CPITN Code 0 (healthy
periodontal tissues) – 6.19±0.45, at code 1 (bleeding after
probing) – 5.26±0.2, at code 2 (supragingival and subgingival
calculus) – 5.74±0.13, and at codes 3, 4 (4-6 mm and
deeper periodontal pockets) – 5.86±0.14 (Fig. 1). The respective
values for mean blood triglyceride levels were
the following: CPITN Code 0 – 2.15±0.91, code 1 –
0.92±0.09, code 2 – 1.46±0.18, and codes 3, 4 – 1.27±0.11
(Fig. 2). Mean values for blood HDL levels were the following:
CPITN code 0 – 1.32 ±0.11, code 1 – 1.43±0.12,
code 2 – 1.45±0.04, and codes 3, 4 – 1.39±0.04 (Fig. 3).
Mean values for blood LDL levels were the following:
CPITN code 0 – 4.19±0.43, code 1 – 3.54±0.24, code 2 –
3.73±0.12, and codes 3, 4 – 3.88±0.13 (Fig. 4).
The analysis of the results in the group of female subjects
yielded the following findings:
Mean total blood cholesterol level at CPITN Code 0 –
5.72±0.33, at code 1 – 5.56±0.21, at code 2 – 5.93±0.454, and
at codes 3, 4 – 5.48±0.21 (Fig. 5). The respective values for
mean blood triglyceride levels were the following: CPITN
Code 0 – 0.87±0.1, code 1 – 0.95±0.11, code 2 – 1.17±0.16,
and codes 3, 4 – 0.94±0.07 (Fig. 6). Mean values for blood
HDL levels were the following: CPITN code 0 – 1.6 ±0.09,
code 1 – 1.58±0.19, code 2 – 1.55±0.03, and codes 3, 4 –
1.56±0.06 (Fig. 7). Mean values for blood LDL levels were
the following: CPITN code 0 – 3.84±0.28, code 1 – 3.53±0.3,
code 2 – 3.45±0.09, and codes 3, 4 – 3.49 ±0.22 (Fig. 8).
Literature contains various findings about possible
relationship between blood serum lipids and periodontal
condition. Katz, J. et al. [23] indicate that in men, total
blood cholesterol and LDL levels are significantly higher
in patients with periodontitis (CPITN codes 3, 4), compared
to patients with healthy periodontium and those with
gingivitis (CPITN codes 0, 1, 2). These authors do not
indicate significant findings in the groups of females. The
association between periodontal condition, lipid concentration,
and CVDs is indicated in other articles as well [24,
25]. Loesche, W. et al. [26] determined a significant association
between, periodontal conditions and the concentration
of triglycerides in blood.
Krause, S. et al. [27] states that hyperlipidemia causes
hyperactivity of white blood corpuscles. It was determined
that hyperactivity of white blood cells (e.g. increased production
of oxygen radicals) may be associated with the
development of periodontitis in adults [28].
Cutler, C. W. et al. [29] in their article stated that there
exists a close relationship between damage to the periodontium,
increased concentration of lipids in blood, and
the presence of Porphyromonas gingivalis antibodies. Although
the studied sample was small (26 people), this study
showed that higher triglyceride levels might modulate the
production of IL-Ib polymorphonuclear leucocytes stimulated
by P. gingivalis.
Morrison, H. I. et al. [30] in their article mention total
blood cholesterol level, c-reactive protein, and fibrinogen
as possible intermediate factors that associate periodontitis
with increased risk for CVDs.
However, these findings do not allow for the determination
of causality, i.e. whether periodontal diseases may
increase blood lipid concentration, or hyperlipidemia exists
as the same risk factor for periodontal diseases and
CVDs [23].
Our study did not show any significant differences in
blood concentration of total cholesterol, triglycerides,
HDL, and LDL between people with healthy periodontium
and those with gingivitis or periodontitis (in both male
and female subjects). The results may have been influenced
by the young age of the subjects (38 years) as well
by the fact that this study did not analyze such aspects as
physical activity, nutrition, experienced stress, etc. Similar
findings were obtained in the study performed by Hujoel,
P. P. et al. [31].
Our study also determined the relationship of LV mass
index (in patients with hypertension) with the CPITN index.
The evaluation of the obtained findings showed that
mean LV mass index in subjects with healthy periodontium
or with gingivitis (CPITN codes 0, 1, 2) was 92.92±2.7, while
that in subjects with periodontitis (CPITN codes 3, 4) –
97.54±11.2. The comparison of these mean values did not
yield any significant results. However, the Kolmagorov-
Smirnov test showed an abnormal distribution, and the
non-parameter study method was applied (Mann-Whitney
test).
The results of the test were the following: mean rank
value of the LV mass index in subjects with healthy periodontium
of gingivitis was 48.3, while in subjects with periodontitis
– 61.36 (p<0.05). Similar results were obtained
by Angeli, F. et al. [32]. Possible mechanisms that associate
LV mass index and periodontal condition are not fully
understood. It is thought that in case of patients with hypertension,
both hypertrophied heart and periodontium
may be characterized by common microcirculatory dysfunction
and rarefaction of the network of arterioles and
capillaries.
Elevated pressure may play a role in the development
of LV hypertrophy and general narrowing of the lumen of
micro blood vessels. This may result in ischemia on the
levels of both the heart and the periodontium [33].
Thus, a simple evaluation of the periodontal condition
may be useful for the evaluation and specification of
CVDs when examining patients with hypertension.
G. Valentaviciene et al. SCIENTIFIC ARTICLES
100 Stomatologija, Baltic Dental and Maxillofacial Journal, 2006, Vol. 8., No. 3.
Received: 26 04 2005
Accepted for publishing: 25 09 2005
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SCIENTIFIC ARTICLES G. Valentaviciene et al.
1. The concentration of total cholesterol, triglycerides,
HDL, and LDL in blood serum did not differ significantly
in people (either males or females) with healthy periodontium,
gingivitis, or periodontitis.
2. The evaluation of the association of the LV mass
index with the CPITN index (in patients with hypertension)
yielded the following results: mean rank value in people
with healthy periodontium or with gingivitis (CPITN codes
0, 1, 2) was 48.3, and in people with periodontitis (CPITN
codes 3, 4) – 61.36 (p<0.05). The LV mass index elevated
with the increase in the degree of damage to periodontium
(the results were significant).
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