Parodontale und orale mikrobielle Parameter bei Patienten mit verschiedenen koronaren Herzerkrankungen

Abstract

The aim of the study was to evaluate the impact on clinical periodontal parameters and the presence of periodontal pathogens in patients with different coronary heart diseases. Our objectives were to find a direct correlation between coronary events and periodontal inflammation (healthy, gingivitis, periodontitis) regarding to a higher prevalence of defined periodontal pathogens in patients with coronary events. A total of 158 subjects were included and graduated in 5 groups (group 1 = 30 (myocardial infarction), group 2 = 37 (aortic stenosis), group 3 = 25 (coronary heart disease), group 4 = 36 (coronary heart disease and aortic stenosis), group 5 = 30 (healthy control group), with an average age in group 1 - 4 of 67.3 and 65 ± 12 years in group 5. In order to increase the comparability of periodontal conditions all patients were matched to age, smoking and gender. All individuals were screened for suitability to this study. After the patient was informed and signed the consent form, a medical history was taken including dental notation (DMFT and Papilla Bleeding Index (PBI)) and a periodontal chart. The periodontal inflammation was measured by the BOP. The degree of periodontitis severity was determined by the probing depth and the attachment level. During surgery, thoracic and cardiovascular surgeons took blood samples. Subgingival bacterial samples were collected from all patients. The deepest pocket of each quadrant was selected for sampling. Polymerase chain reaction (PCR) technique was used to look for 11 periodontal pathogens, for example A.actinomycetemcomitans (Aac) or Porphyromonas gingivalis (Pg). Results: Statistical analysis of anamnestic parameters showed a significant influence of high blood pressure (p = 0.00002) and hyperlipidemia (p = 0.00065) on the groups. The average DMFT was 21.79 ± 5.8. The highest average probing depth with 3.64 ± 0.93mm was in group 3, the lowest in group 5 with 3.2 ± 0.69mm. The highest clinical attachment level also was in group 3 with 6.2 ± 2.2 and the lowest in Group 5 5.6 ± 1.23mm. The amount of probing depth ≥ 4mm was in group 2 and 3 45%, in group 1 36%. In group 1 23, in group 2 30, in group 3 24, in group 4 25 and in group 5 25 patients had a severe periodontitis. The periodontal disease was not significant for all groups (p = 0.13). Statistical analysis of BOP (p = 0.0011) and furcation findings (p = 0.04) showed a significant influence for the groups. Also the group comparison showed for the BOP (group 1 p = 0.004, group 2 p = 0.007, group 3 p = 0.061, group 4 p < 0.0001) and the furcation findings (group 1 p = 0.054, group 2 p = 0.002, group 3 p = 0.004, group 4 p = 0.0002) a statistical significant influence for these heart diseases. The statistic analysis of probing depth with different confounders (smoking p = 0.028, diabetes mellitus p = 0.039 and high blood pressure p = 0.047) were also significant for these parameters. All periodontal pathogens were found at increased frequency. Especially Fn was found in 90% of the samples. In group 1 Pg was found in 70% of the samples. Aac (p = 0.034) und Pg (p = 0.035) showed statistically significant differences between the groups. After adjusting for potential confounders Aac (p* = 0.076) and Pg (p* = 0.042) still remained statistically significant associated with coronary heart disease. The group comparison did not show any significant correlation to the control group. Conclusion: Based on the present results it is not possible to answer the initial question if there is a correlation between coronary heart disease and periodontal disease and microbiological found.