Abstract
Summary:Background: Although epidemiological data suggest an association between periodontitis (PD) and peripheral arterial disease (PAD), it is currently unclear whether treatment of PD influences the severity of PAD. Patients and methods: Whether periodontal treatment is associated with PAD disease severity was examined by analysing health insurance claims data of patients insured by the German health insurance fund, BARMER, between January 1, 2012 and December 31, 2016. The presence of PAD was determined in individuals using International Classification of Diseases (ICD) 10th revision codes for intermittent claudication (IC) or chronic limb threatening ischaemia (CLTI). Treatment of PD was assessed by adequate ambulatory coding for non-surgical and surgical treatment of PD. Multivariate logistic regression analysis was performed to evaluate the association between PAD stages and periodontal treatment, adjusted for diabetes, age and sex. Results: The study cohort included 70,944 hospitalized patients with a diagnosis of symptomatic PAD (54.99 % women, 49.05 % IC). Among these patients, 3,567 (5.03 %) had received prior treatment for PD by supra- or sub-gingival debridement. PAD patients who had received periodontal treatment showed a lower proportion of CLTI (28.76 % among treated vs. 52.12 % among non-treated). Using multivariable regression methods, exhibiting a CLTI (vs. IC) was associated with not being treated for PD (Odds Ratio 1.97, 95 %–CI 1.83–2.13) after adjustment for age, gender, and diabetes. Conclusions: In this large-scale retrospective analysis of health insurance claims data comprising hospitalized symptomatic PAD patients, treatment of PD was associated with PAD disease severity independent of age, gender and diabetes. A potential benefit of periodontal treatment in relation to PAD will have to be determined in further prospective studies.
References
1 Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382:1329–40.
2 Comorbidity Patterns Among Patients with Peripheral Arterial Occlusive Disease in Germany: A Trend Analysis of Health Insurance Claims Data. Eur J Vasc Endovasc Surg. 2019; In Press.
3 . Association between periodontitis and peripheral artery disease: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2018;18:141.
4 The Association of Periodontitis and Peripheral Arterial Occlusive Disease-A Systematic Review. Int J Mol Sci. 2019;20.
5 . Periodontal disease and atherosclerotic cardiovascular disease. VASA. 2013;42:3–7.
6 . Periodontal diagnoses and classification of periodontal diseases. Periodontol. 2000;2004(34):9–21.
7 . Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation. J Clin Periodontol. 2006;33:401–7.
8 , Periodontal bacterial invasion and infection: contribution to atherosclerotic pathology. J Periodontol. 2013;84(4 Suppl):S30–50.
9 . Periodontal health status and bacteraemia from daily oral activities: systematic review/meta-analysis. J Clin Periodontol. 2012;39:213–28.
10 . Detection of bacterial DNA in atheromatous plaques by quantitative PCR. Microbes Infect. 2006;8:687–93.
11 Molecular detection of Treponema denticola and Porphyromonas gingivalis in carotid and aortic atheromatous plaques by FISH: report of two cases. J Med Microbiol. 2005;54:93–6.
12 . Detection of Treponema denticola in atherosclerotic lesions. J Clin Microbiol. 2001;39:1114–7.
13 Detection of Porphyromonas gingivalis DNA in aortic tissue by PCR. J Periodontol. 2002;73:868–70.
14 . Relationship of periodontal attachment loss to peripheral vascular disease: an analysis of NHANES 1999–2002 data. Atherosclerosis. 2008;200:199–205.
15 . Oral health and peripheral arterial disease. Circulation. 2003;107:1152–7.
16 . Differences in sociodemographic characteristics, health, and health service use of children and adolescents according to their health insurance funds. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2014;57:455–63.
17 Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence. Eur Heart J. 2015;36:932–8.
18 . The Challenge of Data Privacy Compliant Registry Based Research. Eur J Vasc Endovasc Surg. 2018;55:601–2.
19 . Novel risk factors for systemic atherosclerosis: a comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease. JAMA. 2001;285:2481–5.
20 . Impact of periodontal therapy on general health: evidence from insurance data for five systemic conditions. Am J Prev Med. 2014;47:166–74.
21 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.
22 Periodontal treatment improves endothelial dysfunction in patients with severe periodontitis. Am Heart J. 2005;149:1050–4.
23 Treatment of periodontal disease results in improvements in endothelial dysfunction and reduction of the carotid intima-media thickness. FASEB J. 2009;23:1196–204.
24 Association between periodontal disease and its treatment, flow-mediated dilatation and carotid intima-media thickness: a systematic review and meta-analysis. Atherosclerosis. 2014;236:39–46.
25 . Zahnreport 2017. Berlin: 2017.
26 , Fünfte Deutsche Mundgesundheitsstudie (DMS V). Deutscher Ärzteverlag. 2016.
27 Changes in prevalence of periodontitis in two German population-based studies. J Clin Periodontol. 2015;42:121–30.
28 . Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med. 2008;5:e12.
29 Rationale and Design of the Hamburg City Health Study. Eur J Epidemiol. 2019; In Press.
