Research References

General

US Department of Health and Human Services.
Oral Health in America: A Report of the Surgeon General--
Executive Summary. Rockville, MD: US Department of Health and Human Services,
National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.

http://www2.nidcr.nih.gov/sgr/execsumm.htm#message

http://www.docharrison.com/

Mouth Body Connection

http://www.perio.org/consumer/mbc.top2.htm

http://www.lookhealthfit.com

Cardiovascular

The first National Health and Nutrition Examination survey followed 9760 subjects for 14 years. DeStafano
and co-workers found that individuals with periodontitis at baseline had a 25% greater chance of having coronary artery
disease. After adjusting for age, gender, race, education, poverty index, marital status, blood pressure, cholesterol, body
mass index, physical activity, alcohol consumption and cigarette smoking, men with periodontitis had a 1.72 fold greater
chance of cardiovascular disease!

http://www.perio.org/consumer/mbc.heart.htm

http://www.perio.org/consumer/happy-heart.htm

CRP levels are predictive of heart disease, and as a predictor for heart disease, is superior to and independent of cholesterol.

http://atvb.ahajournals.org/cgi/content/full/22/10/1512

"Comparison of C-Reactive Protein and Low-Density Lipoprotein Cholesterol Levels in the Prediction of First Cardiovascular Events,
" abstract, New England Journal of Medicine, Nov. 14 (vol. 347, issue 20)

http://content.nejm.org/cgi/content/full/347/20/1557

Prospective Study of C-Reactive Protein, Homocysteine, and Plasma Lipid Levels as Predictors of Sudden Cardiac Death
http://circ.ahajournals.org/cgi/content/abstract/99/2/237

High-Sensitivity C-Reactive Protein 
Potential Adjunct for Global Risk Assessment in the
Primary Prevention of Cardiovascular Disease

Paul M. Ridker, MD, MPH  http://circ.ahajournals.org/cgi/content/full/103/13/1813#F4

The cutpoints of low risk (<1.0 mg/L), average risk (1.0 to 3.0 mg/L), and high risk (>3.0 mg/L)
correspond to approximate tertiles of hs-CRP in the adult population. The high-risk tertile has an 2-fold increase in
relative risk compared with the low-risk tertile. These tertiles are based on distributions of hs-CRP samples from >15
populations involving >40 000 persons gathered for the purpose of this workshop, allowing adequate
definition of the population distribution. In general, the high-risk category includes the skewed tail of the distribution.

Markers of Inflammation and Cardiovascular Disease

Application to Clinical and Public Health Practice: A Statement for Healthcare Professionals From the Centers
for Disease Control and Prevention and the American Heart Association http://circ.ahajournals.org/cgi/content/full/107/3/499

The presence of gum disease might increase the risk of a second heart attack in people with a history of heart disease.

CHAPEL HILL -- Heart attack survivors who suffer advanced gum disease show significantly higher levels of a protein in their blood
called C-reactive protein (CRP) than such patients without gum disease, new University of North Carolina at Chapel Hill research indicates.

http://www.unc.edu/news/archives/nov00/deliar111300.htm

Markers of Inflammation and Cardiovascular Disease

Application to Clinical and Public Health Practice: A Statement for Healthcare Professionals
From the Centers for Disease Control and Prevention and the American Heart Association

The cutpoints of low risk (<1.0 mg/L), average risk (1.0 to 3.0 mg/L), and high risk (>3.0 mg/L) correspond to approximate tertiles
of hs-CRP in the adult population. The high-risk tertile has an 2-fold increase in relative risk compared with the low-risk tertile.
These tertiles are based on distributions of hs-CRP samples from >15 populations involving >40 000 persons gathered for the
purpose of this workshop, allowing adequate definition of the population distribution. In general, the high-risk category includes
the skewed tail of the distribution.

Writing Group endorses (at Evidence Level B) the optional use of hs-CRP to identify patients without known CVD who may be at
higher absolute risk than estimated by major risk factors. Specifically, those patients at intermediate risk (eg, 10% to 20% risk of
coronary heart disease (CHD) over 10 years), in whom the physician may need additional information to guide considerations of
further evaluation (eg, imaging, exercise testing) or therapy (eg, drug therapies with lipid-lowering, antiplatelet, or cardioprotective
agents), may benefit from measurement of hs-CRP. Those who have a 10-year risk of >20% are designated as CHD risk equivalents
and already qualify for intensive medical interventions. This recommendation assumes the assessment of traditional cardiovascular risk
factors and the calculation of an absolute risk score before measurement of hs-CRP.75

CRP is more than a marker it is actually a causative agent in the heart disease process.

UC Davis study identifies C-reactive protein as cause of blood clot formation

(SACRAMENTO, Calif.) -- The study appears in the Jan. 28 print edition of the journal Circulation, a publication of the American
Heart Association, and is available on the Web at

http://www.eurekalert.org/pub_releases/2003-01/uocd-uds010903.php

Treatment of Periodontal Disease significantly reduces CRP levels.

Periodontal Treatment Reduces CRP and TNF-a, Y. IWAMOTO, F. NISHIMURA, Y. SOGA, K. TAKEUCHI, and S. TAKASHIBA,
http://iadr.confex.com/iadr/2003Goteborg/techprogram/abstract_30513.htm

Periodontal therapy lowers levels of heart disease inflammation markers

Treating periodontal disease with scaling and root planing combined with a topical antibiotic gel can significantly lower the levels of
two inflammatory proteins associated with a heightened risk of heart disease,scientists from the State University of New York at
Buffalo report. People who have high levels of CRP in their blood are at high risk of heart disease," Dr. Sara Grossi, senior author
of the study, said. "Our results showed that in people who had elevated levels of CRP at baseline, removal of dental plaque bacteria
by scaling or scaling combined with topical antibiotics produced a statistically significant
reduction, bringing CRP levels close to the low-risk level."

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=841

People with periodontitis have been shown to have increased levels of inflammatory markers in their blood. These occur when
pathogenic bacteria, their by products and cytokines enter circulation from the periodontal lesion, stimulating the liver and white
blood cells to increase their production of inflammatory proteins such as C-Reactive Protein, inflammatory cytokines
(IL-1 beta, tumor necrosis factor a and IL-6)
blood coagulation and adhesion factors, and increased blood lipid levels.

 Loos BG, Craandijk, et al Elevation of systemic markers related to cardiovascular disease in peripheral blood of
periodontitis patients. J Periodontology, 2000 Oct;71(10):1528-34
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=11063384&dopt=Abstract

Periodontitis and Systemic Inflammation: Control of the Local Infection
is Associated with a Reduction in Serum Inflammatory Markers

F. D’Aiuto^1,2, M. Parkar¹, G. Andreou^1,2, J. Suvan^1,2, P.M. Brett¹, D. Ready³, and M.S. Tonetti^1,2,*

http://jdr.iadrjournals.org/cgi/content/full/83/2/156

Short-term Effects of Intensive Periodontal Therapy on Serum
Inflammatory Markers and Cholesterol

F. D’Aiuto, L. Nibali, M. Parkar, J. Suvan, and M.S. Tonetti^*

^{http://jdr.iadrjournals.org/cgi/content/abstract/84/3/269}

Joint Effects of C-Reactive Protein and Glycated Hemoglobin in
Predicting Future Cardiovascular Events of
Patients With Advanced Atherosclerosis

http://circ.ahajournals.org/cgi/content/abstract/108/19/2323

C-Reactive Protein and LDL Cholesterol Levels in Women

http://www.aafp.org/afp/20030315/tips/27.html

Persson G., Pettersson T., Ohlsson O., Renvert S.: High-Sensitivity Serum C-Reactive Protein Levels in Subjects With or
Without Myocardial Infarction or Periodontitis. J Clin Perio 32: 219–224, 2005.
http://www.hygienetown.com/article.aspx?aid=59

Population Distributions of C-reactive Protein in Apparently Healthy
Men and Women in the United States: Implication for Clinical Interpretation

Nader Rifai^1,2,a and Paul M. Ridker^2,3

http://www.clinchem.org/cgi/content/full/49/4/666

LIVE ORAL BACTERIA FOUND IN ARTERIAL PLAQUE

March 22, 2005  U FL

http://www.napa.ufl.edu/2005news/plaque.htm

Vitamin C reduces level of C-reactive protein, finds UC Berkeley-led study

http://www.eurekalert.org/pub_releases/2004-04/uoc--vcr041204.php

Statin Drugs

http://www.epic4health.com/coqandstatdr.html?engine=adwords!1086&keyword=%28statin+drugs%29

Thus, in the long run, statin drugs could predispose the patients to heart disease by lowering their CoQ10 status, the very condition that these drugs
are intended to prevent.

CRP and Colon Cancer

INFLAMMATION MARKER PREDICTS COLON CANCER

C-reactive protein (CRP) -- a marker of inflammation circulating in the blood already associated with increased risk of heart disease --
can also be used to identify a person's risk of developing coloncancer, according to a Johns Hopkins study

http://www.hopkinsmedicine.org/Press_releases/2004/02_10_04.html

Oral Cancer & Periodontal Disease

UB study links gum disease with oral cancer risk

http://www.eurekalert.org/pub_releases/2003-03/uab-usl031303.php

Stroke

People with periodontal disease are more likely to have thickened carotid arteries, which can lead to stroke, according to a study released at the American
Academy of Neurology's 51st annual meeting in Toronto.

http://www.pslgroup.com/dg/f896a.htm

Periodontal Disease and Risk of Cerebrovascular Disease

The First National Health and Nutrition Examination Survey and Its Follow-up Study

Tiejian Wu, MD, PhD; Maurizio Trevisan, MD, MS; Robert J. Genco, DDS, PhD; Joan P. Dorn, PhD; Karen L. Falkner, PhD; Christopher T. Sempos, PhD

Arch Intern Med. 2000;160:2749-2755.

Background  Periodontal disease has been found to be a potential risk factor for coronary heart disease. However, its association with cerebrovascular
accidents (CVAs) is much less studied.

http://archinte.ama-assn.org/cgi/content/abstract/160/18/2749

PTLBW Babies

http://www.perio.org/consumer/women_risk.htm 

Study boosts suspected link between mothers’
gum disease and both premature
birth, low birth weight

http://www.eurekalert.org/pub_releases/2002-03/uonc-sbs030502.php

This trial indicates that performing SRP in pregnant women with periodontitis may reduce PTB in this population. The rate of
PTB at <35 was 0.8% in the SRP plus placebo group (P = 0.75 and 0.12, respectively).
The rate of PTB at <35 weeks was 6.3% in the reference group.

Periodontal Disease and Preterm Birth: Results of a Pilot Intervention Study

Marjorie K. Jeffcoat, John C. Hauth, Nico C. Geurs, Michael S. Reddy, Suzanne P. Cliver, Pamela M. Hodgkins, and Robert L. Goldenberg 
J Periodontol 2003;74:1214-1218.

http://www.joponline.org/doi/abs/10.1902/jop.2003.74.8.1214?prevSearch=allfield%3A%28Jeffcoat+Pregnant%29

Pregnant women who receive treatment for their periodontal disease can reduce their risk of giving birth to a low birth-weight or pre- term baby.
In a study of 400 pregnant women aged 18 to 35 with advanced periodontal disease, half of the subjects were given periodontal treatment before the end of the
second trimester while the other half were treated after giving birth. Treatment included scaling and root planing, instruction in good oral hygiene habits and
antimicrobial mouth rinse for daily use. Of the women who received treatment during pregnancy, 2 percent gave birth to either a low
birth-weight or pre-term infant. By comparison, 10 percent of the women who received treatment after birth had either a low birth-weight or pre-term baby.

University of Chile were published in the August issue of the Journal of Periodontology August 2002

A total of 1,313 pregnant women were recruited from the Perinatal Emphasis Research Center at the University of Alabama at Birmingham. Patients with severe
or generalized periodontal disease had adjusted odds ratios (95 percent CI) of 4.45 (2.16-9.18) for preterm delivery (that is, before 37 weeks gestational age).
The adjusted odds ratio increased with increasing prematurity to 5.28 (2.05-13.60) before 35 weeks' gestational age and to 7.07 (1.70-27.4) before 32 weeks'
gestational age.

Periodontal Infection and Preterm Birth: Results of a Prospective Study
Jeffcoat M.K.[1], Geurs N.C.[2], Reddy M.S.[2], Cliver S.P.[3], Goldenberg R.L.[3], Hauth J.C.[3]
JADA 2001; 132:875-880.

Mental deficits common after very preterm birth. More than three-quarters of children who were born before the 26th week of
pregnancy are affected by cognitive and neurologic impairments by the time they reach school age, British researchers report.

Floss or die is a phrase coined by Dr. Raul Garcia, a research periodontist from Boston, at a recent dental research conference. The phrase was picked up by the Associated Press and received extensive news coverage this past summer. Since the original AP news release, a large number of newspapers and magazines have run related stories on the possible association of periodontal disease with a series of potentially life-threatening disorders. Credible scientific evidence now exists that strongly suggests causal associations between poor periodontal health and certain systemic illnesses. This evidence includes:

*Major References. Learn More...

* Heart Disease. Oral bacteria may compromise cardiovascular health by promoting the formation of blood clots and fatty deposits. Periodontitis has been implicated as a risk factor for cardiovascular disease, comparable in importance to elevated cholesterol.

*Birthweight. Women with periodontitis are eight times more likely to give birth to premature low-birthweight babies. The inflammatory process associated with gum diseases appears to promote pre-term delivery. Learn More...

Low birth weight children are more likely to develop cardiovascular problems later in life. An article makes the comparison that: "like a poorly made car, an undernourished fetus is more likely to break down later." Learn More...

*Diabetes. Periodontal diseases may make it more difficult for people who have diabetes to control their blood sugar. In addition, diabetics with periodontitis are more likely to have heart attacks than those with healthy gums.

*Respiratory Disease. Oral infections, including periodontitis, are associated with increased risk of respiratory infection and endocarditis, especially in those with chronic obstructive pulmonary disease.

Researchers are only beginning to sort out the causal relationships involved between periodontal disease and other serious health problems. There is one underlying fact, however, that forms the basis of all clinical findings: Periodontal disease is a bacterial plaque induced infection.

Suppressing plaque formation is critical in lowering the risk of periodontal disease-related illnesses that may be fatal. A regular re-care schedule and root planing where indicated are essential in the prevention and treatment of periodontal disease. Of even more importance, however, is effective plaque removal on a daily basis.

Daily brushing with a manual toothbrush has been shown to have limited effectiveness in the interproximal (between the teeth) areas. Typically, the onset of periodontal disease begins in these interproximal areas, so it is imperative that these areas be cleansed of plaque on a daily basis. Unquestionably, floss is designed to effectively clean these areas and does work. Unfortunately, fewer that ten percent of the population ever flosses regularly or effectively. Perhaps, the correlation between lack of flossing (periodontal disease) and life-threatening illnesses will provide new incentive for people to use it.

Now, more than ever, the statement by Dr. Mayo, of the famed Mayo Clinic, takes on appropriate significance: "Daily plaque control can add ten years to your life. "