Reaccion en cadena de la polimerasa

UNIVERSITAT INTERNACIONAL DE CATALUNYA

HOSPITAL GENERAL DE L’HOSPITALET

“Relaciones clínicas, histológicas y microbiológicas entre la aterosclerosis y la periodontitis crónica”

“Clinical,

histological

and

microbiological

associations between atherosclerosis and chronic periodontitis”

TESIS DOCTORAL Opción a Mención Europea Enero 2010

Doctoranda: Deborah Violant HolzDirector: Dr. Josep Clotet Erra

“Clinical, histological and microbiological associations between atherosclerosis and chronic periodontitis”

DOCTORAL THESIS European Mention February 2010

Universitat Internacional de Catalunya Dental School Ph student: Deborah Violant Holz (Dep. of Periodontics)
U N IV E R S IT A T IN T E R N A C IO N A L D E C A T A LU N YA

Director: Ph Dr Josep Clotet(Dep. of Basic Sciences) Co-director: Ph Dr. Antonio Santos (Dep. of Periodontics)

Hospital General de l’Hospitalet Co-director: Dr. Oriol Lapiedra (Cardiovascular Unit)
H O S P IT A L G E N E R A L D E L’ H O S P IT A LE T

ABSTRACT: Background and Objective: A relationship between some systemic diseases and periodontitis has been described. Several studies have reported a link betweenperiodontal disease and atherosclerosis. This study aimed (i) to support the link between the two diseases by evaluating the statistically significant simultaneous detection of five putative periodontopathogens (A. actynomicetemcomitans, P. intermedia, T. forsythia, F. nucleatum and P .gingivalis) in periodontal pockets and carotid atheromatous plaques, and (ii) to analyze the risk factors associatedto atherosclerosis and/or periodontitis in the study population. Materials and Methods: A complete periodontal and medical examination was conducted on 31 patients scheduled for carotid endarterectomy. Subgingival samples and atheromatous plaques were microbiologically analyzed using nested polimerase chain reaction to improve the bacterial threshold detection level in atheroma. Histologicalanalysis of atheromatous plaques was also performed. Results: All subgingival and atheroma samples were positive to at least one of the five target periodontopathogens. P. gingivalis, T. forsythia and F. nucleatum established a statistically significant relationship between the concomitant presence of bacteria in atheroma and periodontal pockets. A strong link was demonstrated between increasedglucose serum levels and the presence of P. intermedia in atheroma. High lymphocytes serum levels were also strongly related to the detection of the five target periodotopathogens in atheroma. Conclusion: The concomitant presence of P. gingivalis, F. nucleatum, and T. forsythia in the subgingival plaque and atheroma samples suggests that these bacteria might play a role in the development ofatherosclerosis. Serum glucose levels could be responsible for the colonization of periodontopathogens in atheromatous plaques and the progression of cardiovascular disease. Atherosclerosis and periodontitis might be strongly linked by a direct and an indirect pathogenic pathway.

MAIN TEXT OF THE ORIGINAL ARTICLE: INTRODUCTION: Chronic periodontitis is a highly prevalent inflammatory disease (1, 2)caused by the subgingival accumulation of bacterial species, predominantly Gram-negative anaerobic bacteria (3). The pathogenesis of this disease is characterized by a chronic destruction of the dental support tissues, which may lead to tooth loss if periodontal treatment is not performed. Several authors (4-6) have reported that chronic periodontitis may play an important role in the development ofcertain systemic diseases. Periodontitis has even been linked to cardiovascular disease (7-11), respiratory diseases (12), diabetes mellitus (13,14), preterm low-weight births (15,16), hyperlipidemia (17,18) and osteoporosis (19) as an independent risk factor. Morover, periodontitis has been linked to atherosclerosis (2031), a highly prevalent inflammatory vascular disease, responsible for 30% of...