Periodontal disease and carotid atherosclerosis: are hemodynamic forces a link?

The link between periodontal disease and atherosclerosis has not yet been clarified, though systemic inflammation seems to be the common soil for both conditions. Inflammation influences also hemodynamic forces, that act as local risk factors for carotid plaques. It is not known if the link between periodontitis and carotid atherosclerosis is mediated, at least in part, by physical forces. Therefore, aim of the present study was to evaluate the association between carotid shear stress force and periodontal disease.

Thirty-three subjects underwent complete cardiovascular screening, carotid hemodynamic evaluation and dental inspection. Presence of classical risk factors for atherosclerosis, common carotid peak and mean wall shear stress values and periodontal indices of disease (plaque index, gingival index and pocket deep) have been evaluated.

Worse periodontal health was associated to the presence of carotid atherosclerosis. Patients with carotid plaques (n=19) had higher periodontal indices compared with subjects without plaques (n=14) (gingival index: 1.40 ± 0.71 vs. 0.69 ± 0.64, p=0.006). These relations were independent of the presence of cardiovascular risk factors in multiple logistic regression analysis. In the 66 examined common carotids, wall shear stress was inversely related to all periodontal indices (r=0.54, p<0.00001 for peak wall shear stress and gingival index). These relations remained significant also in multiple regression analysis, after correction for cardiovascular risk factors, gender and age.

The present study identifies for the first time a link between periodontal indices and wall shear stress, suggesting that an alteration of hemodynamic profile might contribute to atherosclerosis in subjects with periodontal disease.