Gesundheitswesen 2002; 64(2): 89-98
DOI: 10.1055/s-2002-20272
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Spielt die marginale Parodontitis eine Rolle in der Pathogenese kardio- und zerebrovaskulärer Erkrankungen?

Does Chronic Periodontitis Play a Role in the Pathogenesis of Cardiovascular and Cerebrovascular Diseases?H.-P Müller
  • 1Mund-, Zahn-, Kieferklinik der Ruprecht-Karls-Universität Heidelberg
Further Information

Publication History

Publication Date:
20 March 2002 (online)

Zusammenfassung

Die Bedeutung chronischer Infektionen bei der Entstehung atherosklerotischer Läsionen war in den vergangenen Jahren ein heiß diskutiertes Thema. Eine mögliche ursächliche Beziehung kardiovaskulärer Erkrankungen zu Infektionen mit Chlamydia pneumoniae, Helicobacter pylori oder Herpesviren wurde insbesondere nach dem Nachweis von DNA-typischen Parodontalpathogenen in atheromatösen Plaques auf die marginale Parodontitis ausgedehnt. Vor allem in longitudinalen epidemiologischen Studien wurden geringe bis mäßig starke Assoziationen zwischen einer bestehenden Parodontitis und der Entwicklung von z. B. koronarer Herzerkrankung oder nichthämorrhagischem Apoplex gefunden. In der vorliegenden Übersicht sollen die bisher publizierten Daten einer kritischen Beurteilung unterzogen werden. Insbesondere soll der Einfluss einer nicht erfolgten oder ungeeigneten Berücksichtigung von gemeinsamen Risikofaktoren für kardiovaskuläre Erkrankungen und Parodontitis auf die beobachteten Assoziationen untersucht werden. Metaanalysen prospektiver Untersuchungen, in denen das Zielereignis nach Beginn der Studie auftrat, ergaben eine Erhöhung des Risikos bei Vorliegen einer chronischen Parodontitis um den Faktor 1,12 (95 %-Konfidenzinterval 0,95-1,33) für koronare Herzerkrankung und 1,73 (0,89-3,34) für ischämischen Schlaganfall. Ob die marginale Parodontitis ein Risiko für die Entwicklung kardiovaskulärer Erkrankungen darstellt, bleibt nach wie vor eine offene Frage. Bereits geplante Interventionsstudien müssen daher als voreilig und ethisch höchst fragwürdig angesehen werden.

Abstract

The role of chronic infections in the initiation of atherosclerotic lesions has been vividly discussed in recent years. A possible causal relationship between cardiovascular diseases and infections with, e. g., Chlamydia pneumoniae, Helicobacter pylori, or herpes viruses had also been established for chronic periodontitis, in particular after discovery of DNA of typical periodontal pathogens in atheromatous plaques. Especially in longitudinal epidemiologic studies, a low or moderate association between existing periodontitis and the development of, e. g., coronary heart disease or non-haemorrhagic stroke had been observed. In this article the respective literature is critically reviewed. In particular, the influence of incomplete or inappropriate adjustment for common risk factors for both diseases, i. e., cardiovascular disease and periodontitis should be analysed. In metaanalyses of prospective studies, in which the respective endpoint occurred after the investigation had commenced, relative risks of periodontitis of 1.12 (95 % confidence interval 0.95-1.33) for coronary heart disease and 1.73 (0.89-3.34) for ischaemic stroke were calculated. Whether chronic periodontitis actually represents an important risk for the development of cardiovascular diseases remains questionable. Already planned intervention studies appear to be premature and ethically highly problematic.

Literatur

  • 1 Miller W D. The human mouth as a focus of systemic disease.  Dent Cosmos. 1891;  33 689-713
  • 2 Hunter W. Oral sepsis as a cause of disease.  BMJ. 1900;  1 215-216
  • 3 Billings F. Chronic focal infections and their etiologic relations to arthritis and nephritis.  Arch Intern Med. 1912;  9 484-498
  • 4 Hunter W. The role of sepsis and antisepsis in medicine.  Lancet. 1910;  1 79-86
  • 5 Axelsson P, Lindhe J, Nyström B. On the prevention of caries and periodontal disease. Results of a 15-year longitudinal study in adults.  J Clin Periodontol. 1991;  18 182-189
  • 6 Pallasch T J, Slots J. Antibiotic prophylaxis and the medically compromised patient.  Periodontol 2000. 1996;  10 107-138
  • 7 Syrjänen J. Vascular diseases and oral infections.  J Clin Periodontol. 1990;  17 497-500
  • 8 Mattila K J, Nieminen M J, Valtonen V V. et al . Association between dental health and acute myocardial infarction.  BMJ. 1989;  298 779-781
  • 9 Syrjänen J, Peltola J, Valtonen V V. et al . Dental infections in association with cerebral infarction in young and middle-aged men.  J Intern Med. 1989;  225 179-184
  • 10 Stamm J W. Proceedings of the Sunstar-Chapel Hill Symposium ’97 on periodontal diseases and human health: New directions in periodontal medicine.  Ann Periodontol. 1998;  3 1-387
  • 11 Berenson G S, Srinivasan S R, Bao W. et al . Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study.  N Engl J Med. 1998;  338 1650-1656
  • 12 Ross R. Atherosclerosis - an inflammatory disease.  N Engl J Med. 1999;  340 115-126
  • 13 Heinecke J W. Oxidants and antioxidants in the pathogenesis of atherosclerosis: implications for the oxidized low density lipoprotein hypothesis.  Atherosclerosis. 1998;  141 1-15
  • 14 Danesh J, Collins R, Peto R. Chronic infections and coronary heart disease: is there a link?.  Lancet. 1997;  350 430-436
  • 15 Wiesner R. Über Veränderungen der Koronargefäße bei Infektionskrankheiten.  Wien Klin Wochenschr. 1906;  19 725-726
  • 16 Frothingham C. The relation between acute infectious diseases and arterial lesions.  Arch Intern Med. 1911;  8 153-162
  • 17 Ophüls W. Arteriosclerosis and cardiovascular disease. Their relation to infectious diseases.  JAMA. 1921;  76 700-701
  • 18 Saikku P, Leinonen M, Mattila K. et al . Serological evidence of an association of a novel Chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction.  Lancet. 1988;  2 983-986
  • 19 Shor A, Kuo C C, Patton D L. Detection of Chlamydia pneumoniae in coronary arterial fatty streaks and atheromatous plaques.  S Afr Med J. 1992;  82 158-161
  • 20 Chiu B. Multiple infections in carotid atherosclerotic plaques.  Am Heart J. 1999;  138 S534-S536
  • 21 Maass M, Bartels C, Engel P M, Mamat U, Sievers H H. Endovascular presence of viable Chlamydia pneumoniae is a common phenomenon in coronary artery disease.  J Am Coll Cardiol. 1998;  31 827-832
  • 22 Esposito G, Blasi F, Allegra L. et al . Demonstration of viable Chlamydia pneumoniae in atherosclerotic plaques of carotid arteries by reverse transcriptase polymerase chain reaction.  Ann Vasc Surg. 1999;  13 421-425
  • 23 Haraszthy V I, Zambon J J, Trevisan M, Zeid M, Genco R J. Identification of periodontal pathogens in atheromatous plaques.  J Periodontol. 2000;  71 1554-1560
  • 24 Thomas M, Wong Y, Thomas D. et al . Relation between direct detection of Chlamydia pneumoniae DNA in human coronary arteries at postmortem examination and histological severity (Stary grading) of associated atherosclerotic plaque.  Circulation. 1999;  99 2733-2736
  • 25 Grau A J, Buggle F, Heindl S. et al . Recent infection as a risk factor for cerebrovascular ischemia.  Stroke. 1995;  26 373-379
  • 26 Grau A J, Brandt T, Buggle F. et al . Association of cervical artery dissection with recent infection.  Arch Neurol. 1999;  56 851-856
  • 27 Bova I Y, Bornstein N M, Korczyn A D. Acute infection as a risk factor for ischemic stroke.  Stroke. 1996;  27 2204-2206
  • 28 Macko R F, Ameriso S F, Barndt R. et al . Precipitants of brain infarction. Roles of preceding infection/inflammation and recent psychological stress.  Stroke. 1996;  27 1999-2004
  • 29 Becher H, Grau A, Steindorf K, Buggle F, Hacke W. Previous infection and other risk factors for acute cerebrovascular ischaemia: attributable risks and the characterisation of high risk groups.  J Epidemiol Biostat. 2000;  5 277-283
  • 30 Grau A J, Buggle F, Ziegler C. et al . Association between acute cerebrovascular ischemia and chronic and recurrent infection.  Stroke. 1997;  28 1724-1729
  • 31 Ahlbeck Glader C, Stegmayr B, Boman J. et al . Chlamydia pneumoniae antibodies and high lipoprotein(a) levels do not predict ischemic cerebral infarctions. Results from a nested case-control study in northern Sweden.  Stroke. 1999;  30 2013-2018
  • 32 Wimmer M L, Sandmann-Strupp R, Saikku P, Haberl R L. Association of chlamydial infection with cerebrovascular disease.  Stroke. 1996;  27 2207-2210
  • 33 Cook P J, Honeybourne D, Lip G YH. et al . Chlamydia pneumoniae antibody titers are significantly associated with acute stroke and transient cerebral ischemia. The West Birmingham Stroke Project.  Stroke. 1998;  29 404-410
  • 34 Elkind M S, Lin I F, Grayston J T, Sacco R L. Chlamydia pneumoniae and the risk of first ischemic stroke: the Northern Manhattan Stroke Study.  Stroke. 2000;  31 1521-1525
  • 35 Fagerberg B, Gnarpe J, Gnarpe H, Agewall S, Wikstrand J. Chlamydia pneumoniae but not cytomegalovirus antibodies are associated with future risk of stroke and cardiovascular disease. A prospective study in middle-aged to elderly men with treated hypertension.  Stroke. 1999;  30 299-305
  • 36 Grayston J T. Infections caused by Chlamydia pneumoniae strain TWAR.  Clin Infect Dis. 1992;  15 757-763
  • 37 Puolakkainen M, Kuo C C, Shor A. et al . Serological response to Chlamydia pneumoniae in adults with coronary arterial fatty streaks and fibrolipid plaques.  J Clin Microbiol. 1993;  31 2212-2214
  • 38 Hahn D L, Golubjatnikov R. Smoking is a potential confounder of the Chlamydia pneumoniae-coronary artery disease association.  Arterioscler Thromb. 1992;  12 945-947
  • 39 Karvonen M, Tuomilehto J, Pitkäniemi J, Naukkarinen A, Saikku P. Importance of smoking for Chlamydia pneumoniae seropositivity.  Int J Epidemiol. 1994;  23 1315-1321
  • 40 Rajashekhar V, Bhasin D K, Ray P. et al . Helicobacter pylori infection in chronic smokers with non ulcer dyspepsia.  Trop Gastroentrerol. 2000;  21 71-72
  • 41 Saito T, Shimazaki Y, Koga T, Tsuzuki M, Ohshima A. Relationship between upper body obesity and periodontitis.  J Dent Res. 2001;  80 1631-1636
  • 42 Danesh J, Whincup P, Walker M. et al . Chlamydia pneumoniae IgG titres and coronary heart disease: prospective study and meta-analysis.  BMJ. 2000;  321 208-213
  • 43 Ridker P M, Kundsin R B, Stampfer M J, Poulin S, Hennekens C H. Prospective study of Chlamydia pneumoniae IgG seropositivity and risks of future myocardial infarction.  Circulation. 1999;  99 1161-1164
  • 44 Wald N J, Law M R, Morris J K. et al . Chlamydia pneumoniae infection and mortality from ischaemic heart disease: large prospective study.  BMJ. 2000;  321 204-207
  • 45 Wald N J, Law M R, Morris J K, Bagnall A M. Helicobacter pylori infection and mortality from ischaemic heart disease: negative result from a large, prospective study.  BMJ. 1997;  315 1199-1201
  • 46 Danesh J, Peto R. Risk factors for coronary heart disease and infection with Helicobacter pylori: meta-analysis of 18 studies.  BMJ. 1998;  316 1130-1132
  • 47 Danesh J, Youngman L, Clark S. et al . Helicobacter pylori infection and early onset myocardial infarction: case control and sibling pairs study.  BMJ. 1999;  319 1157-1162
  • 48 Whincup P, Danesh J, Walker M. et al . Prospective study of potentially virulent strains of Helicobacter pylori and coronary heart disease in middle-aged men.  Circulation. 2000;  101 1647-1652
  • 49 Agen C, Danesi R, Blandizzi C. et al . Macrolide antibiotics as antiinflammatory agents: roxithromycin in an unexpected role.  Agents Actions. 1993;  38 85-90
  • 50 Gupta S, Leatham E W, Carrington D. et al . Elevated Chlamydia pneumoniae antibodies, cardiovascular events, and azithromycin in male survivors of myocardial infarction.  Circulation. 1997;  96 404-407
  • 51 Gurfinkel E, Bozovich G, Beck E. et al . Treatment with the antibiotic roxithromycin in patients with acute non-Q-wave coronary syndromes: the final report of the ROXIS study.  Eur Heart J. 1999;  20 121-127
  • 52 Muhlestein J B, Anderson J L, Carlquist J. et al . Randomized secondary prevention trial of azithromycin in patients with coronary artery disease: primary clinical results of the ACADEMIC study.  Circulation. 2000;  102 1755-1760
  • 53 Ridker P M, Cushman M, Stampfer M J, Russell P T, Hennekens C H. Inflammation, aspirin and risk of cardiovascular disease in apparently healthy men.  N Engl J Med. 1997;  336 973-979
  • 54 Ridker P M, Buring J E, Shih J, Matias M, Hennekens C H. Prospective study of C-reactive protein and the future cardiovascular events among apparently healthy women.  Circulation. 1998;  98 731-733
  • 55 Folsom A R, Rosamond W D, Sharar E. et al . Prospective study of markers of hemostatic function with risk of ischemic stroke.  Circulation. 1999;  100 736-742
  • 56 Koenig W, Sund M, Fröhlich M. et al . C-reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men. Results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992.  Circulation. 1999;  99 237-242
  • 57 Danesh J, Whincup P, Walker M. et al . Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses.  BMJ. 2000;  321 199-204
  • 58 Albandar J M, Brunelle J A, Kingman A. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994.  J Periodontol. 1999;  70 13-29
  • 59 Flemmig T F. Periodontitis.  Ann Periodontol. 1999;  4 32-37
  • 60 Page R C, Offenbacher S, Schroeder H E, Seymour G J, Kornman K S. Advances in the pathogenesis of periodontitis: summary of developments, clinical implications and future directions.  Periodontol 2000. 1997;  14 216-248
  • 61 Darveau R P, Tanner A, Page R C. The microbial challenge in periodontitis.  Periodontol 2000. 1997;  14 12-32
  • 62 Page R C. Milestones in periodontal research and the remaining critical issues.  J Periodont Res. 1999;  32 331-339
  • 63 Allenspach-Petrzilka G E, Guggenheim B. Bacterial invasion of the periodontium: an important factor in the pathogenesis of periodontitis?.  J Clin Periodontol. 1983;  10 609-617
  • 64 Christersson L A, Albini B, Zambon J J, Wikesjö U ME, Genco R J. Tissue localization of Actinobacillus actinomycetemcomitans. I. Light, immunofluorescence and electron microscopic studies.  J Periodontol. 1987;  58 529-539
  • 65 Riviere G R, Weisz K S, Adams D F, Thomas D D. Pathogen-related oral spirochetes from dental plaque are invasive.  Infect Immun. 1991;  59 3377-3380
  • 66 Offenbacher S, Odle B M, Gray R C, van Dyke T E. Crevicular fluid prostaglandin E levels as a measure of the periodontal disease status of adult and juvenile periodontitis patients.  J Periodont Res. 1984;  19 1-13
  • 67 Stashenko P, Jandinski J J, Fujiyoshi P, Rynar J, Socransky S S. Tissue levels of bone resorptive cytokines in periodontal disease.  J Periodontol. 1991;  62 504-509
  • 68 Silver J G, Martin A W, McBride B C. Experimental transient bacteraemias in human subjects with varying degrees of plaque accumulation and gingival inflammation.  J Clin Periodontol. 1977;  4 92-99
  • 69 Schlein R A, Kudlick E M, Reindorf C A, Gregory J, Royal G C. Toothbrushing and transient bacteremia in patients undergoing orthodontic treatment.  Am J Orthod Dentofacial Orthop. 1991;  99 466-472
  • 70 Barco C T. Prevention of infective endocarditis: a review of the medical and dental literature.  J Periodontol. 1991;  62 510-523
  • 71 Messini M, Skourti I, Markopoulos E. et al . Bacteremia after dental treatment in mentally handicapped people.  J Clin Periodontol. 1999;  26 469-473
  • 72 Müller-Glauser W, Schroeder H E. The pocket epithelium: a light- and electron microscopic study.  J Periodontol. 1982;  53 133-144
  • 73 Davenport R H Jr, Simpson D M, Hassell T M. Histometric comparison of active and inactive lesions of advanced periodontitis.  J Periodontol. 1982;  53 285-295
  • 74 Page R C. The pathobiology of periodontal diseases may affect systemic diseases: inversion of a paradigm.  Ann Periodontol. 1998;  3 108-120
  • 75 Hujoel P P, White B A, García R I, Listgarten M A. The dentogingival epithelial surface area revisited.  J Periodont Res. 2001;  36 48-55
  • 76 Gmür R, Marinello C P, Guggenheim B. Periodontitis associated bacteria in supragingival plaque of dental hygienists: stability of carrier state and clinical development.  Eur J Oral Sci. 1999;  107 225-228
  • 77 Müller H P, Heinecke A, Fuhrmann A, Eger T, Zöller L. Intraoral distribution of Actinobacillus actinomycetemcomitans in young adults with minimal periodontal disease.  J Periodont Res. 2001;  36 114-123
  • 78 Salvi G E, Yalda B, Collins J G. et al . Inflammatory mediator response as a potential risk marker for periodontal diseases in insulin-dependent diabetes mellitus patients.  J Periodontol. 1997;  68 127-135
  • 79 Cutler C W, Shinedling E A, Nunn M. et al . Association between periodontitis and hyperlipidemia: cause or effect?.  J Periodontol. 1999;  70 1429-1434
  • 80 Ebersole J L, Capelli D. Acute-phase reactants in infections and inflammatory diseases.  Periodontol 2000. 2000;  23 19-49
  • 81 Herzberg M C, Meyer M W. Dental plaque, platelets, and cardiovascular diseases.  Ann Periodontol. 1998;  3 151-160
  • 82 Pepys M B, Baltz M L. Acute phase proteins with special reference to C-reactive and related proteins (pentaxins) and serum amyloid A protein.  Adv Immunol. 1983;  34 141-212
  • 83 Lagrand W K, Visser C A, Hermens W T. et al . C-reactive protein as a cardiovascular risk factor. More than an epiphenomenon?.  Circulation. 1999;  100 96-102
  • 84 Slade G D, Offenbacher S, Beck J D, Heiss G, Pankow J S. Acute-phase inflammatory response to periodontal disease in the US population.  J Dent Res. 2000;  79 49-57
  • 85 Wu T, Trevisan M, Genco R J. et al . Examination of the relation between periodontal health status and cardiovascular risk factors: serum total and high-density lipoprotein cholesterol, C-reactive protein, and plasma fibrinogen.  Am J Epidemiol. 2000;  151 273-282
  • 86 Frederiksson M I, Figueredo C MS, Gustafsson A, Bergström K G, Asman B E. Effect of periodontitis and smoking on blood leukocytes and acute-phase proteins.  J Periodontol. 1999;  70 1355-1360
  • 87 Loos B G, Craandijk J, Hoek F J, van Wertheim-Dillen P ME, van der Velden U. Elevation of systemic markers related to cardiovascular diseases in the peripheral blood of periodontitis patients.  J Periodontol. 2000;  71 1528-1534
  • 88 Noack B, Genco R J, Trevisan M, Grossi S, Zambon J J, De Nardin E. Periodontal infection contribute to elevated systemic C-reactive protein level.  J Periodontol. 2001;  72 1221-1227
  • 89 Hujoel P P, Leroux B G, Selipsky H, White B A. Non-surgical periodontal therapy and tooth loss. A cohort study.  J Periodontol. 2000;  71 736-742
  • 90 Mongardini C, van Steenberghe D, Dekeyser C, Quirynen M. One stage full- versus partial-mouth disinfection in the treatment of chronic adult or generalized early-onset periodontitis. I. Long-term clinical observations.  J Periodontol. 1999;  70 632-645
  • 91 Lockhart P B. The risk for endocarditis in dental practice.  Periodontol 2000. 2000;  23 127-135
  • 92 Quirynen M, Mongardini C, de Soete M. et al . The role of chlorhexidine in the one-stage full-mouth disinfection treatment of patients with advanced adult periodontitis. Long-term clinical and microbiological observations.  J Clin Periodontol. 2000;  27 578-589
  • 93 Kornman K S, Crane A, Wang H Y. et al . The interleukin 1- genotype as a severity factor in adult periodontal disease.  J Clin Periodontol. 1997;  24 72-77
  • 94 Engebretson S P, Lamster I B, Herrera-Abreu M. et al .The influence of interleukin gene polymorphism on expression of interleukin-1β and tumor necrosis factor-α in periodontal tissue and gingival crevicular fluid. J Periodontol 1999 70: 567-573
  • 95 Kornman K S, Pankow J, Offenbacher S. et al . Interleukin-1 genotypes and the association between periodontitis and cardiovascular disease.  J Periodont Res. 1999;  34 353-357
  • 96 Offenbacher S. Periodontal diseases: pathogenesis.  Ann Periodontol. 1996;  1 821-878
  • 97 Offenbacher S, Madianus P N, Champagne C ME. et al . Periodontitis - atherosclerosis syndrome: an expanded model of pathogenesis.  J Periodont Res. 1999;  34 346-352
  • 98 Mattila K J, Asikainen S, Wolf J. et al . Age, dental infections, and coronary heart disease.  J Dent Res. 2000;  79 756-760
  • 99 Paunio K, Impivaara O, Tiekso J, Maki J. Missing teeth and ischemic heart disease in men aged 45-64 years.  Eur Heart J. 1993;  14 (Suppl. K) 54-56
  • 100 Mattila K J, Valle M S, Nieminen M S, Valtonen V V, Hietaniemi K L. Dental infections and coronary atherosclerosis.  Atherosclerosis. 1993;  103 205-211
  • 101 Loesche W J, Schork A, Terpenning M S. et al . Assessing the relationship between dental disease and coronary heart disease in elderly U.S. veterans.  J Am Dent Assoc. 1998;  129 301-311
  • 102 Arbes S J Jr, Slade G D, Beck J D. Association between extent of periodontal attachment lossand self-reported history of heart attack: an analysis of NHANES III data.  J Dent Res. 1999;  78 1777-1782
  • 103 DerSimonian R, Laird N. Meta-analysis in clinical trials.  Control Clin Trials. 1986;  7 177-186
  • 104 Beck J D, Garcia R, Heiss G, Vokonas P S, Offenbacher S. Periodontal disease and cardiovascular disease.  J Periodontol. 1996;  67 1123-1137
  • 105 Joshipura K J, Rimm E B, Douglass C W. et al . Poor oral health and coronary heart disease.  J Dent Res. 1996;  75 1631-1636
  • 106 Hujoel P P, Drangsholt M, Spiekerman C, DeRouen T A. Periodontal disease and coronary heart disease risk.  JAMA. 2000;  284 1406-1410
  • 107 Howell T H, Ridker P M, Ajani U A, Hennekens C H, Christen W G. Periodontal disease and risk of subsequent cardiovascular disease in U.S. male physicians.  J Am Coll Cardiol. 2001;  37 445-450
  • 108 Mendez M V, Scott T, LaMorte W. et al . An association between periodontal disease and peripheral vascular disease.  Am J Surg. 1998;  176 153-157
  • 109 DeStefano F, Anda R F, Kahn H S, Williamson D F, Russell C M. Dental disease and risk of coronary heart disease and mortality.  BMJ. 1993;  306 688-691
  • 110 Mattila K J, Valtonen V V, Nieminen M, Huttunen J K. Dental infection and the risk of new coronary events: prospective study of patients with documented coronary artery disease.  Clin Infect Dis. 1995;  20 588-592
  • 111 Jansson L, Lavstedt S, Frithiof L, Theobald H. Relationship between oral health and mortality in cardiovascular diseases.  J Clin Periodontol. 2001;  28 762-768
  • 112 Wu T, Trevisan M, Genco R J. et al . Periodontal disease and risk of cerebrovascular disease. The First National Health and Nutrition Examination Survey and its follow-up study.  Arch Intern Med. 2000;  160 2749-2755
  • 113 Morrison H I, Ellison L F, Taylor G W. Periodontal disease and risk of fatal coronary heart and cerebrovascular diseases.  J Cardiovasc Risk. 1999;  6 7-11
  • 114 Albandar J M, Kingman A. Gingival recession, gingival bleeding, and dental calculus in the United States, 1988-1994.  J Periodontol. 1999;  70 30-43
  • 115 Beck J D, Offenbacher S, Williams R, Gibbs P, Garcia R. Periodontitis: a risk factor for coronary heart disease?.  Ann Periodontol. 1998;  3 127-141
  • 116 Genco R J, Trevisan M, Wu T, Beck J D. Periodontal disease and risk of coronary heart disease.  JAMA. 2001;  285 40
  • 117 West R. Commentary: adjustment for potential confounders may have been taken too far.  BMJ. 2000;  321 213
  • 118 Hujoel P P, Drangsholt M, Spiekerman C, DeRouen T A. Examining the link between coronary heart disease and the elimination of dental infections.  J Am Dent Assoc. 2001;  132 883-889
  • 119 Danesh J. Coronary heart disease, Helicobacter pylori, dental disease, Chlamydia pneumoniae, and cytomegalovirus: Meta-analyses of prospective studies.  Am Heart J. 1999;  138 S434-S437

1 Ergebnisse der einzelnen Studien werden als relative Risiken (Größe der schwarzen Quadrate in Relation zur Anzahl der Fälle) und 99%-Konfidenzintervalle angegeben, Ergebnisse der Metaanalysen als Rauten (relatives Risiko und 95%-Konfidenzintervall). Grad der Berücksichtigung von möglichen Confoundern: *****: demographische Einflussfaktoren, sozioökonomische Faktoren, klassische Risikofaktoren für koronare beziehungsweise zerebrovaskuläre Erkrankungen; ****: demographische Faktoren und klassische Risikofaktoren für CHD und CVD; *** und **: demographische Faktoren und einige klassische Risikofaktoren für CHD/CVD.

Prof. Dr. med. dent. Hans-Peter Müller

Department of Surgical Sciences
Faculty of Dentistry

Kuwait University

Email: hp.muller@hsc.kuniv.edu.kw