Periodontitis Treatment Reduces Carotid Intima-Media Thickness Over 2 Years: Study Shows
UK: A randomized clinical trial published in the European Heart Journal has found that intensive treatment of periodontitis not only improves oral health but also leads to favourable vascular changes, potentially lowering cardiovascular risk. The study was led by Dr. Marco Orlandi and colleagues from the Periodontology Unit, UCL Eastman Dental Institute, London.
Periodontitis, a chronic inflammatory disease of the gums, has long been linked with systemic inflammation and cardiovascular complications. While earlier studies have shown that treating gum disease improves endothelial function, it remained uncertain whether these improvements could also slow structural vascular changes. This trial was designed to address that question by examining the effect of intensive periodontal treatment (IPT) on carotid intima-media thickness (cIMT), a marker of vascular health and a predictor of cardiovascular events.
A total of 135 otherwise healthy patients with severe periodontitis were enrolled in the single-centre, single-blind trial. Participants were randomly assigned to receive either IPT, which involved deep cleaning procedures such as scaling, root planing, and surgical corrective therapy when required, or control periodontal treatment (CPT), consisting of standard cleaning and polishing above the gum line. Vascular changes were tracked for two years using cIMT measurements at baseline, 12 months, and 24 months. Secondary outcomes included flow-mediated dilatation (FMD), blood pressure, pulse wave velocity (PWV), and biochemical markers of inflammation, oxidative stress, and metabolism.
The study revealed the following notable findings:
- After 24 months, participants who received intensive periodontal treatment had significantly lower cIMT compared with the control group.
- Improvements in endothelial function, measured by FMD, were evident within two months in the intensive treatment group and remained consistently better throughout the study.
- These vascular improvements correlated strongly with better periodontal health outcomes in the same group.
- No notable differences were found between groups in blood pressure, PWV, or metabolomic markers.
- Levels of glycoprotein acetyl, a marker of inflammation and oxidative stress, were significantly reduced in the intensive treatment group compared to controls.
- No differences in adverse events were reported, indicating the treatment was safe and well-tolerated.
The authors acknowledged limitations, including the trial being conducted at a single centre, the absence of patient-reported outcomes, and the exploratory nature of secondary analyses. However, they emphasized that even modest improvements in cIMT—within ranges considered “normal”—can have important prognostic value, particularly for younger patients at risk of cardiovascular disease.
The study concluded that treating periodontitis not only improves oral health but also brings systemic benefits by enhancing vascular function, reducing inflammation, and slowing vascular remodelling. These findings highlight the broader impact of periodontal care and suggest that effective gum disease treatment could play an important role in cardiovascular prevention strategies.
Reference:
Orlandi, M., Masi, S., Lucenteforte, E., Bhowruth, D., Malanima, M. A., Darbar, U., Patel, K., Lim, C., Curra, C., Shiehfung, T., Suvan, J., Chiesa, S. T., & Deanfield, J. Periodontitis treatment and progression of carotid intima-media thickness: A randomized trial. European Heart Journal. https://doi.org/10.1093/eurheartj/ehaf555
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