Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases
Identifieur interne : 000063 ( Istex/Corpus ); précédent : 000062; suivant : 000064Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases
Auteurs : Maurizio S. Tonetti ; Thomas E. Van DykeSource :
- Journal of Clinical Periodontology [ 0303-6979 ] ; 2013-04.
English descriptors
- KwdEn :
- Acvd, Acvd outcomes, Acvd prevention, American academy, Animal studies, Arterial blood pressure, Atheroma, Atheroma formation, Atherosclerotic, Available evidence, Baehni tonetti, Biological mechanism, Biological plausibility, Blood stream, Cardiovascular, Cardiovascular disease, Cardiovascular diseases, Cardiovascular events, Cardiovascular risk factors, Chronic multifactorial disease, Clin periodontol, Clinical outcomes, Clinical periodontology, Clinical studies, Consensus report, Coronary heart disease, Endothelial, Endothelial cell activation, Endothelial function, Epidemiological evidence, European federation, European workshop, Excess risk, Feasibility study, Future trials, Health issue, High prevalence, Host response, Initial intervention trials, Intervention trials, James beck, Joint workshop, Limited evidence, Longitudinal studies, Moderate evidence, Multiple mechanisms, Myocardial infarction, Oral microbiota, Other risk factors, Periodontal, Periodontal diseases, Periodontal education, Periodontal health, Periodontal intervention studies, Periodontal pathogens, Periodontal status, Periodontal therapy, Periodontal treatment, Periodontitis, Periodontitis patients, Periodontology, Periodontology periodontitis, Plausible mechanisms, Population level, Progressive destruction, Public health perspective, Risk factors, Secondary acvd prevention trials, Study populations, Suppl, Surrogate measures, Systematic review, Tonetti, Tooth loss, Unknown confounders, Younger individuals.
- Teeft :
- Acvd, Acvd outcomes, Acvd prevention, American academy, Animal studies, Arterial blood pressure, Atheroma, Atheroma formation, Atherosclerotic, Available evidence, Baehni tonetti, Biological mechanism, Biological plausibility, Blood stream, Cardiovascular, Cardiovascular disease, Cardiovascular diseases, Cardiovascular events, Cardiovascular risk factors, Chronic multifactorial disease, Clin periodontol, Clinical outcomes, Clinical periodontology, Clinical studies, Consensus report, Coronary heart disease, Endothelial, Endothelial cell activation, Endothelial function, Epidemiological evidence, European federation, European workshop, Excess risk, Feasibility study, Future trials, Health issue, High prevalence, Host response, Initial intervention trials, Intervention trials, James beck, Joint workshop, Limited evidence, Longitudinal studies, Moderate evidence, Multiple mechanisms, Myocardial infarction, Oral microbiota, Other risk factors, Periodontal, Periodontal diseases, Periodontal education, Periodontal health, Periodontal intervention studies, Periodontal pathogens, Periodontal status, Periodontal therapy, Periodontal treatment, Periodontitis, Periodontitis patients, Periodontology, Periodontology periodontitis, Plausible mechanisms, Population level, Progressive destruction, Public health perspective, Risk factors, Secondary acvd prevention trials, Study populations, Suppl, Surrogate measures, Systematic review, Tonetti, Tooth loss, Unknown confounders, Younger individuals.
Abstract
This consensus report is concerned with the association between periodontitis and atherosclerotic cardiovascular disease (ACVD). Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth supporting apparatus leading to tooth loss; as such, it is a major public health issue.
Url:
DOI: 10.1111/jcpe.12089
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ISTEX:13327CE8D945B912A6ECC19A207C0B4321C7EC6ELe document en format XML
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All manuscripts were fully peer‐reviewed.</title><title level="j" type="alt">JOURNAL OF CLINICAL PERIODONTOLOGY</title><idno type="ISSN">0303-6979</idno><idno type="eISSN">1600-051X</idno><imprint><biblScope unit="vol">40</biblScope><biblScope unit="page" from="S24">S24</biblScope><biblScope unit="page" to="S29">S29</biblScope><biblScope unit="page-count">6</biblScope><date type="published" when="2013-04">2013-04</date></imprint><idno type="ISSN">0303-6979</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0303-6979</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acvd</term><term>Acvd outcomes</term><term>Acvd prevention</term><term>American academy</term><term>Animal studies</term><term>Arterial blood pressure</term><term>Atheroma</term><term>Atheroma formation</term><term>Atherosclerotic</term><term>Available evidence</term><term>Baehni tonetti</term><term>Biological mechanism</term><term>Biological 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evidence</term><term>Multiple mechanisms</term><term>Myocardial infarction</term><term>Oral microbiota</term><term>Other risk factors</term><term>Periodontal</term><term>Periodontal diseases</term><term>Periodontal education</term><term>Periodontal health</term><term>Periodontal intervention studies</term><term>Periodontal pathogens</term><term>Periodontal status</term><term>Periodontal therapy</term><term>Periodontal treatment</term><term>Periodontitis</term><term>Periodontitis patients</term><term>Periodontology</term><term>Periodontology periodontitis</term><term>Plausible mechanisms</term><term>Population level</term><term>Progressive destruction</term><term>Public health perspective</term><term>Risk factors</term><term>Secondary acvd prevention trials</term><term>Study populations</term><term>Suppl</term><term>Surrogate measures</term><term>Systematic review</term><term>Tonetti</term><term>Tooth loss</term><term>Unknown confounders</term><term>Younger individuals</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Acvd</term><term>Acvd outcomes</term><term>Acvd prevention</term><term>American academy</term><term>Animal studies</term><term>Arterial blood pressure</term><term>Atheroma</term><term>Atheroma formation</term><term>Atherosclerotic</term><term>Available evidence</term><term>Baehni tonetti</term><term>Biological mechanism</term><term>Biological plausibility</term><term>Blood stream</term><term>Cardiovascular</term><term>Cardiovascular disease</term><term>Cardiovascular diseases</term><term>Cardiovascular events</term><term>Cardiovascular risk factors</term><term>Chronic multifactorial disease</term><term>Clin periodontol</term><term>Clinical outcomes</term><term>Clinical periodontology</term><term>Clinical studies</term><term>Consensus report</term><term>Coronary heart disease</term><term>Endothelial</term><term>Endothelial cell activation</term><term>Endothelial function</term><term>Epidemiological evidence</term><term>European federation</term><term>European workshop</term><term>Excess risk</term><term>Feasibility study</term><term>Future trials</term><term>Health issue</term><term>High prevalence</term><term>Host response</term><term>Initial intervention trials</term><term>Intervention trials</term><term>James beck</term><term>Joint workshop</term><term>Limited evidence</term><term>Longitudinal studies</term><term>Moderate evidence</term><term>Multiple mechanisms</term><term>Myocardial infarction</term><term>Oral microbiota</term><term>Other risk factors</term><term>Periodontal</term><term>Periodontal diseases</term><term>Periodontal education</term><term>Periodontal health</term><term>Periodontal intervention studies</term><term>Periodontal pathogens</term><term>Periodontal status</term><term>Periodontal therapy</term><term>Periodontal treatment</term><term>Periodontitis</term><term>Periodontitis patients</term><term>Periodontology</term><term>Periodontology periodontitis</term><term>Plausible mechanisms</term><term>Population level</term><term>Progressive destruction</term><term>Public health perspective</term><term>Risk factors</term><term>Secondary acvd prevention trials</term><term>Study populations</term><term>Suppl</term><term>Surrogate measures</term><term>Systematic review</term><term>Tonetti</term><term>Tooth loss</term><term>Unknown confounders</term><term>Younger individuals</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract">This consensus report is concerned with the association between periodontitis and atherosclerotic cardiovascular disease (ACVD). 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Tonetti</name><affiliations><json:string>European Research Group on Periodontology, Genova, Italy</json:string></affiliations></json:item><json:item><name>Thomas E. 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Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth supporting apparatus leading to tooth loss; as such, it is a major public health issue.</abstract><qualityIndicators><score>6.012</score><pdfWordCount>3436</pdfWordCount><pdfCharCount>24649</pdfCharCount><pdfVersion>1.7</pdfVersion><pdfPageCount>6</pdfPageCount><pdfPageSize>595.276 x 782.362 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>48</abstractWordCount><abstractCharCount>362</abstractCharCount><keywordCount>11</keywordCount></qualityIndicators><title>Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases</title><pmid><json:string>23627332</json:string></pmid><corporate><json:item><name>working group 1 of the joint EFP/AAP workshop</name></json:item></corporate><genre><json:string>article</json:string></genre><host><title>Journal of Clinical Periodontology</title><language><json:string>unknown</json:string></language><doi><json:string>10.1111/(ISSN)1600-051X</json:string></doi><issn><json:string>0303-6979</json:string></issn><eissn><json:string>1600-051X</json:string></eissn><publisherId><json:string>JCPE</json:string></publisherId><volume>40</volume><pages><first>S24</first><last>S29</last><total>6</total></pages><genre><json:string>journal</json:string></genre><subject><json:item><value>Supplement Article</value></json:item></subject></host><namedEntities><unitex><date><json:string>2011</json:string><json:string>2013-02-11</json:string></date><geogName></geogName><orgName><json:string>European Workshop in Periodontology group C</json:string><json:string>CDC Periodontal Disease Surveillance workgroup: James Beck (University of North Carolina, Chapel Hill, USA), Gordon Douglass (Past President, American Academy of Periodontology), Roy Page (University of Washington)</json:string><json:string>Periodontology and American Academy of Periodontology Periodontitis</json:string><json:string>Group 1 of the European Workshop on Periodontology</json:string><json:string>Periodontology and American Academy of Periodontology How</json:string><json:string>European Research Group on Periodontology, Genova, Italy</json:string><json:string>American Academy of Periodontology</json:string><json:string>Forsyth Institute, Cambridge, MA, USA Tonetti MS, Van Dyke TE and on behalf</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Ann Progulske-Fox</json:string><json:string>Maurizio Tonetti</json:string><json:string>Barbara Shearer</json:string><json:string>Thomas Hart</json:string><json:string>James Beck</json:string><json:string>Thomas Dietrich</json:string><json:string>Philippe Bouchard</json:string><json:string>Federation</json:string><json:string>Harvey Schenkein</json:string><json:string>David Herrera</json:string><json:string>Ray Williams</json:string><json:string>To</json:string><json:string>Bruno G. Loos</json:string><json:string>Chris Cutler</json:string><json:string>Thomas Van Dyke</json:string><json:string>Stefan Renvert</json:string><json:string>Filippo Graziani</json:string><json:string>John Gunsolley</json:string></persName><placeName><json:string>Germany</json:string><json:string>PISA</json:string><json:string>UK</json:string><json:string>Italy</json:string><json:string>Sweden</json:string><json:string>Spain</json:string><json:string>Netherlands</json:string></placeName><ref_url></ref_url><ref_bibl><json:string>Toms et al. 2012</json:string><json:string>Dietrich et al. 2013</json:string><json:string>Jain et al. 2003</json:string><json:string>Friedewald et al. 2009</json:string><json:string>Tonetti & Claffey 2005</json:string><json:string>Adams et al 2007</json:string><json:string>van Tulder et al. 1997</json:string><json:string>Tonetti et al.</json:string><json:string>Nesse et al. 2008</json:string><json:string>Eke et al. 2012</json:string><json:string>Jneid et al 2012</json:string><json:string>Aiuto et al. 2013</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/WNG-2K2T8MCS-5</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - dentistry, oral surgery & medicine</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - clinical medicine</json:string><json:string>3 - dentistry</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Dentistry</json:string><json:string>3 - Periodontics</json:string></scopus></categories><publicationDate>2013</publicationDate><copyrightDate>2013</copyrightDate><doi><json:string>10.1111/jcpe.12089</json:string></doi><id>13327CE8D945B912A6ECC19A207C0B4321C7EC6E</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/13327CE8D945B912A6ECC19A207C0B4321C7EC6E/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/13327CE8D945B912A6ECC19A207C0B4321C7EC6E/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/13327CE8D945B912A6ECC19A207C0B4321C7EC6E/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main">Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Wiley Publishing Ltd</publisher><availability><licence>© 2013 European Federation of Periodontology and American Academy of Periodontology</licence></availability><date type="published" when="2013-04"></date></publicationStmt><notesStmt><note type="content-type" subtype="article" source="article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</note><note type="publication-type" subtype="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="article"><analytic><title level="a" type="main">Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases</title><author xml:id="author-0000"><persName><forename type="first">Maurizio S.</forename><surname>Tonetti</surname></persName><affiliation><orgName>European Research Group on Periodontology</orgName><address><settlement type="city">Genova</settlement><country key="IT">Italy</country></address></affiliation></author><author xml:id="author-0001"><persName><forename type="first">Thomas E.</forename><surname>Dyke</surname></persName><affiliation><orgName>The Forsyth Institute, Cambridge</orgName><address><settlement type="city">MA</settlement><country key="US">USA</country></address></affiliation></author><author xml:id="author-0002"><author><orgName>working group 1 of the joint EFP/AAP workshop</orgName></author></author><idno type="istex">13327CE8D945B912A6ECC19A207C0B4321C7EC6E</idno><idno type="ark">ark:/67375/WNG-2K2T8MCS-5</idno><idno type="DOI">10.1111/jcpe.12089</idno><idno type="unit">JCPE12089</idno><idno type="toTypesetVersion">file:JCPE.JCPE12089.pdf</idno></analytic><monogr><title level="j" type="main">Journal of Clinical Periodontology</title><title level="j" type="sub">Periodontitis and Systemic Diseases ‐ Proceedings of a workshop jointly held by the European Federation of Periodontology and American Academy of Periodontology. Co‐edited by Maurizio Tonetti and Kenneth S. Kornman. The workshop was funded by an unrestricted educational grant from Colgate‐Palmolive to the European Federation of Periodontology and the American Academy of Periodontology. All manuscripts were fully peer‐reviewed.</title><title level="j" type="alt">JOURNAL OF CLINICAL PERIODONTOLOGY</title><idno type="pISSN">0303-6979</idno><idno type="eISSN">1600-051X</idno><idno type="book-DOI">10.1111/(ISSN)1600-051X</idno><idno type="book-part-DOI">10.1111/jcpe.2013.40.issue-s14</idno><idno type="product">JCPE</idno><imprint><biblScope unit="vol">40</biblScope><biblScope unit="page" from="S24">S24</biblScope><biblScope unit="page" to="S29">S29</biblScope><biblScope unit="page-count">6</biblScope><date type="published" when="2013-04"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main" xml:id="jcpe12089-abs-0001"><head>Abstract</head>
Background
<p>This consensus report is concerned with the association between periodontitis and atherosclerotic cardiovascular disease (<hi rend="fc">ACVD</hi>). Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth supporting apparatus leading to tooth loss; as such, it is a major public health issue.</p>
Aims
<p>This report examined biological plausibility, epidemiology and early results from intervention trials.</p>
Plausibility
<p>Periodontitis leads to entry of bacteria in the blood stream. The bacteria activate the host inflammatory response by multiple mechanisms. The host immune response favors atheroma formation, maturation and exacerbation.</p>
Epidemiology
<p>In longitudinal studies assessing incident cardiovascular events, statistically significant excess risk for <hi rend="fc">ACVD</hi> was reported in individuals with periodontitis. This was independent of established cardiovascular risk factors. The amount of the adjusted excess risk varies by type of cardiovascular outcome and across populations by age and gender. Given the high prevalence of periodontitis, even low to moderate excess risk is important from a public health perspective.</p>
Intervention
<p>There is moderate evidence that periodontal treatment: (i) reduces systemic inflammation as evidenced by reduction in C‐reactive protein (<hi rend="fc">CRP</hi>) and improvement of both clinical and surrogate measures of endothelial function; but (ii) there is no effect on lipid profiles – supporting specificity. Limited evidence shows improvements in coagulation, biomarkers of endothelial cell activation, arterial blood pressure and subclinical atherosclerosis after periodontal therapy. The available evidence is consistent and speaks for a contributory role of periodontitis to <hi rend="fc">ACVD</hi>. There are no periodontal intervention studies on primary <hi rend="fc">ACVD</hi> prevention and there is only one feasibility study on secondary <hi rend="fc">ACVD</hi> prevention.</p>
Conclusions
<p>It was concluded that: (i) there is consistent and strong epidemiologic evidence that periodontitis imparts increased risk for future cardiovascular disease; and (ii) while in vitro, animal and clinical studies do support the interaction and biological mechanism, intervention trials to date are not adequate to draw further conclusions. Well‐designed intervention trials on the impact of periodontal treatment on prevention of <hi rend="fc">ACVD</hi> hard clinical outcomes are needed.</p></abstract><textClass><keywords><term xml:id="jcpe12089-kwd-0001">atherosclerosis</term><term xml:id="jcpe12089-kwd-0002">bacteremia</term><term xml:id="jcpe12089-kwd-0003">cardiovascular diseases</term><term xml:id="jcpe12089-kwd-0004">clinical trials</term><term xml:id="jcpe12089-kwd-0005"><hi rend="fc">C</hi>‐reactive protein</term><term xml:id="jcpe12089-kwd-0006">epidemiology</term><term xml:id="jcpe12089-kwd-0007">inflammation</term><term xml:id="jcpe12089-kwd-0008">myocardial infarction</term><term xml:id="jcpe12089-kwd-0009">periodontal diseases</term><term xml:id="jcpe12089-kwd-0010">periodontitis</term><term xml:id="jcpe12089-kwd-0011">stroke</term></keywords><keywords rend="articleCategory"><term>Supplement Article</term></keywords><keywords rend="tocHeading1"><term>Periodontitis and Systemic Diseases ‐ Proceedings of a workshop jointly held by the European Federation of Periodontology and American Academy of Periodontology. Co‐edited by Maurizio Tonetti and Kenneth S. Kornman. The workshop was funded by an unrestricted educational grant from Colgate‐Palmolive to the European Federation of Periodontology and the American Academy of Periodontology. All manuscripts were fully peer‐reviewed.</term></keywords><keywords rend="tocHeading2"><term>Supplement articles</term></keywords></textClass><langUsage><language ident="en"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/13327CE8D945B912A6ECC19A207C0B4321C7EC6E/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component type="serialArticle" version="2.0" xml:id="jcpe12089" xml:lang="en"><header><publicationMeta level="product"><doi origin="wiley" registered="yes">10.1111/(ISSN)1600-051X</doi><issn type="print">0303-6979</issn><issn type="electronic">1600-051X</issn><idGroup><id type="product" value="JCPE"></id></idGroup><titleGroup><title sort="JOURNAL OF CLINICAL PERIODONTOLOGY" type="main">Journal of Clinical Periodontology</title><title type="short">J Clin Periodontol</title></titleGroup></publicationMeta><publicationMeta level="part" position="35"><doi origin="wiley">10.1111/jcpe.2013.40.issue-s14</doi><titleGroup> <title type="specialIssueTitle">Periodontitis and Systemic Diseases ‐ Proceedings of a workshop jointly held by the European Federation of Periodontology and American Academy of Periodontology. Co‐edited by Maurizio Tonetti and Kenneth S. Kornman. The workshop was funded by an unrestricted educational grant from Colgate‐Palmolive to the European Federation of Periodontology and the American Academy of Periodontology. All manuscripts were fully peer‐reviewed.</title> </titleGroup><copyright ownership="publisher">Copyright © 2013 John Wiley & Sons A/S</copyright><numberingGroup><numbering number="40" type="journalVolume">40</numbering><numbering type="supplement">s14</numbering></numberingGroup><coverDate startDate="2013-04">April 2013</coverDate></publicationMeta><publicationMeta level="unit" position="40" status="forIssue" type="article"><doi>10.1111/jcpe.12089</doi><idGroup><id type="unit" value="JCPE12089"></id></idGroup><countGroup><count number="6" type="pageTotal"></count></countGroup><titleGroup><title type="articleCategory">Supplement Article</title><title type="tocHeading1">Periodontitis and Systemic Diseases ‐ Proceedings of a workshop jointly held by the European Federation of Periodontology and American Academy of Periodontology. Co‐edited by Maurizio Tonetti and Kenneth S. Kornman. The workshop was funded by an unrestricted educational grant from Colgate‐Palmolive to the European Federation of Periodontology and the American Academy of Periodontology. All manuscripts were fully peer‐reviewed.</title><title type="tocHeading2">Supplement articles</title></titleGroup><copyright ownership="thirdParty">© 2013 European Federation of Periodontology and American Academy of Periodontology</copyright><eventGroup><event date="2012-11-14" type="manuscriptAccepted"></event><event agent="SPS" date="2013-02-11" type="xmlCreated"></event><event agent="SPS" date="2013-07-24" type="xmlCorrected"></event><event type="publishedOnlineFinalForm" date="2013-04-30"></event><event type="firstOnline" date="2013-04-30"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:4.0.1" date="2014-03-19"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.6.4 mode:FullText" date="2015-10-02"></event></eventGroup><numberingGroup><numbering type="pageFirst">S24</numbering><numbering type="pageLast">S29</numbering></numberingGroup><correspondenceTo><lineatedText><line>Address:</line><line><i>Maurizio Tonetti</i></line><line>European Research Group on Periodontology</line><line>WTC Tower Genoa, Via De Marini 1 – 16149 Genova, Italy.</line><line>Email: <email>maurizio.tonetti@ergoperio.eu</email></line></lineatedText></correspondenceTo><selfCitationGroup><citation type="self" xml:id="jcpe12089-cit-1001"><author><givenNames>Tonetti</givenNames> <familyName>MS</familyName></author>, <author><familyNamePrefix>Van</familyNamePrefix><givenNames>Dyke</givenNames> <familyName>TE</familyName></author> <groupName>and on behalf of working group 1 of the joint EFP/AAP workshop and</groupName>. <articleTitle>Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases</articleTitle>. <journalTitle>J Clin Periodontol</journalTitle> <vol>40</vol> (<issue>suppl. 14</issue>): <pageFirst>S24</pageFirst>–<pageLast>S29</pageLast>. doi: <accessionId ref="info:doi/10.1111/jcpe.12089">10.1111/jcpe.12089</accessionId></citation></selfCitationGroup><linkGroup><link type="toTypesetVersion" href="file:JCPE.JCPE12089.pdf"></link></linkGroup></publicationMeta><contentMeta><titleGroup><title type="main">Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases</title><title type="shortAuthors">Tonetti et al.</title></titleGroup><creators><creator affiliationRef="#jcpe12089-aff-0001" creatorRole="author" xml:id="jcpe12089-cr-0001"><personName><givenNames>Maurizio S.</givenNames> <familyName>Tonetti</familyName></personName></creator><creator affiliationRef="#jcpe12089-aff-0002" creatorRole="author" xml:id="jcpe12089-cr-0002"><personName><givenNames>Thomas E.</givenNames> <familyNamePrefix>Van</familyNamePrefix> <familyName>Dyke</familyName></personName></creator><creator creatorRole="author" noteRef="#jcpe12089-note-0003" xml:id="jcpe12089-cr-0003"><groupName>working group 1 of the joint EFP/AAP workshop</groupName></creator></creators><affiliationGroup><affiliation countryCode="IT" type="organization" xml:id="jcpe12089-aff-0001"><orgName>European Research Group on Periodontology</orgName> <address><city>Genova</city> <country>Italy</country></address></affiliation><affiliation countryCode="US" type="organization" xml:id="jcpe12089-aff-0002"><orgName>The Forsyth Institute, Cambridge</orgName> <address><city>MA</city> <country>USA</country></address></affiliation></affiliationGroup><keywordGroup type="author"><keyword xml:id="jcpe12089-kwd-0001">atherosclerosis</keyword><keyword xml:id="jcpe12089-kwd-0002">bacteremia</keyword><keyword xml:id="jcpe12089-kwd-0003">cardiovascular diseases</keyword><keyword xml:id="jcpe12089-kwd-0004">clinical trials</keyword><keyword xml:id="jcpe12089-kwd-0005"><fc>C</fc>‐reactive protein</keyword><keyword xml:id="jcpe12089-kwd-0006">epidemiology</keyword><keyword xml:id="jcpe12089-kwd-0007">inflammation</keyword><keyword xml:id="jcpe12089-kwd-0008">myocardial infarction</keyword><keyword xml:id="jcpe12089-kwd-0009">periodontal diseases</keyword><keyword xml:id="jcpe12089-kwd-0010">periodontitis</keyword><keyword xml:id="jcpe12089-kwd-0011">stroke</keyword></keywordGroup><abstractGroup><abstract type="main" xml:id="jcpe12089-abs-0001" xml:lang="en"><title type="main">Abstract</title><section xml:id="jcpe12089-sec-0001"><title type="main">Background</title><p>This consensus report is concerned with the association between periodontitis and atherosclerotic cardiovascular disease (<fc>ACVD</fc>). Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth supporting apparatus leading to tooth loss; as such, it is a major public health issue.</p></section><section xml:id="jcpe12089-sec-0002"><title type="main">Aims</title><p>This report examined biological plausibility, epidemiology and early results from intervention trials.</p></section><section xml:id="jcpe12089-sec-0003"><title type="main">Plausibility</title><p>Periodontitis leads to entry of bacteria in the blood stream. The bacteria activate the host inflammatory response by multiple mechanisms. The host immune response favors atheroma formation, maturation and exacerbation.</p></section><section xml:id="jcpe12089-sec-0004"><title type="main">Epidemiology</title><p>In longitudinal studies assessing incident cardiovascular events, statistically significant excess risk for <fc>ACVD</fc> was reported in individuals with periodontitis. This was independent of established cardiovascular risk factors. The amount of the adjusted excess risk varies by type of cardiovascular outcome and across populations by age and gender. Given the high prevalence of periodontitis, even low to moderate excess risk is important from a public health perspective.</p></section><section xml:id="jcpe12089-sec-0005"><title type="main">Intervention</title><p>There is moderate evidence that periodontal treatment: (i) reduces systemic inflammation as evidenced by reduction in C‐reactive protein (<fc>CRP</fc>) and improvement of both clinical and surrogate measures of endothelial function; but (ii) there is no effect on lipid profiles – supporting specificity. Limited evidence shows improvements in coagulation, biomarkers of endothelial cell activation, arterial blood pressure and subclinical atherosclerosis after periodontal therapy. The available evidence is consistent and speaks for a contributory role of periodontitis to <fc>ACVD</fc>. There are no periodontal intervention studies on primary <fc>ACVD</fc> prevention and there is only one feasibility study on secondary <fc>ACVD</fc> prevention.</p></section><section xml:id="jcpe12089-sec-0006"><title type="main">Conclusions</title><p>It was concluded that: (i) there is consistent and strong epidemiologic evidence that periodontitis imparts increased risk for future cardiovascular disease; and (ii) while in vitro, animal and clinical studies do support the interaction and biological mechanism, intervention trials to date are not adequate to draw further conclusions. Well‐designed intervention trials on the impact of periodontal treatment on prevention of <fc>ACVD</fc> hard clinical outcomes are needed.</p></section></abstract></abstractGroup></contentMeta><noteGroup xml:id="jcpe12089-ntgp-0001"><note numbered="no" xml:id="jcpe12089-note-0001"><p><b>Conflict of interest and sources of funding statement</b></p><p>Group participants declare no conflict of interest. The workshop was funded by an unrestricted educational grant from Colgate‐Palmolive to the European Federation of Periodontology and the American Academy of Periodontology.</p></note><note xml:id="jcpe12089-note-0002">The proceedings of the workshop were jointly and simultaneously published in the <url href="http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12089/abstract">Journal of Clinical Periodontology</url> and <url href="http://www.joponline.org/doi/abs/10.1902/jop.2013.1340019">Journal of Periodontology</url>.</note><note xml:id="jcpe12089-note-0003">Working group participants: James Beck, USA; Philippe Bouchard, France; Chris Cutler, USA; Francesco D'Aiuto, UK; Thomas Dietrich, UK; Paul Eke, USA; Filippo Graziani, Italy; John Gunsolley, USA; David Herrera, Spain; Thomas Hart, USA; Alice De Forest, USA; Søren Jepsen, Germany; Alpdogan Kantarci, USA; Bruno G. Loos, The Netherlands; Ann Progulske‐Fox, USA; Harvey Schenkein, USA; Stefan Renvert, Sweden; Maurizio Tonetti, Italy; Thomas Van Dyke, USA; Ray Williams, USA.</note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases</title></titleInfo><name type="personal"><namePart type="given">Maurizio S.</namePart><namePart type="family">Tonetti</namePart><affiliation>European Research Group on Periodontology, Genova, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Thomas E.</namePart><namePart type="family">Van Dyke</namePart><affiliation>The Forsyth Institute, Cambridge, MA, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="corporate"><namePart>working group 1 of the joint EFP/AAP workshop</namePart></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><dateIssued encoding="w3cdtf">2013-04</dateIssued><dateCreated encoding="w3cdtf">2013-02-11</dateCreated><dateValid encoding="w3cdtf">2012-11-14</dateValid><edition>Tonetti MS, VanDyke TE and on behalf of working group 1 of the joint EFP/AAP workshop and. Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Clin Periodontol 40 (suppl. 14): S24–S29. doi: 10.1111/jcpe.12089</edition><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><abstract>This consensus report is concerned with the association between periodontitis and atherosclerotic cardiovascular disease (ACVD). Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth supporting apparatus leading to tooth loss; as such, it is a major public health issue.</abstract><abstract>This report examined biological plausibility, epidemiology and early results from intervention trials.</abstract><abstract>Periodontitis leads to entry of bacteria in the blood stream. The bacteria activate the host inflammatory response by multiple mechanisms. The host immune response favors atheroma formation, maturation and exacerbation.</abstract><abstract>In longitudinal studies assessing incident cardiovascular events, statistically significant excess risk for ACVD was reported in individuals with periodontitis. This was independent of established cardiovascular risk factors. The amount of the adjusted excess risk varies by type of cardiovascular outcome and across populations by age and gender. Given the high prevalence of periodontitis, even low to moderate excess risk is important from a public health perspective.</abstract><abstract>There is moderate evidence that periodontal treatment: (i) reduces systemic inflammation as evidenced by reduction in C‐reactive protein (CRP) and improvement of both clinical and surrogate measures of endothelial function; but (ii) there is no effect on lipid profiles – supporting specificity. Limited evidence shows improvements in coagulation, biomarkers of endothelial cell activation, arterial blood pressure and subclinical atherosclerosis after periodontal therapy. The available evidence is consistent and speaks for a contributory role of periodontitis to ACVD. There are no periodontal intervention studies on primary ACVD prevention and there is only one feasibility study on secondary ACVD prevention.</abstract><abstract>It was concluded that: (i) there is consistent and strong epidemiologic evidence that periodontitis imparts increased risk for future cardiovascular disease; and (ii) while in vitro, animal and clinical studies do support the interaction and biological mechanism, intervention trials to date are not adequate to draw further conclusions. Well‐designed intervention trials on the impact of periodontal treatment on prevention of ACVD hard clinical outcomes are needed.</abstract><subject><genre>keywords</genre><topic>atherosclerosis</topic><topic>bacteremia</topic><topic>cardiovascular diseases</topic><topic>clinical trials</topic><topic>C‐reactive protein</topic><topic>epidemiology</topic><topic>inflammation</topic><topic>myocardial infarction</topic><topic>periodontal diseases</topic><topic>periodontitis</topic><topic>stroke</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Clinical Periodontology</title></titleInfo><titleInfo type="abbreviated"><title>J Clin Periodontol</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><genre>article-category</genre><topic>Supplement Article</topic></subject><identifier type="ISSN">0303-6979</identifier><identifier type="eISSN">1600-051X</identifier><identifier type="DOI">10.1111/(ISSN)1600-051X</identifier><identifier type="PublisherID">JCPE</identifier><part><date>2013</date><detail type="title"><title>Periodontitis and Systemic Diseases ‐ Proceedings of a workshop jointly held by the European Federation of Periodontology and American Academy of Periodontology. 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