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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Strength of Evidence Relating Periodontal Disease and Atherosclerotic Disease</title>
<author><name sortKey="Joshipura, Kaumudi" sort="Joshipura, Kaumudi" uniqKey="Joshipura K" first="Kaumudi" last="Joshipura">Kaumudi Joshipura</name>
<affiliation><nlm:aff id="A1"> Professor of Epidemiology, University of Puerto Rico, School of Dentistry, San Juan, Puerto Rico; Adjunct Faculty, Harvard School of Dental Medicine, Harvard School of Public Health, Boston, Massachusetts</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Zevallos, Juan Carlos" sort="Zevallos, Juan Carlos" uniqKey="Zevallos J" first="Juan Carlos" last="Zevallos">Juan Carlos Zevallos</name>
<affiliation><nlm:aff id="A2"> Associate Professor of Medicine and Public Health and Director, Endowed Health Service Research Center, University of Puerto Rico, San Juan, Puerto Rico</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ritchie, Christine Seel" sort="Ritchie, Christine Seel" uniqKey="Ritchie C" first="Christine Seel" last="Ritchie">Christine Seel Ritchie</name>
<affiliation><nlm:aff id="A3"> Associate Professor of Medicine, Birmingham–Atlanta Veterans Administration Geriatric Research, Education and Clinical Center (GRECC) and the University of Alabama at Birmingham, Department of Medicine, Birmingham, Alabama; Adjunct Faculty, University of Puerto Rico, School of Oral Health, San Juan, Puerto Rico</nlm:aff>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">19757736</idno>
<idno type="pmc">2894475</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894475</idno>
<idno type="RBID">PMC:2894475</idno>
<date when="2009">2009</date>
<idno type="wicri:Area/Pmc/Corpus">002140</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002140</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Strength of Evidence Relating Periodontal Disease and Atherosclerotic Disease</title>
<author><name sortKey="Joshipura, Kaumudi" sort="Joshipura, Kaumudi" uniqKey="Joshipura K" first="Kaumudi" last="Joshipura">Kaumudi Joshipura</name>
<affiliation><nlm:aff id="A1"> Professor of Epidemiology, University of Puerto Rico, School of Dentistry, San Juan, Puerto Rico; Adjunct Faculty, Harvard School of Dental Medicine, Harvard School of Public Health, Boston, Massachusetts</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Zevallos, Juan Carlos" sort="Zevallos, Juan Carlos" uniqKey="Zevallos J" first="Juan Carlos" last="Zevallos">Juan Carlos Zevallos</name>
<affiliation><nlm:aff id="A2"> Associate Professor of Medicine and Public Health and Director, Endowed Health Service Research Center, University of Puerto Rico, San Juan, Puerto Rico</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ritchie, Christine Seel" sort="Ritchie, Christine Seel" uniqKey="Ritchie C" first="Christine Seel" last="Ritchie">Christine Seel Ritchie</name>
<affiliation><nlm:aff id="A3"> Associate Professor of Medicine, Birmingham–Atlanta Veterans Administration Geriatric Research, Education and Clinical Center (GRECC) and the University of Alabama at Birmingham, Department of Medicine, Birmingham, Alabama; Adjunct Faculty, University of Puerto Rico, School of Oral Health, San Juan, Puerto Rico</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)</title>
<idno type="ISSN">1548-8578</idno>
<imprint><date when="2009">2009</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><p id="P1">This review assesses the strength of evidence relating periodontal disease and atherosclerotic disease (ischemic heart disease, peripheral arterial disease, and ischemic stroke). Periodontal disease and atherosclerotic disease may be linked causally, or their relationship could be explained, wholly or partially, by common risk factors. Many potential pathways for the relationship have been postulated. This article focuses on evaluating the overall body of evidence, according to the following standard causal inference criteria: strength of association, dose-response relationship, time sequence, consistency, specificity, biologic plausibility, and independence from confounding. Each criterion is reviewed and evaluated against the existing literature. In summary, the overall strength of evidence for causal criteria for the relation between periodontal disease and atherosclerotic disease is as follows: The magnitude and consistency of the association is stronger for ischemic stroke (and is low for ischemic heart disease), some evidence for dose response exists, time sequence has been established with more evidence for stroke, and there is definitely biologic plausibility for all these associations. Independence from confounding is also stronger for ischemic stroke and peripheral arterial disease. Specificity is not established for any of these associations, as there are multiple risk factors for atherosclerotic disease; however, specificity is not considered an important criterion for causality. Because the underlying pathogenesis of atherosclerosis is common across the diseases, it is likely that if additional studies show consistent associations, periodontal disease may be an important independent causal risk factor for atherosclerotic disease, especially for ischemic stroke.</p>
</div>
</front>
</TEI>
<pmc article-type="research-article" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">9600713</journal-id>
<journal-id journal-id-type="pubmed-jr-id">21008</journal-id>
<journal-id journal-id-type="nlm-ta">Compend Contin Educ Dent</journal-id>
<journal-title>Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)</journal-title>
<issn pub-type="ppub">1548-8578</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">19757736</article-id>
<article-id pub-id-type="pmc">2894475</article-id>
<article-id pub-id-type="manuscript">NIHMS207984</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Strength of Evidence Relating Periodontal Disease and Atherosclerotic Disease</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Joshipura</surname>
<given-names>Kaumudi</given-names>
</name>
<degrees>BDS, MS, ScD</degrees>
<xref rid="A1" ref-type="aff">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Zevallos</surname>
<given-names>Juan Carlos</given-names>
</name>
<degrees>MD</degrees>
<xref rid="A2" ref-type="aff">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ritchie</surname>
<given-names>Christine Seel</given-names>
</name>
<degrees>MD, MSPH</degrees>
<xref rid="A3" ref-type="aff">3</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
Professor of Epidemiology, University of Puerto Rico, School of Dentistry, San Juan, Puerto Rico; Adjunct Faculty, Harvard School of Dental Medicine, Harvard School of Public Health, Boston, Massachusetts</aff>
<aff id="A2"><label>2</label>
Associate Professor of Medicine and Public Health and Director, Endowed Health Service Research Center, University of Puerto Rico, San Juan, Puerto Rico</aff>
<aff id="A3"><label>3</label>
Associate Professor of Medicine, Birmingham–Atlanta Veterans Administration Geriatric Research, Education and Clinical Center (GRECC) and the University of Alabama at Birmingham, Department of Medicine, Birmingham, Alabama; Adjunct Faculty, University of Puerto Rico, School of Oral Health, San Juan, Puerto Rico</aff>
<pub-date pub-type="nihms-submitted"><day>1</day>
<month>6</month>
<year>2010</year>
</pub-date>
<pub-date pub-type="ppub"><month>9</month>
<year>2009</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>30</day>
<month>6</month>
<year>2010</year>
</pub-date>
<volume>30</volume>
<issue>7</issue>
<fpage>430</fpage>
<lpage>439</lpage>
<abstract><p id="P1">This review assesses the strength of evidence relating periodontal disease and atherosclerotic disease (ischemic heart disease, peripheral arterial disease, and ischemic stroke). Periodontal disease and atherosclerotic disease may be linked causally, or their relationship could be explained, wholly or partially, by common risk factors. Many potential pathways for the relationship have been postulated. This article focuses on evaluating the overall body of evidence, according to the following standard causal inference criteria: strength of association, dose-response relationship, time sequence, consistency, specificity, biologic plausibility, and independence from confounding. Each criterion is reviewed and evaluated against the existing literature. In summary, the overall strength of evidence for causal criteria for the relation between periodontal disease and atherosclerotic disease is as follows: The magnitude and consistency of the association is stronger for ischemic stroke (and is low for ischemic heart disease), some evidence for dose response exists, time sequence has been established with more evidence for stroke, and there is definitely biologic plausibility for all these associations. Independence from confounding is also stronger for ischemic stroke and peripheral arterial disease. Specificity is not established for any of these associations, as there are multiple risk factors for atherosclerotic disease; however, specificity is not considered an important criterion for causality. Because the underlying pathogenesis of atherosclerosis is common across the diseases, it is likely that if additional studies show consistent associations, periodontal disease may be an important independent causal risk factor for atherosclerotic disease, especially for ischemic stroke.</p>
</abstract>
<contract-num rid="DE1">R01 DE017176-03S1
||DE</contract-num>
<contract-num rid="DE1">R01 DE017176-01A1
||DE</contract-num>
<contract-sponsor id="DE1">National Institute of Dental and Craniofacial Research : NIDCR</contract-sponsor>
</article-meta>
</front>
</pmc>
</record>
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