Association of periodontal disease with the instability carotid plaque

Abstract

Aim-Background

Periodontal disease has been associated with an increased risk of stroke. Unstable carotid plaques are more prone to rupture and produce emboli that result in stroke or transient ischaemic episodes (TIA). The aim of this pilot study was to investigate whether periodontal disease is associated with a) symptomatic carotid disease and b) the instability of carotid plaques as indicated by ultrasound.

Methods

The study included 57 patients that underwent surgery for carotid artery stenosis at Hellenic Red Cross Hospital in Athens. Prior to surgery, symptomatic plaques were recorded and patients were examined with ultrasonography for plaque stability. Additionally, patients received full mouth periodontal examination including measurements of attachment loss (AL) and probing pocket depth (PPD) to define periodontitis. Statistical analysis was performed using the X² test.

Results

Seventeen patients were edentulous. More patients with mean PPD >3.5mm had symptomatic plaques compared to patients with mean PPD <2.5mm (p=0.06). There was also a trend for unstable plaques (type I and II) for the first group (p=0.1). A similar trend was also evident when patients suffered from periodontitis defined as the verification of at least 4 sites with PPD≥6mm and AL≥5mm. Finally, significantly more edentulous patients had symptomatic plaques than patients with mean PPD<2.5mm (p=0.05).

Conclusion

The results of this pilot study indicate that patients with more severe periodontitis may be associated with symptomatic and “softer” atherosclerotic plaques. However, a larger sample size is required to verify this association.