Effect of a periodontal intervention on pulse wave velocity in Indigenous Australians with periodontal disease: the PerioCardio randomized controlled trial

Abstract

Introduction: Indigenous Australians have high rates of premature cardiovascular disease and high prevalence of periodontitis, an inflammatory disease of the tissues surrounding teeth. Periodontitis has been associated with arterial stiffening and incident cardiovascular events and. periodontal bacteria have been isolated from atheromatous plaques. If periodontitis contributes causally to cardiovascular disease, periodontal treatment may confer important benefits to the health of Indigenous Australians. Objectives: To determine if a single episode of periodontal treatment improved arterial stiffness in otherwise healthy Indigenous Australian adults. Methods: Participants were 273 Indigenous Australian adults (57% male; age 40.3years [SD 10.2]) with moderate or severe periodontal disease in the Northern Territory, Australia. Participants were randomized into intervention (n¼138) or control (n¼135) groups. The intervention involved removal of sub- and supra-gingival calculus and plaque biofilm by scaling and root-planing once, at randomization. Pulse wave velocity (PWV) was assessed by applanation tonometry (SphygmoCor- PVMx device, AtCor Medical, Sydney, Australia) between the carotid and dorsalis pedis arteries, at baseline and again 3-months (n¼169) and 12-months (n¼171) post randomization. Comparison of randomized groups was by complete case analysis using ANCOVA adjusted for baseline measures. Results: At baseline, the average carotid-dorsalis pedis PWV was 8.34 m/s (SD 1.25). The mean reduction in periodontal pocketing from enrollment to 3-months was 0.14 mm greater [95% CI 0.24 to 0.05] in the intervention group compared to control, P¼0.004). This was less marked at 12-months, mean reduction in periodontal pocketing 0.09 mm greater [95% CI -0.01 to 0.18] in the intervention versus control, P¼0.08). In contrast, the intervention did not affect PWV at 3-months [the primary endpoint] (between-group difference in means +0.06 m/s [95% CI -0.17 to 0.29] intervention vs. control, P ¼ 0.59), although there was some evidence that the intervention increased PWV at 12-months, this was not statistically significant (between-group difference in means +0.21 m/s [95% CI -0.01 to 0.43] intervention vs. control, P¼0.06). Conclusion: A single episode periodontal intervention in Indigenous Australians with periodontal disease provides short-term improvement in periodontal health, but did not significantly influence arterial stiffness as measured by pulse wave velocity. Disclosure of Interest: None Declared