Published Online
on February 3, 2005

A more recent version of this article appeared on March 1, 2005

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Submitted on November 11, 2004
Accepted on November 22, 2004

Radiographic Measures of Chronic Periodontitis and Carotid Artery Plaque

Steven P. Engebretson DMD, MS^*; Ira B. Lamster DDS, MMSc; Mitchell S.V. Elkind MD, MS; Tatjana Rundek MD, PhD; Neill J. Serman DDS; Ryan T. Demmer MPH; Ralph L. Sacco MD, MS; Panos N. Papapanou DDS, PhD; and Moïse Desvarieux MD, PhD

From the Division of Periodontics (S.P.E., I.B.L., P.N.P.), Section of Oral and Diagnostic Sciences, School of Dental and Oral Surgery, Departments of Neurology (M.S.E., R.L.S.), College of Physicians and Surgeons, Columbia University Medical Center, Sergievsky Center, and Epidemiology (R.L.S.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Division of Epidemiology, School of Public Health (R.T.D., M.D.) and Division of Infectious Diseases and International Medicine, Department of Medicine, Medical School (M.D.), University of Minnesota, Minneapolis.

^* To whom correspondence should be addressed. E-mail: spe3{at}columbia.edu.

Background and Purpose--Chronic periodontitis (CP) is associated with stroke and subclinical atherosclerosis, but clinical measurement of CP can be time consuming and invasive. The purpose of this study was to determine whether radiographically assessed CP is associated with nonstenotic carotid artery plaque as an ultrasound measure of subclinical atherosclerosis.

Methods--Panoramic oral radiographs were obtained from 203 stroke-free subjects ages 54 to 94 during the baseline examination of the Oral Infections and Vascular Disease Epidemiology Study (INVEST). CP exposure among dentate subjects was defined either categorically (periodontal bone loss 50% [severe] versus <50% bone loss) or via tertile formation (for dose-response investigation), with edentulous subjects categorized separately. In all subjects, high-resolution B-mode carotid ultrasound was performed. Carotid plaque thickness (CPT) and prevalence (present/absent) were recorded. Covariates included age, sex, smoking, diabetes, hypertension, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein cholesterol.

Results--Among dentate subjects with severe periodontal bone loss, mean CPT was significantly greater (1.20±1.00 mm versus 0.73±0.89 mm; P=0.003). CPT increased with more severe bone loss (upper versus lower tertile bone loss; P=0.049; adjusted for age, sex, and hypertension). This apparent dose-response effect was more evident among never-smokers. In a fully adjusted multivariate logistic regression model, severe periodontal bone loss was associated with a nearly 4-fold increase in risk for the presence of carotid artery plaque (adjusted odds ratio, 3.64; CI, 1.37 to 9.65).

Conclusions--Severe periodontal bone loss is associated independently with carotid atherosclerosis. Panoramic oral radiographs may thus provide an efficient means to assess CP in studies of atherosclerosis risk.

Key words: alveolar bone loss • carotid stenosis • periodonitis • radiography, panoramic • ultrasonography

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