Asociación entre enfermedad periodontal y disfunción endotelial. Revisión sistemática de la literatura / Association between Periodontal Disease and Endothelial Dysfunction. Systematic Review of Literature
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Antecedentes: La periodontitis es una enfermedad infecciosa crónica de las estructuras de soporte de los dientes que en los últimos años se ha asociado con eventos cardiovasculares. Objetivo: Determinar si la enfermedad periodontal es un factor de riesgo para la disfunción endotelial en pacientes entre 40 y 80 años de edad, por medio de una revisión sistemática de la literatura. Métodos: Se realizó la búsqueda en ocho bases de datos para identificar la literatura publicada que incluyera pacientes en el rango de edad propuesto. Resultados: Se identificaron cinco artículos, de los cuales cuatro fueron ensayos clínicos aleatorizados y un estudio cohorte. Dos estudios evaluaron la dilatación mediada por flujo de la arteria braquial, la cual presentó mejoría 6 meses después del tratamiento periodontal intensivo (TPI) (7,1 % a 8,4 % y 4,12 % a 11,12 %). Las concentraciones séricas de IL-6 disminuyeron; pero solo un estudio reportó una disminución estadísticamente significativa (de 1,3 pg/ml a 0,8 pg/ml seis meses después de la TPI). En cuanto a las concentraciones séricas de proteína C reactiva, solo un estudio reportó una disminución estadísticamente significativa seis meses después del TPI (1,8 mg/l a 1,1 mg/l). Conclusión: No se encontraron artículos que relacionen la enfermedad periodontal como factor de riesgo para la disfunción endotelial; sin embargo, con los hallazgos de esta revisión se puede inferir que el TPI a largo plazo mejora la función endotelial, pero el grado de mejoría no se correlaciona directamente con el cambio en los biomarcadores inflamatorios.
Background: Periodontitis is a chronic infectious disease of the supporting structures of the teeth that cause a chronic inflammatory response and, in recent years, has been associated with cardiovascular events. Objective: Determine if periodontal disease is a risk factor for endothelial dysfunction in patients with an age range between 40 and 80 years through a systematic review of the literature. Methods: Eight databases were searched to identify related literature including patients in the age range aimed. Results: We identified five articles of which four were about randomized trials and cohort study. Two studies evaluated flow-mediated dilation of the brachial artery, which showed improvement six months after periodontal treatment improves (IPT) (7.1 % to 8.4 % and 4.12 % to 11.12 %). Serum levels of IL-6 decreased but only one study reported statistically significant decrease (1.3 pg/ml to 0.8 pg/ml six months after the IPT). As serum levels of CRP only one study reported statistically significant decrease six months after IPT (1.8 mg/l at 1.1 mg/l). One study reported on the first day of increased levels of inflammatory biomarkers (IL-6 and PCR). Conclusion: We found no articles linking periodontal disease as a risk factor for endothelial dysfunction. However, the findings of this review we conclude that IPT improves long-term endothelial function, but the degree of improvement does not correlate directly with changes in inflammatory biomarkers.
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