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Inicio Revista Clínica de Periodoncia, Implantología y Rehabilitación Oral Relación entre Periodontitis y Enfermedad Cardiovascular
Información de la revista
Vol. 2. Núm. 2.
Páginas 91-97 (Agosto 2009)
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Vol. 2. Núm. 2.
Páginas 91-97 (Agosto 2009)
DOI: 10.1016/S0718-5391(09)70153-3
Open Access
Relación entre Periodontitis y Enfermedad Cardiovascular
Relationship between Periodontitis and Cardiovascular Disease
Visitas
8096
A. Contreras1,
Autor para correspondencia
adolfoco@yahoo.com

Correspondencia autor.
, J. Ramírez2
1 Profesor Titular, Escuela de Odontologia, Vicedecano de Investigaciones, Facultad de Salud, Universidad del Valle. Colombia
2 Director del Programa de Medicina, Facultad de Ciencias de la Salud, Universidad Icesi. Colombia. Profesor Asistente, Escuela de Medicina, Facultad de Salud, Universidad del Valle. Colombia
Este artículo ha recibido
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Visitas

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Información del artículo
Resumen

Las enfermedades periodontales son patologías crónicas de alta prevalencia en la población afectando principalmente a los adultos mayores de 40 años, sin embargo si tenemos en cuenta las gingivitis, la prevalencia de ambas patologías asciende al 80%. Múltiples estudios sugieren un incremento en el riesgo de presentar enfermedades cardiovasculares (ECV) en sujetos con periodontitis. Recientes hallazgos permiten proponer que las periodontitis no tratada y quizá las gingivitis crónicas, puedan generar efectos sistémicos y de esta forma promover la aterogénesis por dos vías principales :

  • 1.

    Vía directa: a través de un efecto directo, representado por bacterias periodontopaticas que invaden las células endoteliales y estimulan la producción de mediadores pro-inflamatorios que favorecen el desarrollo de aterosclerosis.

  • 2.

    La segunda vía plausible o vía indirecta se genera por el aumento de citoquinas proinflamatorias que estimulan la expresión de moléculas de adhesión en el endotelio (e-selectina, ICAM-1 y VCAM) favoreciendo la migración de leucocitos a las lesiones ateromatosas.

Existe plausibilidad biológica de que por alguna de las vías o su combinación, se asocie la periodontitis con las enfermedades cardiovasculares. El tratamiento periodontal exitoso reduce los niveles plasmáticos de citoquinas proinflamatorias y reactantes de fase aguda. Adicionalmente, se ha descrito una mejoría de la función endotelial posterior al tratamiento periodontal en sujetos con periodontitis severa.

La enfermedad periodontal por su alta prevalencia ha recibido una creciente atención por ser un posible factor de riesgo modificable en la prevención primaria y secundaria de eventos cardiovasculares. Sin embargo, se requieren más estudios de observación que confirmen el vinculo entre periodontitis y aterosclerosis, así como ensayos clínicos controlados que permitan establecer si, el tratamiento periodontal reduce el riesgo cardiovascular.

Palabras clave:
Periodontitis
enfermedad cardiovascular
riesgo
evidencia epidemiológica
plausibilidad biológica
Abstract

Periodontitis is mostly a chronic pathology that affects adults over 40 years old in all populations. However, if gingivitis is added to periodontitis then the prevalence may be increased to affect almost 80% of the people. Several studies suggest a posible link between periodontitis and cardiovascular disease (CVD). Recent epidemiological and experimental evidence lead to think that untreated periodontitis and gingivitis produce some effects on the General Health and promote the atherogenesis by at least two ways :

  • 1.

    Direct damage : thourough a direct effect caused by invasión of periodontal pathogens of endotelial cells that are stimulated to produce pro-inflammatory cytokines that favour atherogenesis.

  • 2.

    Secondary damage : It is generated by the increase of pro-inflammatory cytokines that increase the expresión of adhesión molecules on endotelial cells like e-selectine, ICAM -1 and VCAM, and favours the migration of leukocytes into the atheroma lesions.

Its posible that periodontitis may be linked to CVD by diverse mechanisms. Succesfull periodontal treatment could reduce plasmatic levels of proimflammatoty cytokines and acute phase proteins. In addition, there is evidence that Periodontal tretatment could improve endotelial function among people affected by severe periodontitis.

Periodontitis is a prevalent disease that has claimed recent Public Health interest because It is a modifiable factor to prevent/reduce cardiovascular disease. However, more and better epidemiological evidence needs to be produced to confirm the posible link between periodontitis and cardiovascular disease. Clinical controlled trials are neccesary to determine the positive effect of periodontal intervention by lowering the risk of Cardiovascular disease.

Key words:
Periodontitis
cardiovascular disease
epidemiological studies
biological plausibility
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