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Rev Clin Periodoncia Implantol Rehabil Oral. 2009;2:91-97
REVISIÓN BIBLIOGRÁFICA [PDF]

Relación entre Periodontitis y Enfermedad Cardiovascular

Relationship between Periodontitis and Cardiovascular Disease

Contreras A1, Ramírez J2

1DDS., MSc., PhD. Profesor Titular, Escuela de Odontologia, Vicedecano de Investigaciones, Facultad de Salud, Universidad del Valle. Colombia.
2MD., MSc. 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.

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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Referencias bibliográficas

1.
A. Lazzini,S. Lazzini
Cardiovascular disease: an economical perspective
Curr Pharm Des, 15 (2009), pp. 1142-1156
2.
F. Levi,L. Chatenoud,P. Bertuccio,F. Lucchini,E. Negri,C.L. Vecchia
Mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world: an update
Eur J Cardiovasc Prev Rehabil, (2009),
3.
D. Wood
Established and emerging cardiovascular risk factors
Am Heart J, 141 (2001), pp. S49-S57
4.
K.J. Mukamal,R.A. Kronmal,R.P. Tracy,M. Cushman,D.S. Siscovick
Traditional and novel risk factors in older adults: cardiovascular risk assessment late in life
Am J Geriatr Cardiol, 13 (2004), pp. 69-80
5.
G.K. Hansson
Inflammation, atherosclerosis, and coronary artery disease
N Engl J Med, 352 (2005), pp. 1685-1695 http://dx.doi.org/10.1056/NEJMra043430
6.
L.G. Best,Y. Zhang,E.T. Lee,J.L. Yeh,L. Cowan,V. Palmieri
C-reactive protein as a predictor of cardiovascular risk in a population with a high prevalence of diabetes: the Strong Heart Study
Circulation, 112 (2005), pp. 1289-1295 http://dx.doi.org/10.1161/CIRCULATIONAHA.104.489260
7.
J.M. Sinning,C. Bickel,C.M. Messow,R. Schnabel,E. Lubos,H.J. Rupprecht
Impact of C-reactive protein and fibrinogen on cardiovascular prognosis in patients with stable angina pectoris: the AtheroGene study
Eur Heart J, 27 (2006), pp. 2962-2968 http://dx.doi.org/10.1093/eurheartj/ehl362
8.
D. Tanne,M. Benderly,U. Goldbourt,M. Haim,A. Tenenbaum,E.Z. Fisman
C-reactive protein as a predictor of incident ischemic stroke among patients with preexisting cardiovascular disease
9.
E. Reszka,B. Jegier,W. Wasowicz,M. Lelonek,M. Banach,R. Jaszewski
Detection of infectious agents by polymerase chain reaction in human aortic wall
Cardiovasc Pathol, 17 (2008), pp. 297-302 http://dx.doi.org/10.1016/j.carpath.2007.11.002
10.
E. Kozarov,D. Sweier,C. Shelburne,A. Progulske-Fox,D. Lopatin
Detection of bacterial DNA in atheromatous plaques by quantitative PCR
Microbes Infect, 8 (2006), pp. 687-693 http://dx.doi.org/10.1016/j.micinf.2005.09.004
11.
E.V. Kozarov,B.R. Dorn,C.E. Shelburne,W.A. Dunn Jr.,A. Progulske-Fox
Human atherosclerotic plaque contains viable invasive Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis
Arterioscler Thromb Vasc Biol, 25 (2005), pp. e17-e18 http://dx.doi.org/10.1161/01.ATV.0000155018.67835.1a
12.
J.E. Botero,A. Contreras,B. Parra
Profiling of inflammatory cytokines produced by gingival fibroblasts after human cytomegalovirus infection
Oral Microbiol Immunol, 23 (2008), pp. 291-298 http://dx.doi.org/10.1111/j.1399-302X.2007.00427.x
13.
J.E. Botero,B. Parra,A. Jaramillo,A. Contreras
Subgingival human cytomegalovirus correlates with increased clinical periodontal parameters and bacterial coinfection in periodontitis
J Periodontol, 78 (2007), pp. 2303-2310 http://dx.doi.org/10.1902/jop.2007.070252
14.
A. Contreras,H. Nowzari,J. Slots
Herpesviruses in periodontal pocket and gingival tissue specimens
Oral Microbiol Immunol, 15 (2000), pp. 15-18
15.
C. Lunardi,M. Dolcino,D. Peterlana,C. Bason,R. Navone,N. Tamassia
Endothelial cells’ activation and apoptosis induced by a subset of antibodies against human cytomegalovirus: relevance to the pathogenesis of atherosclerosis
16.
E. Lalla,I.B. Lamster,M.A. Hofmann,L. Bucciarelli,A.P. Jerud,S. Tucker
Oral infection with a periodontal pathogen accelerates early atherosclerosis in apolipoprotein E-null mice
Arterioscler Thromb Vasc Biol, 23 (2003), pp. 1405-1411 http://dx.doi.org/10.1161/01.ATV.0000082462.26258.FE
17.
R.G. Deshpande,M.B. Khan,C.A. Genco
Invasion of aortic and heart endothelial cells by Porphyromonas gingivalis
Infect Immun, 66 (1998), pp. 5337-5343
18.
B.R. Dorn,W.A. Dunn Jr.,A. Progulske-Fox
Invasion of human coronary artery cells by periodontal pathogens
Infect Immun, 67 (1999), pp. 5792-5798
19.
K.J. Mattila,P.J. Pussinen,S. Paju
Dental infections and cardiovascular diseases: a review
J Periodontol, 76 (2005), pp. 2085-2088 http://dx.doi.org/10.1902/jop.2005.76.11-S.2085
20.
G.J. Seymour,P.J. Ford,M.P. Cullinan,S. Leishman,K. Yamazaki
Relationship between periodontal infections and systemic disease
Clin Microbiol Infect, 13 (2007), pp. 3-10 http://dx.doi.org/10.1111/j.1469-0691.2007.01798.x
21.
K.J. Mattila,M.S. Nieminen,V.V. Valtonen,V.P. Rasi,Y.A. Kesaniemi,S.L. Syrjala
Association between dental health and acute myocardial infarction
BMJ, 298 (1989), pp. 779-781
22.
S.J. Arbes Jr.,G.D. Slade,J.D. Beck
Association between extent of periodontal attachment loss and self-reported history of heart attack: an analysis of NHANES III data
J Dent Res, 78 (1999), pp. 1777-1782
23.
F. DeStefano,R.F. Anda,H.S. Kahn,D.F. Williamson,C.M. Russell
Dental disease and risk of coronary heart disease and mortality
BMJ, 306 (1993), pp. 688-691
24.
J. Beck,R. Garcia,G. Heiss,P.S. Vokonas,S. Offenbacher
Periodontal disease and cardiovascular disease
J Periodontol, 67 (1996), pp. 1123-1137 http://dx.doi.org/10.1902/jop.1996.67.10s.1123
25.
J.D. Beck,J.R. Elter,G. Heiss,D. Couper,S.M. Mauriello,S. Offenbacher
Relationship of periodontal disease to carotid artery intima-media wall thickness: the atherosclerosis risk in communities (ARIC) study
Arterioscler Thromb Vasc Biol, 21 (2001), pp. 1816-1822
26.
J.D. Beck,P. Eke,D. Lin,P. Madianos,D. Couper,K. Moss
Associations between IgG antibody to oral organisms and carotid intima-medial thickness in community-dwelling adults
Atherosclerosis, 183 (2005), pp. 342-348 http://dx.doi.org/10.1016/j.atherosclerosis.2005.03.017
27.
H.C. Hung,K.J. Joshipura,G. Colditz,J.E. Manson,E.B. Rimm,F.E. Speizer
The association between tooth loss and coronary heart disease in men and women
J Public Health Dent, 64 (2004), pp. 209-215
28.
K.J. Joshipura,H.C. Wand,A.T. Merchant,E.B. Rimm
Periodontal disease and biomarkers related to cardiovascular disease
J Dent Res, 83 (2004), pp. 151-155
29.
S.P. Engebretson,I.B. Lamster,M.S. Elkind,T. Rundek,N.J. Serman,R.T. Demmer
Radiographic measures of chronic periodontitis and carotid artery plaque
30.
M. Desvarieux,R.T. Demmer,T. Rundek,B. Boden-Albala,D.R. Jacobs Jr.,R.L. Sacco
Periodontal microbiota and carotid intima-media thickness: the Oral Infections and Vascular Disease Epidemiology Study (INVEST)
Circulation, 111 (2005), pp. 576-582 http://dx.doi.org/10.1161/01.CIR.0000154582.37101.15
31.
P.O. Soder,B. Soder,J. Nowak,T. Jogestrand
Early carotid atherosclerosis in subjects with periodontal diseases
32.
P.J. Pussinen,G. Alfthan,H. Rissanen,A. Reunanen,S. Asikainen,P. Knekt
Antibodies to periodontal pathogens and stroke risk
33.
P.J. Pussinen,K. Nyyssonen,G. Alfthan,R. Salonen,J.A. Laukkanen,J.T. Salonen
Serum antibody levels to Actinobacillus actinomycetemcomitans predict the risk for coronary heart disease
Arterioscler Thromb Vasc Biol, 25 (2005), pp. 833-838 http://dx.doi.org/10.1161/01.ATV.0000157982.69663.59
34.
C.C. Abnet,Y.L. Qiao,S.M. Dawsey,Z.W. Dong,P.R. Taylor,S.D. Mark
Tooth loss is associated with increased risk of total death and death from upper gastrointestinal cancer, heart disease, and stroke in a Chinese populationbased cohort
Int J Epidemiol, 34 (2005), pp. 467-474 http://dx.doi.org/10.1093/ije/dyh375
35.
A. Agueda,J.M. Ramon,C. Manau,A. Guerrero,J.J. Echeverria
Periodontal disease as a risk factor for adverse pregnancy outcomes: a prospective cohort study
J Clin Periodontol, 35 (2008), pp. 16-22 http://dx.doi.org/10.1111/j.1600-051X.2007.01166.x
36.
C. Manau,A. Echeverria,A. Agueda,A. Guerrero,J.J. Echeverria
Periodontal disease definition may determine the association between periodontitis and pregnancy outcomes
J Clin Periodontol, 35 (2008), pp. 385-397 http://dx.doi.org/10.1111/j.1600-051X.2008.01222.x
37.
A. Fardi,D. Papadimitriou
Periodontal and atherosclerosis-induced diseases
Int Angiol, 26 (2007), pp. 197-205
38.
I.Z. Mustapha,S. Debrey,M. Oladubu,R. Ugarte
Markers of systemic bacterial exposure in periodontal disease and cardiovascular disease risk: a systematic review and meta-analysis
J Periodontol, 78 (2007), pp. 2289-2302 http://dx.doi.org/10.1902/jop.2007.070140
39.
F.A. Scannapieco,R.B. Bush,S. Paju
Associations between periodontal disease and risk for atherosclerosis, cardiovascular disease, and stroke. A systematic review
Ann Periodontol, 8 (2003), pp. 38-53 http://dx.doi.org/10.1902/annals.2003.8.1.38
40.
S. Ajwani,K.J. Mattila,R.S. Tilvis,A. Ainamo
Periodontal disease and mortality in an aged population
Spec Care Dentist, 23 (2003), pp. 125-130
41.
J.H. Meurman,M. Sanz,S.J. Janket
Oral health, atherosclerosis, and cardiovascular disease
Crit Rev Oral Biol Med, 15 (2004), pp. 403-413
42.
M.V. Vettore
Periodontal disease cardiovascular disease
Evid Based Dent, 5 (2004), pp. 69 http://dx.doi.org/10.1038/sj.ebd.6400272
43.
Y.S. Khader,Z.S. Albashaireh,M.A. Alomari
Periodontal diseases and the risk of coronary heart and cerebrovascular diseases: a meta-analysis
J Periodontol, 75 (2004), pp. 1046-1053 http://dx.doi.org/10.1902/jop.2004.75.8.1046
44.
S.A. Harding,J. Sarma,D.H. Josephs,N.L. Cruden,J.N. Din,P.J. Twomey
Upregulation of the CD40/CD40 ligand dyad and platelet-monocyte aggregation in cigarette smokers
Circulation, 109 (2004), pp. 1926-1929 http://dx.doi.org/10.1161/01.CIR.0000127128.52679.E4
45.
C.R. Conti,J.L. Mehta
Acute myocardial ischemia: role of atherosclerosis, thrombosis, platelet activation, coronary vasospasm, and altered arachidonic acid metabolism
Circulation, 75 (1987), pp. V84-V95
46.
A. Lourbakos,Y.P. Yuan,A.L. Jenkins,J. Travis,P. Andrade-Gordon,R. Santulli
Activation of protease-activated receptors by gingipains from Porphyromonas gingivalis leads to platelet aggregation: a new trait in microbial pathogenicity
Blood, 97 (2001), pp. 3790-3797
47.
X. Li,T. Iwai,H. Nakamura,Y. Inoue,Y. Chen,M. Umeda
An ultrastructural study of Porphyromonas gingivalis-induced platelet aggregation
Thromb Res, 122 (2008), pp. 810-819 http://dx.doi.org/10.1016/j.thromres.2008.03.011
48.
M. Nylander,T.L. Lindahl,T. Bengtsson,M. Grenegard
The periodontal pathogen Porphyromonas gingivalis sensitises human blood platelets to epinephrine
Platelets, 19 (2008), pp. 352-358 http://dx.doi.org/10.1080/09537100802056102
49.
M.C. Herzberg,M.W. Weyer
Dental plaque, platelets, and cardiovascular diseases
Ann Periodontol, 3 (1998), pp. 151-160 http://dx.doi.org/10.1902/annals.1998.3.1.151
50.
M.W. Meyer,K. Gong,M.C. Herzberg
Streptococcus sanguis-induced platelet clotting in rabbits and hemodynamic and cardiopulmonary consequences
Infect Immun, 66 (1998), pp. 5906-5914
51.
D. Papapanagiotou,E.A. Nicu,S. Bizzarro,V.E. Gerdes,J.C. Meijers,R. Nieuwland
Periodontitis is associated with platelet activation
Atherosclerosis, 202 (2009), pp. 605-611 http://dx.doi.org/10.1016/j.atherosclerosis.2008.05.035
52.
R. Rajaiah,K.D. Moudgil
Heat-shock proteins can promote as well as regulate autoimmunity
Autoimmun Rev, 8 (2009), pp. 388-393 http://dx.doi.org/10.1016/j.autrev.2008.12.004
53.
K. Yamazaki,Y. Ohsawa,H. Itoh,K. Ueki,K. Tabeta,T. Oda
T-cell clonality to Porphyromonas gingivalis and human heat shock protein 60s in patients with atherosclerosis and periodontitis
Oral Microbiol Immunol, 19 (2004), pp. 160-167 http://dx.doi.org/10.1111/j.0902-0055.2004.00134.x
54.
P. Ford,E. Gemmell,P. Walker,M. West,M. Cullinan,G. Seymour
Characterization of heat shock protein-specific T cells in atherosclerosis
Clin Diagn Lab Immunol, 12 (2005), pp. 259-267 http://dx.doi.org/10.1128/CDLI.12.2.259-267.2005
55.
J.G. Argueta,S. Shiota,N. Yamaguchi,Y. Masuhiro,S. Hanazawa
Induction of Porphyromonas gingivalis GroEL signaling via binding to Toll-like receptors 2 and 4
Oral Microbiol Immunol, 21 (2006), pp. 245-251 http://dx.doi.org/10.1111/j.1399-302X.2006.00286.x
56.
B. Chiu
Multiple infections in carotid atherosclerotic plaques
Am Heart J, 138 (1999), pp. S534-S536
57.
M. Khlgatian,H. Nassar,H.H. Chou,F.C. Gibson 3rd,C.A. Genco
Fimbriadependent activation of cell adhesion molecule expression in Porphyromonas gingivalis-infected endothelial cells
Infect Immun, 70 (2002), pp. 257-267
58.
H.H. Chou,H. Yumoto,M. Davey,Y. Takahashi,T. Miyamoto,F.C. Gibson 3rd
Porphyromonas gingivalis fimbria-dependent activation of inflammatory genes in human aortic endothelial cells
Infect Immun, 73 (2005), pp. 5367-5378 http://dx.doi.org/10.1128/IAI.73.9.5367-5378.2005
59.
H. Yumoto,H.H. Chou,Y. Takahashi,M. Davey,F.C. Gibson 3rd,C.A. Genco
Sensitization of human aortic endothelial cells to lipopolysaccharide via regulation of Toll-like receptor 4 by bacterial fimbria-dependent invasion
Infect Immun, 73 (2005), pp. 8050-8059 http://dx.doi.org/10.1128/IAI.73.12.8050-8059.2005
60.
M.B. Giacona,P.N. Papapanou,I.B. Lamster,L.L. Rong,V.D. D’Agati,A.M. Schmidt
Porphyromonas gingivalis induces its uptake by human macrophages and promotes foam cell formation in vitro
FEMS Microbiol Lett, 241 (2004), pp. 95-101 http://dx.doi.org/10.1016/j.femsle.2004.10.009
61.
M. Qi,H. Miyakawa,H.K. Kuramitsu
Porphyromonas gingivalis induces murine macrophage foam cell formation
Microb Pathog, 35 (2003), pp. 259-267
62.
A. Jain,E.L. Batista Jr.,C. Serhan,G.L. Stahl,T.E. Van Dyke
Role for periodontitis in the progression of lipid deposition in an animal model
Infect Immun, 71 (2003), pp. 6012-6018
63.
L. Li,E. Messas,E.L. Batista Jr.,R.A. Levine,S. Amar
Porphyromonas gingivalis infection accelerates the progression of atherosclerosis in a heterozygous apolipoprotein E-deficient murine model
Circulation, 105 (2002), pp. 861-867
64.
G. Yan,B. You,S.P. Chen,J.K. Liao,J. Sun
Tumor necrosis factor-alpha downregulates endothelial nitric oxide synthase mRNA stability via translation elongation factor 1-alpha 1
Circ Res, 103 (2008), pp. 591-597 http://dx.doi.org/10.1161/CIRCRESAHA.108.173963
65.
R.Z. Zhao,X. Chen,Q. Yao,C. Chen
TNF-alpha induces interleukin-8 and endothelin-1 expression in human endothelial cells with different redox pathways
Biochem Biophys Res Commun, 327 (2005), pp. 985-992 http://dx.doi.org/10.1016/j.bbrc.2004.12.109
66.
C.W. Wyble,K.L. Hynes,J. Kuchibhotla,B.C. Marcus,D. Hallahan,B.L. Gewertz
TNF-alpha and IL-1 upregulate membrane-bound and soluble E-selectin through a common pathway
J Surg Res, 73 (1997), pp. 107-112 http://dx.doi.org/10.1006/jsre.1997.5207
67.
A. Rahman,J. Kefer,M. Bando,W.D. Niles,A.B. Malik
E-selectin expression in human endothelial cells by TNF-alpha-induced oxidant generation and NFkappaB activation
Am J Physiol, 275 (1998), pp. L533-L544
68.
D.S. Celermajer,K.E. Sorensen,V.M. Gooch,D.J. Spiegelhalter,O.I. Miller,I.D. Sullivan
Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis
Lancet, 340 (1992), pp. 1111-1115
69.
S. Amar,N. Gokce,S. Morgan,M. Loukideli,T.E. Van Dyke,J.A. Vita
Periodontal disease is associated with brachial artery endothelial dysfunction and systemic inflammation
Arterioscler Thromb Vasc Biol, 23 (2003), pp. 1245-1249 http://dx.doi.org/10.1161/01.ATV.0000078603.90302.4A
70.
F. D’Aiuto,D. Ready,M.S. Tonetti
Periodontal disease and C-reactive proteinassociated cardiovascular risk
J Periodontal Res, 39 (2004), pp. 236-241 http://dx.doi.org/10.1111/j.1600-0765.2004.00731.x
71.
J.R. Elter,A.L. Hinderliter,S. Offenbacher,J.D. Beck,M. Caughey,N. Brodala
The effects of periodontal therapy on vascular endothelial function: a pilot trial
Am Heart J, 151 (2006), pp. 47 http://dx.doi.org/10.1016/j.ahj.2005.10.002
72.
G. Seinost,G. Wimmer,M. Skerget,E. Thaller,M. Brodmann,R. Gasser
Periodontal treatment improves endothelial dysfunction in patients with severe periodontitis
Am Heart J, 149 (2005), pp. 1050-1054 http://dx.doi.org/10.1016/j.ahj.2004.09.059
73.
M.S. Tonetti,F. D’Aiuto,L. Nibali,A. Donald,C. Storry,M. Parkar
Treatment of periodontitis and endothelial function
N Engl J Med, 356 (2007), pp. 911-920 http://dx.doi.org/10.1056/NEJMoa063186
74.
Y. Higashi,C. Goto,D. Jitsuiki,T. Umemura,K. Nishioka,T. Hidaka
Periodontal infection is associated with endothelial dysfunction in healthy subjects and hypertensive patients
Hypertension, 51 (2008), pp. 446-453 http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.101535
75.
Y. Higashi,C. Goto,T. Hidaka,J. Soga,S. Nakamura,Y. Fujii
Oral infection-inflammatory pathway, periodontitis, is a risk factor for endothelial dysfunction in patients with coronary artery disease
Atherosclerosis, (2009),

 

CORRESPONDENCIA AUTOR
Adolfo Contreras.
adolfoco@yahoo.com
Trabajo recibido el 16/07/2009.

Aprobado para su publicación el 22/07/2009.

Copyright © 2009.
Sociedad de Periodoncia de Chile, Sociedad de Implantología Oral de Chile y Sociedad de Prótesis y Rehabilitación Oral de Chile.