THE EFFECT OF PERIODONTAL THERAPY ON CAROTID INTIMA-MEDIA THICKNESS AMONG ABORIGINAL AUSTRALIANS: A RANDOMISED CONTROLLED TRIAL

Monday, 18 August 2014
Exhibit hall (Dena'ina Center)
Kostas Kapellas, BS , the University of Adelaide, Adelaide, Australia
Louise J Maple-Brown, PhD , Royal Darwin Hospital, Darwin, Australia
Lisa M Jamieson, PhD , the University of Adelaide, Adelaide, Australia
Loc G Do, PhD , the University of Adelaide, Adelaide, Australia
Kerin O'Dea, PhD , University of South Australia, Adelaide, Australia
Alex Brown, PhD , South Australian Health & Medical Research Institute, Adelaide, Australia
David S Celermajer, PhD , the University of Sydney, Sydney, Australia
Gary D Slade, PhD , University of North Carolina at Chapel Hill, Chapel Hill, NC
Michael R Skilton, PhD , the University of Sydney, Sydney, Australia
INTRODUCTION:  Periodontitis is characterised by chronic inflammation of the tissues around teeth. Evidence from observational cohort studies and non-randomized trials suggest a possible association between periodontitis and atherosclerotic vascular disease. Currently, a causative relationship is unsupported due to a lack of evidence from randomized trials.

METHODS: This parallel-group, randomised, open label clinical trial enrolled 273 Aboriginal Australians aged ≥18 years with periodontitis. Intervention participants received full-mouth non-surgical periodontal scaling during a single, untimed visit while the control group received no treatment. Pre-specified primary endpoints measured vascular health; change in pulse wave velocity (PWV) at 3-months and change in mean & maximum carotid intima-media thickness (cIMT) at 12-months following periodontal therapy. Within-group change in cIMT was assessed using paired-t-test. Primary analysis was based on the complete-case approach using ANCOVA.

RESULTS:  Endpoints could be calculated for 169 participants with follow-up data at 3-months and 168 at 12 months. Maximum cIMT decreased after 12 months in the intervention group (mean reduction = ‑0.023 mm [95% CI -0.038, -0.008]), but not in the control group (mean increase = 0.002 mm [95% CI -0.017, 0.022]). The difference in change in maximum cIMT between groups was statistically significant (-0.026 mm [95% CI -0.048, -0.003], P = 0.03). By contrast, there were no significant differences in mean cIMT (-0.013 mm [95% CI -0.030, 0.004], P= 0.134) or PWV (mean difference 0.06 m/s [95% CI -0.17 to 0.29], p=0.594). The intervention improved periodontal health at 3-months post-intervention (mean pocket depth: -0.16 mm [95% CI -0.25, -0.07], P = 0.0008) treatment versus control but not at 12-months (mean pocket depth: -0.09 mm [95% CI -0.19, 0.01], P = 0.08).

CONCLUSIONS:  Periodontal therapy reduces the severity of subclinical atherosclerosis but not  PWV among Aboriginal Australians with periodontal disease. This suggests a possible causal link between periodontal disease and atherosclerosis.

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