Authors: Marco Orlandi, Stefano Masi, Ersilia Lucenteforte, Devina Bhowruth, Marco A Malanima, Ulpee Darbar, Kalpesh Patel, Chong Lim, Chiara Curra, Tay Shiehfung, Jeanie Suvan, Scott T Chiesa, John Deanfield, Francesco D’Aiuto
Journal reference: Orlandi, M., Masi, S., Lucenteforte, E., Bhowruth, D., Malanima, M.A., Darbar, U., Patel, K., Lim, C., Curra, C., Shiehfung, T., Suvan, J., Chiesa, S.T., Deanfield, J. and D’Aiuto, F. (2025). Periodontitis treatment and progression of carotid intima-media thickness: a randomized trial. European Heart Journal. doi:https://doi.org/10.1093/eurheartj/ehaf555.
Background
Periodontitis and atherosclerosis are both chronic inflammatory diseases with significant implications for systemic health. Periodontitis is caused by bacterial plaque biofilms and is characterised by progressive destruction of the tooth-supporting structures, including the periodontal ligaments and alveolar bone. There is increasing evidence that it has systemic effects on cardiovascular disease, especially atherosclerosis, beyond its local effects. Atherosclerosis is characterised by the accumulation of lipid rich plaques within the intima, leading to reduced elasticity and narrowing of the arterial walls and ultimately an increased risk of cardiovascular diseases. A non-invasive marker of early atherosclerosis is carotid intima-media thickness (cIMT). The relationship between periodontitis and increased cIMT has been shown in observational studies, but there is limited evidence showing a causal effect of intensive periodontal therapy on cardiovascular health in long term randomised trials.
Aims
This randomised controlled trial aims to determine whether intensive periodontal therapy could attenuate the progression of atherosclerosis over 24 months. The study assesses using carotid intima-media thickness, improvement of endothelial function and systemic inflammatory markers.
Methods
This single centre randomised controlled trial enrolled 135 otherwise healthy patients with periodontitis from the UCL Eastman Dental Institute. Participants were randomly allocated to receive either intensive periodontal therapy (IPT, n=68) or control periodontal treatment (CPT, n=67), with allocation stratified by factors such as smoking status, sex, and disease severity. Participants were followed over a period of 24 months. In both CPT and IPT, dental treatment occurred at similar intervals, although the specifics of the dental care differed. The CPT group received supragingival scaling and polishing, whereas the IPT group received full mouth subgingival scaling and root surface debridement under local anaesthesia, with corrective or supportive treatment according to the periodontal response. The primary outcome was the intergroup difference in cIMT at 24 months in carotid intima-media thickness, which was assessed using B-mode ultrasonography. The secondary outcomes included endothelial function, pulse wave velocity, blood pressure, systemic inflammatory and metabolic biomarkers and periodontal parameters.
Results
Results showed significant improvements in periodontal clinical parameters in the IPT group compared to the CPT group. Reduction in probing pocket depth, plaque accumulation and bleeding on probing was evident and sustained throughout the 24 months. The progression of carotid intima-media thickness was significantly lower in the IPT group, showing attenuation of atherosclerosis, in comparison to the CPT group. Furthermore, endothelial function improved significantly following IPT, and oxidative stress markers as well as markers of systemic inflammation decreased. Observations in blood pressure, pulse wave velocity and tooth loss showed no significance.
Conclusion
This study provides compelling evidence that intensive periodontal therapy can attenuate the progression of atherosclerosis and improve endothelial function, alongside reducing systemic inflammatory and oxidative stress markers. This study highlights the potential for periodontal treatment to modify cardiovascular health. It reinforces the importance of early diagnosis and effective management of periodontitis, taking a holistic approach to patient care.
Research summary written by: Jathursa Nithiyananthasivam, University of Manchester – BDS 1