Effects of Non-surgical Periodontal Therapy on Cardiovascular Risk

Effects of Non-surgical Periodontal Therapy on Cardiovascular Risk in People at Risk of Cardiovascular Disease

This study is to evaluate whether non-surgical periodontal therapy can help to control the cardiovascular risk among patients with moderate/severe periodontitis and at risk of cardiovascular disease.

Previous studies showed that the treatment of periodontitis can partially improve the control of risk factors of cardiovascular disease (e.g. blood pressure, interleukin 6), whereas the evidence is still limited. Moreover, there is currently no study reporting the impact of periodontal treatment on the overall risk of cardiovascular disease. The prevalence of periodontitis in China was 62.4%. In clinical practice, a large number of patients with moderate/severe periodontitis and at risk of cardiovascular disease seek medical advice. However, the existing guidelines lack relevant recommendations. Therefore, this study intends to evaluate whether non-surgical periodontal therapy can help to control cardiovascular risk. 376 patients with moderate/severe periodontitis and at risk of cardiovascular disease will be randomized. Those randomized to the intervention arm will receive non-surgical periodontal therapy which includes full-mouth subgingival scaling and root planing. Those randomized to the control arm will receive supragingival ultrasonic scaling. All patients were given instructions on basic oral hygiene.

Due to the characteristics of the intervention in this trial, it would be impossible to blind the enrolled participants. However, the investigators and outcomes assessors will be blinded. Allocation to arms will be concealed in an envelope and revealed to the stomatologist and patient before delivering the first treatment. Other investigators like outcomes assessors and staff involved in the data collection and analyses will be masked.

Basic oral hygiene instructions. Full-mouth subgingival scaling and root planing under local anesthesia. Additional full-mouth subgingival scaling and root planing under local anesthesia every 3 months during the follow-up period if necessary.

Non-surgical periodontal therapy includes basic oral hygiene instructions and full-mouth subgingival scaling and root planing under local anesthesia.

Control periodontal treatment includes basic oral hygiene instructions and full-mouth supragingival ultrasonic scaling.

Cardiovascular risk is assessed by "Framingham risk score (FRS)". (Circulation, 2008,117(6): 743-753.) Generally, the "Framingham risk score (FRS)" ranges from -4 to 33 for men and -5 to 33 for women. A higher "Framingham risk score (FRS)" means a higher risk of developing cardiovascular disease.

China-PAR is an abbreviation of "Prediction for ASCVD Risk in China". It is a prediction model developed by YANG X. (Circulation, 2016,134(19):1430-1440.) Through China-PAR, the investigators can assess one's cardiovascular risk in 10 years. The result of China-PAR is directly one's predicted cardiovascular risk in 10 years, ranging from 0% - 100%, with a higher probability meaning a higher risk of cardiovascular disease.

Community periodontal index will be evaluated according to the guidelines by stomatologists. The community periodontal index ranges from 0 - 4 points for each tooth. Higher points mean more severe periodontitis.

The major adverse cardiovascular event includes acute myocardial infarction, stroke, heart failure, peripheral artery disease, and coronary heart disease.

Anxiety will be assessed through "Self-Rating Anxiety Scale (SAS)". The SAS score range from 20 - 80 points. Higher points mean more serious anxiety.

The degree of pain will be assessed through "Visual Analogue Scale (VAS)". The VAS score range from 0 - 10 points. Higher points mean more serious pain.

Inclusion Criteria: Age ≥ 18 years; At risk of cardiovascular disease (defined as "Framingham Score" predicted 10-year risk of cardiovascular disease ≥ 20%); Moderate//severe periodontitis; Exclusion Criteria: Cardiovascular diseases at baseline (coronary heart disease, stroke and peripheral artery disease); Received periodontal treatment within the past 6 months; Pregnant or lactating females; Non residents of Guangzhou and its surrounding cities or expected to leave Guangzhou or its surrounding cities within 1 year; Malignant tumors or other end-stage diseases with life expectancy less than 1 year; End-stage renal disease; Patients with high bleeding risk, high blood pressures or other situations that make them unable to receive interventions; Refuse to provide informed consent;