Periodontal disease is characterized by inflammation and destruction of some or all of the tooth-supporting structures (periodontum), which include the gingiva (gingivitis), cementum, periodontal ligament, and alveolar bone (periodontitis). Periodontal disease is considered to be one of the most common health problems affecting dogs.1 The prevalence of periodontal disease in dogs substantially increases with age but decreases with increasing body weight.2 The pathogenesis of periodontal disease involves bacteria, primarily gramnegative motile anaerobic rods, that accumulate within the gingival sulcus. This causes inflammation of the gingiva and formation of periodontal pockets, which result in periodontitis when left untreated. This is accompanied by an inflammatory response to periodontal pathogens resulting in endotoxin formation that mediates local release of inflammatory cytokines. The American Veterinary Dental Society3 cautions pet owners, “Studies have shown that oral bacteria will be filtered out by the kidney and liver, and can cause microabscesses within these organs. This leads to a decrease in function of these vital organs over time. In addition, it has been suggested that these bacteria can become attached to the heart valves and cause a disease called endocarditis.”
Because the prevalence of periodontal disease in dogs is > 75%,4 any association of periodontal disease with systemic organ damage is important to canine health. Systemic disease in dogs with chronic periodontal disease has been attributed to bacteremia and absorption of bacterial toxins from the oral cavity.5 Systemic diseases suggested to be associated with periodontal disease in dogs include chronic bronchitis, pulmonary fibrosis, endocarditis, interstitial nephritis, glomerulonephritis, and hepatitis. One report6 of 45 dogs at necropsy found a statistical relationship between the extent of periodontal disease and histopathologic changes in the kidneys, myocardium (papillary muscle), and liver.
A review7 of numerous case-control and longitudinal studies in humans found a significant association between periodontitis and an increased risk of cardiovascular disease. Many of the studies contained large numbers of subjects and were adjusted for traditional host-related risk factors and potential confounders. The availability of millions of medical records in electronic format from Banfield the Pet Hospital allowed us to conduct a similar epidemiologic study. In the study reported here, we tested the hypothesis that an increase in the severity of periodontal disease in dogs is associated with a subsequent increase in the risk of cardiovascular-related events, such as endocarditis and cardiomyopathy, as well as markers of inflammation but that an increase in the severity of periodontal disease in dogs is not associated with a subsequent increase in the risk of common endocrine, urinary tract, and musculoskeletal conditions; cancer; or infectious diseases.
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