Index Assessment of Periodontal Tissue Status in Patients with Generalized Periodontitis and Coronary Artery Disease

Abstract

Generalized periodontitis (GP) is recognized as a significant risk factor for the development of coronary artery disease (CAD). Chronic infectious foci within the periodontal tissues contribute to systemic inflammation, accelerate atherogenesis, and promote the progression of atherosclerotic vascular lesions. Conversely, circulatory disorders characteristic of CAD impair tissue perfusion and oxygenation in the periodontium, leading to hypoxia and reduced regenerative capacity. Given the bidirectional aggravating relationship between GP and CAD, it is essential to investigate the clinical features of GP in the context of cardiac pathology and to account for local risk factors associated with periodontal disease. Such an approach is crucial for developing effective strategies to improve periodontal health in patients with CAD.
Aim. To perform a comprehensive index-based assessment of periodontal tissue condition and individual oral hygiene in patients with CAD, followed by analysis of their clinical significance.
Materials and Methods. Dental examinations were conducted in 114 patients with GP and CAD (main group). The comparison group included 35 patients with GP without CAD. Periodontal tissue status was evaluated using the following indices: PMA (Papillary-Marginal-Alveolar Index, M. Massler, modified by S. Parma, 1960) and the Gingival Bleeding Index (PBI, Mühlemann & Saxer, 1977). Treatment needs were determined using the PSR screening test (Periodontal Screening and Recording, AAP and ADA, 1992). Oral hygiene status was assessed using the OHI-S (Oral Hygiene Index-Simplified, J.C. Green & J.R. Vermillion, 1964).
Results. Patients with GP and CAD demonstrated significantly higher PMA, PBI, and PSR scores compared with those with GP alone. The mean PMA value in the GP + CAD group was 63.27 ± 1.92%, indicating severe inflammation. In the comparison group, the PMA index reflected a moderate degree of gingival inflammation (43.32 ± 2.18%), which was significantly lower (p < 0.001). The mean PBI score in patients with GP and CAD was 2.06 ± 0.08, significantly higher than in patients with GP without CAD (1.20 ± 0.08; p < 0.001). A more pronounced degree of periodontal tissue damage was also evident in the PSR index, which reached 3.30 ± 0.06 in the main group versus 3.01 ± 0.09 in the comparison group (p < 0.01). No significant differences in oral hygiene status (OHI-S) were observed between groups (p > 0.05). However, most CAD patients demonstrated “unsatisfactory” (27.19 ± 4.17%) or “poor” (53.50 ± 14.67%) oral hygiene. In the GP+CAD group, no significant gender differences were found in PMA and PSR scores (p > 0.05). However, gingival bleeding measured by PBI was higher in men than in women (p < 0.05), while individual oral hygiene was significantly better in women (p < 0.01).
Conclusion. The findings indicate that, against the background of poor oral hygiene, inflammatory changes in periodontal tissues are particularly pronounced in patients with GP when accompanied by atherosclerotic processes such as CAD.