art-Fala-p161-169-2019
PERIODONTICS
IMPACT OF PERIODONTITIS ON THE ECG DISPERSION MAPPING
Original Articles
OF THE MYOCARDIAL TISSUES
Valeriu Fala1a* , Victor Lăcustă2b, Sergiu Ciobanu3c, Gheorghe Bordeniuc1d
1
Department of Therapeutic Dentistry, Faculty of Dentistry, “Nicolae Testemițanu” State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
2
Department of Alternative and Complementary Medicine, Faculty of Medicine, “Nicolae Testemițanu” State University of Medicine and Pharmacy, Chișinău,
Republic of Moldova
3
Department of Odontology, Periodontology and Oral Pathology, Faculty of Dentistry, “Nicolae Testemițanu” State University of Medicine and Pharmacy,
Chișinău, Republic of Moldova
a
DMD, PhD, MSc, Assistant Professor, Head of the Department of Therapeutic Dentistry
b
DMD, PhD, Academician, Professor
c
DMD, PhD, Professor, Dean of the Faculty of Stomatology
d
DMD, University Assistant
ABSTRACT DOI: https://doi.org/10.25241/stomaeduj.2019.6(3).art.1
OPEN ACCESS This is an Open Access
Introduction: The periodontal disease is considered to have an epidemic reach in article under the CC BY-NC 4.0 license.
the general population. The impact of the periodontal disease on the general health Peer-Reviewed Article
is studied from the perspective of the existence of complex interrelationships,
Citation: Fala V, Lăcustă V, Ciobanu S, Bordeniuc
especially with respect to the cardiovascular system. The aim of the study was the G. Impact of periodontitis on the ECG dispersion
mapping of the myocardial tissues. Stoma Edu J.
assessment of the correlation between the clinical signs of the chronic periodontitis 2019;6(3):161-169.
and the changes in the ECG dispersion of the myocardial tissues and the analysis
Received: May 02, 2019
of the efficiency of the masticatory test and full mouth disinfection procedure for Revised: May 14, 2019
Accepted: September 26, 2019
recording these signs in patients with chronic periodontitis. Published: September 27, 2019
Methodology: 92 patients with chronic periodontitis without the clinical
*Corresponding author:
manifestations of the cardiovascular disease and pathological signs on standard Valeriu Fala, București str., Chișinău,
Republic of Moldova; T
ECG were included in the study. Periodontitis was diagnosed based on the clinical el.: (+373)69500080; Fax.: (+373)22-270536;
and radiological exams.The ECG dispersion mapping technology was used to e-mail: valeriu.fala@usmf.md
identify changes in the myocardial tissues, under various conditions. Copyright: © 2019 the Editorial Council for the
Stomatology Edu Journal.
Results: The pathological system of periodontitis-target organ (heart), its elements
and the pathways of interaction were described. The research outlined the
diagnostic value of the masticatory test and of the full mouth disinfection procedure
in the process of identifying the changes in ECG dispersion of the myocardial
tissues in patients with chronic periodontitis. It also proposed an algorithm for the
interdisciplinary management of patients with chronic periodontitis, based upon
the periodontitis-target organ (heart) concept.
Conclusion: The periodontitis-target organ (heart) concept represents a cumulative
synthesis of the available data from literature and of our investigations, and it may
prove as a step towards an integrative medicine approach in periodontology.
Keywords: Interdisciplinary management; Index myocardium; Periodontal index;
Periodontics; Target organ.
1. Introduction emerged, which refers to the multiple and complex
According to the epidemiological studies published interrelationship between periodontal diseases and
by WHO, gingivitis and periodontitis can be classified general health. In 1891, W. D. Miller described the
as presenting epidemic traits, even in highly oral cavity as the infection foci, by which bacteria and
developed countries – severe chronic periodontitis their products enter adjacent or remote parts of the
affects about 35% of the US population and it is body. There are three ways of interaction between
forecast that by 2030, the number of individuals with the affected periodontium and non-oral organs:
chronic periodontitis in the US will reach 71 million bacteremia, systemic inflammation (interleukins,
(1 in 5 individuals) [1,2]. Chronic periodontitis is a etc.) and endotoxemia caused by swallowed bacteria
public health issue, not only based on the dramatic [5].
increase in the number of patients, but also due to Hypothesis: For patients with chronic periodontitis,
serious medical, social and economic consequences. ischemic myocardial disorders develop gradually,
Currently, the relationship between the periodontal and at the initial stages they may be asymptomatic,
disease and general health is being thoroughly afterwards they intensify with the increase in the
studied [3,4]. The notion of periodontal medicine has disease’s duration and severity.
Stomatology Edu Journal 161
IMPACT OF PERIODONTITIS ON THE ECG DISPERSION MAPPING
OF THE MYOCARDIAL TISSUES
Original Articles
Figure 1. Values of the Index Myocardium before and after the masticatory test on a patient with chronic periodontitis (48 yr. old).
A – before the masticatory test, IM has a normal value (IM < 15);
B – 20 minutes after the masticatory test, IM has a pathological value (IM > 15);
C – 60 minutes after the masticatory test, IM has a pathological value (IM > 15).
Figure 2. Values of the Index Myocardium before and after the masticatory test on a patient with chronic periodontitis (52 yr. old).
A – before the masticatory test, IM has a pathological value (IM > 15);
B – 20 minutes after the masticatory test, IM has a pathological value (IM > 15);
C – 60 minutes after the masticatory test, IM has a pathological value (IM > 15).
Aim of the study: Assessment of the correlation the analysis and visualization of the electromagnetic
between the clinical signs of the chronic radiation of the myocardium, with the recording of
periodontitis and the changes in ECG dispersion of the small amplitudes fluctuations. The quantitative
the myocardial tissues and analysis of the efficiency and qualitative characteristics of the amplitude
of the masticatory test and full mouth disinfection fluctuations were analyzed using the CardioVisor-
procedure for recording these signs in chronic 06s device (Medical Computer Systems, Russian
periodontitis. Federation). The technology allows recording
multiple indices, including the Index Myocardium
2. Materials and Methods (IM), which quantitatively reflects the myocardial
92 patients with chronic periodontitis (aged ischemic processes in a range between 0-100%.
between 25-58 years) without clinical manifestations In healthy individuals, the Index Myocardium
of cardiovascular disease and pathological signs does not exceed 15%. A higher value of the index
on standard ECG analysis (after a prior exam at translates into more pronounced myocardial
the cardiologist) were selected for this study. ischemic disorders. It is to be noted that the ECG
Periodontitis was diagnosed following the clinical dispersion mapping technology is much more
and radiological exam. The ECG dispersion mapping informative compared to the standard ECG –
[1,6] was used to identify changes in the ECG myocardial ischemic disturbances can be detected in
dispersion of the myocardial tissues, under various individuals who show normal values of the standard
conditions (relaxed state, mastication test – during ECG indices. The diagnostic value of this method for
2 minutes, full mouth disinfection procedure (FMDP) identifying myocardial ischemic disturbances is very
in 2 stages/24h). high – sensitivity >80% [7].
2.1. ECG dispersion mapping
Currently, electrocardiography (ECG) is one of the 3. Results
most widespread medical methods, with wide The ECG dispersion mapping makes it possible to
application not only in cardiology and although identify not only the organic, but also the functional
there is still an ongoing development of standard disturbances of the myocardium. This has provided
ECG methods, they still have a low specificity and the opportunity to highlight ischemic disorders
sensitivity (30-40%) to identify myocardial ischemia at a preclinical level. We have determined that in
[7]. This means that in 60% of cases, the clinical forms 85% cases of patients with chronic periodontitis,
of myocardial ischemia will remain undiagnosed. preclinical ischemic myocardial disorders were
The ECG dispersion mapping technology is based on present (Index Myocardium > 15).
162 Stoma Edu J. 2019;6(3): 161-169. http://www.stomaeduj.com
IMPACT OF PERIODONTITIS ON THE ECG DISPERSION MAPPING
OF THE MYOCARDIAL TISSUES
Original Articles
Figure 3. Values of the Index Myocardium (normal initial IM value) before and after the full mouth disinfection procedure (1st phase – mandible).
A - before FMDP (IM < 15);
B - 20 minutes after FMDP (IM > 15);
C - 12 h after FMDP (IM < 15).
Figure 4. Values of the Index Myocardium (normal initial IM value) before and after the full mouth disinfection procedure (2nd phase – maxilla).
A - before FMDP (IM < 15);
B - 20 minutes after FMDP (IM > 15);
C - 12 h after FMDP (IM < 15).
We have studied the correlation between the Index has increased 20 minutes after conducting the
Myocardium (IM) and the Integrative Periodontal masticatory test;
Index (IPI – synthesis of common periodontal indices • for 38 patients (79.2%), the Index Myocardium
– PMA, OHI-S, PI, PBI, TM), disease duration, patient’s has deviated ~1-2% (without significant
age and systolic blood pressure (SBP). changes).
The correlation analysis has shown that with the The analysis of the data from patients with chronic
increase in the severity of the periodontitis, the value periodontitis with initial pathologic values of the
of the Index Myocardium (ischemic signs) will be Index Myocardium (IM >15), has shown the following
higher; the duration of the chronic periodontitis has changes in comparison to the values observed in a
a stronger correlation with the Index Myocardium relaxed state (46 patients/100%):
(rxy = 0.59, p < 0.01) in comparison to the age factor • for 17 patients (37%), the Index Myocardium
(rxy = 0.42, p < 0.05), which demonstrates that the has increased 20 minutes after the masticatory
duration of pathological periodontal process has a test;
more negative impact on the ischemic myocardial • for 29 patients (63%) the Index Myocardium has
disorders. Although in this study, patients without deviated ~1-2% (without significant changes).
pathological values of SBP were included, statistically 3.2. ECG dispersion mapping dynamics under the
significant correlations were observed between SBP influence of the full mouth disinfection procedure
and the Index Myocardium (rxy = 0.46, p < 0.05). This (FMDP) on patients with chronic periodontitis
demonstrates that the SBP variations, even if they are Preclinical ischemic changes in the myocardium
within the normal range, have a significant influence (IM index) in patients with chronic periodontitis
upon the ischemic myocardial disorders – with the under the influence of the full mouth disinfection
increase of the SBP values, the preclinical ischemic procedure appear in 2 variants – monophasic or
myocardial signs are more expressed. biphasic. The first phase – IM-aggravation phase
3.1. ECG dispersion mapping dynamics under the (worsening of the preclinical ischemic signs) starts
influence of the masticatory test on patients with within the first minutes and hours after the full
chronic periodontitis mouth disinfection procedure; and is probably
The analysis of data from patients with chronic caused by transitory bacteremia. The second phase
periodontitis and initial normal values of the Index - IM-reduction phase (mitigation of preclinical
Myocardium (IM<15) has shown the following ischemic signs) starts after several more hours, after
changes in comparison with the values observed in the full mouth disinfection procedure, possibly
a relaxed state (48 patients/100%): due to the elimination of the periodontal foci, with
• for 10 patients (20.8%), the Index Myocardium a reduction in the degree of bacterial invasion
Stomatology Edu Journal 163
IMPACT OF PERIODONTITIS ON THE ECG DISPERSION MAPPING
OF THE MYOCARDIAL TISSUES
Original Articles
Figure 5. Values of the Index Myocardium (pathological initial IM value) before and after the full mouth disinfection procedure (1st phase – mandible).
A - before FMDP (IM > 15);
B - 20 minutes after FMDP (IM > 15);
C - 12 h after FMDP (IM > 15).
Figure 6. Values of the Index Myocardium (pathological initial IM value) before and after the full mouth disinfection procedure (2nd phase – maxilla).
A - before FMDP (IM > 15);
B - 20 minutes after FMDP (IM > 15);
C - 12 h after FMDP (IM < 15).
and dissemination into the bloodstream. In 79.8% with various cardiac conditions (stenocardia,
cases, during FMDP, both phases can be observed myocarditis, atherosclerosis, etc.);
(a biphasic response – aggravation/reduction). In • the presence of certain bacterial agents
20.2% cases, the aggravation phase is maintained for (T. forsynthensis, T. denticola, P. gingivalis, A.
a longer time, without transitioning to the reduction actinomycetemcomitans), simultaneously in the
phase (monophasic response). It is to be noted that periodontal tissues and in the endothelium of
when the values of the Index Myocardium are higher the cardiac vessels;
than 50% or if FMDP induces only a monophasic • experimental administration of Porphyromonas
response, it is advised to conduct the consequent gingivalis in animals leads to the occurrence
dental treatment under the surveillance of a of myocarditis and myocardial infarction and
cardiologist. induces a pro-coagulant response to the
vasculopathic effects; a simultaneous worsening
4. Discussion of the inflammation degree of the periodontium
Numerous studies have been published in the and myocardium, at the injection of certain pro-
last decade, that indicate a close relationship inflammatory factors;
between periodontal disease and systemic diseases • bacteremia in patients with chronic periodontitis
(cardiovascular diseases, diabetus mellitus, low- leads to the thickening of the heart valves;
preterm birth-weight, osteoporosis, etc.), especially • acceleration of atherogenic processes due
highlighting the more profound impact in regard to to periodontal pathogens; followed by the
the cardiovascular system. The analysis of the data destabilization of atherosclerotic plaques under
from the literature and of our own results enabled us the influence of periodontal bacteria that enter
to identify a pathological system – the periodontitis- the endothelium and the vascular myocytes;
target organ (heart) (Fig. 7). exacerbation of inflammation with a progression
Other organs may serve as target organs for of the atherosclerotic plaque, based on immune
periodontitis (liver, lungs, pancreas, kidneys, etc.). mechanisms, under the influence of periodontal
Currently, most data, however, are related to the bacterial products (molecular mimicry);
relationship between chronic periodontitis and • the existence of common toxic factors in chronic
heart disease [3,8,9,10], and may be summarized as periodontitis and cardiovascular diseases;
follows: • the existence of common mechanisms in the
• the presence of common risk factors for chronic process of diminishing dento-periodontal
periodontitis and cardiovascular diseases support and bone resorption, with the
(smoking, stress, etc.); occurrence of cardiovascular disturbances – each
• frequent association of chronic periodontitis 20% bone loss is associated with an increase in
164 Stoma Edu J. 2019;6(3): 161-169. http://www.stomaeduj.com
IMPACT OF PERIODONTITIS ON THE ECG DISPERSION MAPPING
OF THE MYOCARDIAL TISSUES
Original Articles
susceptibility to periodontal disease, effects of risk factors,
poor oral hygiene
reduction of the body's defense capabilities and of the
anatomical-physiological barriers in the stomatognathic
system
primary infection of the oral cavity and of the dento-
periodontal structures
critical noxious burden (bacteria/pathogens), penetration of
the defence (barriers), initiation of inflammatory processes in
the periodontium
chronicization of the pathological process, progressive
damage to the dento-periodontal structures, creation of a
continuously-renewing pathogenic periodontal reservoir
invasion of bacteria/pathogens from the periodontal reservoir
into the systemic bloodstream
(bacteremia/toxemia/endotoxemia, etc.), the onset and
development of systemic disorders
adherence of bacteria to various non-oral structures and target
organs (locus minoris resistentiae), their colonization,
formation of multidirectional connections, establishment of
the periodontitis-target organ pathological system
Figure 7. The periodontitis-target organ (heart) pathological system.
the incidence of cardiovascular diseases by 40%; disappearance of PIMD after the removal of occlusal
chronic periodontitis and tooth loss increases trauma in patients with chronic periodontitis;
the risk of fatal events in cardiac patients; aggravation of PIMD in patients with chronic
• diminishing the severity of the pathological periodontitis under the influence of the masticatory
manifestations of chronic periodontitis under test and the professional oral hygiene procedure
the influence of treatment, simultaneously (microtrauma, transient bacteremia); the positive
with the reduction of the morpho-functional correlation between the severity of the chronic
disorders in the cardiovascular system; periodontitis and the duration of the disease with
• existence of a common genetic predisposition the PIMD expression.
for periodontal and heart disease; the genes The analysis of the results obtained in combination
for the immune and inflammatory response with the data from the literature allowed us to
inter-penetrate and influence the expression highlight the main ways of interaction in the
of a hyper-inflammatory phenotype, that periodontitis-target organ (heart) pathological
predisposes both to coronary atherosclerosis system: interaction based on the infectious factor
and to periodontal disease. (bacteremia); neurogenic interaction; humoral-
Our own investigations revealed the presence metabolic interaction, immune and toxic factors;
of preclinical ischemic myocardial disturbances interaction based on genetic determinism.
(PIMD), evidenced by changes in ECG dispersion The bacterial factor is one of the most important in
of the myocardial tissues in patients with chronic the periodontitis-target organ (heart) system.
periodontitis, which demonstrates the role of Actinobacillus actinomycetemcomitans, Campy-
the heart as a target organ for periodontitis at a lobacter rectus and Eikenella corrodens are most
preclinical level: the frequent occurrence of PIMD in commonly found in periodontal processes, but
patients with chronic periodontitis (85% of cases); under various pathological conditions, the role of
diminution/disappearance of PIMD after efficient major bacteria can be played by various species. In
treatment of chronic periodontitis; reduction/ patients with chronic periodontitis, more than 700
Stomatology Edu Journal 165
IMPACT OF PERIODONTITIS ON THE ECG DISPERSION MAPPING
OF THE MYOCARDIAL TISSUES
Original Articles
Figure 8. Algorithm of the interdisciplinary management of patients with chronic periodontitis (in the vision of the periodontitis-target organ (heart)
concept).
bacterial species have already been detected [11]. present in the case of chronic periodontitis. The
Periodontal bacteria can induce proliferation of afferent part of the trigeminal-cardiac reflex consists
smooth muscle cells in the vessels of the heart, of the somatosensory trigeminal terminations, the
causing destruction and endothelial damage, Gasser node, and the trigeminal sensory nuclei.
vasomotor functional disorders [7]. In our studies, Afterwards, via interconnecting short internuclear
we highlighted the distinct phases of the changes in fibers, there is a link established with the structures
ECG dispersion of the myocardial tissues, under the of the reticulated formation and with the motor
effect of the FMDP, associated with the occurrence of nuclei of the vagus nerve.
transient bacteremia: the worsening phase (the first Various pathological irritations, dental manipulations
minutes and hours, during and after the procedure) in the area innervated by the trigeminal nerve can
and the mitigation phase of the ischemic disturbance cause the trigeminal-cardiac reflex [12]. In recent
(hours and days after the procedure). years, the maxillo-mandibulo-cardiac reflex has
In 79.8% cases, both phases (worsening/mitigation) been described, with pronounced bradycardic
are manifested, and in 20.2% cases the worsening effects. Arakeri et al. describes the dento-cardiac
stage persists without a transition to the mitigation reflex, which is manifested at the irritation of the
phase, which is an indication for additional maxillary jaw (hypotension, syncope, hyperhidrosis,
investigations/monitoring by the cardiologist. bradycardia) [13]. This reflex may be observed in
Therefore, the dentist, based on the peculiarities of patients without cardiovascular disease.
the chronic periodontitis management, may be the The interaction of humoral-metabolic, immune and
first specialist to detect the presence of preclinical toxic factors is another important component in
ischemic myocardial disorders associated with the periodontitis-target organ (heart) pathological
chronic periodontitis, based on the detection of system. There is a strong interaction between
changes in the ECG dispersion of the myocardial periodontal metabolic disorders and the
tissues. cardiovascular pathology – IL-1β, IL-6, TNF-α, PGE2
Another point is represented by the neurogenic and other pro-inflammatory factors produced in
interaction, which is fundamental in achieving the affected periodontal tissues, may enter the
sanogenic and pathogenic connections, which are bloodstream and casue various infections at remote
166 Stoma Edu J. 2019;6(3): 161-169. http://www.stomaeduj.com
IMPACT OF PERIODONTITIS ON THE ECG DISPERSION MAPPING
OF THE MYOCARDIAL TISSUES
sites, including in the heart [3,14]. in order to act on the interaction pathways in the
Original Articles
A series of endocrine-like substances [15] are produced periodontitis-target organ (heart) system, we applied
in the periodontal foci, with immune complexes biologically active preparations (BioR®), the pituitary
being formed, that amplify the inflammation, both neuropeptide – oxytocin, transcranial direct-
in the dento-periodontal region and in the tissues of current stimulation, transcutaneous electric nerve
the heart [10,20]. stimulation (TENS) [8,19,20].
The affected marginal periodontium represents a Based on the periodontitis-target organ (heart)
continuously-renewing reservoir with a permanent concept, it is recommended to monitor the risk
secretion of toxic substances into the bloodstream, factors of cardiovascular disorders during dental
inducing and perpetuating the pathological effects treatment; the dental consultation should include
and systemic disorders of the internal organs, gathering information on cardiovascular system
including the heart. diseases and disorders, the medications prescribed
In patient with periodontitis, even mild mastication by the cardiologist, etc.
already releases bacterial endotoxins from the oral Dental treatment of chronic periodontitis based on
cavity into the bloodstream with harmful effects on the proposed concept is a paradigm that opens new
the cardiovascular system. perspectives in the development of interdisciplinary
Applying ECG dispersion mapping as a screening test and personalized dentistry, based on principles
for the preclinical myocardial ischemic disorders by that emphasize the fundamental relationships
detecting changes in ECG dispersion of the myocardial between dental diseases, the general condition of
tissues, in patients with chronic periodontitis has the organism, metabolism and the internal organs
allowed us to highlight the diagnostic value of that are multidirectionally involved in pathological
this method: Se (sensitivity) – 36.9%, Sp (specificity) processes.
– 79.1 %, +PV (positive predictive value) – 62.9%,
-PV (negative predictive value) – 43.2%. These data 5. Conclusions
demonstrate that the masticatory test and the ECG The Index Myocardium (ECG dispersion mapping)
dispersion mapping can be applied first of all, in positively correlates with the severity and duration
order to exclude ischemic processes involving the of the periodontal disease, patient’s age and the
myocardium in patients with periodontitis. systolic blood pressure level. Around 85% of patients
Genetic factors are studied insufficiently, although with chronic periodontitis had preclinical ischemic
the DNA of the microbiota represents 99% of the signs, revealed by changes of the ECG dispersion
collective genome of the human body [16]. The first to mapping of myocardial tissues.
demonstrate the association between periodontitis The subsequent dental treatment for patients with
and genetic determinism was Michalowicz et al. high initial values of the Index Myocardium (IM > 50)
[17]. In heterozygous and homozygous mice with a or with an aggravation of the preclinical ischemic
congenital apolipoprotein-E deficit, there was a high signs during dental procedures will require the
risk of atherosclerosis of the aortic and cardiac vessels surveillance of the cardiologist.
at the intravenous administration of P. gingivalis [6]. The periodontitis-target organ (heart) concept
A relationship between a specific polymorphism of represents a cumulative synthesis of the available
the IL-1 genotype and the phenotypic expression of data from literature and our investigations, and it
the marginal periodontitis was detected. may prove as a step towards an integrative medicine
The increased risk for severe periodontitis in approach in periodontology.
individuals with a positive genotype (periodontitis
susceptibility test) is estimated to be 6.8 times higher Author Contributions
compared to subjects with a negative genotype. It VF: Idea, experimental design, performed
is estimated that about 30% of the population may investigations, data analysis, manuscript writing. VL:
be positive for this genetic marker [4]. There is a Idea, experimental design, data gathering, analysis
common genetic predisposition for periodontitis and interpretation, manuscript writing. SC: Data
and heart disease [18]. analysis, manuscript proofreading. GB: Data analysis,
Highlighting these interactions based on the manuscript proofreading.
periodontitis-target organ (heart) concept – provides
the opportunity to monitor the patient’s condition Acknowledgments
and to optimize the complex personalized treatment The authors have no conflicts of interest. This
programs in accordance with an interdisciplinary research did not receive any specific grant from
algorithm for the management of patients with funding agencies in the public, commercial, or non-
chronic periodontitis (Fig. 8). profit sectors. The authors declare that the research
The first results in regard to the optimization of was conducted in the absence of any commercial or
the diagnosis and complex treatment based on financial relationship that could be construed as a
the proposed concept seem to be promising. Thus, potential conflict of interest.
Stomatology Edu Journal 167
IMPACT OF PERIODONTITIS ON THE ECG DISPERSION MAPPING
OF THE MYOCARDIAL TISSUES
References
Original Articles
1. Eke PI, Dye BA, Wei L, et al. Prevalence of periodontitis in adults 11. Marsh PD, Martin MV. Oral microbiology. 5th Edition. Salisbury,
in the United States: 2009 and 2010. J Dent Res. 2012;91(10):914-920. UK: Elsevier Health Sciences; 2009.
[Full text links] [CrossRef ] [PubMed] Google Scholar Scopus 12. Abdulazim A, Stienen MN, Sadr-Eshkevari P, et al.
2. Page RC, Eke PI. Case definitions for use in population- Trigeminocardiac reflex in neurosurgery – current knowledge and
based surveillance of periodontitis. J Periodontol. 2007;78(7 prospects. 2015.
Suppl):1387-1399. Google Scholar
[Full text links] [CrossRef ] [PubMed] Google Scholar Scopus 13. Arakeri G, Arali V. A new hypothesis of cause of syncope:
3. Lockhart PB, Bolger AF, Papapanou PN, et al. Periodontal disease trigeminocardiac reflex during extraction of teeth. Med
and atherosclerotic vascular disease: does the evidence support an Hypotheses. 2009;74(2):248-251.
independent association? Circulation. 2012;125(20):2520-2544. [Full text links] [CrossRef ] [PubMed] Google Scholar Scopus
[Full text links] [CrossRef ] [PubMed] Google Scholar 14. Elter JR, Hinderliter AL, Offenbacher S, et al. The effects of
4. Mârțu S. [Periodontal medicine - a deep medical concept in periodontal therapy on vascular endothelial function: a pilot trial.
dentistry]. [Article in Romanian]. Rom J Periodont. 2010;1(1):7-16. Am Heart J. 2006;151(1):47.
5. Hajishengallis G. Periodontitis: from microbial immune [Full text links] [CrossRef ] [PubMed] Google Scholar Scopus
subversion to systemic inflammation. Nat Rev Immunol. 15. Pradhan AD, Ridker PM. Do atherosclerosis and type 2 diabetes
2015;15(1):30-44. share a common inflammatory basis? Eur Heart J. 2002;23(11):831-834.
[Full text links] [CrossRef ] [PubMed] Google Scholar Scopus [Full text links] [CrossRef ] [PubMed] Google Scholar
6. Chi H, Messas E, Levine RA, et al. Interleukin-1 receptor signaling 16. MacDougall R. NIH Human Microbiome Project defines normal
mediates atherosclerosis associated with bacterial exposure and/ bacterial makeup of the body. 2012. http://www.nih.gov/news/
or a high-fat diet in a murine apolipoprotein E heterozygote health/jun2012/nhgri-13.htm
model: pharmacotherapeutic implications. Circulation. [PubMed]
2004;110(12):1678-1685. 17. Michalowicz BS, Hodges JS, DiAngelis AJ, et al. Treatment of
[Full text links] [CrossRef ] [PubMed] Google Scholar periodontal disease and the risk of preterm birth. N Engl J Med.
7. Ryabykina GV, Sula AS. [Applying CardioVisor –06c in screening 2006;355(18):1885-1894.
examination. Method of dispersion plotting] [in Russian]. Moscow, [Full text links] [CrossRef ] [PubMed] Google Scholar Scopus
RU: Ministry of Public Health of Russia; 2004. 18. Schaefer AS, Richter GM, Groessner-Schreiber B, et al.
8. Fala V. [BioR - the basis for optimizing tissue regeneration Identification of a shared genetic susceptibility locus for coronary
processes] [in Romanian]. Chişinău, MD: HM Design; 2014. heart disease and periodontitis. PLoS Genet. 2009;5(2):e1000378.
9. Saini R, Saini S, Saini SR. Periodontal diseases: a risk factor to [Full text links] [Free PMC Article] [CrossRef ] [PubMed] Google
cardiovascular disease. Ann Card Anaesth. 2010;13(2):159-161. Scholar Scopus
[Full text links] [CrossRef ] [PubMed] Google Scholar Scopus 19. Lăcustă V. [Direct transcranial stimulation with direct current] [in
10. Tonetti MS, Van Dyke TE; working group 1 of the joint EFP/ Romanian]. Chişinău, MD: Elena VI; 2011.
AAP workshop. Periodontitis and atherosclerotic cardiovascular 20. Puhar I, Kapudija A, Kasaj A, et al. Efficacy of electrical
disease: consensus report of the Joint EFP/AAP Workshop on neuromuscular stimulation in the treatment of chronic
Periodontitis and Systemic Diseases. J Periodontol. 2013;84(4 periodontitis. J Periodontal Implant Sci. 2011;41(30):117-122.
Suppl):S24-S29. [CrossRef ] [PubMed] Google Scholar Scopus
[Full text links] [CrossRef ] [PubMed] Google Scholar
Valeriu FALA
DMD, PhD, MSc, Associate Professor,
Head Department of Therapeutic Dentistry
Faculty of Dentistry“Nicolae Testemițanu” State University of Medicine and Pharmacy
Chișinău, Republic of Moldova
CV
Author of more than 55 inventions in the field of dentistry. Participant at national and international invention fairs (Moldova,
Romania, Ukraine, USA, Belgium, Switzerland, China, Poland, Germany, Czech Republic, Spain), awarded with 61 medals,
including 26 gold, 19 silver and 11 bronze medals and others.
In 2010, his practice received WIPO (World Intellectual Property Organization) Award for Innovative Enterprises. In 2018, he
has received the WIPO Award for Innovational Activity. Author of more than 92 scientific articles in national and international
journals. Author of clinical guidebooks and monographs. Double champion (2001, 2004) of the International Contest for
Restorative Dentistry “Prisma Championship” (Poltava, Ukraine). 1st place at the International Dental Contest of Clinical Cases,
Moscow, Russia, 2004. Vice-president of Association of Stomatologists of Republic of Moldova (ASRM).
168 Stoma Edu J. 2019;6(3): 161-169. http://www.stomaeduj.com
IMPACT OF PERIODONTITIS ON THE ECG DISPERSION MAPPING
OF THE MYOCARDIAL TISSUES
Questions
Original Articles
1. How many individuals are forecasted to have periodontitis in US population in 2030?
qa. One in ten;
qb. One in two;
qc. One in three;
qd. One in five.
2. What does a high value of MI (myocardial index) mean?
qa. A high value means less myocardial ischemic disorders;
qb. A low value means higher myocardial ischemic disorders;
qc. A high value means higher myocardial ischemic disorders;
qd. A low value means less myocardial ischemic disorders.
3. What is the sensitivity of the ECG dispersion mapping?
qa. 78%;
qb. 80%;
qc. 99%;
qd. 26%.
4. How big is the risk for developing severe periodontal disease in individuals with a
positive genotype (detected on periodontitis-susceptibility test)?
qa. 2 times higher;
qb. 6,8 times higher;
qc. 4 times higher;
qd. It is the same as in individuals with negative genotype.
ACADEMY OF DENTAL MATERIALS
October 2-5, 2019 | WY, USA
www.admconference.com
Stomatology Edu Journal 169