periodontitis increases risk of thrombotic events

There is growing evidence that a broad range of inflammatory processes are risk
factors for both arterial and venous thrombotic events. Periodontitis is a
chronic inflammatory process of the gums which arises in response to the
accumulation of bacteria in a biofilm on tooth surfaces (dental plaque).
Periodontitis is known to be associated with intermittent bacteraemia
originating from oral microbiota and systemic inflammation, e.g. increased CRP
levels. Periodontitis has been associated with an increased risk of
cardiovascular disease. Although never previously studied, we hypothesize that
periodontitis, quantified through the Periodontal Inflammatory Surface Area
(PISA) is a risk factor for venous thrombotic events as well. More
specifically, we hypothesize that an increasing severity of periodontitis is
associated with an increasingly hypercoagulable, proinflammatory and disturbed
metabolic state that may predispose to acute thrombotic events.

To evaluate wheter patients with parodontitis have a more procoagulant,
proinflammatory and metabolically disturbed state than patients with a lower
periodontal disease burden. Additionally, we want to explore how this
relationship is modified by oral microbiota

This study has a combined crossectional and longitudinal design:
PIRATE A: cross-sectional study: serum markers for coagulation, inflammation
and metabolism parameters, AGEs and oral microbiota of patients referred for
extraction of all teeth will be compared to the same measurements randomly
selected volunteers. In this analysis, PISA is the main independent variable,
and not case vs volunteer.
PIRATE B: cohort study, serum markers for coagulation, inflammation and
metabolism parameters and oral microbiota of patients with severe periodontitis
will be compared before and after extraction of all teeth, when the PISA is
reduced to zero.

Patients will be asked questions in relationship to their general health and
social-economic status. They will undergo venous blood sampling three times.
Before their procedure, a scraping of tongue, and an oral lavage will be
collected. For patients undergoing the procedure in general anaesthesia,
periodontal status will be acquired during general anaesthesia, just before the
surgeon performs the total tooth extraction. Time under general anesthesia will
be prolonged for 30 minutes to ascertain PISA measurements and for sampling of
Gingival plaque. A final visit ill be required at least 12 weeks after the
procedure. At this visit a scraping of tongue, a oral lavage and venous blood
will be collected. For measurements of lipids and glucose, they will be
requested to fast for this visit. volunteers will be asked to fast for their
visit to the UMCG. They wil be asked questions related to their general health
and social-economic status. They will undergo venous blood sampling once, after
which measurements of PISA will be done. Finally, samples of gingival plaque,
tong scrapings and a oral lavage will be collected.