Systemic inflammatory markers, periodontal diseases, and periodontal infections in an elderly population

OBJECTIVES: To study the levels of systemic markers for inflammation with parameters of periodontal diseases in older people. DESIGN: A cross-sectional study was conducted in a cohort that is being followed prospectively on the effects of aging and body composition on morbidity. SETTING: University of Pittsburgh, Pittsburgh, and University of Tennessee, Memphis. PARTICIPANTS: One thousand one hundred thirty-one participants (mean age +/- standard deviation 72.7 +/- 2.8); 66% white and 50% male. MEASUREMENTS: Periodontal examination, including probing depth and attachment loss, was performed. Periodontal disease extent was divided into 0% of sites with probing depth of 6 mm or more, 1% to 10% of sites with probing depth of 6 mm or more and more than 10% of sites with probing depth of 6 mm or more. Subgingival plaque samples were collected from four molar teeth, and the levels of periodontal pathogens were determined using the benzoyl-DL-arginine-naphthylamide (BANA) test. Plasma interleukin-6 (IL-6), C-reactive protein (CRP), plasminogen activator inhibitor type-1 (PAI-1), and tumor necrosis factor alpha (TNF-alpha) levels were measured in all participants. Assessments of risk factors associated with elevated levels of markers of systemic inflammation were also determined. Multiple regression analysis was employed to analyze the data. RESULTS: IL-6 levels were significantly higher in participants with more-extensive periodontal disease than in other participants. Periodontal disease extent was significantly associated with higher TNF-alpha plasma levels, controlling for established risk factors for elevated TNF-alpha levels. Participants with BANA-positive species had significantly higher CRP plasma levels when controlling for risk factors for elevated CRP levels. CONCLUSION: Periodontal disease and infection may be modifiable risk indicators for elevated levels of systemic inflammatory markers in older people.