Molecular markers relevant to myocardial injury following dental extraction in patients with or without coronary artery disease

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Abstract

Objectives

The aim of this study was to characterize biological changes following dental extractions in patients with or without coronary artery disease (CAD).

Materials and methods

Forty-five patients (36 males and 9 females) referred for dental extraction underwent treatment and provided blood samples before, immediately after, and 24 h after the procedure. A broad array of biomarkers was employed to assess myocardial injury (highly sensitive troponin T, hs-TnT), bacterial burden (LPS endotoxin activity), and systemic inflammation (CRP, fibrinogen, IFN-γ, IL-1β, IL-6, IL-8, IL-10, IL-12, and TNF-α).

Results

Dental extraction in patients with or without CAD was associated with rises in hs-TnT ( p = 0.013), hs-CRP ( p < 0.001), fibrinogen ( p = 0.005), endotoxin activity ( p < 0.001), IFN-γ ( p < 0.001), IL-6 ( p < 0.001), IL-8 ( p = 0.011), and IL-12 ( p < 0.001) at 24 h compared with immediately post procedure. Changes in systemic inflammation and endotoxin activity were more evident in those with hs-TnT rise.

Conclusions

Simple dental extractions may cause mild increase in hs-TnT, indicating minor myocardial injury in both patients with or without CAD. Acute systemic inflammation and endotoxemia could represent a possible link between invasive dental treatment and increased risk of acute cardiovascular events. These findings indicate that invasive dental treatment (as simple as a single dental extraction) may impact negatively on clinical outcomes in dental patients, especially those with CAD.

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Most cited references 43

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Peter Libby, Paul M Ridker, Göran K Hansson (2009)

Until recently, most envisaged atherosclerosis as a bland arterial collection of cholesterol, complicated by smooth muscle cell accumulation. According to that concept, endothelial denuding injury led to platelet aggregation and release of platelet factors which would trigger the proliferation of smooth muscle cells in the arterial intima. These cells would then elaborate an extracellular matrix that would entrap lipoproteins, forming the nidus of the atherosclerotic plaque. Beyond the vascular smooth muscle cells long recognized in atherosclerotic lesions, subsequent investigations identified immune cells and mediators at work in atheromata, implicating inflammation in this disease. Multiple independent pathways of evidence now pinpoint inflammation as a key regulatory process that links multiple risk factors for atherosclerosis and its complications with altered arterial biology. Knowledge has burgeoned regarding the operation of both innate and adaptive arms of immunity in atherogenesis, their interplay, and the balance of stimulatory and inhibitory pathways that regulate their participation in atheroma formation and complication. This revolution in our thinking about the pathophysiology of atherosclerosis has now begun to provide clinical insight and practical tools that may aid patient management. This review provides an update of the role of inflammation in atherogenesis and highlights how translation of these advances in basic science promises to change clinical practice.

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Inflammatory bio-markers and cardiovascular risk prediction.

G. Blake, P Ridker (2002)

Inflammatory processes are now recognized to play a central role in the pathogenesis of atherosclerosis and its complications. Plasma levels of several markers of inflammation have been found to be associated with future cardiovascular risk in a variety of clinical settings. These markers include cell adhesion molecules, cytokines, pro-atherogenic enzymes and C-reactive protein (CRP). Initially thought of as an inactive downstream marker of the inflammatory cascade, emerging evidence suggests that CRP may be directly involved in atherogenesis, and that arterial plaque can produce CRP, independent of traditional hepatic pathways. In addition to being a strong predictor of future cardiovascular risk amongst patients presenting with acute coronary syndromes, numerous studies have found that baseline levels of CRP are associated with risk of future myocardial infarction, stroke, peripheral vascular disease and cardiovascular death amongst apparently healthy populations. The combination of measurement of a marker of inflammation with lipid testing may improve upon risk stratification based on lipid testing alone, and intensification of programmes for exercise, weight loss, and smoking cessation is recommended for those with elevated CRP levels. Further trials are needed to confirm the potential benefits of statins amongst individuals with elevated CRP levels.

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Response of serum interleukin-6 in patients undergoing elective surgery of varying severity.

Jean-Luc Laethem, Jean Burns, A Cruickshank … (1990)

1. Recent studies have suggested that interleukin-6 is a major mediator of the acute-phase protein response in man. The aim of the present study was to investigate the relationships between the response of serum interleukin-6 to surgery, the type of surgical procedure performed and the response of serum C-reactive protein. 2. Timed venous blood samples were taken from 26 patients in five broad surgical categories (minor surgery, cholecystectomy, hip replacement, colorectal surgery and major vascular surgery). C-reactive protein and interleukin-6 were measured in each sample. 3. Serum interleukin-6 rose within 2-4 h of incision in all patients and the magnitude of the response differed among the various surgical groups. The response of interleukin-6 correlated (r = 0.80, P less than 0.001) with the duration of surgery. In contrast, serum C-reactive protein was not detectable after minor surgery (less than 10 mg/l) and the response of C-reactive protein did not differ among the more major surgical groups. The response of interleukin-6 showed a weak, but significant, correlation with the response of C-reactive protein (r = 0.67, P less than 0.001). 4. We conclude that serum interleukin-6 is a sensitive, early marker of tissue damage. In general, the greater the surgical trauma, the greater the response of serum interleukin-6 and the greater the peak serum concentration of interleukin-6. Our results are consistent with a role for interleukin-6 in the induction of C-reactive protein synthesis.

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Author and article information

Contributors

K. M. Habbab: khaledhabbab@pscc.med.sa

Journal

Journal ID (nlm-ta): BDJ Open

Journal ID (iso-abbrev): BDJ Open

Title: BDJ Open

Publisher: Nature Publishing Group UK (London )

ISSN (Electronic): 2056-807X

Publication date (Electronic): 20 June 2019

Publication date PMC-release: 20 June 2019

Publication date Collection: 2019

Volume: 5

Electronic Location Identifier: 9

Affiliations

[1 ]ISNI 0000000121901201, GRID grid.83440.3b, UCL Eastman Dental Institute, ; London, England UK

[2 ]ISNI 0000 0000 9759 8141, GRID grid.415989.8, Prince Sultan Cardiac Center, ; Riyadh, Saudi Arabia

Article

Publisher ID: 18

DOI: 10.1038/s41405-019-0018-8

PMC ID: 6586777

SO-VID: bfff422c-f2b7-4a83-a548-be7e7b295f3b

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 16 December 2018

Date revision received : 7 May 2019

Date accepted : 12 May 2019

Custom metadata

Keywords: special care dentistry,periodontitis

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Keywords: special care dentistry, periodontitis

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Molecular markers relevant to myocardial injury following dental extraction in patients with or without coronary artery disease

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Abstract

Objectives

Materials and methods

Results

Conclusions

Related collections

Alternative approaches to Alzheimer's Disease

Most cited references 43

Inflammation in atherosclerosis: from pathophysiology to practice.

Inflammatory bio-markers and cardiovascular risk prediction.

Response of serum interleukin-6 in patients undergoing elective surgery of varying severity.

Author and article information

Contributors

Journal

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Article

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Cited by 4

Most referenced authors 805