Acute-phase inflammatory response to periodontal disease in the US population

Moderate elevation of serum C-reactive protein (CRP) is a risk factor for c ardiovascular disease among apparently healthy individuals, although factor s that create this inflammatory response in the absence of systemic illness have not been clarified. This study aimed to: (1) evaluate associations am ong periodontal disease, established risk factors for elevated CRP, and CRP levels within the US population; and (2) determine whether total tooth los s is associated with reduced CRP. Data were obtained from the third Nationa l Health and Nutrition Examination Survey. A random sample of the US popula tion was interviewed in their homes and examined at mobile examination cent ers. CRP was quantified from peripheral blood samples and analyzed as a con tinuous variable and as the prevalence of elevated CRP (greater than or equ al to 10 mg/L). Some 12,949 people aged 18+ years who had periodontal exami nations and an additional 1817 edentulous people aged 18+ years were includ ed in the analysis. Dentate people with extensive periodontal disease (> 10 % of sites with periodontal pockets 4+ mm) had an increase of approximately one-third in mean CRP and a doubling in prevalence of elevated CRP compare d with periodontally healthy people. Raised CRP levels among people with ex tensive periodontal disease persisted in multivariate analyses (P < 0.01), with established risk factors for elevated CRP (diabetes, arthritis, emphys ema, smoking, and anti-inflammatory medications) and sociodemographic facto rs controlled for. However, CRP levels were similarly raised in edentulous people. Furthermore, the established risk factors for elevated CRP modified relationships between oral status and CRP levels. Periodontal disease and edentulism were associated with systemic inflammatory response in the US po pulation, most notably among people who had no established risk Factors for elevated CRP.