Bacteremia From Periodontal Treatment to Elucidate the Underpinnings of Sepsis

Bacteremia from periodontal treatment to elucidate the underpinnings of sepsis

Hypothesis In the context of cardiovascular disease (CVD) and sepsis this study hypothesise that (1) periodontal disease causes a specific CVD phenotype that can, to some extent, be reversed by treating periodontal disease; (2) that non-surgical periodontal treatment can be used as a human bacteremia model for evaluating biomarkers that can be used in the sepsis clinic; (3) that endogenous antimicrobial peptide profile dictate the severity of a bacteremia; (4) that proteinases from the oral biofilm can impact the severity of a bacteremia induced by oral bacteria and their products.

Aims A. What are the long term clinical, and 'omics related CVD-phenotypical effects from treating periodontal disease compared to an untreated group? B. Can biomarkers be used for detecting a bacteremia or previous bacteremia? C. Are the effects from bacteremia on cardiovascular biomarkers related to the individual's antimicrobial peptide profile? D. Does the presence of bacterial proteases, such as gingipain, relate to having a bacteremia from periodontal treatment and the systemic response from a bacteremia?

Project description To answer the clinical problems from the dental chair and the sepsis intensity care unit the investigators have designed the Bacteremia Study. Aim 1 is an intervention study, while Aim 2 and 3 are investigating the pathophysiological underpinnings of the association. When studying the long term effects of periodontal treatment on CVD phenotype Malmö Offspring Dental Study (MODS) participants who have not sought dental care despite being told they have periodontal disease, will be invited as non-treated controls. The primary outcome variable will be changes in total carotid plaque area (TPA) per year.

In Aim 2 and 3 the parameters used to dissect the different aspects of the bacteremia. The AMP profile may be different in subjects with more severe bacteremia (measured by blood culturing) versus no bacteremia. The primary outcome will be concentration of CVD biomarkers during and following bacteremia (positive blood culture) compared to those who have negative blood culture.