non communicable diseases are taking an epidemic form and will be a major cause of death in developing countries by the year 2020 .
studies conducted in india show that every second person above 35yrs of age has periodontal pockets and 30% of total teeth extracted after 35yrs of age are due to periodontal disease . as a result of high prevalence of both coronary artery disease ( cad ) and periodontal disease
framingham heart study has identified a list of classical risk factors ( hypertension , male gender , age , smoking , diabetes mellitus , and obesity ) .
however , they were not sufficient to account for the etiology of this multifactorial pathological process .
although major improvements have been made in primary and secondary prevention of major risk factors of cad , it continues to be highly prevalent .
around 40% cases of atherosclerosis can not be attributed to the classical risk factors . due to these facts
, there is an increased interest for considering chronic infections as a risk factor for atherosclerosis . as inflammatory mechanisms play a central role in mediating all phases of atherosclerosis and destructive periodontal disease , when left untreated they become a chronic inflammatory condition leading to an increase in local and systemic inflammatory mediators
periodontal associated inflammatory process contributes to an increase in inflammatory mediators including tumor necrosis factor- ( tnf- ) , c reactive proteins ( crp ) and interleukin- 6 ( il- 6 ) .
epidemiological studies have associated plasma levels of il-6 and tnf -  with cardio vascular risk factors and have associated il- 6levels with a risk of cad .
thus , the purpose of this interventional survey was to see the effect of periodontal treatment on levels of serum inflammatory markers crp , tnf- and white blood cell ( wbc ) counts .
twenty subjects were recruited from the department of cardiology , csm medical university , lucknow , india , for the survey .
subjects with a chronic generalized periodontitis having coronary artery disease confirmed by clinical findings and ecg as interpreted by a cardiologist were included in the study .
exclusion criteria included current smoking , smoking within last 6 months , diabetes and acute / chronic systemic diseases ( e.g. influenza , rheumatoid arthritis , copd , or kidney disease ) , antibiotics or anti inflammatory drug administration within the last 2 months , and pregnancy / lactation .
probing depth was recorded at six sites per tooth ( mesio buccal , mid buccal , disto buccal , mesio lingual , mid lingual , and disto lingual ) .
the presence or absence of bleeding was recorded using sulcular bleeding index ( sbi , muhlemann and son 1971 ) .
oral hygiene instructions were given and the subjects were recalled 1 month after the last treatment visit .
serum high - sensitivity c reactive protein ( hscrp ) was measured by using particle- enhanced turbidimetric assay ( hscrp , latex , cobas , integra 400 plus , roche , basel , switzerland ) .
tnf-  serum levels were determined by sensitive enzyme- linked immunosorbent assay ( elisa ) using commercially available kit ( r and d systems inc , minneapolis , mn , usa ) .
the plates were read using an automated microplate reader ( bio rad , hercules , california , usa ) . wbc count ( /10 ) was obtained . all the parameters ( pd ,
bop , hscrp , tnf- , wbc counts ) were obtained at the baseline and 1 month post treatment .
probing depth was recorded at six sites per tooth ( mesio buccal , mid buccal , disto buccal , mesio lingual , mid lingual , and disto lingual ) .
probing depth was recorded to the nearest millimeter using unc 15 probe . the presence or absence of bleeding
oral hygiene instructions were given and the subjects were recalled 1 month after the last treatment visit .
serum high - sensitivity c reactive protein ( hscrp ) was measured by using particle- enhanced turbidimetric assay ( hscrp , latex , cobas , integra 400 plus , roche , basel , switzerland ) .
tnf-  serum levels were determined by sensitive enzyme- linked immunosorbent assay ( elisa ) using commercially available kit ( r and d systems inc , minneapolis , mn , usa ) .
the plates were read using an automated microplate reader ( bio rad , hercules , california , usa ) .
all the parameters ( pd , bop , hscrp , tnf- , wbc counts ) were obtained at the baseline and 1 month post treatment .
serum high - sensitivity c reactive protein ( hscrp ) was measured by using particle- enhanced turbidimetric assay ( hscrp , latex , cobas , integra 400 plus , roche , basel , switzerland ) .
tnf-  serum levels were determined by sensitive enzyme- linked immunosorbent assay ( elisa ) using commercially available kit ( r and d systems inc , minneapolis , mn , usa ) .
the plates were read using an automated microplate reader ( bio rad , hercules , california , usa ) .
all the parameters ( pd , bop , hscrp , tnf- , wbc counts ) were obtained at the baseline and 1 month post treatment .
bop was reduced by 28% and pd was reduced by 41% at the end of 1 month [ table 1 ] .
data on periodontal disease markers before and after treatment hscrp and wbc levels were significantly reduced post treatment .
the hscrp , tnf-  levels and wbc counts reduced by 18 , 2 , and 14% , respectively [ table 2 ] .
the present study was conducted with the purpose of detecting the role of non surgical periodontal therapy in subjects with coronary artery disease .
the study clearly showed that there was a significant reduction in the levels of serum inflammatory markers ( hscrp and wbc counts ) after periodontal therapy .
the study is in agreement with the results of previous studies[610 ] that stated a reduction in systemic inflammatory markers of inflammation associated with periodontitis post treatment . in this study ,
bop is an informative parameter to estimate the severity of gingival inflammation as well as the response to treatment , and it is a clinical indicator of disease progression and stability . bop 
20% of sites is associated with a lower risk for periodontal attachment loss . in the present study
, bop was significantly reduced 1 month after treatment , and the number of subjects with bop > 20% of sites at baseline was reduced by almost half after therapy .
similarly , all subjects experienced significant reductions in pd after the treatment . in this study ,
1month after mechanical therapy , the circulating levels of hscrp and wbc counts significantly reduced in all subjects .
crp is a prognostic marker for future cardiovascular events . the release of bacteria and proinflammatory mediators such as bacterial endotoxins and cytokines in the bloodstream that causes the release of acute phase reactants ( such as c reactive protein ) leading to increased inflammatory activity in atherosclerotic lesions may represent the link between periodontal infection and cad .
wbc count , a crude marker of systemic inflammation associated with the prediction of future cardiovascular events also significantly decreased for subjects with cad .
tnf- has a role in apoptosis , bone resorption , matrix metalloproteinase ( mmp ) and il- 6 production .
however , the role of tnf -  remains disputed as several studies have not been able to recognize its association to cardiovascular events .
also , in our study there was no significant reduction in the levels of tnf- . large sample size is required to justify the association of tnf-. the observation that cardiovascular risk factors might be influenced by periodontitis may have important clinical consequences .
first , as inflammation plays an important role in the pathophysiology of various conditions ( metabolic syndrome , bp , vascular health ) .
the association of mild chronic inflammation with future serious events in observational studies may be influenced by an underlying severe periodontal infection .
second , periodontitis may increase the risk of future cardiovascular events because of the pro atherogenic changes ( increased cholesterol ) and increased systolic blood pressure induced in affected individuals .
cigarette smoking represents the major influential factor with regard to the association between periodontal infections and systemic inflammation , and this preliminary investigation raises the hypothesis of a possible interaction of smoking , periodontal infection and systolic blood pressure on systemic health.third , if periodontitis were the major inflammatory stimulus in at least some patients with periodontitis , severe periodontal infections may represent a major etiologic factor for atherosclerosis , metabolic syndrome , and their sequelae .
still , the causal relationship between periodontitis and cad can not be established as the sample size was small and the role of other risk factors was not explored .
on the basis of the data obtained , a large scale interventional study could be conducted in future .

 poor oral health is detrimental to systemic health.inflammatory markers are significantly associated with periodontitis.periodontitis is a modifiable risk factor , which can be prevented and treated . 
 
 background : periodontitis is a chronic inflammatory condition believed to cause a low but long lasting systemic inflammatory reaction which in turn contributes to the development of atherosclerosis . 
 recent data suggests that around 40% cases of coronary artery disease remain unaccounted despite the identification of the classical risk factors.objectives:to evaluate the efficacy of non surgical periodontal therapy on the levels of serum inflammatory markers in subjects with chronic periodontitis and known coronary artery disease.materials and methods : twenty subjects with known coronary artery disease ( cad ) were recruited from the department of cardiology , csm medical university , lucknow , india , for this study . 
 periodontal disease was measured through the clinical parameters bleeding on probing ( bop ) and probing depth ( pd ) . 
 all subjects received non surgical periodontal therapy that included oral hygiene instructions and meticulous scaling and root planing . 
 systemic levels of inflammatory markers such as high - sensitivity c reactive proteins ( hscrp ) , tumor necrosis factor- ( tnf- ) , and white blood cell ( wbc ) counts were measured prior to and 1 month after periodontal therapy.results:subjects experienced significant reductions in bleeding on probing ( bop ) and probing depth ( pd ) , indicating improvement in overall periodontal health . in all subjects , high - sensitivity c reactive proteins ( hscrp ) , and wbc counts 
 were reduced significantly , ; however , tumor necrosis factor- ( tnf- ) levels showed no statistically significant reduction.conclusion:in this study , periodontal treatment resulted in a significant decrease in bleeding on probing ( bop ) and probing depth ( pd ) , and this treatment lowered the serum inflammatory markers ( hscrp and wbc counts ) in patients with coronary artery disease . 
 this may result in a decreased risk for coronary artery disease in the periodontally treated patients . 