Monthly Archives: July 2011

Biomarkers for Cardiovascular and Periodontal Diseases


What is a biomarker? How does this relate to cardiovascular or periodontal diseases?

A biomarker is anything that can be used as an indicator of a particular disease state, but it is typically a protein which can be measured in the blood and may reflect the severity of a disease.  The two biomarkers connected to both cardiovascular diseases and periodontal disease, are C-reactive protein (CRP) and PLAC2.

C-reactive protein was discovered almost a century ago, it is a biomarker for a protein produced by the liver in response to inflammation and infection.  Recent research suggests that patients with elevated basal levels of CRP are at increased risk of hypertension, diabetes, and cardiovascular disease.  Coronary artery disease can result from white blood cells responding to chronic inflammation in the heart arteries.  A level above 2.4 has been associated with double the risk of coronary event compared to levels below 1.   Periodontal disease was found to be a cause for elevated CRP levels some years ago.   Periodontal infection involves a chronic bacterial infection possibly leading to bacterial bi-products entering the blood stream and triggering CRP to elevate.  “Periodontal disease needs to be considered as a major contributor to increased levels of CRP by the medical community,” said Dr. Steven Offenbacher, member of the American Academy of Periodontology.  

Read more here

However, CRP levels in this instance should be used only as one indicator for further exploration.  If this test is normal, it can actually be a false positive for chonic periodontal infection and inflammation.  Often, we have actually tested and treated patients with advanced periodontal disease who have no elevation of CRP whatsoever.  CRP alone is not an accurate assessment for a physician or cardiologist to use for thorough diagnosis of a chronic inflammatory state.  On the other hand, we have also treated patients with elevated CRP (high risk catagory over 2.4) who experience a reduction of CRP levels to normal after our treatment.  Studies show that the adjunctive use of a medication called Periostat will actually reduce CRP levels with traditional periodontal therapy.  CRP, or hs-CRP (high sensitivity CRP), can be requested during a routine blood draw with any physician or lab.  A patients overall health and more comprehensive labs should also be taken into consideration. While CRP is a “marker”, it is not a “player”, as we will see with the biomarker PLAC2 below.

PLAC2 is also a measure of a protein level in the blood.  This test was approved by the FDA in 2003.  PLAC2 is an enzyme which co-traffics with LDL (low density lipoproteins – bad cholesterol), then oxidizes in the arteries, leading to white blood cells coming to the area – foam cells are then formed, which leads to increased cytokines (inflammatory signaling enzymes) and the release of MMP 9  (tissue destroying enzymes)…this leads to a weakened fibrous cap (which covers the plaque build up in the arteries)…if this fibrous cap ruptures, as PLAC2 seems to promote, the person ends up with a thrombus (blood clot) – leading to heart attack or stroke. 

The only known cause of elevated PLAC2 at this time is periodontal disease.  Oral pathogens can travel into arteries from the mouth. PLAC2 is a major “player” in deadly coronary heart disease.   Anyone, especially anyone with hyperlipidemia (high cholesterol) and periodontal disease, should seriously consider having this biomarker checked.  If traditional approach periodontal treatment is not reducing this biomarker we highly recommend more definitive periodontal treatment to eliminate periodontal pathogens, chronic infection, and the chronic inflammation associated with it.  

To learn more about the PLAC2 test click here

Vitamin D deficiency – Its impact on oral and systemic health

Vitamin D deficiency – could this be contributing to your periodontal disease problem?

Vitamin D deficiency is a common problem world wide and is gaining much attention with researchers.  Vitamin D deficiency may be a major risk factor for many chronic diseases, such as:  periodontal disease, bone loss in the jaw and tooth loss, many types of cancer, numerous cardiovascular diseases, several auto-immune conditions, metabolic syndrome (weight gain and high BMI, prediabetes and type II diabetes, hypertension, low HDL cholesterol and high LDL cholesterol levels, high triglycerides), low mineral bone density (osteopenia), and osteoporosis.

What is significant about this is that periodontal disease in and of itself has been associated with many of the chronic diseases mentioned above.    We encourage anyone with any degree of periodontal disease to have the necessary blood tests performed to determine vitamin D levels.

Published papers and more information about vitamin D deficiency:

J Tenn Dent Assoc. 2011 Spring;91(2):30-3; quiz 34-5.
Vitamin D and its impact on oral health–an update.

Stein SH, Tipton DA.


Department of Periodontology, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA.


Vitamin D has been shown to regulate musculoskeletal health by mediating calcium absorption and mineral homeostasis. Evidence has demonstrated that vitamin D deficiency may place subjects at risk for not only low mineral bone density/osteoporosis and osteopenia but also infectious and chronic inflammatory diseases. Studies have shown an association between alveolar bone density, osteoporosis and tooth loss and suggest that low bone mass may be a risk factor for periodontal disease. Several recent reports demonstrate a significant association between periodontal health and the intake of vitamin D. An emerging hypothesis is that vitamin D may be beneficial for oral health, not only for its direct effect on bone metabolism but also due to its ability to function as an anti-inflammatory agent and stimulate the production of anti-microbial peptides.

Eur J Intern Med. 2011 Aug;22(4):355-62. Epub 2011 May 31.

Novel roles of vitamin D in disease: What is new in 2011?

Makariou S, Liberopoulos EN, Elisaf M, Challa A.


Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece; Department of Child Health, Medical School, University of Ioannina, Ioannina, Greece.


Vitamin D is a steroid molecule, mainly produced in the skin that regulates the expression of a large number of genes. Until recently its main known role was to control bone metabolism and calcium and phosphorus homeostasis. During the last 2 decades it has been realized that vitamin D deficiency, which is really common worldwide, could be a new risk factor for many chronic diseases, such as the metabolic syndrome and its components, the whole spectrum of cardiovascular diseases, several auto-immune conditions, and many types of cancer as well as all-cause mortality. Except for the great number of epidemiological studies that support the above presumptions, vitamin D receptors (VDRs) have been identified in many tissues and cells. The effect of vitamin D supplementation remains controversial and the need for more persuasive study outcomes is intense.

Copyright © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Mol Nutr Food Res. 2011 Jan;55(1):96-108. doi: 10.1002/mnfr.201000174. Epub 2010 Sep 7.

A review of the critical role of vitamin D in the functioning of the immune system and the clinical implications of vitamin D deficiency.

Schwalfenberg GK.


University of Alberta, Edmonton, Alberta, Canada.


This review looks at the critical role of vitamin D in improving barrier function, production of antimicrobial peptides including cathelicidin and some defensins, and immune modulation. The function of vitamin D in the innate immune system and in the epithelial cells of the oral cavity, lung, gastrointestinal system, genito-urinary system, skin and surface of the eye is discussed. Clinical conditions are reviewed where vitamin D may play a role in the prevention of infections or where it may be used as primary or adjuvant treatment for viral, bacterial and fungal infections. Several conditions such as tuberculosis, psoriasis, eczema, Crohn’s disease, chest infections, wound infections, influenza, urinary tract infections, eye infections and wound healing may benefit from adequate circulating 25(OH)D as substrate. Clinical diseases are presented in which optimization of 25(OH)D levels may benefit or cause harm according to present day knowledge. The safety of using larger doses of vitamin D in various clinical settings is discussed.

Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

J Environ Pathol Toxicol Oncol. 2009;28(1):1-4.

Modern concepts in the diagnosis and treatment of vitamin D deficiency and its clinical consequences.

Edlich R, Fisher AL, Chase ME, Brock CM, Gubler K, Long WB 3rd.


University of Virginia Health System, Charlottesvill, VA, USA.


It is the purpose of this comprehensive report to outline a revolutionary strategy to prevent vitamin D deficiency in our nation. Vitamin D is a unique vitamin. Its metabolic product, calcitriol, is a profound secosteroid hormone that has impact on over 1000 genes in the human body. Recent clinical research has implicated vitamin D deficiency as a major factor in the etiology of rickets, a wide variety of cancers, as well as hypertension, stroke, heart attack, diabetes, bone fractures, periodontal disease, and even multiple sclerosis. There are two forms of vitamin D utilized in the human body: D2 and D3. Measurement of 25(OH)D is the most reliable method of detecting vitamin D deficiency. Several methods, including high-performance liquid chromatography (HPLC), chemoluminescence, and radioimmunoassay (RIA), have been developed for the measurement of total 25(OH)D levels. Prevention and treatment of vitamin D deficiency is accomplished by regulated sun exposure as well as vitamin D, supplementation. This information describing our plan to prevent vitamin D deficiency in the patients and employees of Legacy Health System is a landmark accomplishment that should be replicated in every healthcare setting in our country to prevent vitamin D deficiency.

Important re vitamin D. When vitamin D is converted to its active form, vitamin K and small amount of vitamin A are needed (found in orange veggies or supplements). Vitamin K can be supplemented or found in the following foods: parsley, kale, spinach, Brussels sprouts, Swiss chard, green beans, asparagus, broccoli, kale, mustard greens, turnip greens, collard greens, thyme, romaine lettuce, sage, oregano, cabbage, celery, sea vegetables, cucumber, leeks, cauliflower, tomatoes, and blueberries.

The ideal vitamin D level is 50-80, some physicians do check vitamin K when they discover this deficiency. The Cleveland Clinic recommends a multivitamin at least daily for all. We like to see our patients take nano-vitamins (LifePak Nano) by Pharmanex, or other comparable high quality supplement for greater absorption. We are also giving our patients a list of foods to add to their diet. Most people have never been taught what or how to eat to be healthy.

In our experience most adults need a minimum of 2000IU vitamin D supplementation, even more in the winter months. If someone is severely deficient they will be put on high doses (Rx by their physician – 50K IU per week), then retested in 8-12 weeks. The patient is then put on a maintenance dose daily and monitored. Vitamin D is found in fish and fortified foods but one would have to eat a lot of fish and get sun daily with no sun screen to keep normal levels typically (most do not have this lifestyle). Many find it hard to believe that all that milk drinking and taking a multivitamin is not enough. If you are not supplementing you can assume you are deficient, its a given usually. Get tested.