COMPLEX TREATMENT OF CHRONIC GENERALIZED PERIODONTITIS IN PATIENTS WITH STABLE ANGINA PECTORIS

Abstract

Objective: To assess the clinical efficacy of complex periodontal therapy in patients with chronic generalized periodontitis and stable angina pectoris, focusing on periodontal outcomes, systemic inflammatory markers, and patient-reported quality of life.

Materials and Methods: A prospective cohort study included 60 adult patients treated between 2023 and 2024. Inclusion criteria were: chronic generalized periodontitis (moderate to severe), confirmed stable angina pectoris (CCS class II–III), and stable baseline cardiologic therapy for at least 4 weeks prior to enrollment. Exclusion criteria comprised acute coronary syndrome within the previous 6 months, decompensated heart failure, uncontrolled diabetes, active infections requiring systemic antibiotics, and pregnancy.

The complex treatment protocol consisted of: professional oral hygiene, full-mouth scaling and root planing, local antiseptic/antimicrobial applications, individualized home-care instruction, and supportive periodontal therapy. All patients continued guideline-based antianginal therapy; cardiology supervision ensured treatment stability and safety. Follow-up duration was 24 weeks.

Primary endpoints included reduction of gingival inflammation and bleeding, changes in periodontal pocket depth (PPD), and improvement in clinical attachment level (CAL).

Secondary endpoints included dynamics of C-reactive protein (CRP) and interleukin-6 (IL-6), frequency of angina episodes (patient diary), and quality of life assessed using SF-36.

Results: By week 8, bleeding on probing decreased from 62.0% to 36.1% (p<0.001). Mean PPD decreased from 4.9±0.7 mm to 3.8±0.6 mm (p<0.001), and CAL improved by 0.6±0.3 mm (p<0.01). At week 12, periodontal stabilization (no further increase in PPD and reduced bleeding) was observed in 43 patients (71.7%). CRP decreased from 8.7 mg/L to 6.0 mg/L by week 12 (31.0% reduction; p<0.001), while IL-6 decreased by 27.5% by week 24 (p<0.001). The monthly frequency of angina episodes decreased in 35 patients (58.3%), with no deterioration in CCS functional class during follow-up. SF-36 physical component score increased from 45.8 to 54.1 points (p<0.001). Adverse events were infrequent (10.0%) and mainly consisted of transient gingival sensitivity and mild mucosal irritation; no serious cardiovascular complications related to periodontal procedures were recorded.

Conclusion: Complex periodontal therapy in patients with chronic generalized periodontitis and stable angina pectoris significantly improves periodontal clinical indices, reduces systemic inflammatory markers, and is associated with better patient-reported quality of life. The approach appears safe under cardiology supervision and supports the concept that effective periodontal inflammation control may contribute to improved overall clinical status in this comorbid population.