Periodontal disease has come to be recognized as one of the risk factors for the development of cardiovascular disease. However, few previous studies have investigated the cardiovascular risk associated with periodontal disease after adjusting for the wide range of factors that could confound this association. The purpose of this study was to examine the effects of periodontal disease and its treatment on the risk of cardiovascular disease using health insurance receipt data.

This study was conducted using the data of 235,779 subjects retrieved from the database of the National Health Insurance Association, Hokkaido Branch. They underwent a specific health examination and did not receive a dental examination in 2014, and were analyzed using health examination data and medical and dental receipt data.

The subjects were classified into 3 groups based on the 2015 dental receipts, as follows: 1) "No dental visits"; 2) "1 to 4 dental visits"; 3) "5 or more dental visits."

Logistic regression analyses were conducted to determine whether periodontal disease represents a risk factor for the development of cerebral infarction and myocardial infarction. In these analyses, the outcomes were cerebral infarction and myocardial infarction in 2015 and 2016, and the explanatory variables were the periodontal disease classification (explained above) and confounding factors in 2015.

The results of the logistic regression analysis using the 2015 cerebral infarction data showed that the incidence of cerebral infarction was significantly associated with the presence of periodontal disease ( "1 to 4 dental visits" OR: 1.95; "5 or more dental visits" OR: 1.63), suggesting the increased risk of cerebral infarction associated with periodontal disease. Similar results were obtained using the 2016 cerebral infarction data ( "1 to 4 dental visits" OR: 1.63; "5 or more dental visits" OR: 1.61), suggesting that the risk of development of cerebral infarction in patients with periodontal disease may not have changed one year after the start of periodontal treatment.

For transition to supportive periodontal therapy (SPT) or oral health maintenance following periodontal treatment, it is imperative that certain criteria indicating a stable condition or cure be met. However, the purpose of the treatment itself is not to achieve transition to SPT or maintenance, but rather to sustain a favorable condition for a long period of time after the transition. Unlike the positive attitude that they exhibit during active treatment, patients often tend to lose motivation for self-care and regular clinic visits in their busy daily lives. For long-term SPT cases, not only the technical aspects related to periodontal treatment, but also a trusting relationship between the patient and caregiver is indispensable, with the latter realized by the provision of care with compassion. Moreover, even when long-term SPT is planned, it is not assured that the oral environment that is observed at the time that the therapy is begun will be maintained over several years. Furthermore, especially in cases requiring comprehensive treatment, a variety of factors, such as damage to the prosthetic appliance, root breakage, aggravation of the condition of a tooth once diagnosed as conservable, aging of the patient, and onset of systemic disease, could complicate the course during the long SPT period.

In the present article, we present the case of a patient with generalized aggressive periodontitis who underwent comprehensive treatment combined with periodontal regenerative therapy, periodontal plastic surgery, implant treatment, and orthodontic therapy for approximately three years, and was then transitioned to SPT. Nine years later, active treatment was performed as therapeutic re-intervention was required, and successful transition to SPT was again achieved. In addition to the approximately 15 years of treatment from the first consultation to the present, findings over a total of nearly 30 years, including information obtained at a medical interview conducted before the start of treatment, are reviewed and discussed.

Gingival hyperplasia is one of the well-known side effects of calcium channel blockers, which are often used for the treatment of hypertension. Gingival hyperplasia may induce malalignment of the teeth and aesthetic problems. Although the mechanisms of gingival hyperplasia are not yet clearly understood, inflammatory conditions of the periodontal tissue caused by dental plaques are known to be involved in the pathogenesis of gingival hyperplasia. In general, a change of the antihypertensive drug to one without the side effect of gingival hyperplasia by the patient's attending physician, and thorough initial treatment, including plaque control and scaling and root planing are effective for the treatment of calcium channel blockers-induced gingival hyperplasia. Periodontal surgery may be performed, if necessary.

Herein, we report the case of a 41-year-old male patient, a hypertensive under treatment with the calcium channel blocker amlodipine besilate^®, who was diagnosed as having gingival hyperplasia and chronic periodontitis (Stage III, Grade C). He presented with marked gingival enlargement and bleeding, mobility of the anterior maxillary teeth, and disordered teeth. We attempted periodontal infection control, including instructions on oral hygiene, and professional care, including scaling and root planing and professional mechanical tooth cleaning. After re-evaluation, persistence of deep pockets with a pocket depth of more than 4 mm at multiple sites was observed, although the gingival hyperplasia had almost completely resolved. We planned a flap operation, but we could not do it, because the patient was very busy with his career and did not provide informed consent. So, we repeated scaling and root planing, and used a local drug delivery system in order to eliminate periodontopathic microorganisms. Furthermore, we motivated the patient by repeatedly explaining the importance of plaque control, professional care, as well as blood pressure control. As a result, the periodontal tissue and dentition improved with non-surgical therapy.