Objective: To establish the association between dental diseases in high altitude area and its association with risk factors for cardiovascular diseases.

Study Population 1032 combatants were screened for their routine medical and dental check up.

Methods: All the combatants had undergone general medical examination which include the physical parameters like weight, height and BMI. General examination also included serial blood pressure measurement for six days. For dental examination all the combatants were examined for various dental diseases i.e dental caries, Infected root stumps, periodontal conditions and other oral conditions that will hamper their abilities to perform their duties in high altitude area. For identifying dental caries we use dental explorer, dental mirror and for periodontal conditions we use UNC15 periodontal probe. Individuals with generalised periodontitis were subjected for lab investigations in the form of blood sugar (fasting blood sugar level and post prandial blood sugar levels), HbA1c, lipid profile and sonography for fatty liver.

Results: Out of 1032 combatants, 65% had carious tooth,13% had a infected root stumps and 36% had a periodontitis .however some of them had a combination of dental diseases like dental caries and infected root stump/stumps, caries and periodontitis, periodontitis and infected root stumps or all three dental diseases. Out of 130  generalised periodontitis cases, 12.30% (16) had impaired glucose tolerance, 8%(11) were diabetics, 13.84%(18) had dyslipidaemia and 10%(13) had isolated hypertriglyceridemia.  Also those patients who had dyslipidemia or isolated hypertriglycerdemia along with periodontitis were subjected for sonological study for fatty liver. 91% of cases had fatty liver. This shows a significant association between periodontal diseases and cardiovascular diseases.

Conclusion: Thus our study correlates association between dental diseases and risk factors for cardiovascular diseases like hypertension, Body mass index, Dyslipidemia, Type 2 diabetes mellitus & impaired glucose tolerance in high altitude areas.

Keywords: High altitude area, hypertension, BMI, dental caries, infected root stumps, periodontitis, dyslipidemia.

1. Bärtsch P, Saltin B: General introduction to altitude adaptation and mountain sickness. Scand J Med Sci Sports. 2008, 18 (Suppl 1): 1-10.
2. Cremona G, Asnaghi R, Baderna P, Brunetto A, Brutsaert T,et al: Pulmonary extravascular fluid accumulation in recreational climbers: a prospective study. Lancet. 2002, 359: 303-309.
3. Paralikar S J,  Paralikar J H : High-altitude medicine. Indian J Occup Environ Med. 2010 Jan-Apr; 14(1): 6–12.
4. Yanamandra u, nair v. high altitude systemic hypertension : a newentity. API Mediine update 2017:118-22.
5. Flemmig TF: Periodontitis. Ann Periodontol 4:32–38, 1999.
6. Bergstrom J: Tobacco smoking and chronic destructive periodontal disease. Odontology 92:1–8, 2004.
7. Lang NP,Schatzle MA, Loe H: Gingivitis as a risk factor in periodontal disease, J Clin Periodontal 36(Suppl 10):3-8,2009.
8. Kebschull M, Demmer RT, Papapanou PN: “Gum bug, leave my heart alone!”— epidemiologic and mechanistic evidence linking periodontal infections and atherosclerosis. J Dent Res 89:879–902, 2010.
9. Offenbacher S, Barros SP, Altarawneh S, et al: Impact of tooth loss on oral and systemic health. Gen Dent 60:494–500, quiz p 501-592, 2012.
10. Pihlstrom BL, Michalowicz BS, Johnson NW: Periodontal diseases. Lancet 366:1809–1820, 2005.
11. Tonetti MS: Periodontitis and risk for atherosclerosis: an update on intervention trials. J Clin Periodontol 36(Suppl 10):15–19, 2009.
12. Preshaw PM, Alba AL, Herrera D, et al: Periodontitis and diabetes: a two-way relationship. Diabetologia 55:21–31, 2012.
13. Deschner J, Haak T, Jepsen S, et al: Diabetes mellitus and periodontitis. Bidirectional relationship and clinical implications. A consensus doccument. Der Internist 52:466–477, 2011.
14. Tsai C, Hayes C, Taylor GW: Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population. Community DentOral Epidemiol 30:182–192, 2002.
15. Graves DT, Liu R, Oates TW: Diabetes-enhanced inflammation and apoptosis: impact on periodontal pathosis. Periodontol 2000 45:128– 137, 2007.
16. Meurman J H, Sanj M, Janket S J : Oral Health, atherosclerosis, and cardiovascular disease. Critical Reviews Oral Biology and Medicine. 2004,403-13.
17. Mustapha I Z, Debrey S, Oladabu M, Ugarte R : Cardiocascular Disease markers of systematic bacterial exposure in periodontal disease and risk: a systematic review and meta-analysis. Journal of Peiodontology 2007,2289-2302.
18. Rao KS, Natsan R, Singh KPB, Bobdey CS Medical problems at high altitude . Internet Rev. Armed forces medical Services 1993;66:109-11.
19. Anand IS, Chandrasekhar YC,Rao KS, Malhotra RM, et al. Body fluid compartments, renal blood flow, and hormones at 6000m in normal subjects. J Appl Physiol 1993;74:1234-1239
20. Okumiya K, Sakamoto R, Ishimoto Y, Kimura Y, Fukutomi E, et al. Glucose intolerance associated with hypoxia in people living at high altitude in the Tibetan highland. Journal Of Clinical Pathology Vol 6,Issue 2.
21. Taylor GW, Burt BA, Becker MP, et al: Severe periodontitis and risk for poor glycemic control in patients with non–insulin-dependent diabetes mellitus. J Periodontol 67:1085, 1996.
22. Mattila KJ: Viral and bacterial infections in patients with acute myo- cardial infarction. J Intern Med 225:293–296, 1989.
23. Janket S, Qvarnstrom M, Muerman JH, et al: Asymptomatic dental score and prevalent coronary heart disease. Circulation 109:1095– 1100, 2004.
24. Mattila KJ, Nieminen MS, Valtonen VV, et al: Association between dental health and acute myocardial infarction. Br Med J 298:779–781, 1989.
25. Bahekar AA, Singh S, Saha S, et al: The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis Am Heart J 154:830–837, 2007.

Lt Col Tentu Ajai Kumar

Classified Specialist, Pulmonary Medicine Department, Military Hospital, Namkum, Ranchi, Jharkhand, India