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Pro-inflammatory cytokines and bone catabolism enhance periodontal disease, a local inflammatory, bacteria-induced disease that causes bone loss and periodontal soft tissue destruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Medical and dental examinations were performed on patients with HF (n = 39), following heart transplantation (post-HTx, n = 38) and controls (n = 32). Blood, saliva, and gingival crevicular fluid were analysed for bone metabolism and inflammation markers. HF average New York Heart Association classification was III. Average time since HTx was 1414 days. Pro-inflammatory tumour necrosis factor-alpha was higher in HF and HTx as compared with controls (P &amp;lt; 0.05). Both HF and HTx participants had higher levels of bone resorption marker C-terminal telopeptide and parathyroid hormone with subjects in the HF group having the highest serum levels of all groups (P \u2264 0.05). In contrast, 25-hydroxyvitamin D was lowest in HF. HF patients had greater clinical attachment loss, cumulative pockets depth (greater than 3 mm) and probing depth (P &amp;lt; 0.05) as compared with controls. Cumulative pockets depth correlated significantly with measures of the inflammatory burden, \u03b2-glucuronidase in saliva (r = 0.4863, P &amp;lt; 0.01), interleukin-1b in saliva (r = 0.5149, P &amp;lt; 0.01), and gingival crevicular fluid (r = 0.6056, P &amp;lt; 0.001) in HF. However, adjustment of periodontal results for measures of oral hygiene (plaque, bleeding on probing), systemic 25-hydroxyvitamin D, and race attenuated significant differences between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with HF exhibit more severe periodontal disease associated with increased bone turnover markers when compared with control patients. However, local and systemic factors may account for this association and should be evaluated in future studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.12126","type":"journal-article","created":{"date-parts":[[2017,3,1]],"date-time":"2017-03-01T00:21:27Z","timestamp":1488327687000},"page":"169-177","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Periodontitis and Bone Metabolism in Patients with Advanced Heart Failure and After Heart Transplantation"],"prefix":"10.1093","volume":"4","author":[{"given":"Ulrike","family":"Schulze-Sp\u00e4te","sequence":"first","affiliation":[{"name":"Division of Periodontics, College of Dental Medicine, Columbia University , New York, NY ,","place":["USA"]},{"name":"Section of Geriodontics, Department of Conservative Dentistry and Periodontology, University Hospital Jena, Friedrich Schiller University , Jena ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iman","family":"Mizani","sequence":"additional","affiliation":[{"name":"Division of Periodontics, College of Dental Medicine, Columbia University , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina Rodriguez","family":"Salaverry","sequence":"additional","affiliation":[{"name":"Division of Periodontics, College of Dental Medicine, Columbia University , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Periodontics, College of Dental Medicine, Columbia University , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Columbia University College of Physicians and Surgeons , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meaghan","family":"Jones","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Columbia University College of Physicians and Surgeons , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Kennel","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Columbia University College of Physicians and Surgeons , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle L.","family":"Brunjes","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Columbia University College of Physicians and Surgeons , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tse-Hwei","family":"Choo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Columbia University College of Physicians and Surgeons , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko S.","family":"Kato","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Columbia University College of Physicians and Surgeons , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Mancini","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Columbia University College of Physicians and Surgeons , New York, NY ,","place":["USA"]},{"name":"Department of Cardiology, The Mount Sinai Hospital , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Grbic","sequence":"additional","affiliation":[{"name":"Division of Periodontics, College of Dental Medicine, Columbia University , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. Christian","family":"Schulze","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Columbia University College of Physicians and Surgeons , New York, NY ,","place":["USA"]},{"name":"Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University , Jena ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,3,1]]},"reference":[{"key":"2026012115132108600_ehf212126-bib-0001","first-page":"28","article-title":"Mechanisms of contraction of the normal and failing heart","volume":"11","author":"Braunwald","year":"2009","journal-title":"N Engl J Med"},{"key":"2026012115132108600_ehf212126-bib-0002","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1161\/01.RES.0000043825.01705.1B","article-title":"Inflammatory mediators and the failing heart: past, present, and the foreseeable future","volume":"91","author":"Mann","year":"2002","journal-title":"Circ Res"},{"key":"2026012115132108600_ehf212126-bib-0003","doi-asserted-by":"crossref","first-page":"SI3","DOI":"10.1016\/S0140-6736(98)90012-5","article-title":"Epidemiology of heart failure and ventricular dysfunction","volume":"352","author":"Sharpe","year":"1998","journal-title":"Lancet"},{"key":"2026012115132108600_ehf212126-bib-0004","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1056\/NEJMra063052","article-title":"The failing heart\u2014an engine out of fuel","volume":"356","author":"Neubauer","year":"2007","journal-title":"N Engl J Med"},{"key":"2026012115132108600_ehf212126-bib-0005","first-page":"1012","article-title":"The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult heart transplant report\u20142010","volume":"277","author":"Stehlik","year":"1987","journal-title":"J Heart Lung Transplant: the official publication of the International Society for Heart Transplantation"},{"key":"2026012115132108600_ehf212126-bib-0006","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.1161\/01.CIR.85.5.1751","article-title":"Alterations of skeletal muscle in chronic heart failure","volume":"85","author":"Drexler","year":"1992","journal-title":"Circulation"},{"key":"2026012115132108600_ehf212126-bib-0007","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1093\/eurjhf\/hfn004","article-title":"Bone mineral status and bone loss over time in men with chronic systolic heart failure and their clinical and hormonal determinants","volume":"11","author":"Jankowska","year":"2009","journal-title":"Eur J Heart Fail"},{"key":"2026012115132108600_ehf212126-bib-0008","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1093\/eurjhf\/hfs138","article-title":"Dynamics of bone turnover markers in patients with heart failure and following haemodynamic improvement through ventricular assist device implantation","volume":"14","author":"Wu","year":"2012","journal-title":"Eur J Heart Fail"},{"key":"2026012115132108600_ehf212126-bib-0009","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1177\/0022034510385236","article-title":"Inflammation and uncoupling as mechanisms of periodontal bone loss","volume":"90","author":"Graves","year":"2011","journal-title":"J Dent Res"},{"key":"2026012115132108600_ehf212126-bib-0010","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1177\/0022034512457373","article-title":"CDC Periodontal Disease Surveillance workgroup: James Beck GDRP. 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