title: Increased levels of Porphyromonas gingivalis are associated with ischemic and hemorrhagic cerebrovascular disease in humans: an in vivo study.
abstract: OBJECTIVE
  This study investigated the role of periodontal disease in the development of stroke or cerebral infarction in patients by evaluating the clinical periodontal conditions and the subgingival levels of periodontopathogens.
  
  
  METHODS
  Twenty patients with ischemic (I-CVA) or hemorrhagic (H-CVA) cerebrovascular episodes (test group) and 60 systemically healthy patients (control group) were evaluated for: probing depth, clinical attachment level, bleeding on probing and plaque index. Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were both identified and quantified in subgingival plaque samples by conventional and real-time PCR, respectively.
  
  
  RESULTS
  The test group showed a significant increase in each of the following parameters: pocket depth, clinical attachment loss, bleeding on probing, plaque index and number of missing teeth when compared to control values (p<0.05, unpaired t-test). Likewise, the test group had increased numbers of sites that were contaminated with P. gingivalis (60%x10%; p<0.001; chi-squared test) and displayed greater prevalence of periodontal disease, with an odds ratio of 48.06 (95% CI: 5.96-387.72; p<0.001). Notably, a positive correlation between probing depth and the levels of P. gingivalis in ischemic stroke was found (r=0.60; p=0.03; Spearman's rank correlation coefficient test). A. actinomycetemcomitans DNA was not detected in any of the groups by conventional or real-time PCR.
  
  
  CONCLUSIONS
  Stroke patients had deeper pockets, more severe attachment loss, increased bleeding on probing, increased plaque indexes, and in their pockets harbored increased levels of P. gingivalis. These findings suggest that periodontal disease is a risk factor for the development of cerebral hemorrhage or infarction. Early treatment of periodontitis may counteract the development of cerebrovascular episodes.
authors.affiliation: Discipline of Oral Pathology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.
authors.forename: Janaina Salomon
authors.initials: JS
authors.lastname: Ghizoni
authors.forename: Luís Antônio de Assis
authors.initials: LA
authors.lastname: Taveira
authors.forename: Gustavo Pompermaier
authors.initials: GP
authors.lastname: Garlet
authors.forename: Marcos Flávio
authors.initials: MF
authors.lastname: Ghizoni
authors.forename: Jefferson Ricardo
authors.initials: JR
authors.lastname: Pereira
authors.forename: Thiago José
authors.initials: TJ
authors.lastname: Dionísio
authors.forename: Daniel Thomas
authors.initials: DT
authors.lastname: Brozoski
authors.forename: Carlos Ferreira
authors.initials: CF
authors.lastname: Santos
authors.forename: Adriana Campos Passanezi
authors.initials: AC
authors.lastname: Sant'Ana
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003774:Dental Plaque Index; D005260:Female; D006092:Gram-Negative Facultatively Anaerobic Rods / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010510:Periodontal Diseases / Q000150:complications* / Q000382:microbiology; D010512:Periodontal Index; D016966:Porphyromonas gingivalis / Q000472:pathogenicity*; D011897:Random Allocation; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000382:microbiology*