Original article Periodontal care may improve endothelial function Arnon Blum a, ⁎ , Konstantin Kryuger b , Michal Mashiach Eizenberg d , Sameh Tatour a , Fina Vigder b , Zvi Laster c , Eran Front c a Department of Internal Medicine A, Baruch-Padeh Poriya Medical Center, Lower Galilee 15208, Israel b Department of Imaging, Baruch-Padeh Poriya Medical Center, Lower Galilee 15208, Israel c Dental Surgery Department, Baruch-Padeh Poriya Medical Center, Lower Galilee 15208, Israel d Department of Health System Management, Emek Yesrael College, Israel Received 20 January 2006; received in revised form 24 November 2006; accepted 14 December 2006 Abstract Background: Periodontitis is a chronic, infectious, insidious disease of the tooth-supporting structures that causes a general inflammatory response. The aims of this study were to determine whether periodontitis is associated with endothelial dysfunction leading to cardiovascular events and whether proper management of periodontal disease would improve endothelial function and prevent cardiovascular events in the future. Methods: Twenty-two patients (12 women, 10 men; 40±5 years old) took part in the study. All had severe periodontitis (without systemic disorders) and were all treated conservatively. Thirteen patients returned for a second visit after 3 months of treatment. Endothelial function and periodontal status were evaluated on entry into the study and 3 months following treatment. Ten age-matched, healthy volunteers without periodontal disease served as the control group. Results: There was a significant difference between the patient group and the healthy controls: FMD% 4.12 ± 3.96 vs. 16.60 ± 7.86% (p = 0.0000). Periodontitis improved significantly in all 13 patients who completed 3 months of treatment, and their endothelial function improved as well: FMD% 4.12 ± 3.96% vs. 11.12 ± 7.22% ( p = 0.007). No difference was found in FID% before and after 3 months of treatment: 20.97 ± 10.66% vs.17.94 ± 6.23% ( p = NS). Conclusions: Periodontitis may be an insidious cause of endothelial dysfunction and cardiovascular events. Treating periodontitis can improve endothelial function and be an important preventive tool for cardiovascular disease. © 2007 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. Keywords: Endothelial function; Periodontitis; Atherosclerosis 1. Introduction Acute coronary syndromes (unstable angina pectoris, myocardial infarction, post-PTCA restenosis, sudden death) are commonly due to rupture or erosion of atheromatous plaques in coronary arteries, with exposure of thrombogenic substances within the plaque to blood and rapid development of an occlusive thrombus. Inflammation is increasingly recognized as a major component of atherosclerosis, especially in plaques associated with acute coronary syndromes, as often demonstrated at necropsy. Chronic infection is now recognized as one of the possible causes of chronic inflammation that could lead to atherogenesis and plaque instability. Periodontitis is an inflammatory reaction (to gram-negative, anaerobic bacterial infections) of the tooth-supporting structures, including the periodontal liga- ment, cementum, and supporting bone to bacterial invasion. The purpose of this study was to determine whether periodontitis could be an inflammatory/infectious trigger for endothelial dysfunction and vascular inflammation (leading to atherosclerosis) and whether proper management would European Journal of Internal Medicine 18 (2007) 295 – 298 www.elsevier.com/locate/ejim ⁎ Corresponding author. Cardiovascular Branch, NHLBI, National Institutes of Health, USA. E-mail addresses: bluma@mail.nih.gov , navablum@hotmail.com (A. Blum). 0953-6205/$ - see front matter © 2007 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ejim.2006.12.003