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PerioFrogz: Research Summaries and Implementation Strategies
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The objective of PerioFrogz is to help dental professionals stay current with on-going research; facilitate integration of research findings into daily practice, ultimately elevating the level of patient care.
Association between periodontal pathogens and risk of nonfatal myocardial infarction
Source: Community Dent Oral Epidemiol. 2011 April;39(2):177-85      PerioFrogz Issue No.: 3911
Authors: Andriankaja O, Trevisan M, et al.

This study was testing the theory of the direct effects of perio pathogens on the development of atherosclerotic plaque development. The study had two objectives; assess the effect of perio pathogens in periodontal pockets with the risk of myocardial infarction (MI) and assess whether an increase in the number of perio bacterial species increases the risk of an MI.

  • 313 cases and 747 controls consisting of Caucasian males and females aged 35-69 years were enrolled in the study
  • The presence of six perio pathogens and their co-occurrence was compared to the odds of having an MI
Results and Conclusions:
  • Only Tannerella forsythia (Tf) and Prevotella intermedia (Pi) were statistically associated with an increased risk of an MI
  • An increase in the number of different periodontal bacteria in pockets also increased the odds of having a nonfatal heart attack.
  • Patients with 3 or more species of perio pathogens had about a two fold increase in the odds of having a nonfatal heart attack compared to patients with none of the bacterial species studied.
Key take-aways:

The study authors concluded by stating that the presence of periodontal pathogens, specifically Tf or Pi and an increase in the total bacterial burden were both associated with an increased risk of a nonfatal heart attack. They further stated that additional studies are necessary to determine a causal relationship and underlying mechanisms.

Implementation Strategies:

The result of this research points to the fact that we should be measuring periodontal pathogens as part of comprehensive risk assessment. When a patient, either existing or new, is diagnosed with periodontal disease, we should provide the patient with a DNA-PCR salivary diagnostic test. Many patients are at increased risk for an MI and are completely unaware. By simply treating their periodontal condition and eliminating the pathogens, the patient can lower their risk of MI. I believe this is an incredible opportunity for us to help our patients be healthier, especially those who have already been diagnosed with heart disease. You may want to use the patient education handout #311: Heart Health and Periodontal Disease on

Knowing the type and quantity of periodontal pathogens becomes even more important when the patient has more than one risk factor. Keep in mind that risk factors are exponentially multiplied. When a patient has 4 risk factors they are 256 times at greater risk for the progression of periodontal disease. If your current protocols do not include providing each patient with comprehensive risk assessment, you might consider getting started with the risk assessment document located on the home page at

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