Relationship of oral conditions to the incidence of infective endocarditis in periodontitis patients with valvular heart disease : a cross-sectional study

Objectives
Infective endocarditis (IE) is a life-threatening infectious disease, but the pathogenesis of the disease remains uncertain. The objective of this study was to examine whether oral infectious conditions are associated with the occurrence of IE in valvular heart disease (VHD) patients.
Materials and Methods
A total of 119 periodontitis (P) patients with or without VHD were enrolled, and cross-sectional analyses were performed. Patients were classified as follows: 1) mild-to-moderate P without VHD, 2) mild-to-moderate P with VHD, 3) severe P without VHD, or 4) severe P with VHD. A total of 78 VHD patients were classified as 1) VHD without IE or 2) VHD with IE. Conditional logistic regression analysis was performed to compute the odds ratio (OR) and 95% confidence interval (CI).
Results
No significant differences were observed between patients with or without VHD in oral conditions. A significant increase in the percentage of alveolar bone loss in VHD patients with IE was observed compared with that of patients without IE. The ratio of both Porphyromonas gingivalis (Pg) IgG titer>1.68 and Pg fimA type II genotype in patients with IE was significantly higher than in patients without IE. There was a significant correlation between the occurrence of IE and clinical oral findings (number of remaining teeth: OR, 0.17; rate of alveolar bone loss>40%: OR, 11.8).
Conclusions
VHD patients with IE might have severe periodontitis compared with patients without IE, although further investigation will be needed because this is based on only 7 VHD patients with IE.
Clinical relevance
The patients with IE had fewer remaining teeth, more advanced bone resorption compared with those of patients without IE. These findings suggest a possible association between the occurrence of IE and periodontal infection.

This is a post-peer-review, pre-copyedit version of an article published in Clinical Oral Investigations. The final authenticated version is available online at: https://doi.org/10.1007/s00784-019-02973-2.