Treatment of periodontitis and endothelial function

N Engl J Med. 2007 Mar 1;356(9):911-20. doi: 10.1056/NEJMoa063186.


Background: Systemic inflammation may impair vascular function, and epidemiologic data suggest a possible link between periodontitis and cardiovascular disease.

Methods: We randomly assigned 120 patients with severe periodontitis to community-based periodontal care (59 patients) or intensive periodontal treatment (61). Endothelial function, as assessed by measurement of the diameter of the brachial artery during flow (flow-mediated dilatation), and inflammatory biomarkers and markers of coagulation and endothelial activation were evaluated before treatment and 1, 7, 30, 60, and 180 days after treatment.

Results: Twenty-four hours after treatment, flow-mediated dilatation was significantly lower in the intensive-treatment group than in the control-treatment group (absolute difference, 1.4%; 95% confidence interval [CI], 0.5 to 2.3; P=0.002), and levels of C-reactive protein, interleukin-6, and the endothelial-activation markers soluble E-selectin and von Willebrand factor were significantly higher (P<0.05 for all comparisons). However, flow-mediated dilatation was greater and the plasma levels of soluble E-selectin were lower in the intensive-treatment group than in the control-treatment group 60 days after therapy (absolute difference in flow-mediated dilatation, 0.9%; 95% CI, 0.1 to 1.7; P=0.02) and 180 days after therapy (difference, 2.0%; 95% CI, 1.2 to 2.8; P<0.001). The degree of improvement was associated with improvement in measures of periodontal disease (r=0.29 by Spearman rank correlation, P=0.003). There were no serious adverse effects in either of the two groups, and no cardiovascular events occurred.

Conclusions: Intensive periodontal treatment resulted in acute, short-term systemic inflammation and endothelial dysfunction. However, 6 months after therapy, the benefits in oral health were associated with improvement in endothelial function.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analysis of Variance
  • Biomarkers / blood
  • Brachial Artery / physiology
  • C-Reactive Protein / analysis
  • Dental Scaling
  • E-Selectin / blood
  • Endothelium, Vascular / drug effects
  • Endothelium, Vascular / physiology*
  • Female
  • Humans
  • Interleukin-6 / blood
  • Male
  • Middle Aged
  • Neutrophils
  • Nitroglycerin / pharmacology
  • Periodontitis / classification
  • Periodontitis / physiopathology
  • Periodontitis / therapy*
  • Single-Blind Method
  • Vasodilation / drug effects
  • Vasodilator Agents / pharmacology


  • Biomarkers
  • E-Selectin
  • Interleukin-6
  • Vasodilator Agents
  • C-Reactive Protein
  • Nitroglycerin