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

  • Masami Ninomiya
  • Mari Hashimoto
  • Kouji Yamanouchi
  • Yoshiaki Fukumura
  • Toshihiko Nagata
  • Koji NaruishiEmail author
Original Article



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).


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).


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.


Infective endocarditis (IE) Valvular heart disease (VHD) Periodontitis Oral examination 



The authors thank the medical staff of Tokushima Red Cross Hospital and Tokushima University Hospital for their assistance.


This study was supported by a Grant-in-Aid for Scientific Research (B) (No. 15H05054), Scientific Research (C) (No. 26463135), and Scientific Research (C) (No. 16 K11832) from the Japan Society for the Promotion of Science.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was conducted according to the guidelines described in Declaration of Helsinki, and was approved by the ethics committee of Tokushima Red Cross Hospital (No. 459).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

784_2019_2973_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 18 kb)
784_2019_2973_MOESM2_ESM.docx (40 kb)
ESM 2 (DOCX 39 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Periodontology and Endodontology, Graduate School of Biomedical SciencesTokushima UniversityTokushimaJapan
  2. 2.Yamanouchi Dentistry and Oral SurgeryKomatsushimaJapan
  3. 3.Department of Cardiovascular SurgeryTokushima Red Cross HospitalKomatsushimaJapan

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