Periodontitis and gingival bleeding associate with intracranial aneurysms and risk of aneurysmal subarachnoid hemorrhage

Oral bacteria DNA has been found in intracranial aneurysms (IA) and a high prevalence of periodontitiswas reported in IA patients. We investigated whether periodontitisassociates with IA formation and aneurysmal subarachnoid hemorrhage (aSAH). First, we compared in a case-control setting the prevalence of periodontaldisease in IA patients (42 unruptured IA, 34 ruptured IA) and in age- and gender-matched controls (n = 70) from the same geographical area (Health 2000 Survey, BRIF8901). Next, we investigated whether periodontitisat baseline associated with aSAH in a 13-year follow-up study of 5170 Health 2000 Survey participants. Follow-up data was obtained from national hospital discharge and cause of death registries. Univariate analysis, logistic regression, and Cox-regression were used. Periodontitis(≥ 4mm gingivalpocket) and severe periodontitis(≥ 6mm gingivalpocket) were found in 92% and 49% of IA patients respectively and associated with IAs (OR 5.3, 95%CI 1.1–25.9, p < 0.000 and OR 6.3, 95%CI 1.3–31.4, p < 0.001, respectively). Gingivalbleeding had an even stronger association, especially if detected in 4–6 teeth sextants(OR 34.4, 95%CI 4.2–281.3). Severe periodontitisin ≥ 3 teeth or gingivalbleeding in 4–6 teeth sextantsat baseline increased the risk of aSAH during follow-up (HR 22.5, 95%CI 3.6–139.5, p = 0.001 and HR 8.3, 95%CI 1.5–46.1, p = 0.015, respectively). Association of periodontitisand gingivalbleeding with risk of IA development and aSAH was independent of gender, smoking status, hypertension, or alcohol abuse. Periodontitisand gingivalbleeding associate with increased risk for IA formation and eventual aSAH. Further epidemiological and mechanistic studies are indicated.