Periodontitis and atherosclerosis: an observational study. 
Poor oral health has been related with cardiovascular diseases.  Specifically, periodontitis has been implicated in the pathogenesis of atherosclerosis.  Our aim was to evaluate the relationship between the degree of carotid atherosclerosis and severity of periodontitis in a patient cohort.  Fifty adult patients receiving carotid duplex scans in a cerebral hemodynamics lab were included in the study.  Ultrasound protocol included measurement of carotid intima-media thickness (IMT), which is a marker of atherosclerosis, and characterization of any atherosclerotic plaques in the cervical common and internal carotid arteries.  Patients were divided into two main groups: the test group had IMT ≥ 1 mm or the presence of any carotid atherosclerotic plaque, and the control group had IMT < 1 mm and absence of atherosclerotic plaques.  Periodontal evaluation was performed in all the teeth and characterized according to the clinical attachment level, which between 1 mm and 2 mm was classified as slight, 3 mm and 4 mm as moderate and ≥5 mm as severe.  The control group included 15 (30%), while the test group included 35 (70%) subjects.  The most common diagnosis was severe periodontitis (40%); moderate and slight periodontitis were also frequent occurrences (32% and 28%, respectively).  In the control group, 53.3% had slight, 33.3% had moderate and 13.3% had severe periodontitis.  In the test group, those percentages were respectively 22.2%, 44.4% and 33.3%.  Patients with atheroma plaque had the highest percentage of severe periodontitis (70.6%).  More severe periodontitis was related to atherosclerosis (P = 0.007).  This study showed an association between periodontitis severity and carotid atherosclerosis, suggesting that periodontal disease might be a risk indicator for atherosclerotic disease.