Archives of Pediatric Infectious Diseases

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Periodontitis, Bacteremia and Infective Endocarditis: A Review Study

Shree V. Dhotre 1 , Milind S. Davane 2 and Basavraj S. Nagoba 2 , *
Authors Information
1 Department of Microbiology, M.M. Patel Public Charitable Trust’s, Ashwini Medical College and Hospital, Kumbhari-413006, Solapur, M.S., India
2 Department of Microbiology, Maharashtra Institute of Medical Sciences and Research, Latur-413 531, M.S., India
Article information
  • Archives of Pediatric Infectious Diseases: July 2017, 5 (3); e41067
  • Published Online: January 16, 2017
  • Article Type: Review Article
  • Received: July 26, 2016
  • Revised: October 31, 2016
  • Accepted: November 21, 2016
  • DOI: 10.5812/pedinfect.41067

To Cite: Dhotre S V, Davane M S, Nagoba B S. Periodontitis, Bacteremia and Infective Endocarditis: A Review Study, Arch Pediatr Infect Dis. 2017 ; 5(3):e41067. doi: 10.5812/pedinfect.41067.

Copyright © 2017, Pediartric Infections Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Context
2. Pathogenesis
3. Periodontitis and Bacteremia
4. Bacteremia and Viridans Group Streptococci
5. Infective Endocarditis
6. Conclusions
  • 1. Hugoson A, Norderyd O, Slotte C, Thorstensson H. Distribution of periodontal disease in a Swedish adult population 1973, 1983 and 1993. J Clin Periodontol. 1998; 25(7): 542-8[PubMed]
  • 2. Haffajee AD, Socransky SS. Microbial etiological agents of destructive periodontal diseases. Periodontol 2000. 1994; 5: 78-111[PubMed]
  • 3. Loe H, Theilade E, Jensen SB. Experimental Gingivitis in Man. J Periodontol. 1965; 36: 177-87[DOI][PubMed]
  • 4. Theilade E, Wright WH, Jensen SB, Loe H. Experimental gingivitis in man. II. A longitudinal clinical and bacteriological investigation. J Periodontal Res. 1966; 1: 1-13[PubMed]
  • 5. Douglas CW, Heath J, Hampton KK, Preston FE. Identity of viridans streptococci isolated from cases of infective endocarditis. J Med Microbiol. 1993; 39(3): 179-82[DOI][PubMed]
  • 6. Drangsholt MT. A new causal model of dental diseases associated with endocarditis. Ann Periodontol. 1998; 3(1): 184-96[DOI][PubMed]
  • 7. Silver JG, Martin AW, McBride BC. Experimental transient bacteraemias in human subjects with varying degrees of plaque accumulation and gingival inflammation. J Clin Periodontol. 1977; 4(2): 92-9[PubMed]
  • 8. Daly CG, Mitchell DH, Highfield JE, Grossberg DE, Stewart D. Bacteremia due to periodontal probing: a clinical and microbiological investigation. J Periodontol. 2001; 72(2): 210-4[DOI][PubMed]
  • 9. Albandar JM, Kingman A. Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. J Periodontol. 1999; 70(1): 30-43[DOI][PubMed]
  • 10. Socransky SS, Haffajee AD. Periodontal microbial ecology. Periodontol 2000. 2005; 38: 135-87[DOI][PubMed]
  • 11. Mariotti A. Dental plaque-induced gingival diseases. Ann Periodontol. 1999; 4(1): 7-19[DOI][PubMed]
  • 12. Page RC. The pathobiology of periodontal diseases may affect systemic diseases: inversion of a paradigm. Ann Periodontol. 1998; 3(1): 108-20[DOI][PubMed]
  • 13. Axelsson P, Albandar JM, Rams TE. Prevention and control of periodontal diseases in developing and industrialized nations. Periodontol 2000. 2002; 29: 235-46[PubMed]
  • 14. Ximenez-Fyvie LA, Haffajee AD, Socransky SS. Comparison of the microbiota of supra- and subgingival plaque in health and periodontitis. J Clin Periodontol. 2000; 27(9): 648-57[PubMed]
  • 15. Graves DT, Cochran D. The contribution of interleukin-1 and tumor necrosis factor to periodontal tissue destruction. J Periodontol. 2003; 74(3): 391-401[DOI][PubMed]
  • 16. Marsh PD. Microbial ecology of dental plaque and its significance in health and disease. Adv Dent Res. 1994; 8(2): 263-71[PubMed]
  • 17. Raber-Durlacher JE, Laheij AM, Epstein JB, Epstein M, Geerligs GM, Wolffe GN, et al. Periodontal status and bacteremia with oral viridans streptococci and coagulase negative staphylococci in allogeneic hematopoietic stem cell transplantation recipients: a prospective observational study. Support Care Cancer. 2013; 21(6): 1621-7[DOI][PubMed]
  • 18. Lockhart PB, Brennan MT, Thornhill M, Michalowicz BS, Noll J, Bahrani-Mougeot FK, et al. Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia. J Am Dent Assoc. 2009; 140(10): 1238-44[PubMed]
  • 19. Forner L, Larsen T, Kilian M, Holmstrup P. Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation. J Clin Periodontol. 2006; 33(6): 401-7[DOI][PubMed]
  • 20. Lockhart PB, Brennan MT, Sasser HC, Fox PC, Paster BJ, Bahrani-Mougeot FK. Bacteremia associated with toothbrushing and dental extraction. Circulation. 2008; 117(24): 3118-25[DOI][PubMed]
  • 21. Kinane DF, Riggio MP, Walker KF, MacKenzie D, Shearer B. Bacteraemia following periodontal procedures. J Clin Periodontol. 2005; 32(7): 708-13[DOI][PubMed]
  • 22. Lucas VS, Gafan G, Dewhurst S, Roberts GJ. Prevalence, intensity and nature of bacteraemia after toothbrushing. J Dent. 2008; 36(7): 481-7[DOI][PubMed]
  • 23. Bartova J, Sommerova P, Lyuya-Mi Y, Mysak J, Prochazkova J, Duskova J, et al. Periodontitis as a risk factor of atherosclerosis. J Immunol Res. 2014; 2014: 636893[DOI][PubMed]
  • 24. Gorelick PB. Stroke prevention therapy beyond antithrombotics: unifying mechanisms in ischemic stroke pathogenesis and implications for therapy: an invited review. Stroke. 2002; 33(3): 862-75[PubMed]
  • 25. Bouvet A. [Invasive infections by Streptococcus viridans (oral streptococci) excluding pneumococci]. Presse Med. 1997; 26(37): 1768-73[PubMed]
  • 26. Coulter WA, Coffey A, Saunders ID, Emmerson AM. Bacteremia in children following dental extraction. J Dent Res. 1990; 69(10): 1691-5[PubMed]
  • 27. Hoecker JL, Pickering LK, Groschel D, Kohl S. Streptococcus salivarius sepsis in children with malignancies. J Pediatr. 1978; 92(2): 337-8[PubMed]
  • 28. Mascret B, Maraninchi D, Gastaut JA, Novakovitch G, Sebahoun G, Meyer G, et al. Risk factors for streptococcal septicaemia after marrow transplantation. Lancet. 1984; 1(8387): 1185-6[PubMed]
  • 29. Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME, et al. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association. Circulation. 2012; 125(20): 2520-44[DOI][PubMed]
  • 30. Li X, Kolltveit KM, Tronstad L, Olsen I. Systemic diseases caused by oral infection. Clin Microbiol Rev. 2000; 13(4): 547-58[PubMed]
  • 31. Sreedevi M, Ramesh A, Dwarakanath C. Periodontal status in smokers and nonsmokers: a clinical, microbiological, and histopathological study. Int J Dent. 2012; 2012: 571590[DOI][PubMed]
  • 32. Tomas I, Alvarez M, Limeres J, Potel C, Medina J, Diz P. Prevalence, duration and aetiology of bacteraemia following dental extractions. Oral Dis. 2007; 13(1): 56-62[DOI][PubMed]
  • 33. Takai S, Kuriyama T, Yanagisawa M, Nakagawa K, Karasawa T. Incidence and bacteriology of bacteremia associated with various oral and maxillofacial surgical procedures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 99(3): 292-8[DOI][PubMed]
  • 34. Brennan MT, Kent ML, Fox PC, Norton HJ, Lockhart PB. The impact of oral disease and nonsurgical treatment on bacteremia in children. J Am Dent Assoc. 2007; 138(1): 80-5[PubMed]
  • 35. Cohen J, Donnelly JP, Worsley AM, Catovsky D, Goldman JM, Galton DA. Septicaemia caused by viridans streptococci in neutropenic patients with leukaemia. Lancet. 1983; 2(8365-66): 1452-4[PubMed]
  • 36. Henslee J, Bostrom B, Weisdorf D, Ramsay N, McGlave P, Kersey J. Streptococcal sepsis in bone marrow transplant patients. Lancet. 1984; 1(8373): 393[PubMed]
  • 37. Kern W, Kurrle E, Schmeiser T. Streptococcal bacteremia in adult patients with leukemia undergoing aggressive chemotherapy. A review of 55 cases. Infection. 1990; 18(3): 138-45[PubMed]
  • 38. Richard P, Amador Del Valle G, Moreau P, Milpied N, Felice MP, Daeschler T, et al. Viridans streptococcal bacteraemia in patients with neutropenia. Lancet. 1995; 345(8965): 1607-9[PubMed]
  • 39. Classen DC, Burke JP, Ford CD, Evershed S, Aloia MR, Wilfahrt JK, et al. Streptococcus mitis sepsis in bone marrow transplant patients receiving oral antimicrobial prophylaxis. Am J Med. 1990; 89(4): 441-6[PubMed]
  • 40. McWhinney PH, Gillespie SH, Kibbler CC, Hoffbrand AV, Prentice HG. Streptococcus mitis and ARDS in neutropenic patients. Lancet. 1991; 337(8738): 429[PubMed]
  • 41. McWhinney PH, Patel S, Whiley RA, Hardie JM, Gillespie SH, Kibbler CC. Activities of potential therapeutic and prophylactic antibiotics against blood culture isolates of viridans group streptococci from neutropenic patients receiving ciprofloxacin. Antimicrob Agents Chemother. 1993; 37(11): 2493-5[PubMed]
  • 42. Beighton D, Hardie JM, Whiley RA. A scheme for the identification of viridans streptococci. J Med Microbiol. 1991; 35(6): 367-72[DOI][PubMed]
  • 43. Beighton D, Carr AD, Oppenheim BA. Identification of viridans streptococci associated with bacteraemia in neutropenic cancer patients. J Med Microbiol. 1994; 40(3): 202-4[DOI][PubMed]
  • 44. Vergis EN, Demas PN, Vaccarello SJ, Yu VL. Topical antibiotic prophylaxis for bacteremia after dental extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 91(2): 162-5[PubMed]
  • 45. Rajasuo A, Perkki K, Nyfors S, Jousimies-Somer H, Meurman JH. Bacteremia following surgical dental extraction with an emphasis on anaerobic strains. J Dent Res. 2004; 83(2): 170-4[PubMed]
  • 46. Parahitiyawa NB, Jin LJ, Leung WK, Yam WC, Samaranayake LP. Microbiology of odontogenic bacteremia: beyond endocarditis. Clin Microbiol Rev. 2009; 22(1): 46-64[DOI][PubMed]
  • 47. MacMahon SW, Roberts JK, Kramer-Fox R, Zucker DM, Roberts RB, Devereux RB. Mitral valve prolapse and infective endocarditis. Am Heart J. 1987; 113(5): 1291-8[PubMed]
  • 48. Gershon AS, de Azavedo JC, McGeer A, Ostrowska KI, Church D, Hoban DJ, et al. Activities of new fluoroquinolones, ketolides, and other antimicrobials against blood culture isolates of viridans group streptococci from across Canada, 2000. Antimicrob Agents Chemother. 2002; 46(5): 1553-6[PubMed]
  • 49. Li W, Somerville J. Infective endocarditis in the grown-up congenital heart (GUCH) population. Eur Heart J. 1998; 19(1): 166-73[PubMed]
  • 50. van der Meer JT, Thompson J, Valkenburg HA, Michel MF. Epidemiology of bacterial endocarditis in The Netherlands. I. Patient characteristics. Arch Intern Med. 1992; 152(9): 1863-8[PubMed]
  • 51. Strom BL, Abrutyn E, Berlin JA, Kinman JL, Feldman RS, Stolley PD, et al. Dental and cardiac risk factors for infective endocarditis. A population-based, case-control study. Ann Intern Med. 1998; 129(10): 761-9[PubMed]
  • 52. Lepeschkin E. On the relation between the site of valvular involvement in endocarditis and the blood pressure resting on the valve. Am J Med Sci. 1952; 224(3): 318-9[PubMed]
  • 53. Sande MA, Kartalija M, Anderson J. The Heart. 2001; : 2087-125
  • 54. Kanafani ZA, Mahfouz TH, Kanj SS. Infective endocarditis at a tertiary care centre in Lebanon: predominance of streptococcal infection. J Infect. 2002; 45(3): 152-9[PubMed]
  • 55. Barrau K, Boulamery A, Imbert G, Casalta JP, Habib G, Messana T, et al. Causative organisms of infective endocarditis according to host status. Clin Microbiol Infect. 2004; 10(4): 302-8[DOI][PubMed]
  • 56. Tariq M, Alam M, Munir G, Khan MA, Smego RA Jr. Infective endocarditis: a five-year experience at a tertiary care hospital in Pakistan. Int J Infect Dis. 2004; 8(3): 163-70[DOI][PubMed]
  • 57. Garg N, Kandpal B, Garg N, Tewari S, Kapoor A, Goel P, et al. Characteristics of infective endocarditis in a developing country-clinical profile and outcome in 192 Indian patients, 1992-2001. Int J Cardiol. 2005; 98(2): 253-60[DOI][PubMed]
  • 58. Nakatani S, Mitsutake K, Ohara T, Kokubo Y, Yamamoto H, Hanai S, et al. Recent picture of infective endocarditis in Japan--lessons from Cardiac Disease Registration (CADRE-IE). Circ J. 2013; 77(6): 1558-64[PubMed]
  • 59. Loupa C, Mavroidi N, Boutsikakis I, Paniara O, Deligarou O, Manoli H, et al. Infective endocarditis in Greece: a changing profile. Epidemiological, microbiological and therapeutic data. Clin Microbiol Infect. 2004; 10(6): 556-61[DOI][PubMed]
  • 60. Tariq M, Siddiqui BK, Jadoon A, Alam M, Khan SA, Atiq M, et al. Clinical profile and outcome of infective endocarditis at the Aga Khan University Hospital. Int J Collaborat Res Intern Med Public Health. 2009; 1: 84-99
  • 61. Van Scoy RE. Culture-negative endocarditis. Mayo Clin Proc. 1982; 57(3): 149-54[PubMed]
  • 62. Wilson WR, Karchmer AW, Dajani AS, Taubert KA, Bayer A, Kaye D, et al. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. JAMA. 1995; 274(21): 1706-13[PubMed]
  • 63. Bayliss R, Clarke C, Oakley CM, Somerville W, Whitfield AG, Young SE. The microbiology and pathogenesis of infective endocarditis. Br Heart J. 1983; 50(6): 513-9[PubMed]
  • 64. Roberts RB, Krieger AG, Schiller NL, Gross KC. Viridans streptococcal endocarditis: the role of various species, including pyridoxal-dependent streptococci. Rev Infect Dis. 1979; 1(6): 955-66[PubMed]
  • 65. Piper C, Hetzer R, Korfer R, Bergemann R, Horstkotte D. The importance of secondary mitral valve involvement in primary aortic valve endocarditis; the mitral kissing vegetation. Eur Heart J. 2002; 23(1): 79-86[DOI][PubMed]
  • 66. Heimdahl A, Hall G, Hedberg M, Sandberg H, Soder PO, Tuner K, et al. Detection and quantitation by lysis-filtration of bacteremia after different oral surgical procedures. J Clin Microbiol. 1990; 28(10): 2205-9[PubMed]
  • 67. Roberts GJ, Holzel HS, Sury MR, Simmons NA, Gardner P, Longhurst P. Dental bacteremia in children. Pediatr Cardiol. 1997; 18(1): 24-7[DOI][PubMed]
  • 68. Kennedy HF, Morrison D, Tomlinson D, Gibson BE, Bagg J, Gemmell CG. Gingivitis and toothbrushes: potential roles in viridans streptococcal bacteraemia. J Infect. 2003; 46(1): 67-70[PubMed]
  • 69. Baddour LM, Christensen GD, Lowrance JH, Simpson WA. Pathogenesis of experimental endocarditis. Rev Infect Dis. 1989; 11(3): 452-63[PubMed]
  • 70. Freedman LR. The pathogenesis of infective endocarditis. J Antimicrob Chemother. 1987; 20 Suppl A: 1-6[PubMed]
  • 71. Moreillon P, Que YA, Bayer AS. Pathogenesis of streptococcal and staphylococcal endocarditis. Infect Dis Clin North Am. 2002; 16(2): 297-318[PubMed]
  • 72. Brown M, Griffin GE. Immune responses in endocarditis. Heart. 1998; 79(1): 1-2[PubMed]
  • 73. Ford I, Douglas CW, Preston FE, Lawless A, Hampton KK. Mechanisms of platelet aggregation by Streptococcus sanguis, a causative organism in infective endocarditis. Br J Haematol. 1993; 84(1): 95-100[PubMed]
  • 74. Herzberg MC, Gong K, MacFarlane GD, Erickson PR, Soberay AH, Krebsbach PH, et al. Phenotypic characterization of Streptococcus sanguis virulence factors associated with bacterial endocarditis. Infect Immun. 1990; 58(2): 515-22[PubMed]
  • 75. Herzberg MC, Brintzenhofe KL, Clawson CC. Aggregation of human platelets and adhesion of Streptococcus sanguis. Infect Immun. 1983; 39(3): 1457-69[PubMed]
  • 76. Herzberg MC. Platelet-streptococcal interactions in endocarditis. Crit Rev Oral Biol Med. 1996; 7(3): 222-36[PubMed]
  • 77. Larsen T, Fiehn NE, Gutschik E, Bangsborg JM. Current status of taxonomic groups of oral streptococci in endocarditis. Can virulence factors discriminate between endocarditis and non-endocarditis strains? Clin Microbiol Infect. 1999; 5(2): 73-7[PubMed]
  • 78. Lowrance JH, Hasty DL, Simpson WA. Adherence of Streptococcus sanguis to conformationally specific determinants in fibronectin. Infect Immun. 1988; 56(9): 2279-85[PubMed]
  • 79. Monchois V, Lakey JH, Russell RR. Secondary structure of Streptococcus downei GTF-1 glucansucrase. FEMS Microbiol Lett. 1999; 177(2): 243-8[PubMed]
  • 80. Coykendall AL. Classification and identification of the viridans streptococci. Clin Microbiol Rev. 1989; 2(3): 315-28[PubMed]
  • 81. Kilian M. Dental Microbiology . 1982; : 832-8
  • 82. Loesche WJ. Oral Microbiology and Immunology. 1994; : 307-19
  • 83. Van Dyke TE, Bartholomew E, Genco RJ, Slots J, Levine MJ. Inhibition of neutrophil chemotaxis by soluble bacterial products. J Periodontol. 1982; 53(8): 502-8[DOI][PubMed]
  • 84. Gould K, Ramirez-Ronda CH, Holmes RK, Sanford JP. Adherence of bacteria to heart valves in vitro. J Clin Invest. 1975; 56(6): 1364-70[DOI][PubMed]
  • 85. Kuusela P, Vartio T, Vuento M, Myhre EB. Attachment of staphylococci and streptococci on fibronectin, fibronectin fragments, and fibrinogen bound to a solid phase. Infect Immun. 1985; 50(1): 77-81[PubMed]
  • 86. Nealon TJ, Beachey EH, Courtney HS, Simpson WA. Release of fibronectin-lipoteichoic acid complexes from group A streptococci with penicillin. Infect Immun. 1986; 51(2): 529-35[PubMed]
  • 87. Mandell GL, Korzeniowski OM. Cardiovascular infections. 1998;
  • 88. Durack DT, Beeson PB. Experimental bacterial endocarditis. I. Colonization of a sterile vegetation. Br J Exp Pathol. 1972; 53(1): 44-9[PubMed]
  • 89. Ishida H, Ishida Y, Kurosaka Y, Otani T, Sato K, Kobayashi H. In vitro and in vivo activities of levofloxacin against biofilm-producing Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1998; 42(7): 1641-5[PubMed]
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