Plasma fibrinogen and C-reactive protein decreased after nonsurgical periodontal therapy in non-coronary heart disease subjects with periodontitis

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Apimart Bamrungphuet
Supanee Rassameemasmaung
Pariwat Pengkaew
Chayasin Mansanguan


Objective: To evaluate the effect of nonsurgical periodontal therapy (NSPT) on the level of fibrinogen, plasminogen activator inhibitor-1 (PAI-1), and C-reactive protein (CRP).

Materials and Methods: This study comprised 12 subjects with coronary heart disease (CHD) and 15 subjects without CHD (non-CHD). Each group had 2 subgroups with or without periodontitis. Periodontal parameters and cardiovascular biomarkers were measured at baseline. All subjects received NSPT. All parameters were re-evaluated at 3- and 6-months post-treatment.

Results: At baseline, there were no significant differences in the patients’ characteristics. The periodontal inflammation and periodontal disease status results revealed that the non-CHD with periodontitis group had a significantly higher percentage of bleeding on probing + pocket depth > 4 mm + clinical attachment level t 5 mm compared with the CHD with periodontitis group. After NSPT, there was a significant periodontal improvement in all groups. The non-CHD with periodontitis group demonstrated a significant reduction in fibrinogen and CRP level at 6 months after NSPT compared with baseline.

Conclusion: NSPT significantly reduced fibrinogen and CRP in non-CHD subjects with periodontitis.

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Bamrungphuet A, Rassameemasmaung S, Pengkaew P, Mansanguan C. Plasma fibrinogen and C-reactive protein decreased after nonsurgical periodontal therapy in non-coronary heart disease subjects with periodontitis. M Dent J [Internet]. 2022 Mar. 23 [cited 2024 Jun. 17];42(1):1-12. Available from:
Original articles


Ahmed U, Tanwir F. Association of periodontal pathogenesis and cardiovascular diseases: a literature review. Oral Health Prev Dent 2015; 13: 21-27.

Moshage HJ, Roelofs HM, van Pelt JF, Hazenberg BP, van Leeuwen MA, Limburg PC et al. Aaden LA, Yap SH. The effect of interleukin-1, interleukin-6 and its interrelationship on the synthesis of serum amyloid A and C-reactive protein in primary cultures of adult human hepatocytes. Biochem Biophys Res Commun 1988; 155: 112-117.

Zimmermann O, Li K, Zaczkiewicz M, Graf M, Liu Z, Torzewski J. C-reactive protein in human atherogenesis: facts and fiction. Mediators Inflamm 2014; 2014: 561428.

Arbustini E, Narula N, D’Armini AM. Fibrinogen: a circulating factor in search of its genetic architecture. Circulation 2013; 128: 1276-1280.

D'Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Clin Periodontol 2013; 40: S85-S105.

Sawdey M, Podor TJ, Loskutoff DJ. Regulation of type 1 plasminogen activator inhibitor gene expression in cultured bovine aortic endothelial cells. Induction by transforming growth factor-beta, lipopolysaccharide, and tumor necrosis factor-alpha. J Biol Chem 1989; 264: 10396-100401.

Bizzarro S, Van Der Velden U, Ten Heggeler JMAG, Leivadaros E, Hoek FJ, Gerdes VEA, et al. Periodontitis is characterized by elevated PAI-1 activity. J Clin Periodontol 2007; 34 :574-580.

Chandy S, Joseph K, Sankaranarayanan A, Issac A, Babu G, Wilson B, et al. Evaluation of c-reactive protein and fibrinogen in patients with chronic and aggressive periodontitis: a clinico-biochemical study. J Clin Diagn Res 2017; 11: ZC41-ZC45.

Tuttolomondo A, Raimondo DD, Pecoraro R, Arnao V, Pinto A, Licata G. Atherosclerosis as an Inflammatory Disease. Curr Pharm Des 2012; 18: 4266-4288.

Lowe GDO, Rumley A, Mackie IJ. Plasma fibrinogen. Ann of Clin Biochem 2004; 41: 430-440.

Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol 2008; 35: 277-290.

Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH. Prospective study of c-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 1998; 98: 731-733.

Song B, Shu Y, Xu YN, Fu P. Plasma fibrinogen lever and risk of coronary heart disease among Chinese population: a systematic review and meta-analysis. Int J Clin Exp Med 2015; 8:13195-13202.

Tonetti MS, Van Dyke TE. Periodontitis and atherosclerotic cardiovascular disease: consensus report of the joint EFP/AAP workshop on periodontitis and systemic diseases. J Periodontol 2013; 84: S24-S29.

Winning L, Patterson CC, Linden K, Evans A, Yarnel J, McKeown PP, et al. Periodontitis and risk of prevalent and incident coronary heart disease events. J Clin Periodontol 2020; 47: 1446-1456.

Bokhari SAH, Khan AA, Butt AK, Azhar M, Hanif M, Hanif M, et al. Non-surgical periodontal therapy reduces coronary heart disease risk markers: a randomized controlled trial. J Clin Periodontol 2012; 39: 1065-1074.

Bokhari SAH, Khan AA, Tatakis DN, Azhar M, Hanif M, Izhar M. Non-surgical periodontal therapy lowers serum inflammatory markers: a pilot study. J Periodontol 2009; 80: 1574-1580.

Montebugnoli L, Servidio D, Miaton RA, Prati C, Tricoci P, Melloni C, et al. Periodontal health improves systemic inflammatory and haemostatic status in subjects with coronary heart disease. J Clin Periodontol 2005; 32: 188-192.

Montenegro MM, Ribeiro IWJ, Kampits C, Saffi MAL, Furtado MV, Polanczyk CA, et al. Randomized controlled trial of the effect of periodontal treatment on cardiovascular risk biomarkers in patients with stable coronary artery disease: Preliminary findings of 3 months. J Clin Periodontol 2019; 46: 321-331.

Zhou SY, Duan XQ, Hu R, Ouyang XY. Effect of non-surgical periodontal therapy on serum levels of TNF-a, IL-6 and C-reactive protein in periodontitis subjects with stable coronary heart disease. Chin J Dent Res 2013; 16: 145-151.

Tonetti MS, D'Aiuto F, Nibali L, Donald A, Storry C, Parkar M, et al. Treatment of periodontitis and endothelial function. N Engl J Med 2007; 356: 911-920.

Pan W-H, Yeh W-T. How to define obesity? Evidence-based multiple action points for public awareness, screening, and treatment: An extension of Asian-Pacific recommendations. Asia Pac J Clin Nutr 2008; 17: 370-374.

O'Leary TJ, Drake RB, Naylor JE. The Plaque Control Record. J Periodontol 1972; 43: 38.

Lenox JA, Kopczyk RA. A clinical system for scoring a patient's oral hygiene performance. J Am Dent Assoc 1973; 86: 849-852.

Machado V, Botelho J, Escalda C, Hussain SB, Luthra S, Mascarenhas P, et al. Serum C-Reactive Protein and Periodontitis: A Systematic Review and Meta-Analysis. Front Immunol 2021; 12: 3054.

Ritam S, Jyoti R. Effect of periodontal treatment on plasma fibrinogen, serum C-reactive protein and total white blood cell count in periodontitis patients – a prospective interventional trial. Rom J Intern med 2013; 51: 45-51.

Taylor B, Tofler G, Morel‐Kopp MC, Carey H, Carter T, Elliott M, et al. The effect of initial treatment of periodontitis on systemic markers of inflammation and cardiovascular risk: a randomized controlled trial. Eur J Oral Sci 2010; 118: 350-356.

Buhlin K, Hultin M, Norderyd O, Persson L, Pockley AG, Pussinen PJ, et al. Periodontal treatment influences risk markers for atherosclerosis in patients with severe periodontitis. Atherosclerosis 2009; 206: 518-522.

D’Aiuto F, Parkar M, Tonetti MS. Periodontal therapy: a novel acute inflammatory model. Inflamm Res 2005; 54: 412-414.

Mattila K, Vesanen M, Valtonen V, Nieminen M, Palosuo T, Rasi V, et al. Effect of treating periodontitis on C-reactive protein levels: a pilot study. BMC Infect Dis 2002; 2: 30.

Radafshar G, Shad B, Ariamajd E, Geranmayeh S. Effect of intensive non-surgical treatment on the level of serum inflammatory markers in advanced periodontitis. J Dent (Tehran) 2010; 7: 24-30.

Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, c-reactive protein, albumin, or leukocyte count with coronary heart disease: Meta-analyses of prospective studies. JAMA 1998; 279: 1477-1482.

Demmer RT, Trinquart L, Zuk A, Fu BC, Blomkvist J, Michalowicz BS, et al. The influence of anti-infective periodontal treatment on C-reactive protein: a systematic review and meta-analysis of randomized controlljed trials. PLoS One 2013; 8: 77441.

Slots J, Emrich LJ, Genco RJ, Rosling BG. Relationship between some subgingival bacteria and periodontal pocket depth and gain or loss of periodontal attachment after treatment of adult periodontitis. J Clin Periodontol 1985; 12: 540-552.