University of Oulu

Hallikainen, J., Lindgren, A., Savolainen, J. et al. Periodontitis and gingival bleeding associate with intracranial aneurysms and risk of aneurysmal subarachnoid hemorrhage. Neurosurg Rev 43, 669–679 (2020).

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

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Author: Hallikainen, Joona1,2; Lindgren, Antti2,3; Savolainen, Jarno1,4;
Organizations: 1Department of Dentistry, University of Eastern Finland, Kuopio, Finland
2Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland
3Department of Neurosurgery, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
4Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
5Science Service Center, Kuopio University Hospital, Kuopio, Finland
6National Institute for Health and Welfare, Helsinki, Finland
7Department of Biomedicine, University of Eastern Finland, Kuopio, Finland
8Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
9Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.1 MB)
Persistent link:
Language: English
Published: Springer Nature, 2019
Publish Date: 2019-10-25


Oral bacteria DNA has been found in intracranial aneurysms (IA) and a high prevalence of periodontitis was reported in IA patients. We investigated whether periodontitis associates with IA formation and aneurysmal subarachnoid hemorrhage (aSAH). First, we compared in a case-control setting the prevalence of periodontal disease 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 periodontitis at 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 gingival pocket) and severe periodontitis (≥ 6mm gingival pocket) 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). Gingival bleeding had an even stronger association, especially if detected in 4–6 teeth sextants (OR 34.4, 95%CI 4.2–281.3). Severe periodontitis in ≥ 3 teeth or gingival bleeding in 4–6 teeth sextants at 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 periodontitis and gingival bleeding with risk of IA development and aSAH was independent of gender, smoking status, hypertension, or alcohol abuse. Periodontitis and gingival bleeding associate with increased risk for IA formation and eventual aSAH. Further epidemiological and mechanistic studies are indicated.

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Series: Neurosurgical review
ISSN: 0344-5607
ISSN-E: 1437-2320
ISSN-L: 0344-5607
Volume: 43
Pages: 669 - 679
DOI: 10.1007/s10143-019-01097-1
Type of Publication: A1 Journal article – refereed
Field of Science: 313 Dentistry
3124 Neurology and psychiatry
Funding: Open access funding provided by University of Eastern Finland (UEF) including Kuopio University Hospital. The present study is part of the Health 2000 Survey (BRIF8901), organized by the National Institute for Health and Welfare (THL), the former Public Health Institute (KTL) of Finland (, and partly supported by the Finnish Dental Society Apollonia and the Finnish Dental Association. This study was also supported by personal grants to J.H. by Planmeca, by a research grant to J.F by the Finnish Medical Foundation, and by Kuopio University Hospital research grants.
Copyright information: © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.