ISSN : 0376-4672
This paper reviews a current view regarding the association between periodontitis and atherosclerotic cardiovascular diseases (ACVD). Many evidences have suggested that there exist biological mechanisms by which periodontitis can lead to ACVD. Periodontal infection can lead to direct bacterial invasion into endothelial tissues through the blood stream, then the bacteria can activate the host inflammatory response followed by atheroma formation, maturation and exacerbation. Also, chronic periodontal infections may indirectly induce endothelial activation or dysfunction through a state of systemic inflammation as evidenced by elevated plasma acute proteins, IL-6 and fibrinogen as well. There is moderate evidence that periodontal treatment can reduce systemic inflammation and improvement of both clinical surrogate markers. But there is no periodontal intervention study available on primary ACVD prevention. There is consistent and strong epidemiologic evidence, including in vitro, animal and clinical studies, that periodontitis imparts increased risk for future ACVD. However, evidences from intervention trials to date are not sufficient to confirm the multi directional causality of periodontitis in ACVD etiology. Well-designed intervention trials on the impact of periodontal treatment on the prevention of ACVD outcomes are needed.
1. Lockhart P, Bolger A, Papapanou P, Osinbowale O, Trevisan M, Levison M, et al. on behalf of the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, and Council on Clinical Cardiology. 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.
2. Tonetti MS, Van Dyke TE. Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. Journal of clinical periodontology. 2013;40(s14):S24-S9.
3. Mattila KJ, Nieminen MS, Valtonen VV, Rasi VP, Kes?niemi YA, Syrj?l? SL, et al. Association between dental health and acute myocardial infarction. BMJ: British Medical Journal. 1989;298(6676):779.
4. Tonetti M, Claffey N. Advances in the progression of periodontitis and proposal of definitions of a periodontitis case and disease progression for use in risk factor research. Journal of clinical periodontology. 2005;32(s6):210-3.
5. Eke P, Dye B, Wei L, Thornton-Evans G, Genco R. Prevalence of periodontitis in adults in the United States: 2009 and 2010. Journal of dental research. 2012;91(10):914-20.
6. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart Disease and Stroke Statistics?2012 Update A Report From the American Heart Association. Circulation. 2012;125(1):e2-e220.
7. Heitz-Mayfield L. Disease progression: identification of high?risk groups and individuals for periodontitis. Journal of clinical periodontology. 2005;32(s6):196- 209.
8. Beck JD. Methods of Assessing Risk for Periodontitis and Developing Multifactorial Models*. Journal of Periodontology. 1994;65(5s):468-78.
9. Page R. The etiology and pathogenesis of periodontitis. Compendium of continuing education in dentistry (Jamesburg, NJ: 1995). 2002;23(5 Suppl):11.
10. Palmer RM, Wilson RF, Hasan AS, Scott DA. Mechanisms of action of environmental factors?tobacco smoking. Journal of clinical periodontology. 2005;32(s6):180-95.
11. Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003;107:363-9.
12. Van Dyke TE, Winkelhoff AJ. Infection and inflammatory mechanisms. Journal of clinical periodontology. 2013;40(s14):S1-S7.
13. Madianos P, Bobetsis Y, Kinane D. Generation of inflammatory stimuli: how bacteria set up inflammatory responses in the gingiva. Journal of clinical periodontology. 2005;32(s6):57-71.
14. Haraszthy V, Zambon J, Trevisan M, Zeid M, Genco R. Identification of periodontal pathogens in atheromatous plaques. Journal of Periodontology. 2000;71(10):1554-60.
15. Molmeret M, Abu Kwaik Y. How does Legionella pneumophila exit the host cell? Trends in microbiology. 2002;10(6):258-60.
16. Reyes L, Kozarov E, Herrera D, Roldan S, Progulske-Fox A. Periodontal bacterial invasion and infection: Contribution to cardiovascular disease. Journal of clinical periodontology. 2013;40:30-50.
17. Amar S, Gokce N, Morgan S, Loukideli M, Van Dyke TE, Vita JA. Periodontal disease is associated with brachial artery endothelial dysfunction and systemic inflammation. Arteriosclerosis, thrombosis, and vascular biology. 2003;23(7):1245-9.
18. Schenkein HA, Loos BG. Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. Journal of clinical periodontology. 2013;40(s14):S51-S69.
19. Terricabras E, Benjamim C, Godessart N. Drug discovery and chemokine receptor antagonists: Autoimmunity reviews. 2004;3(7):550-6.
20. Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. Journal of clinical periodontology. 2013;40(s14):S70-S84.
21. Lee HJ, Garcia RI, Janket S-J, Jones JA, Mascarenhas AK, Scott TE, et al. The association between cumulative periodontal disease and stroke history in older adults.
22. D'Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. Journal of clinical periodontology. 2013;40(s14):S85-S105.
23. Tonetti MS, D'Aiuto F, Nibali L, Donald A, Storry C, Parkar M, et al. Treatment of periodontitis and endothelial function. New England Journal of Medicine. 2007;356(9):911-20.
24. Armstrong MJ, Gronseth G, Anderson DC, Biller J, Cucchiara B, Dafer R, et al. Summary of evidence-based guideline: Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80(22):2065-9.
