Mounting evidence suggests that chronic inflammation plays a significant role in the development of CVD, leading to speculation that periodontitis could be a modifiable risk factor contributing to CVD. “Periodontitis is a bacterially induced inflammatory disease that destroys the connective tissue and bone supporting the teeth. Alongside dental caries, it is one of the most common oral health conditions”. Dietrich et al (2007). In the UK, nearly half of all adults experience some form of irreversible periodontitis, a condition that becomes more prevalent with age, while almost a third of the population has visible dental decay. Given its high prevalence and association with chronic inflammation, researchers have increasingly explored the potential link between periodontitis and systemic conditions such as CVD, emphasising the need for further investigation into its broader health implications.
The link between periodontal disease and CVD has garnered substantial attention due to shared inflammatory mechanisms and common risk factors. Epidemiological evidence suggests that periodontitis, especially chronic periodontitis, is associated with several cardiovascular conditions, including hypertension, diabetes mellitus, hyperlipidemia atrial fibrillation, coronary artery disease (CAD), and stroke. Studies indicate that individuals with periodontal disease are at a higher risk for atherosclerotic vascular disease (ASVD), even after adjusting for traditional risk factors such as smoking, diabetes, and hypertension. For example, meta-analyses have shown that chronic periodontitis increases the risk of stroke, with a relative risk of 1.63, and contributes to the development of coronary heart disease (CHD). Despite these findings, the mechanisms driving the association between periodontal disease and CVD remain unclear.
Biologically, the relationship between periodontal disease and cardiovascular health is driven by chronic inflammation. Elevated proinflammatory cytokines (IL-1, IL-6, TNF-α) contribute to atherosclerosis, with disease severity correlating to increased systemic inflammation. Ko et al (2011) “found that periodontitis patients had higher IL-6 levels, highlighting its role in vascular inflammation and atherogenesis”. Oral bacteria like Porphyromonas gingivalis can enter the bloodstream through periodontal tissues, leading to systemic inflammation and platelet aggregation, which contribute to the formation of atherosclerotic plaques. Further, the severity of periodontitis may influence cardiovascular risk, as more severe cases can lead to heightened systemic inflammation and endothelial dysfunction. A study by D’Aiuto et al (2004) showed that patients with severe periodontitis had higher levels of C-reactive protein (CRP), a marker of inflammation that is strongly correlated with cardiovascular disease risk.
Periodontal therapy, particularly non-surgical periodontal therapy (NSPT), has been shown to play a crucial role in reducing systemic inflammation and lowering cardiovascular risk. Studies have demonstrated that successful periodontal treatment can positively influence the progression of subclinical cardiovascular disease (CVD) by reducing inflammatory markers such as C-reactive protein (CRP) and fibrinogen. Holmlud et al. (2006) “found that individuals who responded well to periodontal treatment had a lower incidence of CVD compared to poor responders”. Similarly, Lee et al. (2015) and Park et al. (2019) “highlighted that professional dental care, including regular cleanings and improved oral hygiene habits, significantly reduced cardiovascular risk”. These findings highlight that periodontal health has a more significant impact on overall cardiovascular well-being than previously understood. By addressing periodontal disease and reducing systemic inflammation, periodontal therapy can improve vascular health and potentially lower cardiovascular event risks, underscoring the importance of integrating periodontal care into broader cardiovascular disease prevention and management strategies.
The integration of oral health into cardiovascular care offers significant public health benefits by guiding policymakers toward effective preventive strategies. Collaborative efforts, such as those with Public Health England, highlight the importance of incorporating oral health into public health policies. By promoting oral health, healthcare systems can improve outcomes, reduce costs, and enhance population well-being. Public health initiatives focused on oral care can contribute to controlling hypertension, improving glycemic control in diabetic patients, and lowering the risk of ischemic heart disease.
While the existing evidence remains compelling establishing causality between periodontitis and cardiovascular disease (CVD) is challenging due to overlapping risk factors like smoking, obesity, and poor diet. The variability in periodontal treatments makes it difficult to determine the most effective approach for reducing CVD risk. Therefore, further high-quality studies are needed to elucidate the exact mechanisms and determine whether periodontal treatment can effectively reduce cardiovascular risk. Further studies should prioritise large-scale, longitudinal studies and randomised controlled trials to assess the impact of periodontal therapy on CVD outcomes such as myocardial infarction and stroke. Controlling for lifestyle confounders will be essential for more accurate conclusions. Addressing these challenges will help clarify the relationship between periodontal health and cardiovascular disease.
In conclusion, the relationship between periodontal disease and cardiovascular health presents both opportunities and challenges for improving public health. While evidence linking oral health to cardiovascular risk is growing, establishing causality remains difficult due to shared risk factors and treatment variability. Nevertheless, incorporating periodontal care into cardiovascular management could offer significant public health benefits, particularly through preventive measures. Future research is necessary to fully understand the mechanisms underlying this link and to optimise treatment strategies. Ultimately, integrating oral health into cardiovascular care could lead to better outcomes for patients and reduce the burden of both conditions.
References
Hopkins, S., Gajagowni, S., Qadeer, Y., Wang, Z., Virani, S. S., Meurman, J.
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Hopkins, S., Gajagowni, S., Qadeer, Y., Wang, Z., Virani, S. S., Meurman, J. H., Leischik, R., Lavie, C. J., Strauss, M., & Krittanawong, C. (2024). More than just teeth: How oral health can affect the heart. American heart journal plus: cardiology research and practice, 43, 100407.
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Dietrich, T., Webb, I., Stenhouse, L., Pattni, A., Ready, D., Wanyonyi, K. L., White, S., & Gallagher, J. E. (2017). Evidence summary: the relationship between oral and cardiovascular disease. British dental journal, 222 (5), 381–385. https://doi.org/10.1038/sj.bdj.2017.224
Bertoldi, C., Salvatori, R., Pinti, M., & Mattioli, A. V. (2024). Could the periodontal therapy improve the cardiologic patient health? A narrative review. Current Problems in Cardiology, 49 (9), 102699.