Periodontal Disease and Cardiovascular Disease

Abstract

It is our central hypothesis that periodontal diseases, which are chronic Gram-negative infections, represent a previously unrecognized risk factor for atherosclerosis and thromboembolic events. Previous studies have demonstrated an association between periodontal disease severity and risk of coronary heart disease and stroke. We hypothesize that this association may be due to an underlying inflammatory response trait, which places an individual at high risk for developing both periodontal disease and atherosclerosis. We further suggest that periodontal disease, once established, provides a biological burden of endotoxin (lipopolysaccharide) and inflammatory cytokines (especially TxA2, IL-1 beta, PGE2, and TNF-alpha) which serve to initiate and exacerbate atherogenesis and thromboembolic events. A cohort study was conducted using combined data from the Normative Aging Study and the Dental Longitudinal Study sponsored by the United States Department of Veterans Affairs. Mean bone loss scores and worst probing pocket depth scores per tooth were measured on 1,147 men during 1968 to 1971. Information gathered during follow-up examinations showed that 207 men developed coronary heart disease (CHD), 59 died of CHD, and 40 had strokes. Incidence odds ratios adjusted for established cardiovascular risk factors were 1.5, 1.9, and 2.8 for bone loss and total CHD, fatal CHD, and stroke, respectively. Levels of bone loss and cumulative incidence of total CHD and fatal CHD indicated a biologic gradient between severity of exposure and occurrence of disease.

Salivary Biomarkers, Oral Inflammation, and Functional Status in Patients With Heart Failure

“…Oral bacteria can live throughout the body and have ''stealth-like'' properties that allow them to evade the immune system and stay in the body long term. Beck, Garcia, Heiss, Vokonas, and Offenbacher (1996) proposed that the relationship between periodontal disease and CVD was due to this systemic bacterial dissemination altering the blood vessels and triggering an acute phase response in the liver, leading to systemic inflammation. This persistent systemic inflammation then contributes to the development of CVD.…”

Periodontitis and systemic disease

“…Skipping forward to more recent times, evidence from well-designed studies began to emerge in the late 1980's of possible linkages between chronic periodontal disease and other systemic diseases. 3,4 Since then there has been an exponential rise in the number of studies that have investigated links between periodontal disease and various diseases with the main areas of interest being: atherosclerotic cardiovascular disease, 5 diabetes, 6 and adverse pregnancy outcome. 7 Associations between periodontitis and many other diseases and conditions have also been reported including respiratory disease; chronic kidney disease; rheumatoid arthritis; cognitive impairment; obesity; metabolic syndrome; and cancer.…”

Mechanisms of Periodontitis - Induced Atherosclerosis

“…In many epidemiological studies, periodontitis was proven to play important roles in initiation and progression of CVD, [69,70] by chronic infection on the blood vessels [20][21][22][23][24][25][26][27][28][29] or by the elevation of body�s CRP level. [29][30][31][32][33][34][35][36][37][38][39] The prevalence of chronic periodontitis was very high among populations, especially in chronic form.…”

“…[75] Chronic infection was known to be able to cause endothelial dysfunction. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] PG�s fimbriae secretes protein, called gp130, [83] which facilitate PG to invade EC and trigger celluler immune response. [84] The host will secrete TNF, [85] IL-1, IL-6, IL-10, and IL-12 [86][87][88] by TLR�s stimulation.…”

“…[19,20] Atherosclerosis had been proven to be induced by periodontopathogen from periodontitis. [21][22][23][24][25][26][27][28] Inflammation in mouth may cause systemic inflammation, which is indicated by the elevation of CRP in the body, [29,30] which is functioned as markers, [31,32] predictors of CVD, [33,34] and may induce atherosclerosis lesions. [35][36][37][38] Focal infection in mouth may induce atherosclerosis lesions by initiate systemic and humoral immune responses.…”