Title: Periodontal disease as a modifiable inflammatory risk factor for cardiovascular disease: A systematic review of clinical and biomarker evidence
Abstract:
Periodontal disease is frequently cited as a potential inflammatory risk factor for cardiovascular disease, yet evidence supporting this is not yet conclusive. Observational studies reveal higher risk of subsequent cardiovascular disease, coronary heart disease, stroke, and first myocardial infarction among individuals with periodontitis compared to individuals without periodontitis. Reviews have also shown this association may be stronger among young adults and those with severe periodontitis. Though these findings hint that periodontal disease may affect certain populations more than others, there is not consistency in the magnitude of the association across studies. Biomarker data also provides some evidence for the development of systemic inflammation with periodontal disease. Periodontitis has been associated with increased C-reactive protein, interleukin-6, leukocytes, neutrophils, and markers of endothelial dysfunction. These findings bolster the theory that oral infection may increase overall inflammation. Proposed pathways reviewed in the literature also include invasion of oral bacteria into the bloodstream, local release of inflammatory mediators, prothrombotic alterations, and dyslipidemia. While the proposed biological mechanisms make sense, there are steps in the process that need further clarification. Data from treatment studies have primarily focused on surrogate outcomes. Periodontal treatment has been shown to improve inflammatory markers and has some evidence supporting improvement in endothelial function. There is also some evidence showing improvements in blood pressure and lipid levels with treatment, though these are mixed. However, the current body of randomized evidence does not support periodontal treatment reducing incident myocardial infarction, stroke, or other cardiovascular events. Together, the literature establishes periodontal disease as a potential modifiable inflammatory risk factor for cardiovascular disease. The main question that remains to be answered is if periodontal treatment can help prevent future cardiovascular events or if it simply improves biomarkers.
