Influence of the Periodontium on Cardiovascular Disease

The results of several recent cross-sectional and longitudinal human epidemiologic studies have demonstrated a statistical link between the occurrence of destructive periodontal disease in the oral cavity and an increased risk of cardiovascular disease. Several theories have been advanced to explain the association of the two diseases. However, it is not presently known if periodontitis plays an etiologic role in the pathogenesis of cardiovascular disease or whether the relationship is merely a statistical correlate for an undetermined risk factor common to both diseases. The strength and limitations of the available data from major studies are discussed, along with potential clinical implications for dental practitioners. 1Thomas E. Rams, DDS, Professor and Chairman, Department of Periodontology and Professor of Oral Biology, Associate Dean for Advanced Education and Research, Temple University School of Dentistry 2Eugene J. Whitaker, DMD, PhD, Associate Professor of Restorative Dentistry and Oral Biology, and Director of Oral Biology Research Laboratory, Temple University School of Dentistry Address: Professor Thomas E. Rams, Department of Periodontology Director, Oral Microbiology Testing Service Laboratory. Temple University School of Dentistry. 3223 North Broad Street. Philadelphia, PA, U.S.A. ➢ Until recently, the most widely recognized link between the status of the periodontium in the oral cavity and cardiovascular disease was related to the key role played by inflamed gingival tissues in the pathogenesis of subacute infective endocarditis. Chewing, oral hygiene procedures, trauma, and various dental therapies have an increased potential in the presence of gingival inflammation to seed viridans streptococci and periodontal pathogens (i.e., Actinobacillus actinomycetemcomitans) from subgingival dental plaque biofilms into the bloodstream and increase the risk of subacute infective endocarditis in individuals with pre-existing valvular heart conditions. Subactute infective endocarditis thus represents a type of "dental focal infection" where systemic dissemination of certain pathogenic oral microorganisms via transient bacteremias leads to clinical disease at a non-oral body site. More recently, emerging research data has implicated destructive periodontal disease as a risk factor in other types of heart conditions, most notably, acute myocardial infarction and coronary heart disease. This paper will provide a critical review of major studies reported to date on this issue and their possible implications for dental practitioners.