Cardiovascular and periodontal diseases

Associate Professor of Cardiac Surgery at the Campinas State University Medical School. E-mail: [email protected] Cardiovascular diseases, especially those associated with atherosclerosis, are still one of the main causes of death worldwide. There are well-established risk factors for cardiovascular diseases, one of them being elevated levels of serum lipids combined with infections such as odontogenic infections, which consist of dental caries and periodontal disease (gingivitis and periodontitis). Periodontal and cardiovascular diseases share many risk factors, such as age, educational level, gender, income level, smoking and drinking habits, hypertension, stress, depression, and diabetes. Several studies have shown that patients with periodontitis and acute ischemic syndromes share various characteristics. It should be noted that severe chronic periodontitis can alter lipid profiles as well as lead to acute coronary events. In addition, the presence of periodontal organisms in coronary arteries has been linked to the development and progression of atherosclerosis. The presence of Chlamydia pneumoniae in 35% of the coronary and internal thoracic arteries suggests that this bacterium plays an important role in the progression of atherosclerosis [1]. In the United States, 25% of adults age 60 and older lose all their teeth (edentulism), half of them due to periodontal disease; the other half, to caries [2]. Chronic periodontitis consist of chronic oral infections found on the surface of teeth and in adjacent tissues. Clinically, the onset is marked by gingival inflammation and is followed by formation of a periodontal pocket, which fosters the development and growth of anaerobic Gram-negative bacteria, including Porphyromonas gingivalis, Prevotella intermedia, Aggregatibacter actinomycetemcomitans, and Tannerella forsythia, among others [3]. Experimental studies have convincingly demonstrated the release of inflammatory mediators from peripheral monocytes when taken from patients with periodontitis and exposed in vitro to bacterial lipopolysaccharides. The accumulation of bacteria in the periodontal microflora results in the production of lipopolysaccharides, which are released from the external membrane of Gram-negative bacteria.