Medicine
Oral health and periodontitis are linked to cardiovascular disease
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Ainhoa Pérez
Alumni
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MPH, MSc.
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Periodontitis is a chronic inflammatory disease with systemic implications. Several studies link its presence to an increased risk of cardiovascular disease. This connection raises the need to integrate oral health into cardiovascular prevention and overall health.
The oral cavity harbors a complex and diverse microbiota that is essential for both local and systemic homeostasis. The bacterial genera present regulate pH, modulate the immune response, and maintain the integrity of periodontal tissues. Various factors can alter this homeostasis and promote dysbiosis, a prime example of which is periodontitis, a chronic inflammatory disease that affects millions of people. In periodontitis, colonization by species such as Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola predominates, which progressively erode the dental support tissues, including alveolar bone and periodontal ligament, releasing proinflammatory molecules capable of crossing the oral mucosa, passing into the bloodstream, and producing systemic immune responses that elevate levels of cytokines such as IL-1, IL-6, TNF-alpha, and C-reactive protein. These signals promote a pro-inflammatory, proatherogenic, and prothrombotic environment, potentially contributing to the development and progression of cardiovascular disease.
A recent review has summarized the evidence linking periodontitis and cardiovascular disease, addressing the main pathophysiological mechanisms, the relationship with comorbidities (endocarditis, hypertension, atrial fibrillation, ischemic heart disease, diabetes, and dyslipidemia), and the potential impact of periodontal therapy on reducing cardiovascular risk, including observational studies, clinical trials, and meta-analyses published through 2024 (Hopkins et al., 2024). The available evidence shows a robust association between periodontitis and multiple cardiovascular diseases. Approximately 90% of the bacteria responsible for infectious endocarditis, such as Staphylococcus aureus, Streptococcus viridans, and Enterococcus faecalis, come from the oral microbiota. Poor oral hygiene and bleeding during brushing are associated with a substantial increase in the risk of bacteremia.
Periodontal disease is consistently associated with an increased risk of coronary artery disease and major coronary events, and periodontal bacterial material has been detected in atherosclerotic lesions. An increased risk of atrial fibrillation has also been found, with a dose-response relationship linked to the number of missing teeth and levels of systemic inflammation, and adherence to oral hygiene measures has been linked to the risk of arrhythmias. On the other hand, there is a higher prevalence of high blood pressure in adults with periodontitis, with a linear relationship between the severity of periodontal disease and blood pressure. Bidirectional relationships have also been found between periodontitis and type 2 diabetes, as well as with the lipid profile. In people with diabetes, some studies show that periodontal intervention improves glycemic control and contributes to reducing cardiovascular risk. Some clinical trials and prospective studies show that periodontal treatment reduces systemic inflammatory markers, improves endothelial function, and lowers blood pressure, particularly in people with coronary heart disease or hypertension.
Despite these findings, there are not yet enough large-scale clinical trials on hard events to draw a direct clinical recommendation for systematic oral intervention. However, it is reasonable to pay attention to oral health care, which may be more relevant in people with cardiovascular risk and other metabolic conditions. This would also call into question the lack of integration of oral care into health systems.
The oral cavity harbors a complex and diverse microbiota that is essential for both local and systemic homeostasis. The bacterial genera present regulate pH, modulate the immune response, and maintain the integrity of periodontal tissues. Various factors can alter this homeostasis and promote dysbiosis, a prime example of which is periodontitis, a chronic inflammatory disease that affects millions of people. In periodontitis, colonization by species such as Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola predominates, which progressively erode the dental support tissues, including alveolar bone and periodontal ligament, releasing proinflammatory molecules capable of crossing the oral mucosa, passing into the bloodstream, and producing systemic immune responses that elevate levels of cytokines such as IL-1, IL-6, TNF-alpha, and C-reactive protein. These signals promote a pro-inflammatory, proatherogenic, and prothrombotic environment, potentially contributing to the development and progression of cardiovascular disease.
A recent review has summarized the evidence linking periodontitis and cardiovascular disease, addressing the main pathophysiological mechanisms, the relationship with comorbidities (endocarditis, hypertension, atrial fibrillation, ischemic heart disease, diabetes, and dyslipidemia), and the potential impact of periodontal therapy on reducing cardiovascular risk, including observational studies, clinical trials, and meta-analyses published through 2024 (Hopkins et al., 2024). The available evidence shows a robust association between periodontitis and multiple cardiovascular diseases. Approximately 90% of the bacteria responsible for infectious endocarditis, such as Staphylococcus aureus, Streptococcus viridans, and Enterococcus faecalis, come from the oral microbiota. Poor oral hygiene and bleeding during brushing are associated with a substantial increase in the risk of bacteremia.
Periodontal disease is consistently associated with an increased risk of coronary artery disease and major coronary events, and periodontal bacterial material has been detected in atherosclerotic lesions. An increased risk of atrial fibrillation has also been found, with a dose-response relationship linked to the number of missing teeth and levels of systemic inflammation, and adherence to oral hygiene measures has been linked to the risk of arrhythmias. On the other hand, there is a higher prevalence of high blood pressure in adults with periodontitis, with a linear relationship between the severity of periodontal disease and blood pressure. Bidirectional relationships have also been found between periodontitis and type 2 diabetes, as well as with the lipid profile. In people with diabetes, some studies show that periodontal intervention improves glycemic control and contributes to reducing cardiovascular risk. Some clinical trials and prospective studies show that periodontal treatment reduces systemic inflammatory markers, improves endothelial function, and lowers blood pressure, particularly in people with coronary heart disease or hypertension.
Despite these findings, there are not yet enough large-scale clinical trials on hard events to draw a direct clinical recommendation for systematic oral intervention. However, it is reasonable to pay attention to oral health care, which may be more relevant in people with cardiovascular risk and other metabolic conditions. This would also call into question the lack of integration of oral care into health systems.
#oralhealth #periodontitis #microbiota #mouthwashes
References:
Hopkins, S et al, 2024. More than just teeth: How oral health can affect the heart. American Heart Journal Plus: Cardiology Research and Practice, 43, 100407. https://doi.org/10.1016/j.ahjo.2024.100407
* The news published on studies do not represent an official position of ICNS, nor a clinical recommendation.
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