Scientific evidence for the relationship between periodontitis and cardiovascular disease

DOI: 10.4236/wjcd.2013.34A009   PDF   HTML   XML   4,148 Downloads   6,419 Views   Citations


A lot of clinical studies have investigated the possible association between periodontitis and coronary heart disease (CHD). Some of them indicate the existence of an epidemiologic association between these two concepts, and support previous investigations that have found that chronic periodontal inflammation, persistent bacterial infection with the presence of major periodontal pathogens, deep periodontal pockets. The number of missing teeth and other periodontal markers, seem to be important risk factors for cardiovascular diseases. Nevertheless, it will be required to carry out better controlled and larger studies to identify if these biological mechanisms are responsible for these increased risks and to provide a convincing support of a casual association and to determine if periodontal treatments could prevent CHD. Since periodontal disease and cardiovascular disease are common, their association has a significant public health importance. They share common risk factors, such as increasing age, smoking, stress, socioeconomic status and body fat metabolism, and that is the reason why there could be significant bias.

Share and Cite:

Rosado, A. , Marcos, H. and Gómez, P. (2013) Scientific evidence for the relationship between periodontitis and cardiovascular disease. World Journal of Cardiovascular Diseases, 3, 62-68. doi: 10.4236/wjcd.2013.34A009.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Lindhe, N.Y. (2000) Exploración de pacientes con enfermedad periodontal. Periodontología clínica e implantología odontológica. Editorial Médica Panamericana, Madrid, 387-398.
[2] Offenbacher, S. (1999) Periodontitis-atherosclerosis syndrome: An expanded model of pathogenesis. Journal of Periodontal Research, 34, 346-352. doi:10.1111/j.1600-0765.1999.tb02264.x
[3] Joshipura, K.J., Rimm, E.B., Douglass, C.W., Trichopoulos, D., Ascherio, A. and Willett, W.C. (1996) Poor oral health and coronary heart disease. Journal of Dental Research, 75, 1631-1636. doi:10.1177/00220345960750090301
[4] Kaski, J.C. (2000) Inflamación, infección y enfermedad coronaria: Mitos y realidades. Revista Espanola de Cardiología, 53, 1311-1317. doi:10.1016/S0300-8932(00)75234-1
[5] Mattila, K.J., Valtonen, V.V., Nieminen, M. and Huttunen, J.K. (1995) Dental infection and the risk of new coronary events: Prospective study of patients with documented coronary artery disease. Clinical Infectious Diseases, 20, 588-592. doi:10.1093/clinids/20.3.588
[6] Wu, T., Trevisan, M., Genco, R.J., Falkner, K.L., Dorn, J.P. and Sempos, C.T. (2000) Examination of the relation between periodontal health status and cardiovascular risk factors: Serum total and high density lipoprotein cholesterol, C-reactive protein, and plasma fibrinogen. American Journal of Epidemiology, 151, 273-282. doi:10.1093/oxfordjournals.aje.a010203
[7] DeStefano, F., Anda, R.F., Kahn, H.S., Williamson, D.F. and Russell, C.M. (1993) Dental disease and risk of coronary heart disease and mortality. British Medical Journal, 306, 688-691. doi:10.1136/bmj.306.6879.688
[8] Seymour, R.A. and Steele, J.G. (1998) Is there a link between periodontal disease and coronary heart disease? British Dental Journal, 184, 33-38. doi:10.1038/sj.bdj.4809536
[9] Meikle, L.C., Heath, J.K. and Reinolds, J.J. (1986) Advances in understanding cell interactions in tissue resorption. Relevance to the pathogenesis of periodontal diseases and a new hypothesis. Journal of Oral Pathology & Medicine, 15, 239-250. doi:10.1111/j.1600-0714.1986.tb00616.x
[10] Herzberg, M.C. and Weyer, M.W. (1998) Dental plaque, platelets and cardiovascular diseases. Journal of Periodontology Online, 3, 151-160. doi:10.1902/annals.1998.3.1.151
[11] Genco, D.K. (1998) Invasión of the bucal pathogen porphyromonas gingivalis: Implications for cardiovascular disease. Invasion Metastasis, 18, 57-69.
[12] Meurman, J.H., Sanz, M. and Janket, S.J. (2004) Oral health, atherosclerosis and cardiovascular disease. Critical Reviews in Oral Biology & Medicine, 15, 403-413. doi:10.1177/154411130401500606
[13] Pussinen, P.J., Jauhiainen, M., Vilkuna-Rautiainen, T., Sundvall, J., Vesanen, M., Mattila, K., Palosuo, T., Alfthan, G. and Asikainen, S. (2004) Periodontitis decreases the antiatherogenic potency of high density lipoprotein. The Journal of Lipid Research, 45, 139-147. doi:10.1194/jlr.M300250-JLR200
[14] Li, L., Messas, E., Batista, E.L. Jr., Levine, R.A. and Amar, S. (2002) Porphyromonas gingivalis infection accelerates the progression of atherosclerosis in a heterozygous apolipoprotein E-deficient murine model. Circulation, 105, 861-867. doi:10.1161/hc0702.104178
[15] Li, J., Helmerhorst, E.J., Leone, C.W., Troxler, R.F., Yaskell, T., Haffajee, A.D., Socransky, S.S. and Oppenheim, F.G. (2004) Identification of early microbial colonizers in human dental biofilm. Journal of Applied Microbiology, 97, 1311-1318. doi:10.1111/j.1365-2672.2004.02420.x
[16] Furuichi, Y., Shimotsu, A., Ito, H., Namariyama, Y., Yotsumoto, Y., Hino, Y., Mishige, Y., Inoue, M. and Izumi, Y. (2003) Associations of periodontal status with general health conditions and serum antibody titers for Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans. Journal of Periodontology Online, 74, 1491-1497. doi:10.1902/jop.2003.74.10.1491
[17] Beck, J., García, R., Heiss, G., Vokonas, P.S. and Offenbacher, S. (1996) Periodontal disease and cardiovascular disease. Journal of Periodontology Online, 67, 11231137.
[18] Emingil, G., Buduneli, E., Aliyev, A., Akilli, A. and Atilla, G. (2000) Association between periodontal disease and acute myocardial infarction. Journal of Periodontology Online, 71, 1882-1886. doi:10.1902/jop.2000.71.12.1882
[19] Loesche, W.J., Schork, A., Terpenning, M.S., Chen, Y.M., Dominguez, B.L. and Grossman, Y.N. (1998) Assessing the relationship between dental disease and coronary heart disease in elderly US veterans. The Journal of the American Dental Association, 129, 301-311.
[20] Takata, Y., Ansai, T., Matsumura, K., Awano, S., Hamasaki, T., Sonoki, K., Kusaba, A., Akifusa, S. and Takehara, T. (2001) Relationship between tooth loss and electrocardiographic abnormalities in octogenarian. Journal of Dental Research, 80, 1648-1652. doi:10.1177/00220345010800071001
[21] Hung, H.C., Willett, W., Merchant, A., Rosner, B.A., Ascherio, A. and Joshipura, K.J. (2003) Oral health and peripheral arterial disease. Circulation, 107, 1152-1157. doi:10.1161/01.CIR.0000051456.68470.C8
[22] Joshipura, K.J., Hung, H.C., Rimm, E.B., Willett, W.C. and Ascherio, A. (2003) Periodontal disease, tooth loss, and incidence of ischemic stroke. Stroke, 34, 47-52. doi:10.1161/01.STR.0000052974.79428.0C
[23] Pussinen, P.J., Jousilahti, P., Alfthan, G., Palosuo, T., Asikainen, S. and Salomaa, V. (2003) Antibodies to periodontal pathogens are associated with coronary heart disease. Arteriosclerosis, Thrombosis, and Vascular Biology, 23, 1250-1264. doi:10.1161/01.ATV.0000072969.71452.87
[24] Sinisalo, J., Paronen, J., Mattila, K.J., Syrjala, M., Alfthan, G., Palosuo, T., Nieminen, M.S. and Vaarala, O. (2000) Relation of inflammation to vascular function in patients with coronary heart disease. Atherosclerosis, 149, 403-411. doi:10.1016/S0021-9150(99)00333-0
[25] Amar, S., Gokce, N., Morgan, S., Loukideli, M., Van Dyke, T.E. and Vita, J.A. (2003) Periodontal disease is associated with brachial artery endothelial dysfunction and systemic inflammation. Arteriosclerosis, Thrombosis, and Vascular Biology, 23, 1245-1249. doi:10.1161/01.ATV.0000078603.90302.4A
[26] Tonetti, M.S., D’Aiuto, F., Nibali, L., Donald, A., Storry, C., Parkar, M., Suvan, J., Hingorani, A.D., Vallance, P. and Deanfield, J. (2007) Treatment of periodontitis and endothelial function. The New England Journal of Medicine, 356, 911-920. doi:10.1056/NEJMoa063186
[27] Haynes, W.G. and Stanford, C. (2003) Periodontal disease and atherosclerosis: From dental to arterial plaque. Arteriosclerosis, Thrombosis, and Vascular Biology, 23, 1309-1311. doi:10.1161/01.ATV.0000087144.24654.71
[28] Slade, G.D., Offenbacher, S., Beck, J.D., Heiss, G. and Pankow, J.S. (2000) Acute-phase inflammatory response to periodontal disease in the US population. Journal of Dental Research, 79, 49-57. doi:10.1177/00220345000790010701
[29] Haraszthy, V.I., Zambon, J.J., Trevisan, M., Zeid, M. and Genco, R.J. (2000) Identification of periodontal pathogens in atheromatous plaques. Journal of Periodontology Online, 71, 1554-1560. doi:10.1902/jop.2000.71.10.1554
[30] Deshpande, R.G., Khan, M.B. and Genco, C.A. (1998) Invasion of aortic and heart endothelial cells by Porphyromonas gingivalis. Infection and Immunity, 66, 53375343.
[31] Suwaidi, J.A., Hamasaki, S., Higano, S.T., Nishimura, R.A., Holmes, D.R. Jr. and Lerman, A. (2000) Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation, 101, 948-954. doi:10.1161/01.CIR.101.9.948
[32] Katz, J., Flugelman, M.Y., Goldberg, A. and Heft, M. (2002) Association between periodontal pockets and elevated cholesterol and low density lipoprotein cholesterol levels. Journal of Periodontology Online, 73, 494-500. doi:10.1902/jop.2002.73.5.494
[33] Beck, J.D. and Offenbacher, S. (2001) The association between periodontal diseases and cardiovascular diseases: A state-of-the-science review. Journal of Periodontology Online—Annals of Periodontology, 6, 9-15. doi:10.1902/annals.2001.6.1.9
[34] Herzberg, M.C. and Meyer, M.W. (1996) Effects of oral flora on platelets: Possible consequences in cardiovascular disease. Journal of Periodontology Online, 67, 11381142. doi:10.1902/jop.1996.67.10s.1138
[35] Chong, P.H. and Kezele, B. (2000) Periodontal disease and atherosclerotic cardiovascular disease: Confounding effects or epiphenomenon? Pharmacotherapy, 20, 805818. doi:10.1592/phco.20.9.805.35189
[36] Armitage, G.C. (2000) Periodontal infections and cardiovascular disease—how strong is the association? Oral Diseases, 6, 335-350. doi:10.1111/j.1601-0825.2000.tb00126.x
[37] Hujoel, P.P., Drangsholt, M., Spiekerman, C. and De Rouen, T.A. (2000) Periodontal disease and coronary heart disease risk. Journal of the American Medical Association, 284, 1406-1410. doi:10.1001/jama.284.11.1406
[38] Cairo, F., Gaeta, C., Dorigo, W., Oggioni, M.R., Pratesi, C., Pini Prato, G.P. and Pozzi, G. (2004) Periodontal pathogens in atheromatous plaques. A controlled clinical and laboratory trial. Journal of Periodontal Research, 39, 442-446. doi:10.1111/j.1600-0765.2004.00761.x

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.