Oral Connections

The potential for active periodontal inflammation to affect overall health, including cardiovascular disease and stroke, has initiated research to further study linkages between oral health and systemic disease. A special report published in Scientific American and a supplement to the Journal of the American Dental Association explored potential links between oral infections and systemic relationships; however, the causality of the relationship has yet to be fully determined.⁴⁷ Such potential relationships afford unprecedented opportunities for oral health care professionals to collaborate with the medical profession in addressing the management of systemic disease.

Associations between hyperlipidemia, hyperglycemias, and periodontal disease and CVD and stroke have been documented.^48,49 Diabetes mellitus, periodontal disease, and cardiovascular disease form a mutually reinforcing triad mediated by systemic inflammation and metabolic dysregulation. Integrated, multidisciplinary care models and precision health strategies are essential to address this inflammatory burden and improve long-term outcomes. Further large-scale interventional trials and mechanistic human studies are needed to establish causal links and optimize combined therapeutic approaches.⁴⁸

Since the publication of the 2012 American Heart Association scientific statement on the association between periodontal disease and atherosclerotic cardiovascular disease, the body of literature on this topic has grown tremendously. Atherosclerotic cardiovascular disease is still the leading cause of death globally, and understanding contributors and potential targets to decrease this risk is of vital importance. This updated scientific statement from the American Heart Association (AHA) synthesizes new evidence concerning an association between periodontal disease and atherosclerotic cardiovascular disease, including findings from randomized clinical studies, interventions targeting periodontal disease, and studies exploring systemic markers, such as inflammatory cytokines and vascular measures. The scientific statement also highlights disparities in the prevalence of periodontal disease, particularly among under resourced populations; explores potential mechanisms linking periodontal disease with cardiovascular outcomes through direct pathways, such as bacteremia, and indirect pathways, such as chronic systemic inflammation; and identifies areas needing further clarification that would benefit from additional research.⁴⁹ Periodontal and cardiovascular diseases share many risk factors, such as age, educational level, sex/gender, income level, smoking and drinking habits, hypertension, stress, depression, and diabetes. The statement identifies direct and indirect biological pathways that may explain the association. Some of the direct mechanisms include: bacteremia and vascular infection, atherosclerotic plaques, sysyemic inflammation, immune responses, and platelet activation and oral microbiome alteration.

While precise links and causal factors between CVD, stroke and periodontal disease continue to be researched, oral concerns commonly associated with medications are well-documented.⁵³ With numerous reports in medical and dental journals substantiating a periodontal-systemic relationship, the role of oral health care professionals to risk assess patients demonstrating inflammatory burdens, recognize oral adverse reactions often encountered from medications, and educate patients about the benefits from daily self-care regimens will improve oral health outcomes and further establish oral health as an essential component necessary for overall health. With a yearly estimate of 15 million people worldwide suffering from stroke, recognition and treatment for gingival and inflammatory periodontal diseases can potentially minimize further risk for systemic disorders. Oral healthcare professionals can identify patients who are unaware of their risk of developing serious complications as a result of CVD, who are in need of medical intervention, and provide appropriate referrals.