Cardiovascular disease (CVD), in particular atherosclerosis, involves an inflammatory response that may occur systemically and sometimes within atherosclerotic lesions.9 Periodontal disease and CVD share many inflammatory pathways and risk factors (such as diabetes mellitus, smoking, and obesity).10-12 Several large epidemiology studies have evaluated the association between periodontal disease and CVD. A meta-analysis summarizing their findings suggest that periodontal disease may convey a moderate risk for atherosclerosis.13-15 However, despite the biologic plausibility suggested by these interactions, at this time the literature does not support a causative relationship and further studies examining the underlying etiology are necessary.8 Understanding the interaction between these two widespread diseases is critical for the clinician to understand to allow for the optimal management of dental patients.
Periodontitis is initiated by infectious agents resulting in tissue destruction caused by host inflammation within the supporting structures of the teeth.16,17 It has been shown to be associated with numerous systemic conditions in a bidirectional manner.18 This association is related to the systemic inflammation produced by chronic periodontal infection. Bacteremias in the systemic circulation and bacterial byproducts (e.g., endotoxins) as well as the resultant proinflammatory cytokines produced in response to those bacteria may result in a systemic immune response, dyslipidemia, and an increased risk of atherosclerotic lesion formation.19 Due to the high number of individuals affected by both periodontal disease20 and CVD,1 dental healthcare providers are likely to encounter many patients who have both conditions and require management within the dental office to safely and effectively deliver dental care.
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