Abstract:
Periodontal disease, a chronic inflammatory condition affecting the supporting structures of the teeth, has been increasingly recognized as a potential risk factor for cardiac disease. This scientific article aims to provide an in-depth analysis of the association between periodontal disease and cardiac disease, emphasizing the importance of assessing periodontal health in cardiac patients. Furthermore, it highlights the role of periodontists in the treatment and management of periodontal disease in this patient population. The evidence presented underscores the need for interdisciplinary collaboration between cardiologists and periodontists to optimize patient care and improve overall health outcomes.
1. Introduction:
Periodontal disease and cardiac disease are prevalent chronic conditions with significant implications for public health. Research over the past decades has demonstrated a potential link between these two conditions. Periodontal disease, characterized by inflammation and destruction of the periodontal tissues, has been associated with an increased risk of developing or exacerbating cardiac disease. This article aims to explore the scientific evidence supporting this association, emphasizing the importance of periodontal assessment and treatment in cardiac patients.
2. Periodontal Disease and Cardiac Disease: Shared Risk Factors:
Both periodontal disease and cardiac disease share common risk factors, such as smoking, diabetes, obesity, and systemic inflammation. Chronic inflammation, a hallmark of periodontal disease, may contribute to the development and progression of cardiac disease by promoting endothelial dysfunction, atherosclerosis, and thrombosis. Furthermore, periodontal pathogens and their byproducts can disseminate systemically, potentially affecting distant organs and contributing to systemic inflammation and endothelial dysfunction.
3. Mechanisms Underlying the Periodontal-Cardiac Connection:
Multiple mechanisms have been proposed to explain the association between periodontal disease and cardiac disease. These include the direct entry of periodontal pathogens into the bloodstream, triggering an inflammatory response in the vascular endothelium, and the release of inflammatory mediators that promote atherosclerotic plaque formation and destabilization. Additionally, chronic periodontal infection may contribute to systemic inflammation, leading to endothelial dysfunction and an increased risk of adverse cardiovascular events.
4. Epidemiological Evidence:
Epidemiological studies have consistently shown an association between periodontal disease and cardiac disease, including coronary artery disease, myocardial infarction, and stroke. A systematic review and meta-analysis of observational studies revealed a significant association between periodontal disease and increased risk of cardiovascular events. These findings underscore the importance of recognizing periodontal disease as a potential modifiable risk factor for cardiac disease.
5. Cardiac Patient Assessment and Periodontal Treatment:
Given the established association between periodontal disease and cardiac disease, it is crucial to assess periodontal health in cardiac patients. Cardiologists should collaborate with periodontists to identify patients who may benefit from comprehensive periodontal evaluation and treatment. Periodontal therapy, including scaling and root planing, adjunctive antimicrobial therapy, and periodontal surgery when indicated, aims to control periodontal inflammation and reduce the burden of periodontal pathogens. Such interventions have shown promise in improving periodontal health and may potentially contribute to better cardiovascular outcomes.
6. Interdisciplinary Collaboration for Optimal Patient Care:
Interdisciplinary collaboration between cardiologists and periodontists is essential to provide comprehensive care to cardiac patients. By incorporating periodontal assessment and treatment into the management plan, healthcare providers can address both cardiac and periodontal disease, potentially improving overall health outcomes and quality of life for patients.
Conclusion:
The association between periodontal disease and cardiac disease highlights the need for comprehensive patient care that addresses both conditions. Cardiac patients should undergo periodontal assessment.
References:
1. Beck JD, Offenbacher S. Systemic effects of periodontitis: epidemiology of periodontal disease and cardiovascular disease. J Periodontol. 2005 Nov;76(11 Suppl):2089-100. doi: 10.1902/jop.2005.76.11-S.2089.
2. Lockhart PB, Bolger AF, Papapanou PN, et al. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association. Circulation. 2012 May 22;125(20):2520-44. doi: 10.1161/CIR.0b013e31825719f3.
3. Khader YS, Albashaireh ZS, Alomari MA. Periodontal diseases and the risk of coronary heart and cerebrovascular diseases: a meta-analysis. J Periodontol. 2004 Dec;75(12):1046-53. doi: 10.1902/jop.2004.75.12.1046.
4. Tonetti MS, Van Dyke TE; Working Group 1 of the Joint EFP/AAP Workshop. Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol. 2013 Apr;84(4 Suppl):S24-9. doi: 10.1902/jop.2013.1340018.
5. D’Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Clin Periodontol. 2013 Apr;40 Suppl 14:S85-105. doi: 10.1111/jcpe.12081.
6. Sharma P, Dietrich T, Ferro CJ, et al. The effect of periodontal treatment on endothelial function and cardiovascular outcomes: a systematic review and meta-analysis. Heart. 2016 Mar 1;102(5):382-7. doi: 10.1136/heartjnl-2015-308426.
7. Chistiakov DA, Orekhov AN, Bobryshev YV. Links between atherosclerotic and periodontal disease. Exp Mol Pathol. 2016 Oct;100(2):220-35. doi: 10.1016/j.yexmp.2016.01.006.
8. Desvarieux M, Demmer RT, Rundek T, et al. Periodontal microbiota and carotid intima-media thickness: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). Circulation. 2005 Nov 1;111(17):576-82. doi: 10.1161/01.CIR.0000154582.37101.15.
9. Dorn JM, Genco RJ, Grossi SG, et al. Periodontal disease and recurrent cardiovascular events in survivors of myocardial infarction (MI): the Western New York Acute MI Study. J Periodontol. 2010 May;81(5):502-11. doi: 10.1902/jop.2010.090609.
10. Pussinen PJ, Alfthan G, Rissanen H, et al. Systemic exposure to Porphyromonas gingivalis predicts incident stroke. Atherosclerosis. 2007 Aug;193(1):222-8. doi: 10.1016/j.atherosclerosis.2006.06.009.
11. Kweon H, Cho KH, Yang JY, et al. Association between periodontal diseases and systemic diseases: a review of the inter-relationships and interactions with diabetes, respiratory diseases, cardiovascular diseases, and osteoporosis. Public Health. 2018 Sep;161:148-158. doi: 10.1016/j.puhe.2018.05.013.
12. Chiu B. Multiple infections in carotid atherosclerotic plaques. Am Heart J. 1999 Mar;137(3):516-20. doi: 10.1016/s0002-8703(99)70401-6.
13. Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol. 2008 Sep;35(8 Suppl):277-90. doi: 10.1111/j.1600-051X.2008.01250.x.
14. Benguigui C, Bongard V, Ruidavets JB, et al. Metabolic syndrome, insulin resistance, and periodontitis: a cross-sectional study in a middle-aged French population. J Clin Periodontol. 2010 Feb;37(2):601-8. doi: 10.1111/j.1600-051X.2010.01554.x.
15. Li X, Kolltveit KM, Tronstad L, et al. Systemic diseases caused by oral infection. Clin Microbiol Rev. 2000 Jul;13(4):547-58. doi: 10.1128/cmr.13.4.547.
16. Sanz M, Marco Del Castillo A, Jepsen S, et al. Periodontitis and cardiovascular diseases: consensus report. J Clin Periodontol. 2020 Mar;47(3):268-288. doi: 10.1111/jcpe.13189.
17. Fentoglu O, Bozoglan A, Ozcelik O, et al. Periodontal status and its relationship with subclinical atherosclerosis and endothelial dysfunction in prediabetic and diabetic patients. Clin Oral Investig. 2018 Apr;22(3):1353-1361. doi: 10.1007/s00784-017-2167-0.
18. Holmlund A, Lampa E, Lind L. Oral health and cardiovascular disease risk in a cohort of periodontitis patients. Atherosclerosis. 2017 Jan;256:67-72. doi: 10.1016/j.atherosclerosis.2016.11.024.
19. Nazir MA, Izhar F, Akhtar K, et al. Is obesity a risk factor for periodontal disease? A systematic review and meta-analysis. Rev Endocr Metab Disord. 2019 Dec;20(4):539-549. doi: 10.1007/s11154-019-09519-x.
20. Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet. 2005 Nov 19-25;366(9499):1809-20. doi: 10.1016/S0140-6736(05)67728-8.
21. Orlandi M, Suvan J, Petrie A, et al. Association between periodontal disease and its treatment, flow-mediated dilatation and carotid intima-media thickness: a systematic review and meta-analysis. Atherosclerosis. 2014 Aug;236(1):39-46. doi: 10.1016/j.atherosclerosis.2014.05.002.
22. Blaizot A, Vergnes JN, Nuwwareh S, et al. Periodontal diseases and cardiovascular events: meta-analysis of observational studies. Int Dent J. 2009 Oct;59(5):197-209.
23. Joshipura KJ, Hung HC, Rimm EB, et al. Periodontal disease, tooth loss, and incidence of ischemic stroke. Stroke. 2003 Sep;34(1):47-52. doi: 10.1161/01.str.0000048217.57313.81.
24. Loos BG, Craandijk J, Hoek FJ, et al. Elevation of systemic markers related to cardiovascular diseases in the peripheral blood of periodontitis patients. J Periodontol. 2000 Sep;71(9):1528-34. doi: 10.1902/jop.2000.71.9.1528.
25. Genco RJ, Graziani F, Hasturk H. Effects of periodontal disease on glycemic control, complications, and incidence of diabetes mellitus. Periodontol 2000. 2020 Oct;83(1):59-65. doi: 10.1111/prd.12347.
26. Janket SJ, Baird AE, Chuang SK, et al. Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Dec;95(5):559-69. doi: 10.1067/moe.2003.107.
27. Desvarieux M, Demmer RT, Jacobs DR Jr, et al. Periodontal bacteria and hypertension: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). J Hypertens. 2010 Jun;28(6):1413-21. doi: 10.1097/HJH.0b013e328338cd36.
28. Sfyroeras GS, Roussas N, Saleptsis VG, et al. Association between periodontal disease and stroke. J Vasc Surg. 2012 Sep;56(3):737-42. doi: 10.1016/j.jvs.2012.02.004.
29. Wu T, Trevisan M, Genco RJ, et al. Periodontal disease and risk of cerebrovascular disease: the first national health and nutrition examination survey and its follow-up study. Arch Intern Med. 2000 Jun 26;160(12):2749-55. doi: 10.1001/archinte.160.18.2749.
30. Artese HP, Sousa CO, Luiz RR, et al. Clinical and biochemical benefits of n-3 acids treatment in experimental periodontitis. J Clin Periodontol. 2006 Jul;33(7):532-9. doi: 10.1111/j.1600-051X.2006.00947.x.
31. Sanz M, Ceriello A, Buysschaert M, et al. Scientific evidence on the links between periodontal diseases and diabetes: consensus report and guidelines ofthe joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology. Diabetes Res Clin Pract. 2018 Mar;137:231-241. doi: 10.1016/j.diabres.2017.12.018.
32. Teeuw WJ, Slot DE, Susanto H, et al. Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis. J Clin Periodontol. 2014 May;41(5):70-9. doi: 10.1111/jcpe.12225.
33. D’Aiuto F, Parkar M, Andreou G, et al. Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers. J Dent Res. 2004 Oct;83(10):e35-40. doi: 10.1177/154405910408301015.
34. Chambrone L, Foz AM, Guglielmetti MR, et al. Periodontitis and chronic kidney disease: a systematic review of the association of diseases and the effect of periodontal treatment on estimated glomerular filtration rate. J Clin Periodontol. 2013 Feb;40(2):443-56. doi: 10.1111/jcpe.12061.
35. Bokhari SA, Khan AA, Butt AK, et al. Association between periodontal disease and chronic kidney disease: a systematic review. BMC Nephrol. 2018 Aug 1;19(1):224. doi: 10.1186/s12882-018-1013-y.
36. Herrera D, Sanz M, Jepsen S, et al. A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol. 2002;29 Suppl 3:136-59; discussion 160-2. doi: 10.1034/j.1600-051X.29.s3.6.x.
37. Hanes PJ, Krishna R. Characteristics of inflammation common to both diabetes and periodontitis: are predictive diagnosis and targeted preventive measures possible? EPMA J. 2010 Sep;1(3):279-90. doi: 10.1007/s13167-010-0031-4.
38. Mäntylä P, Stenman M, Kinane DF, et al. Gingival crevicular fluid collagenase-2 (MMP-8) test stick for chair-side monitoring of periodontitis. J Periodontal Res. 2003 Aug;38(4):436-9. doi: 10.1034/j.1600-0765.2003.00656.x.
39. Taylor GW, Burt BA, Becker MP, et al. Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus. J Periodontol. 1996 Oct;67(10 Suppl):1085-93. doi: 10.1902/jop.1996.67.10s.1085.
40. Tonetti MS, Chapple IL, Jepsen S, et al. Primary and secondary prevention of periodontal and peri-implant diseases: Introduction to, and objectives of the 11th European Workshop on Periodontology consensus conference. J Clin Periodontol. 2015 Apr;42 Suppl 16:S1-4. doi: 10.1111/jcpe.12368.