Management of cardiovascular risk in patients with periodontal diseases

Abstract

Periodontitis is a chronic infectious disease characterized by progressiveinflammatory loss of the tooth's supporting tissues. It is a major public health issue as itaffects in severe forms > 10% of the adult population and it is the major cause of toothloss and oral disability. It is caused by a bacterial biofilm harboring gram negativeanaerobes and microaerophilic pathogens. Bacteria, however, are necessary but notsufficient for clinical manifestation of the disease. Indeed, the host inflammatoryresponse has a pivotal role in determining tissue damage. The variance on the individualresponsiveness of inflammation is modulated by environmental, acquired and geneticfactors.Periodontitis has been associated not just with local tissue damage but also with amoderate systemic inflammatory response, representing a chronic source of systemicinflammation which, together with the bacteremia due to periodontal infection, mayconstitute the biological rationale of cardiovascular connections.Indeed Periodontitis has been connected with an increased risk of cardiovascularevents. Nevertheless, the nature of the association is unclear since both periodontitis andatherosclerosis share numerous risk factors. Causality of this association may be exploredthrough intervention trials. Early systematic reviews and a definitive intervention clinicaltrial indicate that intensive periodontal therapy results in decrease in systemic inflammation and improvement of endothelial dysfunction in systemically healthysubjects.Evidence to date is consistent with the notion that severe generalized periodontitismay play a determinant role in the development of systemic inflammation and endothelialdysfunction. Periodontitis has effects that reach beyond the oral cavity and their treatmentand prevention may contribute to prevention of atherosclerosis. Periodontal treatment ofcardiovascular patients should also be performed with careful assessment of hemostasis.Indeed treatment may constitute a serious hazard in patient with a bleeding tendency.Finally, the most recent infective endocarditis prevention guidelines are reported. © 2012 by Nova Science Publishers, Inc. All rights reserved.