An update on periodontal infections, systemic inflammatory biomarkers, and cardiovascular disease

Abstract

Cardiovascular disease (CVD) describes diseases of the heart and blood vessels, consisting mainly of coronary heart disease and stroke, which are among the main causes of premature death in humans. It is currently believed that long-lasting infections and low-grade chronic systemic inflammation play an important role in the pathogenesis of atherosclerosis and CVD. Periodontal diseases are induced by bacteria and bacterial products of plaque biofilm and characterised by inflammatory destruction of tooth-supporting connective tissues and alveolar bone. A number of case-control, cross-sectional and longitudinal studies indicate an association between periodontal disease and CVD after adjustment of common confounders, and a potential effect of periodontal infections on an increased risk of atherosclerosis, ischaemic heart disease and stroke, although a causal association of periodontal infection with atherosclerotic CVD remains to be elucidated. The emerging evidence suggests that periodontal disease, as one of the most common and unique infections in humans, may significantly contribute to systemic inflammation. Observations include the relationship between periodontitis and an elevated number of peripheral blood leukocytes, as well as increased levels of C-reactive protein (CRP) and IL-6, which may partly explain the association of periodontal disease with CVD, as documented in a number of studies. Although some initial studies have shown promising effects of periodontal treatment on the reduction of serum levels of CRP and IL-6, and improvement of the endothelial function in periodontitis patients, the potential mechanisms and exact effects of controlling periodontal infections on the reduction of systemic inflammation remain to be determined. Future studies are highly warranted to clarify these points and elaborate the relevant clinical implications.