Relationship Between Periodontal Disease, Inflammation, and Cardiovascular Disease

IS PERIODONTAL DISEASE A COMORBIDITY…?Relationship Between Periodontal Disease, Inflammation, and Cardiovascular Disease

Studies of inflammation and coronary artery disease (CAD) have shown that proinflammatory cytokines can recruit leukocytes, lymphocytes, and macrophages to produce a local inflammatory response, resulting in smooth muscle cell proliferation and extracellular matrix deposition. This can lead to accelerated atherosclerosis and, in some cases, instability in the fibrous cap leading to plaque rupture and myocardial infarction.

Risk factors for periodontal disease (PD) VS cardiovascular disease (CVD)
  • Transfer of periodontal bacteria to atheromatous plaques;

In patients with periodontal inflammation, daily oral activities, including chewing and oral hygiene procedures, may result in transfer of periodontal bacteria from the inflamed pockets to the bloodstream. A following infection of atherosclerotic arterial walls may result in instability of plaques with rupture and thrombus formation. Studies have demonstrated the presence of DNA from oral bacteria in atheromatous plaques, and some studies using advanced cultivation techniques have also shown viable periodontal bacteria in the plaques.

  • Spillover of cytokines from periodontal tissues to the bloodstream;

Inflammation in the periodontal tissues involves local production of proinflammatory cytokines. Spillover of such cytokines and cytokine producing cells to the bloodstream may enhance inflammation in the atherosclerotic arterial walls and result in unstable plaques. Thus, elevated levels of some proinflammatory cytokines, including interleukin (IL)-6 and tumor necrosis factor alpha, have been found in the bloodstream of patients with PD, and PD may thus cause systemic low-grade inflammation promoting, for example, endothelial dysfunction and development of insulin resistance.

  • Systemic production of cytokines;

Increased plasma level of cytokines in response to bacteremia after oral procedures is a well-described phenomenon. Increased IL-6 levels were found in the bloodstream as a result of bacteremia after scaling, and this cytokine is a known risk marker for CVD, including AMI.

  • Change of lipid metabolism as a result of PD;

In patients with PD, the lipid balance in the bloodstream, disturbance of which is associated with increased risk of atherosclerotic disease, shows an unfavorable shift with less high-density lipoprotein and more low-density lipoprotein cholesterol. In addition, studies have indicated improvement of lipid parameters after periodontal treatment.

  • Endothelial dysfunction;

PD is associated with endothelial dysfunction, which is considered the earliest marker of atherosclerosis. Furthermore, periodontal treatment may improve endothelial function.

  • Shared genetic risk factors;

A shared variant in the IL-1 gene complex could be part of the background for the simultaneous occurrence of both diseases, and recent studies have identified a number of other shared genetic risk factors. However, these factors do not appear to explain the observed association fully.

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