The evidence for an association between cardiovascular diseases and periodontitis is as follows:
- Plausibility – periodontitis leads to entry of bacteria and bacterial by-products into the blood stream. The bacteria activate the host’s inflammatory-immune response by multiple mechanisms. Several animal models have demonstrated the host’s inflammatory response favors atheroma formation, maturation and exacerbation.
- Epidemiological data – there is consistent epidemiological evidence that periodontitis imparts increased risk for future cardiovascular disease, independently of other confounding factors. At a Perio & Cardio Workshop, a joint event of the European Federation of Periodontology (EFP) and the World Heart Federation (WHF) the following statement was published, underlining the continuing message of a possible link between cardiac health and oral health: "After reviewing the latest evidence on the associations between periodontitis and cardiovascular diseases, the 20 experts from the two organisations noted that good oral health can improve cardiovascular outcomes and how both cardiologists and periodontists should integrate these findings into their daily practice."18
- Intervention studies – there is moderate evidence periodontal treatment reduces systemic inflammation as evidenced by reductions in C-reactive protein (CRP) and oxidative stress, and leads to improvements of surrogate clinical and biochemical measures of vascular endothelial function.