Periodontal disease and atherosclerosis: from dental to arterial plaque.

Abstract

The conventional risk factors for atherosclerosis are well understood, but they can account for only about 50% to 70% of atherosclerotic events in the general population. Many other putative risk factors for atherosclerosis have been proposed, including traits related to obesity, inflammation, and infection. Periodontal disease is a candidate risk factor that shares many of these related traits. The periodontal diseases reflect a spectrum of oral pathology from gingivitis (gum inflammation) to severe periodontitis (progressive loss of gum attachment) with alveolar bone and tooth loss. See page 1405 The pathogenesis of periodontal disease is thought to be due to accumulation of dental plaque (bacteria in subgingival biofilms) with consequent mucosal infection and inflammation. Abnormal host responses, with upregulation of matrix metalloproteinases, contribute to a more rapid disease progression in some patients. Periodontal disease is more common with cigarette smoking, obesity, and diabetes, and it affects about 75% of the adult population in the United States, with about 20% to 30% of adults having severe forms.1,2⇓ Increasing evidence over the past decade suggests a link between periodontal disease and atherosclerosis. Multiple cross-sectional studies have demonstrated a higher incidence of atherosclerotic complications in patients with periodontal disease.3–6⇓⇓⇓ In the NHANES III cohort, severe periodontal disease was associated with an almost 4-fold higher incidence of myocardial infarction than found in patients without periodontal disease.6 In cross-sectional studies, the cardiovascular risk associated with periodontal disease appears dependent on severity of the disease, and it is independent of conventional risk factors (including smoking, poverty, diabetes, and body mass index).7 One problem with cross-sectional and case-control studies is that they do not tell us whether a disease is a cause or a consequence of another condition. For example, it is possible that atherosclerosis might exacerbate periodontal disease, by …