Managment of Cardiovascular Risk in Patients with Periodontal Diseases

Periodontitis is a chronic infectious disease characterized by progressive inflammatory loss of the tooth’s supporting tissues. It is a major public health issue as it affects in severe forms >10% of the adult population and it is the major cause of tooth loss and oral disability. It is caused by a bacterial biofilm harboring gram negative anaerobes and microaerophilic pathogens. Bacteria, however, are necessary but not sufficient for clinical manifestation of the disease. Indeed, the host inflammatory response has a pivotal role in determining tissue damage. The variance on the individual responsiveness of inflammation is modulated by environmental, acquired and genetic factors. Periodontitis has been associated not just with local tissue damage but also with a moderate systemic inflammatory response, representing a chronic source of systemic inflammation which, together with the bacteremia due to periodontal infection, may constitute the biological rationale of cardiovascular connections. Indeed Periodontitis has been connected with an increased risk of cardiovascular events. Nevertheless, the nature of the association is unclear since both periodontitis and atherosclerosis share numerous risk factors. Causality of this association may be explored through intervention trials. Early systematic reviews and a definitive intervention clinical trial indicate that intensive periodontal therapy results in decrease in systemic inflammation and improvement of endothelial dysfunction in systemically healthy subjects. Evidence to date is consistent with the notion that severe generalized periodontitis may play a determinant role in the development of systemic inflammation and endothelial dysfunction. Periodontitis has effects that reach beyond the oral cavity and their treatment and prevention may contribute to prevention of atherosclerosis. Periodontal treatment of cardiovascular 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