Current Oral Health Reports

, Volume 5, Issue 1, pp 13–18 | Cite as

Cardiovascular Diseases and Periodontal Disease

  • Thomas T. NguyenEmail author
  • Kevin Y. Wu
  • Maude Leclerc
  • Hieu M. Pham
  • Simon D. Tran
Systemic Diseases (N Buduneli, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Systemic Diseases


Purpose of Review

Periodontitis and cardiovascular diseases are both inflammatory conditions. Recent epidemiological studies have associated the effects of periodontitis on cardiovascular disease (CVD) progression. This review aims to summarize the relationship between those two conditions.

Recent Findings

Although there is no evidence of a causal relationship, an association between the two conditions is apparent. The potential factors include bacterial pathway, inflammation, and genetics. Periodontal bacteria affect endothelial cells through interactions that aggravate the atherogenic process. Ulcerated periodontium produces cytokines which increase the production of acute-phase proteins that have been associated with cardiovascular events. Genetic studies have demonstrated the presence of risk alleles in the genes ANRIL and CAMTA1/VAMP3 that are shared between these two diseases.


This review discusses the current understanding of CVD pathogenesis, underlying mechanisms of periodontitis in CVD, and effects of periodontal therapy on CVD, and provides guidelines for treating patients with CVD risks in respect to periodontal disease.


Periodontal disease Cardiovascular disease Periodontitis Atherosclerosis Inflammation Clinical guidelines 



We would like to thank previous contributions from Doctors C.M. Nguyen, J.W.M. Kim, V.H. Quan, and B.H. Nguyen who led to this updated review.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    World Health Organization. (2017). Accessed 12 Oct 2017.
  2. 2.
    Mitchell ME, Sidawy AN. The pathophysiology of atherosclerosis. Semin Vasc Surg. 1998;11(3):134–41.PubMedGoogle Scholar
  3. 3.
    • Gistera A, Hansson GK. The immunology of atherosclerosis. Nat Rev Nephrol. 2017;13(6):368–380. This manuscript provides a good review on the immunology of atherosclerosis to clinicians and researchers. Scholar
  4. 4.
    Lindhe J, Haffajee AD, Socransky SS. Progression of periodontal disease in adult subjects in the absence of periodontal therapy. J Clin Periodontol. 1983;10(4):433–42. Scholar
  5. 5.
    Van Dyke TE, van Winkelhoff AJ. Infection and inflammatory mechanisms. J Periodontol. 2013;84(4 suppl):S1–7. Scholar
  6. 6.
    Orlandi M, Suvan J, Petrie A, Donos N, Masi S, Hingorani A, et al. Association between periodontal disease and its treatment, flow-mediated dilation and carotid intima-media thickness: a systematic review and meta-analysis. Atherosclerosis. 2014;236(1):39–46. Scholar
  7. 7.
    Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME, et al. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association? A scientific statement from the American Heart Association. Circulation. 2012;125(20):2520–44. Scholar
  8. 8.
    Tonetti MS, Van Dyke TE. Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol. 2013;84(4 suppl):S24–9. Scholar
  9. 9.
    Schenkein HA, Loos BG. Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. J Periodontol. 2013;84(4 suppl):S51–69. Scholar
  10. 10.
    Prochnau D, Lehmann M, Straube E, Figulla HR, Rödel J. Human cytomegalovirus induces MMP-1 and MMP-3 expression in aortic smooth muscle cells. Acta Microbiol Immunol Hung. 2011;58(4):303–17. Scholar
  11. 11.
    Bartruff JB, Yukna RA, Layman DL. Outer membrane vesicles from Porphyromonas gingivalis affect the growth and function of cultured human gingival fibroblasts and umbilical vein endothelial cells. J Periodontol. 2005;76(6):972–9. Scholar
  12. 12.
    Fitzpatrick RE, Wijeyewickrema LC, Pike RN. The gingipains: scissors and glue of the periodontal pathogen, Porphyromonas gingivalis. Future Microbiol. 2009;4(4):471–87. Scholar
  13. 13.
    Gibson FC III, Hong C, Chou HH, et al. Innate immune recognition of invasive bacteria accelerates atherosclerosis in apolipoprotein E-deficient mice. Circulation. 2004;109(22):2801–6. Scholar
  14. 14.
    Ramirez JH, Parra B, Gutierrex S, et al. Biomarkers of cardiovascular disease are increased in untreated chronic periodontitis: a case control study. Australian Dent J. 2014;59(1):29–36. Scholar
  15. 15.
    Quieroz-Junior CM, Pacheco CM, Fonseca A, et al. Myeloperoxidase content is a marker of systemic inflammation in chronic condition: the example given by the periodontal disease in rats. Mediat Inflamm. 2009;2009:760–837.Google Scholar
  16. 16.
    Matthews JB, Wright HJ, Roberts A, Ling-Mountford N, Cooper PR, Chapple ILC. Neutrophils hyper-responsiveness in periodontitis. J Dent Res. 2007;86(8):718–22. Scholar
  17. 17.
    Zakynthinos E, Pappa N. Inflammatory biomarkers in coronary artery disease. J Cardiol. 2009;53(3):317–33. Scholar
  18. 18.
    Schaefer AS, Richter GM, Dommisch H, Reinartz M, Nothnagel M, Noack B, et al. CDKN2BAS is associated with periodontitis in different European populations and is activated by bacterial infection. J Med Genet. 2011;48(1):38–47. Scholar
  19. 19.
    Schaefer A, Richter GM, Groessner-Schreiber B, et al. Identification of a shared genetic susceptibility locus for coronary heart disease and periodontitis. PLoS Genet. 2009;5(2):e1000378. Scholar
  20. 20.
    Bochenek G, Hasler R, El Mokhtare NE, et al. The large non-coding RNA ANRIL, which is associated with atherosclerosis, periodontitis and several forms of cancer, regulates ADIPOR1, VAMP3 and C11ORF10. Hum Mol Genet. 2013;22(22):4516–27. Scholar
  21. 21.
    Schwenk RW, Angin Y, Steinbusch LK, et al. Overexpression of vesicle-associated membrane protein (VAMP) 3, but not VAMP2, protects glucose transporter (GLUT) 4 protein translocation in an in vitro model of cardiac insulin resistance. J Biol Chem. 2012;287(44):37530–9. Scholar
  22. 22.
    Schaefer AS, Bochenek G, Jochens A, Ellinghaus D, Dommisch H, Güzeldemir-Akçakanat E, et al. Genetic evidence of PLASMINOGEN as a shared genetic risk factor of coronary artery disease and periodontitis. Circ Cardiovasc Genet. 2015;8(1):159–67. Scholar
  23. 23.
    Lahteenmaki K, Edelman S, Korhonen TK. Bacterial metastasis: the host plasminogen system in bacterial invasion. Trends Microbiol. 2005;13(2):79–85. Scholar
  24. 24.
    Boyle MD, Lottenberg R. Plasminogen activation by invasive human pathogens. Thromb Haemost. 1997;77(1):1–10.PubMedGoogle Scholar
  25. 25.
    Lahteenmaki K, Kuusela P, Korhonen TK. Bacterial plasminogen activators and receptors. FEMS Microbiol Rev. 2001;25(5):531–52. Scholar
  26. 26.
    Grenier D. Degradation of host protease inhibitors and activation of plasminogen by proteolytic enzymes from Porphyromonas gingivalis and Treponema denticola. Microbioly. 1996;142(Pt 4):955–61. Scholar
  27. 27.
    Schunkert H, Konig IR, Kathiresan S, Cardiogenics; CARDIOGRAM Consortium, et al. Large-scale association analysis identifies 13 new susceptibility loci for coronary artery disease. Nat Genet. 2011;42:333–8.CrossRefGoogle Scholar
  28. 28.
    Ebersole JL, Cappelli D. Acute-phase reactants in infections and inflammatory diseases. Periodontol. 2000;23(1):19–49. Scholar
  29. 29.
    Buhlin K, Gustafsson A, Pockley AG, Frostegård J, Klinge B. Risk factors for cardiovascular disease in patients with periodontitis. Euro Heart J. 2003;24(23):2099–107. Scholar
  30. 30.
    Craig RG, Yip JK, So MK, Boylan RJ, Socransky SS, Haffajee AD. Relationship of destructive periodontal disease to the acute-phase response. J Periodontol. 2003;74(7):1007–16. Scholar
  31. 31.
    D’Aiuto F, Parkar M, Andreou G, Suvan J, Brett PM, Ready D, et al. Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers. J Dent Res. 2004;83(2):156–60. Scholar
  32. 32.
    Joshipura KJ, Wand HC, Merchant AT, Rimm EB. Periodontal disease and biomarkers related to cardiovascular disease. J Dent Res. 2004;83(2):151–5. Scholar
  33. 33.
    Vidal F, Figueredo CM, Cordovil I, et al. Periodontal therapy reduces plasma levels of interleukin-6, C-reactive protein, and fibrinogen in patients with severe periodontitis and refractory arterial hypertension. J Periodontol. 2009;80(5):786–91. Scholar
  34. 34.
    Ide M, McPartlin D, Coward PY, Crook M, Lumb P, Wilson RF. Effect of treatment of chronic periodontitis on levels of serum markers of acute-phase inflammatory and vascular responses. J Clin Periodontol. 2003;30(4):334–40. Scholar
  35. 35.
    Yamazaki K, Honda T, Oda T, Ueki-Maruyama K, Nakajima T, Yoshie H, et al. Effect of periodontal treatment on the C-reactive protein and profinflammatory cytokine levels in Japanese periodontitis patients. J Perio Res. 2005;40(1):53–8. Scholar
  36. 36.
    D’Aiuto F, Nibali L, Parkar M, Suvan J, Tonetti MS. Short-term effects of intensive periodontal therapy on serum inflammatory markers and cholesterol. J Dent Res. 2005;84(3):269–73. Scholar
  37. 37.
    Vidal F, Cordovil I, Figueredo C, et al. Non-surgical treatment reduces cardiovascular risk in refractory hypertensive patients: a pilot study. J Clin Periodontol. 2013;40(7):681–7. Scholar
  38. 38.
    Bokhari SAH, Khan AA, Butt AK, et al. Non-surgical periodontal therapy reduces coronary heart disease risk markers: a randomized controlled trial. J Clin Periodontol. 2012;39(11):1065–74. Scholar
  39. 39.
    Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation: aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997;336(14):973–9. Scholar
  40. 40.
    D’Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Periodontol. 2013;84(4 suppl):S85–105. Scholar
  41. 41.
    Freitas CO, Gomes-Filho IS, Naves RC, et al. Influence of periodontal therapy on C-reactive protein level: a systematic review and meta-analysis. J Appl Oral Sci. 2012;20(1):1–8. Scholar
  42. 42.
    Demmer RT, Trinquart L, Zuk A, Fu BC, Blomkvist J, Michalowicz BS, et al. The influence of anti-infective periodontal treatment on C-reactive protein: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2013;8(10):e77441. Scholar
  43. 43.
    • Teeuw WJ, Slot DE, Susanto H, Gerdes VEA, Abbas F, D’Aiuto F, et al. Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis. J Clin Periodontol. 2014;41(1):70–79. This manuscript is a systematic review on the treatment of periodontitis to improve the atherosclerotic profile. Scholar
  44. 44.
    • Caula AL, Lira-Junior R, Tinoco EMB, et al. The effect of periodontal therapy on cardiovascular risk markers: a 6-month randomized clinical trial. J Clin Periodontol. 2014;41(9):875–882. This manuscript is a clinical study on non-surgical mechanical periodontal treatment on inflammatory markers related to the risk for cardiovascular disease. Scholar
  45. 45.
    Higashi Y, Goto C, Hidaka T, Soga J, Nakamura S, Fujii Y, et al. Oral infection- inflammatory pathway: periodontitis, is a risk factor for endothelial dysfunction in patients with coronary artery disease. Atherosclerosis. 2009;206(2):604–10. Scholar
  46. 46.
    D’Aiuto F, Parkar M, Nibali L, et al. Periodontal infections cause changes in traditional and novel cardiovascular risk factors: results from a randomized controlled clinical trial. Am Heart J. 2006;151(5):977–84. Scholar
  47. 47.
    Kamil W, Al Habashneh R, Khader Y, et al. Effects of nonsurgical periodontal therapy on C-reactive protein and serum lipids in Jordanian adults with advanced periodontitis. J Perio Res. 2011;46:616–21.Google Scholar
  48. 48.
    Losche W. Periodontitis and cardiovascular disease: periodontal treatment lowers plasma cholesterol. Southern Med J. 2007;100(7):663–4. Scholar
  49. 49.
    CDC, NCHS. Underlying Cause of Death 1999–2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999–2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed 3 Feb 2015.Google Scholar
  50. 50.
    •• Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ. Update on prevalence of periodontitis in adults in the United States. J Dent Res. 2015;86:611–22. This manuscript describes the prevalence, severity, and extent of periodontitis in the US adult population by combining data from the NHANES 2009–2010 and 2011–2012 surveys. Google Scholar
  51. 51.
    • Nguyen CM, Kim JWM, Quan VH, Nguyen BH, Tran SD. Periodontal associations in cardiovascular diseases: the latest evidence and understanding. J Oral Biol Craniofac Res. 2015;5(3):203–206. This manuscript is a recent review on the association between periodontal and cardiovascular diseases. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Thomas T. Nguyen
    • 1
    Email author
  • Kevin Y. Wu
    • 2
  • Maude Leclerc
    • 1
  • Hieu M. Pham
    • 2
  • Simon D. Tran
    • 2
  1. 1.Faculty of DentistryUniversity of MontrealMontrealCanada
  2. 2.Faculty of DentistryMcGill UniversityMontrealCanada

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