Periodontology/Oral Medicine: Periodontal infections and cardiovascular disease—how strong is the association?

Abstract

In the past decade there has been renewed interest in the old hypothesis that infections increase the risk of developing cardiovascular disease and stroke. There is now a convincing body of evidence that atherosclerosis has a major inflammatory component and is much more than the simple vascular accumulation of lipids. Infectious agents that have been linked to an increased risk of coronary heart disease (CHD) include Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, and herpesviruses. The concept has emerged that each of these agents is an independent risk factor for CHD and that common chronic infections are important. In addition, periodontal infections have also been implicated as one of several factors contributing to the development of CHD. Evidence supporting a causative role of chronic infections in CHD is largely circumstantial. However, the evidence is sufficiently strong to warrant further examination of the possible link between chronic infections and CHD. In this review the lines of evidence for a causative role of C. pneumoniae in the development of CHD are summarized and contrasted with the lines of evidence suggesting a periodontal infection -CHD association. If common or widespread chronic infections are truly important risk factors for CHD, it is unlikely that a single infection will be shown to be causative. It is likely that the entire microbial burden of the patient from several simultaneous chronic infections is more important (eg, H. pylori-caused gastric ulcers ؉ C. pneumoniae-caused bronchitis ؉ periodontitis). Increased cooperation between cardiologists and periodontists will be required to determine if, and what, combinations of common chronic infections are important in the pathogenesis of CHD and stroke.

Association between acute myocardial infarction and periodontitis: A case-control study with north Indian population.

“…This is suspected to be the reason behind an observed association between the two conditions (Armitage, 2000).…”

Prevalence of periodontal diseases among the patient visiting at Periodontology OPD Update Dental College Hospital, Dhaka

“…This is said to be an accurate method of recording, and time efficient in the outpatient department. 20 It is important to note, the diagnosis criteria of Armitage (2000), that the probing depth measurements was not used as the primary criterion for establishing the severity of periodontitis. According to him, the gingival margin is not a fixed reference, it can be considerably coronal to the cementoenamel junction in pathological conditions, and can be apical to the cementoenamel junction in the case of gingival recession.…”

“…1 Priodontal infections have also been implicated as one of several factors in the development of coronary heart disease. 2 Oral infections may have an association with the occurrence and severity of a wide variety of systemic conditions and diseases such as heart diseases, preterm low birth weight babies, respiratory diseases and diabetes mellitus. 3 WHO report (2005) described that the global problem persisted with the worldwide oral diseases such as dental caries, periodontal disease, tooth loss, oral mucosal lesions and oropharyngeal cancers.…”

Contemporary evidences of the relationship between periodontal disease and stroke

“…Ayrıca bu proteinlerin fagosit aktivasyonu ve nitrik oksit salımı sonucu hasarlı kan damarlarında birikerek aterom formasyonuna katkıda bulunduğu da gözlenmiştir. 28 Bu ateromatöz değişikler sonucu ani ölüm, miyokard enfarktüsü, stabil olmayan anjina, geçici serebral iskemik atak, beyin sirkülasyonunda enfarktüs sonucu oluşan inme veya kritik bacak tıkanması gibi iskemik sendromlar görülebilir. Enflamasyon süresince kemokin salımının artışı, selektif olarak lökositlerin yaralanma bölgesine çağrılmasında artışa neden olur.…”