European workshop in periodontal health and cardiovascular disease-scientific evidence on the association between periodontal and cardiovascular diseases: a review of the literature

In the last 10 years, a rising number of epidemiological investigations have studied the possible association between chronic oral infections and cardiovascular diseases (CVD). These studies were based on the hypothesis that periodontal diseases (PD), may confer an independent risk for CVD. There is, however, still controversy whether these associations are causal or whether there are common aetiological factors common to both diseases (residual confounding). The objective of this paper was to review the possible association between PD and CVD on both the epidemiological association and the possible preventive and treatment implications. Although the reported epidemiological studies have shown a significant, albeit week associations, we still lack properly designed clinical trials demonstrating that these chronic infections are independent factors of cardiovascular risk. The use of surrogate variables assessing the infective load and measures of subclinical atherosclerosis have clearly shown, not only a significant pathogenic relationship, but also a significant impact after periodontal therapy. From a public health perspective, if further studies consistently identify PD as a risk factor for CHD and treatment studies show benefit, the implications are significant, since PD is mostly avoidable and treatable when not prevented. In addition, good preventive dental care has multiple other benefits, particularly on quality of life. Furthermore, identifying individuals at higher risk for CHD than predicted by traditional risk factors could facilitate treatment of risk factors known to decrease CHD events in high-risk individuals and this might be significant given the high prevalence of PD in the population and the common problem of CHD.