Am J Cardiovasc Dis 2011;1(1):76-83

Original Article
Periodontitis and coronary artery disease: a questioned association
between vascular and periodontal plaques  

Costas Thomopoulos, Costas Tsioufis, Nikos Soldatos, Alexandros Kasiakogias, Christodoulos Stefanadis

First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece

Received May 5, 2011; accepted May 16, 2011; Epub May 18, 2011; published June 1, 2011

Abstract: Periodontitis is a bacterially-induced, localized chronic inflammatory disease destroying both the connective
tissue and the supporting bone of the teeth. In the general population, severe forms of the disease demonstrate a
prevalence of almost 5%, whereas initial epidemiological evidence suggests an association between periodontitis and
coronary artery disease (CAD). Both the infectious nature of periodontitis and the yet etiologically unconfirmed infectious
hypothesis of CAD, question their potential association. Ephemeral bacteremia, systemic inflammation and
immune-pathological reactions constitute a triad of mechanisms supporting a cross-talk between periodontal and
vascular damage. To which extent each of these periodontitis-mediated components contribute to vascular damage still
remains uncertain. More than twenty years from the initial epidemiological association, the positive weight of evidence
remains still alive but rather debated, because of both the presence of many uncontrolled confounding factors and the
different assessment of periodontal disease. From the clinical point of view, advising periodontal prevention or treatment
targeting on the prevention of CAD it is unjustified. By contrast, oral hygiene including periodontal health might contribute to
the overall well-being and healthy lifestyle and hence as might at least partially contribute to cardiovascular prevention.        

Keywords: Periodontitis, periodontal disease, coronary artery disease, prevention, bacteremia, atherosclerosis

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Address all correspondence to:
Dr. Costas Thomopoulos
First Cardiology Clinic
University of Athens, Hippokration Hospital
Athens, Greece.
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