Periodontitis and Atherosclerosis, a Causal Relationship?

Periodontal and atheromatous diseases affect a large proportion of the general population. They have been associated with each other and may be causally linked. It has not proved possible to confirm a causal relationship between periodontitis and atherosclerosis to date and contradictory results have been published, likely due to the multi-factorial nature of these diseases. The Medline database (PubMed) was explored for papers published in English, using a wide search strategy. This review discusses pathophysiological hypotheses on the possible link between atherosclerosis and periodontitis and analyzes the direct effect on the vascular endothelium of periodontopathogens, biochemical markers of chronic inflammation, pro-inflammatory cytokines and the role of atherogenic proteins in periodontitis. The article includes crosssectional, case-control, longitudinal, and interventional studies, and describes the latest meta-analyses published in the literature. Scientific evidence to date indicates that periodontitis is a risk factor for atherosclerosis, but longitudinal studies of large samples are required to determine whether there is a causal relationship between these diseases.