Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases
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BACKGROUND: This consensus report is concerned with the association between periodontitis and atherosclerotic cardiovascular disease (ACVD). Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth supporting apparatus leading to tooth loss; as such, it is a major public health issue. AIMS: This report examined biological plausibility, epidemiology and early results from intervention trials. PLAUSIBILITY: Periodontitis leads to entry of bacteria in the blood stream. The bacteria activate the host inflammatory response by multiple mechanisms. The host immune response favors atheroma formation, maturation and exacerbation. EPIDEMIOLOGY: In longitudinal studies assessing incident cardiovascular events, statistically significant excess risk for ACVD was reported in individuals with periodontitis. This was independent of established cardiovascular risk factors. The amount of the adjusted excess risk varies by type of cardiovascular outcome and across populations by age and gender. Given the high prevalence of periodontitis, even low to moderate excess risk is important from a public health perspective. INTERVENTION: There is moderate evidence that periodontal treatment: (i) reduces systemic inflammation as evidenced by reduction in C-reactive protein (CRP) and improvement of both clinical and surrogate measures of endothelial function; but (ii) there is no effect on lipid profiles - supporting specificity. Limited evidence shows improvements in coagulation, biomarkers of endothelial cell activation, arterial blood pressure and subclinical atherosclerosis after periodontal therapy. The available evidence is consistent and speaks for a contributory role of periodontitis to ACVD. There are no periodontal intervention studies on primary ACVD prevention and there is only one feasibility study on secondary ACVD prevention. CONCLUSIONS: It was concluded that: (i) there is consistent and strong epidemiologic evidence that periodontitis imparts increased risk for future cardiovascular disease; and (ii) while in vitro, animal and clinical studies do support the interaction and biological mechanism, intervention trials to date are not adequate to draw further conclusions. Well-designed intervention trials on the impact of periodontal treatment on prevention of ACVD hard clinical outcomes are needed.
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There is consistent observational evidence that periodontitis is associated with an increased risk for future cardiovascular diseases independent of traditional risk factors such as smoking and obesity.
“There is consistent observational evidence that periodontitis is associated with an increased risk for future CVDs independent of traditional risk factors such as smoking and obesity.17,18”
From Periodontitis is associated with hypertension: a systematic review and meta-analysis (2020) · cites this paper as [17]
The interplay between the bacterial burden and host response is the most plausible biological mechanism linking periodontitis to a number of chronic systemic diseases, such as diabetes mellitus, cardiovascular diseases, and neurological diseases such as Alzheimer.
“The interplay between the bacterial burden and host response is the most plausible biological mechanism linking periodontitis to a number of chronic systemic diseases, such as diabetes mellitus, CVDs, and neurological diseases such as Alzheimer.17,19,20”
From Periodontitis is associated with hypertension: a systematic review and meta-analysis (2020) · cites this paper as [17]
The link between periodontitis and cardiometabolic risk factors exists.
“Besides, because of the link between periodontitis and cardiometabolic risk factors, 17,82 this review also included data from observational studies on MetS and CVD”
From Periodontitis is associated with hypertension: a systematic review and meta-analysis (2020) · cites this paper as [17]
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- Authors
- Tonetti, M. S., Van Dyke, T. E., & working group 1 of the joint EFP/AAP workshop
- Affiliations
- European Research Group on Periodontology Genova Italy
- The Forsyth Institute, Cambridge MA USA
- Corresponding author
- Tonetti, Maurizio S.
- ORCID
- Tonetti, Maurizio S.
- Venue
- Journal Of Clinical Periodontology
- Publisher
- Wiley
- Published
- 2013-04
- Volume
- 40
- Issue
- s14
- Pages
- S24-9
- ISSN
- 0303-6979 (ISSN-L)
- 1600-051X
- OpenAlex
- W4232763769
- Cited by
- 395
- References
- 20
- Citations by year
- 2026: 30 · 2025: 39 · 2024: 32 · 2023: 27 · 2022: 27 · 2021: 29 · 2020: 30 · 2019: 27 · 2018: 27 · 2017: 43 · 2016: 25 · 2015: 26 · 2014: 25 · 2013: 8
- FWCI
- 33.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal Of Clinical Periodontology (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
- Health Sciences › Medicine › Urology › Periodontal Regeneration and Treatments
- Keywords
- periodontitis, atherosclerotic cardiovascular disease, periodontal treatment, systemic inflammation, C-reactive protein, endothelial function, atherosclerotic plaque, cardiovascular risk, periodontal pathogens, cardiovascular disease prevention, subclinical atherosclerosis, coagulation
- MeSH terms
- Animals, C-Reactive Protein, Cardiovascular Diseases, Humans, Periodontitis, Risk Factors, Atherosclerosis
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