Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association?: A Scientific Statement From the American Heart Association
Open accessAbstract
A link between oral health and cardiovascular disease has been proposed for more than a century. Recently, concern about possible links between periodontal disease (PD) and atherosclerotic vascular disease (ASVD) has intensified and is driving an active field of investigation into possible association and causality. The 2 disorders share several common risk factors, including cigarette smoking, age, and diabetes mellitus. Patients and providers are increasingly presented with claims that PD treatment strategies offer ASVD protection; these claims are often endorsed by professional and industrial stakeholders. The focus of this review is to assess whether available data support an independent association between ASVD and PD and whether PD treatment might modify ASVD risks or outcomes. It also presents mechanistic details of both PD and ASVD relevant to this topic. The correlation of PD with ASVD outcomes and surrogate markers is discussed, as well as the correlation of response to PD therapy with ASVD event rates. Methodological issues that complicate studies of this association are outlined, with an emphasis on the terms and metrics that would be applicable in future studies. Observational studies to date support an association between PD and ASVD independent of known confounders. They do not, however, support a causative relationship. Although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent ASVD or modify its outcomes.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
There is inconsistent evidence on the causal nature of the association between periodontitis and systemic inflammation and on the effects of periodontal treatment on systemic inflammation.
“However, there is inconsistent evidence on the causal nature of the association and the effects of the treatment of periodontitis on systemic inflammation (Lockhart et al., 2012).”
From Treatment of periodontitis and <scp>C</scp> ‐reactive protein: A systematic review and meta‐analysis of randomized clinical trials (2023) · cites this paper as Lockhart et al., 2012
The ‘Periodontal Intervention and ASVD Risk’ section reports inconsistent findings on how treatment affects circulating inflammatory markers, and the ‘Summary Assessment of the Literature’ says effects differ across studies. The ‘Association of Periodontitis With Systemic Inflammation’ section notes uncertainty about some proposed pathways and markers, but says chronic periodontal infection contributes to systemic inflammation; it does not characterize the evidence for that association’s causal nature as inconsistent. Page numbers were not available in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThrough a shared inflammatory pathway, periodontal disease is associated with diabetes, cardiovascular diseases and dementia.
“Through a shared inflammatory pathway, periodontal disease is associated with other chronic diseases including diabetes, cardiovascular diseases and dementia.[19][20][21][22]”
From Oral diseases: a global public health challenge (2019) · cites this paper as [21]
The Summary Assessment of the Literature (page not provided) says periodontal disease is associated with atherosclerotic vascular disease, while the Association of Periodontitis With Systemic Inflammation section reports systemic inflammation. The Risk Factors for PD and Cardiovascular Disease section identifies diabetes as a shared risk factor, but the copy does not establish a shared inflammatory pathway linking periodontal disease to diabetes or dementia; a search for dementia found no relevant passage. (LLM, conf=0.86)
Experimental — accuracy not yet measuredVarious disease states are associated with the oral microbiome, including caries, periodontal disease, oral, esophageal, pancreatic, and colorectal cancers, cardiovascular disease, and inflammatory bowel disease.
“This is demonstrated by the association of various disease states with the oral microbiome, including not only caries and periodontal disease but also oral, esophageal, pancreatic, and colorectal cancers, cardiovascular disease, and inflammatory bowel disease.147, 148, 149, 150, 151, 152, 153”
From The oral microbiome: Role of key organisms and complex networks in oral health and disease (2021) · cites this paper as [153]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 291 · Cited by 1,038
Part of this paper’s reference list could not be split into single entries.
Research works printed but not linked: 2
- Lewis T, Grant R. Observations relating to subacute infective endo- carditis. Heart. 1923;10:21-77.
- Ferrari A, Brusa T, Rutili A, Canzi E, Biavati B. Isolation and character- ization of Methanobrevibacter oralis sp. nov. Curr Microbiol. 1994; 29:7-12.
- Authors
- Lockhart, P. B., Bolger, A. F., Papapanou, P. N., Osinbowale, O., Trevisan, M., Levison, M. E., Taubert, K. A., Newburger, J. W., Gornik, H. L., Gewitz, M. H., Wilson, W. R., Smith, S. C., & Baddour, L. M.
- Affiliations
- Carolinas Medical Center (US)
- ORCID
- Venue
- Circulation
- Published
- 2012-05-22
- Volume
- 125
- Issue
- 20
- Pages
- 2520-2544
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2109704767
- Cited by
- 1,038
- References
- 291
- Citations by year
- 2026: 48 · 2025: 53 · 2024: 49 · 2023: 59 · 2022: 72 · 2021: 91 · 2020: 83 · 2019: 59 · 2018: 66 · 2017: 70 · 2016: 91 · 2015: 76 · 2014: 106 · 2013: 88 · 2012: 26
- FWCI
- 114.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
- Keywords
- periodontal disease, atherosclerosis, cardiovascular disease, oral health, periodontal treatment, systemic inflammation, endothelial dysfunction, causality, surrogate markers, confounding, shared risk factors, mechanistic pathways
- MeSH terms
- American Heart Association, Cardiology, Humans, Periodontal Diseases, Risk Factors, United States, Evidence-Based Medicine, Atherosclerosis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
