The association between periodontitis and atherosclerosis: The current state of knowledge

Atherosclerosis is a chronic inflammatory condition and infectious diseases are believed to contribute to its pathophysiology. Periodontitis is a chronic infectious disease of the supporting tissues of the teeth, and the epidemiological association with atherosclerosis is now beyond doubt. However causal mechanisms are still lacking; research suggests that bacteria from the periodontal lesions may enter atherosclerotic plaques. Alternatively, elevated CRP and a prothrombotic state in periodontitis contribute to exacerbation of atherosclerosis. Finally, the link may also be explained by polymorphisms in the ANRIL gene, which has been associated with both atherosclerosis and periodontitis. Previous studies used surrogate biomarkers to investigate the association between atherosclerosis and periodontitis, and to evaluate the effects of periodontal intervention. Unfortunately, more definitive cardiovascular parameters are still lacking, because of methodological difficulties in study design and ethical considerations.