PERIODONTAL

DISEASE

AND

CARDIOVASCULAR

DISEASE

DENTAID MEDICAL DEPARTMENT

Cardiovascular disease (CVD) is a series of diseases

that affect the heart and the blood vessels.

They are the leading cause of death worldwide.

In Spain they represent 29% of all deaths.

CARDIOVASCULAR DISEASE

CARDIOVASCULAR DISEASE

CVD caused by atherosclerosis:

• Coronary heart disease (myocardial

infarction)

• Cerebrovascular disease (stroke)

• Peripheral vascular disease

• Hypertension (high blood pressure)

Other CVD:

• Congenital heart disease

• Rheumatic heart disease

• Cardiomyopathy

• Cardiac arrhythmias

ATHEROSCLEROSIS

Atherosclerosis is an inflammatory disease characterised by an alteration of the

vascular endothelium and the formation of atherosclerotic plaques that

decrease the lumen of blood vessels, narrowing them progressively.

These plaques are formed by a LDL cholesterol core and a fibrous capsule, and

may be pathologic in two ways:

Blood vessel stenosis

Rupture of the atherosclerotic plaque

ATHEROSCLEROSIS

Blood vessel stenosis

The narrowing of the blood vessel due to the formation of atherosclerotic

plaque may allow passage of enough blood flow under basal conditions, but

this blood flow can not increase when necessary like during exercise

Rupture of the plaque

The content of the plaque core has, among other components,

thrombogenic material which can cause the formation of a thrombus when

it comes in contact with the blood, thereby completely occluding the blood

vessel lumen.

CARDIOVASCULAR DISEASE –PERIODONTAL

DISEASECardiovascular disease (CVD) caused by atheroesclerosis have been

proven to be associated with periodontal disease.

Periodontitis is a risk factor for the

development of cardiovascular disease

The Guidelines of the European Society of

Cardiology (ESC) include periodontitis as a risk factor

Individuals with periodontitis:

Are 25% more likely to develop coronary heart disease

As periodontitis severity increases, so does the probability of CVD

Exhibit increased serum biomarkers and clinical markers (mediators of

inflammation) of endothelial dysfunction and of atherosclerosis:

- 30% increase in C-reactive protein (CRP) levels

- 11% increase in cholesterol (LDL)

EPIDEMIOLOGICAL EVIDENCE

Direct association between an increased risk of atherosclerosis and the presence of

periodontal pathogens such as:

- C. rectus

- P. micros

- A. actinomycetemcomitans

- P. gingivalis

- T. denticola

- T. forsythensis

MICROBIOLOGICAL EVIDENCE

ETIOPATHOGENESIS

Atheromatous plaque

Periodontal disease

Blood vessel

Blood vessel Atheromatous plaque

formation

Atheromatous plaque

maturation

Vascular subendothelium

Periodontal bacteria (P. gingivalis, F.nucleatum…)

Proinflammatory signals (Cytokines IL6, IL8, etc.)

Med

ium

layer

Inn

er

layer

Blo

od

vessel

lum

en

Individuals with periodontitis are at increased risk:

2.1 times for acute myocardial infarction

4.3 times for stroke

2.3 times for peripheral vascular disease

ETIOPATHOGENESIS

PERIODONTITIS

Local inflammationEntry of

inflammatory mediators in blood

Systemic inflammation

Formation, maturation and exacerbation of

ATHEROMATOUS PLAQUE

Local infectionEntry of periodontal pathogens in blood

Periodontal pathogens in

vascular tissues

The initial aim of treatment is to control the infection to stop disease progression:

Mechanical biofilm control:

• Oral hygiene at home: brushing, interproximal hygiene, oral

irrigation

• Supragingival tartar removal

• Subgingival scaling and root planing

• Periodontal surgery

Chemical biofilm control:

• Use of daily-use antiseptics as adjunctive therapy

PERIODONTAL TREATMENT

- Locally:

Restores health of gums and teeth

- Systemically:

Reduces systemic inflammation: by lowering levels of C-reactive

protein

Improves clinical levels of endothelial function

Both parameters are related to an increased risk for future cardiovascular

episodes.

BENEFITS FROM PERIODONTAL

TREATMENT

PREVENTION

In patients with healthy gums, the occurrence of gingivitis must be prevented.

If gingivitis already exists, its evolution to periodontitis (related with an increased risk

for CVD) must be prevented.

A daily-use antiseptic with Cetylpyridinium chloride

(CPC) is recommended:

Prevents and helps treat gingival inflammation

and bleeding from gingivitis

TREATMENT

In patients with periodontal disease, the use of antiseptics such as

Chlorhexidine (CHX) combined with Cetylpyridinium chloride (CPC) are

recommended for controlling the level of periodontal pathogens.

• Maintenance (up to 6 months):

CHX 0.05% + CPC 0.05%

• Treatment (2-4 weeks):

CHX 0.12% + CPC 0.05%

- Teaching oral hygiene (brushing technique, interproximal hygiene, etc.)

- Motivation: long-term treatment success depends on patient compliance

- We recommend that dentists form part of a multidisciplinary team, in

which primary care doctors and/or cardiologists are also

participating, to ensure safe and effective treatment of patients.

RECOMMENDATIONS

CONCLUSIONS

It has been proven that a link exists between periodontal disease and

cardiovascular disease.

Periodontal disease is a risk factor for the future development of cardiovascular

disease.

The prevention and treatment of periodontal disease reduces the risk of

cardiovascular disease.

@Dentaid