Increased cardiovascular disease risk in patients with periodontal disease: Insights from studies of periodontal treatment

Oropharyngeal infection has long been associated with cardiovascular disease (CVD), specifically valvular disease and endocarditis. However, the relationship between periodontal disease (PD), with associated infection and inflammation, and CVD is often overlooked. The aim of this review was to synthesize and critically appraise interventional clinical evidence of nonsurgical periodontal therapy (NSPT) effects on systemic inflammatory mediators, cardiovascular biomarkers, and clinical cardiovascular outcomes. Across interventional studies, NSPT was associated with reductions in systemic inflammatory biomarkers (e.g., C-reactive protein, interleukin 6), as well as modest improvements in blood pressure and select lipid parameters, particularly among patients with coexisting cardiometabolic disease. In contrast, most studies evaluating clinical cardiovascular endpoints did not demonstrate superiority of NSPT over less intensive periodontal care, reflecting small sample sizes, short follow-up durations, and heterogeneous study designs. A prospective study in patients undergoing atrial fibrillation ablation reported significantly fewer arrhythmia recurrences among those receiving periodontal therapy. Although NSPT reduced inflammatory biomarkers, 4 of 5 studies that evaluated clinical atherosclerotic vascular disease outcomes did not show superiority of NSPT versus less intensive treatment. In contrast, a nonrandomized study of patients with atrial fibrillation demonstrated significantly reduced arrhythmia after radiofrequency catheter ablation when PD therapy was given during postablation recovery. Existing evidence supports a consistent association and biological plausibility for a contributory role of PD in increased cardiovascular risk, while definitive causal relationships remain to be established. Adequately powered, properly randomized clinical trials with longer follow-up are warranted to evaluate the potential for NSPT to reduce CVD outcomes.