Review Article

Interrelationships of Periodontal Disease, Systemic Inflammation, and Cardiovascular Disease

Author: Charles H. Hennekens

In United States (US) adults, periodontal disease is the most common dental condition and, worldwide, is also one of the most common chronic inflammatory diseases affecting a majority of the population. Bacteria in the plaque seem to be the initial cause of periodontal disease. This triggers an inflammatory response where inflammatory mediators and local oral bacteria in people with periodontitis will eventually enter the systemic circulation. These, in turn, will stimulate the liver to produce acute phase proteins which are biomarkers of the systemic inflammatory response (3). High sensitivity C-reactive protein (hsCRP) is an acute phase protein that it produced and released by the liver in response to inflammation. HsCRP levels elevate with systemic inflammation and tend to remain stable over time. Further, hsCRP is an accurate measure of systemic inflammation and a sensitive marker for cardiovascular disease (CVD). The hypothesis that decreasing inflammation reduces risks of cardiovascular disease is strongly supported by the results of the Justification for the Use of Statins in Primary Prevention: Intervention Trial Evaluating Rosuvastatin (JUPITER) trial as well as the Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS). All these findings provide support for the hypothesis that reduction of dental plaque in patients with periodontal disease will decrease inflammation as measured by hsCRP. As hsCRP is an accurate measure of inflammation and sensitive marker of CVD it is also plausible to hypothesize that reduction of dental plaque in patients with periodontal disease will decrease in risks of CVD. The direct test of this hypothesis requires a large scale randomized trial of sufficient size and duration designed a priori to do so. Such a finding would have major clinical and public health implications.