Periodontitis and
cardiovascular diseases:
Consensus report.
A joint periodontal and cardiology consensus connects epidemiology, biological pathways and clinical care in one shared view of health.
Volume 47 · 268–288 · 2020
DOI: 10.1111/jcpe.13189
ORIGINAL PAPER · AT A GLANCE
J Clin Periodontol · 47 · 268–288
Periodontitis and cardiovascular diseases: Consensus report
Mariano Sanz and colleagues
A joint European Federation of Periodontology and World Heart Federation workshop examines the epidemiological and biological connections between periodontitis and cardiovascular disease and translates them into recommendations for dental and medical practice.
This is a PerioMed-designed bibliographic presentation and editorial synthesis, not a reproduction of the publisher’s first page or full abstract.
01 · WHY THIS PAPER
Periodontitis and cardiovascular disease are often discussed in separate clinical settings. This report brings periodontists and cardiologists into the same scientific conversation.
The European Federation of Periodontology and the World Heart Federation convened a joint workshop to examine whether periodontitis is associated with atherosclerotic cardiovascular disease, which biological pathways may connect them, how periodontal treatment influences systemic markers and how cardiovascular patients can be treated safely.
THE CENTRAL IDEA
Local inflammation.
A wider biological response.
Periodontal tissues form an active interface between microbial communities and the host. When this barrier is chronically inflamed, bacteria, microbial products and inflammatory mediators can enter pathways that are also relevant to vascular biology.
biologyPathways examined across several lines of evidence
Not a one-way claim of causation. A biological route investigated through epidemiology, mechanisms, treatment studies and clinical care.
FROM QUESTION TO SHARED CARE
A consistent association
Population studies repeatedly connect periodontitis with coronary heart disease and also report associations with stroke and peripheral artery disease.
Multiple converging pathways
Microbial dissemination, systemic inflammation, platelet activation, immune responses and shared genetic factors provide biological coherence.
Two professions one patient
The consensus translates the evidence into coordinated screening, referral and periodontal management for people with cardiovascular disease.
THE EVIDENCE LANDSCAPE
One connection.
Several lines of evidence.
The report considers epidemiology, mechanistic science, treatment studies and clinical safety together, allowing each type of evidence to answer a different part of the question.
Coronary heart disease
The epidemiological evidence is strongest for coronary heart disease. Recent case control and cohort studies consistently report a higher risk of a first coronary event among people with periodontitis.
Stroke
The evidence base is smaller but points in the same direction. In the ARIC cohort, periodontitis was associated with more than twice the risk of cardioembolic and thrombotic stroke.
Peripheral artery disease
The available studies describe a consistent association, with adjusted odds ratios of approximately 2.
Biological pathways
Bacteraemia, periodontal pathogens within atherosclerotic plaques, systemic inflammatory mediators, platelet activation and shared genetic loci support several plausible pathways.
Treatment markers
Periodontal treatment lowers C reactive protein and interleukin 6 and improves endothelial function, connecting local treatment with measurable systemic responses.
Clinical management
The consensus supports periodontal screening in cardiovascular patients, coordinated referral and safe delivery of care with appropriate local haemostatic measures.
WHAT THE EVIDENCE CONNECTS
The periodontal and cardiovascular conversation belongs together.
- Periodontitis is consistently associated with atherosclerotic cardiovascular disease.
- Microbial and inflammatory findings support biologically plausible pathways.
- Periodontal treatment can improve systemic inflammatory markers and endothelial function.
WHAT THIS MEANS IN PRACTICE
Connected evidence should lead to connected care.
- Dentists should ask about cardiovascular health and screen cardiovascular patients for periodontitis.
- Physicians should include periodontal health in history taking and referral.
- Periodontal care can usually proceed without stopping antithrombotic medication, using appropriate local measures and medical coordination when needed.
PERIOMED BOTTOM LINE
“The mouth and the cardiovascular system are not separate clinical stories. Their connection asks dentistry and medicine to care for the same patient together.”
The consensus supports periodontal health as part of coordinated cardiovascular care. It brings association, biological plausibility, treatment response and clinical management into a shared framework without reducing either discipline to the other.