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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 cau...
CARDIOVASCULAR DISEASE
CVD caused by atherosclerosis:
• Coronary heart disease (myocardial
infarction)
• Cerebrovascular d...
ATHEROSCLEROSIS
Atherosclerosis is an inflammatory disease characterised by an alteration of the
vascular endothelium and ...
ATHEROSCLEROSIS
 Blood vessel stenosis
The narrowing of the blood vessel due to the formation of atherosclerotic
plaque m...
CARDIOVASCULAR DISEASE –PERIODONTAL
DISEASE
Cardiovascular disease (CVD) caused by atheroesclerosis have been
proven to be...
Individuals with periodontitis:
 Are 25% more likely to develop coronary heart disease
 As periodontitis severity increa...
Direct association between an increased risk of atherosclerosis and the presence of
periodontal pathogens such as:
- C. re...
ETIOPATHOGENESIS
Atheromatous plaque
Periodontal disease
Blood vessel
Blood vessel Atheromatous plaque
formation
Atheromat...
Individuals with periodontitis are at increased risk:
 2.1 times for acute myocardial infarction
 4.3 times for stroke
...
The initial aim of treatment is to control the infection to stop disease progression:
 Mechanical biofilm control:
• Oral...
- Locally:
 Restores health of gums and teeth
- Systemically:
 Reduces systemic inflammation: by lowering levels of C-re...
PREVENTION
In patients with healthy gums, the occurrence of gingivitis must be prevented.
If gingivitis already exists, it...
TREATMENT
In patients with periodontal disease, the use of antiseptics such as
Chlorhexidine (CHX) combined with Cetylpyri...
- Teaching oral hygiene (brushing technique, interproximal hygiene, etc.)
- Motivation: long-term treatment success depend...
CONCLUSIONS
 It has been proven that a link exists between periodontal disease and
cardiovascular disease.
 Periodontal ...
@Dentaid
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Periodontal disease and cardiovascular disease

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Periodontal disease and cardiovascular disease

  1. 1. PERIODONTAL DISEASE AND CARDIOVASCULAR DISEASE DENTAID MEDICAL DEPARTMENT
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. 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.
  6. 6. CARDIOVASCULAR DISEASE –PERIODONTAL DISEASE Cardiovascular 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
  7. 7. 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
  8. 8. 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
  9. 9. 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.) Medium layer Inner layer Bloodvessellumen
  10. 10. 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 inflammation Entry of inflammatory mediators in blood Systemic inflammation Formation, maturation and exacerbation of ATHEROMATOUS PLAQUE Local infection Entry of periodontal pathogens in blood Periodontal pathogens in vascular tissues
  11. 11. 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
  12. 12. - 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
  13. 13. 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
  14. 14. 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%
  15. 15. - 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
  16. 16. 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.
  17. 17. @Dentaid

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