Cardiovascular disease is the leading cause of death worldwide and is often caused by atherosclerosis. The document discusses how periodontal disease is a risk factor for cardiovascular disease, as periodontitis increases systemic inflammation and the presence of periodontal pathogens. Treating periodontal disease through mechanical removal of dental plaque and use of antiseptics can reduce cardiovascular risk by lowering inflammation and improving endothelial function. The guidelines recommend dental professionals work with medical providers to ensure safe and effective treatment of patients with both conditions.

1. PERIODONTAL
DISEASE
AND
CARDIOVASCULAR
DISEASE
DENTAID MEDICAL DEPARTMENT

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. - 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. 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. 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. - 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. 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.

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