The findings presented in this article pose a dilemma for oral health care providers who have traditionally used clinical and radiographic measures to define periodontal disease; the current literature regarding the linkages between periodontal disease and coronary heart disease has primarily focused on using such parameters. The studies selected for this meta-analysis, however, represent an extension of traditional clinical markers to include those that signal systemic bacterial exposure, an important innovation.

These findings place a renewed emphasis on the burden of bacterial exposure as not only related to local periodontal destruction, but also the systemic influence of bacteria associated with periodontal disease. Further, the findings of a significant association between periodontal disease with elevated bacterial exposure and CHD, especially in its early stages, add more strength to existing studies using conventional indices for periodontal disease and inflammation. Clinicians should consider expanding the scope of parameters used in the clinical assessment of periodontal disease beyond the clinical and radiographic examination, and consider markers of systemic bacterial exposure as well.

The effect of cardiovascular disease on humans cannot be overemphasized: it is one of the leading causes of death in the United States, Canada, Europe, and Japan. Interestingly, periodontal disease is one of the most common human diseases, and is highly prevalent during late middle age when coronary artery disease is also most common. The effects that periodontal disease has on the incidence of CHD make it a major public health concern. For this reason, prevention and/or control of periodontal disease can be seen as an important and valuable component in the prevention of heart disease.