There has been mounting evidence accumulating over the past decade that supports a strong association between periodontal disease and cardiovascular risk. This Editors' Consensus paper reports on a very focused review of the existing evidence in an effort to provide guidance statements that have value to both the periodontal and cardiovascular clinical and research communities.

Periodontal disease is common, with mild to moderate forms affecting up to 50% of adults in the United States. Studies have demonstrated that moderate to severe periodontitis increases the level of systemic inflammation, and indeed inflammation is the common thread tying many disease processes together.

The host response to challenges such as lipids and bacteria, initially thought to be protective in nature, can be destructive in certain high risk individuals, leading to the development of chronic diseases, such as atherosclerotic disease and periodontitis. Inflammation can operate in all stages of both atherosclerotic and periodontal diseases, increasing the risk for cardiovascular events (MI and stroke) and tooth loss. Common risk factors between the two diseases include genetics, advancing age, male gender, stress, smoking, diabetes mellitus, rheumatoid arthritis, and obesity. It is noteworthy, however, that periodontitis has also been reported to be a risk factor or marker independent of traditional risk factors for coronary artery, cerebrovascular, and peripheral arterial diseases.

Moderate to severe forms of periodontitis can lead to an acute-phase inflammatory response, as measured by elevations in blood levels of cytokines, TNF-α, and C-reactive protein (CRP). High levels of CRP,measured by a high-sensitivity assay (hsCRP), are predictive of future acute myocardial infarction, unstable angina pectoris, and the onset of systemic arterial hypertension, diabetes mellitus, and stroke, independent of blood lipid levels. Treatment of periodontitis reduces the level of systemic inflammatory mediators. In untreated cases of periodontitis, bacterial species found predominantly in periodontal pockets have also been found in atheromas, deposits of lipid-containing plaques on the innermost layer of an arterial wall.