Link between Periodontal and Cardiovascular diseases

Spread the love

The global burden of morbidity and mortality due to cardiovascular diseases is significant. More than 550 million people worldwide have cardiovascular problems, and it was responsible for 18 million fatalities in 2019.1  In America two people die every 68 seconds due to cardiovascular disease.2

To comprehend the pathophysiology of this group of disorders, many factors have been researched. However, atherosclerosis is the fundamental cause of the majority of these conditions i.e., Lipid-rich granules that are deposited in blood vessels as a result of inflammation bring on atherosclerosis. This results in lumen narrowing and is the cause of peripheral artery disease, myocardial infarction, and stroke.

Periodontal disease is characterized by inflammation and infection in the bones that support the teeth and gums. Gingivitis, the first stage of periodontal disease, is a condition that occurs when the gums swell and begin to bleed. Periodontitis may develop if this problem worsens, which can cause bone loss and gums that tear away from the teeth.3

Periodontal and Cardiovascular diseases

There have been several scientific studies that have showed the linkage between periodontal disease and increase cardiovascular disease risk. Also, having periodontal disease increases your chance of having a heart attack by 35%.4

Gram-negative anaerobes along with some other motile bacterial species are a part of sub-gingival microflora. These bacteria when entering blood vessels through a break in the oral lining can cause endothelial injury of these vessels by direct effect. This results in an inflammatory reaction, which causes the formation of atherosclerotic plaque.

Similarly, these bacteria also result in the production of inflammatory cytokines, which cause atherosclerosis. Some species e.g. Streptococcus sanguis have the ability to promote platelet activation and aggregation leading to the formation of thrombus. This may cause acute myocardial infarction and can be life-threatening.5,6

According to Haraszthy et al., almost 45% of carotid atheroma harbor some kind of periodontal pathogens.This shows the high prevalence of these bacteria and their role in causing carotid narrowing and hence a precursor of stroke.7

In addition to the lining of the blood vessels, the lining of the heart can be damaged by periodontal bacteria. A background cardiac disease can lead to the creation of blood flow jets, which can be dangerous.

When these jets collide with structures, such as valves, blood bacteria lodge in the damaged structures and valves. Endocarditis is one of the complications that could result from this.8 Endocarditis can cause a mortality rate as high as 20% in some cases.9

Risk factors for periodontal disease

Different risk factors increase the risk of periodontal diseases. These include:

  • Bad oral hygiene
  • Use of tobacco
  • Uncontrolled diabetes or excessive intake of carbohydrates
  • Stress
  • Heredity
  • Defective teeth or filling defects in teeth
  • Underlying immune diseases—e.g., AIDS
  • Medication or drug abuse that results in dry mouth e.g. Meth
  • Bridges that do not have a suitable fit any longer
  • Changes in female hormone levels, such as those that occur during pregnancy or as a result of using oral contraceptives10

Signs and symptoms

Periodontal disease can present with different signs and symptoms. Some of them are;

  • Bad breath – This is one of the most common symptoms of periodontal disease. Oral bacteria produce bad breath. Excessive bacteria result in the production of a foul smell and this results in bad breath
  • Swollen gums – Swollen gums are a sign of active infection. Increased blood flow in the damaged region causes this swelling along with redness
  • Tender gums – Accumulation of inflammatory markers and edema causes the gums to become tender. Damage to the epithelium also causes bleeding from the gums
  • Difficulty chewing –Swelling and tenderness make it difficult to chew.
  • Sensitivity – Because of periodontal diseases, the nerve endings in the gums are over-sensitive and exposed. This leads to increase sensitivity to cold and hot food.11

When periodontal diseases cause cardiovascular disease, it can present as follows:

  • Chest pain
  • Myocardial Infarction
  • Stroke
  • Fever secondary to bacterial infection as in Infective endocarditis
  • Difficulty breathing due to heart failure caused by damaged valves12

All of the above mentioned conditions can be life-threatening and the person must immediately report to the nearest medical center for proper workup and care.

Prevention of periodontal disease

Given the serious morbidity and mortality associated with this condition, prevention is the best cure. Daily floss and brushing of teeth are recommended to limit and prevent the accumulation of bacteria.13

It may also be helpful to use mouthwashes. Additionally, it is essential to visit the dentist at least twice a year for dental checkup. People who already have cardiovascular disease require more thorough examinations regularly.

Patients who have previously undergone any kind of cardiac operation are required to have a consultation with a cardiologist before undergoing any kind of dental procedure, and they may be required to take antibiotics as a preventative measure against infective endocarditis.14


Though bacteria most likely play a role in the health of your cardiovascular and dental systems, the choices you make in your daily life are still very important. It has been demonstrated without a reasonable doubt that people who suffer from severe periodontal disease often have unhealthy lifestyles.

And studies have presented facts that people who have periodontal disease have substantial risk factor for cardiovascular disease. Therefore, leading a healthy lifestyle is necessary if one wants to lessen the effects of the connection that exists between periodontal disease and the cardiovascular system.

The early detection and treatment of periodontal disorders, as well as their prevention, are of the utmost significance. It has the potential to prevent a person from having a myocardial infarction, a stroke, and even passing away. Therefore, it is necessary to place significance on it.


Written by: Emmanuel J. Osemota


1.         Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76(25):2982-3021.

2.         Soni J, Ansari U, Sharma D, Soni S. Predictive data mining for medical diagnosis: An overview of heart disease prediction. International Journal of Computer Applications. 2011;17(8):43-8.

3.         Eke PI, Dye B, Wei L, Thornton-Evans G, Genco R. Prevalence of periodontitis in adults in the United States: 2009 and 2010. Journal of dental research. 2012;91(10):914-20.

4.         Humphrey LL, Fu R, Buckley DI, Freeman M, Helfand M. Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis. Journal of general internal medicine. 2008;23(12):2079-86.

5.         Kalayoglu MV, Byrne GI. A Chlamydia pneumoniae component that induces macrophage foam cell formation is chlamydial lipopolysaccharide. Infection and Immunity. 1998;66(11):5067-72.

6.         Herzberg MC, Meyer MW. Effects of oral flora on platelets: possible consequences in cardiovascular disease. Journal of periodontology. 1996;67:1138-42.

8.         Sullam PM, Drake TA, Sande MA. Pathogenesis of endocarditis. Am J Med. 1985;78(6b):110-5.

9.         Sandre RM, Shafran SD. Infective endocarditis: review of 135 cases over 9 years. Clin Infect Dis. 1996;22(2):276-86.

10.       Genco RJ, Borgnakke WS. Risk factors for periodontal disease. Periodontology 2000. 2013;62(1):59-94.

11.       Dunning T. Periodontal disease-the overlooked diabetes complication. Nephrol Nurs J. 2009;36(5):489-95.

12.       Carrizales-Sepúlveda EF, Ordaz-Farías A, Vera-Pineda R, Flores-Ramírez R. Periodontal disease, systemic inflammation and the risk of cardiovascular disease. Heart, Lung and Circulation. 2018;27(11):1327-34.

13.       Gurenlian JR. The role of dental plaque biofilm in oral health. American Dental Hygienists’ Association. 2007;81(suppl 1):116-.

14.       Duval X, Leport C. Prophylaxis of infective endocarditis: current tendencies, continuing controversies. The Lancet infectious diseases. 2008;8(4):225-32.

Leave a Comment

Your email address will not be published. Required fields are marked *