Periodontal Disease: A Risk Factor for Diabetes and Cardiovascular Disease

Abstract

Periodontitis is a chronic inflammatory disease, initiated by the presence of a bacterial biofilm, called dental plaque, which affects both the periodontal ligaments and bone surrounding teeth. In the last decades, several lines of evidence have supported the existence of a relationship between periodontitis and systemic health. For instance, as periodontitis acts within the same chronic inflammatory model seen in cardiovascular disease (CVD), or other disorders, such as diabetes, several studies have suggested the existence of a bi-directional link between periodontal health and these pathologies. For instance, people with diabetes are more susceptible to infections and are more likely to suffer from periodontitis than people without this syndrome. Analogously, it is now evident that cardiac disorders are worsened by periodontitis, both experimentally and in humans. For all these reasons, it is very plausible that preventing periodontitis has an impact on the onset or progression of CVD and diabetes. On these grounds, in this review, we have provided an updated account on the current knowledge concerning periodontal disease and the adverse effects exerted on the cardiovascular system health and diabetes, informing readers on the most recent preclinical studies and epidemiological evidence.

Keywords: bacteria; cardiovascular disease; diabetes; inflammation; periodontitis.

Figure 1

Schematic representation of inflammatory mechanisms linking periodontitis to CVDs. (1) The imbalance in pathogens of the biofilm leads to gingival epithelium inflammation that releases chemical mediators, such as interleukins (ILs), prostaglandin E2 (PGE2), tumor necrosis factor alpha (TNF-α) and MMPs, that recruit immune cells. This inflammatory response induces alveolar bone reabsorption, by osteoclasts. (2) At a chronic stage, oral pathogenic dissemination into the bloodstream leads to the onset of CVDs including atherosclerosis, myocardial infarction and peripheral artery disease (3).