New Trends in the Impact of Periodontal Treatment on Early Cardiovascular Diseases Outcomes: Insights and Future Perspectives

Cardiovascular diseases represent the primary worldwide cause of mortality, and periodontitis is the main cause of tooth loss. The incidence of atherosclerotic disease has been reported to be higher in individuals affected by periodontitis than in individuals without, regardless of many common risk factors are present. Various pathogenetic models have been presented to clarify the close correlation between these two diseases. First, periodontal bacteria and their toxins can enter the circulation both during dental procedures and normal activities such as eating and teeth brushing. Periodontal bacteria may indirectly contribute to coronary artery disease (e.g., by causing immunological reactions) or directly by damaging coronary arteries. Periodontal treatment significantly reduces periodontal pathogens such as Porphyromonas gingivalis (Pg) or Actinobacillus actinomycetemcomitans (Aa) in deep periodontal pockets. Moreover, periodontal treatment may lower blood inflammatory mediators, enhance the lipid profile, and cause favourable changes in various surrogate markers for cardiovascular disease. The way in which oral bacteremia and periodontal inflammation cause atherosclerosis is still unclear and needs further studies. The real effectiveness of periodontal treatment in preventing cardiovascular events is a topic of current interest. In this regard, this review article explores new insights and provides an indication of future directions on the function of periodontal inflammation and oral bacteria in the incidence and progression of atherosclerosis and cardiovascular diseases, with the main focus on assessing the impact of periodontal treatment on cardiovascular disease outcome biomarkers.