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Medically Compromised Patients Periodontics Supporting Your Practice

Does periodontal treatment matter for periodontitis patients with cardiovascular disease?

This summary is based on the article publishedin the Journal of Clinical Periodontology: Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis (January 2014)

Wijnand J. Teeuw, Dagmar E. Slot, Hendri Susanto, Victor E. A. Gerdes, Frank Abbas, Francesco D’Aiuto, John J. P. Kastelein and Bruno G. Loos


Periodontitis is a common chronic multifactorial infectious disease of the supporting structures of the teeth (root cementum, periodontal ligament and alveolar bone) and a major cause of tooth loss.

Several causal mechanisms have been proposed whereby bacterial pathogens, antigens, endotoxins, and/or inflammatory cytokines from periodontal lesions in the oral cavity contribute to the process of atherogenesis as well as to thromboembolic events and thereby increase the risk for cardiovascular disease (1, 2).

Treatment of periodontitis includes mechanical removal of supra- and subgingival bacterial plaque deposits and intensive oral hygiene instructions. Regularly, periodontal surgery is needed to reduce or eliminate residual periodontitis lesions.

Purpose of the Review

The systematic review of clinical intervention trials was performed to assess the question whether periodontal treatment affects the cardiovascular risk profile in periodontitis patients compared to no treatment, taking inter-trial differences into account.

Key Findings

  • Periodontal treatment reduces the risk for CVD by improving plasma levels of inflammatory, thrombotic (fibrinogen) and metabolic markers and endothelial function. This improvement is sustained well over 6 months after therapy and it is greater in those individuals suffering from both periodontitis and co-morbidities like CVD and/or diabetes mellitus.
  • The findings of the review emphasize the effectiveness and need for periodontal diagnosis and periodontal therapy in atherosclerotic and diabetic individuals to improve their systemic health.
  • The review recommends that:
    • Cardiologists, diabetologist and general physicians ask their patients to be screened by dental care professionals for the presence of periodontitis and if so, to undergo periodontal therapy to improve their cardiovascular risk profile and thereby reducing the risk for future occurrence of CVD events.
    • Periodontists and dentists should discuss CVD risk factors, like overweight and smoking, with their patients as part of their priodontal treatment protocol.


  1. Humphrey, L. L., Fu, R., Buckley, D. I., Freeman, M. & Helfand, M. (2008) Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis. Journal of General Internal Medicine 23, 2079–2086.
  2. Friedewald, V. E., Kornman, K. S., Beck, J. D., Genco, R., Goldfine, A., Libby, P., Offenbacher, S., Ridker, P. M., Van Dyke, T. E. & Roberts, W. C. (2009) The American Journal of Cardiology and Journal of Periodontology Editors’ Consensus: periodontitis and atherosclerotic cardiovascular disease. American Journal of Cardiology 104, 59–68.

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