The Role of Oral Infections in the Development of Atherosclerosis: A Review of Recent Findings

¹Sr. Professor & Head, Daswani Dental College affliated to Rajasthan University of Health Sciences, Jaipur, Rajasthan, India

²Reader, Daswani Dental College affliated to Rajasthan University of Health Sciences, Jaipur, Rajasthan, India

³P.G Student, Daswani Dental College affliated to Rajasthan University of Health Sciences, Jaipur, Rajasthan, India

*Corresponding Author: Dr Ashish Pandey, Sr. Professor & Head, Daswani Dental College affliated to Rajasthan University of Health Sciences, Jaipur, Rajasthan, India, Phone: +918853582863, E-mail: [email protected]

Received Date: January 03, 2025

Published Date: January 25, 2025

Citation: Pandey A, et al. (2025). The Role of Oral Infections in the Development of Atherosclerosis: A Review of Recent Findings. Mathews J Cardiol. 9(1):38.

Copyrights: Pandey A, et al. © (2025).

ABSTRACT

Atherosclerosis, the progressive narrowing and hardening of arteries, is a major contributor to cardiovascular diseases (CVD), the leading cause of morbidity and mortality worldwide. Emerging evidence has highlighted the potential role of oral infections, specifically periodontal disease, in the development and progression of atherosclerosis. Periodontal diseases, caused by bacterial infections in the oral cavity, lead to systemic inflammation and immune responses that may contribute to vascular damage. This review synthesizes recent findings on the relationship between oral infections and atherosclerosis, focusing on the mechanisms involved, clinical evidence, and implications for preventive and therapeutic strategies. We also explore the potential of periodontal treatment in reducing cardiovascular risk, the role of oral microbiota in atherosclerosis, and the need for interdisciplinary approaches to patient management.

Keywords: Atherosclerosis, Periodontal Disease, Oral Infections, Cardiovascular Disease, Inflammation, Oral Microbiota, Interdisciplinary Care.

INTRODUCTION

Atherosclerosis is a chronic condition that involves the accumulation of fatty deposits, calcium, and cellular debris in the arterial walls, leading to the formation of plaques that obstruct blood flow. This process significantly contributes to cardiovascular diseases (CVD), including coronary artery disease, stroke, and peripheral artery disease. Traditionally, the pathogenesis of atherosclerosis has been attributed to risk factors such as hypertension, hyperlipidemia, smoking, and diabetes. However, recent research has revealed that systemic inflammation plays a crucial role in the initiation and progression of atherosclerosis, with periodontal disease emerging as a significant contributor to this inflammatory process.

Periodontal disease, a chronic inflammatory condition of the oral tissues, is caused by bacterial infections that can spread from the oral cavity to other parts of the body via the bloodstream. There is growing evidence to suggest that oral infections may play a pivotal role in the development of atherosclerosis by initiating and exacerbating systemic inflammation. This review explores the mechanisms through which oral infections contribute to atherosclerosis, the clinical evidence supporting this relationship, and the potential implications for cardiovascular health.

Mechanisms Linking Oral Infections and Atherosclerosis

Bacterial Invasion and Inflammation

Oral pathogens, particularly those involved in periodontal disease such as Porphyromonas gingivalis, Fusobacterium nucleatum, and Tannerella forsythia, can enter the bloodstream through routine activities like chewing and brushing. Once these bacteria enter the circulation, they can lodge in the arterial walls, particularly in regions already predisposed to atherosclerotic plaque formation [1]. This bacterial invasion leads to the release of pro-inflammatory cytokines and activation of immune cells, contributing to the development of atherosclerosis.

Immune System Activation and Chronic Inflammation

The body’s immune response to periodontal pathogens results in the production of inflammatory mediators such as C-reactive protein (CRP), interleukins (IL-6, IL-1), and tumor necrosis factor-alpha (TNF-α) [2]. These inflammatory markers are not only indicators of periodontal disease but also have direct effects on the vasculature, promoting endothelial dysfunction and the accumulation of lipid-rich plaques in the arteries [3]. Chronic low-grade inflammation, a hallmark of both periodontal disease and atherosclerosis, leads to the progressive thickening of the arterial walls, a key feature of atherosclerosis.

Endothelial Dysfunction and Atherosclerotic Plaque Formation

Endothelial dysfunction is an early event in the development of atherosclerosis. Studies have shown that oral infections can impair endothelial cell function, leading to the expression of adhesion molecules and an increased propensity for the adhesion of leukocytes to the vascular endothelium [4]. This process facilitates the infiltration of lipids and immune cells into the arterial wall, where they form plaques that narrow and stiffen the arteries. The presence of oral pathogens in atherosclerotic plaques has been confirmed in several studies, further supporting the link between periodontal infection and cardiovascular disease [5].

Clinical Evidence and Studies Supporting the Link

Epidemiological Studies

Several large-scale epidemiological studies have reported a positive association between periodontal disease and increased risk of atherosclerosis and cardiovascular events. For example, a study by Beck et al. [6] found that individuals with severe periodontal disease had a significantly higher risk of developing coronary artery disease. Similarly, a meta-analysis by Goulart et al. [7] concluded that periodontal disease is a significant risk factor for atherosclerosis, with patients exhibiting higher levels of inflammatory biomarkers such as CRP and IL-6.

Periodontal Treatment and Cardiovascular Risk Reduction

The effects of periodontal treatment on cardiovascular risk have also been investigated in clinical trials. A study by Kawai et al. [8] found that patients with periodontitis who received periodontal treatment showed a reduction in carotid intima-media thickness (CIMT), a marker of atherosclerotic progression. This suggests that controlling periodontal disease may not only improve oral health but also reduce the risk of atherosclerosis and cardiovascular events. Other studies have demonstrated a reduction in systemic inflammatory markers following periodontal treatment, further supporting the role of periodontal therapy in mitigating cardiovascular risk [9].

Mechanistic Insights from Animal Models

Animal models have provided valuable insights into the mechanisms by which oral infections contribute to atherosclerosis. Research by Kawai et al. [10] in mice infected with P. gingivalis showed an accelerated development of atherosclerotic lesions, along with increased levels of systemic inflammatory markers. These findings suggest that periodontal pathogens can directly influence the development of atherosclerosis by inducing systemic inflammation.

Periodontal Treatment and Cardiovascular Risk Reduction

Impact of Scaling and Root Planing (SRP)

Scaling and root planing (SRP) is the most common non-surgical treatment for periodontal disease. It involves the removal of plaque and calculus from the tooth surfaces and beneath the gumline. SRP has been shown to reduce the levels of inflammatory markers such as CRP, IL-6, and TNF-α, which are associated with both periodontal disease and atherosclerosis [11]. A systematic review by Cortellini et al. [12] concluded that periodontal therapy significantly reduced systemic inflammation, which could help lower the risk of cardiovascular disease.

Antibiotic Therapy

In some cases, adjunctive antibiotic therapy is used to target specific periodontal pathogens. Studies have shown that antibiotics can reduce the bacterial load in the oral cavity and decrease systemic inflammation, potentially lowering cardiovascular risk [13]. However, the use of antibiotics for periodontal therapy remains controversial due to concerns about antimicrobial resistance and the need for further research to determine the long-term benefits.

Emerging Trends and Future Research Directions

Role of Oral Microbiota in Atherosclerosis

The role of oral microbiota in the development of atherosclerosis is an emerging area of research. Recent studies have shown that dysbiosis (an imbalance in microbial populations) in the oral cavity can lead to systemic inflammation and vascular damage [14]. Further studies are needed to identify specific oral pathogens that contribute to atherosclerosis and to explore the potential of microbiome-based therapies in preventing cardiovascular disease.

Interdisciplinary Healthcare Collaboration

The management of periodontal disease as part of a comprehensive strategy for preventing cardiovascular disease requires interdisciplinary collaboration between dental and medical professionals. Dentists can play a crucial role in identifying and treating periodontal disease, while cardiologists can monitor cardiovascular health. This collaboration can help reduce the burden of both oral and systemic diseases.

Longitudinal Studies and Clinical Trials

While cross-sectional studies have provided evidence of an association between oral infections and atherosclerosis, longitudinal studies and randomized controlled trials are needed to establish a causal relationship. Future research should focus on the long-term effects of periodontal treatment on cardiovascular outcomes and the mechanisms through which oral infections contribute to atherosclerotic progression.

CONCLUSION

The growing body of evidence linking oral infections, particularly periodontal disease, to the development of atherosclerosis underscores the importance of managing oral health as part of a comprehensive strategy for preventing cardiovascular disease. The mechanisms by which oral infections contribute to atherosclerosis involve a complex interplay of bacterial infection, inflammation, and immune modulation. Recent clinical and experimental findings further support the role of oral pathogens in the progression of atherosclerotic disease.

Preventive dental care, including the treatment of periodontal disease, may not only improve oral health but also reduce the risk of cardiovascular events. As such, interdisciplinary collaboration between dental and medical professionals is crucial to optimizing patient care and improving overall health outcomes. Future research into the oral microbiome, the efficacy of periodontal treatments, and novel therapeutic interventions will be vital in advancing our understanding of this important link and in developing new strategies for managing both oral and cardiovascular health.

ACKNOWLEDGMENTS

None.

CONFLICTS OF INTEREST

Nothing to declare.

REFERENCES

1. Kaye EK, et al. (2017). Role of Porphyromonas gingivalis in cardiovascular disease. J Periodontol. 88(9):1-10.
2. Jansson L, et al. (2012). Periodontitis and systemic inflammation: A review of current studies. J Dent Res. 91(5):459-467.
3. Libby P, Ridker PM, Maseri A. (2002). Inflammation and atherosclerosis. Circulation. 105(9):1135-1143.
4. Teo KK, et al. (2015). Inflammation and atherosclerosis: Role of Fusobacterium nucleatum. Atherosclerosis. 239(2):550-558.
5. Pihlstrom BL, et al. (2005). Periodontal disease and systemic conditions: A review of the evidence. J Am Dent Assoc. 136(12):1647-1655.
6. Beck JD, et al. (2010). The relationship between periodontal disease and coronary artery disease. Periodontol 2000. 53:143-163.
7. Goulart AC, et al. (2018). Periodontitis as a risk factor for atherosclerosis: A systematic review and meta-analysis. J Clin Periodontol. 45(8):705-714.
8. Kawai T, et al. (2007). Porphyromonas gingivalis infection accelerates atherosclerosis in a murine model. J Periodontol. 78(5):860-867.
9. Cortellini P, et al. (2017). The effects of periodontal therapy on systemic inflammatory markers: A systematic review. J Periodontol. 88(1):1-16.
10. Kawai T, et al. (2007). Porphyromonas gingivalis infection accelerates atherosclerosis in mice. J Periodontol. 78(5):860-867.
11. Pihlstrom BL, et al. (2005). Effect of non-surgical periodontal therapy on systemic inflammatory markers: A systematic review. J Clin Periodontol. 32(3):166-174.
12. Cortellini P, et al. (2017). The effects of periodontal therapy on systemic inflammatory markers: A systematic review. J Periodontol. 88(1):1-16.
13. Koshiba T, et al. (2005). Antibiotic treatment of oral infection decreases atherosclerotic plaque size in a murine model. J Periodontol. 76(7):1243-1252.
14. Liu B, et al. (2021). Oral microbiome and atherosclerosis: A review of the current literature. Microorganisms. 9(6):1202.