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Cardiovascular diseases (CVDs) are the leading cause of global morbidity and mortality. Recently, an increasing amount of preventive and therapeutic scrutiny has been directed towards lifestyles and their effect on CVDs. Maintaining good dental health is a lifestyle behavior that can help prevent periodontitis (PD), tooth caries, and tooth loss. Published scientific data is persuasive that dental infections, such as PD, have significant deleterious effects on the cardiovascular system. This paper briefly reviews the association of PD with CVDs.

References

  1. burden of periodontal diseases on health, nutrition and wellbeing of mankind: a call for global action. J Clin Periodontol 2017;44:456–462.
     Google Scholar
  2. Paster BJ, Boches SK, Galvin JL, et al. Bacterial diversity in human subgingival plaque. Journal of Bacteriology. 2001;183(12):3770–3783.
     Google Scholar
  3. Socransky SS, Haffajee AD. Dental biofilms: Difficult therapeutic targets. Periodontol 2000 2002; 28: 12-55.
     Google Scholar
  4. Hajishengallis G, Darveau RP, Curtis MA. The keystonepathogen hypothesis. Nat Rev Microbiol 2012; 10: 717-25.
     Google Scholar
  5. Tomás I, Diz P, Tobías A, Scully C, Donos N. Periodontal health status and bacteraemia from daily oral activities: systematic review/meta-analysis. J Clin Periodontol. 2012 Mar;39(3):213-28. doi: 10.1111/j.1600-051X.2011.01784.x.
     Google Scholar
  6. Pink C, Kocher T, Meisel P, Dorr M, Markus MR, Jablonowski L, et al. Longitudinal effects of systemic inflammation markers on periodontitis. Journal of clinical periodontology. 2015;42(11):988–97. 10.1111/jcpe.12473.
     Google Scholar
  7. Pizzo G, Guiglia R, Lo Russo L, Campisi G. Dentistry and internal medicine: from the focal infection theory to the periodontal medicine concept. Eur J Intern Med. 2010 Dec;21(6):496-502. doi: 10.1016/j.ejim.2010.07.011.
     Google Scholar
  8. Cardoso EM, Reis C, Manzanares-Cespedes MC. Chronic periodontitis, inflammatory cytokines, and interrelationship with other chronic diseases. Postgrad Med. 2018;130(1):98–104. doi: 10.1080/00325481.2018.1396876.
     Google Scholar
  9. Seymour GJ, Ford PJ, Cullinan MP, Leishman S, Yamazaki K. Relationship between periodontal infections and systemic disease. Clin Microbiol Infect. 2007;13(Suppl 4):3–10.
     Google Scholar
  10. G. B. D. Disease Injury and Incidence and Prevalence Collaborators (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 392, 1789–1858. 10.1016/S0140-6736(18)32279-7.
     Google Scholar
  11. Pussinen PJ, Jousilahti P, Alfthan G, Palosuo T, Asikainen S, Salomaa V. Antibodies to periodontal pathogens are associated with coronary heart disease. Arterioscler Thromb Vasc Biol 2003; 23: 1250-4.
     Google Scholar
  12. Hosomi N, Aoki S, Matsuo K, et al. Association of serum antiperiodontal pathogen antibody with ischemic stroke. Cerebrovasc Dis 2012; 34: 385-92.
     Google Scholar
  13. Sanz M, Marco Del Castillo A, Jepsen S, et al. Periodontitis and cardiovascular diseases: Consensus report. J Clin Periodontol. 2020;47(3):268-288. doi:10.1111/jcpe.13189.
     Google Scholar
  14. WHO About cardiovascular diseases. World Heal. Organ. 2018.
     Google Scholar
  15. https://www.who.int/cardiovascular_diseases/about_cvd/en/ - accessed October 29, 2020.
     Google Scholar
  16. Yusuf S, Reddy S, Ounpuu S, et al. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001;104:2746–53. 10.1161/hc4601.099487.
     Google Scholar
  17. Chambless L, Keil U, Dobson A, et al. Population versus clinical view of case fatality from acute coronary heart disease: results from the WHO MONICA Project 1985-1990. Multinational MONItoring of Trends and Determinants in CArdiovascular Disease. Circulation 1997;96:3849–59. 10.1161/01.cir.96.11.3849.
     Google Scholar
  18. Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Periodontol. 2013 Apr;84(4 Suppl):S70-84. doi: 10.1902/jop.2013.134008.
     Google Scholar
  19. Van Dyke, TE, Kholy, KE, Ishai, A, et al. Inflammation of the periodontium associates with risk of future cardiovascular events. J Periodontol. 2021; 92: 348– 358. https://doi.org/10.1002/JPER.19-0441.
     Google Scholar
  20. Sen S, Sumner R, Hardin J, et al. Periodontal disease and recurrent vascular events in stroke/transient ischemic attack patients. Journal of Stroke and Cerebrovascular Diseases,2013, 22, 1420–1427. 10.1016/j.jstrokecerebrovasdis.2013.06.024.
     Google Scholar
  21. D'Aiuto, F., Orlandi, M., & Gunsolley, J. C. (2013). Evidence that periodontal treatment improves biomarkers and CVD outcomes. Journal of Clinical Periodontology, 40(Suppl 14), S85–105. 10.1111/jcpe.12061.
     Google Scholar
  22. Fukui A., Ohta K., Nishi H., Shigeishi H., Tobiume K., Takechi M., Kamata N. Interleukin-8 and CXCL10 expression in oral keratinocytes and fibroblasts via Toll-like receptors. Microbiol. Immunol. 2013;57:198–206. doi: 10.1111/1348-0421.12022.
     Google Scholar
  23. Reyes L., Herrera D., Kozarov E., Roldá S., Progulske-Fox A. Periodontal bacterial invasion and infection: Contribution to atherosclerotic pathology. J. Periodontol. 2013;84:S30–S50. doi: 10.1902/jop.2013.1340012.
     Google Scholar
  24. Forner L., Larsen T., Kilian M., Holmstrup P. Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation. J. Clin. Periodontol. 2006;33:401–407. doi: 10.1111/j.1600-051X.2006.00924.x.).
     Google Scholar
  25. Tomas, I., Diz, P., Tobias, A., Scully, C., & Donos, N. (2012). Periodontal health status and bacteraemia from daily oral activities: Systematic review/meta‐analysis. Journal of Clinical Periodontology, 39, 213–228. 10.1111/j.1600-051X.2011.01784.x.
     Google Scholar
  26. Nakano K., Inaba H., Nomura R., Nemoto H., Takeda M., Yoshioka H., Matsue H., Takahashi T., Taniguchi K., Amano A., et al. Detection of cariogenic Streptococcus mutans in extirpated heart valve and atheromatous plaque specimens. J. Clin. Microbiol. 2006;44:3313–3317. doi: 10.1128/JCM.00377-06.
     Google Scholar
  27. Chhibber-Goel J., Singhal V., Bhowmik D., Vivek R., Parakh N., Bhargava B., Sharma A. Linkages between oral commensal bacteria and atherosclerotic plaques in coronary artery disease patients. NPJ Biofilms Microbiomes. 2016;2:7. doi: 10.1038/s41522-016-0009-7.
     Google Scholar
  28. Beukers, N. G., van der Heijden, G. J., van Wijk, A. J., & Loos, B. G. (2017). Periodontitis is an independent risk indicator for atherosclerotic cardiovascular diseases among 60 174 participants in a large dental school in The Netherlands. Journal of Epidemiol Community Health, 71(1), 37–42. 10.1136/jech-2015-206745.
     Google Scholar
  29. Nakano K., Inaba H., Nomura R., Nemoto H., Takeda M., Yoshioka H., Matsue H., Takahashi T., Taniguchi K., Amano A., et al. Detection of cariogenic Streptococcus mutans in extirpated heart valve and atheromatous plaque specimens. J. Clin. Microbiol. 2006;44:3313–3317. doi: 10.1128/JCM.00377-06.
     Google Scholar
  30. Louhelainen A.M., Aho J., Tuomisto S., Aittoniemi J., Vuento R., Karhunen P.J., Pessi T. Oral bacterial DNA findings in pericardial fluid. J. Oral Microbiol. 2014;6:25835. doi: 10.3402/jom.v6.25835.
     Google Scholar
  31. Pessi T., Karhunen V., Karjalainen P.P., Ylitalo A., Airaksinen J.K., Niemi M., Pietila M., Lounatmaa K., Haapaniemi T., Lehtimäki T., et al. Bacterial signatures in thrombus aspirates of patients with myocardial infarction. Circulation. 2013;127:1219–1228. doi: 10.1161/CIRCULATIONAHA.112.001254.
     Google Scholar
  32. Pussinen PJ, Alfthan G, Tuomilehto J, Asikainen S, Jousilahti P. High serum antibody levels to Porphyromonas gingivalis predict myocardial infarction. Eur J Cardiovasc Prev Rehabil 2004; 11: 408-11.
     Google Scholar
  33. Taniguchi A, Nishimura F, Murayama Y, et al. Porphyromonas gingivalis infection is associated with carotid atherosclerosis in non-obese Japanese type 2 diabetic patients. Metabolism 2003; 52: 142-5.
     Google Scholar
  34. Hosomi N, Aoki S, Matsuo K, et al. Association of serum antiperiodontal pathogen antibody with ischemic stroke. Cerebrovasc Dis 2012; 34: 385-92.
     Google Scholar
  35. Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2015; 15: 30‐ 44.
     Google Scholar
  36. Pink C, Kocher T, Meisel P, Dorr M, Markus MR, Jablonowski L, et al. Longitudinal effects of systemic inflammation markers on periodontitis. Journal of clinical periodontology. 2015;42(11):988–97. 10.1111/jcpe.12473.
     Google Scholar
  37. Ling, M. R., Chapple, I. L., & Matthews, J. B. (2016). Neutrophil superoxide release and plasma C‐reactive protein levels pre‐ and post‐periodontal therapy. Journal of Clinical Periodontology, 43, 652–658. 10.1111/jcpe.12575.
     Google Scholar
  38. Kirby M, Jackson G, Simonsen U. Endothelial dysfunction links erectile dysfunction to heart disease. Int J Clin Pract. 2005;59:225–9.
     Google Scholar
  39. Zuo Z, Jiang J, Jiang R, Chen F, Liu J, Yang H, et al. Effect of periodontitis on erectile function and its possible mechanism. J Sex Med. 2011;8:2598–605.
     Google Scholar
  40. Gimbrone MA., Jr Vascular endothelium: An integrator of pathophysiologic stimuli in atherosclerosis. Am J Cardiol. 1995;75:67–70B.
     Google Scholar
  41. Mudau M, Genis A, Lochner A, Strijdom H. Endothelial dysfunction: the early predictor of atherosclerosis. Cardiovasc J Afr. 2012 May;23(4):222-31. doi: 10.5830/CVJA-2011-068.
     Google Scholar
  42. Schenkein HA, Loos BG. Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. Journal of Clinical Periodontology. 2013; 40(Suppl 14): S51–69. DOI: https://doi.org/10.1111/jcpe.12060.
     Google Scholar
  43. Choy PC, Siow YL, Mymin D, O K. Lipids and atherosclerosis. Biochem Cell Biol. 2004 Feb;82(1):212-24. doi: 10.1139/o03-085.
     Google Scholar
  44. Chandy, S., Joseph, K., Sankaranarayanan, A., Issac, A., Babu, G., Wilson, B., & Joseph, J. (2017). Evaluation of C‐reactive protein and fibrinogen in patients with chronic and aggressive periodontitis: A clinico‐biochemical study. Journal of Clinical and Diagnostic Research, 11, Zc41‐zc45 10.7860/jcdr/2017/23100.9552.
     Google Scholar
  45. Arvanitidis, E., Bizzarro, S., Alvarez Rodriguez, E., Loos, B. G., & Nicu, E. A. (2017). Reduced platelet hyper‐reactivity and platelet‐leukocyte aggregation after periodontal therapy. Thrombosis Journal, 15, 5 10.1186/s12959-016-0125-x.
     Google Scholar
  46. Tatsumi K, Mackman N. Tissue Factor and Atherothrombosis. J Atheroscler Thromb. 2015;22(6):543-9. doi: 10.5551/jat.30940. Epub 2015 May 27.
     Google Scholar
  47. 47. Aarabi, G., Zeller, T., Seedorf, H., Reissmann, D. R., Heydecke, G., Schaefer, A. S., & Seedorf, U. (2017). Genetic susceptibility contributing to periodontal and cardiovascular disease. Journal of Dental Research, 96, 610–617. 10.1177/0022034517699786.
     Google Scholar
  48. Munz, M., Richter, G. M., Loos, B. G., Jepsen, S., Divaris, K., Offenbacher, S., Schaefer, A. S. (2018). Genome‐wide association meta‐analysis of coronary artery disease and periodontitis reveals a novel shared risk locus. Scientific Reports, 8, 13678 10.1038/s41598-018-31980-8.
     Google Scholar
  49. D'Aiuto F, Parkar M, Andreou G, Suvan J, Brett PM, Ready D, et al. Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers. Journal of dental research. 2004;83(2):156–60.
     Google Scholar
  50. Ling, M. R., Chapple, I. L., & Matthews, J. B. (2016). Neutrophil superoxide release and plasma C‐reactive protein levels pre‐ and post‐periodontal therapy. Journal of Clinical Periodontology, 43, 652–658. 10.1111/jcpe.12575.
     Google Scholar
  51. Vidal, F., Cordovil, I., Figueredo, C. M., & Fischer, R. G. (2013). Non‐surgical periodontal treatment reduces cardiovascular risk in refractory hypertensive patients: A pilot study. Journal of Clinical Periodontology, 40, 681–687. 10.1111/jcpe.12110.
     Google Scholar
  52. Arvanitidis, E., Bizzarro, S., Alvarez Rodriguez, E., Loos, B. G., & Nicu, E. A. (2017). Reduced platelet hyper‐reactivity and platelet‐leukocyte aggregation after periodontal therapy. Thrombosis Journal, 15, 5 10.1186/s12959-016-0125-x.
     Google Scholar
  53. Teeuw, W. J., Slot, D. E., Susanto, H., Gerdes, V. E., Abbas, F., D'Aiuto, F., Loos, B. G. (2014). Treatment of periodontitis improves the atherosclerotic profile: A systematic review and meta‐analysis. Journal of Clinical Periodontology, 41, 70–79. 10.1111/jcpe.12171.
     Google Scholar
  54. Park SY, Kim SH, Kang SH, Yoon CH, Lee HJ, Yun PY, Youn TJ, Chae IH. Improved oral hygiene care attenuates the cardiovascular risk of oral health disease: A population-based study from Korea. European Heart Journal. 2019; 40: 1138–1145. DOI: 10.1093/eurheartj/ehy836.
     Google Scholar
  55. Lee, Y. L., Hu, H. Y., Chou, P., & Chu, D. (2015). Dental prophylaxis decreases the risk of acute myocardial infarction: A nationwide population‐based study in Taiwan. Clinical Interventions in Aging, 10, 175–182. 10.2147/CIA.S67854.
     Google Scholar
  56. Sen S, Giamberardino LD, Moss K, Morelli T, Rosamond WD, Gottesman RF, Beck J, Offenbacher S. Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke. Stroke. 2018; 49: 355–362. DOI: https://doi.org/10.1161/STROKEAHA.117.018990/
     Google Scholar
  57. Holmlund, A., Lampa, E., & Lind, L. (2017). Poor response to periodontal treatment may predict future cardiovascular disease. Journal of Dental Research, 96, 768–773. 10.1177/0022034517701901.
     Google Scholar
  58. Sanz M, Marco Del Castillo A, Jepsen S, et al. Periodontitis and cardiovascular diseases: Consensus report. J Clin Periodontol. 2020 Mar;47(3):268-288. doi: 10.1111/jcpe.13189.
     Google Scholar
  59. Doganay, O., Atalay, B., Karadag, E., Aga, U., & Tugrul, M. Bleeding frequency of patients taking ticagrelor, aspirin, clopidogrel, and dual antiplatelet therapy after tooth extraction and minor oral surgery. Journal of the American Dental Association, 2018, 149, 132–138. 10.1016/j.adaj.2017.09.052.
     Google Scholar
  60. Nathwani, S., & Martin, K. Exodontia in dual antiplatelet therapy: The evidence. British Dental Journal, 2016. 220, 235–238. 10.1038/sj.bdj.2016.173.
     Google Scholar
  61. Shi, Q., Xu, J., Zhang, T., Zhang, B., & Liu, H. (2017). Post‐operative bleeding risk in dental surgery for patients on oral anticoagulant therapy: A meta‐analysis of observational studies. Frontiers in Pharmacology, 8, 58 10.3389/fphar.2017.00058.
     Google Scholar
  62. Kwak, E. J., Nam, S., Park, K. M., Kim, S. Y., Huh, J., & Park, W. (2019). Bleeding related to dental treatment in patients taking novel oral anticoagulants (NOACs): A retrospective study. Clinical Oral Investigations, 23, 477–484. 10.1007/s00784-018-2458-2.
     Google Scholar
  63. Steffel, J., Verhamme, P., Potpara, T. S., Albaladejo, P., Antz, M., Desteghe, L. ESC Scientific Document Group (2018b). The 2018 European Heart Rhythm Association Practical Guide on the use of non‐vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. European Heart Journal, 39, 1330–1393. 10.1093/eurheartj/ehy136.
     Google Scholar
  64. https://www.heart.org/en/health-topics/infective-endocarditis -accessed March 31, 2021.
     Google Scholar
  65. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Infective-Endocarditis-Guidelines-on-Prevention-Diagnosis-and-Treatment-of - accessed March 31, 2021.
     Google Scholar
  66. Eva Muñoz Aguilera, Jean Suvan, Jacopo Buti, Marta Czesnikiewicz-Guzik, et al. Periodontitis is associated with hypertension: a systematic review and meta-analysis, Cardiovascular Research, Volume 116, Issue 1, 1 January 2020, Pages 28–39, https://doi.org/10.1093/cvr/cvz201.
     Google Scholar
  67. Tsakos G, Sabbah W, Hingorani ADetal. Is periodontal inflammation associated with raised blood pressure Evidence from a National US survey. J Hypertens. 2010;28:2386–93.
     Google Scholar
  68. Ong G. Periodontal disease and tooth loss. Int Dent J, 1998. 48(3 Suppl 1), 233–238.
     Google Scholar
  69. Völzke H, Schwahn C, Dörr M, et al. Gender differences in the relation between number of teeth and systolic blood pressure. J Hypertens. 2006;24:1257–63.
     Google Scholar
  70. Czesnikiewicz-Guzik M, Osmenda G, Siedlinski M, et al. Causal association between periodontitis and hypertension: evidence from Mendelian randomization and a randomized controlled trial of non-surgical periodontal therapy. Eur Heart J. 2019 Nov 1;40(42):3459-3470. doi: 10.1093/eurheartj/ehz646.
     Google Scholar
  71. Tonetti MS, D'Aiuto F, Nibali L, Donald A, Storry C, Parkar M, Suvan J, Hingorani AD, Vallance P, Deanfield J. Treatment of periodontitis and endothelial function. N Engl J Med 2007;356:911–920.
     Google Scholar
  72. Lockhart PB, Bolger AF, Papapanou PN, et al. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association? A scientific statement from the american heart association. Circulation. 2012;125(20):2520–2544.
     Google Scholar
  73. Bronner LL, Kanter DS, Manson JE. Primary prevention of stroke. N Engl J Med. 1995;333:1392–400.
     Google Scholar
  74. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009;338:b1665.
     Google Scholar
  75. Rydén L, Buhlin K, Ekstrand E, et al. Periodontitis Increases the Risk of a First Myocardial Infarction: A Report From the PAROKRANK Study. Circulation. 2016 Feb 9;133(6):576-83. doi: 10.1161/CIRCULATIONAHA.115.020324.
     Google Scholar
  76. Gomes-Filho IS, Coelho JMF, Miranda SS, et al, Severe and moderate periodontitis are associated with acute myocardial infarction. J Periodontol. 2020 Nov;91(11):1444-1452. doi: 10.1002/JPER.19-0703.
     Google Scholar
  77. Romandini M, Baima G, Antonoglou G, Bueno J, Figuero E, Sanz M. Periodontitis, Edentulism, and Risk of Mortality: A Systematic Review with Meta-analyses. J Dent Res. 2021 Jan;100(1):37-49. doi: 10.1177/0022034520952401.
     Google Scholar
  78. Ala-Korpela M. The culprit is the carrier, not the loads: cholesterol, triglycerides and apolipoprotein B in atherosclerosis and coronary heart disease. Int J Epidemiol. 2019 Oct 1;48(5):1389-1392. doi: 10.1093/ije/dyz068.
     Google Scholar
  79. Pinho MM, Faria-Almeida R, Azevedo E, Manso MC, Martins L. Periodontitis and atherosclerosis: an observational study. J Periodontal Res. 2013 Aug;48(4):452-7. doi: 10.1111/jre.12026;
     Google Scholar
  80. Tong C, Wang YH, Chang YC. Increased Risk of Carotid Atherosclerosis in Male Patients with Chronic Periodontitis: A Nationwide Population-Based Retrospective Cohort Study. Int J Environ Res Public Health. 2019;16(15):2635. Published 2019 Jul 24. doi:10.3390/ijerph16152635.
     Google Scholar
  81. Jeevarethinam A, Venuraju S, Weymouth M, Atwal S, Lahiri A. Carotid intimal thickness and plaque predict prevalence and severity of coronary atherosclerosis: a pilot study. Angiology. 2015 Jan;66(1):65-9. doi: 10.1177/0003319714522849.
     Google Scholar
  82. Crea F, Libby P. Acute coronary syndromes: the way forward from mechanisms to precision treatment. Circulation. 2017;136:1155‐1166.
     Google Scholar
  83. Bentzon JF, Otsuka F, Virmani R, Falk E. Mechanisms of plaque formation and rupture. Circ Res. 2014 Jun 6;114(12):1852-66. doi: 10.1161/CIRCRESAHA.114.302721.
     Google Scholar
  84. Schenkein H.A., Loos B.G. Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. J. Periodontol. 2013;1:S51–S69. doi: 10.1902/jop.2013.134006.
     Google Scholar
  85. Haraszthy VI, Zambon JJ, Trevisan M, Zeid M, Genco RJ. Identification of periodontal pathogens in atheromatous plaques. J Periodontol. 2000;71(10):1554–60.
     Google Scholar
  86. de Boer, S. P., Cheng, J. M., Range, H., et al. Antibodies to periodontal pathogens are associated with coronary plaque remodeling but not with vulnerability or burden. Atherosclerosis, 2014:237, 84–91. 10.1016/j.atherosclerosis.2014.08.050.
     Google Scholar
  87. Tabas I, Bornfeldt KE. Macrophage Phenotype and Function in Different Stages of Atherosclerosis. Circ Res. 2016 Feb 19;118(4):653-67. doi: 10.1161/CIRCRESAHA.115.306256.
     Google Scholar
  88. Papapanagiotou D, Nicu EA, Bizzarro S, et al. Periodontitis is associated with platelet activation. Atherosclerosis. 2009; 202: 605‐ 611.
     Google Scholar
  89. Sfyroeras GS, Roussas N, Saleptsis VG, Argyriou C, Giannoukas AD. Association between periodontal disease and stroke. J Vasc Surg. 2012 Apr;55(4):1178-84. doi: 10.1016/j.jvs.2011.10.008.
     Google Scholar
  90. Sen, S., Giamberardino, L. D., Moss, K., et al. Periodontal disease, regular dental care use, and incident ischemic stroke. Stroke, 2018:49, 355–362. 10.1161/STROKEAHA.117.018990.
     Google Scholar
  91. Wood N, Johnson RB. The relationship between tomato intake and congestive heart failure risk in periodontitis subjects. J Clin Periodontol. 2004 Jul;31(7):574-80. doi: 10.1111/j.1600-051X.2004.00531.x.
     Google Scholar
  92. Aoyama N, Kure K, Minabe M, Izumi Y. Increased Heart Failure Prevalence in Patients with a High Antibody Level Against Periodontal Pathogen. Int Heart J. 2019 Sep 27;60(5):1142-1146. doi: 10.1536/ihj.19-010.
     Google Scholar
  93. Cekici A, Kantarci A, Hasturk H, Van Dyke TE. Inflammatory and immune pathways in the pathogenesis of periodontal disease. Periodontol 2000. 2014; 64: 57–80.
     Google Scholar
  94. Fröhlich H, Herrmann K, Franke J, et al. Periodontitis in Chronic Heart Failure. Tex Heart Inst J. 2016 Aug 1;43(4):297-304. doi: 10.14503/THIJ-15-5200.
     Google Scholar
  95. Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ; CDC Periodontal Disease Surveillance workgroup: James Beck, Gordon Douglass, Roy Page. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012 Oct;91(10):914-20. doi: 10.1177/0022034512457373.
     Google Scholar
  96. Lessem J, Drisko C, Greenwell H, et al. Are cardiac transplant patients more likely to have periodontitis? A case record study. J Int Acad Periodontol. 2002 Jul;4(3):95-100.
     Google Scholar
  97. Schulze-Späte U, Mizani I, Salaverry KR, et al. Periodontitis and bone metabolism in patients with advanced heart failure and after heart transplantation. ESC Heart Fail. 2017 May;4(2):169-177. doi: 10.1002/ehf2.12126.
     Google Scholar
  98. Reynolds MA. Modifiable risk factors in periodontitis: at the intersection of aging and disease. Periodontol 2000. 2014;64(1):7–19.
     Google Scholar
  99. Hofmann U, Frantz S. How can we cure a heart “in flame”? A translational view on inflammation in heart failure. Basic Res Cardiol. 2013;108(4):356.
     Google Scholar
  100. Holm-Pedersen P, Avlund K, Morse DE, Stoltze K, Katz RV, Viitanen M, et al. Dental caries, periodontal disease, and cardiac arrhythmias in community-dwelling older persons aged 80 and older: is there a link? Journal of the American Geriatrics Society. 2005;53(3):430–7. 10.1111/j.1532-5415.2005.53160.x.
     Google Scholar
  101. AlQobaly L, Sabbah W. The association between periodontal disease and root/coronal caries. Int J Dent Hyg. 2020 Feb;18(1):99-106. doi: 10.1111/idh.12422.
     Google Scholar
  102. Yu G, Yu Y, Li YN, Shu R. Effect of periodontitis on susceptibility to atrial fibrillation in an animal model. Journal of electrocardiology. 2010;43(4):359–66. 10.1016/j.jelectrocard.2009.12.002.
     Google Scholar
  103. Chen DY, Lin CH, Chen YM, Chen HH. Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study. PLoS One. 2016 Oct 31;11(10):e0165601. doi: 10.1371/journal.pone.0165601.
     Google Scholar
  104. Im SI, Heo J, Kim BJ, et al. Impact of periodontitis as representative of chronic inflammation on long-term clinical outcomes in patients with atrial fibrillation. Open Heart. 2018 Apr 25;5(1):e000708. doi: 10.1136/openhrt-2017-000708.
     Google Scholar
  105. Chen SJ, Liu CJ, Chao TF, Wang KL, Chen TJ, Chou P, et al. Dental scaling and atrial fibrillation: a nationwide cohort study. International journal of cardiology. 2013;168(3):2300–3. 10.1016/j.ijcard.2013.01.192.
     Google Scholar
  106. Aarabi G, Schnabel RB, Heydecke G, Seedorf U. Potential Impact of Oral Inflammations on Cardiac Functions and Atrial Fibrillation. Biomolecules. 2018 Aug 1;8(3):66. doi: 10.3390/biom8030066.
     Google Scholar
  107. Wisniewska-Spychala B, Sokalski J, Grajek S, et al. Dentigenous infectious foci - a risk factor of infective endocarditis. Med Sci Monit. 2012 Feb;18(2):CR93-104. doi: 10.12659/msm.882464.
     Google Scholar
  108. Lockhart P.B., Brennan M.T., Sasser H.C., Fox P.C., Paster B.J., Bahrani-Mougeot F.K. Bacteremia associated with toothbrushing and dental extraction. Circulation. 2008;117:3118–3125. doi: 10.1161/CIRCULATIONAHA.107.758524.
     Google Scholar
  109. Lockhart P.B., Brennan M.T., Thornhill M., Michalowicz B.S., Noll J., Bahrani-Mougeot F.K., Sasser H.C. Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia. J. Am. Dent. Assoc. 2009;140:1238–1244. doi: 10.14219/jada.archive.2009.0046.
     Google Scholar
  110. Ninomiya M, Hashimoto M, Yamanouchi K, Fukumura Y, Nagata T, Naruishi K. Relationship of oral conditions to the incidence of infective endocarditis in periodontitis patients with valvular heart disease: a cross-sectional study. Clin Oral Investig. 2020 Feb;24(2):833-840. doi: 10.1007/s00784-019-02973-2.
     Google Scholar
  111. Suzuki H, Matsuo K, Okamoto M, Nakata H, Sakamoto H, Fujita M. Preoperative periodontal treatment and its effects on postoperative infection in cardiac valve surgery. Clin Exp Dent Res. 2019 Jul 10;5(5):485-490. doi: 10.1002/cre2.212.
     Google Scholar
  112. Louhelainen A.M., Aho J., Tuomisto S., Aittoniemi J., Vuento R., Karhunen P.J., Pessi T. Oral bacterial DNA findings in pericardial fluid. J. Oral Microbiol. 2014;6:25835. doi: 10.3402/jom.v6.25835.
     Google Scholar
  113. McCormick MC. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med 1985;312:82–90.; Shennan AH. Recent developments in obstetrics. BMJ 2003;327:604–18.
     Google Scholar
  114. Mathew RJ, Bose A, Prasad JH, Muliyil JP, Singh D. Maternal periodontal disease as a significant risk factor for low birth weight in pregnant women attending a secondary care hospital in South India: a case-control study. Indian J Dent Res. 2014 Nov-Dec;25(6):742-7. doi: 10.4103/0970-9290.152184.
     Google Scholar
  115. Tasioula V, Balmer R, Parsons J. Dental health and treatment in a group of children with congenital heart disease. Pediatr Dent 2008;30:323-8.
     Google Scholar
  116. Franco F, Saunders CP, Roberts GJ, Suwanprasit A. Dental disease, caries related microflora and salivary IgA of children with severe congenital cardiac disease: an epidemiological and oral microbial survey. Pediatr Dent 1996;18:228-35.
     Google Scholar
  117. Jalevik B, Noren JG. Enamel hypomineralization of permanent first molars: A morphological study and survey of possible aetiological factors. Int J Paediatr Dent 2000;10:278-89.
     Google Scholar
  118. Hallett KB, Radford DJ, Seow WK. Oral health of children with congenital cardiac diseases: a controlled study. Pediatr Dent 1992;14:224-30.
     Google Scholar
  119. Hayes PA, Fasules J. Dental screening of pediatric cardiac surgical patients, J Dent Child 2001; 68:255-58.
     Google Scholar
  120. Folwaczny M, Bauer F, Grünberg C. Significance of oral health in adult patients with congenital heart disease. Cardiovasc Diagn Ther. 2019;9(Suppl 2):S377-S387. doi:10.21037/cdt.2018.09.17.
     Google Scholar
  121. Gruter MO, Brand HS. Oral health complications after a heart transplant: a review. Br Dent J. 2020 Feb;228(3):177-182. doi: 10.1038/s41415-020-1244-0.
     Google Scholar
  122. Salyer J, Flattery MP, Joyner PL, et al. Lifestyle and quality of life in long-term cardiac transplant recipients. J Heart Lung Transplant 2003;22:309–21.
     Google Scholar
  123. Sezgin Y, Sezgin A. Periodontal status and dental behaviour of heart transplant recipients and healthy controls. Acta Odontol Scand. 2020 Jan;78(1):20-25. doi: 10.1080/00016357.2019.1683889.
     Google Scholar
  124. Cao Y, Chen X, Jia Y, Lv Y, Sun Z. Oral health status of adult heart transplant recipients in China: A cross-sectional study. Medicine (Baltimore). 2018 Sep;97(38):e12508. doi: 10.1097/MD.0000000000012508.
     Google Scholar
  125. Schmalz G, Eisner M, Binner C, et al. Oral health-related quality of life of patients after heart transplantation and those with heart failure is associated with general health-related quality of life: a cross-sectional study. Qual Life Res. 2020;29(6):1621-1630. doi:10.1007/s11136-020-02439-z.
     Google Scholar
  126. Mendez MV, Scott T, LaMorte W, Vokonas P, Menzoian JO, Garcia R. An association between periodontal disease and peripheral vascular disease. Am J Surg. 1998;176(2):153–157. doi: 10.1016/S0002-9610(98)00158-5.
     Google Scholar
  127. Soto-Barreras U, Olvera-Rubio JO, Loyola-Rodriguez JP, Reyes-Macias JF, Martinez-Martinez RE, Patino-Marin N, et al. Peripheral arterial disease associated with caries and periodontal disease. J Periodontol. 2013;84(4):486–494. doi: 10.1902/jop.2012.120051.
     Google Scholar
  128. Lu, B, Parker, D, & Eaton CB. Relationship of periodontal attachment loss to peripheral vascular disease: An analysis of NHANES 1999–2002 data. Atherosclerosis, 2018:200, 199–205. 10.1016/j.atherosclerosis.2007.12.037.
     Google Scholar
  129. Yang S, Zhao LS, Cai C, Shi Q, Wen N, Xu J. Association between periodontitis and peripheral artery disease: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2018 Jul 6;18(1):141. doi: 10.1186/s12872-018-0879-0.
     Google Scholar
  130. Chen YW, Umeda M, Nagasawa T, Takeuchi Y, Huang Y, Inoue Y, Iwai T, Izumi Y, Ishikawa I. Periodontitis may increase the risk of peripheral arterial disease. Eur J Vasc Endovasc Surg. 2008 Feb;35(2):153-8. doi: 10.1016/j.ejvs.2007.08.016.
     Google Scholar
  131. Aoyama N, Suzuki JI, Kobayashi N, Hanatani T, Ashigaki N, Yoshida A, et al. Periodontitis deteriorates peripheral arterial disease in Japanese population via enhanced systemic inflammation. Heart Vessel. 2017;32(11):1314–1319. doi: 10.1007/s00380-017-1003-6.
     Google Scholar
  132. Yang S, Zhao LS, Cai C, Shi Q, Wen N, Xu J. Association between periodontitis and peripheral artery disease: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2018 Jul 6;18(1):141. doi: 10.1186/s12872-018-0879-0.
     Google Scholar
  133. Heidelbaugh JJ. Management of erectile dysfunction. Am Fam Physician. 2010;81:305–12.
     Google Scholar
  134. Sharma A, Pradeep AR, Raju PA. Association between chronic periodontitis and vasculogenic erectile dysfunction. J Periodontol. 2011;82:1665–9.
     Google Scholar
  135. Uppal RS, Bhandari R, Singh K. Association between erectile dysfunction and chronic periodontitis: A clinical study. Indian J Dent Res 2014;25:430.
     Google Scholar
  136. Zadik Y, Bechor R, Galor S, Justo D, Heruti RJ. Erectile dysfunction might be associated with chronic periodontal disease: Two ends of the cardiovascular spectrum. J Sex Med. 2009;6:1111–6.
     Google Scholar
  137. Oguz F, Eltas A, Beytur A, Akdemir E, Uslu MO, Günes A. Is there a relationship between chronic periodontitis and erectile dysfunction? J Sex Med. 2013;10:838–43.
     Google Scholar
  138. Matsumoto S, Matsuda M, Takekawa M, Okada M, Hashizume K, Wada N, et al. Association of ED with chronic periodontal disease. Int J Impot Res. 2013;26:13–5.
     Google Scholar
  139. Uppal RS, Bhandari R, Singh K. Association between erectile dysfunction and chronic periodontitis: A clinical study. Indian J Dent Res. 2014;25:430.
     Google Scholar
  140. Chou MH, Tsao CW, Cha TL, Wu ST, Liu CY. Chronic periodontitis as risk indicator of erectile dysfunction in young population. Int J Urol. 2016;23(Suppl 1):1–142.
     Google Scholar
  141. Liu LH, Li EM, Zhong SL, et al. Chronic periodontitis and the risk of erectile dysfunction: a systematic review and meta-analysis. Int J Impot Res. 2017 Jan;29(1):43-48. doi: 10.1038/ijir.2016.43.
     Google Scholar
  142. Bizzarro S, Loos BG. The link between periodontitis and erectile dysfunction: a review. Br Dent J. 2019 Oct;227(7):599-603. doi: 10.1038/s41415-019-0724-6.
     Google Scholar
  143. Wang Q, Kang J, Cai X, Wu Y, Zhao L. The association between chronic periodontitis and vasculogenic erectile dysfunction: A systematic review and metaanalysis. J Clin Periodontol 2016;43:206-15.
     Google Scholar
  144. Singh VP, Nettemu SK, Nettem S, Hosadurga R, Nayak SU. Oral Health and Erectile Dysfunction. J Hum Reprod Sci. 2017 Jul-Sep;10(3):162-166. doi: 10.4103/jhrs.JHRS_87_17.
     Google Scholar
  145. Montague D.K. Jarow J.P. Broderick G.A. et al. Chapter 1: the management of erectile dysfunction: an AUA update. J Urol. 2005; 174: 230-239.
     Google Scholar
  146. Eltas A, Oguz F, Uslu MO, Akdemir E. The effect of periodontal treatment in improving erectile dysfunction: A randomized controlled trial. J Clin Periodontol. 2013;40:148–54.
     Google Scholar
  147. Sanchez-Siles M, Rosa-Salazar V, Camacho-Alonso F, Salazar-Sanchez N, & Cozar-Hidalgo J (2013). Association between periodontal disease and venous thromboembolic disease. Quintessence Int, 44(8), 567–573. doi:10.3290/j.qi.a29749.
     Google Scholar
  148. Lippi G, Nocini R, Favaloro EJ. Periodontal Disease and Venous Thromboembolism. Semin Thromb Hemost. 2021 Feb;47(1):110-111. doi: 10.1055/s-0040-1714399.
     Google Scholar
  149. Cowan LT, Lakshminarayan K, Lutsey PL, Folsom AR, Beck J, Offenbacher S, Pankow JS. Periodontal disease and incident venous thromboembolism: The Atherosclerosis Risk in Communities study. J Clin Periodontol. 2019 Jan;46(1):12-19. doi: 10.1111/jcpe.13029.
     Google Scholar
  150. Folsom AR, Lutsey PL, Astor BC, & Cushman M (2009). C-reactive protein and venous thromboembolism. A prospective investigation in the ARIC cohort. Thromb Haemost, 102(4), 615–619. doi:10.1160/TH09-04-0274.
     Google Scholar
  151. Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: a two-way relationship. Ann Periodontol. 1998;3:51–61.
     Google Scholar
  152. Benguigui C, Bongard V, Ruidavets JB, Chamontin B, Sixou M, Ferrières J, Amar J. Metabolic syndrome, insulin resistance, and periodontitis: a cross-sectional study in a middle-aged French population. J Clin Periodontol. 2010 Jul;37(7):601-8. doi: 10.1111/j.1600-051X.2010.01571.x.
     Google Scholar
  153. Teixeira FCF, Marin-Leon L, Gomes EP, PedrÃo AMN, Pereira ADC, Francisco PMSB. Relationship between periodontitis and subclinical risk indicators for chronic non-communicable diseases. Braz Oral Res. 2020 Jun 19;34:e058. doi: 10.1590/1807-3107bor-2020.vol34.0058.
     Google Scholar
  154. Gautam, D. K., Jindal, V., Gupta, S. C., Tuli, A., Kotwal, B., & Thakur, R. (2011). Effect of cigarette smoking on the periodontal health status: A comparative, cross sectional study. Journal of Indian Society of Periodontology, 15(4), 383–387. 10.4103/0972-124x.92575.
     Google Scholar
  155. Fenol, A., Jebi, S., Krishnan, S., Perayil, J., Vyloppillil, R., Bhaskar A., XXX, & Mohandas, Ashitha. (2017). Association of stress, salivary cortisol level, and periodontitis among the inmates of a central prison in Kerala. Dental Research Journal (Isfahan), 14(4), 288–292. 10.4103/1735-3327.211625.
     Google Scholar
  156. Linden, G. J., Lyons, A., & Scannapieco, F. A. (2013). Periodontal systemic associations: Review of the evidence. Journal of Clinical Periodontology, 40(Suppl 14), S8–19. 10.1111/jcpe.12064.
     Google Scholar
  157. Sharma, P., Dietrich, T., Ferro, C. J., Cockwell, P., & Chapple, I. L. (2016). Association between periodontitis and mortality in stages 3–5 chronic kidney disease: NHANES III and linked mortality study. Journal of Clinical Periodontology, 43, 104–113. 10.1111/jcpe.12502.
     Google Scholar