Oral dysbiosis and cardiovascular disease: reappraising the evidence from periodontal inflammation to vascular risk

Cardiovascular disease remains the leading cause of morbidity and mortality worldwide despite major advances in pharmacological prevention and lifestyle-based risk reduction. In recent years, increasing attention has been directed toward non-traditional contributors to residual cardiovascular risk, including chronic inflammatory and microbiota-related conditions. Among these, oral microbiota dysbiosis and periodontitis have emerged as plausible and potentially modifiable determinants of vascular health. Over the last decade, a growing body of mechanistic, epidemiological, and translational evidence has suggested that the relationship between oral disease and cardiovascular pathology extends beyond simple confounding by shared risk factors. Recurrent bacteremia, endothelial dysfunction, innate and adaptive immune activation, altered nitric oxide bioavailability, oral–gut microbial interactions, and pro-thrombotic metabolic signaling have all been proposed as biologically relevant pathways linking oral dysbiosis to atherosclerotic disease and its acute manifestations. Observational studies and recent meta-analyses consistently report significant associations between periodontitis and major cardiovascular phenotypes, including acute myocardial infarction, stroke, and hypertension, while interventional studies indicate that periodontal therapy may reduce systemic inflammatory burden and improve vascular surrogate markers such as endothelial function and arterial stiffness. Although definitive randomized trials powered for hard cardiovascular outcomes are still lacking, the overall convergence of evidence supports a biologically coherent association between oral health and cardiovascular risk. This review critically reassesses the literature published between 2016 and 2026 on the oral–cardiovascular axis, with particular emphasis on pathophysiological mechanisms, clinical evidence, and the potential role of periodontal and dental care within a broader, multidisciplinary model of cardiovascular prevention.