Periodontitis and systemic disease: A clinical perspective

Periodontitis is a common chronic inflammatory disease that has traditionally been considered primarily within the domain of dentistry. Increasing evidence, however, associates periodontitis with systemic inflammatory conditions, particularly atherosclerotic cardiovascular disease. Dysbiotic subgingival microbial communities, disruption of the periodontal epithelial barrier, transient bacteremia, microbial products, and locally generated inflammatory mediators provide biologically plausible pathways through which periodontal inflammation may influence systemic vascular biology. Epidemiologic and mechanistic studies support an association between periodontitis and cardiovascular disease, although direct causality has not been established. Importantly, periodontal treatment has been associated with improvement in endothelial function and reductions in selected systemic inflammatory biomarkers, but evidence that treatment prevents myocardial infarction, stroke, or cardiovascular mortality remains insufficient. For the practicing internist, the principal message is therefore both practical and appropriately cautious: Periodontal health should be recognized as one component of overall health, and closer collaboration between physicians and dental professionals may strengthen preventive care. This Perspective reviews the clinical evidence linking periodontitis with systemic disease, using cardiovascular disease as the principal example, and considers its implications for prevention, interdisciplinary care, and future research.