Periodontal Disease and Carotid Atherosclerosis: Mechanisms of the Association

Abstract

Despite advances in its diagnosis and management, cardiovascular disease remains the leading cause of death in western countries. Many risk factors are involved in the development of cardiovascular disease; recently, periodontal disease was recognized as a new risk factor in many epidemiological studies. The association between dental and cardiovascular disease is intriguing for the potential clinical implications, and it is independent of other risk factors. This association has been demonstrated for several localization of atherosclerotic plaques, involving coronary, cerebral and/or peripheral arteries. The finding that patients with periodontitis show also more evident carotid atherosclerotic plaques is clinically important because this disease localization is the most important cause of cerebral ischemia, in turn the main cause of disabilities in western world (A.H.A, 2002). On this basis, the following chapters highlight the links between periodontal disease and carotid atherosclerosis, focusing on the mechanisms of this association: inflammation, dental pathogens and toxins, endothelial dysfunction, with the addition of hemorheology as a new evidence. In details, the first chapters exploit the main features of these processes (chronic periodontitis, atherosclerosis, wall shear stress in hemorheology); then, we report and analyze a series of cross sectional, prospective and intervention studies in this field. In the last section will elucidate the interplays between periodontal disease, hemodynamic forces and atherosclerosis.