Association of chronic periodontitis in a broad spectrum of cardiometabolic syndrome: A minireview

Table 1 Epidemiological evidence for the association between chronic periodontitis and cardio-vascular disease

Ref.	Year	Main findings
Gonçalves et al[17]	2010	Patients with chronic PD have PBMC in their peripheral blood that had been activated with LPS. These LPS were used to measure the amounts of TNF-α, IL-6, IL-10, and IL-8 that are released. The findings of their investigation showed that when compared to PBMC from persons without PD, Escherichia coli LPS-stimulated PBMC from subjects with PD presented a distinct pattern of cytokine release
Genco et al[18]	2010	Patients with CVD who exhibit the signs and symptoms of gingivitis or have sudden tooth loss should have a periodontal assessment. Additionally, a dentist and a doctor should work closely together to maximize periodontal care and CVD risk reduction when PD is initially detected in a patient with CVD
Kebschull et al[19]	2010	Periodontal infections may be independently linked to both preclinical and symptomatic atherosclerotic vascular disease, according to evidence from epidemiologic research. They concluded that although there is significant variation in responses, periodontal therapy generally has positive effects on subclinical atherosclerosis indicators
Kaptoge et al[20]	2010	CRP levels were consistently associated with a risk of developing CAD and ischemic stroke. However, it is unknown how CRP relates to such a wide spectrum of illnesses. Relationships with ischemic vascular disease were largely influenced by traditional risk factors and additional inflammation-related indicators
Bălan[21]	2010	Determined that there is a direct causal link between periodontal diseases and CVDs. He concluded that the high prevalence of both conditions and some common risk factors could account for their relationship
Dhotre et al[22]	2011	Stated that a highly significant increase in total cholesterol, low-density lipoprotein-cholesterol and triglyceride levels with a concomitant decline in high-density lipoprotein-cholesterol was observed in PD patients. The increased oxidative stress and altered lipid profile in PD patients could contribute to the development of CVD
Matsuo et al[23]	2011	The prevalence of latent pulmonary veins conduction was observed to be the same in individuals with paroxysmal AF, persistent AF, and long-lasting AF. In vitro, animal, and clinical studies do support the interaction and biological mechanism, intervention trials to date were not sufficient to make further inferences; and there was consistent and strong epidemiologic evidence that PD imparts an increased risk for future CVD
Tonetti and Van Dyke[24]	2013	Undertook a study to look into the epidemiological evidence for a link between incident ACVD, e.g. peripheral artery disease, cerebrovascular disease, coronary heart disease, and PD. They concluded that patients without PD had a lower risk of acquiring ACVD. Not all demographic groupings may be affected by this. The relationship between PD and the frequency of subsequent cardiovascular events is not supported by enough data
Dietrich et al[16]	2013	Researched to give a summary of studies on the connection between CVD and periodontal disease and its function as a potential danger for the onset of cardiac disease. According to a study of epidemiological data, they discovered that there was evidence of a link between periodontal diseases and CVD. A possible connection joining oral bacteria and atherosclerosis is also highlighted by the in vitro investigations. To determine how these therapies can have a favourable impact on CVDs, there is an urgent need for accurate case controls and effective interventional trials
Ahmed and Tanwir[25]	2015	Stated that the risk for myocardial infarction was significantly increased among subjects with PD with a crude OR of 1.49 (95%CI: 1.21–1.83). When edentulous participants (patients: 12; controls: 4) were excluded from the analysis of periodontal status, the corresponding prevalence was 41% vs 33% and the OR for myocardial infarction risk was 1.46 (95%CI: 1.19–1.80). Following statistical adjustments for confounders (diabetes mellitus, smoking habits, years of education, and marital status) and including edentulous participants, there was still a positive association between PD and the risk of myocardial infarction with an OR of 1.28 (95%CI: 1.03–1.60)
Rydén et al[26]	2016	Stated that periodontal inflammatory response could exacerbate vascular inflammation via secreted cytokines that ultimately modulate atherosclerosis and CVD. The inflammatory cytokine IL-6 and TNF-α, and CRP levels in serum increased are associated with CVD and periodontal diseases. Periodontal intervention had a positive impact on the established risk factors for CVD to reduce inflammatory responses. Periodontal intervention studies have strengthened the evidence for an association between periodontal disease and CVD, and have also indicated a causal link
Chen et al[27]	2017	Undertook a study investigating the association between PAOD and periodontal diseases. They concluded that the data is consistent with a connection between periodontal diseases and PAOD. Additional research on the temporal relationship between periodontal diseases and PAOD as well as randomized controlled intervention trials looking at the causative role of periodontal diseases in PAOD is required
Kaschwich et al[28]	2019	HbA1c and smoking history were found to be reliable indicators of adults in the United States with a specificity of 67.6% and sensitivity of 70.0% for moderate-to-severe PD
Montero et al[29]	2019	A study was conducted to establish and evaluate a predictive model for adult Americans with moderate-to-severe PD. Data from the National Health and Nutrition Examination Survey cycle of 2011–2012 were used in the study. The results of their investigation showed that, as per the Centers for Disease Control/American Academy of Periodontology categorization, there were 371% and 13.2% of people with moderate and severe PD, respectively. HbA1c and smoking history were found to be reliable indicators of adults in the United States with a specificity of 67.6% and sensitivity of 70.0% for moderate-to-severe PD
Kang et al[30]	2019	Performed a study to ascertain whether periodontal diseases and other CVD risk factors or prevalence had an independent association. Their investigation made use of the Korea National Health and Nutrition Examination Survey's representative details. They discovered that as PD severity increases, the percentage of participants with high FRS and/or prevalent CVD increases. The FRS according to the severity of PD rose in people without prevalent CVD, and they concluded that PD was linked to CVD in the Korean population. Therefore, people with PD in particular young adults with severe PD-may need to have their risk for CVD constantly evaluated
Voinescu et al[31]	2019	Performed a systematic review to update the degree of evidence that connects periodontal disease and CVD. Despite significant methodological heterogeneity and the lack of randomized research, they discovered a strong link between CVD and periodontal pathology in 17 of the examined studies. Although the underlying mechanism was still not conclusively established, they concluded that there is a connection between periodontal and CVD
Sadiqa and Cheema[32]	2020	Conducted a review of the literature and discovered a brief description of the aetiology, pathophysiology, importance of the relationship, and common mediators of CVDs and PD. Epidemiological research confirmed that persistent PD plays a causal role in CVDs. Atherosclerosis has been associated with periodontal flora and the toxic substances it produces. The aetiology of heart and vascular diseases was significantly influenced by common immune-inflammatory mediators

ACVD: Atherosclerotic cardiovascular disease; AF: Atrial fibrillation; CVD: Cardio-vascular disease; CRP: C-reactive protein; FRS: Framingham Risk Score; HbA1c: Glycated hemoglobin; IL: Interleukin; LPS: Lipopolysaccharide; OR: Odds ratio; PAOD: Peripheral artery occlusive disease; PBMC: Peripheral blood mononuclear cell; PD: Periodontitis; TNF-α: Tumour necrosis factor alpha.