Abstract
The high prevalence of cardiovascular diseases (CVD) and infections of the mouth has lead to a hypothesis that these disease entities might be connected. Oral biofilms contain numerous micro-organisms with more than 700 identified species. In dental plaque the microbial concentrations are up to 109 colony forming units per mg. These micro-organisms cause dental caries and periodontal disease of which the majority of humans suffer during their life. Oral bacteria are presumed to gain access to the blood circulation and are postulated to trigger systemic reactions by up-regulating a variety of cytokines and inflammatory mediators. Infection and inflammation play a role also in atherogenesis. Furthermore, traces of oral micro-organisms, such as the gram-negative anaerobic bacterium Porphyromonas gingivalis, have been detected in atheroma plaques. This bacterium seems to be potentially atherogenic in animal models. Epidemiologic data have shown a statistical association between periodontal disease and coronary heart disease and stroke. In a meta-analysis, the odds ratio increase for CVD in persons with periodontal disease was almost 20%. Poor oral health also seems to be associated with all-cause mortality. Although there is evidence to indicate that poor oral health was associated with vascular health, no study has proved causal association between oral health and vascular health unequivocally. Large scale trials are needed to determine the causality in this relationship. Nevertheless, whether a causal link exists or not, an individual patient with vascular disease should be advised to take good care of the teeth and oral mucosa.
Keywords: Oral infection, cytokines, atherosclerosis, cardiovascular disease, myocardial infarction, stroke