Periodontal disease as a risk marker in coronary heart disease and chronic kidney disease.
OBJECTIVE
More than half a million Americans die each year from coronary heart disease (CHD), 26 million suffer from chronic kidney disease (CKD), and a large proportion have periodontal disease, a chronic infection of the tissues surrounding teeth. Chronic inflammation contributes to CHD and CKD occurrence and progression, and periodontal disease contributes to the cumulated chronic systemic inflammatory burden. This review examines recent evidence regarding the role of periodontal disease in CHD and CKD.


RESULTS
Periodontal pathogens cause both local infection and bacteremia, eliciting local and systemic inflammatory responses. Periodontal disease is associated with the systemic inflammatory reactant C-reactive protein (CRP), a major risk factor for both CHD and CKD. Nonsurgical periodontal disease treatment is shown to improve periodontal health, endothelial function, levels of CRP, and other inflammatory markers. Evidence for the association of periodontal disease with CKD consists of a small body of literature represented mainly by cross-sectional studies. No definitive randomized controlled trials exist with either CHD or CKD as primary endpoints.


CONCLUSIONS
Recent evidence links periodontal disease with CHD and CKD. Adding oral health self-care and referral for professional periodontal assessment and therapy to the repertoire of medical care recommendations is prudent to improve patients' oral health and possibly reduce CHD and CKD risk.
Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Wichita, Kansas 67214-3199, USA. mfisher2@kumc.edu
Monica A
MA
Fisher
Wenche S
WS
Borgnakke
George W
GW
Taylor
D015415:Biomarkers / Q000378:metabolism; D002908:Chronic Disease; D003327:Coronary Disease / Q000209:etiology* / Q000276:immunology; D019317:Evidence-Based Medicine; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D007674:Kidney Diseases / Q000209:etiology* / Q000276:immunology; D010510:Periodontal Diseases / Q000150:complications* / Q000276:immunology; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
D015415:Biomarkers; D018836:Inflammation Mediators