title: Evaluating Periodontal Treatment to Prevent Cardiovascular Disease: Challenges and Possible Solutions.
abstract: OBJECTIVE
  Periodontal disease is correlated with cardiovascular disease (CVD) in observational studies, but a causal connection has not been established. The empirical evidence linking periodontal disease and CVD consists of a large body of observational and mechanistic studies, but a limited number of clinical trials evaluating the effects of periodontal treatment on surrogate CVD endpoints.
  
  
  RESULTS
  No randomized controlled trial has been conducted to evaluate the effect of periodontal treatment on CVD risk. In this review, we have summarized these data, described possible biological mechanisms linking periodontal disease and CVD, discussed barriers to conducting a randomized controlled trial to evaluate this hypothesis, and provided an alternative analytical approach using causal inference methods to answer the question. The public health implications of addressing this question can be significant because periodontal disease is under-treated, and highly prevalent among adults at risk of CVD. Even a small beneficial effect of periodontal treatment on CVD risk can be important.
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA. merchant@mailbox.sc.edu.|WJB Dorn VA Medical Center, Columbia, SC, USA. merchant@mailbox.sc.edu.
authors.forename: Anwar T
authors.initials: AT
authors.lastname: Merchant
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications / Q000517:prevention & control*; D006801:Humans; D010510:Periodontal Diseases / Q000150:complications / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
keywords: Cardiovascular disease; Causal inference; Periodontal disease; Periodontal treatment