Consensus report on periodontitis and cardiovascular diseases provides recommendations for dentists, doctors, and patients

There is strong epidemiological evidence that periodontitis increases the risk of future atherosclerotic cardiovascular disease, according to the consensus report from the Perio-Cardio Workshop, an expert meeting organised jointly by the European Federation of Periodontology (EFP) and the World Heart Federation (WHF).

The report, published simultaneously on February 3 in the EFP’s Journal of Clinical Periodontology and the WHF’s Global Heart, explains the latest evidence on the associations between the two diseases and provides a series of recommendations for dentists, doctors, and patients.

The EFP is preparing an outreach campaign based on the findings of the report, which is due to launch in April.

Recommendations in Periodontitis and cardiovascular disease: Consensus report include:

• Patients with periodontitis should be advised that they have a higher risk of suffering cardiovascular diseases – including myocardial infarction and stroke.
• They should be advised to actively manage risk factors (such as smoking, lack of exercise, excess weight, blood pressure, and a diet high in saturated fats and refined sugars).
• Patients who have both periodontitis and cardiovascular disease should be informed that they may be at higher risk of suffering subsequent cardiovascular complications and that they should therefore stick to recommended dental regimes of prevention, treatment, and maintenance.

The report states that severe periodontitis is independently and significantly associated with cardiovascular disease from all causes and with cardiovascular mortality in various populations. Proposed mechanisms to explain this association include bacteraemia and the associated systemic inflammatory sequelae, including elevations in C-reactive protein and oxidative stress.

The consensus report was based on four technical papers that systematically reviewed the evidence for epidemiological associations between periodontitis and incident CVD, mechanisms of biological plausibility relating to periodontal bacteria and systemic inflammation (two reviews), and periodontal intervention studies.

The Perio-Cardio Workshop also reviewed the potential risk and complications of periodontal therapy in patients who are on anti-thrombotic medication and the report provides detailed recommendations in this area.

The report is the fruit of the Perio & Cardio Workshop, held in Madrid in February 2019. This workshop brought together more than 20 experts from the EFP and the WHF to consider the latest evidence about the associations between periodontal and cardiovascular diseases and to draft a series of recommendations on prevention and therapy.

This workshop built on and updated the pioneering work of the IX European Workshop on Periodontology, a joint workshop of the EFP and the American Academy of Periodontology held in 2012, which explored the links between periodontitis and systemic conditions including cardiovascular diseases. 

‘A great opportunity’

“This workshop was a great opportunity for both cardiology and periodontal communities to review the scientific evidence behind these associations in a rigorous and unbiased manner,” said Mariano Sanz, co-chair of the Perio-Cardio Workshop, professor of periodontology at the Complutense University of Madrid (Spain), and lead author of the consensus report.  “In this way, the health implications and recommendations from this consensus report should serve all stakeholders in implementing actions aimed at the prevention of both cardiovascular and periodontal diseases.”

Pablo Perel, senior science adviser of the World Heart Federation, editor of Global Heart, and professor of clinical epidemiology at the Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine (UK), commented: “This report shows that there is an association between periodontitis and coronary heart disease, and people with periodontitis share many of the cardiovascular risk factors .It is important to be aware of this association and emphasise that tackling risk factors such as smoking or poor diet in people with periodontitis will also have a significant impact on cardiovascular risk.”

Outreach campaign

The EFP will now create an outreach campaign on periodontal and cardiovascular health which will provide specific materials to dentists, physicians, and patients who visit both dental and medical practices.

This campaign, like the Perio-Cardio Workshop, will be sponsored by Dentaid, which is an EFP partner. It is due to be launched in April 2020.