The Periodontal-Cardiovascular Axis: Molecular Mechanisms, Clinical Evidence, and Therapeutic Perspectives

Periodontitis, a chronic inflammatory disease of the supporting tooth structures, affects nearly 10-12% of the global population and represents a significant public health concern. Beyond localized oral pathology, periodontitis is strongly associated with cardiovascular diseases-including atherosclerosis, coronary artery disease, stroke, and heart failure-through converging mechanisms of chronic inflammation, immune dysregulation, microbial translocation, and epigenetic modifications. Key molecular mediators include NLRP3 inflammasome activation, oxidative stress, asymmetric dimethylarginine-driven endothelial dysfunction, and vascular smooth muscle cell phenotypic modulation. Clinical studies demonstrate that individuals with periodontitis exhibit elevated systemic inflammatory biomarkers, impaired endothelial function, and increased risk of cardiovascular events. Importantly, periodontal therapy-ranging from behavioral interventions to subgingival instrumentation-reduces systemic inflammation and cardiovascular risk, particularly in high-risk populations such as patients with metabolic disorders or on hemodialysis. This mini-review synthesizes current evidence connecting periodontitis and cardiovascular disease, integrates molecular and clinical insights, and highlights the potential for interdisciplinary preventive and therapeutic strategies.