Understanding the complex interaction between chronic infections, such as periodontal disease and systemic conditions such as cardio-vascular disease, has led to a new way of thinking about the importance of periodontal disease in overall health.
Periodontitis is prevalent in patients with cardiovascular disease, and periodontal therapy may have a positive impact on the overall health status of these individuals. Hence, periodontal management includes a complete assessment of each individual patient. Medical and dental history, clinical and radiographic examination, as well as an assessment of risk factors is all important to making an accurate diagnosis, prognosis, and developing an optimal treatment plan.
Despite the localized nature of periodontal disease, infection of the sulcus / periodontal pocket with periodontopathogens may be responsible for inflammatory responses that develop beyond the periodontium. In cases of periodontal disease, the inflamed and ulcerated pocket epithelium is vulnerable to bacterial penetration and forms an easy port of entry for the bacteria. This leads to an increase in the number of periodontopathogens, mainly anaerobic Gram-negative, in the gingival tissues and consequently in the circulation.
So, periodontal infection may induce an inflammatory response that is not limited to the tissues surrounding the teeth, but is also extended systemically. Since they circulate throughout the body they can affect ectopic sites, causing inflammation or exacerbation of existing inflammatory processes.
This concept takes on new meaning in light of the recent implication of CRP in the pathogenesis of cardiovascular disease. One of the factors with the strongest evidence as a biomarker for predicting CVD events is CRP.
There is now abundant clinical evidence demonstrating that many biomarkers of inflammation are elevated years in advance of first-ever myocardial infarction (MI) or thrombotic stroke, and that these same biomarkers are highly predictive of recurrent MI, recurrent stroke, and death due to CVD.
It is reasonable to suggest that the understanding and ability to manipulate resolution of inflammation may provide a new treatment paradigm for inflammatory diseases, local and systemic.