Is there an association between oral diseases and cardiovascular diseases in adults?
Date First Published:
January 5, 2026
Last Updated:
January 5, 2026
Report by:
Ola Babiker Hamed Elkhidir, Dentist (-)
Search checked by:
Ola Babiker Hamed Elkhidir, Dentist
Three-Part Question:
Adults with periodontal disease or poor oral health Improving oral health or treating periodontal disease Reducing the risk of cardiovascular disease
Clinical Scenario:
You are seeing several adult patients with poor oral hygiene and periodontal disease. Some ask whether untreated gum disease could increase their risk of heart disease, including coronary artery disease and endocarditis. You want to know if scientific evidence supports a link between oral conditions and cardiovascular disease.
Search Strategy:
Databases searched: PubMed, Cochrane Library, Google Scholar, NICE guidelines.
Keywords: “periodontitis AND cardiovascular disease”, “oral health AND heart disease”, “periodontal treatment AND cardiovascular outcomes”, “dental infection AND endocarditis risk”.
Limits: Adults, English language, systematic reviews, cohort studies, randomized controlled trials.
Keywords: “periodontitis AND cardiovascular disease”, “oral health AND heart disease”, “periodontal treatment AND cardiovascular outcomes”, “dental infection AND endocarditis risk”.
Limits: Adults, English language, systematic reviews, cohort studies, randomized controlled trials.
Search Details:
A systematic search of PubMed, Cochrane Library, Google Scholar, and NICE was conducted. Keywords were combined using Boolean operators. Titles and abstracts were screened for relevance to periodontal disease and cardiovascular outcomes. Full texts of relevant studies were reviewed.
Outcome:
The search identified over 200 papers. After screening for relevance and quality, 6 high-quality studies were selected, including systematic reviews, a randomized controlled trial, and large cohort studies that examined the association between oral health and cardiovascular disease.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis. Bahekar AA, Singh S, Saha S, Molnar J, Arora R. 2007 United States | Participants from 5 prospective cohort studies (over 86,000 adults) comparing people with and without periodontitis. | Meta-analysis of prospective cohort studies. Follow-up 6–21 years. Assessed incidence of coronary heart disease events in relation to periodontal status. |
Risk of coronary heart disease (CHD) associated with periodontal disease. | Periodontal disease was associated with a 24% increased risk of CHD. | Observational data — cannot prove causation. Variability in periodontal disease definitions. Potential confounders (smoking, SES) not fully controlled. |
| Stronger association seen for fatal cardiovascular events. | |||||
| Treatment of periodontitis and endothelial function. Tonetti MS, D'Aiuto F, Nibali L, Donald A, Storry C, Parkar M, et al. 2007 United states | 120 adults with severe chronic periodontitis and no cardiovascular disease at baseline. | Randomised controlled trial. Compared intensive periodontal treatment vs standard treatment. Follow-up for 6 months. Measured endothelial function (flow-mediated dilation) and inflammatory markers. |
Changes in endothelial function and systemic inflammatory markers after periodontal treatment. | Intensive treatment initially caused inflammation but by 6 months led to significant improvement in endothelial function and reduced inflammatory markers. | Small sample size. Short follow-up. Measured surrogate markers, not actual cardiovascular events. Single-centre study. |
| Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease. Dietrich T, Jimenez M, Krall Kaye EA, Vokonas PS, Garcia RI. 2008 United Kingdom | 1,203 men from the VA Normative Aging Study, free of coronary heart disease at baseline, followed for up to 35 years. | Prospective cohort study. Dental and medical exams every 3 years. Periodontitis measured using radiographic bone loss and probing depth. Outcome was incident coronary heart disease (MI, angina, fatal CHD). Cox regression used, adjusting for cardiovascular risk factors. |
Risk of new coronary heart disease events in relation to periodontitis severity and edentulism. | - In men younger than 60, severe periodontitis doubled CHD risk (HR ≈ 2.1). | - Only men included, limiting generalisability. - Residual confounding possible (e.g., lifestyle & socioeconomic factors). - Periodontal measures complex and may vary. - Edentulism may result from causes other than periodontitis. |
| - Greater bone loss and deeper pockets were associated with higher CHD risk. | |||||
| -No significant association in men above 60. |
Author Commentary:
The available evidence consistently shows an association between periodontal disease and cardiovascular disease. Although causation cannot be fully proven, multiple cohort studies demonstrate higher cardiovascular risk in individuals with periodontitis. An RCT also shows improvement in vascular function following periodontal treatment. The biological mechanism is plausible, involving systemic inflammation and bacteremia from dental infections. Overall, good oral health appears beneficial for cardiovascular risk reduction.
Bottom Line:
Periodontal disease is associated with an increased risk of cardiovascular disease. Treating gum disease may improve markers of cardiovascular health. Good oral hygiene should be recommended as part of overall cardiovascular risk management.
Level of Evidence:
Level 2: Studies considered were neither 1 or 3
References:
- Bahekar AA, Singh S, Saha S, Molnar J, Arora R.. The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis.
- Tonetti MS, D'Aiuto F, Nibali L, Donald A, Storry C, Parkar M, et al.. Treatment of periodontitis and endothelial function.
- Dietrich T, Jimenez M, Krall Kaye EA, Vokonas PS, Garcia RI.. Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease.