Periodontitis is a multifactorial chronic inflammatory disease that may have an impact on Cardiovascular Disease. It is associated with bacterial plaque biofilms and characterized by progressive tissue destruction of the supporting apparatus of the tooth, essentially attributable to gram-negative bacteria colonizing the gingival sulcus. It is known that agents involved in periodontal infections(Porphyromonas gingivalis and S. sanguinis) have been found in endarterectomy specimens because of their systemic action potential: they are able to penetrate the endothelium and contribute to the inflammatory process of atherosclerosis.
In the National Health and Nutrition Examination Survey (NHANES), Periodontitis was an important risk factor for ACVI. The presence of the microorganisms can influence the morphology of atherosclerotic plaques and predispose them to rupture, precipitating an acute coronary syndrome or an LVCA, which makes it logical that patients with periodontitis have a considerably higher risk of acute myocardial infarction, independent of the presence of other cardiovascular risk factors; both entities share several risk factors.
In several countries, until before the Covid 19 pandemic, cardiovascular disease was the leading cause of mortality. In addition to traditional cardiovascular risk factors, chronic inflammation accelerates the atherosclerotic process and the process involved in acute coronary syndromes.
An excellent strategy for patients susceptible to endocarditis is to educate them on the importance of receiving effective preventive periodontal procedures such as regular periodontal therapy (every 3 months or at the latest every 6 months), this of course after eliminating any infectious focus if necessary. Patients susceptible to endocarditis should be encouraged to optimize the health of their gingival tissues by improving oral hygiene procedures. By helping the patient to reduce the degree of gingival inflammation, the periodontist reduces the risk of bacteremia associated with dental procedures; every periodontal and/or dental procedure in general should be started with rinses prior to any treatment with chlorhexidine 0.12% for one minute or chlorhexidine 0.2% for 30 seconds, if necessary: also perform antibiotic prophylaxis and following indications or warnings indicated by the cardiologist.
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