Role of periodontal pathology associated with Porphyromonas gingivalis in the genesis of cardiac atherosclerosis and clinical manifestation
Bulgarian Medical Journal, 2025, 19(4), 27-32.
R. Angelova1,2, D. Tonkova1,2, R. Hristova1,2, V. Slavova3, A. Nyagolova3
1Second Cardiology Clinic – Department of Invasive Cardiology, UMHAT ,,Sveta Marina” – Varna
2First Department of Internal Diseases, Faculty of Medicine, Medical University – Varna
3Department of Periodontology and Dental Implantology, Faculty of Dental Medicine, Medical University – Varna
Abstract. Ischemic heart disease and periodontitis are the most common diseases globally, which makes them socially significant for all countries. Cardiovascular mortality remains one of the leading causes of death in the world, with an increasing trend in the low- and middle-income countries, as opposed to developed countries. According to data from the World Health Organization, the prevalence of periodontitis also shows a tendency to increase in frequency in developing countries, which necessitates the preparation of a global plan to preserve and improve oral health worldwide. Well-known and studied risk factors for the development of ischemic heart disease and periodontitis are similar, such as smoking, diabetes mellitus, gender and diet. The basis of the pathogenesis of both diseases is inflammation. The main oral periodontopathogens are gram-negative, mainly anaerobes and some spirochetes: Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Treponema denticola and Fusobacterium nucleatum. Porphyromonas gingivalis is a gram-negative anaerobe responsible for severe forms of periodontitis and is a key pathogen in the development of gingival inflammatory processes. There are studies in the world database on the influence of Porphyromonas gingivalis on the development, progression and complications of the atherosclerotic process. A mechanism of direct invasion of oral pathogens into the bloodstream, as a result of mechanical entrapment during dental procedures or other types of injury to the oral mucosa, providing a gateway for the pathogen, has been suggested. Another type of presumed mechanism is through immune-mediated inflammatory mechanisms, activation of platelet aggregation and synthesis of pro-inflammatory molecules, free radicals and acute-phase proteins, damage to endothelial and smooth muscle cells of vessels and development of endothelial dysfunction. Although periodontitis is recognized as the new risk factor for atherosclerosis, the underlying mechanism of the manifestation and the direct cause-and-effect relationship are not fully understood and remain a challenge.
Key words: atherosclerosis, risk factors, Porphyromonas gingivalis, periodontitis, inflammation, atheroma
Address for correspondence: Assist. Prof. R. Angelova, MD, e-mail: radosveta92@gmail.com