The Periodontal-Cardiovascular Axis: Mechanisms, Clinical Implications, and Integrated Management Strategies

A growing body of evidence underscores a significant bidirectional relationship between periodontal disease (PD) and cardiovascular diseases (CVD), particularly atherosclerotic cardiovascular disease (ASCVD) and its interventions. This review synthesizes current knowledge on the pathophysiological mechanisms linking oral dysbiosis and chronic periodontal inflammation to endothelial dysfunction, plaque instability, and adverse cardiovascular events. We examine epidemiological data establishing PD as an independent risk factor for CVD, explore shared inflammatory pathways, and critically evaluate clinical evidence regarding the impact of periodontal treatment on cardiovascular surrogate markers and hard outcomes. Furthermore, we discuss the implications for interdisciplinary care models integrating dentistry and clinical cardiology. A comprehensive literature search of PubMed, Embase, and Cochrane Library databases was conducted, encompassing observational studies, randomized controlled trials (RCTs), systematic reviews, and mechanistic investigations. The evidence strongly supports PD as a contributor to cardiovascular risk via systemic inflammation, bacteremia, and immune dysregulation. While periodontal therapy improves endothelial function and reduces systemic inflammation, large-scale RCTs on hard cardiovascular endpoints are ongoing. Collaborative management strategies between dental and cardiovascular health professionals are crucial for optimizing patient outcomes and warrant broader implementation.