Association of periodontal disease with risk atrial fibrillation: systematic review

Periodontal disease (PD), a chronic inflammatory condition affecting nearly 50% of adults globally, drives systemic inflammation and cardiovascular diseases. Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, shares pathophysiological links with inflammation. This systematic review evaluates the association between PD and AF risk, addressing gaps in existing evidence. A comprehensive literature search was conducted in MEDLINE, EMBASE, and the Cochrane Library up to September 2025. Observational studies that met PICOS criteria (adults with/without PD, PD exposure, AF outcome) were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Data were synthesized narratively due to heterogeneity in PD/AF definitions. Four high-quality studies (NOS ≥ 6) were analyzed. All studies demonstrated a consistent association between PD and increased AF risk, with adjusted hazard ratios (HRs) ranging from 1.03 to 1.31. Severe PD showed stronger associations (HR: 1.31, 95% CI: 1.06–1.62), while PD recovery attenuated risk (HR: 1.00, 95% CI: 0.97–1.04). Mechanistically, PD-related systemic inflammation (e.g., elevated C-reactive protein) and pathogen translocation (e.g., Porphyromonas gingivalis) was implicated in atrial remodeling. Regular dental care was associated with reduced AF incidence. PD is significantly associated with an elevated risk of AF, particularly in severe or persistent cases. The findings underscore PD as a modifiable risk factor, highlighting the potential of periodontal interventions in AF prevention.