Bidirectional interplay between periodontal disease and carotid artery disease: a comprehensive holistic review

Background: Periodontal disease and atherosclerosis are two highly prevalent chronic inflammatory conditions that may be pathophysiologically linked. Objective: This review aims to critically assess the current literature regarding the potential causal relationship between periodontitis, the atherosclerotic process, and particularly the progression of carotid artery disease. Although numerous observational studies support an association between periodontitis and cardiovascular diseases, the evidence remains inconclusive in demonstrating periodontal disease as an independent risk factor in the development of carotid atherosclerotic plaques. Conclusion: While there is substantial biological plausibility for a link between periodontal disease and atherosclerosis, current evidence is insufficient to confirm a direct causal role, particularly in carotid artery disease. Further longitudinal and interventional studies are necessary to elucidate the mechanisms involved and determine whether periodontal treatment may contribute to cardiovascular risk reduction. The potential public health implications of these findings highlight the necessity for comprehensive preventive and therapeutic oral health interventions aimed at reducing associated systemic risks.