Evidence for periodontitis as a tertiary vascular infection

Periodontal infections create an oral wound that serves as a portal for the systemic dissemination of oral pathogens. Clinical assessments of periodontal disease that account for the number and severity of diseased periodontal sites and teeth; including measurements of pocketing, the degree of redness, inflammation and bleeding on probing, can all provide an estimate of the severity of the clinical condition. However, these clinical signs appear inadequate to completely characterize the size, patency and integrity of the periodontal lesion which serves as a portal for systemic exposure. Increasingly, measures of infectious exposure including systemic antibodies, inflammatory mediators and acute phase reactants serve as surrogates or biomarkers for periodontal disease that provide further insight into the linkages between periodontitis and atherogenesis. This review discusses the evidence for systemic inflammatory responses to oral organisms and the potential role of chronic vessel pathology as a manifestation of tertiary periodontal infections.