Periodontitis and peripheral artery disease: a mini-review

Periodontitis is a inflammatory disease characterized by progressive loss of periodontal attachment and alveolar bone, leading to tooth mobility and eventual tooth loss. Periodontal disease affects about half of U.S. adults. Epidemiologic evidence links periodontitis to increased incidence of cardiovascular disease (CVD). Peripheral artery disease (PAD) is common in adults aged ≥65 years and is associated with substantially increased cardiovascular risk. It is an atherosclerotic condition that shares major risk factors, diabetes, smoking, older age, hypertension, and chronic kidney disease. Although the link between periodontitis and CVD is well established, comparatively few studies have examined PAD specifically. This mini-review synthesizes recent studies on periodontitis and PAD. Across heterogeneous designs and populations, most reports support a modest association, which appears stronger in the presence of shared risk factors (e.g., diabetes, smoking) and with more severe periodontal involvement. Several studies have detected oral pathogens or pathogen-specific antibodies (e.g., Porphyromonas gingivalis, Treponema denticola) in patients with PAD and report higher circulating inflammatory mediators. Nonetheless, substantial heterogeneity in populations, exposure/outcome definitions, and confounding control, and the likelihood of residual confounding, limit causal inference. Large, well-designed prospective studies with standardized periodontal phenotyping and rigorous adjustment (including attention to temporal trends in dental extraction practices) are needed to define effect magnitude and clinical relevance.