The diseases. The severity of the oral manifestations determines

The mouth is an important part of the body as it plays a
vital role in various physiological processes in the body. It acts as a gateway
to the body
G1 for pathogens and unwanted substances. It is known that the
oral health is the mirror of systemic health. Presence of any oral
manifestations such as periodontal disease, dental caries and many others may be directly associated
with the underlying causes of systemic diseases. The severity of the oral
manifestations determines the G2 G3 severity of the systemic diseases. (Mehrotra, et al., 2010) One such widely
studied link is the interplay between periodontitis and atherosclerosis. The
oral microbiome consists of around 700 microbial species. Bacteria forms biofilms
which are resistant to antibiotics and mechanical stress and are also host to
virus, fungus and many protozoans. Oral commensal microbiota colonizes surfaces
of the mouth, preventing pathogens from invading and colonizing the mouth. (Avila, et al., 2009) When there is a
disruption in commensal microbiota, opportunistic pathogens will cause
infections in the oral cavity. These pathogens will invade the oral mucosa,
tongue, gingiva and periodontium causing inflammation and these marks the start
of the periodontal disease. (Wade, 2013)G4 G5 G6 


Periodontitis is the 6th most predominant
disease worldwide with an overall incidence of 11.2%, with a total of 743
million people affected as indicated by the Global Burden of Disease Study. (Tonetti, et al., 2017) Periodontitis is the
chronic inflammatory G7 disease of periodontium mainly caused by pathogenic
bacteria in the subgingival plaque. (Ge, et al., 2013) . The pathogenic bacteria involved in
periodontitis are gram-negative anaerobic bacteria such as Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Prevotella
intermedia, Fusobacterium nucleatum, Tannerella forsythia, Treponema denticola and
others. (Bartova, et al., 2014)
Periodontitis is a multifactorial disease as it does not only involves bacteria
but also genetics of the patient. G8 This leads to an alteration in the immune reaction,
destruction of connective tissues surrounding the teeth and loss of alveolar
bones. (Bartova, et al., 2014) Risk factors
of periodontitis include maintenance of oral health, cigarette smoking,
alcohol consumption, ethnicity, age, diabetes, osteoporosis and obesity. (Sochalska & Potempa, 2017)G9 G10 G11 G12 

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Epidemiology studies have shown that periodontitis can lead
to atherosclerosis. (Chistiakov, et al., 2016) Atherosclerosis is
one of the leading cause of mortality in the world and a major cause of cardiovascular
diseases (CVD) like carotid artery diseases, peripheral artery diseases, stroke
etc. Atherosclerosis is characterized by the buildup of atheroma in the
arteries due to damage to the endothelium and initiation of inflammatory
responses. It can eventually cause thromboembolism in the heart, brain
resulting in stroke and infarction. Atherosclerosis being a multifactorial
disease have the same risk factors as periodontitis. Infection by
periodontopathic bacteria as discuss contributes to the development of
atherosclerosis. Oral infection leads to increase in the release of
inflammatory cytokines which can enter the systemic circulation and penetrate
the vascular endothelium thus leading to accumulation of atheromatous plaque. (Benedek, 2017)


The aim of this study is to review the interplay between
periodontitis and atherosclerosis and to throw light on whether periodontal
disease serves as a risk factor for the growth of atheromatous plaque, leading
to high incidence cardiovascular diseases by using past 10 year’s articles.  Research papers areG13  selected using the key
terms: “Periodontitis” “Cardiovascular diseases” “Atherosclerosis”
“inflammation “and “Porphyromonas
gingivalis”. For
this, the MEDLINE-PubMed database and the Science Direct database were searched
to retrieve review and original research articles published between the years
2008 to 2017.G14 G15 

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