The diseases. The severity of the oral manifestations determines

The mouth is an important part of the body as it plays avital role in various physiological processes in the body. It acts as a gatewayto the bodyG1 for pathogens and unwanted substances. It is known that theoral health is the mirror of systemic health. Presence of any oralmanifestations such as periodontal disease, dental caries and many others may be directly associatedwith the underlying causes of systemic diseases. The severity of the oralmanifestations determines the G2 G3 severity of the systemic diseases. (Mehrotra, et al.

, 2010) One such widelystudied link is the interplay between periodontitis and atherosclerosis. Theoral microbiome consists of around 700 microbial species. Bacteria forms biofilmswhich are resistant to antibiotics and mechanical stress and are also host tovirus, fungus and many protozoans. Oral commensal microbiota colonizes surfacesof the mouth, preventing pathogens from invading and colonizing the mouth. (Avila, et al., 2009) When there is adisruption in commensal microbiota, opportunistic pathogens will causeinfections in the oral cavity. These pathogens will invade the oral mucosa,tongue, gingiva and periodontium causing inflammation and these marks the startof the periodontal disease. (Wade, 2013)G4 G5 G6  Periodontitis is the 6th most predominantdisease worldwide with an overall incidence of 11.

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2%, with a total of 743million people affected as indicated by the Global Burden of Disease Study. (Tonetti, et al., 2017) Periodontitis is thechronic inflammatory G7 disease of periodontium mainly caused by pathogenicbacteria in the subgingival plaque. (Ge, et al., 2013) . The pathogenic bacteria involved inperiodontitis are gram-negative anaerobic bacteria such as Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Prevotellaintermedia, Fusobacterium nucleatum, Tannerella forsythia, Treponema denticola andothers.

 (Bartova, et al., 2014)Periodontitis is a multifactorial disease as it does not only involves bacteriabut 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 alveolarbones. (Bartova, et al., 2014) Risk factorsof periodontitis include maintenance of oral health, cigarette smoking,alcohol consumption, ethnicity, age, diabetes, osteoporosis and obesity. (Sochalska & Potempa, 2017)G9 G10 G11 G12  Epidemiology studies have shown that periodontitis can leadto atherosclerosis.

(Chistiakov, et al., 2016) Atherosclerosis isone of the leading cause of mortality in the world and a major cause of cardiovasculardiseases (CVD) like carotid artery diseases, peripheral artery diseases, strokeetc. Atherosclerosis is characterized by the buildup of atheroma in thearteries due to damage to the endothelium and initiation of inflammatoryresponses. It can eventually cause thromboembolism in the heart, brainresulting in stroke and infarction. Atherosclerosis being a multifactorialdisease have the same risk factors as periodontitis.

Infection byperiodontopathic bacteria as discuss contributes to the development ofatherosclerosis. Oral infection leads to increase in the release ofinflammatory cytokines which can enter the systemic circulation and penetratethe vascular endothelium thus leading to accumulation of atheromatous plaque. (Benedek, 2017)  The aim of this study is to review the interplay betweenperiodontitis and atherosclerosis and to throw light on whether periodontaldisease serves as a risk factor for the growth of atheromatous plaque, leadingto high incidence cardiovascular diseases by using past 10 year’s articles.  Research papers areG13  selected using the keyterms: “Periodontitis” “Cardiovascular diseases” “Atherosclerosis””inflammation “and “Porphyromonasgingivalis”. Forthis, the MEDLINE-PubMed database and the Science Direct database were searchedto retrieve review and original research articles published between the years2008 to 2017.G14 G15 Inserted: tInserted: hInserted: wiDeleted:fDeleted:rDeleted:oInserted: ryInserted: sDeleted:iDeleted:nDeleted:ityDeleted:s underInserted: sInserted: ereDeleted:as