REVIEW article
Front. Immunol.
Sec. Microbial Immunology
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1640904
This article is part of the Research TopicPeriodontal Disease and Systemic Health: Translational Insights and Clinical ApproachesView all 5 articles
The Oral Microbiome and Atherosclerosis: Current Evidence on Association, Mechanisms, and Clinical Implications
Provisionally accepted
- 1Oral Medicine Center, The First People’s Hospital of Yunnan Province, Jinbi Road, Kunming, Yunnan 650032, China, Kunming, China
- 2The First People’s Hospital of Yunnan Province, Kunming, China
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Atherosclerosis, the primary pathology of cardiovascular disease (CVD), is not fully explained by traditional risk factors. The oral microbiome has emerged as a key environmental contributor, yet the evidence for its role remains complex. This review moves beyond summarizing established associations to critically appraise the evidence, synthesize novel mechanistic insights, and outline future clinical frameworks. While traditional mechanisms such as direct bacteremia and systemic inflammation are covered, this review highlights emerging pathways including the oral-gut-vascular axis, epigenetic reprogramming ("inflammatory memory"), and the role of the multi-kingdom microbiome. We critically evaluate the evidence landscape, reconciling conflicting findings from observational studies, Mendelian randomization, and randomized controlled trials (RCTs) by systematically examining methodological heterogeneity. Furthermore, future directions are explored, focusing on the application of artificial intelligence (AI) for biomarker discovery and the development of novel interventions like engineered microbial therapeutics. Finally, the review translates scientific consensus into actionable clinical frameworks for interdisciplinary patient care. This comprehensive synthesis underscores the need to move towards mechanism-based, personalized strategies for CVD prevention.
Keywords: oral microbiome, Atherosclerosis, Periodontal disease, systemic inflammation, mechanisms, oral-gut axis, artificial intelligence, Clinical guidelines
Received: 13 Jun 2025; Accepted: 17 Sep 2025.
Copyright: © 2025 Xiao, Gong, Li and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bin Gong, 9y140299@kust.edu.cn
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