EDITORIAL: Oral inflammation as an Emerging Risk Factor for Cardiovascular Health

Martina Cardisciani¹Sara Di Nicolantonio^1,2Davide Pietropaoli^3*

• ¹Universita degli Studi dell'Aquila Dipartimento di Medicina Clinica Sanita Pubblica Scienze della Vita e dell'Ambiente, L'Aquila, Italy
• ²Case Western Reserve University, Cleveland, United States
• ³Universita degli Studi dell'Aquila Dipartimento di Scienze Fisiche e Chimiche, L'Aquila, Italy

Conversely, non-surgical periodontal therapy (NSPT) and intensive professional oral hygiene have been shown to lower systemic inflammation and reduce blood pressure in pre-hypertensive, hypertensive, and treatment-resistant individuals [1,2]. These benefits may persist over time and can potentially contribute to the attenuation of atherosclerosis progression. Such evidence strengthens the concept that maintaining oral health represents a cost-effective, non-pharmacological strategy for managing hypertension and reducing cardiovascular risk.The aim of this Research Topic was to deepen understanding of the molecular and clinical links between oral inflammation and cardiovascular diseases. Building on this premise, the contributions included in this issue provide complementary insights that collectively reinforce the cardio-oral connection. Roberts et al., for instance, explored the association between dental caries and cardiovascular events using data from both the NHANES and DRDR databases. Their analysis revealed that higher DMFT/DMFS scores correlated with a history of cardiovascular events, even after adjustment for traditional risk factors. Interestingly, the association was stronger in the NHANES cohort, which included non-dental care seekers. Although the corss-sectional design and the absence of confounders such as BMI, diet, and physical activity limit causal inference, the findings underscore the importance of integrating medical and dental datasets in large-scale population studies to fully capture the oral-systemic interface.Continuing this line of evidence, Church et al. emphasized the critical role of oral health awareness in cardiovascular disease prevention. Their review showed that hospitalized cardiac patients often exhibit poor adherence to oral hygiene practices, with fewer than half reported regular flossing.Educational programs (digitally or face-to-face) significantly improved both oral hygiene behaviors and postoperative cardiovascular outcomes. These results suggest that incorporating oral health education into patient management could serve as an effective secondary prevention strategy; however, a key knowledge gap remains: none assessed changes in systemic inflammatory markers.Addressing this gap, Usmani et al. conducted a scoping review of 12 studies that linked improvements in oral health improvements to reductions in inflammatory biomarkers and CVD mortality. Specifically, non-surgical periodontal therapy (NSPT) was associated with decreases in CRP, cholesterol, and triglycerids in cardiovascular patients. Additionally, combining NSPT with good oral hygiene resulted in a halving of Staphilococcus Aureus infections and coronary heart disease mortality. Despite these clear benefits, the authors stressed the need to implement and standardize programs designed to empower vulnerable, high-risk patients to improve their oral health for better overall systemic health. In conclusion, this review reinforces the concept that oral health should be integrated into broader CVD prevention frameworks, encouraging interdisciplinary collaboration between dental and medical practitioners to reduce the global burden of non-communicable diseases.Finally, Molina et al., provided robust clinical evidence trough a triple-blinded randomized clinical trial assessing the effects of NSPT on cardiovascular and oral outcomes in patients with chronic periodontitis and established cardiovascular disease. Over a six-month period, both supragingival scaling (Step 1) and complete subgingival instrumentation (Step 2) improved periodontal parameters, with Step 2 yielding greater reductions in bleeding on probing and probing depth. Interestingly, both protocols significantly reduced carotid intima-media thickness (cIMT), though neither influenced endothelial function as measured by flow-mediated dilation (FMD). These results, consistent with recommendations from the European Federation of Periodontology and the World Heart Federation, confirm that periodontal therapy is safe and beneficial for vascular health, even when initiated as early as three months after an acute cardiovascular event Collectively, the studies featured in this Research Topic provide compelling evidence of the cardiooral connection. Maintaining periodontal health is no longer a purely dental matter but a fundamental component of systemic disease prevention. Despite this increasing body of evidence, oral health promotion remains insufficiently addressed within cardiovascular care protocols. Integrating dental assessment and preventive oral therapy into routine cardiology practice could be a simple yet highly effective strategy to mitigate systemic inflammation and improve vascular outcomes.