Smbat Marukyan: How Inflamed Gums Can Lead to a Heart Attack – The Chain of Events
Smbat Marukyan, General Dentist at Wigmore Group CJSC, shared a post on LinkedIn:
“How Inflamed Gums Can Lead to a Heart Attack – The Chain of Events
Many are surprised to hear that periodontitis is an independent risk factor for cardiovascular events. But the pathophysiology is fairly clear.
Here is the step-by-step chain:
- P. gingivalis and other periodontal pathogens enter the bloodstream during everyday activities like chewing and even tooth brushing (transient bacteraemia).
- Their lipopolysaccharides (LPS) activate TLR4 on immune cells, triggering the release of IL-6, TNF-α, and IL-1β.
- IL-6 stimulates the liver to produce C-reactive protein (CRP). CRP levels in periodontitis patients are 2–3 times higher.
- CRP itself promotes the uptake of oxidised LDL by macrophages and the formation of foam cells in the arterial wall – the beginning of an atherosclerotic plaque.
- Gingipains from P. gingivalis activate platelets, promoting thrombus formation on the surface of unstable plaques.
The result:
According to meta-analyses (Li X et al., 2023), periodontitis increases the risk of myocardial infarction by 20–50% and stroke by 20–40%.
What is especially important:
Quality periodontal treatment (scaling and root planing) reduces CRP by 0.5–1.0 mg/L, which corresponds to a 10–15% reduction in cardiovascular risk.
A periodontist and a cardiologist should work in tandem. If a patient has elevated CRP and no obvious cause – take a look at their gums.”
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