Periodontitis-atherosclerosis syndrome: an expanded model of pathogenesis

The early reports of a linkage between periodontitis and atherosclerosis ha ve garnered further support by additional data generated by several investi gative teams in many different countries. The evidence continues to suggest that periodontitis may be an important risk factor or risk indicator for c ardiovascular pathology for some individuals. The term periodontitis-athero sclerosis syndrome (PAS) is proposed as a new diagnostic term to describe t his condition in these individuals, Current evidence. albeit preliminary in nature, which describes a cluster of clinical signs and symptoms that are associated with this condition, is presented. It is clear that this syndrom e will require considerable study and refinement before a definitive diagno sis and treatment plan can be formulated. Potential mechanisms by which sys temic inflammation and infectious challenge of periodontal origin may serve as a potential modifier of cardiovascular disease are discussed in the con text of a detailed working model of pathogenesis. This hypothetical model e mbraces many cellular and molecular components of atherogenesis and thrombo embolic diseases from the perspective of periodontitis pathogenesis. Many a spects of the hypothetical model remain unproved; however, it is our opinio n that only through the clarification of the mechanisms of pathogenesis can we ultimately construct a knowledge framework for accurate diagnoses and s uccessful therapies. The concept of diagnosing and treating a periodontal p atient to minimize the deleterious effects of this chronic infectious and i nflammatory condition on the cardiovascular system represents an unpreceden ted challenge to our profession.