{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T09:55:33Z","timestamp":1791453333322,"version":"4.3.3"},"reference-count":177,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,5,8]],"date-time":"2020-05-08T00:00:00Z","timestamp":1588896000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Periodontology 2000"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Atherosclerosis is central to the pathology of cardiovascular diseases, a group of diseases in which arteries become occluded with atheromas that may rupture, leading to different cardiovascular events, such as myocardial infarction or ischemic stroke. There is a large body of epidemiologic and animal model evidence associating periodontitis with atherosclerotic disease, and many potential mechanisms linking these diseases have been elucidated. This chapter will update knowledge on these mechanisms, which generally fall into 2 categories: microbial invasion and infection of atheromas; and inflammatory and immunologic. With respect to the invasion and infection of atheromas, it is well established that organisms from the subgingival biofilm can enter the circulation and lodge in most distant tissues. Bacteremias resulting from oral interventions, and even oral hygiene activities, are well documented. More recently, indirect routes of entry of oral organisms (via phagocytes or dendritic cells) have been described for many oral organisms, into many tissues. Such organisms include the periodontal pathogens\n                    <jats:italic>Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Tannerella forsythia<\/jats:italic>\n                    , and\n                    <jats:italic>Fusobacterium nucleatum<\/jats:italic>\n                    . Intracellular survival of these organisms with dissemination to distant sites (The Trojan Horse approach) has been described. Their relative contribution to atheroma formation and progression has been studied mainly in experimental research, with results demonstrating that these organisms can invade endothelial cells and phagocytic cells within the atheroma, leading to pathogenic changes and progression of the atheroma lesion. The second category of mechanisms potentially linking periodontitis to atherosclerosis includes the dumping of inflammatory mediators originating from periodontal lesions into the systemic circulation. These inflammatory mediators, such as C\u2010reactive protein, matrix metalloproteinases, fibrinogen, and other hemostatic factors, would further accelerate atheroma formation and progression, mainly through oxidative stress and inflammatory dysfunction. Moreover, direct effects on lipid oxidation have also been described. In summary, the evidence supports the concept that periodontitis enhances the levels of systemic mediators of inflammation that are risk factors for atherosclerotic diseases.\n                  <\/jats:p>","DOI":"10.1111\/prd.12304","type":"journal-article","created":{"date-parts":[[2020,5,9]],"date-time":"2020-05-09T01:34:42Z","timestamp":1588988082000},"page":"90-106","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":403,"title":["Mechanisms underlying the association between periodontitis and atherosclerotic disease"],"prefix":"10.1111","volume":"83","author":[{"given":"Harvey A.","family":"Schenkein","sequence":"first","affiliation":[{"name":"Department of Periodontics School of Dentistry Virginia Commonwealth University Richmond Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panos N.","family":"Papapanou","sequence":"additional","affiliation":[{"name":"Division of Periodontics Section of Oral, Diagnostic and Rehabilitation Sciences Columbia University College of Dental Medicine NewYork New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Genco","sequence":"additional","affiliation":[{"name":"Departments of Oral Biology, and Microbiology and Immunology Center for Microbiome Research University at Buffalo Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariano","family":"Sanz","sequence":"additional","affiliation":[{"name":"ETEP (Etiology and Therapy of Periodontal Diseases) Research Group University Complutense Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,5,8]]},"reference":[{"issue":"14","key":"e_1_2_5_2_1","first-page":"S30","article-title":"Periodontal bacterial invasion and infection: contribution to atherosclerotic pathology","volume":"40","author":"Reyes L","year":"2013","journal-title":"J Clin 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