Dear Colleagues,

Periodontitis is an inflammatory disease and is mainly caused by a dysbiotic subgingival biofilm. The disease is characterized by the destruction of the tooth-supportive apparatus. Periodontitis has a high prevalence of 45%–50%, with the most severe form affecting 11.2% of the world's population (Kassebaum et al., 2014). In most cases, periodontitis can be successfully treated with anti-inflammatory therapy such as scaling and root planing, access flap, and in rare cases adjuvant systemic antibiotic therapy along with lifelong supportive periodontal therapy. Cardiovascular disease (CVD) is responsible for 17.9 million deaths (a third of total mortality) (Roth et al., 2017). In addition to the classic influenceable risk factors for CVD (age, male gender, hypertension, dyslipoproteinemia, diabetes, smoking, stress, obesity, unhealthy diet, and physical inactivity), periodontitis appears to be a risk factor.

Data from several cross-sectional and longitudinal epidemiologic studies have supported the concept that periodontitis or periodontal conditions are linked to atherosclerosis and CVD. Essentially, three underlying mechanisms for this connection are discussed. Firstly, periodontal bacteria and their toxins can enter the bloodstream, e.g., during dental interventions, but also during daily activities, such as eating or tooth brushing. Periodontal bacteria may contribute indirectly (e.g., by triggering autoimmune reactions) or directly by damage to coronary arteries. Secondly, periodontitis leads to an increase in the proinflammatory (increased serum levels for CRP and IL-6) and prothrombotic (increased levels for fibrinogen and PAI [plasminogen activator inhibitor]) status. Thirdly, periodontitis and CVD share some risk factors such as age, smoking, diabetes, and genetic factors. There is still a lack of convincing data demonstrating that successful periodontal therapy may reduce the risk of primary or secondary cardiovascular events. This Special Issue will summarize previous and new findings on periodontitis–CVD interaction and present therapy recommendations for cardiologists and periodontists.

Prof. Gaetano Isola, Dr. Simona Santonocito and Dr. Alessandro Polizzi
Guest Editors