Table 1.

CVD Comorbidities and periodontal therapy summary of sources.

First author	Year	Type of study	Key findings	Limitations
Chang	2020	Population-based cohort study	-Frequent tooth brushing (≥3 times/day) was significantly associated with attenuated risk of atrial fibrillation (hazard ratio: 0.90, 95 % confidence interval (0.83–0.98)) and heart failure (0.88, (0.82–0.94)). -Number of missing teeth ≥22 was positively (1.32, (1.11–1.56)) associated with risk of heart failure.	-Difficult to generalize to other ethnicities, as study population consisted of only Asian individuals. -Did not confirm the presence of periodontal disease with dental X-rays.
Baeza	2020	Meta-analysis of Randomized clinical trials	-Scaling and root planning reduced HbA1c [DM = 0.56 (0.36–0.75); p < 0.01] and CRP [DM = 1.89 (1.70–2.08); p < 0.01].	-Lack of adequate placebo in analyzed studies. -Lack of statistical analysis to evaluate the possibility of publication bias.
Lockhart	2017	Placebo – controlled study	-Participants with mean plaque and calculus scores of 2 or greater were at a 3.78- and 4.43-fold increased risk of developing bacteremia, respectively. -The presence of generalized bleeding after toothbrushing was associated with an almost eightfold increase in risk of developing bacteremia.	-All participants required dental extraction, therefore not representative of broader adult population. -Did not test for associations between gingival disease parameters and bacteremia risk.
Söder	2016	Prospective cohort study	-High dental calculus score, indicative of poor dental hygiene, was associated with incidence of angina pectoris	-Did not include blood pressure or lipid profile data.
Chen	2016	Retrospective cohort study	-There was an increased risk of atrial fibrillation or flutter in the periodontal disease group compared to the non-periodontal disease group (HR, 1.31; 95 % CI, 1.25–1.36)	-Lack of information regarding risk factors for atrial fibrillation in study population (obesity, alcohol use). -Lack of clinical data to validate the diagnoses of atrial fibrillation and atrial flutter.
Merchant	2015	Prospective cohort study	-Periodontal treatment at baseline and follow-up reduced HbA1c by −0.02 % and −0.074 %, respectively. -Treatment at follow-up increased the likelihood of individuals achieving diabetes control by 5 % and 3 % at the HbA1c < 7 % and HbA1c < 9 % thresholds, respectively.	-Confounding due to the observational study design. -Baseline periodontal status was unknown.
Söder	2014	Prospective cohort study	-Increased dental calculus score was significantly associated with mortality from heart infarction.	-Study lacked other metrics known to be risks for heart infarction, such as body mass index, and serum lipid values.
Vidal	2013	Interventional prospective cohort study	-Periodontal therapy reduced median values of SBP and DBP by 12.5 mmHg and 10.0 mmHg, respectively. -Levels of CRP, IL-6 and fibrinogen lowered by 0.5 mg/dL, 1.4 pg/dL and 37.5 mg/dL (p < 0.01), respectively, 6 months after periodontal therapy.	-Small population study (26 individuals).
Bokhari	2012	Single blind, parallel arm randomized controlled clinical trial	-The number of subjects with CRP > 3 mg/L in intervention group decreased by 38 % and in control group increased by 4 %.	-Lack of lipid fractions.
Yakob	2012	Prospective cohort study	-Periodontitis found to be major predictor of higher arotid artery intima-media area (cIMA), a metric of carotid atherosclerosis (odds ratio, 3.82; 95 % confidence interval, 1.19–12.26)	-Small study population (134 individuals).
Fajardo	2010	Controlled, double blind randomized clinical trial	-Significant improvements were observed in cholesterol levels (Δ = −58.5 ± 37.6 versusΔ = 5.4 ± 41.2 mg/dL, p < 0.0002), low-density lipoprotein levels (Δ = −48.1 ± 31.7 versusΔ = 1.9 ± 42.8 mg/dL, p < 0.002), dental mobility (Δ = −0.17 ± 0.11 versusΔ = −0.06 ± 0.11 %, p < 0.04), and the distance from the crestal alveolar bone to the cemento-enamel junction (Δ = −0.75 ± 0.7 versusΔ = 0.09 ± 0.4 mm, p < 0.0006) in the treatment group	-Small study population (38 individuals).
Tonetti	2007	Parallel-group, single-blind, randomized, controlled trial	-Twenty-four hours after treatment, flow-mediated dilatation was significantly lower in the intensive-treatment group than in the control-treatment group (absolute difference, 1.4 %; 95 % confidence interval [CI], 0.5 to 2.3; P = 0.002) -The degree of improvement was associated with improvement in measures of periodontal disease (r = 0.29 by Spearman rank correlation, P = 0.003).	-Lack of longitudinal follow up (capped at 180 days post-treatment).
D'Aiuto	2005	Three-arm preliminary randomized trial	-Two months following intervention, treatment esulted in significant reductions in serum CRP compared with the untreated control (0.5 ± 0.2 mg/L for SPT, P = 0.030 and 0.8 ± 0.2 mg/L for IPT, P = 0.001). -Intensive treatment group showed a decrease in total and LDL cholesterol after 2 months.	-Small study population (65 individuals).