Oral Biofilms and Their Connection to Cardiovascular Health
Main Article Content
Abstract
Systemic and oral health are interconnected via bacteria in the oral biofilm and their byproducts which can circulate throughout the body. Oral biofilm and its associated periodontal health have not been frequently addressed in patients with systemic health issues, especially cardiac related health. This is especially true for those patients who do not respond to medical treatment for their cardiac health issues via their physician. The periodontal sulcus around the teeth in the absence of the clinical evidence of periodontal disease (bleeding on probing or brushing, gingival inflammation) may have oral biofilm present. Inflammatory reaction is patient dependent on their immune response to the associated bacteria and their byproducts present in the oral biofilm. Increasing evidence has emerged in recent years connecting oral biofilms with systemic conditions including cardiac related issues, either by initiating them or by complicating those medical conditions. The patient’s health needs to be considered as a whole-body system with connections that may originate in the oral cavity and have distant effects throughout the body. In order to maximize the patient’s total health, healthcare needs to be a coordination between the physician and dentist to eliminate the oral biofilm and aid in the prevention of systemic disease or minimize those effects to improve the overall patient health and their quality of life. This article will focus on oral biofilm, and its connection to cardiovascular health.
Keywords:
Oral biofilm, cardiovascular disease, stroke
Article Details
How to Cite
KURTZMAN, Gregori M. et al.
Oral Biofilms and Their Connection to Cardiovascular Health.
Medical Research Archives, [S.l.], v. 13, n. 5, may 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6585>. Date accessed: 21 june 2025.
doi: https://doi.org/10.18103/mra.v13i5.6585.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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16. Suntharalingam P, Cvitkovitch DG: Quorum sensing in streptococcal biofilm formation. Trends Microbiol. 2005 Jan; 13(1):3-6.
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21. Marsh PD, Featherstone A, McKee AS, et al.: A microbiological study of early caries of approximal surfaces in schoolchildren. J Dent Res. 1989 Jul; 68(7):1151-4.
22. Larsen T, Fiehn NE. Dental biofilm infections - an update. APMIS. 2017 Apr;125(4):376-384. doi: 10.1111/apm.12688. PMID: 28407420.
23. Fragkioudakis I, Riggio MP, Apatzidou DA. Understanding the microbial components of periodontal diseases and periodontal treatment-induced microbiological shifts. J Med Microbiol. 2021 Jan;70(1). doi: 10.1099/jmm.0.001247. Epub 2020 Dec 4. PMID: 33295858.
24. Marsh, P.D.: Dental plaque as a biofilm and a microbial community - implications for health and disease. BMC Oral Health. 2006. 6(Suppl 1): S14.
25. Sbordone, L., Bortolaia, C.: Oral microbial biofilms and plaque-related diseases: microbial communities and their role in the shift from oral health to disease. Clin Oral Invest. 2003. Volume 7. P. 181-188.
26. Hua, X, Cook, GS, Costerton, JW, et al.: Intergeneric Communication in Dental Plaque Biofilms. Journal of Bacteriology. 2000. Volume 182. p. 7067-7069.
27. Ng HM, Kin LX, Dashper SG, Slakeski N, Butler CA, Reynolds EC. Bacterial interactions in pathogenic subgingival plaque. Microb Pathog. 2016 May;94:60-9. doi: 10.1016/j.micpath.2015.10.022. Epub 2015 Nov 2. PMID: 26541672.
28. Könönen E, et al. "Periodontal pathogens and carotid artery atherosclerosis." European Journal of Oral Sciences. 2012;120(1):63-68.
29. Ganganna A, Subappa A, Bhandari P. Serum migration inhibitory factor levels in periodontal health and disease, its correlation with clinical parameters. Indian J Dent Res. 2020 Nov-Dec;31(6):840-845. doi: 10.4103/ijdr.IJDR_896_18. PMID: 33753651.
30. Hajishengallis G. Interconnection of periodontal disease and comorbidities: Evidence, mechanisms, and implications. Periodontol 2000. 2022 Jun;89(1):9-18. doi: 10.1111/prd.12430. Epub 2022 Mar 4. PMID: 35244969; PMCID: PMC9018559.
31. Beck J, et al. "Periodontal disease and cardiovascular disease: Epidemiology and possible mechanisms." Journal of the American Dental Association. 2005;136(12):1626-1636.
32. Pussinen PJ, et al. "Oral infections and cardiovascular disease—an update." Journal of Clinical Periodontology. 2007;34(10):1119-1132.
33. Beck J, et al. "Periodontal disease and cardiovascular disease: Epidemiology and possible mechanisms." Journal of the American Dental Association. 2003;134(1):12S-21S.
34. Mattila KJ, et al. "Association between dental health and coronary heart disease." Journal of Clinical Periodontology. 1989;16(6):390-394.
35. Genco RJ, et al. "The role of inflammation and immunity in the pathogenesis of cardiovascular disease." Journal of Periodontology. 2005;76(11):2108-2118.
36. Genco RJ, et al. "The role of inflammation and immunity in the pathogenesis of cardiovascular disease." Journal of Periodontology. 2005;76(11):2108-2118.
37. Beck J, et al. "Periodontal disease and cardiovascular disease: Epidemiology and possible mechanisms." Journal of the American Dental Association. 2003;134(1):12S-21S.
38. Könönen E, et al. "Periodontal pathogens and carotid artery atherosclerosis." European Journal of Oral Sciences. 2012;120(1):63-68.
39. Genco RJ, et al. "The role of inflammation and immunity in the pathogenesis of cardiovascular disease." Journal of Periodontology. 2005;76(11):2108-2118.
40. Bangalore S, et al. "Oral hygiene, periodontal disease, and cardiovascular disease." Journal of the American College of Cardiology. 2002;39(3):376-378.
41. D'Aiuto F, et al. "Periodontal disease and systemic inflammation: The link to cardiovascular disease." Journal of Clinical Periodontology. 2004;31(8):463-472.
42. Miller S, et al. "Oral biofilms and infective endocarditis." Journal of the American Dental Association. 2006;137(9):1266-1274.
43. Palmer, RJ, Caldwell DE.: A flowcell for the study of plaque removal and regrowth. J Micro Methods 1995;24(2):171-82.
44. Teles FR, Teles RP, Sachdeo A.: Comparison of microbial changes in early redeveloping biofilms on natural teeth and dentures. J Periodontol. 2012 Sep;83(9):1139-48. doi: 10.1902/jop.2012.110506. Epub 2012 Mar 23.
45. Teles FR, Teles RP, Uzel NG, et al.: Early microbial succession in redeveloping dental biofilms in periodontal health and disease. J Periodontal Res. 2012 Feb;47(1):95-104. doi: 10.1111/j.1600-0765.2011.01409.x. Epub 2011 Sep 5.
46. Shen Y, Stojicic S, Haapasalo M.: Antimicrobial efficacy of chlorhexidine against bacteria in biofilms at different stages of development. J Endod. 2011 May;37(5):657-61. doi: 10.1016/j.joen.2011.02.007. Epub 2011 Mar 23.
47. Guggenheim B, Meier A.: In vitro effect of chlorhexidine mouth rinses on polyspecies biofilms. Schweiz Monatsschr Zahnmed. 2011;121(5):432-41.
48. Kerémi B, Márta K, Farkas K, et al. Effects of chlorine dioxide on oral hygiene–A systematic review and meta-analysis. Curr Pharm Des. 2020;26(25):3015-3025. doi:10.2174/1381612826666200515134450
49. Sauer K, Thatcher E, Northey R, Gutierrez AA. Neutral super-oxidised solutions are effective in killing P. aeruginosa biofilms. Biofouling. 2009;25(1):45-54. doi: 10.1080/08927010802441412. PMID: 18846439.
50. Kouidhi B, Al Qurashi YM, Chaieb K.: Drug resistance of bacterial dental biofilm and the potential use of natural compounds as alternative for prevention and treatment. Microb Pathog. 2015 Mar;80:39-49. doi:10.1016/j.micpath.2015.02.007. Epub 2015 Feb 21.
51. Rams TE, Degener JE, van Winkelhoff AJ.: Antibiotic resistance in human chronic periodontitis microbiota. J Periodontol. 2014 Jan;85(1):160-9. doi: 10.1902/jop.2013.130142. Epub 2013 May 20.
52. Rams TE, Degener JE, van Winkelhoff AJ.: Antibiotic resistance in human peri-implantitis microbiota. Clin Oral Implants Res. 2014 Jan;25(1):82-90. doi: 10.1111/clr.12160. Epub 2013 Apr 2.
2. Hajishengallis G, Chavakis T. Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities. Nat Rev Immunol. 2021 Jul;21(7):426-440. doi: 10.1038/s41577-020-00488-6. Epub 2021 Jan 28. PMID: 33510490; PMCID: PMC7841384.
3. Sintim HO, Gürsoy UK. Biofilms as "Connectors" for Oral and Systems Medicine: A New Opportunity for Biomarkers, Molecular Targets, and Bacterial Eradication. OMICS. 2016 Jan;20(1):3-11. doi: 10.1089/omi.2015.0146. Epub 2015 Nov 19. PMID: 26583256; PMCID: PMC4739346.
4. Marsh PD: Dental plaque as a microbial biofilm. Caries Res. 2004 May-Jun; 38(3):204-11.
5. Socransky SS, Haffajee AD: Dental biofilms: difficult therapeutic targets. Periodontol 2000. 2002; 28():12-55.
6. Kanwar I, Sah AK, Suresh PK. Biofilm-mediated Antibiotic-resistant Oral Bacterial Infections: Mechanism and Combat Strategies. Curr Pharm Des. 2017;23(14):2084-2095. doi: 10.2174/1381612822666161124154549. PMID: 27890003.
7. van Steenbergen TJ, van Winkelhoff AJ, de Graaff J: Pathogenic synergy: mixed infections in the oral cavity. Antonie Van Leeuwenhoek. 1984; 50(5-6):789-98.
8. Gilbert P, Maira-Litran T, McBain AJ, Rickard AH, Whyte FW: The physiology and collective recalcitrance of microbial biofilm communities. Adv Microb Physiol. 2002; 46():202-56.
9. Kouidhi B, Al Qurashi YM, Chaieb K. Drug resistance of bacterial dental biofilm and the potential use of natural compounds as alternative for prevention and treatment. Microb Pathog. 2015 Mar;80:39-49. doi: 10.1016/j.micpath.2015.02.007. Epub 2015 Feb 21. PMID: 25708507.
10. Marcinkiewicz J, Strus M, Pasich E. Antibiotic resistance: a "dark side" of biofilm associated chronic infections. Pol Arch Med Wewn. 2013;123(6):309-13. PMID: 23828150.
11. Huang R, Li M, Gregory RL. Bacterial interactions in dental biofilm. Virulence. 2011 Sep-Oct;2(5):435-44. doi: 10.4161/viru.2.5.16140. Epub 2011 Sep 1. PMID: 21778817; PMCID: PMC3322631.
12. Hojo K, Nagaoka S, Ohshima T, Maeda N.: Bacterial interactions in dental biofilm development. J Dent Res. 2009 Nov;88(11):982-90. doi: 10.1177/0022034509346811.
13. Prado MM, Figueiredo N, Pimenta AL, Miranda TS, Feres M, Figueiredo LC, de Almeida J, Bueno-Silva B. Recent Updates on Microbial Biofilms in Periodontitis: An Analysis of In Vitro Biofilm Models. Adv Exp Med Biol. 2022;1373:159-174. doi: 10.1007/978-3-030-96881-6_8. PMID: 35612797.
14. Wade W, Thompson H, Rybalka A, Vartoukian S.: Uncultured Members of the Oral Microbiome. J Calif Dent Assoc. 2016 Jul;44(7):447-56.
15. Prazdnova EV, Gorovtsov AV, Vasilchenko NG, Kulikov MP, Statsenko VN, Bogdanova AA, Refeld AG, Brislavskiy YA, Chistyakov VA, Chikindas ML. Quorum-Sensing Inhibition by Gram-Positive Bacteria. Microorganisms. 2022 Feb 3;10(2):350. doi: 10.3390/microorganisms10020350. PMID: 35208805; PMCID: PMC8875677.
16. Suntharalingam P, Cvitkovitch DG: Quorum sensing in streptococcal biofilm formation. Trends Microbiol. 2005 Jan; 13(1):3-6.
17. Kolaczkowska E, Kubes P.: Neutrophil recruitment and function in health and inflammation. Nature Review 2013(13):159-175
18. Kumar BP, Khaitan T, Ramaswamy P, Sreenivasulu P, Uday G, Velugubantla RG. Association of chronic periodontitis with white blood cell and platelet count - A Case Control Study. J Clin Exp Dent. 2014 Jul 1;6(3):e214-7. doi: 10.4317/jced.51292. PMID: 25136419; PMCID: PMC4134847.
19. http://medicalxpress.com/news/2013-04-white-blood-cell-enzymecontributes.html
20. Al-Rasheed A. Elevation of white blood cells and platelet counts in patients having chronic periodontitis. Saudi Dent J. 2012 Jan;24(1):17-21. doi: 10.1016/j.sdentj.2011.10.006. Epub 2011 Dec 2. PMID: 23960523; PMCID: PMC3723072.
21. Marsh PD, Featherstone A, McKee AS, et al.: A microbiological study of early caries of approximal surfaces in schoolchildren. J Dent Res. 1989 Jul; 68(7):1151-4.
22. Larsen T, Fiehn NE. Dental biofilm infections - an update. APMIS. 2017 Apr;125(4):376-384. doi: 10.1111/apm.12688. PMID: 28407420.
23. Fragkioudakis I, Riggio MP, Apatzidou DA. Understanding the microbial components of periodontal diseases and periodontal treatment-induced microbiological shifts. J Med Microbiol. 2021 Jan;70(1). doi: 10.1099/jmm.0.001247. Epub 2020 Dec 4. PMID: 33295858.
24. Marsh, P.D.: Dental plaque as a biofilm and a microbial community - implications for health and disease. BMC Oral Health. 2006. 6(Suppl 1): S14.
25. Sbordone, L., Bortolaia, C.: Oral microbial biofilms and plaque-related diseases: microbial communities and their role in the shift from oral health to disease. Clin Oral Invest. 2003. Volume 7. P. 181-188.
26. Hua, X, Cook, GS, Costerton, JW, et al.: Intergeneric Communication in Dental Plaque Biofilms. Journal of Bacteriology. 2000. Volume 182. p. 7067-7069.
27. Ng HM, Kin LX, Dashper SG, Slakeski N, Butler CA, Reynolds EC. Bacterial interactions in pathogenic subgingival plaque. Microb Pathog. 2016 May;94:60-9. doi: 10.1016/j.micpath.2015.10.022. Epub 2015 Nov 2. PMID: 26541672.
28. Könönen E, et al. "Periodontal pathogens and carotid artery atherosclerosis." European Journal of Oral Sciences. 2012;120(1):63-68.
29. Ganganna A, Subappa A, Bhandari P. Serum migration inhibitory factor levels in periodontal health and disease, its correlation with clinical parameters. Indian J Dent Res. 2020 Nov-Dec;31(6):840-845. doi: 10.4103/ijdr.IJDR_896_18. PMID: 33753651.
30. Hajishengallis G. Interconnection of periodontal disease and comorbidities: Evidence, mechanisms, and implications. Periodontol 2000. 2022 Jun;89(1):9-18. doi: 10.1111/prd.12430. Epub 2022 Mar 4. PMID: 35244969; PMCID: PMC9018559.
31. Beck J, et al. "Periodontal disease and cardiovascular disease: Epidemiology and possible mechanisms." Journal of the American Dental Association. 2005;136(12):1626-1636.
32. Pussinen PJ, et al. "Oral infections and cardiovascular disease—an update." Journal of Clinical Periodontology. 2007;34(10):1119-1132.
33. Beck J, et al. "Periodontal disease and cardiovascular disease: Epidemiology and possible mechanisms." Journal of the American Dental Association. 2003;134(1):12S-21S.
34. Mattila KJ, et al. "Association between dental health and coronary heart disease." Journal of Clinical Periodontology. 1989;16(6):390-394.
35. Genco RJ, et al. "The role of inflammation and immunity in the pathogenesis of cardiovascular disease." Journal of Periodontology. 2005;76(11):2108-2118.
36. Genco RJ, et al. "The role of inflammation and immunity in the pathogenesis of cardiovascular disease." Journal of Periodontology. 2005;76(11):2108-2118.
37. Beck J, et al. "Periodontal disease and cardiovascular disease: Epidemiology and possible mechanisms." Journal of the American Dental Association. 2003;134(1):12S-21S.
38. Könönen E, et al. "Periodontal pathogens and carotid artery atherosclerosis." European Journal of Oral Sciences. 2012;120(1):63-68.
39. Genco RJ, et al. "The role of inflammation and immunity in the pathogenesis of cardiovascular disease." Journal of Periodontology. 2005;76(11):2108-2118.
40. Bangalore S, et al. "Oral hygiene, periodontal disease, and cardiovascular disease." Journal of the American College of Cardiology. 2002;39(3):376-378.
41. D'Aiuto F, et al. "Periodontal disease and systemic inflammation: The link to cardiovascular disease." Journal of Clinical Periodontology. 2004;31(8):463-472.
42. Miller S, et al. "Oral biofilms and infective endocarditis." Journal of the American Dental Association. 2006;137(9):1266-1274.
43. Palmer, RJ, Caldwell DE.: A flowcell for the study of plaque removal and regrowth. J Micro Methods 1995;24(2):171-82.
44. Teles FR, Teles RP, Sachdeo A.: Comparison of microbial changes in early redeveloping biofilms on natural teeth and dentures. J Periodontol. 2012 Sep;83(9):1139-48. doi: 10.1902/jop.2012.110506. Epub 2012 Mar 23.
45. Teles FR, Teles RP, Uzel NG, et al.: Early microbial succession in redeveloping dental biofilms in periodontal health and disease. J Periodontal Res. 2012 Feb;47(1):95-104. doi: 10.1111/j.1600-0765.2011.01409.x. Epub 2011 Sep 5.
46. Shen Y, Stojicic S, Haapasalo M.: Antimicrobial efficacy of chlorhexidine against bacteria in biofilms at different stages of development. J Endod. 2011 May;37(5):657-61. doi: 10.1016/j.joen.2011.02.007. Epub 2011 Mar 23.
47. Guggenheim B, Meier A.: In vitro effect of chlorhexidine mouth rinses on polyspecies biofilms. Schweiz Monatsschr Zahnmed. 2011;121(5):432-41.
48. Kerémi B, Márta K, Farkas K, et al. Effects of chlorine dioxide on oral hygiene–A systematic review and meta-analysis. Curr Pharm Des. 2020;26(25):3015-3025. doi:10.2174/1381612826666200515134450
49. Sauer K, Thatcher E, Northey R, Gutierrez AA. Neutral super-oxidised solutions are effective in killing P. aeruginosa biofilms. Biofouling. 2009;25(1):45-54. doi: 10.1080/08927010802441412. PMID: 18846439.
50. Kouidhi B, Al Qurashi YM, Chaieb K.: Drug resistance of bacterial dental biofilm and the potential use of natural compounds as alternative for prevention and treatment. Microb Pathog. 2015 Mar;80:39-49. doi:10.1016/j.micpath.2015.02.007. Epub 2015 Feb 21.
51. Rams TE, Degener JE, van Winkelhoff AJ.: Antibiotic resistance in human chronic periodontitis microbiota. J Periodontol. 2014 Jan;85(1):160-9. doi: 10.1902/jop.2013.130142. Epub 2013 May 20.
52. Rams TE, Degener JE, van Winkelhoff AJ.: Antibiotic resistance in human peri-implantitis microbiota. Clin Oral Implants Res. 2014 Jan;25(1):82-90. doi: 10.1111/clr.12160. Epub 2013 Apr 2.