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Khader YS, Albashaireh ZSM et al. J Periodontol 2004; 75: 1046–1053

Moderate associations between cardiovascular and periodontal diseases have been found in a number of studies, and there is controversy over whether the latter are causally implicated in the former. One widely-held view is that both are associated because both share the same major risk factor of smoking. In this study, 292 primary references to the literature were selected by a search, 25 were considered potentially relevant, but 14 were excluded because they did not meet inclusion criteria. Seven cohort studies and 4 of other design were included.

In 8 studies, a significantly higher risk of coronary heart disease in periodontal disease subjects was found in 2 only. Meta-analysis gave a relative risk of 1.15 (95% CI: 1.06, 1.25) for periodontitis and 1.11 for gingivitis (NS); for cerebrovascular disease, respective RRs were 1.13 (1.01, 1.27) and 1.37 (1.1, 1.73). The authors suggest these small increased risks should be treated with caution, and note that lack of control for smoking history and lack of power are possible explanations for the studies reporting significant associations.