CARDIOVASCULAR PHARMACOTHERAPY AND PERIODONTAL OUTCOMES: A NARRATIVE REVIEW

Irina – Georgeta Sufaru, Ioana Martu, Diana Tatarciuc, Maria-Alexandra Martu, Silvia Martu, Sorina Mihaela Solomon, Liliana Pasarin

Abstract
Background: Cardiovascular disease and periodontitis commonly coexist, and cardiovascular pharmacotherapy may affect periodontal tissues and clinical indices, thereby influencing treatment planning. Objective: To synthesize clinically relevant associations between major cardiovascular medication classes and periodontal status and to translate these findings into practical considerations for periodontal care. Summary of evidence: Calcium channel blockers provide the most consistent signal, with a strong association with drug-induced gingival overgrowth. Enlargement can promote pseudo-pocketing, impair plaque control, and intensify gingival inflammation; expression is modified by local biofilm burden and supportive periodontal care. Statins show a plausible host-modulatory signal; observational studies and adjunctive trials report improvements in inflammatory parameters and, in selected settings, modest additional reductions in probing depth and clinical attachment gain, but heterogeneity and risk of bias limit certainty. Evidence for ACE inhibitors/angiotensin receptor blockers, beta-blockers, and diuretics is limited and often mediated by xerostomia, frailty, and oral health behaviors. Antiplatelet and anticoagulant therapy mainly affects bleeding-based indices; increased bleeding on probing does not necessarily indicate greater attachment loss. Polypharmacy can amplify xerostomia and complicate home care, while bleeding-based indices may be misleading without concurrent attachment and radiographic endpoints for assessment. Conclusions: Cardiovascular medications can alter periodontal presentation and complicate longitudinal monitoring. Medication-aware history taking (agent, dose, duration, combinations), interpretation anchored in attachment and bone measures, and tailored management of gingival overgrowth, bleeding risk, and xerostomia are recommended. Future research should apply standardized periodontal outcomes and detailed exposure definitions in longitudinal designs and, in pragmatic trials, evaluate whether optimized periodontal care in cardiovascular-medicated patients improves systemic inflammatory and vascular biomarkers.

DOI : 10.62610/RJOR.2025.4.17.1